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procedure for multiple fillings on immunocompromised patient

User Level:
Patient
Posted by: sophieseyes  (6 years ago)
I went to a new dentist and was told that I have 9 cavities that developed since my last dental ck up six months ago according to xrays (last xrays also 6 months ago). I have lupus and am on serious immunosuppressants, which I told the new dentist. He gave me antibiotics to take before the first filling appt for the first 3 fillings. My question was about how he went about the drilling and filling. He drilling everything out, then left me with everything open for about 20 min while he worked on another patient. Then he came back and filled everything all at once. I was surprised because I had always had fillings done one at a time in the past: drill/fill, drill/fill... When I inquired, the dentist said this was "more efficient". I haven't had fillings in years. Is this the new way of doing things, or did I just get a new dentist that is an assembly line operator? Is there any risk of infection with the tooth being left open for 15-20 minutes?
User Level:
Dentist
I went to a new dentist and was told that I have 9 cavities that developed since my last dental ck up six months ago according to xrays (last xrays also 6 months ago). I have lupus and am on serious immunosuppressants, which I told the new dentist. He gave me antibiotics to take before the first filling appt for the first 3 fillings. My question was about how he went about the drilling and filling. He drilling everything out, then left me with everything open for about 20 min while he worked on another patient. Then he came back and filled everything all at once. I was surprised because I had always had fillings done one at a time in the past: drill/fill, drill/fill... When I inquired, the dentist said this was "more efficient". I haven't had fillings in years. Is this the new way of doing things, or did I just get a new dentist that is an assembly line operator? Is there any risk of infection with the tooth being left open for 15-20 minutes?

There is nothing wrong with doing fillings this way. The surprise is he did not use a rubber dam while doing your fillings. This reduces inhaled bacterial burden in an immunocompromised patient like yourself.

I would also avoid leaving and interacting with another patient before returning to treat you. However, the increased risk is probably trivial.
Posted 6 years ago
User Level:
Patient
Posted by: sophieseyes  (6 years ago)
Thank you so much for your reply. I have not heard of a rubber dam and this was my first experience with fillings in many years so I will definitely insist on this for the future. Would you have any recommendations for any follow-up testing or care/changes based on these dramatic changes in my mouth? The only change recommended by this dentist was to start using floride mouthwash twice a day, which I did immediately. My meds have not changed at all in several years so I don't know how that could be a factor. Is there any way to determine the culprit behind the decay?
User Level:
Dentist
Thank you so much for your reply. I have not heard of a rubber dam and this was my first experience with fillings in many years so I will definitely insist on this for the future. Would you have any recommendations for any follow-up testing or care/changes based on these dramatic changes in my mouth? The only change recommended by this dentist was to start using floride mouthwash twice a day, which I did immediately. My meds have not changed at all in several years so I don't know how that could be a factor. Is there any way to determine the culprit behind the decay?

Possible causes of your decay:

Acid reflux from stomach.
High soda pop or other sweetened beverage consumption.
High sweet intake.
Mouthbreathing may be a contributing factor, as could be decreased salivary flow.

A prescription fluoride gel brushed on before bed, without rinsing afterwards is a good idea.

The ultimate protection from caries would be to fabricate plastic trays (similar to bleaching trays) to fill with fluoride gel and wear each night during sleep. If you wear these every night, it is practically impossible to get new decay.

Some dentists are just too lazy to use rubber dams, even though it was invented over 100 years ago. When decay is deep under the gums, rubber dams cannot always be used.
Posted 6 years ago
User Level:
Patient
Posted by: sophieseyes  (6 years ago)
thank you again dr. henry for your very informative response! the hygenist actually asked the dentist if I should get "fluoride trays" and he said "not at this time" to try to mouthwash first. However, with such a dramatic change in such a brief period was very alarming, not to mention the expense of all of the dental work. I already wear a mouthguard because of grinding my teeth so I would not think trays would be that much of a transition. I was not aware that there was also a fluoride gel to brush on, as opposed to just the mouthwash. I am a healthy eater and don't drink sugar drinks. I have been having some stomach pain even tho I am on a PPI but it never occurred to me that could have an impact on my teeth...DUH. I will be sure and discuss this right away with specialists who prescribed it and let them know about the dental issues. Will also discuss the dry mouth side effects (which I have and just ignore) of my immuno drugs w those docs and these new dental issues. You have been wonderful. Wish you lived in my area!
User Level:
Dentist
thank you again dr. henry for your very informative response! the hygenist actually asked the dentist if I should get "fluoride trays" and he said "not at this time" to try to mouthwash first. However, with such a dramatic change in such a brief period was very alarming, not to mention the expense of all of the dental work. I already wear a mouthguard because of grinding my teeth so I would not think trays would be that much of a transition. I was not aware that there was also a fluoride gel to brush on, as opposed to just the mouthwash. I am a healthy eater and don't drink sugar drinks. I have been having some stomach pain even tho I am on a PPI but it never occurred to me that could have an impact on my teeth...DUH. I will be sure and discuss this right away with specialists who prescribed it and let them know about the dental issues. Will also discuss the dry mouth side effects (which I have and just ignore) of my immuno drugs w those docs and these new dental issues. You have been wonderful. Wish you lived in my area!

Depending how much your mouthguard extends over your teeth, you may be able to put fluoride gel inside the mouthguard, and it will act as a fluoride resovior during the night. It would afford some protection, but no as much as custom fluoride trays.

Unfortunately, it is not possible to wear fluoride trays and a mouthguard at the same time. It is either one or the other. If you are night grinder, fluoride trays provide some protection from tooth grinding, but you would probably wear through the fluoride trays fairly quickly.

It sounds like your dentist is wise and has your best interest in mind.
Posted 6 years ago
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