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Medical Forum / General / Dentistry / February 2006Okay, I went to the endodontist
Opinion please: I went to the endodontist, finally, after I got my permanenet crown installed (with temp. cement) and it still is sensitive to hot and cold and pressure, the day after having the perm crown installed. The endo took an xray, quickly touched something very cold on it and said, "Let's see if this hurts or how long it hurts". It hurt for about 4 minutes with a pulsating throbbing pain, not too strong but strong enough that if it kept it up I'd have to take an ibuprofen or two to calm it down. After the 4 min. it subsided. Now I came home, drank some hot tea with sugar, and it hardly hurts at all after the tea, but there IS some little twinge of pain there, very slight, almost imperceptible. He had me make an appointment for RCT next Thur. and said that if it calms down completely, then it might be okay forever or for a long time. But if it hurts at all during the next week I should have the RCT. He said his guess was we may as well RCT it, but it was not 100% clear and so we should wait and see. (Boy! This rct stuff sure can be tricky, can't it? or so it seems to me, based on 3 opinions of people who've looked at it (only 1 endo) and their inability to say for sure...) Any comments/opinions based on what I"ve said here... Painful with heat and lingering pain to cold are very bad signs. I'll bet 2ยข you end up with a root canal. JMO, Dartos > I went to the endodontist, finally, after I got my permanenet crown > installed (with temp. cement) and it still is sensitive to hot and > cold and pressure, the day after having the perm crown installed. > > The endo took an xray, quickly touched something very cold on it and > said, "Let's see if this hurts or how long it hurts". > After the 4 min. it subsided. > Any comments/opinions based on what I"ve said here... My Crystal Ball had not trouble with it.  Signature/ Amatus / > Opinion please: > [quoted text clipped - 26 lines] > > Any comments/opinions based on what I"ve said here... > Opinion please: > [quoted text clipped - 26 lines] > > Any comments/opinions based on what I"ve said here... If the endodontist who's seen you isn't sure, who am I to argue? Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > If the endodontist who's seen you isn't sure, who am I to argue? Exactly... Seems no one can call this one... > > If the endodontist who's seen you isn't sure, who am I to argue? > > > Exactly... Seems no one can call this one... Based on personal experience here, I have to disagree. This is what I think, and I'll state it clearly in point form with no flowery statements and poetic licence like I often do. In other words: No bullshit. Why is this tooth hard to read? Because it is multi-rooted and so the nerve is not the same everywhere in it. I've opened teeth like this before: one root: fine... nerve OK; one root; problematic... needs more anesthesia to quiet it down and work on it; one root: necrotic... dead, stinks when we pull the sh.t out. This is what I believe you have here, and it will not be easy to treat. The tooth will not be easy to treat because it has a crown on it, and because it will have calcified nerve spaces in the pulp chamber. If I'd seen you first, I'd have taken two photos (P/A and B/W), put a stainless steel band on the tooth, put you on an NTI and shipped you to the Endodontist. Why? Because calcified teeth with crowns on them are hard to treat, and so I can't treat them without losing money. Dartos told you straight: Symotoms like you have (lingering cold, hot) are BAD SIGNS. Get the tooth done NOW. Instead: There's a good chance y ou will wait till the tooth is quiet, and smile smugly to yourself in the mirror, thinking you got 'er beat, man.... Meanwhile, I would phone you to ask how things are going... I would then have you sign the informed consent form that you are delaying vital treatment against advice, and when the tooth starts to give you problems later, you will not come to me but go STRAIGHT to the Endodontist. The Endodontist would swear and say 'hmmmm....' alot, but s/he'd eventually get the job done, and it would cost you $$$$$$$$$$$$$$, because s/he doesn't work for a set fee, as I do as a generalist, but by the hour, or at least according to the difficulty of the case. In light of this, I really don't know why your Endo wouldn't open the tooth NOW, while the RCT is easier to do. I don't get why s/he is waiting till it is calcified inside there and hard to do. The 'wait and see' attitude is OK for Medicine, I guess, where if things don't work themselves out we have to invade the body, but for teeth it's different: they have very limited capacities to repair themselves, they aren't easy to work on, but they're relatively easy to access, and we don't usually have to cut into your body. Maybe if you get other teeth showing the same kinds of symptoms, you can think along those lines a bit more. In the meantime, get yourself an NTI. It will give you the maximum of protection possible against clenching/bruxing types of tooth injuries. And over the Holidays, try to protect the tooth against extremes of temperature (not too hot, not too cold). As far as $$$$ goes, if that is an issue, ask the Endo to make you an estimate that you can take to your bank manager and ask for a medical low interest loan. I was debating whether to hold off till after Xmas to say this, but I think it is better you use that time to reflect on which way to go with this tooth. Cheers, and greetings of the season ;-) SP SignatureTake out the TRAASH to reply >>> If the endodontist who's seen you isn't sure, who am I to argue? >> [quoted text clipped - 71 lines] > > SP You may well be right. I'd still defer to the judgement of the endodontist who has seen the patient and the radiograph. I agree that the symptoms are suggestive. I still don't consider myself qualified to give an expert opinion here. I assume the endodontist's level of training is superior to mine; therefore, if I were in doubt I would refer to the endodontist, and defer to his/her presumably superior judgement. Merry Christmas! Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > You may well be right. I'd still defer to the judgement of the > endodontist who has seen the patient and the radiograph. [quoted text clipped - 6 lines] > Merry Christmas! > Steve Point taken. Happy Holidays to youse as well! SP SignatureTake out the TRAASH to reply Always the gentleman, eh SB ? Ever looked into becoming a diplomat ? It is quite possible that dr. endo is just waiting for a full fee. But then again.... >>>> If the endodontist who's seen you isn't sure, who am I to argue? >>> [quoted text clipped - 82 lines] >Merry Christmas! >Steve -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > In light of this, I really don't know why your Endo wouldn't open the > tooth NOW, while the RCT is easier to do. I don't get why s/he is > waiting till it is calcified inside there and hard to do. Because, if the endodontist does it now, he will only get paid at HMO/PPO rates. If he stalls for two more weeks, he can bill over a thousand dollars for it. AC >> > If the endodontist who's seen you isn't sure, who am I to argue? >> > [quoted text clipped - 71 lines] > > SP >> In light of this, I really don't know why your Endo wouldn't open the >> tooth NOW, while the RCT is easier to do. I don't get why s/he is [quoted text clipped - 5 lines] > >AC While he may THINK he can make more money if doing it later after my insurance expires, I don't think that is his motivation. First, he ENCOURAGED me to go ahead and make an appointment and do it UNLESS It stops hurting COMPLETELY. Second, though he may not realize it, it is doubtful I would go to HIM to get the endo later, I would do it via USC where I am getting my implants and crowns. >>> In light of this, I really don't know why your Endo wouldn't open the >>> tooth NOW, while the RCT is easier to do. I don't get why s/he is [quoted text clipped - 13 lines] > it, it is doubtful I would go to HIM to get the endo later, I would do > it via USC where I am getting my implants and crowns. Well then what was all this about? Just go to USC and move on with your life. >>> In light of this, I really don't know why your Endo wouldn't open the >>> tooth NOW, while the RCT is easier to do. I don't get why s/he is [quoted text clipped - 12 lines] >it, it is doubtful I would go to HIM to get the endo later, I would do >it via USC where I am getting my implants and crowns. Mebbe he spotted you as a kook and didn't want to waste his time. -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com If I was that Endo, I'm already IN that tooth Gabriel Don't lose time SignaturePlease if you resend this message (1) Erase the e-mail address from the person that sent it to you and anyone else that appears (2) Protect the addresses of destination by placing them on the BBC (Blind Copy). Thank You > >>>> In light of this, I really don't know why your Endo wouldn't open the [quoted text clipped - 21 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com > > In light of this, I really don't know why your Endo wouldn't open the > > tooth NOW, while the RCT is easier to do. I don't get why s/he is [quoted text clipped - 5 lines] > > AC Why? Is there something to do with time limits that I missed? Thanks SP SignatureTake out the TRAASH to reply Because Jim plans to drop the managed care Jan. 1. After that, he is fee for service. Unless he signs up for some other worthless plan. AC >> > In light of this, I really don't know why your Endo wouldn't open the >> > tooth NOW, while the RCT is easier to do. I don't get why s/he is [quoted text clipped - 10 lines] > Thanks > SP > Because Jim plans to drop the managed care Jan. 1. After that, he is fee > for service. Unless he signs up for some other worthless plan. > > AC ok, missed that, thanks sp SignatureTake out the TRAASH to reply Am still wondering: cold beer or a warm one ? BTW your dx is dead on. The Endo doc is on the plan, knows it's a matter of time, "insurance" runs out on Jan 1, why not wait and get the full fee ? JimSonWeed is postponing the inevitable. Delaying treament not only complicates treatment, it sacrifices his precious dollar$. >> > If the endodontist who's seen you isn't sure, who am I to argue? >> > [quoted text clipped - 71 lines] > >SP -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Opinion please: > [quoted text clipped - 26 lines] > > Any comments/opinions based on what I"ve said here... It sounds to me like you have an endodontist looking out for your best interests. Rather than recommending RCT right away, s/he is giving it every chance to settle down. As a patient, I would feel comfortable with this doctor's recommendations. -Sue "Sue" <chrlie699@yahoo.com> wrote in message news:1135289938.6d82740.68640@f14g2000cwb.googlegroups.com... > It sounds to me like you have an endodontist looking out for your best > interests. Rather than recommending RCT right away, s/he is giving it > every chance to settle down. As a patient, I would feel comfortable > with this doctor's recommendations. Who cares what you think? > "Sue" <chrlie699@yahoo.com> wrote in message > news:1135289938.6d82740.68640@f14g2000cwb.googlegroups.com... [quoted text clipped - 5 lines] > > Who cares what you think? Why are you such a dick? Because he's onto someone acting in an unusual manner? Three practicing dentists (who have followed this case for quite some time) give thoughtful advice and this gal comes in with some gratuitous comments? Give me a break. Dartos >Why are you such a dick? Because you're such a pussy. ############################ >Path: news.easynews.com!en206!core-easynews!newsfeed2.easynews.com!easynews.com!easynews!indigo.octanews.net!news-out.octanews.net!canary.octanews.net!news-out1.kabelfoon.nl!newsfeed.kabelfoon.nl!xindi.nntp.kabelfoon.nl!chloor.box.nl!130.133.1.3.MISMATCH!fu-berlin.de!uni-berlin.de!individual.net!not-for-mail >From: Tom Doxin <yeah@yeahyeah.net> [quoted text clipped - 23 lines] > >Why are you such a dick? -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com I agree with Tim Signature/ Amatus / > > "Sue" <chrlie699@yahoo.com> wrote in message [quoted text clipped - 6 lines] > > Who cares what you think? >It sounds to me like you have an endodontist looking out for your best >interests. Rather than recommending RCT right away, s/he is giving it >every chance to settle down. As a patient, I would feel comfortable >with this doctor's recommendations. > >-Sue Good point. I also felt that the endodontist was being very careful not to just say "Yes, you need RCT"; rather, he was being cautious in hoping maybe I don't need one, although leaning towards thinking I do. I wish the signs had been more conclusive, but since they apparently are not, I guess it's best to err on the cautious side. Jim, is the Endodontist on the managed care plan as well ? IF so, he is going to try to post-pone therapy until the you are off the plan and can pay full price. H E L L O ! Signature/ Amatus / > >>It sounds to me like you have an endodontist looking out for your best [quoted text clipped - 8 lines] > I wish the signs had been more conclusive, but since they apparently > are not, I guess it's best to err on the cautious side. >Jim, is the Endodontist on the managed care plan as well ? IF so, he is >going to try to post-pone therapy until the you are off the plan and can pay >full price. H E L L O ! Yes he is part of the plan, but I explained that my insurance expires on Jan. 1 and he said, "Okay, why don't you make an appointment for Jan 29th, and then if you decide you don't need it, you can cancel it." >>Jim, is the Endodontist on the managed care plan as well ? IF so, he is >>going to try to post-pone therapy until the you are off the plan and can pay >>full price. H E L L O ! >Yes he is part of the plan, but I explained that my insurance expires >on Jan. 1 and he said, "Okay, why don't you make an appointment for >Jan 29th, and then if you decide you don't need it, you can cancel >it." Did you mean Dec 29th ? -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >Jim, is the Endodontist on the managed care plan as well ? IF so, he is >going to try to post-pone therapy until the you are off the plan and can pay >full price. H E L L O ! Good point. -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > >It sounds to me like you have an endodontist looking out for your best > >interests. Rather than recommending RCT right away, s/he is giving it [quoted text clipped - 7 lines] > I wish the signs had been more conclusive, but since they apparently > are not, I guess it's best to err on the cautious side. Jim, >From your earlier posts, you seemed very hesitant to consider RCT. Maybe this endo sensed your hesitation and offerred more time than usual to see if the nerves would settle down. (I may be way off; just a wild guess). You had mentioned that you thought the diagnosis process seems "tricky." I had this same thought when I was going through this diagnosis. I kept complaining of pain (for several weeks) following crown procedure. My dentist kept telling me to give it time. Finally I was in unbearable pain and my dentist was on vacation, so I was referred to a well-known, reputable endo clinic, as well as another endo clinic. I was also prescribed Vicodin (very strong pain-killer). I went to the large clinic and also made an appt for the 2nd clinic (for consult). At the large clinic I was diagnosed with needing 1 root canal and they could do it that day. Yet they also told me that they could break the crown (50/50 chance). This was on my front tooth. I had a large, formal function to attend that evening and I balked. I was afraid I might have a missing front tooth. Two days later I went to the other clinic for consult. There I was told I needed 2 root canals. Yet I wanted to consult with my dentist. I waited for my dentist to return from vacation. My dentsist said I needed 2 done as well; he could see pustules (infection) on Xray. My point is: I do believe that the need for RCT is not always easily diagnosed until infection is present (as per my experience). I think I went too long before having it done. Jim, I hope the nerves settle down. If they do not, the RCT procedure is a breeze. You will feel so much better (no more PAIN). Good luck and happy holidays, Sue >> >It sounds to me like you have an endodontist looking out for your best >> >interests. Rather than recommending RCT right away, s/he is giving it [quoted text clipped - 14 lines] >usual to see if the nerves would settle down. (I may be way off; just a >wild guess). I have had RCT's before and while not pleasant, most aren't as bad as some say they are. I think it may depend on the tooth, and on the doctor doing it. The thing was, the dentist was telling me that it was kind of a "preventative" RCT, that it wasn't technically needed yet but "probably" would be. So I was hesitant about not getting it until it was clearly needed. Then a couple other dentists also looked at it and said they weren't sure, either. Now even the endo says he isn't sure. Actually I would just as soon get it and stop thinking about it! It's just that no one seems to be sure if I NEED it or not, and I don't think it's a good idea to get one if one isn't needed... The one incentive for doing it now is that I have insurance until Jan 1, then I would have to pay full price for it... and the one thing that ins. does seem to be good for, is getting root canals... (Opinions?) So I am waiting; and actually the endo is right. While it hurt the day after the dentist put the crown on, now, 2 days later, it seems to be hardly hurting at all. So maybe I don't need one after all. I will continue to monitor it for right now. > My point is: I do believe that the need for RCT is not always easily > diagnosed until infection is present (as per my experience). AGAIN, godammit, this is WRONG!!!! Sue, shut UP! SP SignatureTake out the TRAASH to reply > > My point is: I do believe that the need for RCT is not always easily > > diagnosed until infection is present (as per my experience). [quoted text clipped - 3 lines] > -- > Take out the TRAASH to reply SP, Freedom of speech. As a patient (and in my experince), this is my current opinion. I do not think that all dentists are very good at diagnosing the need for RCT. When infection is present, it seems to be a very easy diagnosis. A dentist can see this on x-ray (at least in my case he could). Again, this is my opinion AS A PATIENT. I am not a doctor or a dentist. I am only one person. I am free to state my opinion. This is a public usenet, not private property. My dentist was not able to diagnose the need when I kept telling him I was in pain. I even asked if he could do x-ray to determine if something was wrong. Jim's endodontist is in question as well. The endodontist is waiting to see what happens. Seems a little tricky to diagnose IMO (as a patient). -Sue >> > My point is: I do believe that the need for RCT is not always easily >> > diagnosed until infection is present (as per my experience). [quoted text clipped - 7 lines] > > Freedom of speech. Yeah you can say whatever you want, but it doesn't mean anyone values it. Maybe you and Jim ought to get together in e-mail and share your opinions there. > SP, > [quoted text clipped - 3 lines] > not think that all dentists are very good at diagnosing the need for > RCT. When infection is present, it seems to be a very easy diagnosis. Sometimes. It takes a significant amount of time for an endodontic infection to become apparent on x-ray. Sometimes it never does. You cannot see an infection within the tooth. What a dentist sees on an x-ray with a well-established infection is bony destruction at the tip of the root. Pulpal inflammation and even necrosis are not visible on x-ray. Even in the bone, it sometimes is necessary for the bony cortex to be perforated by the infection in order to visualize the destruction on x-ray. I've seen experimental lesions where significant amounts of the alveolar medullary bone is removed, and there is no evidence of this on x-ray. This is one of my pet peeves about the inferences insurance companies make--and also the inferences made by radiographs alone with internet diagnosis. There is no substitute for seeing the patient. Steve > A dentist can see this on x-ray (at least in my case he could). > [quoted text clipped - 12 lines] > > -Sue > > SP, > > [quoted text clipped - 36 lines] > > > > -Sue Dr. Bornfeld, Thank you for the information. My dentist pointed out what he called " a pustule" on x-ray. He told me that indicated infection. So in your opinion was this "pustule" that he pointed out, bony destruction of the root tip? Also, in your opinion are there any other reasons (other than cost) for not doing a preventive RCT in Jim's case? For ex., are there any long-term complications that can occur as a result of RCT? For example, my dentist placed a post after the RCT. He told me this was necessary for increased strength... that the tooth was dead and will become brittle and weak. So if unecessary RCT is done, could this result in a weakened tooth.. and possibly further complications? ... potential fracture and so forth? Please excuse my uneducated interpetation and/or naive questions. Thank you, Sue .... "This is one of my pet peeves about the inferences insurance companies make--and also the inferences made by radiographs alone with internet diagnosis. There is no substitute for seeing the patient." Comment. I agree. As a pt, I would never be comfortable accepting a diagnosis over the internet. However I do think there is value in evaluating the opinions here when seeking treatment from a porofessional. As far as the ins cos go, that is a catch 22 IMHO from the patient's perspective (at least mine). I have come to realize that ins cos are a huge headache for dentists. They often hinder dentists' ability to get a patient to accept the proper treatment. In the saem token, I have great coverage via my employer at evyr low cost to me. I would not want to give these benefits up, as my salary would not be increased in doing so. (It only costs me about $100/year). Unless my employer drops this benefit, I intend to keep it. I also will not allow the ins co to dictate what my dentist prescribes. I am more concerned about my helaht than out of pocket expense. Who knows....maybe someday, dental insurance will be eliminated from the equation. Typo. I meant to say, I no longer let the ins co dictate what treatments I accept, not: "I will not allow the ins co dictate what my dentist prescribes." I have no control over what the dentist prescribes. -Sue > Dr. Bornfeld, > [quoted text clipped - 3 lines] > So in your opinion was this "pustule" that he pointed out, bony > destruction of the root tip? Doubtless. Of course, one cannot "see" a pustule on x-ray--one can only infer the presence of an abscess from the bony destruction it causes. > Also, in your opinion are there any other reasons (other than cost) for > not doing a preventive RCT in Jim's case? Yes--there is a chance (although in my mind a small one) that it is not necessary. Any procedure carries a certain amount of risk. > For ex., are there any long-term complications that can occur as a > result of RCT? Yes--root canals sometimes fail. > For example, my dentist placed a post after the RCT. He told me this > was necessary for increased strength... that the tooth was dead and > will become brittle and weak. So if unecessary RCT is done, could this > result in a weakened tooth.. and possibly further complications? ... > potential fracture and so forth? Yes. Incidentally, it is no longer believed that posts strengthen root canal treated teeth. Some dentists doubt that they are of any real use. I believe they can decrease the chance of the crown falling off where much of the tooth structure has been destroyed by the decay and/or the root canal. Steve > Please excuse my uneducated interpetation and/or naive questions. > [quoted text clipped - 25 lines] > Who knows....maybe someday, dental insurance will be eliminated from > the equation. > Yes--there is a chance (although in my mind a small one) that it is not >necessary. Any procedure carries a certain amount of risk. Still hurting SOME after several days, when I drink hot or cold liquid, so I am almost certainly going to get the RCT, now. >> For ex., are there any long-term complications that can occur as a >> result of RCT? > > Yes--root canals sometimes fail. Yes, I lost #18 because of what I was told by 2 dentists, was a root canal that was done poorly. This endo I am seeing now also confirmed that one CAN lose a tooth due to a "bad root canal". I assume they can also fail due to extinuating circumstances beyond the endo's control. This is exactly why I have been trying so hard to determine whether or not to get this root canal on #30! I have so few teeth left, and do not want to risk losing another one due to either a root canal that goes bad or just the tooth becoming weak (? or whatever it is that can happen) after the root canal. The reluctance of ANY dentist or endodontist so far to tell me "Yes! This tooth DEFINITELY needs RCT!" had made me very confused as to what to do, thus I came here for opinions and information. I do appreciate all the sincere opinions and information, by the way, and I hope I am making the right decision by going ahead with the RCT without any 100% certainty that I need it. (only about 90% as my endo told me) > This is exactly why I have been trying so hard to determine whether or > not to get this root canal on #30! I have so few teeth left, and do > not want to risk losing another one due to either a root canal that > goes bad or just the tooth becoming weak (? or whatever it is that can > happen) after the root canal. Your best bet is to get it done NOW, while the tooth is not as sick as your #18 surely was when it was done. SP SignatureTake out the TRAASH to reply > > Dr. Bornfeld, > > [quoted text clipped - 61 lines] > > Who knows....maybe someday, dental insurance will be eliminated from > > the equation. Dr. Steve, Thanks for the additional information. It seems that treatment decisions are continually evolving. Although there is nothing I can do now since the post has been placed, I will keep this information in mind should I require RCT in the future (on my other front tooth that was also crowned). I will certainly inquire further, should my dentist suggest placing a post! Also I guess that in the future I will know better than to infer that infection itself can be seen on xray...only the result of abscess can be seen (if I understand you correctly). Also I agree that any invasive procedure is not without risk. IHMO that may be one of the main reasons why the endodontist may be waiting to give more credence that this therapy is necessary. But this is just a guess coming from a patient. As always, thank you for your willingness to share your knowledge and expertise. Sincerely, Sue > Dr. Steve, > [quoted text clipped - 4 lines] > was also crowned). I will certainly inquire further, should my dentist > suggest placing a post! This is a clinical judgement, and honest dentists will differ on their opinions. But your dentist should be able to explain the reasons for the clinical decisions made. It may not be so easy to explain to patients in comprehensible language without a lot of background. Any hesitation in getting into details about this should be viewed in that context. Steve > Also I guess that in the future I will know better than to infer that > infection itself can be seen on xray...only the result of abscess can > be seen (if I understand you correctly). That's about right. > Also I agree that any invasive procedure is not without risk. IHMO > that may be one of the main reasons why the endodontist may be waiting [quoted text clipped - 7 lines] > Sincerely, > Sue > > Dr. Steve, > > [quoted text clipped - 31 lines] > > Sincerely, > > Sue Thanks again Dr. Bornfeld, I believe my dentist is honest. I think he thought he was steering me right when he told me to wait to see if the nerves would calm down (rather than seek endo right away). His staff all look up to him. They have nothing but good things to say; how he supports and advocates further education and training for them. Whenever I talk to him, he comes accross as honest and caring. He is non-pushy. When I was complaining of pain, he never hesitated to see me. He kept adjusting my bite, assuming that was the problem. We both hoped that would take care of the pain. I do not think I was relaying exactly how bad the pain was. I will know better in the future! (especially since I now understand the dangers in waiting too long to have the root canaled) I was always taught to "tough it out" and not complain. For ex., my mom was one who never would allow novacaine or allow the dentist (or doctor) do any procedure that was not absolutely necessary. It was a very difficult decision for me to have the bonding (that my college friend placed many years ago) with porcelain. She suggested having this done (veneers to replace the bonding). My dentist preferred crowns. I consulted with a "cosmetic" dentist as well. The "cosmetic dentist" told me that both procedures removed tooth structure and that crowns just removed a bit more. Then my dentist told me that he had just done the lower and uppers on his wife (all porcelain crowns). That put me more at ease. So I went ahead. In retrospect, I wish I had demanded veneers or rebonding (if that is possible)... but I cannot change my decision now. I think my dentist has learned some things too. His wife has had complications too. Ex., she broke her front tooth off while biting into a Power Bar while they were on a ski vacation. And guess what? Now he has added a "cosmetic specialist" to his staff. I think he is leaving this sort of work to someone that has more experience! So all in all, we have all learned. That is the way I prefer to look at the situation. Dr. Bornfeld, thanks for allowing me to articulate my "crown" story. And once again, thank you for sharing your expertise. Best wishes to you and yours as we ring in the New Year, Sue >>>Dr. Steve, >>> [quoted text clipped - 82 lines] > Best wishes to you and yours as we ring in the New Year, > Sue Same to you and yours! I could have told you about the Power Bars!! Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >Please excuse my uneducated interpetation and/or naive questions. Nope, there's no excuse for you. -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >> SP, >> [quoted text clipped - 19 lines] > >Steve Thanks for this info, Steve. This helps me understand what is going on, or what may be going on. > This is one of my pet peeves about the inferences insurance companies > make--and also the inferences made by radiographs alone with internet > diagnosis. There is no substitute for seeing the patient. > > Steve Well said. Most fractures are also not visible on the photos. SP SignatureTake out the TRAASH to reply >> SP, >> [quoted text clipped - 19 lines] > >Steve Your pet peeve is why we do not make a diagnosis solely on radiographic evidence. Signs and symptoms are an important part of diagnosis. It will be nice when we have minature MRI's to use in the dental office, until then... We gots what we got. >There is no substitute for seeing the patient. Indeed. -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Your pet peeve is why we do not make a diagnosis solely on > radiographic evidence. Signs and symptoms are an important > part of diagnosis. Abzzzolutely > It will be nice when we have minature MRI's to use in the dental > office, until then... We gots what we got. No truer words..... I hear it is coming and I hope it will be centrallized on the 'net and so you would be able to dial in and access your patients' scans, that were done at the x-ray clinic, where _they_ have invested in the 200,000,000,000$ machine, so's _we_ don't have to... > >There is no substitute for seeing the patient. > > Indeed. Jahawl... SP SignatureTake out the TRAASH to reply > > AGAIN, godammit, this is WRONG!!!! Sue, shut UP! > > SP [quoted text clipped - 4 lines] > > Freedom of speech. Bullshit, IMO, Sue: Limelight seeking. > As a patient (and in my experince), this is my current opinion. I do > not think that all dentists are very good at diagnosing the need for > RCT. Bully for your side. >When infection is present, it seems to be a very easy diagnosis. > A dentist can see this on x-ray (at least in my case he could). Then it got too far along. It is NOT easy to see in x-ray in early stages. > Again, this is my opinion AS A PATIENT. I am not a doctor or a > dentist. I am only one person. I am free to state my opinion. This is > a public usenet, not private property. You are leading a patient who asks for info here astray. You claim to have a good Medical Research head on your shoulders. Do this: Look up the pathological processes involved when a tooth becomes symtomatic and compare that with symptoms and pathology in areas of the body that are not encased in ENAMEL and DENTIN. Until then, stop bullshitting, and even worse, your PONTIFICATING.. What's next? You gonna advise people on what cars to buy, based on your on precious experience? Or which computers to get? Fine: go do it somewhere else. > My dentist was not able to diagnose the need when I kept telling him I > was in pain. I even asked if he could do x-ray to determine if > something was wrong. Then you should have moved on. And even if _you_ got the bum steer from an indecisive dentist, you don't have the right to foister that attitude onto another patient. > Jim's endodontist is in question as well. The endodontist is waiting > to see what happens. IMO, this is WRONG. It is so, because once the Endo has finished with the tooth, after waiting till it suits him to treat it, a general dentist will be called upon to put it back together. I feel for that poor guy/gal. > > Seems a little tricky to diagnose IMO (as a patient). It is simple: Chronic symptomatology: Fracture and/or Endo pathology. Your Pharmaco-Medically oriented RESEARCH bullshit is leading people to delay needed treatment. > -Sue Sleep well tonite there, Ma'am, because you cannot be held responsible for the damage you are doing. We, as dentists, CAN be. Your crossposting just may be putting us in danger. I am not going to kill file you, as I don't kill anyone, but, as far as I am concerned, my interactions with you are OVER. SP SignatureTake out the TRAASH to reply >> > My point is: I do believe that the need for RCT is not always easily >> > diagnosed until infection is present (as per my experience). [quoted text clipped - 12 lines] >RCT. When infection is present, it seems to be a very easy diagnosis. > A dentist can see this on x-ray (at least in my case he could). Familiarize yourself with some terminology. Hyperemia Reversible Pulpitis Irreversible Pulpitis Pulpal Necrosis. Your lack of knowledge and critical thinking is simply stupefying. -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > >It sounds to me like you have an endodontist looking out for your best > >interests. Rather than recommending RCT right away, s/he is giving it [quoted text clipped - 3 lines] > >-Sue > Good point. No, it ISN'T.... Sue is applying a Medical strategy, which is: 'Do as much nothing as possible in hopes that the body will heal itself', to a Dental situation. See, Jim, this is what is pissing the regs off about Sue. In situations like this, she should be keeping her mouth SHUT. Sue isn't a dentist; she isn't even an MD. Let's say it was your intra cranial pressure (inside your skull) that was rising due to some injury or infection, and you went to see the MD. Do you think you'd be satisfied if the MD told you to 'wait and see...' instead of aggressively treating that pressure? >I also felt that the endodontist was being very careful > not to just say "Yes, you need RCT"; rather, he was being cautious in > hoping maybe I don't need one, although leaning towards thinking I do. > I wish the signs had been more conclusive, but since they apparently > are not, I guess it's best to err on the cautious side. No, it ISN'T.... I firmly believe the Endo is complicating his work for himself by allowing this tooth to calcify internally. As always, this is JMO SP SignatureTake out the TRAASH to reply > > >It sounds to me like you have an endodontist looking out for your best > > >interests. Rather than recommending RCT right away, s/he is giving it [quoted text clipped - 29 lines] > -- > Take out the TRAASH to reply SP, FYI. Jim knows I am not a MD or dentist. We have exchanged views in the past. I expressed my opinion as a patient. I prefaced my post "as a patient..." This board is open for patients to speak to one another too. My opinion and your opinion do not agree. Your opinion and Jim's endodontist's opinion don't agree. Such is life. BTW, you seem to be underestimating Jim's intelligence. IMO, Jim is intelligent enough to make a decision based upon input from all sources. And he knows how to "weight" these sources. Also thank you also for enlightening me as to your opinion on the dangers of waiting too long. I wish you had spoken to my dentist and his associate who for weeks kept telling me that I should never get a root canal unless it is absolutely warranted... as I was losing weight from weeks of not being able to eat anything solid. In the same token, I happen to believe that in Jim's case, the endodontist is the expert here, especially since he is not working online... he is interacting hands-on with Jim. In my case as well, I came to the conclusion that the endodontist was the expert when it came to diagnosing the need for RCT. My dentist merely confirmed the need, after I went to 2 "experts" that told me I needed RCT. Happy holidays to you and yours. -Sue >> > >It sounds to me like you have an endodontist looking out for your best >> > >interests. Rather than recommending RCT right away, s/he is giving it [quoted text clipped - 31 lines] > > SP, There she goes again thinking she knows better than those who actually have a dental degree. > FYI. Jim knows I am not a MD or dentist. We have exchanged views in > the past. I expressed my opinion as a patient. I prefaced my post "as > a patient..." Your opinion has no real value, because you see, its just that. > This board is open for patients to speak to one another too. My > opinion and your opinion do not agree. Your opinion and Jim's > endodontist's opinion don't agree. Such is life. If Jim is so smart, why is he coming here for answers instead of going to the one who has hands on exprience with his case. > BTW, you seem to be underestimating Jim's intelligence. IMO, Jim is > intelligent enough to make a decision based upon input from all [quoted text clipped - 5 lines] > root canal unless it is absolutely warranted... as I was losing weight > from weeks of not being able to eat anything solid. Stove's opinion has no bearing on your case (if you actaully have one) whatsoever. > In the same token, I happen to believe that in Jim's case, the > endodontist is the expert here, especially since he is not working > online... he is interacting hands-on with Jim. Wrong, Stove is an expert to, unlike you or me. Remember he has the dental degree, and you, well you're just a groupie. > In my case as well, I came to the conclusion that the endodontist was > the expert when it came to diagnosing the need for RCT. My dentist > merely confirmed the need, after I went to 2 "experts" that told me I > needed RCT. Uh-duh >>> > >It sounds to me like you have an endodontist looking out for your >>> > >best [quoted text clipped - 36 lines] > There she goes again thinking she knows better than those who actually > have a dental degree. There YOU go LYING again. She did NO such thing! >> FYI. Jim knows I am not a MD or dentist. We have exchanged views in >> the past. I expressed my opinion as a patient. I prefaced my post "as >> a patient..." > > Your opinion has no real value, because you see, its just that. Her opinion has as much value as YOURS. >> This board is open for patients to speak to one another too. My >> opinion and your opinion do not agree. Your opinion and Jim's >> endodontist's opinion don't agree. Such is life. > > If Jim is so smart, why is he coming here for answers instead of going to > the one who has hands on exprience with his case. WHY are YOU here, Tim? >> BTW, you seem to be underestimating Jim's intelligence. IMO, Jim is >> intelligent enough to make a decision based upon input from all [quoted text clipped - 8 lines] > Stove's opinion has no bearing on your case (if you actaully have one) > whatsoever. There YOU go questioning everyone. I guess YOU think YOU were the ONLY one who ever actually had a case, you self centered, insensitive non caring, excuse for a human being. >> In the same token, I happen to believe that in Jim's case, the >> endodontist is the expert here, especially since he is not working >> online... he is interacting hands-on with Jim. > > Wrong, Stove is an expert to, unlike you or me. Remember he has the > dental degree, and you, well you're just a groupie. And YOU are nothing but a HARASSER of Sue. >> In my case as well, I came to the conclusion that the endodontist was >> the expert when it came to diagnosing the need for RCT. My dentist >> merely confirmed the need, after I went to 2 "experts" that told me I >> needed RCT. > > Uh-duh jan who loves to even call sue a liar. you must be so lonely today jan, Christmas Eve and no one to share some fun with, you poor poor miserable thing. > jan who loves to even call sue a liar. you must be so lonely today jan, Tim, This is not about me. In fact, no I am not lonely, I am busy preparing for all the kids and grandkids who will be here for Christmas dinner tomorrow night. Thank God I was able to prepare it. I wasn't sure, as it has only been six weeks since my jaw bone surgery. Been in lots of pain. > Christmas Eve and no one to share some fun with, you poor poor miserable > thing. Poor Tim, always a desire to belittle. Does that make you feel good, Tim? Once again, it says more about you than it does about me. I have had my differences with Sue. The thing is, Tim. WHY are you jumping ALL OVER HER EVERY WORD?!?! No matter WHO it is, or what has happened, there is NO excuse to jump down one's throat for EVERY WORD she says! Get over that, Tim, grow up. STOP bullying her! Thread Hijacking in progress > > jan who loves to even call sue a liar. you must be so lonely today jan, > [quoted text clipped - 19 lines] > > Get over that, Tim, grow up. STOP bullying her! Re: Jan love Tim Dixon Thread Hijacking in progress > There YOU go LYING again. She did NO such thing! >> >It sounds to me like you have an endodontist looking out for your best >> >interests. Rather than recommending RCT right away, s/he is giving it [quoted text clipped - 26 lines] >As always, this is JMO >SP Okay, Stovepipe, I appreciate what you are saying here and above about how waiting may make it worse. But like Dr. Bornfeld says, maybe the endo who is seeing this xray and seeing me and my tooth in person might have the upper hand, here, in terms of accurately calling the shots. I am taking your comments into consideration, however. This is what this board is good for, getting VARIOUS opinions and feedback. (Although admittedly making it harder to know who to believe and what t do! Sometimes more knowledge leads to a more complicated decision making process!) In all fairness to Sue, what she said is the same as what the endo said. He said that it could be that the crown I just put on - with temp. cement - could be affecting the nerve and that maybe after giving it a chance to calm down it might be okay. That is why he suggested I wait, because he said the new crown may be upsetting the tooth/nerve. I am paraphrasing here, but that is how I understood what he was telling me. I also understand that Sue's opinion is one of a patient, not an endo. or a dentist, so I take it with a grain of salt. But she seems to see it as I see it, and as the endo. explained it to me. The bottom line is, my tooth, while having calmed down, and being better than it was before I had the perm crown put on, does still have some symptoms, and after considering everything I think I am going to go ahead and get the root canal this coming Thursday. >>> >It sounds to me like you have an endodontist looking out for your best >>> >interests. Rather than recommending RCT right away, s/he is giving it [quoted text clipped - 53 lines] > some symptoms, and after considering everything I think I am going to > go ahead and get the root canal this coming Thursday. Is there a sign hanging somewhere saying come to SMD and get your free 2nd opinion. Do you know how crazy that sounds? Jim go to USC and move on with your life man and leave this dental boo-hah alone. It's really in your best interest to get your information from the one who is treating you. "It's really in your best interest to get your information from the one who is treating you." Like you and Webby got your information from the ones who disfigured your jaws? > "It's really in your best > interest to get your information from the one who is treating you." > > Like you and Webby got your information from the ones who disfigured > your jaws? Do you think information here can substitute actual care provided in person? In real life a second opinion has certain medico-legal obligations that go with it, are you suggesting that the same applies here when no one can examine the patient in their chair? And who had their jaws disfigured? There is no substitute for in-person care, but as people with jaws damaged by medical professionals, you and Webby -- if I understand your posts correctly -- are prime examples of how "medico-legal obligations" are insufficient protection against bad practice. You would not have a healed jaw if you hadn't read smd posts by Stradaioli and then communicated directly with him. He had not seen you in person before offering his generous help in coming to treat you. It is not a select few but everyone who has the right to look for further information from newsgroups. > There is no substitute for in-person care, but as people with jaws > damaged by medical professionals, you and Webby -- if I understand your [quoted text clipped - 5 lines] > few but everyone who has the right to look for further information from > newsgroups. There you go again making assumptions that have not been presented. When did I say my jaw was damaged by some medical professional? Or are you suggesting that one of the causes of temporomandibular joint disease is the medical profession? You missed the whole point of the post and you are basing your assumptions on a fractured piece of history. > There is no substitute for in-person care, but as people with jaws > damaged by medical professionals, you and Webby -- if I understand your [quoted text clipped - 5 lines] > few but everyone who has the right to look for further information from > newsgroups. But he _did_ see them and he certainly did a thorough examination before performing surgeries. SP SignatureTake out the TRAASH to reply > There is no substitute for in-person care, but as people with jaws > damaged by medical professionals, you and Webby -- if I understand your [quoted text clipped - 5 lines] > few but everyone who has the right to look for further information from > newsgroups. I think the issue here is not about looking for information in newsgroups as much as it is about using information found in newsgroups. I don't know what the connection (within this thread) is between my situation and "medico-legal obligations". Whatever it is, I rather doubt readers can make the connection either. So what is the point of all this? Please??? ... Webby > "It's really in your best > interest to get your information from the one who is treating you." > > Like you and Webby got your information from the ones who disfigured > your jaws? I don't think you know enough about *my* situation to make a comment/question like that. Webby >> "It's really in your best >> interest to get your information from the one who is treating you." [quoted text clipped - 6 lines] > > Webby Nor does she know enough about mine. Who said anything about jaws being disfigured? And what does that mean? > >> "It's really in your best > >> interest to get your information from the one who is treating you." [quoted text clipped - 9 lines] > Nor does she know enough about mine. Who said anything about jaws being > disfigured? And what does that mean? Not being recognizable to oneself after major maxillofacial surgery until the healing is well underway is not the same as what I think of when I think of someone being disfigured. It's all semantics. Let them say what makes them feel they've made their point. I think the appearance of my jaw/jaws is acceptable on a day to day basis excluding the times related to surgical events. In my life, I'm far more concerned about matters that are much more impacting and outwardly invisible than that. So please, allow this to set the record straight. TW In article <tmjiatroepidemic-C85186.09235925122005@news-lb-02.socal.rr.com>, > > >> "It's really in your best > > >> interest to get your information from the one who is treating you." [quoted text clipped - 22 lines] > > TW The carrying of the heavy "baggage from the journey" is mainly an invisible burden for which there is more than likely neither simple nor complex remedy. Some burdens in life heavier than others. Webby Webby, over the years you have very generously shared large portions of your story. Perhaps you have forgotten which portions you have shared. I have not. The horrific images you painted are likely imprinted on the emotions of anyone who read them. The limited mouth opening you have claimed is enough to know your jaw has been trashed. But if you want to know, someone who knows you in person has given me an oral description of what's left of your jaw area. I would agree that if you enjoy your family, your roses and life in general, what's been done to you is of little consequence. But honestly, I think you are able to continue enjoying life because of the kind of person you are, not because what happened to you was inconsequential. Given the initial betrayal by a "friend," the repeated surgeries, the implants that disintegrated in you, the situations where nurses nearly let you die, I think most people would have caved. You have some very special, strong desire to survive. > The limited mouth opening you have claimed is enough to know your jaw > has been trashed. But if you want to know, someone who knows you in > person has given me an oral description of what's left of your jaw > area. NAME THE PERSON WHO IS TELLING YOU THIS. OR SHUT UP. > > The limited mouth opening you have claimed is enough to know your jaw > > has been trashed. But if you want to know, someone who knows you in > > person has given me an oral description of what's left of your jaw > > area. > > NAME THE PERSON WHO IS TELLING YOU THIS. OR SHUT UP. Oh, be real. >> > The limited mouth opening you have claimed is enough to know your jaw >> > has been trashed. But if you want to know, someone who knows you in [quoted text clipped - 4 lines] > > Oh, be real. You made the statement now back it up. > > The limited mouth opening you have claimed is enough to know your jaw > > has been trashed. But if you want to know, someone who knows you in > > person has given me an oral description of what's left of your jaw > > area. > > NAME THE PERSON WHO IS TELLING YOU THIS. OR SHUT UP. Whatever ... it's the price I pay for being a "public personality" in the TMJ-arena. Webby > Webby, over the years you have very generously shared large portions of > your story. Perhaps you have forgotten which portions you have shared. [quoted text clipped - 14 lines] > nurses nearly let you die, I think most people would have caved. You > have some very special, strong desire to survive. This post (above) is a good, no ... it is an excellent example of how all of our words have the power to impact the lives of our readers. I'm not a very good writer and certainly not very good at writing about my personal experiences; but, I try not to let a lack of skill get in my way. I let a passion for life guide me and I let the imperfections roll off my back. Part of me doesn't want to let anyone in the door to get a clear vision of who I am and part of me knows that I have a uniquely human opportunity to allow my life to be of service to humanity. I'm not much of a follower. I admit it freely. Being a leader has always come for easily to me and quite frankly, people around me have always seemed to put me in the position to lead rather than follow. Why? I guess it's just who I am. Out here in cyberspace, being a leader usually gets people into some sort of trouble. It isn't that I am trying to take over someone else's position my any means. But leader-types don't always get along together. I happen to enjoy working with leaders. But ... Anyway, there isn't any good reason I can think of why any leaders of the "TMJ people" shouldn't be able to work *together*... except that egos get in the way. Whether it is the egos of leaders or followers ... egos are part of the human condition that results in resistance. Why did I let this reply post wander? Partly because I think it will get a little lost in the abyss and that's fine with me and partly because I sense something lurks where I cannot see. For now, that's all ... Webby > "It's really in your best > interest to get your information from the one who is treating you." > > Like you and Webby got your information from the ones who disfigured > your jaws? ... It _still_ is his best bet. They were given a bum steer. Seeing a dental professional in person still is the best insurance of sound treatment. SP SignatureTake out the TRAASH to reply >> "It's really in your best >> interest to get your information from the one who is treating you." [quoted text clipped - 6 lines] > treatment. > SP Thats exactly the point. There is nothing wrong with asking questions, and getting an answer depends on the generosity of the "professionals" who dwell here, not because someone decided they are entitled to ask just because is sci.med.dentistry and the world owes them something. Merry Christmas Stovie!!! My implication about everyone having a right to ask is just that. Nobody is required to answer, but neither do "residents" here have a right to tell someone not to ask their question. This is a public forum. Just because someone's question or presence or opinions don't please you, doesn't mean that person doesn't have the same right you had to read and ask questions. And those asking questions don't owe you any explanations or need to have your permission to ask their questions. I'll say it again; this is a public forum. That means the public is welcome here. If you want a private forum, start one. Agreed 100%. Absolutely no need for Tim to be so hateful. > My implication about everyone having a right to ask is just that. > Nobody is required to answer, but neither do "residents" here have a [quoted text clipped - 7 lines] > a public forum. That means the public is welcome here. If you want a > private forum, start one. "JanD" <JanD@insightbb.com> wrote in message news:_NErf.6256343$_o.256087@attbi_s71... ignore the old hag again read any of your outlandish posts to your alleged grandchildren while they rubbed your fat swollen feet? or did you just do things in the back room that no one could see? > "JanD" <JanD@insightbb.com> wrote in message > news:_NErf.6256343$_o.256087@attbi_s71... [quoted text clipped - 4 lines] > rubbed your fat swollen feet? or did you just do things in the back room > that no one could see? WHY can't YOU just deal with YOUR problems, Tim? Agreed 100%. Absolutely no need for Tim to be so hateful. <pellmellwillynilly@hotmail.com> wrote in message news:1135545355.179157.154310@g44g2000cwa.googlegroups.com... > My implication about everyone having a right to ask is just that. > Nobody is required to answer, but neither do "residents" here have a [quoted text clipped - 7 lines] > a public forum. That means the public is welcome here. If you want a > private forum, start one. > WHY can't YOU just deal with YOUR problems, Tim? You are the problem nazi. re: Jan loves Tim Dixon Thread Hijacking in progress > > WHY can't YOU just deal with YOUR problems, Tim? > > You are the problem nazi. re: Jan loves Tim Dixon Thread Hijacking in progress > "JanD" <JanD@insightbb.com> wrote in message > news:_NErf.6256343$_o.256087@attbi_s71... [quoted text clipped - 4 lines] > rubbed your fat swollen feet? or did you just do things in the back room > that no one could see? re: Jan loves Tim Dixon Thread Hijacking in progress > Agreed 100%. > Absolutely no need for Tim to be so hateful. [quoted text clipped - 10 lines] > > a public forum. That means the public is welcome here. If you want a > > private forum, start one. > My implication about everyone having a right to ask is just that. > Nobody is required to answer, but neither do "residents" here have a > right to tell someone not to ask their question. This is a public |
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