Had a pretty interesting day today at the office. Morning was pretty normal, drill and fill, check hygiene, extract a tooth etc. Nothing too out of the ordinary.
Pretty normal lunch. Trolled around on CP, ate an apple and a handful of wheat thins.
Then the afternoon hit.
I see inmates from the county jail here in town if they have a tooth ache or something, sheriff or deputy will call up and bring them up in shackles and the whole bit. It's not big deal, most of them are just happy to get out of pain and it's not a problem. So dude comes in, my assistant goes in to ask the normal "which tooth is bothering you, let me get an xray, blah blah". I was in the lab doing something so I wasn't really paying attention. She comes in and says "doc, you will need to come look at something" to which I responded "he need a tooth out, which tooth is hurting"?
"All of them". Huh, ok, weird response but lets go check it out. Sure enough, continued meth use pretty much causes things to not go so well intraorally, so he was pretty much decayed out and most teeth were broken off to the gumline (google meth mouth if you want to see it, i'm not messing with photos). Asked if I could extract all 26 teeth he had left in the 30 minute block we had on the schedule for him.
I laughed, said "nah, which one hurts the worst, we'll take that out". He pointed to one, I numbed it up, used an elevator to take it out, about 30 seconds worth of pressure and it was pretty lose. 2 teeth next to it are super mobile and infected (which starts draining as I get this one out, that smelt nice) so I told him he was getting 2 free extractions since he was already numb in that area and they were loose and I was right there, no harm no foul.
It's always fun when we see the inmates, the Sheriff comes up and sits in the room with them all serious, then when I come in the room we talk about hunting or why the Chiefs always break hearts or something.
He breaks down and starts crying thanking me, that he already felt better (if you saw the amount of infection I drained, you'd see why) and asked if he could make an appointment for when he got out. "Sure, how long you think you'll be in this predicament".
"I figure 4 or 5 years, you scheduling ahead that far yet"? Told him nah, just take care of himself and come see me when he gets out.
Next patient is an amish guy (we have a fairly big amish community near us), super nice guy, needs a crown. Asks if he can barter instead of pay, I ask what is in it for me, said he'd bring me a dozen eggs every week for 6 months (they have chicken barns or something) or I could have a quarter of one of the cows they're butchering. Sold, eggs and beef for a crown, sign me up.
Only problem with that is he scheduled an appointment for himself, but brought 4 other family members who all needed work done.
So we had a waiting room full of inmates and Amish this afternoon. Thought that might be a good name of a band or something. [Reply]
Here is a question for you o.city: Have you ever been extra rough with a patient who was a pain in the ass or a jailed convict you treated that you found out did something real bad? [Reply]
Originally Posted by O.city:
Well, after a round of antibiotics, my inmate buddy is back today. I'm waiting for him to get numb, we'll see how it goes.
Had a kid in yesterday, really sad deal. She asked her parents for braces for xmas. Seemed like a weird request, so I tried to get some info out of here on it. She is being bullied at school because of it, kids are calling her spongebob because she has some rather large central incisors and her lateral incisors sit back a little bit making the centrals pronounced.
Kids can be horrible. Mom and dad were upset about it and were struggling to come up with the downpayment for ortho treatment.
Told them not to worry about it, I'd take care of it (i'll just write it off, no biggie) and I hope they have a merry xmas.
Felt bad for the kid, hopefully a round of ortho will have her fixed right up.
you're an awesome guy. and stories like this are why you'll always be busy. [Reply]
Originally Posted by O.city:
Uh, yeah, that's not true. At all.
Abscesses can cross facial planes and get into some real fucked up places. Look up Ludwig's Angina if you want an example. Shit can get away from you real quick.
Seriously, anyone reading, if you have any swelling intraorally, get it taken care of.
Well that is interesting to know, I've had more than 1 person be like oh they make you do weeks of antibiotics before they do anything, they won't just drain it because blood and infection yadda yadda. I always thought that was bullshit cause well abscesses need to be drained. [Reply]
Originally Posted by neech:
So what is the process of the state paying you money for the dental work done?
Do you do, say a filling and have a set rate on what you charge them for it?
The state doesn’t pay me anything. I don’t do Medicaid stuff, it’s only for children and pregnant ladies in Missouri and it’s a nightmare to deal with. In the regards to inmates the county pays it then charges it to the inmate I guess I dunno.
I only do extractions for them. It’s 125 bucks for an X-ray and an extraction. [Reply]
Originally Posted by scho63:
Here is a question for you o.city: Have you ever been extra rough with a patient who was a pain in the ass or a jailed convict you treated that you found out did something real bad?
Nah, I don’t usually ever even know what they did anyway. Don’t really care, not my job to judge them. I’m there to help with their tooth ache. Nothing more.
I do have a few PIA patients (I’ll let you figure that one out) that when I see their name on the schedule I kinda cringe but that’s pretty normal.
I get people had bad experiences and the dentist isn’t the funnest place to be. But it’s hard as shit to hit a moving target with a spinning drill so try to sit still [Reply]
It’s just water and your own spit. It’s ok to swallow it, it won’t kill you.
I had to stitch a guys tongue up the other day because as I was prepping a lower molar for a crown he thought it would be interesting to lick the drill that’s spinning at 40k rpm. “Is that blood I taste doc”?
“Yeah, good thing half your tongue is numb, or you’d be upset right now.” Then I scolded my assistant a bit for now retracting the tongue (it wasn’t her fault I was just half heartedly giving her shit).
A few silk sutures later he was ready to go [Reply]
Originally Posted by O.city:
I only do extractions for them. It’s 125 bucks for an X-ray and an extraction.
Sounds like a good deal, I have a 2 that needs pulled my dentist has been nagging it needs a crown but I've had my 15 pulled and I've learned I don't really need it anyway, any other teeth closer to the front then them I wouldn't want to lose though. [Reply]
Originally Posted by Mecca:
Well that is interesting to know, I've had more than 1 person be like oh they make you do weeks of antibiotics before they do anything, they won't just drain it because blood and infection yadda yadda. I always thought that was bullshit cause well abscesses need to be drained.
It’s harder to get full anesthesia sometimes when there is a presence of infection due to the acidity or something (I don’t remember the exact science behind it) so you have to do some antibiotics first.
I try to limit use of abx as much as possible due to the issues with resistance that are rising, so I usually take the tooth out or drain it.
I have had patients with hot teeth or what we call irreversible pulpitis where it hasn’t abscessed yet but it is intense pain. Only way to fix it is extraction or root canal. Sometimes doing the root canal you can’t get the tooth all the numb so you have to do what’s called an interpulpal injection. Basically you tell the pt “this is going to be uncomfortable for a few seconds” and you drill a hole into the pulp or nerve of the tooth and shove a needle down into the root as far as you can and force anesthetic down it.
It’s not the most comfortable thing but it gives immediate relief and lets us work with a comfortable patient [Reply]
Originally Posted by neech:
Sounds like a good deal, I have a 2 that needs pulled my dentist has been nagging it needs a crown but I've had my 15 pulled and I've learned I don't really need it anyway, any other teeth closer to the front then them I wouldn't want to lose though.
Yeah second molars aren't THAT important. I’m obviously pro keeping teeth but if you have to lose one, that would be it.
The issue people don’t understand is that sure those molars aren’t visible so people won’t know you’ve lost them. But first and foremost those are important for masticatory (chewing) function and once you start taking them out your bite starts collapsing which leads to a whole host of other problems [Reply]
I've always had this thing where I don't get numb. Since I was a kid I'd tell a dentist it still hurt, and they'd assure me I'd had enough and continue. Sometimes it's fine, sometimes I can feel every single thing you're doing and every single nerve twinge while you're drilling.
2-3 years ago, I had a molar crack down into the gum along the root. If I touched my teeth it was a thumping ache like I'd never felt. I was sent to an oral surgeon to pull it. Local shots, and I could feel everything. More shots and I can still feel it. More shots and they start the extraction. It's rough. I'm sweating, It hurts like a sonnabitch and after a few minutes of wrenching on top of me the dentist stands down. I think he's don and tell him "wow, that was way worse than the other times I've had this done"....I'd had 3 wisdom teeth done with local only, and it was fine. He looks mortified and says...we're just getting started. You've got a "hot tooth" and it's not going to go numb....we're far enough along, this has to come out.....Normally I'd knock you out but I can't because...reasons....this isn't going to be fun. He spends 10 minutes wrenching an not only can i feel it, but I get this really intense nerve pain...he finally asks I if I want some gas. I've never had that, but yes I want the F'ing gas.....and they put on the mask....It's good stuff, I'd like to have some for home.......it helps but man. Eventually it comes out.....It was the dental experience everyone is afraid of....fun times.
I had another time a lady dentist cut me with the drill. I didn't move, she slipped...and then she bitched at me for bleeding too much after she cut me.
Last year I went in to a new dentist for 2 fillings. I was in the chair 20 minutes total, it was like a nascar pit stop in my mouth. When they were done, the fillings were rough......and I got charged $1,300.....for 2 fillings that took 20 minutes total.
It's not always bad experiences, but you should know that even reasonable, otherwise tough people aren't enjoying that visit either. [Reply]
Yeah, that’s rough. Sometimes shit happens. They call it practicing dentistry for a reason!
That sucks man, I’ve been there. I had a guy with a bad tooth once and i could not get that dude numb. I tried and tried and to top it off he had some cardio problems so I had to limit my epinephrine and use some local without it. That makes it burn thru it a lot faster so I had to work quick.
When you’re working on the mandible aka lower teeth, you have to do a block on the inferior alveolar nerve because it runs in bone to supple those teeth. You have to get it way back near the tmj and block the whole right or left side. Everyone’s anatomy is different so it can happen where you miss or shoot too low and don’t get anesthesia. I had a really good oral surgeon that taught me in school how to do those so I haven’t missed one in years it seems
Of course I’ll miss 2 Monday now saying that lol.
Some guys run their offices at optimal speed. I am a little more slow paced as I like to spend time talking to each patient as I feel it helps them get more comfortable with me. Corporate dentistry is a big thing and it’s a fucking drain on dentistry
It sucks that patients get screwed at those offices and don’t know their getting screwed. [Reply]
Light complexion people with red hair always have trouble with anesthesia. It’s kinda folk lore and I’m not sure there’s actual literature there but they always have it in my office
Of course my father in law (who posts here hope he doesn’t read this lol) is that way and I have to work on him. He always bitches at me he needs more anesthetic. I’m pretty sure he’s just a baby
And yeah the gas helps. It’s more just turns your give a damn down it doesn’t do anything for anesthesia [Reply]
Injections are the thing that most people hate understandably
Funny story on how we actually learned how to do those. We had the class of course did actually taught by a retired oral surgeon. Really great surgeon and teacher. Anesthesiology 1 or whatever
Then towards the end of the semester we have a Saturday booked up in the oral surgery clinic upstairs at the dental school where all the oral surgery residents are there and we dental students have to partner up. You give your partner the 10 main injections under supervision then switch places and get it done on you.
Stick and squirt is what they called it. I’d had a lot of dental work done as a kid so it did t bother me. A lot of people were kids of dentists or whatever so they’d always had perfect teeth and never a cavity or any issue so they freaked out.
One guy was doing a block on this chick and he went to lateral and the needle comes out the side of her cheek and we can see anesthetic squirting out. Two people pass out.
So we give each other two carps of lidocaine to do the injections. Everyone is numb everywhere
Then we head to the bar up the street for drink and drool [Reply]
