Without insurance, 24-year-old dies of toothache...

August 18, 2012 11:45 PM

I have gingivitis. I don't have health insurance, nor do I really have money.

I don't know I have gingivitis, but all the symptoms are there. My teeth are killing me, particularly my gums, they feel loose where they meet the teeth, they are red at the bottom and bleed sometimes, I have a bad taste in my mouth sometimes (kind of like when I got dry socket after removing my wisdom teeth, except nowhere near that overwhelming) and sometimes I feel my teeth shift a little. Fuck, maybe it's even periodontitis by now. I don't know.

Problem is, I don't have health insurance. I don't know how much treatment will cost - everything I've read says multiple $300 shots, follow-ups, etc - but I know I don't have that kind of money either. And yet my teeth are killing me. (maybe literally?)

How long do I have to see a dentist somehow before I am absolutely, completely fucked? I am in my early twenties. I'm not perfect about brushing but I'm also not terrible. I feel like this shouldn't be happening to me now.

posted by dekathelon to Health & Fitness (22 answers total)

You should see a dentist as soon as you can. IANAD. Getting implants is much more expensive than saving what you have.

My gingivitis symptoms cleared up *very* quickly after I picked up a waterpik and used it religiously.
posted by peeet at 11:53 PM on August 18, 2012 [1 favorite]

Do you floss? Do you brush correctly (I didn't actually understand what my dentist had always been telling me about how to brush until my late 20s, by which time my bad habits were visibly hurting my gums)? Do you get enough vitamin C in your diet? (Yes, modern first-worlders do get scurvy occasionally if their diet is bad enough.) Just throwing that out there.

Most cities do have some low-cost dental clinics; if you tell us where you are someone might be able to suggest one to you.
posted by hattifattener at 11:57 PM on August 18, 2012 [2 favorites]

Take hattifattener's advice. In regards to teeth you should take care of it as soon as possible. It can get worse by affecting more than one tooth before you know it. There are free dental clinics or cheap clinics in most cities. It's too late if you have a toothache, because that means you haven't taken care of your teeth. I would try to save up some money or borrow money from your parents to get that taken care of.
posted by icollectpurses at 12:05 AM on August 19, 2012

I had a dental injury and had to go to the ER for an injection of lidocaine into the nerve to cope with what the dentist later told me must have been just astonishing pain. Total time in the ER: 25 minutes. Total face time with a doctor: 5 minutes. Bill: US$1580. If you don't fix your teeth preemptively, there may be unexpected costs.

AND

When I was at the ER, the doc told me to check out the university dental school at University of Illinois - Chicago. I ended up elsewhere, but he said he thought they'd be able to squeeze me in fast and cheaply.

I think I would go into debt for teeth. I read something in Harper's a few or five years ago that had interviewed a number of working poor in America, and something that cropped up again and again was how so many of them wanted a little bit extra money so they could fix their teeth. It sucked. It's terrible that this costs money. But I think teeth are worth some debt. I know it's easy for me to say that now, though there were times in my life when I was paycheck to paycheck. But seriously, debt to keep teeth seems worth it.
posted by samofidelis at 12:08 AM on August 19, 2012

I certainly think you should make seeing the dentist a priority, and the recommendation of a dental school is a good one. Lest you think you'll be at the mercy of incompetents, usually it's a student being overseen RIGHT THERE by the professor. My parents both got exceptional bridge/crown work done 30+ years ago at a dental school that has lasted far longer than expected and been commented on positively by every dentist they've ever seen since. Biggest downside is it is slow, as they are learning.

In the meantime, however, I highly recommend this toothbrush. I bought the previous version 3 or 4 years ago for about twice the price; even having been chewed on by my dog, it still works (and my dental hygienist was shocked when I told her how cheap it had been -- now she's recommending it to all their patients). Anyway, I didn't have full blown gingivitis but I did have deep gum pockets, lots of bleeding, and cavities at every visit. Since getting the new toothbrush (and, if I'm honest, not using it nearly as religiously as my dentist would like) I have had maybe one, very minor cavity; my gums don't bleed anymore; my pockets have gotten smaller; and I get compliments at every dental visit. Seriously, I was apparently a total incompetent with a toothbrush before the electric one came into my life, and now I am a rockstar. If you get it and use it twice a day, your gums will definitely bleed for the first few days. It will suck. But, within a few days, mine started to bleed less and less and then not at all. I have no idea whether it will reverse the process without you seeing a dentist and/or getting more serious treatment, but it's $12 and you can have it in your hand by next Monday or Tuesday, which is presumably before you could get a dental appointment. And, even in the worst case that you have to get treatment, you'll still have a great toothbrush afterwards to help prevent it happening again.
posted by katemonster at 12:26 AM on August 19, 2012 [7 favorites]

Look around for which community colleges and universities have dental hygiene programs. They generally offer cleanings which are very inexpensive (it's $25 at one school I know; YMMV). A cleaning isn't going to magically solve gingivitis or worse, but the hygienists-in-training and their supervisors almost certainly will notice if you have something serious enough for which you need a dentist. I also nth seeing about Schools of Dentistry at local universities, because they'll often offer cheaper dental care. There are sometimes sliding scale or community-health dentists. Assuming you don't need root canals and fillings/crowns at this point, it shouldn't be enormously expensive.

In the meantime, do work on taking better care of your teeth on a day-to-day basis. Be sure you're flossing. It's really as important as they say. Maybe see about getting an electric toothbrush. Lots of people do see a big improvement after getting a Sonicare, but even a cheaper brand should have good results, because it kind of forces you to change the way you brush your teeth (turns out many people don't brush their teeth particularly well on their own).
posted by asciident at 12:32 AM on August 19, 2012 [1 favorite]

In the meantime, get a medicated mouthwash (the kind where you aren't supposed to drink water for half hour afterwards) and swill it at least three times a day. (What I'm doing right now since its a holiday weekend here and clinics won't open till Tuesday)
posted by infini at 12:36 AM on August 19, 2012

Start by proper brushing and flossing. I use one of those Colgate sonic brushes (which you'll find in any drugstore). Do not scrub your teeth with any powered brush or you'll risk damaging your gums more. Just hold the brush against your teeth as it pulsates and move it gently over your teeth and gums. You should be brushing for at least two minutes.

I also use a power flosser (a Reach one that you can't buy any more) and flossing has made a massive difference to my mouth hygiene.
posted by essexjan at 12:39 AM on August 19, 2012 [1 favorite]

Colgate has a new Gum Defense toothpaste that is supposed to treat gingervitis. That and flossing religiously might be a good start while you sort out dental clinics in your area.
posted by DarlingBri at 1:09 AM on August 19, 2012

You probably do not have serious gum disease yet. It is much more likely that you have a large amount of tartar built up under the gum line because you have not been getting regular cleanings. This will cause your gums to be red, inflamed and bleeding and you will see your gums beginning to recede. A few days after a deep cleaning/scaling, you will see a noticeable improvement and the gums, no longer being pushed back from the tartar, will begin to cover more of the tooth surface again. Then you can start taking better care of your teeth and make future cleanings easier by flossing every day.

Trust me, I've gone way too many years between cleanings because of lack of insurance and experienced the same fear that I had waited too long and now I was going to need expensive gum grafts. After a deep cleaning, a very long lecture from the dentist and hygienist, and one filling, my gums were normal again.

Even if you find out you are going to need 10 fillings and you can't afford them all right now, it all starts with a deep cleaning first. Some dentists offer new patient specials that will include the initial exam, x-rays, and cleaning for a price that is probably much lower than what you are expecting now. Don't wait any longer.
posted by Ariadne at 1:24 AM on August 19, 2012

I had similar gum problems last year. Ariadane is right its probably the build-up on your teeth near the gums due to incorrect brushing technique. It will not really get better until you get the buildup from your teeth removed.

This should not cost too much money. Then get a good soft toothbrush and brush your teeth properly after every meal fastidiously.

There are some mouthwashes that can be used to treat infections but I personally found that these were not really helping and had some weird reactions with the skin inside my mouth. - I also can't use whitening toothpaste anymore as it seems to react with my gums / inside of the mouth weirdly.
posted by mary8nne at 3:26 AM on August 19, 2012

IANAD Gum infections can spread to become systemic, and can affect your heart.

Soft toothbrush, brush 3 x day. Get the toothpaste with the most flouride; it's on the label.
Floss 3x day.
Mouthwash several times a day.
Get your teeth cleaned.

Bonus: people around you will appreciate your better breath.
posted by theora55 at 6:09 AM on August 19, 2012

In addition to the advice given above, my dentist when I lived in Texas recommended I brush with hydrogen peroxide in addition to the toothpaste I was using. Has the advantage of being very cheap and should kill off any infection. This was mild gingivitis though so YMMV. Echoing other in the use of electric toothbrush, floss and getting it checked out sooner, rather than later.
posted by arcticseal at 7:15 AM on August 19, 2012 [1 favorite]

Yes, get thee to a dentist soonest.
The expense can be a real deterrent but don't let that happen; stalling costs a LOT more.
Many dentists have a credit-card system that lets you spread the cost over maybe 18 months WITHOUT INTEREST. I've done this and it helped a lot. One such card is called Care Credit.
posted by fivesavagepalms at 7:18 AM on August 19, 2012

Don't be like me - insurance fears and too much travel/short term contracts meant that my last remaining molar came out in my luncheon sandwich a couple of months ago in the middle of Africa.
posted by infini at 8:02 AM on August 19, 2012 [2 favorites]

In addition to the suggestions above, get one of these rubber gum massagers and use it twice daily. Once in the morning (say, while you're reading MetaFilter), and once after supper, while watching TV. If you can find one with a little brush on the end, even better (they also make disposable gum brushes, look like little tiny bottle brushes). I am not a dental hygenist, but I have seen many dental hygenists. One thing that was stressed to me was the daily gum massaging would help a lot if I kept up with it.

They also sell tablets that let you see where you're missing when you are brushing/flossing, by adhering to plaque and staining said missed places red. Sometimes a dentist's office will send you home with a free sample.

If nothing else, get to an ER or urgent care clinic and see if you need antibiotics, say, if you can't get an appointment right away at a dental school, as there are often wait lists (ours doesn't start taking patients until late August or early September, when school is in session). A lot of antibiotics are free or low-cost at places like Walmart or large chain grocery stores with pharmacies (pick up their list first and bring it with you to your care provider, whether ER or dental school; ask the doc to choose something off that list).
posted by Marie Mon Dieu at 8:19 AM on August 19, 2012

First off, no shame about no dental insurance. Dental "insurance" sucks. My traditional policy has a cap of $1000 a year and I think I pay $600/yr into it for them to decide how to dole it out to me. It's basically a pretax way to pay for my cleanings. I have an autoimmune disease that makes my body eat my teeth. My dental bills are $10k per year plus. I always have 10 cavities at any given point in time. I have always had to get creative with finding/financing dental treatment. And no shame about having any kind of dental issue -- my diagnosis took so long because dentists weren't treating sudden rapid decay, need for multiple root canals and onset of gum disease because they associated it with meth! Too much damn stigma about teeth in this country. I could have found out about my diagnosis with bloodwork rather than jaw surgery where I couldn't talk for a week if I hadn't been so ashamed and the dentists and everybody else hadn't made me feel that way. Please don't let your financial situation, length of time without cleaning or even the need to *put off* treatment make you feel too ashamed to seek help when you can. Do you have a primary care doctor who can give you antibiotics now if you tell him or her you are in pain? IANAD (I'm just their star patient) but the standards for me have been Clindamyicin (works much better on mouth infections, IME) and amoxicillan. I'm pretty sure this is standard. Every dentist on the planet has given me Clindamyicin. I'm had remarkable reversal of symptoms from antibiotics alone (when I was begging for a root canal or extraction), so that might buy you some time. Also, I see deals for dental exams and x-rays on Groupon all the time for a much lower price. That exam would tell you if you have serious gum disease - they measure the pockets in your teeth (if they're big, ya got it). They'd give you abx is you needed them then and there. Try subscribing to every/checking daily deal site there is in your area: Groupon, Living Social, Bloomspot, Tippr, Google Offers, Yelp Deals, etc for a dental exam. Post on your community Yelp Talk saying you're looking for such a deal -- people in the community might know. I have seen these deals for for $40 or $50 - $70 or $80 with full x-rays and sometimes a cleaning (in Seattle). Of course, they hope you will stick with Dr. So and So, but this could be a good way to know if a) you have periodontal disease and b) how bad it is.

As for finding ongoing dental treatment, the dental school suggestion is good, but here in Seattle at least (and I know in a lot of major cities) the cheap clinics and University Clinics are BOOKED. Sometimes with waiting lists to even make an appointment. If you run into that, finding a dental discount plan or dental HMO might be of use. Both offer predictable costs -- they're being offered by major dental plans now, too. I love my local dental HMO and I can't believe I get such quality care for such a small price, with no benefit maximums. I'm kind of afraid to tell people about it. Do you by any chance live in Washington, Oregon, Idaho or California? Those are the areas my said HMO covers. I'm on my partner's traditional dental plan as well, but I get all my care through my individual HMO policy -- the other day I had a jaw CT, exam, cleaning, bite check and TMJ physical therapy and my bill was my office visit of ... $15.

I am sure other HMOs exist. I know of another more expensive private dental HMO in Washington & California (you choose a private dentist from their list and have to stick with them; definitely more freedom than what I have -- but I prefer to relax and be bossed around at the dentist rather than feel like I'm treatment shopping) -- it was closer to $50 a month and honestly the dentists being further away from my house made the decision. My premium is only $33 a month. My root planing operation (first line of treatment for gum disease) was $75 for each quadrant of my mouth ($300, total -- you want to space it out; gum surgery sucks) plus like $30 to seal in antibiotics. A private dentist quoted me $2000, total. Conservatively; she thought it would probably be more (oh, and that was after insurance).

Dental discount plans have the possibility of making gingivitis treatment university clinic level affordable as well. They're not fly by night any more. Delta has one, Aetna has one, Humana has one, Cigna has one -- when I once considered a discount plan I used Dentalplans.com who seem to have a pretty comprehensive database mapping location/price/availability (and found out quickly that Washington isn't dental plan land). Caveat: I wouldn't buy through dentalplans.com -- I'd buy through the provider (e.g. Cigna) themselves; a friend bought through them and had trouble getting the provider to honor the plan and received no support from dentalplans.com (provider was probably being dim and internet illiterate, but who knows). Gives you time to examine the policy too. The discounts are greater with an HMO if you can find one. If they're not as good as they used to be just google dental discount plans. Possibly an insurance broker could help you -- I have actually found them to be useful (though mine says I run circles around him).

Oh and re: mouthwash. Alcohol in mouthwash is bad, bad, bad. Suspected to cause oral cancer in men and women, particularly in concert with HPV or smoking. It's not proven, but oral cancers are indisputably on the rise. If you're not at the point where you can be inspected and swabbed for oral cancer, please don't swish with Listerine or any alcoholic mouthwash. I use Biotene Plaque Biofilm Dissolving Mouthwash, which is indicated for gum disease and the kind of plaque build up you get around your gums with gum disease. It's pleasant enough to do 3 times a day. nthing Water Piks and powered tooth brushes (I like the Oral B Smartseries 5000, because it keep track of how long I've been brushing and frowns at me if I quit early or brush too hard; totally worth the extra $20 for the frowny thing). With gum disease it's even more important to change the brush head every 3 months than usual -- you don't want to re-infect yourself if you're making progress. I idiot-proof it by signing up for autoship with Amazon prime. DIY/OTC remedies that might help: warm salt water, swished and gargled. Dabbing your gums with diluted (VERY DILUTED; your gums can get chemical burns from this stuff; so can your fingers -- I dilute things that are going to be applied to my mouth and ingested with light cooking oils, cold pressed sesame oil for instance; I don't think it matters very much) essential oils which are antibacterial like oil of oregano and lavender (hippie remedy I tried out of desperation and can't argue with results). Lavender is also numbing. And, I guess, smells good. (I have heard Tea Tree Oil, but never tried it.) Oil of oregano has been particularly potent for me and brought down an abscess when my doctor couldn't come in for an emergency appointment. Looking back, it probably helped me avoid a root canal, because I felt fine by the time she was back in the office. If the pain is too bad, there is always Orajel as a topical numbing option, of course.

Best of luck to you. Sorry for the length -- this is what happens when you ask a sick former reference librarian a question they know a lot about. I'm happy to answer questions via MeMail -- I have had a few Ariadnes in my insurance maze and I'm forever trying to pay my way forward. Hope you find some way to access treatment. The ER will always give you antibiotics if you need 'em. If you need them, get them. Dental infections can absolutely be serious/fatal -- it's a scandal that our society makes people scramble for care like this.
posted by sweltering at 8:33 AM on August 19, 2012 [10 favorites]

Sweltering's comment reminded me that I was told that cold sores can be a component in gingivitis and periodontal disease (scroll down to "Viral Causes."). I never had teeth problems until my ex used my cover make-up stick to hide a cold sore on his lip. I dabbed it onto a pimple on my chin and massive cold sores erupted at the pimple site and spread to my lower lip.

So if you are subject to cold sores, let your care provider know, because you may want to ask them about anti-viral medication as well. I only get them about once or twice a year now, but it's always preceded by painful gums, then the dreaded nerve tingling, and a lump below my jaw (swollen lymph node).
posted by Marie Mon Dieu at 8:53 AM on August 19, 2012

In addition to all the other good advice here, you can prioritize your gums over your teeth, if you have to. Get cleanings only, if that's what you have to do, and put off other any other dental work-- if it is indeed needed-- until you have the money. My gums got really awful in my 20s from a combination of factors and the dentist said it was basically trench mouth or acute inflammation. I felt terrible because who gets trench mouth? But my gums are basically my weakest point and despite my best efforts they are always apt to get icky. However the dentists all say my bone levels are fine and to just stay on top of it with cleanings and hygiene.
posted by BibiRose at 9:41 AM on August 19, 2012 [1 favorite]

Also if you don't have money now, CareCredit is a medical loan that gives 0% interest for some number of months based on purchase price and will allow you to pay off dental work over time. From what I've heard they approve much more loosely than traditional credit cards.
posted by bookdragoness at 9:48 AM on August 19, 2012

Previously.
posted by Wordwoman at 11:16 AM on August 19, 2012

Sweltering offers some really great and thorough advice, but I would caution against going to any old dentist. I have good teeth (thankfully) but have a problem with tartar build-up even when I brush and floss regularly. I went to dentist A and since I'd moved to the area and started grad school, finding a dentist hadn't been the priority that it should have been so I let 1.5 years elapse between cleanings. He was the fastest, most slapdash dentist I'd ever been to. I was a bit suspicious, but was hopeful that maybe my new electric toothbrush had really done the trick. Sadly while the electric toothbrush is great, it was also true that my dentist sucked. He never mentioned that I had gingivitis. By the time I found my new dentist, I was looking at the possibility of periodontitis requiring root scaling (an extremely expensive procedure and from what I hear, uncomfortable, procedure). Thankfully my new dentist also employs the best and most thorough hygienist ever and she did a thorough cleaning, getting rid of as much plaque under the gums as she could. They also sold me a PerioMed, an antimicrobial oral rinse. I was always pretty good at flossing although I might miss a night or two, but they scared me straight. Now I floss every night, even if it's late and I'm tired.

Long story short, when I went to my next appointment, they took root scaling off the table as I was no longer was a candidate. I still have a few deep pockets, but overall things are looking good and my last cleaning was a dawdle and took about 2/3 the time as usual. I also get cleanings every 4 months as opposed to every 6 months. After my experience with Dentist A, I elected to stay with new dentist when I switched jobs and she wasn't covered under my new employers plan. I pay out of pocket and it is approximately $90 per visit. I don't have a ton of extra money, but I consider it a worthwhile investment in my health. I wouldn't put off going to a dentist and at least getting a cleaning and seeing where things stand. One thorough cleaning and more diligent brushing, flossing, and perhaps use of some sort of rinse may be all that you need to get your gums healthy again.
posted by kaybdc at 3:24 PM on August 19, 2012