Up-date

[Jaquta]

Dear Dr Tsang

Just an update.  I went to the dentist yesterday and although my teeth are a big mess he is just going to leave them and continue to monitor them.  He said that filling them could put them at increased risk (due to infection, etc).
The toothbrush abrasion is really bad and I was expecting to have a number of them filled.  I'm relieved but still anxious.
I have also been having acidity problems due to binge eating (yes, still) so was given some tooth mousse.  Hopefully this will help remineralize my teeth.  I didn't think that that was possible but I am desperate and beyond caring.

I was told that there is pitting in (?several of) my teeth.  Hopefully that isn't bad and turn into cavities.

I asked him about the possibility of needing dentures.  He didn't want to go there.  Not sure if that is reassuring or not.

Anyway, that's where I'm at with my teeth.

[Jaquta]

Me too.  There may be a medical reason why I feel so tired and run down.
Ironically I was going to ask my doctor about tooth loss when I saw him last week.  It was a bit stressful going to his new surgery (new purpose built health community) and I forgot.  I never expected my tooth to break though.

I have an appointment for Monday 12 pm.  Was Tuesday and then Wednesday.  Sounds like during his lunch break now.  Maybe he'll just smooth it off.  Someone said he might build it up.  ??

I guess it concerns me as it seems to concern my dentist.  Maybe, if there is time, I can follow this up with him.

I need to go. My mother is harassing me.  My brother and his girlfriend are here and they're just getting ready to go and see my sister and nephew.
I'll let you know the outcomes after Monday.

Have a good weekend.

[Jerome Tsang, DDS]

Wish you were doing better.  Ya, it seems to be a tough patch you're going through still.  You should take care of your tooth though since I don't know how the break is and you definitely don't want it to continually break or create any further problems.

I'm not sure about the blood blisters on your cheek.  It may be due to cheek biting but that tends to end up looking very callous and white and rough due to the constant wear and tear of chewing on it.  Perhaps another referral to an oral pathologist if its a concern of yours?

I can't comment on that concerns part cause I don't know what was exactly discussed but ya, usually the patient's concerns and what they say can give you the diagnosis without an examination.  I wouldn't say I could be your dentist over the internet just based upon what you describe but what you say does provide alot of information, more than just looking or an x-ray.

[Jaquta]

Yeah, bummer aye.  I just don't get it.  Besides the poor nutrition I feel as though I have done everything in my power to maintain good healthy teeth.  Self-recrimination doesn't help now though.

I'll call my dentist tomorrow.  I thought that it looked like a clean break (has broken straight across).  It looks like 2-3 mm off the bottom of my tooth.  It looks like a lot, especially when compared to my front tooth.

I guess I was very ignorant about dental issues.  Not surprising when my father brushes his teeth like once a year and my mother isn't too bothered by the state of hers.
We were always given hard toothbrushes as kids and I didn't know that this was harmful.  I also didn't realize that excessive brushing was harmful either.  I always brushed my teeth when leaving the house.

Regardless of what it was or wasn't I still feel the dentist had a responsibility to advise.  Didn't you also say that the dentist is somewhat guided by the patients concerns?  If this had of been adequately addressed then perhaps it could have prevented further tooth loss.  ??  Maybe it is an unfair comment.  It is hard to accept responsibility when it is likely due to a health issue that is/ was beyond my control.

I checked out the web address you provided.  The packaging looks the same so I expect it is the same product just different name.

I think my brain must be on holiday.  I had a box with the tube in it and it had instructions.  They always help -well most of the time anyway.  So I brush with the fluoride toothpaste and then apply the mousse/ paste.  It has about eight indications for use.

When I binge eat I get blood blisters on my cheek.  Maybe that is due to biting.  My dentist thinks it's a stress habit but I think it's something that happens when I binge.

Really not looking forward to revisiting the dentist, especially so soon after my last visit.

I saw my doctor today and was so stressed I wouldn't even let him examine me.  I think having someone look and work in your mouth is even worse.

I was just thinking earlier how my quality of life had deteriorated.  Subjectively I would rate it at about 1%.  Having this happen and needing to have it seen too is overwhelming.

Thank you for the advice and info.

J

[Jerome Tsang, DDS]

http://www.mi-paste.com/apply.php

Is this what you're talking about?  It seems that you should apply it at the end of brushing and allow it to sit for 3 minutes.

[Jerome Tsang, DDS]

A part of your upper tooth broke today huh?  That should be repaired as soon as possible because any unsmooth surface can be a plaque trap and result in a cavity or further damage.

Gum disease and erosion don't usually go hand in hand.  You can have one and not the other but if there's erosion, there can be some damage to the gums as they recede from the injury.  

I don't think any particular order is important but I would say floss, then brush and then rinse with a mouth wash.  As for the GC tooth mousse, I'm assuming its MI Paste from GC?  I believe its a replacement for toothpaste so you would use that instead of toothpaste but I could be wrong.  I know you can apply it with a polisher after a dental cleaning to help with sensitivity.  I don't actually have any MI paste right now.  Let me see if I can find out more online from the actual manufacturer.

Scarring?  I don't imagine that binge eating would cause the scarring.  It may be cheek biting?  Or perhaps lichen planus from a medication?  

[Jaquta]

I have just noticed that one of my upper front teeth, ? tooth # 7, has broken off today.

I was just wondering if you could clarify order of dental routine for me.
I usually floss, then brush and then sometimes use a mouthwash (was concerned about risk of oral cancer.  Not sure if that concern is valid or not.  My dentist said to use it sparingly.)  On the back of some dental hygiene products the order is: brush, floss then rinse.  I guess that makes sense.  If using a high fluoride toothpaste it doesn't seem to make much sense, to me at least, to then use a mouthwash.
My dentist also said to use GC tooth mousse (not sure if that works or not).  When would you consider to be a good time to use this?  In between brushings?

My dentist was also showing his assistant all the scarring on the inside of my cheek.  Is that that unusual?  He was saying something about it being white and iron deficiency.  I sometimes get blood blisters there, especially when I have been binge eating.

Don't feel obligated to answer any of my questions.  I guess I just needed to mourn the loss of that part of my tooth (and I know from experience that you listen).

[Jaquta]

Sorry if I confused you.  I don't want all my teeth ripped out, I'm just anxious I will lose them due to the toothbrush abrasion, etc.  I wish I were able to turn back the clock.

I guess I'm just worried that my teeth will break off or any other number of worst case scenarios.

I asked (my dentist) a while back about gum disease, because I thought that was what the tooth erosion was, and I wasn't given any advice at that time.  I guess I just feel angry and frustrated.  I would like to be given preventative advice sooner rather than later.

Just going through a really bad patch at the moment and my perceptions and beliefs about my teeth aren't helping.
I guess I'm just frustrated with everything.  Everything just seems so messed up.

Thanks for taking the time to respond.

[Jerome Tsang, DDS]

Ya.  I wouldn't go down the denture route until absolutely necessary because nothing can really replace your natural teeth, especially a denture.  

It would be best to preserve what you have and monitor the situation if that's what your dentist feels is best.  Sometimes by treating the situation, it can make it worse and cause pain or infection and require extraction or a root canal.  On the other hand, leaving it alone can allow it to progress to the point where that exact treatment is needed anyways.  Its a tough judgement call and at this stage, I'm assuming your dentist knows best by monitoring it.  Perhaps he feels if you can control all those other factors, it may not progress much at all and it can be treated only when necessary instead of  creating more potential problems later on.