It's time to do this once and for all
June 6, 2014 9:32 PM   Subscribe

So, for a variety of reasons, I was never very good about my dental care regimen. This has come to mean that, at 24, I have one cracked tooth, two chipped ones covered with veneers, two that have been pulled, a mouth full of cavities, gum disease and on-and-off pain in different teeth. I'm so tired of this. I know it's horrible to think this way, but the more time that passes, the less I feel like even brushing my teeth ( I only do it when I have to go out at this point). The guilt and anxiety are wrecking me psychologically as is the constant threat of intractable pain. I've tried to get things done the usual way- one appointment/procedure at a time, when I could afford it and had the emotional fortitude to go through with them. The problem is that my last two or three appointments- for root canals and fillings- have gone terribly. The anaesthetic never, ever worked, even after multiple injections, and even with nitrous. My last visit for a root canal was the first time I ever had the distinct displeasure of knowing what a drill on one's nerve feels like. I now shudder at the mere sound of a drill or anything that sounds like it.

I need to start my life. I need to go out and meet people and be able to smile. The problem is that I can't deal with what's ahead of me with anything but general anaesthesia at this point. I have cerebral palsy and enough of an issue with anxiety as is. Doing anything beyond maybe veneers without GA is too risky and too traumatic a proposition at this point.
Problem is:
- I'm out of work right now and being supported by my parents, who themselves are not in a good financial situation. I have Medicaid ( in NY) as well as Aetna Dental. I know these wouldn't cover anything near what a full mouth restoration under GA costs though.
- I've received various opinions on whether GA is safe for someone who is a) overweight ( by quite a bit) and b) has CP
- I've had so many negative experiences even at the hands of dentists and surgeons who otherwise come highly recommended. I don't know who to trust.

- I need: a) fillings b) more than 2 or 3 root canals c) to pull 3 or four supernumary teeth and d) to replace a pulled tooth and to crown my two chipped front teeth

My question, then: What is the cheapest, most efficient, *safest* and most *painless* way to do all of this in a way that will last and give me a new outlook on life? I need a coherent roadmap, supported by resources- financial, professional ( names of good people) and otherwise.

It's all I can think about, and it's been draining emotionally, physically and mentally. I'm desperate for any advice anyone has. Thanks, everyone.
posted by marsbar77 to Health & Fitness (13 answers total) 2 users marked this as a favorite
Response by poster: I should add that this is in no way a definitive list of what I need done, I'm sure. This is just what I've cobbled together from memory after the many consults I've gone to.
posted by marsbar77 at 9:34 PM on June 6, 2014

I don't have the time right now to do a deep dive into this question, but I am a former dental assistant and I'll try to get back to this. One thing I can tell you (from bitter personal experience) is that if you are a large person (I am enormously tall) you may have to force the dentist to wait much longer than they want to wait, before they start a procedure. It can take a good long while for a shot to kick in, and the dentist will be pacing and fussing, in disbelief that it could possibly take this long for you to feel numb. But if you give it time, eventually the drug will float around enough in your big ol' body for you to go numb. Don't let the dentist give you a shot and then just wait the "normal" time. That won't work.

Also, if you are signed up for Obamacare, you should be able to get dental coverage.
posted by Ursula Hitler at 9:39 PM on June 6, 2014 [1 favorite]

Response by poster: Not to threadsit, but I've pretty much put out of mind that the time between injection and procedure is the issue, just because I've made sure to ask the dentist to wait a good 10 minutes, even after 8 adult doses of lidocaine, and it did nothing. Something else has to be going on....
posted by marsbar77 at 9:43 PM on June 6, 2014

Best answer: A local anesthetic such as lidocaine shouldn't be dependent on your weight/body size to work. It is dependent on anatomy and technique - the anesthetic has to be injected onto or very close to the nerve to work.

General anesthesia is certainly done on people who are very very overweight, IF they need it - the key is weighing the risk versus benefit, which is what anesthesiologists do. If being overweight is your only health problem aside from CP then you're better off than many other people who go under anesthesia (who have heart problems, lung problems, kidney problems, etc). The main problem with GA when you are very overweight is that you might have a more difficult airway (for intubation). So, I'd recommend going to an oral/maxillofacial surgeon who could work with a skilled anesthesiologist at an actual hospital rather than just in an office setting. The anesthesiologist can assess pre-operatively how difficult your airway is likely to be and what your risk level is for the procedure. I'm a physician but I'm not an OMF surgeon or an anesthesiologist so this is just based on my secondary knowledge of situations like yours - ask your OMF surgeon for more details.

It's important to note that your options are (probably) not limited to local anesthetic versus GA. The middle ground is to have a procedural sedation done, which some people call "twilight" sedation. It means that you are still conscious and protecting your airway and do not need to be intubated, but that you are sedated and the goal is that you don't remember the procedure. This is a better and safer option especially if you have extra risks for general anesthesia, but one of the risks of sedation is that you can become overly sedated and might still require intubation if something went wrong - so regardless, it is safest to be in a situation where you'd be in an actual surgical suite with an anesthesiologist (with all the backup/resources that entails) for either of these options.
posted by treehorn+bunny at 9:58 PM on June 6, 2014 [2 favorites]

Response by poster: That's what I've been thinking. There are several good hospital centers that offer dental services in my area ( NYU, LIJ, etc) but I always wondered how much they would be willing to do at once and with what sort of a price tag.
posted by marsbar77 at 10:08 PM on June 6, 2014

I always wondered how much they would be willing to do at once and with what sort of a price tag.

Well, only way to find out is to pick an oral surgeon and give them a call. As to how much at one time? My suspicion would be "as much as humanly possible" - operating room time is expensive, and the procedures I've seen shadowing were all pretty large bundles.
posted by fifthrider at 12:04 AM on June 7, 2014

Best answer: Due to dental phobia my situation was much like yours. I finally realized that it was impacting on many, many areas of my life and made the decision to do something about it. I can't address the financial factor here (for me it was a combination of minimum dental insurance some out of pocket cash and a bit of floating myself a credit card loan to get it done... hopefully you'll be able to pull together the resources)...

The important piece for me was finding the right dentist. I started the search by searching for someone that does "sedation dentistry" , made some calls, explained the situation as best I could and really made clear my fears.. I told them that the only way this was going to happen was if we could get the procedures done in one sitting, because it was unlikely I would be able to force myself to return for multiple appointments.

Perhaps I was lucky, but the dentist I finally found (not an oral surgeon) brought me in for an appointment, did an evaluation (and, consulted with an oral surgeon), and agreed to complete the worst of it in one appointment. This included multiple extractions (we're talking 8 or so, a couple of broken teeth that were difficult to remove), grinding down a sort of abnormal protrusion of bone, doing multiple fillings, sutures to close some of the resulting wounds (gory description to give you an idea of how serious it was...sorry). Prior to the procedure he had taken impressions for an upper denture and a partial plate on the bottom and had them ready to use (with some tweaking on the spot after all the work) at the end of the appointment.

I was in the chair from 8 am until 4 pm.... went home with a healthy supply of pain meds (which, amazingly I hardly had to use). The next day I could remember about 15 minutes of that event... It was pretty much erased from my memory. I wasn't under a general anesthesia, it was a combination of drugs (including a good, pre-procedure dose of Valium the morning of the appointment), that evidently allowed me to stay awake but left me in a state where I just

To be honest, going in I did NOT believe that they could control the pain and fear to the level that they assured me they could (and did)... The only follow up appointments were to deal with sutures and continue to tweak and fit the dentures.

So, yes, you can get it done all at once, and it can be pain free... And it will change your life! I wish you the best....
posted by HuronBob at 3:30 AM on June 7, 2014 [3 favorites]

Some of us just have bad teeth genes. Don't blame yourself. I got outstanding care for my teeth at a dentistry college in Boston. I was a assigned to a fourth-year student and she was wonderful.Someone else also recommended that I take a couple of advils an hour before my appointments, and that helped a lot.
posted by mareli at 3:54 AM on June 7, 2014

Are you a redhead? Lidocaine is less effective on redheads; I don't know if it affects other anesthia. If you are a redhead you might find out.
posted by nat at 4:11 AM on June 7, 2014

Best answer: In my experience, if you've had a lot of work done over a short period of time (1 to 2 years), the 'caine becomes less effective. Your body gets used to it. I had about half a dozen fillings put in one at a time over the course of about 9 months, and by the time we got to the last and smallest one they had to use pressure injected double strength novocaine and it still never numbed completely. That was many years ago and I am now back to normal reaction, but it does happen.
posted by monopas at 12:23 PM on June 7, 2014

10 minutes might not be long enough for me. I would need more drugs than most folks, with a looooong wait for the drugs to kick in.
posted by Ursula Hitler at 1:52 PM on June 7, 2014

Response by poster: Thanks all, but I'm really looking for advice that assumes that all variations on the typical route haven't worked. I'm pretty dead set on doing it under GA- sedation as a last resort (I've done sedation and it helped somewhat but not completely and was expensive for what it did do). I just want to figure out the most optimal way to configure the scheduling/ pricing of the procedures and where to do them in a way that minimizes time and cost involved but maximizes quality and safety.
posted by marsbar77 at 2:42 PM on June 7, 2014

Therapy and pharmacotherapy may help with getting you to the dentist/oral surgeon, once you've found one who is a better fit for you.

Some medical conditions can cause resistance to local anesthesia. It could be a good idea to consult a non-dentist doctor about this - one who understands that CP can occur alongside other conditions and can sometimes make it a bit harder to diagnose those other conditions.

Aetna may have policies in place to cover medications and procedures not normally covered when the covered procedures are ineffective or cannot be done. I know medicaid does even though it can be a pain to get them to do it. Here medicaid overrides almost always require an appeal, and an initial denial is not necessarily an indication that they won't eventually choose to cover something. My insurance company calls these prior authorizations and it's how I get them to pay for the fancy stuff when I need it, including dental procedures with GA. This is worth looking into if you haven't already.
posted by Verba Volant at 9:24 PM on June 7, 2014

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