Dentistry

Janne

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Feb 10, 2016
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Maybe you have a question about anything related between your lips and throat?
I am happy to answer any questions, as far as I am able to without seeing you in person.

I am a general practitioner, post grad qualifications in Implantology, Oral Surgery and Othodontics.
Trained in Sweden, trained first as a MD then went over to DM, and have been practicing for over 30 years in private practice in 3 different countries.
 

Toddy

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Jan 21, 2005
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General queries.

We know of and think well of the book Where there is no Doctor, as a very sound field guide when in need. There is a companion one, Where there is no Dentist? have you read it and if so, how do you rate it ? and what would be practical advice for folks out in the field with no dental care at hand.

I have worked on a dig where one of the mature students had an abcessed tooth flare up. He was 300miles away from his usual NHS dentist, and the local one that was phoned for advice said he'd have to deal with it as a private patient and his receptionist quoted £75 for an initial consultation. This was twenty years ago, and there was no way the student could afford that expense. So he tholed the ache for the fortnight until the dig cleared and we all went home. He took paracetamol and ibuprofen to ease things, but another mature student, who used to be a nurse, ranted at him for taking anything at all since the ibuprofen was from someone else's prescription. He commented that it was the only thing getting him through the work until he could get home to his own dentist.
The rest of us offered to cover the dental bill to get him seen to, but he said no, because then he'd feel he had to pay us back even though it was being freely offered with no expectation of that.
The same thing could easily happen on a wilderness trip though, what would be the best advice where there was no dentist easily available ? Did we do the right thing with the paracetamol and ibuprofen ?

M
 
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Janne

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Self medication is generally not advised, but having worked myself in countries like Haiti and Guatemala, I think it is the correct thing to do.

Pity not one of you other guys had some antibiotics to give him. Of any sirt. They would have helped him

Any painkilker in tabletform is fully ok to give. Imho any antibiotic in tabletform are fine to give.
People in our countries know the basics.
For example, if somebody has a painkilker given for knee ache, and has been told to take maximum of 8 tablets per day, he can give them to somebody else to take maximum 8 tablets in one day, as long as it is not a child or a dwarf, they need to take a smaller maximum ( weight related).

Unfortunately most people do not have an Ethical mind.
Which (sorry Janne, edited this, family forum, etc.,) would tell a person with limited funds to basically go without treatment if in pain?
Yes, business is business, money is goid, it costs to run a clinic, and so on. But to leave a fellow human in pain??
Bad. I am sure Karma was bad for that Scrooge!

I think you posted a link some time ago? If it is the same, it is a book that should be used in schools even in our ‘rich’ countries. Very useful info!
 
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underground

Full Member
May 31, 2005
271
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Janne, are you aware of a link between fillings (lower molar) and sinusitis? I had sinusitis for years, couldn’t shift it. I had a filling replaced and the sinusitis just ‘whooshed’ out of my head during the procedure when the tooth was drilled back to ‘good’ material. I think the resin had shrunk and there was some decay under the filling.

It was clear for 6 weeks or so and came back although far less severely than before. I’m not convinced the tooth is 100% good underneath the resin
 

Paul_B

Bushcrafter through and through
Jul 14, 2008
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My dad had an abscess develop early on a holiday through an area of America and Canada. It was a special trip so they wouldn't cut it short for that. He walked up to a dentist in a small town in America trying to be seen. The dentist wasn't open but there was a number. He called it and spoke directly to the dentist who cut short his weekend and dragged in his dental nurse too, just to see my dad. In fact I think it was the local pharmacist who my dad saw and who called his mate the dentist.

Anyway within a few hours the dental surgery was opened just for my dad and he got seen. It was cleaned out and he got given antibiotics. Asked for the bill the dentist said no charge but he hoped the abscess didn't ruin his holiday. It didn't the abscess died down in a day or so, as did his swollen face. Apparently it was a really bad one. They went on to have a great holiday.

Anyway, I mean no offence to you Janne, but here in the UK I've not met a dentist surgery that wasn't run by a pure money grabbing b'st@rd since I was a kid. I have a very good solution to the lack of good dentistry without going fully private. I don't go to the dentist. Currently about 5 years. Apart from the few years before that when I went every year for the years (when I found a reasonable, south African nhs dentist) it was running at a dentist visit every 7 years since I reached 18. I don't advise it but I look after my teeth and I am to have a good teeth and gums gene thing going on. No filings, issues with gums or anything. So for me a dentist visit consists of an hour sat in the waiting room (IIRC dentists run an hour late even early in the morning round here) followed by 2 minutes in the chair. Then to be told to come back in 6 months for another checkup. If I ever find a good NHS dentist near be I'll consider one visit every 17 months. That's the timescale you can go to without them knocking you off their list. Officially it's 12 months but they never knock you off then but give you another 6 months before your files get buried somewhere the administrator won't go searching for it ime.

My questions to Janne are, have you ever worked in the UK for an NHS practise? And is there anything worse than this private system trying to hang on / claim to be part of our NHS system? Perhaps not the questions for this thread sorry!
 

santaman2000

M.A.B (Mad About Bushcraft)
Jan 15, 2011
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......I have worked on a dig where one of the mature students had an abcessed tooth flare up. He was 300miles away from his usual NHS dentist,.......
.......he tholed the ache for the fortnight until the dig cleared and we all went home. He took paracetamol and ibuprofen to ease things, but another mature student, who used to be a nurse, ranted at him for taking anything at all since the ibuprofen was from someone else's prescription.......
Your post give the impression that Ibuprofen (Motrin) is a prescription drug there? Is that true?
 

Janne

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I have a molar with root canal done and an elmax ceramic cap why dose it feel different when chewing ? its not painful just a bit odd.
Even ‘sucessful’ root filled teeth usually have a tiny bit of irritation around the root tip/tips. This due to the material used inside the root s not 100% biocimpactible.

Very few root fillings are 100% perfectly done anyway, as we can not see exactly what we are doing, and the root anatomy. Usually there is a tiny bit of inflammation around the root tips.

Plus, to get a normal sensation in a tooth, you need the nerve to be there. Temperature indication, pressure.
Missing the nerve = lack of ‘feeling’.

The crown can be a little bit to high, and you can irritate the tooth and bone around it with a little bit to much pressure. Tell your dentist that you are not sure if the bite is correct, that it can be a little bit tender sometimes.
He should check the occlusion with a special Mylar coloured paper.
 
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Janne

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Feb 10, 2016
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Janne, are you aware of a link between fillings (lower molar) and sinusitis? I had sinusitis for years, couldn’t shift it. I had a filling replaced and the sinusitis just ‘whooshed’ out of my head during the procedure when the tooth was drilled back to ‘good’ material. I think the resin had shrunk and there was some decay under the filling.

It was clear for 6 weeks or so and came back although far less severely than before. I’m not convinced the tooth is 100% good underneath the resin

What we know today, no connection between lower teeth and maxillary (upper jaw) sinuses. Also the tooth seemsto be vital from your description. Vital (nerve alive) teeth do not give any inflammations or infections.

The anesthetic does relax muscles and tissues a bit, maybe this is the reason?
 
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Janne

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My dad had an abscess develop early on a holiday through an area of America and Canada. It was a special trip so they wouldn't cut it short for that. He walked up to a dentist in a small town in America trying to be seen. The dentist wasn't open but there was a number. He called it and spoke directly to the dentist who cut short his weekend and dragged in his dental nurse too, just to see my dad. In fact I think it was the local pharmacist who my dad saw and who called his mate the dentist.

Anyway within a few hours the dental surgery was opened just for my dad and he got seen. It was cleaned out and he got given antibiotics. Asked for the bill the dentist said no charge but he hoped the abscess didn't ruin his holiday. It didn't the abscess died down in a day or so, as did his swollen face. Apparently it was a really bad one. They went on to have a great holiday.

Anyway, I mean no offence to you Janne, but here in the UK I've not met a dentist surgery that wasn't run by a pure money grabbing b'st@rd since I was a kid. I have a very good solution to the lack of good dentistry without going fully private. I don't go to the dentist. Currently about 5 years. Apart from the few years before that when I went every year for the years (when I found a reasonable, south African nhs dentist) it was running at a dentist visit every 7 years since I reached 18. I don't advise it but I look after my teeth and I am to have a good teeth and gums gene thing going on. No filings, issues with gums or anything. So for me a dentist visit consists of an hour sat in the waiting room (IIRC dentists run an hour late even early in the morning round here) followed by 2 minutes in the chair. Then to be told to come back in 6 months for another checkup. If I ever find a good NHS dentist near be I'll consider one visit every 17 months. That's the timescale you can go to without them knocking you off their list. Officially it's 12 months but they never knock you off then but give you another 6 months before your files get buried somewhere the administrator won't go searching for it ime.

My questions to Janne are, have you ever worked in the UK for an NHS practise? And is there anything worse than this private system trying to hang on / claim to be part of our NHS system? Perhaps not the questions for this thread sorry!

No offense taken on anything, the spirit of this thread is you can ask or claim anything, even the nastiest stuff about me ( if you are a former patient of mine from East Sussex :) ) and I will try to explain.

With perfectly healthy teeth and adequate oral hygiene there is no need to see a dentist. The vast majority of manking has done since Eve tri ked poor Adam into the ‘9 - 5 plus overtime’ World!

I tell the patient i have with perfect oral health ( no fillings, no gum disease, good oral hygiene) to see me once every 1.5 years. To see them more often is a waste of ny time and their money.

We are supposed to taylor individual recall times. Dirty diseased patients I see once every 3 months ( perio cleanings) and try not to see the perfect mouth patients more than a year and a half or do.
I do still want to see them as it is goid to have your mouth, neck checked for tumors and cancers, plus in the Tropics where I live I also check for skin cancers.

Money. We all need to make money. To cover costs. To live. But there is a line between making money and being greedy.
Greed is todays Mantra everywhere I think.
In Dentistry, patients have not a clue about what we do inside the mouth, and if it is needed. Patients trust us, and unfortunately many dentists abuse this trust.
Happens in many professions of course.
That is sad.

In fact, when I go to Dental Conferences ( try to go once every year) a large % of courses is about making more money. ‘Work smarter not harder’. ‘Use the system to your benefit’. ‘(Treatment) Codes you did not think of using’
I go to US and Canada for these conferences.
But it is the same in Europe.
 
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Janne

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My questions to Janne are, have you ever worked in the UK for an NHS practise? And is there anything worse than this private system trying to hang on / claim to be part of our NHS system? Perhaps not the questions for this thread sorry!

I worked for just over 10 years in UK. The clinic (5 dentists, 3 hygienists) was 100% private when I started, but I argued for it to become mixed. Being from Sweden I am brought up with a sense of duty for the less fortunate.
We saw all children, OAP’s and veterans ( that wanted to be NHS, in fact, weirdly, not many did) on NHS.

I know, we were not alltogether ethical as we refused other needy groups on NHS, but the clinic could not exist without a large Private income. Top of the range German and US equipment, used only the best technicians, high tech equipment .
Weekend call out service without call out fees.
High expense place.

Yes, privately owned and run dentistry and GP clinics system is an unfortunate mix. Working on a maximum points (UDA’s) per year system, with each point having a monetary value.
Many clinics are allocated fewer points (=money) than they request, so when they have worked them off they have three choices. Work for free and pay out of your pocket, close the clinic or work privately.

NHS influences heavily what treatment is done with the point system. Some complex treatments that should be rewarded with more points are not, so of course the dentists either do not perform them, or do them at speed with liw quality as result.

When I looked for work, I approached several clinics around UK. One owner of an NHS clinic told me that I am unable to wotk within NHS having worked and being trained in Sweden. I am not bragging, or dissing British dentists, but the British training is geared to produce dentists that do incredibly fast treatments, of ‘just enough’ quality.
 
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Janne

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Part 2:
I am not saying it is the best system, but in Norway, Sweden there are privately owned clinics ( just like in UK) that accept insurances ( state or private) PLUS state owned and run clinics.
The state owned get grants or support from the state, as they seldom generate enough income to be self sufficient and support its economy.
I worked during my first years in one.
The dentists there were either slow beginners like me, or dentists that could (or would) not work efficently. Some were borderline bad, and needed supervision and help to work ’to minimum acceptable standard’ as set and demanded by the Swedish Dental council.

Everybody has a place somewhere in society. Even a dentist with five thumbs!
My best friend is one. Totally useless clinician, but an excellent researcher and lecturer. Today Professor in Cariology .
 
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Toddy

Mod
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Jan 21, 2005
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Your post give the impression that Ibuprofen (Motrin) is a prescription drug there? Is that true?

The NHS supplies it to those who need it for something like arthritis. They will also supply higher doses than can be bought across the counter. At one point I had a prescription for 800mg tablets.

200mg can be bought in the Chemist's shop.

M
 

Toddy

Mod
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Jan 21, 2005
39,133
4,810
S. Lanarkshire
.........The anesthetic does relax muscles and tissues a bit, maybe this is the reason?

I found the same thing when I had a Dentist's appointment to replace a filling and I had suffered a week of miserable sinus headaches beforehand. I think the anaesthetic just moved stuff enough to let it drain.

New cure ? :D

M
 

Janne

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You know Botox?
Excellent if you sweat too much. Excellent to releave muscle related head aches.
Not so good at making old people looking wrinkle free and young though....
 

Janne

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Feb 10, 2016
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Grand Cayman, Norway, Sweden
Over the counter pain meds are excellent. I do quite a lot of surgical removals of wisdom teeth, and very rarely have to prescribe strong stuff.
You just take the max amount of prescription free tablets.

Media telks you guys about the dangers with Ibuprofen etc. it is not the truth.
To get liver damage you need to eat it daily in huge smounts for years.
 
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Jul 24, 2017
1,163
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somerset
Even ‘sucessful’ root filled teeth usually have a tiny bit of irritation around the root tip/tips. This due to the material used inside the root s not 100% biocimpactible.

Very few root fillings are 100% perfectly done anyway, as we can not see exactly what we are doing, and the root anatomy. Usually there is a tiny bit of inflammation around the root tips.

Plus, to get a normal sensation in a tooth, you need the nerve to be there. Temperature indication, pressure.
Missing the nerve = lack of ‘feeling’.

The crown can be a little bit to high, and you can irritate the tooth and bone around it with a little bit to much pressure. Tell your dentist that you are not sure if the bite is correct, that it can be a little bit tender sometimes.
He should check the occlusion with a special Mylar coloured paper.
Thanks Janne my dentist is first rate, he has one of the best records in my area, this is my first root and cap so I guess I'm just not used to the sensation.
 

Janne

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If it was root treated because it had an abscess ( dead nerve) , the healing can take years. It is a slow process for your bidy to remove an abscess and replace it with healthy bone.

I have a root treated tooth too, was done twice by a specialist. Not 100% sucessfull due to complex root anatomy.
30 years ago. Flares up maybe once every two years. Antibiotics take care of it.
 

santaman2000

M.A.B (Mad About Bushcraft)
Jan 15, 2011
16,909
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Florida
The NHS supplies it to those who need it for something like arthritis. They will also supply higher doses than can be bought across the counter. At one point I had a prescription for 800mg tablets.

200mg can be bought in the Chemist's shop.

M

Thanks Mary. That sounds almost identical to here (just substitute "insurance" for "NHS")

Over the counter pain meds are excellent. I do quite a lot of surgical removals of wisdom teeth, and very rarely have to prescribe strong stuff.
You just take the max amount of prescription free tablets.

Media telks you guys about the dangers with Ibuprofen etc. it is not the truth.
To get liver damage you need to eat it daily in huge smounts for years.

My one wisdom tooth extraction years ago resulted in a Rx for Percodan (or it might have been Percocet----it's been over 33 years now back at RAF Fairford) I needed it but not for nearly so long as they anticipated. I was fine by the day after the extraction.
 

Janne

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Percocet is a hell of a painkiller...... I prescribe it a couple of times a year, but reluctantly.
Have a beer or a drink on top and you can get high as a kite.
Also not good to take a Perc and drive....
 
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