DENTISTSECRETS Q & A APRIL 2010

Thankyou to everyone that has asked us about their dental care. We do apologise that we are unable to answer your questions personally, and we apologise if your qustions have not been answered in this Q&A. Please keep reading fututre editions as we aim to answer all of the important dental queries that you send to us in due course.

(Please note that your questions will be rewritten, not only for brevity in these issues, but to make some questions more easy to understand for other readers ).

Dentistsecrets guarantees strict confidentially for all information received.

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Q1.

I’ve had constant tenderness around my mouth for 20 years. I went to a dentist for a check-up and was told I had several bad cavities and bad infections. I had the infected molars removed and root-canal done. I was told to have bridgework to replace the missing molars. I went to this dentist at least 7 times. Towards the end, the edges of my lips started constantly burning and it looked like a rash was forming. I thought it may be from constantly having my mouth stretched with the denture work.

It never went away. After a year I went to the doctor. I was told it was a form of herpes and had ointment (very expensive) to treat this. It didn’t help and seemed to prolong the rash.

When I use toothpaste to brush my teeth, the burning sensation and rash appears.

I’ve found applying Carmex around the sides of my lips to stop toothpaste touching the sides of my mouth, washing my mouth thoroughly, then applying alcohol to the affected area seems to counter the burning and rawness that comes after brushing. Re- applying Carmex to the affected area seems to keep my problem at bay.

What can I do? I can’t afford a doctor or dentist.

Do I have any legal recourse against this dentist for all these years of suffering? Having constant redness, flaking around my mouth as been embarrassing and has ruined my social life.

The symptoms as you describe sound like angular cheilitis, although it is impossible to give a definitive diagnosis based purely on information given.

Angular cheilitis is a fungal infection very common in denture wearers and in people who have lost and not replaced back teeth - as when they close their mouths, they get creases at the corners which can become infected.

The fungus that causes this infection lives in most peoples’ mouths.

Angular cheilitis would not be cured by antiviral creams which may have been what you were prescribed by your doctor if he thought you had a viral herpes infection.

Obviously, it is impossible to diagnose a condition accurately with the limited information given and without examination, but your symptoms do SOUND like angular cheilitis and that can be treated easily with anti-fungal creams such as canestan- a pharmacist will be able to recommend an oral antifungal cream.

Our advice though, is that you do get this professionally diagnosed. Any condition that is persisting, particularly for this length of time, should be properly diagnosed.

Candidal infection can also appear in anaemic patients and in other medical complaints so if the diagnosis IS correct, the CAUSE needs to be investigated too. If you really cannot afford this, you could try using antifungal creams for a very short period, but if it does not help you MUST get this checked and treated.

If you wear dentures, cleaning these with milton’s sterilising solution may help keep candida away from them.

We hope that this helps some, but again stress that in order to give an accurate diagnosis without examining you is impossible and our advice is to see a dentist. The only help we can give is to say that your symptoms SOUND like candidal infection and that that can be treated with antifungal creams or pastilles which can be bought.

In answer to your other question- no, from what you describe about your treatment, it does not sound to us as if your dentist was responsible for causing your problems.

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Q2.

I have started to get regular, painful ulcers in my mouth. I have tried various “over the counter” mouthwashes and nothing seems to help. What else can I try?

Recurrent ulcers are fairly common, affecting about 25% of people at some time.

Typically, they appear around 10 -19 years of age.

Usually sufferers get recurrent batches of a few ulcers of around

2-4mm diameter which take about 7-10days to heal.

(There is a rarer type of recurrent ulceration, in which ulcers are much bigger – up to 10mm diameter and can last for up to 6 weeks before healing and tend to leave scars).

So………………..

WHAT CAUSES MOUTH ULCERS?

There are many causes, some examples are:

· irritation from or sensitivity to mouthwashes

· trauma from chewing or from sharp foods

· trauma from rough fillings/teeth/braces/dentures

· medically prescribed drugs

· viral infections

· iron deficiency ( also folate or vitamin b12)

· some bowel diseases

· trauma from incorrect tooth brushing

Sometimes they can be triggered when you stop smoking, although these usually clear quite quickly.

You say you’re trying to treat your ulcers with commercial mouthwashes, BUT…….

Many mouthwashes commercially available have a high alcohol content which may irritate mouth ulcers and so, rather than helping may actually be making your ulcers last longer.

See a dentist to check these ulcers, there may be an underlying irritation in your mouth which can easily be fixed, or there may be some underlying medical issue.

Depending on the cause, a dentist may be able to advise mouthwashes that will be beneficial to your condition, or, if more severe, you may need prescription of topical corticosteroid.

In the meantime, you may get some relief from the discomfort by rinsing your mouth with hot, salty water (about 3 tsp. salt to a glass of warm water). This is not irritant and is a natural antiseptic and may help prevent the ulcers from developing secondary infection, so speeding up their healing.

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Q3.

I had a tooth taken out a few days ago, and now am in worse pain. I went back to my dentist who says I have a “dry socket”.

1. Could you explain what this means?

2. Could he be covering that he has actually taken the wrong tooth out?

1. WHAT IS DRY SOCKET?

“Dry socket” is the name of a fairly common infection that can occur 2-3 days after tooth extraction (removal). It is extremely painful and occurs when the blood clot in the socket disintegrates and infection sets into the bone.

HOW DO YOU TREAT DRY SOCKET?

It is usually easily treated by your dentist. The infected socket will be cleaned and a special dressing will be placed in the socket which will numb the pain and kill the infection. Sometimes a course of antibiotics may be needed too.

If you suspect that you have developed a dry socket after having a tooth out – the quicker you return to your dentist for treatment of this infection, the quicker and easier it can be resolved.

HOW CAN YOU HELP AVOID DRY SOCKET?

There are a few simple precautions that you can take to try to avoid dry socket infection after having a tooth out.

1. Don’t rinse your mouth and spit out, it may taste nasty but this disturbs the clot and infection is more likely.

2. Eat and drink normally.

3. Avoid smoking that day

4. The day AFTER having the tooth out gently rinse with hot salt water – a cup of hot water (not hot enough to burn) with 2-3 teaspoons of normal table salt. Hold a mouthful of this rinse by the socket for about 30secs before gently spitting it out.

2. DID YOU HAVE THE WRONG TOOTH OUT?

SORRY - impossible to say without seeing the tooth before treatment or checking X- rays

But………..

Dry socket is not uncommon, and yes, the pain IS generally at least as bad as it was before treatment and yes, it can definitely feel as if your dentist maybe took the wrong tooth out.

If symptoms don’t resolve after the type of treatment steps mentioned above have been carried out, and you still have any reason to doubt that you have had the correct tooth treated, see another dentist and ask THEM to check your relevant X-Rays and hopefully put your mind at ease.

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Q4.

Our new dentist says that my 17yr old daughter should have had orthodontic treatment when she was younger and that she has to have it now.

No-one in the family (including my daughter) thinks she needs it, what should we do?

Orthodontic treatment –tooth straightening- is very popular now, with everyone trying to have that perfectly even “Hollywood” smile. MOST orthodontic courses are purely for cosmetic reasons, but SOME prevent other problems later.

Discuss orthodontics with your daughter and:

· if she is happy with her appearance;

· if her tooth position is not making thorough cleaning difficult or impossible;

she probably does NOT need to undergo months of orthodontic treatment.

Discuss with your dentist exactly why he feels that your daughter should have this treatment:

· Is he trying to avoid future problems for your daughter’s dental health?

· Is he trying to achieve his concept of perfection of appearance for her?

· Is he only thinking of profit?

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Q5.

I had a set of dentures made and cannot wear them. The dentist says they can fix the pain they are causing. I have asked for my money back and am being put off by the dentist who says if they alter them and they will be fine. I have worn dentures for more than 15years with no trouble.

Who do I contact to get my money back?

You do not say if the dentist has tried to adjust your new dentures and they are still hurting or if they are still as they were at fit.

New dentures often need alteration when first fitted. They often cause painful ulceration when first worn.

It can often take more than 1 adjustment to make new dentures comfortable.

There are many reasons for new dentures to feel uncomfortable:

· They may feel uncomfortable if the bite is uneven, which is usually easily altered and fixed,

· they may be pinching into undercuts in the jaw.

· They may be too big, not allowing the jaws to relax and overloading the gums.

You don’t say if you have been wearing the same set of teeth for

15 years – if so, it can be difficult to remember that you probably had to overcome some discomfort when these were originally worn. It is also worth remembering that gums generally become more fragile and tender with age.

· If your dentist is offering to try to alter your new dentures and believes it to be possible, go back and see them.

· If they are offering to solve your problems, they will almost certainly give you a refund if there is a problem with these dentures that they are unable to fix.

· Talk to your dentist and let them try to help first.

If, on the other hand, your dentist is unwilling to see you to try to make your dentures comfortable, you can ask the governing dental board, whose number you will find in the telephone directory, to help you with your claim.

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Q6.

Is there any brand of toothbrush on the market that is better at preventing gum disease? I think I have the symptoms mentioned in “Stop Paying for Dental Treatment”

Not really, but generally speaking, in our opinion, a SOFT toothbrush is usually best for cleaning your teeth.

Plaque – which is the build up on teeth that causes tooth decay and gum disease is only soft, and is easily removed by gentle, thorough brushing. It does not need hard scrubbing.

Soft brushes don’t tend to cause tooth abrasion, which, at the least can make your teeth sensitive and in extreme cases can even kill the teeth.

Soft brushes are often able to clean crowded teeth better than hard brushes, they mould into irregularities better.

A small, compact brush head is, in our opinion, usually best.

Electric toothbrushes can be very useful if you have any sort of handicap that makes manoeuvring the toothbrush effectively difficult.

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Hepatitis C

Hepatitis C is a viral infection that mainly affects the liver. It has featured in the news lately following possible transmission to patients within the hospital environment.

Hepatitis C is transferred when blood of an infected person gets into the bloodstream of another person

Most dental treatment results in contamination of the surgery instruments and environment with both blood and saliva. To be sure that your dental surgery is not putting you at risk of cross-infection with this, or any communicable disease, download the information you need to be able to spot unhygienic practice. The facts that could protect you and your family can be found in “IS YOUR DENTIST DIRTY?”.

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AND FINALLY

Did you know………………

Far from being a modern practice, dental patients have been having their teeth drilled to cure the problem of tooth decay for around 9,000 years?

The earliest known evidence of decayed teeth having been drilled, was found in skulls that were excavated in Pakistan. These “dental patients” are believed to have lived as early as 7000BC.

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