Wednesday, March 9, 2016

The Seven-Week Ordeal

Don't you just hate it when the littlest things in life misbehave and just kick you in the butt?! The latest case-in-point just came to a conclusion today, but began 7 weeks ago! I was flossing before bed one night in January, and one of my crowns popped off. I was thinking that my dentist could just glue it back in, but Dr Chang pointed out that the little stump it was glued to came off with it, so that couldn't happen... I needed to go to an oral surgeon for a "crown lengthening", trim away the gum line and remove some underlying bone to expose more of the tooth to hold a new crown securely. Sounds fun, eh? At left is shown the offending crown that broke off. No response from the tooth fairy - I guess she's not responsive to fake teeth (crowns)!

So I make an appointment to the recommended oral surgeon - of course, 2 weeks away. In the meantime, no chewing on my right side. Finally the day comes - consultation only, it turns out. It also turns out that I've been there before - a good sign as I recall none of it! Evidently I was there 10 years ago for the same procedure on the tooth in back of the one he is working on this time! He said the job was no problem, appointment was 2 weeks away.

Turns out those 2 weeks were needed. Since I'm on blood thinners (artificial heart valve), I need to be off them for the minor surgery. The gold standard is to go on Lovenox for a few days before to bridge my being off Coumadin. While my drug store stocked it, insurance wouldn't pay it unless it came from Walgreen's Specialty drugs from somewhere in Texas. But to get it, the script from the surgeon that went to CVS somehow had to go through the clearinghouse in Columbus, Ohio to the distribution in Texas. It came the day before I needed to start taking it! Close call!

Surgery day came, my INR (measure of blood clotting) was right where the doctor wanted, and the procedure went fine. He used Versed for the anesthetic - same as used for colonoscopies too. So I was awake, but mostly out of it. Melinda came along to drive me home later - all was well. Until the next day... I had started my Coumadin back up, and sometime on Thursday, the tooth, which was well-packed under gauze and tape, started bleeding and wouldn't stop. Not gushing, but steady enough to have big clots of blood in your mouth every 10 minutes. Hard to sleep through the night that way, but showed no signs of abating, so back to the surgeon, where his assistants worked on me (he was out at some insurance meetings). She got it to slow down if we packed rolls of gauze and I bit down hard, so left it at that - after she supplied me with what seemed a case of gauze! Still bled into Friday, when I involved the INR clinic at the hospital. She had me stop taking the Lovenox after my Friday morning dose and that is what did it - full bleeding stop on Saturday - no more issues. Saw the surgeon a week later - I was fine and he okayed 3 weeks to a new crown.

So today was new crown day! For a fan of technology like me, getting a crown is kind of fun these days. A decade ago when I had my first one, it was the 3-week wait for the permanent crown to come back from the lab. These days, there is a new computer-driven system called CEREC that maps out the tooth with a 3D camera, the dentist designs the tooth on a computer CAD (Computer Aided Design) program. And a little diamond milling machine cuts it out of a block of ceramic in the room next door. After a test fit it is baked in a high-temperature oven and it will be harder than your original teeth! And it usually takes about an hour for the entire process! At left is shown the screen where the dentist designs the tooth to fit the stump below, and at left is the typical fit into place.

New Crown in the Middle
The last one Dr. Chang did for me took 57 minutes! This time we started without anesthesia, but I had some twinges, and he saw another patient for 15 minutes while the novacane took effect. As a result it took about 90 minutes, but better than a 3 week wait.  Oh, and the best part as he said goodbye - since the crown that came off was put on just 3 years ago, he didn't charge me the normal $500! What a guy!  And his last words - don't chew on your right side for 24 hours! Can't wait for tomorrow!

1 comment:

Anonymous said...

seems like an implant would have been better than gum trim and new build up with a warfarin pt. oddly, i too had a very old 28 yr old crown come loose on the bottom left and had re-gluing Monday. but the tooth in front of that had a problem several years ago and I ended up with a choice. i chose implant, actually very simple multi step procedure and also on eliquis for a fib. Insurance run around and rx run around is the state of medicine these days. doesn't matter if one is employed in health care....same run around even when paying premium prices for high end health care. spent much of the day on the phone today for needed procedures trying to get best in network options, too much red tape, too much hoop jumping. I feel for those who haven't the stamina to be a self advocate, or who are unable. So dysfunctional and so very messed up. doesn't matter if you have worked in healthcare for 40 yrs. insurance companies have become the enemy of anyone wanting to "obtain health care" oh no they don't really want you to >use it just want you to >have it! just sayin'