Dental Treatment in which order?

Padstow

I know that gum treatment will be the first to be done, but I also want Invisalign and a second to last upper molar replacing.
Does anyone know whether the gap is replaced before Invisalign or vice versa?

Also, if there's a chance that the gap can be completed with a bridge, should I try that before an implant? I know that bridges don't last for ever, but due to my age, an implant could well outlive me. There is also the fact that implants are improving rapidly as they become more popular. A new slim type is on trial for those with insufficient bone for instance.

If a bridge failed in say five years, the advances in implant technology will be way ahead of now.

Shocked at the cost of local antibiotic for the gums, £150, but so be it as that's what's needed.

I have been seeing an NHS dentist since April for cleaning. It's not totally satisfactory as I'm in and out in five minutes, she just hurts with a probe thing, and disturbingly there's a sign on entry that reads something like; "If you have concerns about hygiene, please report them to reception." For someone who almost boils their washing up, it doesn't instil confidence.

I also had airflow which was a waste of £50. A different dentist did it and told me they used BiCarb as the powder. I haven't seen my regular dentist since then, but I feel really cheated as to the results. I expected it to remove stains from between my teeth, but it didn't. The dark lines are still there defining the crookedness.
I can of course complain, but I daresay the claim of using bicarb, rather than that by provided by AirFlow will be disputed and seconded by the assistant.
There was a post from someone who thinks airflow is great. I'm comparing dentists at present and some include it in their hygiene routine. My experience was marked three out of ten as it cleaned the back of my lower teeth but that's all.

brook2jack

If you have gum problems these need to be sorted and stabilised before anything else is even thought of. This will be months.

Airflow is a purely cosmetic treatment , it merely gets rid of stain, it will not get rid of tartar. It should be the last cosmetic part of a hygiene visit where scaling is done first.

From what you describe you need thorough hygiene appointments to remove all the tartar but more importantly you need someone to show you the techniques to keep your gums healthy ie effective tooth brushing, flossing and tepe use. Until you can keep your gums healthy and maintain that health you should not even think about invisalign,bridges or implants as they will cause even more problems.

Who has prescribed antibiotics for your gums? Antibiotics do not cure gum disease they merely control symptoms . Are you having any other treatment other than antibiotics?

You need to get your gums healthy then think about further treatment with a dentist who can see you, your x rays and advise on timing.

Padstow

Thanks for replying. Disappointing that I won't be having invisalign for months, as I assumed the gum control could be done whether or not I was wearing them.
I understand the antibiotic is placed in the pockets after a deep clean. A laser may be used depending on how deep the pockets are.
It's so difficult knowing who to go to. I was looking at a specialist 2 hours drive from me but have settled for this one nearer home due to the number of visits needed.
I even read of one in London who claims to have the only laser of its type in Europe, but then wondered why if it's so good, there are not more in use? £4,000 typical treatment for the gums alone too!

brook2jack

Padstow wrote: »

Thanks for replying. Disappointing that I won't be having invisalign for months, as I assumed the gum control could be done whether or not I was wearing them.
I understand the antibiotic is placed in the pockets after a deep clean. A laser may be used depending on how deep the pockets are.
It's so difficult knowing who to go to. I was looking at a specialist 2 hours drive from me but have settled for this one nearer home due to the number of visits needed.
I even read of one in London who claims to have the only laser of its type in Europe, but then wondered why if it's so good, there are not more in use? £4,000 typical treatment for the gums alone too!

There is a fair amount of scepticism in the dental world of some periodontists claims about gum problems and lasers to say the least!

Did you ask your dentist who they refer to for gum problems or have you just picked people out from googling? Have you actually seen someone,been diagnosed and treatment planned?

Moving teeth that have active gum disease with braces means you will rapidly loose teeth. The gums and bone have to be completely healthy and stable and sufficient bone left to safely carry out brace work. It will be a long time, if ever , before you are ready for anything other than gum treatment if you have active gum disease.

Padstow

brook2jack wrote: »

There is a fair amount of scepticism in the dental world of some periodontists claims about gum problems and lasers to say the least!

Did you ask your dentist who they refer to for gum problems or have you just picked people out from googling? Have you actually seen someone,been diagnosed and treatment planned?

Moving teeth that have active gum disease with braces means you will rapidly loose teeth. The gums and bone have to be completely healthy and stable and sufficient bone left to safely carry out brace work. It will be a long time, if ever , before you are ready for anything other than gum treatment if you have active gum disease.

I saw the Practice Coordinator as I walked in with no appointment had pictures taken, seeing the dentist on Wed. Not sure what you mean about referrals. The letters after his name are; B.Ch.D MFDS RCS Ed

brook2jack

Every dentist , nhs or private, has specialists they choose to refer to for more advanced work.

For anyone thinking of any advanced dental work your first port of call is to ask your regular dentist who they refer to, or sometimes more tellingly who they don't refer to.

Picking a specialist on the basis of internet searches or numbers of letters after their name is never going to be as good as personal recommendation.

Padstow

brook2jack wrote: »

Every dentist , nhs or private, has specialists they choose to refer to for more advanced work.

For anyone thinking of any advanced dental work your first port of call is to ask your regular dentist who they refer to, or sometimes more tellingly who they don't refer to.

Picking a specialist on the basis of internet searches or numbers of letters after their name is never going to be as good as personal recommendation.

Yes they did say who they refer to, in the same city, which made me wonder why I wasn't going there in the first place! ( I was enquiring about gum grafts if needed.)
Finding recommendations for specialties is very difficult, ok for general dentistry but I don't know anyone who has had treatment from a periodontist. After all, it's not something one wishes to broadcast.
My daughter wanted braces and working in the biggest hospital in the UK expected someone knowing of a good orthodontist, but she had to resort to Google as well.
I am doing the best research possible and I did tell this practice that they were one of three possibles. They said they'd be happy to send my X-rays to the others if I wished. My daughter's dentist charges £10 per X-ray to send on.

I could of course ask the NHS dentist I've been seeing, but this private practice seemed rather surprised that I hadn't even received an X-ray there, so who's to say she's any good either? It really is a minefield for us who aren't in the know.

Many years ago when I wanted a nose job, I asked my GP for a referral. That's comparable to asking my dentist. I'm safe to repeat this as the surgeon is long dead. When I went to have the plaster cast removed, he ripped it off in one brutal pull, causing my nose to shatter. I had to have it redone by someone else as it caved in. He was I found out later a severe alcoholic who was often drunk on duty, he is infamous to this day with medical staff who relate tales of things he did. My GP had no idea though, so the referral route is not infallible unfortunately.
Thanks for helping, it's much appreciated. I may well ask my dentist if she at least knows of this practice.

brook2jack

If you have gum disease the first stages of treatment are very simple, you need to have the tartar removed and you need to learn how to clean,floss and use tepes effectively. It's only after you have these basics right, if there's a problem, that referral is indicated and possibly more advanced treatment.

From the sounds of it the first thing you need is not a specialist but a good general dentist with a hygienist to get these basics right. You sound as if you have been trying this and that (airflow etc) without anyone actually explaining, advising and showing you how you are the main component in controlling your gum disease, because once you have gum disease it is never cured, it is kept under control by 75% patient effort, 25% dentists.

A good general dentist is an easier thing to find, ask friends, relatives Tec people love to talk about their dentist.

Specialists are easy to find, asking at a general hospital is useless doctors/nurses have very little knowledge of oral medicine. Far better is to phone local practices and ask who they refer to, most will be happy to give this information.

27col

Why do you seem to think that people on this forum are better qualified to answer your question than your dental practitioner. I would have thought that all your questions about your dental treatment would be far better aimed in that direction.

Padstow

brook2jack wrote: »

If you have gum disease the first stages of treatment are very simple, you need to have the tartar removed and you need to learn how to clean,floss and use tepes effectively. It's only after you have these basics right, if there's a problem, that referral is indicated and possibly more advanced treatment.

From the sounds of it the first thing you need is not a specialist but a good general dentist with a hygienist to get these basics right. You sound as if you have been trying this and that (airflow etc) without anyone actually explaining, advising and showing you how you are the main component in controlling your gum disease, because once you have gum disease it is never cured, it is kept under control by 75% patient effort, 25% dentists.

A good general dentist is an easier thing to find, ask friends, relatives Tec people love to talk about their dentist.

Specialists are easy to find, asking at a general hospital is useless doctors/nurses have very little knowledge of oral medicine. Far better is to phone local practices and ask who they refer to, most will be happy to give this information.

I think I know how to brush, but I bet this will be wrong. I use both an Oral B manual and electric and brush at a 45 degree angle to the gums, i.e trying to aim under the gum line. I use the full range of tepes, in fact I'm quite addicted to them. Flossing I'm useless at, but NHS dentist said no need if using tepes.

I've watched animations of flossing and they seem to get right under the gum line which is where tepes don't go. I'm worried I'll rip the gum if I try, it looks as though there's a real art to it. (Remember how the rich guy in Pretty Woman film knew the prostitute was okay because she flossed?) This private dentist said to floss using a particular Reach tape, but then found it was discontinued. It must be the woven one that the Americans lament the passing of but is on Amazon, not the current Reach site. See I am trying to gain knowledge.

I have obviously misunderstood the dentists here, and thank you all for giving your time to help us posters. In obtaining recommendations, I thought you meant ask your friends or colleagues with nice teeth, which is what my daughter did. She wasn't asking in the medical sense.
Asking a dentist makes sense but I was dreading even telling the NHS one of moving, as she helped me at a time when I was totally broke. She says my mouth is typical for my age, no better or worse, if that means anything. She also said how she hates the make over programmes where they fit veneers without correcting the health of the teeth first, which I totally agree with.

You've been a steadying influence on me and I've taken in everything you've written. I do research, but get carried away with excitement when shown animations of how my teeth will look etc and then want it done yesterday.

Laugh, I went to a face clinic a few weeks ago, luckily had my daughter with me. I said no way would I sign up on the day for fillers. Only her restraining arm stopped me, thank God. Now I've decided plumptious lips will look stupid if there's a rubbish smile behind them. Teeth must come first.

The only procedure I told them not to consider was veneers, much to their surprise. I think old people with veneers look like old people wearing dentures. Very expensive dentures.
I want firstly good gum health, which is why I looked at periodontists in Buckhurst Hill. London and Manchester before even thinking of a smile makeover.

Thankyou for all your advice and I hope it's helping others here too.
I now intend to visit the NHS dentist's office tomorrow and get her opinion. That will still give me 24 hours to cancel/postpone the private one if need be. If she says someone in this town, she'll be wrong.
I went into the only entirely private dentist here and asked for information. The receptionist handed me a leaflet without even raising her head and I left. She didn't speak one word to me, nothing.

Padstow

I contacted my NHS dentist's office who were helpful, in although not having the answers, they rang me back. They can do private treatment for deep cleaning, but don't employ hygienists and cannot start until August. I'm going to go to the private City practice on Wednesday.
One thing she said, was that Airflow doesn't work for everyone. Would have been good to know that before I paid £50.