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Sjogrens Topics => Living With Sjogren's => Topic started by: Tinker on March 05, 2019, 07:26:03 PM

Title: Tooth extraction soon, implant? Help
Post by: Tinker on March 05, 2019, 07:26:03 PM
Hi everyone,
I have been researching prior posts on dental implants.  Oh, yeah, I've had a lot of dental woes in the last couple of years.  In Nov 2018, a crown fell off (literally) and could not be re-crowned as the nerve was dead.  So, I've waited for my insurance to be "recharged " in Jan and proceeded to make the appt for extraction and one implant (my first one).

So, today a different crown right in the FRONT fell off when I ate a piece of bread.  I already had a dental appt for that very day as I had cold/hot sensitivity for 4 days in that vicinity.    The tooth fell off at 1:30 pm and the appt was at 2:30. 

So the dentist says I can save the tooth and got me in to see an endodontist.  Root canal was done and now I need a crown.  $$$ Tooth next to the bread tooth is now visibly decayed also...need a filling on a one yr. old crown. Really? 

Money, money, money and it's leaving my acct. and going somewhere else.

BTW, I take excellent care of my teeth. Floss, brush, flouride treatments and special paste.  Great cleanings everytime...dentist, hygienist, and asst. all said I do a great job.  I really want to keep my teeth but at some point I might have to surrender to dentures.

I researched here for help on implants and dental problems with SJS.  Irish, thank you for your candid advice.   I am surely going to think this over.  While I don't have some of the more serious illnesses a lot of you all have, I do  have SJS, Hashimotos, and lupus ( still not requiring any meds and ANA is neg).

I'm really fighting to keep my teeth.  My mom and sis had dentures and they had many issues.  Thank goodness I have a little $ cushion and dental insurance.  But of course, with my issues the insurance is gone in the first 3 mos of the year. 

I did see that some of you had implants and have doing well with them.  And some of you didn't do so well.  Wish I had a crystal ball to see if luck will be on my side.

Until today, I did not know people with autoimmune issues should not have implants!  Please post with your recent experiences if you can.  And where do I find a dentist who is knowledgeable about sjs?  They ALL say they are but they aren't!  Thanks
Title: Re: Tooth extraction soon, implant? Help
Post by: Joe S. on March 05, 2019, 07:49:12 PM
I am going to the VA,7 to be pulled in near future. no implants.
Title: Re: Tooth extraction soon, implant? Help
Post by: Tinker on March 05, 2019, 08:07:24 PM
Joe, sorry to hear you are losing these teeth.  Will you just be changing your diet to accommodate the loss of the ability to chew?  This is such a complicated issue.

I'm afraid I will run out of money before I settle all these dental issues. 
Title: Re: Tooth extraction soon, implant? Help
Post by: Joe S. on March 06, 2019, 05:34:57 AM
I had changed my diet. The seven to be pulled are in my upper jaw. I have 8 in lower. none of the teeth I have left match for chewing. I have to cut my food into very small pieces, pill size to swallow. The upper denture will help me to chew. A lower denture would be nice but they want to wait until more are decay.

My teeth are not loose. They are solid so I ask to be knocked out when they are pulled. The decay under the crowns is massive and shocked the dentist. This week I have 4 appointments at the VA one is for a cleaning. One is for blood work. One is for blood pressure. One is for an ultra sound of arteries, one is for a MRI. Next week is for teeth options.
Title: Re: Tooth extraction soon, implant? Help
Post by: Carolina on March 06, 2019, 05:56:42 AM
Hi Tinker and Joe:

I know your tooth woes intimately.  I had one implant, about 7 years ago.

All of my life I've had constant problems.  I'm 77 so grew up without fluoride in the water.  Neither of my sons (54 and 48) who grew up with fluoride, has more than three or four cavities!  By their age I had many, many root canals and crowns.

I have 28 teeth (wisdom teeth taken out when I was 16).  Of those 28, 15 have crowns and one implant. 

For some reason 12 of my front teeth are spared.  I had my two bottom front teeth capped, last year, because they had eroded so badly and the roots were exposed, and then the front piece of enamel on one sheared off!  So there was no decay, just 'weird looking' teeth.

Over the years I have spent thousands of dollars on my teeth, and I'm lucky to have had good insurance and enough resources to pay for this attention.

After my diagnosis with Sjogren's, I saw the dentist three times a year, for cleaning and care.  I guess you can say I'm a bit obsessive about my teeth. Only in the past year have I gone back to seeing the dentist only twice a year.

My mother also had every type of dental care available to someone born in 1910, but by age 45 she had full upper dentures and partial lower dentures.  I was 13 at the time and found that very traumatic, even as a bystander!  Her face was changed by the dentures, and I found that scary.  She didn't 'look exactly like' my mother after her dentures were in place.

I know dentures are a marvelous option and a great relief for those who have suffered great woes with their teeth.

I have an implant because that tooth cracked vertically and infection entered my jaw!  The tooth had both a full crown and a root canal, and I guess the underlying tooth structure was weak enough to crack, letting in the infection.

The tooth had to be extracted, and the base for the implant was put in immediately after the tooth was taken out.  Additional bone was also implanted at the time to strengthen that area of my jaw.

This all happened about 7 years ago, and I am pleased with the implant.

Regards, Elaine
Title: Re: Tooth extraction soon, implant? Help
Post by: irish on March 06, 2019, 11:48:50 AM
I HAD MY TEETH PULLED IN 204. I THINK I HAD ABOUT 14 LEFT. I HAD BEGGED TO HAVE MY TEETH PULLED FOR YEARS AS I HAD A MOUTH FULL OF CAPS. OR CROWNS AS YOU CALL THEM, I OST A TOOTH BITING INTO A MARSHMALLOW ONE TIME. MY TEETH STARTED FALLING APART BEFORE I WAS 30 AND BY 40 I WAS LIVING AT THE DENTIST. IT IS FROM THE SJOGRENS AND THERE ISN'T MUCH THAT CAN BE DONE. I WOULD NEVER HAVE IMPLANTS BECAUSE DRILLING INTO THE BONE SCARES ME.

IF A PERSON GETS AN INFECTION IN THE BONE IT ISNT ALWAYS FELT OR SEEN AND CAN BE VERY DANGEROUS. GRANTED IT DOESN'T SEEM TO BE MENTIONED MUCH, BUT IMPLANTS HAVEN'T USED ALL THAT MANY YEARS AND WE DON'T KNOW WHAT THE LONG TERM WILL BRING. BONE INFECTIONS OR OSETEOMYELITIS CAN BE VERY DANGEROUS OAND HAARD TO GET RID OF SO THAT IS MY MAIN THING.

I HAD 13 CROWN I THINK PLUS I HAD 2 BRIDGES WITH CROWNS AND THEN ANOTHER METAL BRIDE WITH ABOUT 4 TEETH ON THE TOP.. I WENT IN FOR MY VISIT ( AND I OOK GOOD CARE OF MY TEETH PLUS I WENT IN FOR CHECKUPS ALL THE TIME) AND I HAD 8 CAVITIES BACK IN ABOUT 2002 OR SO. I HAD THESE FILLED AND AS I WAS PUTTING MY COAT ON I HEARD THE TECH ASK IF SHE SHOULD MAKE ANOTHER APPT FOR ME. DENTIST SAID NO....SHE WILL BE BACK ON HER OWN SOON. I GOT MAD.

NOBODY COULD TELL ME WHAT WAS GOING ON AND MY DENTIST WAS MAD BECAUSE I SAID NO TO IMPLANTS. I FOUND ANOTHER DENTIST WHO WAS SO GREAT. OF COURSE HE REFUSED REMOVE MY TEETH RIGHT AWAY. I WENT TO HIM IN NOVEMBER AND HE FOUND 23 CAVITIS SINCE JANUARY. WHAT HE DID WAS DO PAIN ASSESSMENTS ON ALL MY TEETH....AND THAT WAS ONE OF MY COMPLAINTS. I HAD TOOTH PAIN. I KEPT TELLING DENTIST I FEEL LIKE MY TEETH ARE DYING.

THE NEW DENTIST WENT OVER EACH TOOTH AND XRAYS. HE PULLED OON THAT DAY AND IT HAD BOTHERED ME FOR YEARS AND HAD PAIN. HE SMELLED TO HIGH HEAVEN AND WAS ROTTING FROM INSIDE OUT. I WENT BACK THEN IN A FEW WEEKS AND HE HAD TO POULL 2 OTHER FRONT TEETH AND THEY WERE DRIED OUT AND DEAD LOOKING. NOTHING SHOWED UP ON XRAY BUT PAIN AND A DRIED UP ROOTS. IT ENDED UP THAT I HAD NOT FRONT TEETH LEFT OIN THE BOTTOM AND I WENT WITHOUT THEM FOR ABOUT 8 MONTHS OR SO.............. IF PEOPLE AT MY NURSING JOB LOOKED AT ME FUNNY I JUST TOLD THEM I WAS UNDERGOING MASSIVE  DENTAL WORK.

AFTER QUITE A FEW TRIPS TO DENTIST HE PULLED THE TOP TEETH AND THEY WERE BUGGERS TO GET OUT BUT WERE VERY UNHEALTHY LOOKING. I DIDN'T BEGRUDGE THIS DENTIST THE TIME HE WATCHED MY TEETH BECAUSE AT LEAST HE SHOWED CONCERN AND HAD A PLAN.
DENTISTS HATE TO PULL TEETH SO HE WAS AT LEAST GIVING ME A CHANCE. HE WAS A VERY GOOD DENTIST AND REALLY DID A GOOD JOB PULLING MY TEETH. THE BOTTOM TEETH WENT ABOUT A MONTH LATER AND I HAVE MY DENTURES AND DON'T MIND THEM A BIT. OF COURSE, I HAVE SOME BONE LOSSIN MY JAWS BUT I AM 76 YEARS OLD. I CAN EAT CORN ON THE COB AND MOST EVERYETHING ELSE. GOOD LUCK. IF I HAD KEPT MY TEETH I THINK I COULD HAVE ENDED UP IN THE HOSPITAL. IRISH
Title: Re: Tooth extraction soon, implant? Help
Post by: ohiolady on March 06, 2019, 06:33:08 PM
I had a implant about 9 years ago and have had no problems. If you have enough bone you should be fine. Of course this is my experience only.

Anna
Title: Re: Tooth extraction soon, implant? Help
Post by: Tinker on March 06, 2019, 09:58:40 PM
Thanks everyone for your responses.  I know that eventually, I will have dentures.  But, I have a great desire to keep my teeth just because of the problems I might incur with dentures.  There is no going back once those teeth are pulled and gone.

Looks like we are all greatly affected by the lack of saliva and crummy immune systems.  Joe, Elaine, Irish, Anna...I am sorry any of us have had to suffer this badly with our teeth. 

I have so many questions that no professional seems willing to answer.  No dentist will tell me if the crowns were done correctly.  Did he make a complete seal preventing leaking and bacteria to enter?  I don't know.  What I have to accept is that I research credentials and learn as much as possible, then just make the appt and go. 

My regular dentist tells me they can't get me in to fix the missing front tooth until after spring break.  That's a long time to wait before I can go out in public.  So, I am trying a new dentist who specializes in one day crowns, implants, etc.  They will see me tomorrow for a free consult.  Hope it works out.   Thanks again to all of you for telling me of your experiences. 
Title: Re: Tooth extraction soon, implant? Help
Post by: ktfabian on March 07, 2019, 02:35:05 PM
Tinker,

I just lost my last two bottom molars in the last year and I've always taken very good care of my teeth. I never had the secondary teeth that should have some in along side these two, so a lot of work was done to keep these healthy over the years.

They were both root canalled and had porcelain crowns. The first one I noticed started becoming painful and then it was loose, so it had to come out. There was no decay. About a year later, the second one became very painful after a really bad flare of my gastroparesis and I made it in to the dentist to find that one of the roots has fractured. There was no way to fix it, it had to come out.

My dentist is working with my now to make the best partial he can because one of the issues with gastroparesis is that you have to thoroughly chew your food. I said I don't care if I have to take it out after eating, as long as I can chew.

But I've noticed that the bones around where the teeth came out have flattened, almost like they're disintegrating a little bit. I do have osteoporosis and the dentist said that could be part of it. I've taken steroids for my Sjs for quite a while. I would ask, if you've taken steroids, what your chances of developing osteoporosis are and how that could effect the implants. My dentists didn't think implants would be a good choice for me because of the bone growth in my mouth.

Hope this helps a little. Good luck,
Tracy
Title: Re: Tooth extraction soon, implant? Help
Post by: Skylar on March 07, 2019, 07:11:03 PM
I'm the lucky owner of 4 implants.

The first one I went to an periodontist who my dentist had sent me to for some gum surgery and then to have the tooth pulled. They didn't clearly explain the time line. I had assumed that they pulled the tooth then followed quickly with an implant "tooth". I had no idea I would wait so very long before the implant would be implanted then longer for a "tooth". I also didn't realize that I would keep paying big bucks for each step.

They sedated me for the procedure which at the time I thought was a good idea and would help with the pain immediately after surgery. He had the assistant hand me prescriptions - and there were mistakes. They had prescribed one medication that I had in my chart a documented allergy (I noticed it when I got home and never took it) and they didn't prescribe another medication I should have gotten. I was very angry when I discovered this. The reason they didn't prescribe one medications was because they thought Plaquenil was the same as Prednisone.........

I googled to find out more and discovered that they made me wait 6 months longer than normal for the implant. Besides the long wait - it was a year and a half before I had an actual tooth in my mouth to use, I haven't had any problems since. The worst part was the swelling when my tooth was pulled- my face on that side swelled so much my eye was closed for two days. This was a miserable experience and I didn't want to repeat it if I could.



Because I was so upset with the mishandling of prescriptions I asked around found a periodontist who specializes in autoimmune diseases and started to go to her. I see her twice a year for teeth cleaning and my regular dentist twice a year for teeth cleaning. When I had two other molars that needed to be pulled, she told me that I could live well without, that only having one molar in each quadrant was enough.



I had the two molars pulled and no implants. This time my dentist sent me to an oral surgeon - who is an MD and DDS. This was a very different experience having teeth pulled. I was not sedated (didn't need it), the medications she gave me was different and minimal swelling and pain. I was warned that if I didn't get implants right away, that I probably wouldn't be a candidate later. Because my new periodontist had told me I didn't really need these two molars to eat, I decided against implants.



In the mean time I really missed not having eight molars (my wisdom teeth had been pulled when I was a teenager).  When I had to have a 4th molar pulled, I went back to the MD DDS because she had done such a wonderful job. This time I had her do the implant. Again this was a much better experience.



I then asked if I could have implants for the previous 2 pulled molars. There were no promises made but xrays showed I still have sufficient bone to make it worth taking a chance. I went ahead and everything worked beautifully. I was very lucky to have the bone mass. I do eat a whole food diet which means I'm home cooking my food and it's rarely mashed up. I rarely eat ground up processed foods - so not extruded cereals - I eat steel cut oatmeal. I think because I'm chewing, I'm maintaining the bone in my jaw.



The irony is the MD DDS was significantly cheaper, the office was more professional etc. I recently had a friend have a tooth pulled for implant. She was originally going to someone else for the procedure. When she complained about the office, I suggested where I went. She did switch and was surprised that it was $2,000 less and a better experience for her as well.



Based on my personal experience, I highly recommend implants if you are a candidate and can afford them. Carefully research where you go, hopefully you'll know people who have gone and can speak to their experience. And as it turns out, the more expensive price doesn't mean a better experience. I have two autoimmune diseases in my mouth and I'm concerned that having dentures might be very uncomfortable so I'm trying to avoid them. I do remember my mother having all her teeth pulled for dentures and her complaints. I also grew up without Fluoride and regret I didn't live where it was naturally occurring in the water.
Title: Re: Tooth extraction soon, implant? Help
Post by: irish on March 07, 2019, 09:05:27 PM
Thanks for all the information Skylar, that was interesting and good to know.

Also, forgive me for typing the whole previous post I did on this site in large print. I had been doing another project and didn't change the capitals and didn't even really notice it. It really is .... IN YOUR FACE ....... isn't it. Thanks Irish
Title: Re: Tooth extraction soon, implant? Help
Post by: Tinker on March 11, 2019, 10:25:36 AM
Hi everyone and thanks for the replies!

We traveled over the wkend to my grandson's 1st birthday party so I've been out of pocket.  Tried to post on my cell but couldn't manage it...vision ain't what it used to be so will comment from my laptop. 

I have another consult today with an oral surgeon to remove broken tooth and put in implant.  Hopefully, I can get it done by Friday.

Be back here later to respond to all of you,. I've got a bad case of butterflies and anxiety.  ugh
Title: Re: Tooth extraction soon, implant? Help
Post by: Tinker on March 16, 2019, 07:13:11 PM
I'm finally able to reply to your kind responses.  I've learned a lot about dentistry in the last few wks.  and it sure helps to educate yourself. 

I didn't have a good feeling about the first oral surgeon I was referred to so I found another oral surgeon.  He is an asst. professor at the dental school and teaches about implants.  YES!  He was also in my dental insurance network and that means he writes off expenses that my insurance doesn't cover and he can't charge more than the agreed upon amts. between him and the insurance co.  YES!

So I had the tooth pulled on Wed. and it was a breeze.  I had sedation (Versed and Fentanyl) but I don't remember anything after the first injection.  No pain, no memory, no swelling, no bleeding, no problems.  My share is listed as $644.  The bone graft powder was listed as $595 but since my insur. doesn't pay on that, I'm not sure I'll be charged at all.  When the office staff gave me my treatment plan, they DID NOT list the prices the insurance would cover so I was'nt sure exactly what the damage would be.  When I questioned her later, she said it was his reg. price.  None of that makes sense but it nice to know what insurance will pay. 

Next step: getting the temporary filling replaced in the front of my mouth.  I was lucky they could use the actual crown that fell out to glue back in.  When I go back for the permanent crown, I'm going to make sure there are no black triangles or non matching colors or a funny looking tooth to live with for the rest of my life.

Now, I have two more re-crowns to go.  I had no idea about these teeth being decayed under the crown so hopefully they can be saved.

I've spent a fortune....2 or 3 root canals and crowns last yr., 1 root canal , extraction this yr., and 3 more crowns to go. 

Another thing I learned is if your dentist is leaving questions in your mind, follow your gut and try another one.  My dentist left me high and dry during spring break with no tooth.  Also, if your dentist doesn't apply the crown properly it can leak and bacteria can get in and cause decay.  All dentists are not created equal. 

SKYLAR, I'm so sorry for all you went through with your oral surgeon.  What a difference a good practitioner makes....especially in your case.  I appreciate all the info you shared and know that it did help me make a good decision.

TRACY. thanks for your input as well.  From what I've read, the depressions in the bone after tooth extraction are normal and that's where the bone grafts come in.  I don't know the time limit on getting the bone graft but I'm pretty sure it can be done after the fact if it hasn't been too long.  Thanks for your story.

IRISH, I never thought a thing about the caps...don't give it another thought. 

I believe I developed an ulcer over all this expense and worry.  The ulcer is much better now so maybe I'm on the road to recovery.

I feel better just knowing I will be starting with the new dentist who helped me out when my front tooth fell out. 
Title: Re: Tooth extraction soon, implant? Help
Post by: Tinker on March 20, 2019, 10:17:46 PM
So, things didn't go as well as I thought...

A few days after the extraction my jaws started hurting.  Couldn't chew, couldn't open my mouth without pain and tight muscle feeling in the jaw.  Since I've had a lot of trouble with my left ear, tinnitis, clicks, squeaks, and crackles, eustachian tube popping, etc., I chalked it up to that.

Turns out it's all from having my mouth open for 45 min. and the use of those awful blocks to hold your mouth open.  I wasn't awake so I couldn't refuse.

Ugh, some days are worse than others and today was awful.  I'm so tired of dealing with another ache or pain.

Wouldn't it be nice if we could have a pain free day? 
Title: Re: Tooth extraction soon, implant? Help
Post by: Carolina on March 21, 2019, 05:58:57 AM
Oh, Tinker!

Put me on the list for a pain free day.

Elaine
Title: Re: Tooth extraction soon, implant? Help
Post by: Skylar on March 22, 2019, 07:20:18 PM
Tinker, I always ask for one of those blocks if the dentist has to work for awhile. That block saved straining your muscles trying to keep your mouth open, it allowed your mouth to relax during the surgery.

I suspect that in your case it's not the block, but all the inflammation and stress from having the tooth pulled and all the inflammation is affected everything in the vicinity. When you think about it, having a tooth removed is quite the assault on the mouth - then there's the hole that needs to be heeled and perhaps they packed in some cadaver bone which is another new thing your body has to deal with. Lots of reason for pain and swelling. Have you called your dentist? Maybe there is something they can give you to help tide you over this painful stage?

I've had great help with pain and inflammation following Dr. John McDougall's diet - his website has the complete information needed to follow it, but I also borrowed his books from the library. It really is an anti-inflammatory a diet and I've had many pain free days since starting eating this way over 10 years ago. I hope you can try it and find some relief. I actually found it more effective than the cortisone I was taking just prior to changing my diet.

I'm also glad you switched dentists - how lucky were you to find such a highly qualified dentist.

Title: Re: Tooth extraction soon, implant? Help
Post by: Tinker on March 23, 2019, 08:14:44 PM
Oh, Skylar, I wish what you said is true.  But, unfortunately, it don't think it is. 

When I had a root canal last yr., the endodontist put the blocks in and immediately I felt the uncomfortable stretch in my jaws.  They were removed and I did fine w/out them.

When I saw the oral surgeon asst. for my my one wk.  followup last week, I did tell the asst. that I was having having pain in my jaws.  She volunteered that sometimes this happens when blocks are used and the mouth is held open for extended periods.

The advice I was given was to use a heating pad on both sides (kinda hard to do), massage, and don't chew anything.  So,  this is only helping a little and I"m sure hoping they will give a muscle relaxer.  The ones I have are of small benefit.  Ativan works but getting a script for that may be an issue.  I only need enough to get me through the next week , not a month's supply or anything.

If I do try to chew something, I PAY for it.  I"m just taking liquids, mashed potatoes, frozen yogurt, mac and cheese creamed, applesauce...my options are limited.

Ugh, anti-inflammatories might help but I've got this ulcer so that is contraindicated. 

Truly, having this tooth pulled was only scary before the fact.  It was the easiest thing I've had done in a long time...except for this  chewing issue.  The extraction was so simple:  no bleeding, no pain, no swelling and no memory due to Versed.

I have thought of looking into an anti-inflammatory diet but haven't yet.  The ulcer , no citrus or acid, caffeine/coffee restrictions have me so limited I can't find much to eat. 

Thanks for your reply and maybe I can try the antinflammatory diet soon.  It can't hurt.  I'm glad it has worked for you and it certainly makes a lot of sense.
Title: Re: Tooth extraction soon, implant? Help
Post by: Skylar on March 24, 2019, 06:21:45 PM
Tinker - you're probably right - but I think I'm right too.......

I always ask for a child size block. If they give me the adult block it's too large and I get sore from having my mouth forced open too wide - within a few seconds it's uncomfortable. I get sore if I have to hold my mouth open for an extended time and I also get sore if they give me a block that's too large. Like Goldilocks - I need the children's block, not the baby block and not the adult sized block. If you ever have to have your mouth open an extended time - try the child block. It should feel completely comfortable in your mouth before they start to work.
Title: Re: Tooth extraction soon, implant? Help
Post by: irish on March 26, 2019, 11:06:21 AM
My son had the jaw pain when he had his tonsils removed. He had a very small jaw and they had to pry his mouth open and put blocks in there so they could reeve his tonsils. He could hardly eat for close to a month. The hot water bottle in those days helped and tylenol helped for the pain. Just had to wait til his muscles recovered. The main thing was making sure he got nutrition and fluids. Malts, popsicles etc. Irish.