I'm sorry, I hate to talk about this when everyone else is experiencing so much pain, but I went to my dentist of 35 years today and had a very unusual and bad experience concerning my TN 1. Stress is the one thing that brings on a flare up, and this is really causing stress for me.
Since I got the TN 4 years ago, he did a crown on an implant right next to the space where I experience the TN one year after I was diagnosed. The implant was done before I got the TN. The medicine was working and I told him I was comfortable getting the crown because a crown is not invasive. He did it (of course inside I was worried, but I didn't let him know) but everything went fine.
I went to him today for something else and I mentioned to him that it seemed that the crown was getting longer. He said that because I had an implant below it without a crown it had nothing to rest on so was sinking (not the word he used). I said we should put a crown on that implant on the bottom so it doesn't "sink" any further. He then said I also had the possibility of my face caving in a little because there was no tooth supporting my cheek. So I said we needed to do that crown as soon as possible.
Now here's what shocked me - he said "I won't do it." I asked why. He said he didn't feel comfortable because of the Trigeminal Neuralgia, that he could bring it on. I reminded him that 3 years ago he did a crown on the top where my problem is, right next to the socket where I first got the pain and I have no trouble with non-invasive work. He just kept saying he wouldn't do it. No matter how much I reminded him that this was on the bottom and I'm not bothered on the bottom. AND THAT HE DID A CROWN ON THE SAME SIDE!!
So, I asked him if I needed to find another dentist so that my face wouldn't cave in, and he said, "Yes, I guess so."
I grabbed my purse with tears in my eyes and said "I'm out of here." On my way out I stopped and hugged one of the receptionists whom I've grown close to and told her quickly what happened and she looked at me in shock and said she'd call me.
I've been seeing this dentist for so long. We joke together whenever I go. He's a very sweet guy. He's good at what he does, but I've had some odd things happen in my mouth over the years and he's had to look them up, especially the TN.
Can anyone help to explain his odd behavior so I can understand it? Maybe I would feel better.
Barb
Barb, Dentists in some ways have "the worst of both worlds" when it comes to chronic face pain conditions. They get minimal training in the assessment of neurological pain, but a lot of training in TMJ -- and in consequence, TMJ is probably over-diagnosed, and TN frequently missed. When I did demographic studies of 1800 of our members here on the site, I identified about 450 who associated the emergence of their pain with something a dentist either did or didn't do. Of the 450, only about a hundred dentists recognized what might be going on and referred the patient to a neurologist or pain specialist. About the same number did repeated unhelpful procedures trying to get rid of the pain, before the patient started looking for other doctors.
Dentists sometimes get blamed for causing TN with faulty injections of anesthetic directly into the Lingual nerve. And the medical evidence is pretty convincing for a connection. But certainly not all or even the majority of cases of TN are caused by dentist error. Sometimes there is genuine coincidence. But still Dentists get blamed, and sometimes even sued (almost always unsuccessfully). Whether your dentist ever has been sued would be a total conjecture. But it's conceivable that he is at least sensitive to the fact that there are things going on in the nerves of your face and oral cavity that he has ZERO training to understand. That deficit can put him and his practice at risk. And since your dentist seems like a nice guy, he could also be concerned that his ignorance could put you at risk.
A large number of dentists won't even do a routine tooth extraction these days. They instead refer patients to an oral surgeon. And it is not accidental that dental surgeons pay much more for their malpractice insurance, because they see people who have more complex conditions and issues. Though your dentist certainly didn't seem to handle your interview very well, I think he basically had your welfare in mind when he suggested that you see somebody else who might have more background in the issues you deal with.
Go in Peace and Power
Red
Oral surgeons don’t do crowns. They can do the implant but the general restorative dentist would do the crown.
There are programs that provide dental care to medically complex patients. You should ask your dentist to refer you to one of them, since they are usually by referral only. Otherwise, you could offer to sign a waiver of liability of some sort. Dentists actually get sued a lot, and the lawsuits have a higher chance of success than physicians from what I’ve heard.
My dentist is scared to do anything on me. He said that one of my teeth is at risk of cracking unless I get a crown but he won’t do the crown until “the nerve issue is resolved.” I’m scared to get more dental work anyway so I’m happy to just let it go…I just try not to chew overly hard foods (which I need to avoid anyway).
Toothache:
Thank you and Red for replying. First, to Toothache: My dentist is not an oral surgeon, just a general dentist. To both of you I'm wondering if you read what I kept repeating - this same dentist already did a crown AFTER I had TN and he knew that and he knew it was right next to the "culprit socket" (where an oral surgeon removed a tooth, and where the pain erupted). That crown was put in so my face would not cave in and was done so at my request.
He never told me until now that on the bottom where I was awaiting a crown my face could have caved in and I definitely need a crown there. This is the one he won't do. I have no problem with his doing this one at all, none whatsoever, absolutely zero. But he refuses to do it.
So, if it were the first one I could understand his fear of a lawsuit or like you said, Toothache, he could have me sign a waiver, but it's not, so I need to find another dentist. I will have to upfront tell whomever I find what I have and if they are comfortable working on me. My current dentist is actually trying to think of another dentist for me (his receptionist told me this) and nothing was said about referring me to a program that provides dental care to medically complex patients. Do you know where I could find this? I live in St. Louis, Missouri.
Thank you Red and Toothache.
Toothache said:
Oral surgeons don't do crowns. They can do the implant but the general restorative dentist would do the crown.
There are programs that provide dental care to medically complex patients. You should ask your dentist to refer you to one of them, since they are usually by referral only. Otherwise, you could offer to sign a waiver of liability of some sort. Dentists actually get sued a lot, and the lawsuits have a higher chance of success than physicians from what I've heard.
My dentist is scared to do anything on me. He said that one of my teeth is at risk of cracking unless I get a crown but he won't do the crown until "the nerve issue is resolved." I'm scared to get more dental work anyway so I'm happy to just let it go...I just try not to chew overly hard foods (which I need to avoid anyway).
Hi Barb,
I'm sorry, but I don't know if your city offers such a program. It may be that your dentist thinks that you're too challenging of a case. It would be worth it to find someone with more expertise. 35 years is a long time to be seeing someone - I'm guessing that this guy is close to retirement. At his age, he might be trying to cut down his hours and the patients that he'd first want to get rid of are challenging cases like ours. We are time consuming patients and there are higher risks of complications.
You seem hurt and angry, and I would be too in your situation. After so long, you probably think of him as a friend but he doesn't seem to regard you in the same fashion. I hope you can find someone more qualified and caring to take care of your teeth. Are there any good dental schools close to you? Sometimes the faculty and residents run clinics out of universities. That might be a place to start.
Thank you for all that you said. You made me feel better. Maybe I was too challenging for him and take up too much time. You're very smart, Toothache! You (and everyone else) do not deserve the pain you have!!! Washington University has a dental school (and that's a pretty good school!) - I could start there. Thanks for that idea. Not terribly close to me, but maybe they could help in my search.
Toothache said:
Hi Barb,
I'm sorry, but I don't know if your city offers such a program. It may be that your dentist thinks that you're too challenging of a case. It would be worth it to find someone with more expertise. 35 years is a long time to be seeing someone - I'm guessing that this guy is close to retirement. At his age, he might be trying to cut down his hours and the patients that he'd first want to get rid of are challenging cases like ours. We are time consuming patients and there are higher risks of complications.
You seem hurt and angry, and I would be too in your situation. After so long, you probably think of him as a friend but he doesn't seem to regard you in the same fashion. I hope you can find someone more qualified and caring to take care of your teeth. Are there any good dental schools close to you? Sometimes the faculty and residents run clinics out of universities. That might be a place to start.
Thank you Barb, you're too kind. No one deserves having this, I agree. My pain is much better. There are actually dentists who specialize in TN and related facial pains. I've seen some of these guys and they've helped me a lot - they know more about this than many neurologists.
You deserve to see someone more qualified who is confident in helping you. Wishing you all the best!
LoveLexi said:
Thank you for all that you said. You made me feel better. Maybe I was too challenging for him and take up too much time. You're very smart, Toothache! You (and everyone else) do not deserve the pain you have!!! Washington University has a dental school (and that's a pretty good school!) - I could start there. Thanks for that idea. Not terribly close to me, but maybe they could help in my search.
Toothache said:
Hi Barb,
I'm sorry, but I don't know if your city offers such a program. It may be that your dentist thinks that you're too challenging of a case. It would be worth it to find someone with more expertise. 35 years is a long time to be seeing someone - I'm guessing that this guy is close to retirement. At his age, he might be trying to cut down his hours and the patients that he'd first want to get rid of are challenging cases like ours. We are time consuming patients and there are higher risks of complications.
You seem hurt and angry, and I would be too in your situation. After so long, you probably think of him as a friend but he doesn't seem to regard you in the same fashion. I hope you can find someone more qualified and caring to take care of your teeth. Are there any good dental schools close to you? Sometimes the faculty and residents run clinics out of universities. That might be a place to start.