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Dr. Katz
Dr. Katz, Dentist - DDS
Category: Dental
Satisfied Customers: 2976
Experience:  Dentist and Anesthesiologist for 35 years.Anesthesiology Fellow-Johns Hopkins School of Medicine.Evaluator for Maryland State Board of Dental Examiners.
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I was part of a drug trial new anti depressant and it ruined

Customer Question

Hi. I was part of a drug trial for a new anti depressant and it ruined the inside of my teeth so parts of the outside that looked fine started to come off. The pharm company is paying to have all of my teeth extracted and then will pay for dentures and later implants. I had an examination with a dentist who wrote the referral to an oral surgeon to have the extractions done. All 27 teeth will be removed at once. Is this usually atraumatic? Also sedation would have to be sent to the insurance company on the day of the extraction and I would have to reschedule so they are just using nitrous oxide and a numbing agent like novocaine. Can I expect the extractions to be painful during the surgery and will I have pain after the extractions? Since I have not been able to talk to the oral surgeon I don't know what to expect and the dentist told me that ibuprofen should be sufficient afterwards but I am unsure. I'm scared that it will be extremely painful afterwards.
Submitted: 7 months ago.
Category: Dental
Expert:  Dr. Katz replied 7 months ago.

The extractions themselves should be painless but you will be aware of what is going on even with nitrous oxide.Normally we like to do these cases under IV sedation because it is more comfortable for patients and it reduces the stress.If you cannot go this route,the teeth can be extracted with local anesthesia and nitrous oxide.Make sure that you let the dentist know if you feel anything more than just pressure.Afterwards,there will be some discomfort and slight swelling for about 3 to 4 days.They should prescribe you an antibiotic like penicillin,amoxicillin or clindamycin for you to remain on for one week.Insist that they give you an antibiotic.They should also be giving you a narcotic pain medication like Percocet,Lortab or Vicodin.You will find that you need these medicines for the first few days.It is important that you do not brush or rinse your mouth after the extraction or smoke for 24 hours.Following these instructions and an experienced surgeon should give you a speedy recovery.Do you need any more details?

Customer: replied 7 months ago.
Thank you for responding. I've heard of those antibiotics. My regular dentist gave me 40 Clindamycin 300mg tablets to start taking when I saw her and the pain medications I have heard of those names but the oral surgeons office said I should only need ibuprofen. If that won't be enough I am getting very nervous about having the procedure. Is tooth extractions usually traumatic or atraumatic and they said it should take 45 minutes to get all of them out. Does that sound reasonable? I understand you have not examined me. It is very hard to get any answers from the oral surgeons office (I have not met the surgeon). There is one tooth that broke and is below the gum line do they have to cut the gum to get that out?
Customer: replied 7 months ago.
I've had to beg my regular dentist at times when one tooth was really killing me to come in every day to get a Marcaine shot because ibuprofen was not working. She was very hesitant and said the oral surgeon should be dealing with it (when the appt is 15 days away) The oral surgeons office said the dentist should be dealing with it. It goes backwards and forwards.
Expert:  Dr. Katz replied 7 months ago.

The oral surgeon is not the one having the extractions done.From my experience,and I remove teeth gently,most patients need a stronger pain medicine for a couple of days.If your oral surgeon refuses to do this,find a new oral surgeon.I cannot comment on the difficulty of your extractions without your xrays,but for 27 extractions including sewing up and trimming,the whole process should be less than 1 1/2 hours.I think that you need to find a new oral surgeon if possible.I have never heard of setting up an appointment with an oral surgeon for the extractions without even seeing the oral surgeon.The correct sequence here is to see the oral surgeon,have a full exam,he describes the procedures and you ask questions.Then you set up the appointment.

Customer: replied 7 months ago.
It is interesting. I saw a regular dentist she did the xrays and an exam. She stated they are beyond repair. She then writes a referal stating "Hey Doctor XXX, Hope you are doing great. Can you please remove everything. Pt will be getting a full set of dentures and then implants. Thank You Dr. XXX. She marked Extract and circled all the teeth. Checked the Consult box. She then submitted for dentures to the insurance they approved it. The Oral surgeon got my xrays from her and made sure the procedure to extract was covered. They dentist and surgeon are not affiliated and are not in the same office. The procedures have been prior authed by the oral surgeon to the insurance. The dentures have been authorized by the insurance company for the dentist. They cannot change it without great difficulty. The pharm. company will take care of the implants later. Is there anything else I should know? Is nitrous oxide at all dangerous? How does it make you feel?
Expert:  Dr. Katz replied 7 months ago.

Yes , implants are not a necessity and many people do just fine without them.Nitrous oxide is not dangerous.It never gets absorbed in the body and leaves as you breathe oxygen.The nitrous oxide just gives you a relaxed feeling and a feeling of euphoria.An appointment to have all of you r teeth extracted should always be preceeded by an examination by the oral surgeon who is going to do the extractions.If they will not do this,I can assure you that you can have this procedure done almost anywhere and the insurance company will cooperate.You should never feel that these people are the only ones that can do this procedure.When it is done,it should be done properly.If they will not give you a consult appointment with the surgeon prior to the extractions,that is a danger sign.Find a new office if that is the case.

Customer: replied 7 months ago.
Hypothetically why would an oral surgeon not want to meet with the patient before doing a heavy involved procedure? Again hypothetically. What is a danger sign of?
Expert:  Dr. Katz replied 7 months ago.

Any doctor doing surgery of any kind needs to examine you before the procedure is done.That is just common sense and good medical practice.The only reason that they would not is because they think they are using less time and less time means for you means more money for them.If you are dealing with a corporation based dental office,this is the kind of crap that they would pull. You need to call and insist on meeting with the surgeon that will do the extractions.Do not take no for an answer.If they refuse,find a new office.I am being honest with you.You can take my advice or not.It is up to you.

Expert:  Dr. Katz replied 7 months ago.

When you get a chance,can you please leave a rating so that we can maintain good quality control on this site.Thank you and good luck with your surgery.