I'd rather my teeth not fall out, in all honesty
December 17, 2010 7:31 AM   Subscribe

I have finally gone to the dentist after five years of not being able to afford it. The dentist tells me I have gingivitis and need a $300 treatment. My question is... do I? Do I really?

First off, I should explain that I don't like this particular dentist, and I won't be going back to her office. For a long series of reasons, I found my visit to be disturbing, so I'm not inclined to trust her opinion. If I get the gingivitis treatment, I'll be finding a new dentist to give it to me.

All I really know about gingivitis comes from a childhood of watching Scope Mouthwash commercials. I've tried finding some information online, but the sites seem contradictory. They say things like, "gingivitis is not a serious condition," but also, "you need to take gingivitis seriously." I just don't know how to understand that.

Second, given all the pictures I've seen online, along with the lists of symptoms, if I have gingivitis, it doesn't seem like a very bad case: my gums don't look disgusting at all the way that the gingivitis pictures do. Then again, I also understand that I'm not a professional and not qualified to really judge the state of my gums at all.

Third, the intertubes also describe the treatment for gingivitis as painful and difficult... And, I have recently been harmed by doctors encouraging me to get painful and difficult procedures done when, as I found out later, I probably shouldn't have. So, I'm trying to be less trusting of people in labcoats and more hesitant to agree to procedures.

So, can you give me some more information about how seriously I should be treating this diagnosis? Should I be running to find a new dentist immediately, in order to get a $300 treatment? Is gingivitis the sort of thing that can be serious and require such treatment even if your gums do not have the appearance that the online sites claim they should?

In short, should I just focus on flossing more regularly, or do I need to get to another dentist asap?
posted by meese to Health & Fitness (32 answers total) 6 users marked this as a favorite
Well, since you are going to go to a new dentist no matter what, wait and ask them. In the meantime, floss at least once a day and use a fluoride rinse.

Gum disease affects heart health, although I am sure you are not yet that far gone.
posted by jgirl at 7:36 AM on December 17, 2010 [6 favorites]

Best answer: Gingivitis exists on a continuum. It is not a serious condition at first but has the capacity to become quite serious. Do your gums bleed when you floss? How do your gums respond to pressure against them? Are your gums receding at all? These are all things that the dentist will look for; if you are concerned, get a second opinion, but no one here will be able to tell you if your dentist is correct or not.
posted by proj at 7:36 AM on December 17, 2010 [1 favorite]

You should find a new dentist with whom you feel comfortable, and get a second opinion. No one on the internet can tell you whether or not you need medical treatment. Get another dentist and start over with a new exam. If the new dentist recommends the treatment, ask for details of what it will be like, and ask what will happen if you don't get it. Then decide whether to follow the advice of your new, trusted dentist. Good luck!
posted by decathecting at 7:37 AM on December 17, 2010 [3 favorites]

They say things like, "gingivitis is not a serious condition," but also, "you need to take gingivitis seriously." I just don't know how to understand that.

The problem itself is not serious, but it can lead to a serious problem if left untreated. Like, it you cut yourself, it's not a problem. But if you don't clean and dress the cut, it can get infected, which can lead to other more serious issues.
posted by EndsOfInvention at 7:38 AM on December 17, 2010 [1 favorite]

Just had this treatment (root planing & scaling with some antibiotic placement subsurface).

Much of what happens in your mouth is related to gum health. In addition, there is some evidence that suggests that gum health is linked to other conditions within the body (heart disease, etc). If your gums are separating from your teeth under the gum surface, not only will you experience bad breath but some of that bacterial development (anaerobic by the way, and hard to fix just by rinsing) will lead to other more serious conditions.

As someone who hadn't been in over ten years to the dentist and who recently committed to a very serious and involved treatment regime over several months, i'll say this: Doing it now will save you a lot of trouble, and very little of the true problems manifest themselves on the gum or mouth surface immediately. And after a couple of days discomfort, anecdotally I have noticed a great deal of reduced inflammation in my mouth and throat, something I wouldn't have expected.

On the other hand, i'd seek a second opinion. Unless your gums have been professionally probed and the pockets measured and a treatment plan suggested for each, you're not at the right dentist (or periodontist).
posted by arimathea at 7:39 AM on December 17, 2010 [7 favorites]

Between now and the time you visit a new dentist for a second opinion, may I suggest that you floss at least once a day, everyday. No exceptions! Also, get a waterpik or something similar and use that once a day as well. Then see what your new dentist has to say.

Also, perhaps call the dentist you just visited and ask them if there's anything you can be doing to help the gingivitis that doesn't involve the $300 treatment.
posted by Sassyfras at 7:43 AM on December 17, 2010

Brush and floss like crazy for two or three weeks, and use Listerine, and then go to another dentist. And, as suggested above, make sure you get a proper diagnosis with pocket depth etc. If you are still told you need the treatment, do it; it'll be really good for you in the long run.
posted by BibiRose at 7:45 AM on December 17, 2010 [2 favorites]

IANYD (Dentist.) It depends on the severity. I had gingivitis which consisted of badly bleeding gums, which was fixed in a few weeks with a special toothpaste and flossing every day.
posted by biochemist at 8:09 AM on December 17, 2010

Last dentist visit my gums were pretty bad and I was told I had "severe gingivitis" which was in danger of becoming periodontal disease, if not treated. It looked kind of like the first photo on this page - gums were white and puffy, and bled easily.

Treatment was the normal cleaning to remove plaque, and then heavy flossing and mouthwash use at home. It cleared up after a few weeks. You could perhaps try this for a few weeks and see if it makes a difference.
posted by PercussivePaul at 8:11 AM on December 17, 2010

Best answer: I have a great dentist now whom I found through the recommendation of a friend, but unfortunately my previous not-so-great dentist didn't spot my gingivitis and it developed into something a little more serious that almost required a root planing procedure. I brush and floss everyday, but I must admit that I sometimes missed my 6 month appointments and would go a year or so. Big mistake on my part. For some reason, despite my use of an electric toothbrush and daily flossing, I tend to have problems with plaque, which develops into tartar, which leads to gingivitis and periodontal disease.

So here's what my new dentist did. We scheduled the root planing procedure four months out, but in the meantime the hygienist did an extra thorough cleaning even going going a little under the gums to remove any tartar or plaque buildup that was causing the inflammation. It didnt' hurt much, but I do have a somewhat high tolerance for pain at the dentist's office and that was one of the reasons that she even attempted it. The dentist also prescribed a special rinse (I can't think of the name of it, but it was $25 and I think that it contained hydrogen peroxide -- it might be something like Periogel?). I continued brushing with an electric toothbrush and was even more hypervigilant about flossing.

When I came back in 4 months, I wasn't able to do the root scaling because I had a new job/new dental insurance that wasn't going to cover it (and it was going to be over $1000). However this wasn't a problem because she said that things had so improved since the last appointment that I wouldn't have needed it anyway. First and foremost ask friends for recommendations and find a good dentist. Try being extra good about flossing, seriously don't miss a day, even if you come home drunk at 4:00 AM floss. Have the dentist prescribe a rinse with hydrogen peroxide and use it every night. Do this religiously and see if you can turn things around without resorting to more drastic and expensive procedures.
posted by kaybdc at 8:20 AM on December 17, 2010

Best answer: You should absolutely get a second opinion. You should ALWAYS get a second opinion.

Your dentist (or her technician) should be probing your gums with a little device with graduated lines on it. This measures the sulcus -- the “pocket” between your gum and your teeth. Deeper pockets are bad. According to my recollection and Wikipedia, (IANAD) 3mm is typical, >4 is a problem.

When I first showed up at a dentist after years of no treatment with deep sulcuses, my dentist scheduled a follow-up appointment with me after maybe 3-4 weeks. He said he wanted to see if my gums could heal themselves with the plaque cleared out by a dentist-level cleaning; if they healed, he thought I wouldn’t have to see the periodontist. They did get better, and he basically said FLOSS DAMMIT, but also, that scheduling cleanings more often than normal (3 or 4 times a year) would also help keep my gums healthy. I had the insurance to cover 2 cleanings a year, so I paid out of pocket for extra cleanings, which kept me out of the periodontist’s.

You are not me and I am not your dentist – it looks like your dentist isn’t even your dentist. But part of what’s missing from your story is basic information, like the basis of the diagnosis of gingivitis requiring intervention. If you’ve just not chosen to detail that information, that’s one thing, but you should *have* that information, and be given the background to understand it and what the alternatives are, or why there aren’t any.
posted by endless_forms at 8:20 AM on December 17, 2010 [1 favorite]

I have ridiculously bad gums, plus a history of only sporadic access to dental insurance, so I've had this treatment (if they're talking about the "deep cleaning" scaling type procedure, which usually runs around that much and is sort of your first stop recommendation for gum disease treatment) a couple of times. After the second time, I put my foot down and swore I would never do it again. After that point, it was recommended to me again by my dentist after another couple of years of not being able to go in for cleanings, but I told them no, I'm not going to pay that much again for treatment and it's painful and horrible and I refuse to do it.

Instead, my hygienist recommended just trying more frequent cleanings at 4x a year instead of twice a year, and after a year of this the problem kind of cleared up on it's own. Coupled with flossing at home daily and using a fluoride rinse, regular dental cleaning on it's own was enough to take care of my pretty-bad gum problems, and I've successfully avoided the expensive deep cleaning treatment.

Of course, this strategy depends heavily on your dental insurance situation. If you have good insurance that is steady and will cover 4x annual cleanings, you might try flossing + fluoride rinse for the next few months, then find a new dentist and get their opinion at your next cleaning, in three months or so instead of in six months. Gingivitis is serious, but if your gums look normal even if you have pockets, it's not going to advance so far in three months if you're doing some preventative care that you're going to die or get much worse (obvious confession: IANAD, but I ask a lot of questions when I go to see one).
posted by booknerd at 8:25 AM on December 17, 2010

One way to start. The college I had worked at had and still maintains a dental clinic. It uses this clinic to train dental hygenists, students who become dental assistants. Their work is check by a certified dentist. The clinic is open free of charge to the public. By offering free service, the clinic gets its patients for its students. See if a local college has such a clinic and then ask the folks working there (of course not the students), as a first free evaluation.
posted by Postroad at 8:25 AM on December 17, 2010

I was in a situation similar to yours several years ago. Dentist told me I would need full-mouth root planing and scaling. They scheduled the procedure for several weeks out, and in the meantime, I started brushing, flossing, and using Listerine (I would suggest the kind with flouride added) twice a day. By the time I went back in a week or two, the assistant who was to measure my gum pockets before they began quizzically asked why on earth they scheduled the appt., as my gums looked fine! Dentist looked herself, and sure enough, the procedure was no longer needed. I just got an old fashioned cleaning instead. Can't say this will certainly work for you, but it did for me, and saved me some $$. Best of luck!! If your case isn't too bad, antiseptic mouthwash and floss should really help you out.
posted by I_love_the_rain at 8:32 AM on December 17, 2010

I didn't take minor gingivitis seriously despite knowing that I have a family history of deep gum pockets which basically become bacteria farms if left to their devices. It became more serious: periodontitis. I was able to keep it at bay somewhat with root planing and prescription mouthwash but eventually chose to address it with a more permanent solution, which was a hell of a lot more expensive than $300, and also pretty uncomfortable, and also put me on a liquid/mush diet for several weeks.

So, get a second opinion, but don't let the internet or your own opinion allow you to believe that it's no big thing. Most likely the parts of your gums that you can see in the mirror are the parts that are pretty healthy, so they look just fine; your issues are probably on the lingual side of your gums and toward the back, where it's harder to brush as thoroughly.
posted by padraigin at 8:39 AM on December 17, 2010

I also had planing & scaling done, which is what it sounds like you're describing. It's unpleasant, but I didn't find it to be as horrifically painful as booknerd did. (Mine cost more than $300, btw, so if it turns out that you do need it, at least you're getting a better deal than I did!)

I agree with everyone here about seeing a second dentist and getting a second opinion. If you do have to have the treatment, grit your teeth (heh) and go through with it. Dental health is srs bzns. "Floss" isn't just a suggestion. Once I started flossing after the planing and scaling, my teeth and gums have been perfectly healthy and my twice-a-year visits to the dentist have been a breeze.

One thing--learn how to floss. I know that sounds crazy, but a lot of people do not know how to floss properly. You have to slide the floss down the side of the tooth and into the gap between the gum and the tooth, and then draw it back up again. You don't go back-and-forth, but rather up-and down and you do it on both sides of each tooth, into the gum and back up. Also, I found that using a Sonicare toothbrush, rather than a regular toothbrush, also made a huge difference.
posted by tzikeh at 8:51 AM on December 17, 2010 [1 favorite]

Yes, get a second opinion - but if they agree, then cough up the money. $300 is not that bad to save your teeth now and reduce wallet-busting later. I have a family member who didn't care for their teeth, and in later years of life had to spend thousands upon thousands of dollars to fix it.
posted by etoile at 8:53 AM on December 17, 2010

Ask your dentist "How do you know this is an effective treatment? Are there studies that have been done that demonstrate that this particular treatment you're planning on doing for me actually improves my dental health? Is this evidence-based medicine?"

After having read The Treatment Trap about just how many unnecessary tests and procedures are performed annually, how much it costs, and how much actual harm it does to patients, you'll start asking your doctor more questions about what they plan to do to you (and bill for). You would probably be shocked at how many routine treatment plans there are no studies done showing they actually improve life and health.

Now, I'm sure this gingavitis treatment is nothing like getting a full-body CT scan (MASSIVE ammounts of radiation) or back surgery (ZERO evidence that it has improved a single person's health/mobility outcomes) or other medical procedures that have serious health consequences themselves, but which are routinely ordered (and billed for). But doctors don't get paid unless they perform some kind of billable procedure. This is called "Fee for service" And they're human beings subject to economic pressures, with private schools tuition and mortgages and car payments.

"How do you know this is an effective treatment for me? What are the alternatives? What are the risks and long-term downsides?"
posted by Pirate-Bartender-Zombie-Monkey at 9:02 AM on December 17, 2010 [2 favorites]

I also had planing & scaling done, which is what it sounds like you're describing. It's unpleasant, but I didn't find it to be as horrifically painful as booknerd did.

Er yeah, I should mention that I'm a HUGE FUCKING WUSS with relation to mouth pain, so take my comments with several large grains of salt. They usually have to use topical analgesics just to clean my teeth and gums, and I was fully numbed for the deep gum cleaning and still in pain. I'm just a big baby sometimes.
posted by booknerd at 9:10 AM on December 17, 2010

Best answer: Yes, it's quite possible you have gum disease given your care history, even if it is not visibly evident. No, 300 dollars is not a lot of money for initial treatments for this. The only opinion that is really germane at the end of the day though is that of a competent dentist that you trust.

1. Don't "brush like crazy." Over-brushing, brushing too hard or with too firm a toothbrush, or using a toothbrush too long before replacement (which wears the polish off the bristles and exposes a more abrasive underlayer) can impact gum recession and enamel loss. Get a name-brand electric toothbrush with replacable brushing heads that have some sort of wear indicator on them (i.e. colored bristles that fade with use) and use it according to the directions, twice a day.
3. Find a dentist you trust. Ask questions about alternatives, costs and benefits. Follow their advice.
4. You don't need to make this decision overnight but don't put it off forever, for some people some problems get to the point where self-care just won't bring it back and in that case it will only get worse.
posted by nanojath at 9:33 AM on December 17, 2010

In addition to the advice already given, i would suggest you really really try to find a dentist that you like and trust and commit to going every 6 months for a cleaning and brushing and flossing every day. I've done that my whole life and have avoided any problems with teeth, including cavities, and in the long run that saves you money, pain, and health.
posted by WeekendJen at 9:41 AM on December 17, 2010

Response by poster: Thanks, folks! You've given some really good information.

Thanks for the comments about the sorts of tests the dentist should have done: she didn't do them. She also didn't provide me with any information about what my options were, what was involved in the treatment, or why really I need it. From your comments, I now have a better idea of what she should have done, and what I will want my next dentist to do. Also, thanks to those of you who helped clarify how gingivitis can be not serious but also serious at the same time -- I now understand the importance of dealing with this problem quickly.

I won't put off getting to another dentist, and I'll do everything I can to improve my gum-health. (For those of you who are curious: my five year neglect of my teeth is now over. My gingivitis could very well be called Grad School Rot, given the circumstances. I will be seeing a dentist every 6 months from here on out, as I strongly encourage anyone who comes across this thread for advice to also do.)
posted by meese at 10:31 AM on December 17, 2010

Agreed on the Sonicare or other good electric toothbrush. Even a cheap Spin Brush (sold with the regular toothbrushes) is better than a manual brush, in my opinion.

And, yeah, I shouldn't have suggested brushing like crazy. That will tear up your gums. Let's say, brush and floss very thoroughly and do use an antibacterial mouthwash.
posted by BibiRose at 10:41 AM on December 17, 2010

FWIW, I recently purchased the Waterpik that Sassyfras mentioned after my dentist recommended it (this is the model I bought). The Amazon reviews suggest that some people have had huge improvements in their oral health after using it for a while. I've only been using it 3 weeks or so, so I can't make claims like that. But I have noticed that when I brush, then floss, then use the Waterpik, I sometimes see "food debris" come out in the water that my brushing/flossing apparently didn't catch, so I feel like it's having a positive effect. I would definitely recommend using one in addition to (not instead of) brushing and flossing if you're worried about gum disease. I don't know that it'll solve your problems, but at least it couldn't hurt, and it costs less than $50 USD.
posted by Vorteks at 10:42 AM on December 17, 2010

Regarding affording dental care (for anyone popping along this thread later), any community college with a dental hygienist program will typically offer free or very reduced-price cleanings ($12 at the one nearest me). A lot of people I know for whom money is tight and dental insurance isn't available will see their dentist once a year, and then 6 months later go to the student hygienists for the "in-between" cleaning.

Even seeing the student hygienists exclusively for a longish period of time would be better than not seeing anyone at all! Of course you can only get cleanings, not specialized care, but the cleanings help.
posted by Eyebrows McGee at 10:46 AM on December 17, 2010

meese, I am in Orlando and work for an excellent and non-shystery dentist. Memail me if you want any information/referral.
posted by Jazz Hands at 11:08 AM on December 17, 2010

I agree with the suggestions for dental irrigation (here's the one my dentist recommends) and the increased cleanings. Sometimes you can do everything right and something like sinus infections or genetics will throw off the chemistry in your mouth and let the gingivitis go nuts. The thing that really worked on my gums was this toothpaste that inhibits bacterial growth and helps extend the effects of the cleanings.

It's something you definitely want to get under control, and it's possible it will take more than flossing.
posted by *s at 12:16 PM on December 17, 2010

One thing I've found helpful as I've taken my dental care on the long slog from shitty/gingivitis land to everythings-pretty-much-under-control-land is mild salt water washes. When my gums were really inflamed, it helped to do this after flossing. So I'd do that once a day and the flouride treatment once a day.

After a couple of years of this, a good dentist, and four times a year cleanings, my teeth do. not. suck.

Dental care is serious business -- neglect it, put it off, and awfulness ensues.
posted by A Terrible Llama at 1:52 PM on December 17, 2010

Oh, and I'll offer my standard recommendation for anyone facing frequent dental visits: iPod + a little Xanax makes life a lot better.

Oddly, hygienists always seem really relived if I ask if they mind if I listen to music. Maybe it's just they hate having to talk to me, but I kind of think it's easier for them to just be able to do their work and not feel like they have to make conversation.
posted by A Terrible Llama at 1:55 PM on December 17, 2010 [1 favorite]

The 2nd opinion should be from a periodontist, not a dentist.
posted by Mr. Yuck at 3:00 PM on December 17, 2010

I recommend hydrogen peroxide rinse. Listerine and all mass market mouthwashes contain 30% alcohol, which dries out your gum tissue. Great fun to put hydrogen peroxide [diluted 50/50] in the Water Pik. Try brushing your teeth with baking soda and then rinsing with hydrogen peroxide!!! Plenty of bubbles-- anaerobic bacteria slaughtered by the millions.

I read that dentists don't earn enough with cleanings and fillings. That's when they decided that CROWNS were the way to go. Filling is $50 and crown is $300. Next thing you know, the normal cleaning isn't enough, need to have the four quadrant deep cleaning with scaling. That procedure is usally $300 per quadrant.

It's important to have a dentist that you trust. They should measure the pocket on every tooth 3 times. If you hear numbers like "7" or "9" then you know you have problems

Also, dentist should have very good small muscle control. A nimble dentist can scale and plane your teeth without terrible pain.
posted by ohshenandoah at 5:11 PM on December 17, 2010

Your gums and teeth are under 24/7/365 bacterial assault. There never, ever is any letup. When you brush your teeth and you floss your teeth you are removing the film of bacteria that have accumulated, and you are disrupting their buildup of tartar. Therefore, the trick in brushing and flossing is to do it absolutely regularly and never skip. Because the bacteria never, ever rest. The second you've stopped brushing, they're back at work re-building. It's a non-stop war forever.

So, don't let more than 12 hours elapse between tooth brushing or more than 24 between flossing. Technique is important, so you don't over-brush or damage your gums with flossing. Get a good demonstration of proper technique. Something rarely mentioned: unwaxed floss is better, because it removes the bacterial colonies better.

Perio-washes are bunk. There are no studies that I'm aware of, proving their long term effectiveness. There was a large Canadian study which was inconclusive. They might even make the situation worse by unfavorably altering the bacterial balance in your mouth. Limited time direct in-gum antibiotic treatment may be indicated to control periodontal infection, but all mouth washes are useless or worse.

If you have advanced gingivitis or periodontal disease, root planing is essential and non-optional, and $300 sounds about right. Once you've had the planing, you should continue to conscientiously brush and floss for the rest of your life, and depending on how fast you build up tartar, you should have regular teeth cleaning, perhaps as often as 4 times a year. This is like changing oil in your car - not optional.

Dental health is critical to your overall health - it's not just about your mouth.

Get a dentist you feel comfortable with. And get a dentist who is willing to explain in detail what needs to be done, why it needs to be done, how it's going to be done, what the alternatives are, and if there is clinical evidence of the benefits of one treatment vs another. Any dentist who is not willing to do so, should not be your dentist. Your obligation, in turn, is to educate yourself on the subject of your health in general (including your dental health). It's OK not to know much about your car, and leaving everything in the hands of a mechanic - all you lose is money or car in the worst case. It's not OK not to know everything you can about your body - leaving yourself at the mercy of your physician is much, much worse - you only have one body. You must be not only a patient, but a partner with the physician in getting medical treatment. Good luck!
posted by VikingSword at 10:25 PM on December 17, 2010

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