Dentistry thoughts

[alexxkay]

So yesterday, kestrell and I went to the dentist. It was the first time either of us had been in literally decades. We each have some cavities and wisdom teeth that 'need' dealing with, so we'll going back for a consult on Friday, and for the actual work at the end of the month. Bleagh.

I gotta say, dentistry as a basic concept is a hard sell for me. In order to prevent some unknown amount of future mouth pain, I voluntarily sign up for a system where, every six months they (at minimum) torture my entire mouth so that it hurts for the next 24 hours. Plus maybe more advanced torture to put in fillings and such. I'm pretty sure that I don't generally have that much mouth pain in a year *without* dentistry. Kes points out, correctly, that there is a marginal benefit in being able to *schedule* trauma, as opposed to having it be on an emergency basis. But it's pretty darn marginal. I doubt I'd do it if I was paying for it directly, rather than through insurance.

Comments

[metahacker.livejournal.com]

I'm mostly with you. But there is also the 'minor cost repeatedly' vs. 'major cost every so often' argument. And major costs in dentistry are pretty high; if that tooth is too badly infected and they need to remove it, a replacement could cost you $10k, far more than the cost of 10 years of visits -- and you'll have an artificial tooth implanted for the rest of your life, always not quite as good as a real one. (Ask me how I know!) And that's assuming your jaw is healthy enough for an implant; bridges and caps and whatnot just plain old suck.

[gyzki.livejournal.com]

there is also the 'minor cost repeatedly' vs. 'major cost every so often' argument

And similarly the 'minor pain repeatedly' vs. 'major pain if/when' balance - major dental problems can bring a level of pain that eclipses gout. Ask me how I know.

[damascene.livejournal.com]

What He Said. I didn't go for a decade and a half, which was great while it lasted, but the reckoning has finally come and it's been That Bad and still going on.

[pale-chartreuse.livejournal.com]

There are also the peripheral health benefits. Dental bacteria is a known cause of heart disease and miscarriages. These benefits where only found within the past five years or so. So it is probable that there are other health benefits which have not been uncovered as yet.

[alexx-kay.livejournal.com]

So it is probable that there are other health benefits which have not been uncovered as yet.

That part doesn't follow. It could just as easily turn out that their are unknown health *detriments* to regular dentistry. Assigning value, positive or negative, to unknowns is a perilous business.

[calygrey.livejournal.com]

It could just as easily turn out that their are unknown health *detriments* to regular dentistry

Oh yes. I got two crowns on "vital" teeth. It meant that the metal crowns caused immense pain every time I ate anything hot, cold, or, well, ate. I couldn't brush for two weeks - and acquired a wonderful infection that went on to become a major sinus infection. The teeth hurt for a YEAR. I will NEVER do that again. Root canals suck. Not root canals suck waaaay more.

I pay directly. I use students at the dental school. They really cause pain. For a long time. I sometimes do wonder if this is such a good idea.

[mickeymao.livejournal.com]

As metahacker suggests, the basic purpose is to try to avoid losing teeth and having them replaced by sucky imitations (bridges, dentures) or incredibly expensive imitations (implants). Minimizing pain is not the purpose.

Keep in mind that as you age, bad habits of your youth will more likely catch up to you. I've had all my lower teeth replaced due to a condition which is extremely rare in someone my age, but not rare at all in the 60+ demographic. The cost was about $80k before insurance, $40k after (and the insurance situation could've been a lot worse). If you can manage to avoid that with 2 cleanings a year and a bit of flossing, that would be a win.

Having said that, I agree with you that the current state of dentistry is rather appalling. The fact that it's still such a mechanical approach, with all kinds of stabbing and scraping involved, is total crap. I hope they perfect that anti-cavity bacteria (http://www.oragenics.com/product_replacement.php) soon.

[mickeymao.livejournal.com]

PS - you cannot possibly imagine how much dentures suck.

[alexx-kay.livejournal.com]

I hope they perfect that anti-cavity bacteria soon.

Cool! I wasn't aware that they were even working on that.

[londo.livejournal.com]

Yeah, I've got a dentist trip and probable root canal in my future.

[lauradi7.livejournal.com]

If you do the regular thing regularly (without skipping years and years) it only hurts while they're doing the scraping and poking, plus a couple of hours after that. Flossing at home helps a lot.
Due to toughness training as a child (in my extended family, only my father ever had pain-killers while having his teeth drilled), I can cope OK with dental pain. Drilling without anesthetic is painful, but the feel of vibrations and the sound are worse to me anyway. I have no idea whether gas would make those areas of unpleasantness go away.
On the other hand, careful upkeep does not necessarily prevent something like an abcess. If you ever suspect an infection, get the antibiotics
IMMEDIATELY. Don't let the dentist blow you off in a "wait and see" kind of way. The resultant root canal
causes no pain, because the nerve is dead. I have two crowns but haven't had the problems that calygrey has had.

Much of preventative dental care is for the benefit of your gums as much as your teeth, because susceptibility to cavities is partly in your DNA - the hardness of the enamel, the angles in which your teeth grew in (and therefore impactedness), all of that stuff comes from your parents, although flouride in early youth can
add to tooth strength.

[alexx-kay.livejournal.com]

it only hurts while they're doing the scraping and poking, plus a couple of hours after that.

Obviously, your family has higher pain tolerance than mine. When I *did* go regularly, I still experienced pain for ~24 hours after a cleaning; that hasn't changed.

Much of preventative dental care is for the benefit of your gums

Makes sense in principle. But given how much abuse my gums take during a "cleaning", I am skeptical about their methodology.

[russkay.livejournal.com]

At least be grateful you grew up in the fluoridation generation. When I was a kid, I remember going to the dentist every year for about a dozen new fillings. Then, later on in life, those fillings eventually need to be replaced, except they no longer cost $5.

About root canals, I just don't understand all the bad press. I've had a lot of root canals, and not one of them was painful or traumatic. In fact, in almost every case the root canal eliminated serious pain beginning with the first novocaine injection. I don't do pain well, and anaesthesia is my friend!

I've also got a couple of bridges, and honestly I'm not even aware of them from month to month. One has been in nearly 20 years.

[alexx-kay.livejournal.com]

At least be grateful you grew up in the fluoridation generation.

Ho yeah!

[freerange-snark.livejournal.com]

Apparently untreated tooth infections can lead to brain infections and death. It's not a terribly likely result, but it is a good argument for regular dental care.

[alexx-kay.livejournal.com]

It's not a terribly likely result

Got any more specific numbers? Given that I sometimes drive a car, and that I live in a (relatively) high crime neighborhood, there's a level of risk I'm clearly willing to accept. If, for example, the odds of this happening are less than the odds of being hit by a meteorite, then I don't think it's a very compelling issue.

[freerange-snark.livejournal.com]

Can't be bothered to look up numbers, and they'd be easily dismissed anyway, since you'd (rightly) say, "Well, I'd go to the dentist before it got that bad!"

Even if death by abscess-related brain infection is rarer than being struck by a meteorite, it's still easier to prevent than death by car accident, stray bullet, or extraterrestrial projectile. Low cost, high reward—makes sense to do it.

Of course, knowing these things to be true hasn't kept me from skipping a few cleanings. Especially because, thanks to my TMJ, I really do feel your post-appointment pain.

[jducoeur]

Being able to directly compare the non-trivial but bearable pain of the dentist against the *excruciating* pain when something goes wrong -- I'll take the preventative work. The 12 hours I had to wait when my wisdom tooth went bad were probably the most unpleasant of my life...