Medical Forum / General / Dentistry / February 2007
Keep popping out filling
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Eigenvector - 09 Feb 2007 01:20 GMT I scheduled an appointment with the dentist today because last night I popped out one of my fillings sometime during the night.
This particular filling I've dislodged once before, I'm averaging about 3 years per refill. Its a composite, at the gumline, on the front surface of the canine - right where the canine curves down under the gumline.
I take this to be my punishment for years of neglecting my teeth, but I'm getting tired of having to go in to replace that filling. I wear my nightguard religiously at night, I know that I'm pretty well chowing down on it when I sleep lately, my teeth along the jawline all are sore and cold sensitive.
Basically my dentist described it as I'm grinding my teeth with such force that the teeth are flexing ever so much and this force is breaking the bond with the filling. I mentioned whether there are better options over a nightguard - which doesn't seem to help, hinting at an NTI or similar device, he shook his head indicating that he felt the NTIs had their own set of problems and weren't worth it.
Is this just something that I'm gonna have to deal with? My assumption is that stress is causing the excessive grinding of my teeth, I've been under a lot of it lately.
Well until it gets put back in I'm stuck with a small chip in my tooth below the gumline - drink another lukewarm water for me guys!
Steven Bornfeld - 09 Feb 2007 01:58 GMT > I scheduled an appointment with the dentist today because last night I > popped out one of my fillings sometime during the night. [quoted text clipped - 22 lines] > Well until it gets put back in I'm stuck with a small chip in my tooth below > the gumline - drink another lukewarm water for me guys! Can't say if it's the grinding, but I'm not high on blaming the patient myself. If you're causing damage by grinding, that should be addressed--and a restoration that can hold up should be placed. Otherwise, that filling will turn to a root canal and a crown.
Steve
Steven Fawks - 09 Feb 2007 02:43 GMT > Basically my dentist described it as I'm grinding my teeth with such > force that the teeth are flexing ever so much and this force is [quoted text clipped - 3 lines] > that he felt the NTIs had their own set of problems and weren't worth > it. Two comments:
Retention grooves.
The NTIs do not have 'their own set of problems'.
(just 7 years of experience and hundreds made)
D
toothfairy - 09 Feb 2007 19:27 GMT i had a problem with a filling that would pop out every 2 years or so from a rear molar...every time they replaced it they had to dig deeper into the tooth...eventually i had to have root canal and crown...i wished they had recommended a crown to me before i needed a root canal also. i would have gladly taken a crown early on but i didn't know this was an option. maybe it is an option for you.
> > Basically my dentist described it as I'm grinding my teeth with such > > force that the teeth are flexing ever so much and this force is [quoted text clipped - 13 lines] > > D Eigenvector - 10 Feb 2007 01:44 GMT >> Basically my dentist described it as I'm grinding my teeth with such >> force that the teeth are flexing ever so much and this force is [quoted text clipped - 13 lines] > > D I have to wonder why he would have said that then. It wasn't out of ignorance, he isn't a bad dentist, nor does he appear uneducated. Is there an advantage to using a normal nightguard over an NTI device or vice versa?
As to the retention grooves, I believe he isn't using them due to the extreme shallowness of the cavity. It isn't large by any means, but at the time it was extremely sensitive so he opted to repair it. I'm not defending him by an means, but rather explaining it - I'm sure diagnosing over a newsgroup is extremely difficult.
Steven Fawks - 10 Feb 2007 02:35 GMT There is nothing, absolutely nothing that is wrong with the NTI.
I haven't made a 'conventional splint' for years. They 'work' 'sometimes'. The NTI works *almost* every time that the patient wears them (much better patient compliance than 'horseshoes' too).
An inverted cone bur can give a retention groove without removing a substantial amount of tooth structure.
Yes, internet diagnosis is impossible. NTI superiority over traditional splints is a no-brainer.
Steve
> I have to wonder why he would have said that then. It wasn't out of > ignorance, he isn't a bad dentist, nor does he appear uneducated. Is [quoted text clipped - 6 lines] > defending him by an means, but rather explaining it - I'm sure > diagnosing over a newsgroup is extremely difficult. The Webby - 10 Feb 2007 02:57 GMT The Webby knows something about this ...... and very few understand why.
Webby
> There is nothing, absolutely nothing that is wrong with the NTI. > [quoted text clipped - 20 lines] > > defending him by an means, but rather explaining it - I'm sure > > diagnosing over a newsgroup is extremely difficult. The Webby - 10 Feb 2007 03:13 GMT > There is nothing, absolutely nothing that is wrong with the NTI. If readers had been here, in smd, a decade ago ... they would not have read about "NTI"...
Webby
Steven Fawks - 10 Feb 2007 14:20 GMT They would have read about the travesties before the NTI.
That shouldn't be happening anymore, but.....
:-( Steve
>>There is nothing, absolutely nothing that is wrong with the NTI. > > If readers had been here, in smd, a decade ago ... they would not have > read about "NTI"... > > Webby Steven Fawks - 10 Feb 2007 14:14 GMT >> I have to wonder why he would have said that then. It wasn't out of >> ignorance, he isn't a bad dentist, nor does he appear uneducated. Is >> there an advantage to using a normal nightguard over an NTI device or >> vice versa? I'll add the long version of my NTI experience.
Probably about eight years ago, I first heard about the NTI device. By that time I had watched the destruction of teeth along with all of the other symptoms in hundreds of patients for almost 20 years of practice. I had tried hard splints. I had tried soft splints. I had tried them on the maxillary arch. I had tried them on the mandibular arch. I even tried one that is still being marketed called the 'Bite-Rite' (talk about a chew toy!).
Success with these devices had been minimal. Most of them would help protect the teeth, but they didn't help many other symptoms. Patients hardly ever *felt better*. Without feeling better, the splints usually ended up in a drawer somewhere.
At any rate, here comes this new gizmo called an NTI. Boy, was I impressed..NOT. It was so small and seemed way too SIMPLE to really treat the COMPLEX problems of clenching/bruxism/tmjd.
Over the next year, I would read with interest reports of dentists I had met here and in another professional web list about how this little NTI thing was actually helping people. I had respect for their opinions by the years of reading other posts that they had written. Even Dr. Jim Boyd was always around to explain the device and offer his expertise (he developed the NTI).
Well, Dr. Boyd said he would send any dentist a free sample of NTIs. OK, nothing to loose. Even though it's hard for me to believe these things can be *that* good, maybe they will be better than what I've been doing.
The free sample consisted of 5 stock NTIs. I made one for myself (lining it with Triad gel, instead of SNAP...I got it done, but it wasn't easy). I melted one with the SNAP liquid (not paying adequate attention to the instructions, and being afraid the acrylic might not bond well enough without a primer coat). I wore my new device for a few nights. It seemed comfortable enough, and I had no problem sleeping with it. I had no symptoms before wearing it, so that was about all I could determine so far.
As luck would have it, my receptionist confided in me that she had developed severe jaw and ear pain. She had been to her physician (over an hour away in her home town) and he had her lined up with an oral *SURGEON*. I had seen and heard (much of it on smd, right Webby?) about surgery to treat TMJ pain. It didn't have a stellar record of success, and often left patients in much worse condition than before treatment.
So I said, "Melva, you might want to try one of these new gadgets to see if it will help. I'm not too keen on the idea of surgery."
Even with this being my first attempt at constructing an NTI for a patient with symptoms, it was a tremendous success. Her pain was gone in days, she is still doing well to this date, and she has worn an NTI every night for the past seven years.
I made one for one of my assistants (collapsed bite from molar extractions as a kid) who had a lot of headaches and moderate jaw pain. She cannot imagine not having an NTI. Another seven year success story.
My wife wears one (and sometimes two...she is a severe clencher!). My newer assistant has worn one for 3 years, and had us make one for her husband. Melva's husband wears one. I even had a dental assistant who worked for a dentist in Kansas City come out to my practice to get an NTI. Three years later she came back for another one stating that it was the best 'bite splint' she had ever tried (and she had tried about all of them!). BTW, I don't advertise at all.
The only negative about an NTI is that it is not a cure for the problems it treats. It only works when it is worn. It is just a piece of plastic and it will wear (better it than your teeth). You will have to get new ones made over time.
I have had a few patients come back saying, "I can't sleep with this thing in my mouth." That is pure and unadulterated BS. They *could* if they gave it a few nights. Most people say they actually find that they sleep much better with the NTI than before.
NTIs have been a tremendous positive for my practice and my patients. Without the internet, I might still have never tried a one of them.
I think dentists and patients see this little piece of plastic and have the same opinion that I did eight years ago. "That little thing can't possibly be the answer to the complexities of tmj problems and lots of headaches." Many of the dentists have spent years learning how to treat 'bite problems' and 'tmj'. How could these experts that have been teaching these courses have missed such a simple solution?
I'm sorry, but if a dentist is not using NTIs to treat these problems they are flat missing the boat. These patients keep searching for help spending massive amounts of money on drugs, MRIs, CAT scans, and doctors visits. An NTI is actually worth thousands of dollars by preventing the money being wasted on other treatment. Not to mention the patient actually feeling better.
It is ignorance and stubborness. For some of the "TMJ Experts", I think they should read the childrens' story "The Emperor's New Clothes".
Steve Fawks
The Webby - 10 Feb 2007 16:38 GMT No one who participates in smd as poster or lurker should miss out on reading this excellent post.
And yes, there was *much* to be read here in smd about surgery to "treat" TMJ pain. (I have kept the entire post intact.)
Webby
> >> I have to wonder why he would have said that then. It wasn't out of > >> ignorance, he isn't a bad dentist, nor does he appear uneducated. Is [quoted text clipped - 105 lines] > > Steve Fawks John & Ninetta - 15 Feb 2007 02:05 GMT > The free sample consisted of 5 stock NTIs. I made one for myself > (lining it with Triad gel, instead of SNAP...I got it done, but > it wasn't easy). I melted one with the SNAP liquid (not paying > adequate attention to the instructions, and being afraid the > acrylic might not bond well enough without a primer coat). Steven,
Do you still use the SNAP? One of the local dentists here said he's using those thermoplastic buttons (by Advantage Dental) to reline the stock appliance.
J Suljak DDS
Steven Fawks - 15 Feb 2007 03:56 GMT I still use SNAP. I've tried the thermoplastic buttons, but I can't trim the NTI to final shape with those in place like I can with SNAP.
They work. I just like the SNAP better.
JME, Steve
> Do you still use the SNAP? One of the local dentists here said he's using > those thermoplastic buttons (by Advantage Dental) to reline the stock > appliance. > > J Suljak DDS Newbie - 15 Feb 2007 14:39 GMT Still using SNAP, haven't tried the buttons. Probably won't try them now.
TJ hasn't steered me wrong yet.
>I still use SNAP. I've tried the thermoplastic buttons, but I >can't trim the NTI to final shape with those in place like I can [quoted text clipped - 10 lines] >> >> J Suljak DDS Dartos - 15 Feb 2007 20:03 GMT > Still using SNAP, haven't tried the buttons. > Probably won't try them now. > > TJ hasn't steered me wrong yet. I'm not always right (I just can't remember when I was wrong ...though I'm sure my wife could fill you in <G>).
Anyway, by the time you get them heated in the microwave (in a cup of water), you can already have the SNAP mixed and in the mouth.
From what I understand about the button users, they do not trim the body of the NTI shell what-so-ever. They claim the patients adapt to them just fine. (on another dental site)
Maybe I'm just being too picky.
JME, D
letsconnect - 15 Feb 2007 04:01 GMT > Many of the dentists have > spent years learning how to treat 'bite problems' and 'tmj'. [quoted text clipped - 9 lines] > > It is ignorance and stubborness. IMHO it's more that the majority of dentists aren't particularly internet-savvy and have never heard of it before. There's not much publicity for it outside of the internet (do a PubMed search... see what I mean?). Dentists tend to be very receptive to the idea once they find out about it, though (from my experience, anyway).
I'm not sure if something can be called ignorance if the knowledge is only available to a relatively small group of active internet users. This is the the sort of thing that belongs in textbooks. Pity about the politics.
Dartos - 15 Feb 2007 15:59 GMT > I'm not sure if something can be called ignorance if the knowledge is > only available to a relatively small group of active internet users. Ignorance means that you do not know about something.
Everyone is ignorant about certain things. I'm ignorant of astrophysics. I'm ignorant of the plot on Desparate Housewives. I'm ignorant when it comes to gormet wines, building a top fuel funny car, writing a computer program, etc., etc.
The NTI has been marketed to dentists in the US by ads accompanying several professional publications. Dentists would have to practice in a vacuum not to have heard mention of the device. Some may truly fit that mold. Most have heard of it and have dismissed the possibilities that it is better than anything they are yet using.
I understand the initial skepticism. I had it myself. I think too many have been brain washed by other teachings to allow the new concepts of the NTI to be seriously considered.
Dentistry has been so concerned about occluSION that it has ignored the occluDING. Control the occluding and the occlusion becomes much simpler.
D
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