Do You Shop For your Dentist?

Almost every day my dental office gets a call from a potential patient shopping for a dentist. They ask for fees for certain procedures and often that is the end of the conversation. 

             I should note that my fees fall within the usual and customary range considered reasonable but for some persistent shoppers are too high. It seems that the internet has become the new Yellow Pages and potential patients are letting their fingers do the walking. It's not that hard calling a number of dentists and get a sense of the fees for the procedures that they will need. 

          Unfortunately, no information on the quality of the dental work can be gotten from these phone calls and shopping for dental work for some may be similar to shopping for furniture or other consumer goods. However teeth are not disposable and even implant replacements will not last forever.

         When I buy a piece of furniture, if I go to Ikea or any Local store, I expect to get a good price for what I buy, but I do not have the expectation that my purchases will last a lifetime or even ten years. It is asumed that there is a trade off involved with the inexpensive price paid but most of the time shoppers are  happy with their purchases . Many people like buying new furniture and actually like buying new pieces when they either tire of, or have to, replace them as they age.

            Teeth shouldn't be compared to furniture and restorations that are durable and preserve teeth for long periods of time are not always easily accomplished by dentists whose fees are the most reasonable. Although a higher price does not guarantee quality, it does tend to allow a dentist to to spend the time needed to create a thoughtful treatment plan and also the time to execute excellent restorative dentistry.
            I would like to quote a few examples here.. 

People dont mind paying 300 for Rs 30 popcorn in a theatre, but have reservations paying Rs. 300 consultation to a Dentist..

Also people dont mind paying 4000 bucks for a pair of jeans which shall last for 4-5 yrs and being worn for probably 100 times. While a crown of approximately the same value which you wear everyday and use it thrice daily lasts much longer than that..
             I guess the point of this post is to explain that price of services should not  be the primary method in choosing a dentist. Other attributes are quite important including but not limited to  recommendations from their patients, their skill level and their character.

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Sensitivity after a Crown placement

              There are two types of sensitivity that can commonly experienced after a crown is cemented. One is sensitivity to biting pressure and the other is sensitivity to cold (and or hot) liquids. If a patient is  experiencing either of these after a permanent crown is placed, then probably the best thing to do is to let their dentist know.

                  Sensitivity after a permanent crown is placed is not that uncommon. If a patient reports sensitivity, I check their bite, since a high bite can be irritating to the ligaments holding a tooth and can even cause pulpal sensitivity. A patient should be able to close there mouth comfortably without feeling any pain. If when they close their mouth (without chewing any food) they experience pain from a new crown, the bite should be adjusted.

              If a patient can comfortably close their mouths, but does experience pain on heavy chewing, I usually ask them to wait and see if the pain gets better with time. A crown cementation can sometimes irritate the pulp and with time this irritation can diminish. This can take months to go away and if a patient is willing, its usually best to wait. If I see them at their next recall, the tooth is still sensitive to chewing or when drinking cold liquids, I take a radiograph and if no pathology is evident, I usually try to get the patient to wait longer, since the only real other options are to perform a root canal on the tooth or to cut off the crown and place a temporary crown with a sedative filling. Which of these I would choose, if I feel the need to treat the tooth, is dependent on whether I believe the pulp has a reversible or irreversible pulpitis.

              Deciding whether a pulpitis is reversible is not always easy, but the prior history of the tooth has a lot to do with the decision. If a tooth was assymptomatic prior to me working on it initially, I am more likely to choose to remove a crown and place a temporary. If a tooth had a pre-existing crack in it or was symptomatic prior to me preparing it for a crown, I am more likely to recommend the patient visiting an endodontist and have a root canal done through the crown.

               I feel that the pulp is still vital and not infected, there is usually no harm in watchful waiting, since with enough time sensitive crowned teeth can calm down. I explain this to my patient and if the symptoms are bearable we often wait for the symptoms to slowly go away. If the symptoms are worsening instead, we can always choose the root canal option.

Toothaches : What to do..?

Aching tooth

Although there are many causes for "toothaches", the correct procedure is to call your dentist. If you do not have one, call a friends dentist. If its after hours, call and take the appointment. Ok, but what to do until then?

The first thing to try is to take a pain killer such as Ibuprofen (Combiflam or Flexon) or Crocin. Both of these medications are not only good at cutting down inflammation but also provide pain relief for mild and moderate pain. Both are excellent to be used as first line medications for tooth pain. Do not take a stronger narcotic medication without trying one of these two. The sole exception would be for someone who  has a bleeding  problem or an allergy that can be caused by either of these drugs.

              It is not advisable to place tablets or clove inside the mouth in an attempt to alleviate the pain. Some patients try and holding this against the tooth in an attempt to stop the pain, but the medicines can cause burns in the gingiva. Rinsing frequently with warm saline solution can help in the event that a patient has a swelling in the gum.  It is not advisable to place a hot compress on the outside of the face, since this can draw an infection toward the skin of the face and can cause more swelling.

              Sometimes patients experience toothaches immediately after eating. Usually these people have a tooth or teeth with deep caries and eating can cause the teeth to throb. For these patients I advise not letting food come in contact with the painful tooth (teeth) since it can cause a worsening of the tooth ache. Often teeth with deep cavities and vital pulps will calm down on their own if left alone for a short period of time (an hour).

            If you are experiencing an "after office hours" tooth ache and cannot reach your dentist, a trip to the hospital emergency room is an option, since many emergency rooms have oral surgeons on call.