I know how you feel. When my wife and I moved here we had the same concerns about a lot of the providers of service that we needed. In many cases, you end up going by the recommendation of someone you trust. This is a valid way to initiate the search but I think more needs to be done. In the case of finding a dentist I would suggest the following:
Call the office of the dentist you are considering and speak to the staff. How you are treated on that first phone call can give you an indication of the level of care you can expect.
If things sound good on the phone ask if you can come to the office for a tour. Look for the things that are important to you. Does the office look well kept, clean, modern and like a place you want to go to for your dental care.
You could even ask for a consultation with the dentist. He or she should be willing to meet with you. After all, it is important that the philosophies of care are the same for both of you. I, myself, respect someone who has asked to meet with me before actually making a new patient exam.
Once you decide that you are in the right office go ahead and make an appointment for a new patient exam. This experience should be a good one and let you know that you made the right decision.
If you are certain that there is no decay there are a couple of possible explanations for your sensitivity. They are as follows:
- Some people have thin enamel (the outer layer of the tooth) and a large nerve space - this combination could lead to sensitivity.
- Some people have gum recession and therefore exposed root surface. This root surface is more sensitive than the top or crown of the tooth. The easiest and least costly way to help this is through the use of prescription fluoride rinses and/or toothpastes. The rinse I have in mind is a prescription. You should talk to your dentist about this.
First, let me say congratulations on having all of your own teeth at age 84. It is ironic that I am answering this question tonight. Just this morning I saw a patient about your age with the same set of circumstances. While I was doing some cosmetic work on this patient she brought to my attention a bluish-grey discoloration in her eye tooth. She asked if something could be done about this. I explained that the reason for this discoloration was a silver filling that had been placed in the back of this tooth. While looking at her smile from the front you could see a blue-grey shadow being cast through the translucent enamel. In her case, a simple procedure of removing the old filling and replacing it with a tooth-colored filling was performed. The discoloration was gone and she was very pleased. If your discoloration is in a back tooth the treatment of choice may be a tooth-colored inlay rather than a filling. The reason for this is an inlay has greater strength. This greater strength is needed for the forces that are generated in the back teeth.
In one of my past columns, I reviewed this rather extensively. If you would like to get a copy of that column please give my office a call. I would be happy to send it to you. To follow is a brief summary of what you should expect:
- A thorough review of your medical and dental history
- A review of your expectations as a patient
- An oral cancer screening
- The necessary x-rays - usually a series of small x-rays as well as a panoramic x-ray
- An examination of your teeth for cracks, fractures, and decay
- An examination of your gums for gum disease
- An examination of your facial muscles, bite and tempero-mandibular joint
You should also have scheduled a time for a consultation where your dentist has the time to explain his or her findings and make recommendations for treatment. This should also be an opportunity for you to ask any questions you might have.
First, let me say that it sounds like you are going to a very conscientious dentist. A lot of what you are saying makes a lot of sense. There are a few areas that I would have some questions about. They are as follows:
- Are your teeth so crooked that in preparing your teeth you may expose the nerve and need a root canal? If so you may want to consider orthodontics (braces) first.
- There are many times that when you crown the front six teeth and not any behind them there is a drastic difference from the front to the back. Since you are having your teeth whitened you will probably be okay, but if there is a large filling in the tooth you will end up with a grayish-blue hue coming from within the tooth, even if you whiten. I would urge you to consider crowning at least the first bicuspid (the tooth behind the eye tooth).
- If some of your teeth do not have large fillings in them you may want to consider a porcelain veneer instead of a crown. The benefit of this is that you will have less tooth shaved down with a veneer than with a crown.
- Whenever you engage in work as extensive as this, you want to be sure that your bite is good. By that, I mean that your temporomandibular joint, the muscles, and the teeth need to be working in harmony. If they are not there are some things that can and should be done first - before you have the crowns done.
Congratulations, you have taken the first two steps on your road to a healthy, beautiful smile. The first is realizing that you have a problem that needs to be fixed and the second is writing in this question. Let me put your mind at ease right from the start - most dental procedures performed these days will not cause you undue pain. The anesthetics that we use are very effective and comfortable. The dental office that you choose may have headphones with a variety of music available or offer you to bring in your own music. Perhaps the best form of comfort you can have is simply believing in and having trust in your doctor because he or she spends time with you unrushed. I have found that if a proper diagnosis is made and a plan is established that both the dentist and the patient agree on most procedures should go smoothly. All of the high tech things become secondary to a good doctor/patient relationship.
I will try to answer your question on cosmetics now - depending on your situation there are many things available to attain the cosmetics that the patient is looking for. With all of the new technology in dentistry, esthetics is easy to attain as long as there are a set of goals that the dentist and the patient agree on that are realistic. We have very predictable ways to whiten teeth and many new composite (or plastic) materials that will match your teeth predictably. These can be used to fix some of those black teeth or broken down teeth that you referred to. Crowns can be made to blend in with your own teeth and are thereby unnoticeable. If we need to replace teeth it can be done with either partial dentures, permanent bridges or implants - all of which work beautifully. If it ends up that you need full dentures there are some very beautiful teeth on the market and with custom blending of the tissue area around the teeth they can be made so that they look like your own teeth. In short, please realize that esthetics is rarely a problem - dentistry has a lot to offer.
This is a situation that is relatively common and the only explanation I can offer you is a difference in philosophy of practice. I am going to make a few assumptions in answering your question. If you received an initial examination that included a gum exam you probably heard the dentist or hygienist read off a series of numbers. These numbers indicate the amount of support the teeth get from the surrounding bone and gums much like a foundation helps support the house that is built on it. Depending on these numbers and a number of other factors you will be categorized in one of five categories relating to your gums. They are as follows:
- Early Periodontitis
- Moderate Periodontitis
- Advanced Periodontitis
To briefly explain these terms, gingivitis is a disease that affects the gums, specifically, inflammation of the gums. Periodontitis is a disease of the bone that supports the teeth and gums. Periodontitis is a combination of inflammation of the gums along with a loss of the bone that supports the teeth. There are differing degrees of periodontitis as mentioned above.
Depending on the dentist, you may or may not be examined for the above-mentioned diseases routinely. If you did, in fact, have a gum exam and have been diagnosed with periodontitis, your dentist probably recommended a deep scaling. This, in fact, is the proper recommendation and may actually avoid the need for gum surgery in the future. If in the past you have never been examined for gum disease you were probably never told of the need for a deep scaling.
As you have mentioned, TMJ or tempero-mandibular joint problems are very complex and certainly, I would need to see you to comment for you specifically. Considering that you have stated that you have a severe problem I would probably end up referring you to a specialist in this area. We happen to be very fortunate that an internationally known expert in this field has his office in St. Petersburg. If someone in my family were in the situation that you are in, I would, without a doubt, refer them to this office. If you would like his name and phone number please give my office a call.