A 28 year old patient comes in at 1AM for a toothache. Well, it really isn’t a single tooth – all his teeth hurt. Upper gums and lower gums. Everything is sore. And he can’t sleep at all. He was seen in the ED a couple of weeks ago for a “tooth abscess” and was given a prescription for antibiotics and Vicodin. Unfortunately he was now out of both.
“OK, so how long has this been going on for?”
“Since I was seventeen.”
“Wait a minute. You’ve been having toothaches for 11 years?”
“Yeah. I take antibiotics and the abscess goes away, but it comes right back when I stop taking the antibiotics.”
A quick look inside his mouth reveals multiple black tooth remnants and a moderate case of smoker’s breath, but no abscess.
“All the other ER doctors tell me I have an abscess and send me home on antibiotics and pain medications.”
“You’ve just got really bad teeth. You’re going to need to see a dentist to get these teeth pulled.”
“I tried, but no dentists will see me because I don’t have insurance.”
“In eleven years?”
“Yeah.”
I considered giving him a simple lesson in economics about how saving a dollar a day for the next year would probably give him enough money to have his teeth pulled next year, but neither one of us was in the mood. I shot up his gums with Marcaine (longer acting anesthetic) so he could sleep and sent him home on Motrin.
Am I now a bad person?
 An Eleven Year Tooth Abscess?28 Responses to “An Eleven Year Tooth Abscess?”Leave a Reply |
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Why you evil person! How dare you expect that this man should be ultimately responsible for himself!
Gross. Has this guy ever seen that new invention, the toothbrush?
In all fairness to bad-teeth people out there, there are some very valid reasons for terrible teeth other than poor hygiene or meth use.
My youngest daughter, age 8, has had 2 root canals this year on her primary molars. She has a condition called enamel hypoplasia. She will also need more crowns on her baby teeth to hopefully protect her adult teeth now forming (iffy, at best due to the enamel, but we’ve got to try). With this condition, the enamel basically crumbles away bit by bit.
My oldest daughter has perfect chompers, not one filling.
Go figure.
As far as the abscess goes, I think this guy might be telling you the truth. An endodontist (or a general dentist) is not going to do any work while there is an active infection, antibiotics on board or not. So, he’d have to time everything perfectly in terms of antibiotics, consultations and treatment dates.
FWIW, our endodontist charged 980.00 for the ONE root canal and that does not include the crown. She has to return to her pediatric dentist for the crown portion which will be another 500.00 or so.
When I was eighteen I was working as a printing press operator and the guy next to me used to smoke 3 packs of reds a day and drank three or four 1 liters of Mountain Dew. One day he had a tooth ache, and reached in pulling out a fragment of rotten tooth. I was appalled and I told him he needed to go to the dentist. He informed me that he didn’t need any dentist and boasted that he hadn’t been in seven years. I resigned within the month. Sadly he wasn’t the only one at the company that shared his hygiene skills.
At least he doesn’t think he’s got a tooth abcess anymore.
well you can’t blame someone for not having insurance…
Nope, you are not a bad person. Sometimes, people just have to take responsibility for themselves. The fact that this one didn’t is no reflection on you.
No not a bad person. Obviously he has dental issues but if he is getting used to the pain meds then how will he have incentive to go get the help he needs?
Unfortunately dental work is very expensive and if you are fortunate enough to have dental insurance it still doesn’t cover as well as health insurance although there are varying degrees.
Our ED has recommended such pts go to the dentistry teaching clinics although a lot of those pts don’t have transportation either.
It is sad too when someone doesn’t have money for cosmetic dentistry and have to go around sporting an obvious missing tooth.
BTW…would he just come back every 2 weeks for more meds? Your ED popularity stats would skyrocket!
No, you are not a bad guy. I understand your frustration though. I also understand this guy’s ‘minimalist’ approach to his own care. He does not know better. I was there once.
I was cursed with bad teeth. It is in the genes. When I was a young adult without insurance I lost two molars to the “just pull ‘em, I have no money.” Less than $50 each visit. A bit older and liking my beef steak, I went to a dental teaching school and let the undergrads work on me. Pricey for me at the time but I saved a few.
Going to a dental school to help provide education to students at a reduced cost is something I had not even considered. I’m going to look up the dentistry schools in the area and add those to the list of referrals we give out. Thanks for the idea!
I had a similar problem in that my teeth went bad from the inside out. I had to replace the uppers before I was 25. Unfortunately, in my state if you have Medicaid (in my case coupled with Medicare) a dentist cannot bill you for work done. So most of the dentists will not take a new patient if they are on Medicaid. The nearest dentist to me who will take Medicaid is 200 miles from here. So I’m basically screwed. I know I’m not the only person around here in that situation. This is truly the downside to rural life.
This patient is not a bad person just for having bad teeth, and berating him for not taking responsibility for himself is probably unfair.
Most people suffering from multiple decayed teeth just don’t have enough money to fix them appropriately. Dental treatments are extremely expensive.
When I was a teenager my family was very poor. When I developed several cavities I went to see a dentist. Supposedly friends of my parents recommended him. The guy proved to be a quack, a criminal. In less than three months all the fillings developed infections underneath, right into the root. The pain I had to endure was incredible. The ?=)=(/#~!! did it on purpose, just for me to return for another round of dental work and more fees. I ended up losing several pieces (with a better dentist) that should have remained sound for years.
Dentists often subject patients to needless suffering and total teeth loss just to swell their bank accounts. Shame on them.
My youngest daughter, age 8, has had 2 root canals this year on her primary molars. She has a condition called enamel hypoplasia.
Tell me about it.
There are now some coatings the dentist can apply to newly erupted teeth that help, but she’s gonna have a long expensive road.
I’m 62 and am on my third set of crowns now, on all my teeth. The glue fails after 20 or so years, there is decay under the crown and it all has to be done over, sometimes with root canal and this time with some extractions, titanium studs and gold/ceramic teeth.
She and your bank account have my sympathy.
Funny how Medicaid will cover someone who would rather put the government on the hook for $500 because they don’t want to pay out of pocket for a drug store pregnancy test (re your next post), but there is absolutely no support for people with legitimate dental problems. I’ve seen tons of people who present with toothaches and we really can’t do much more for them than give them a scrip for pain meds and refer them to a dentist which they prob’ly can’t afford in the first place. Either that, or the dental college.
Of course, if they let it get to the point that it requires oral surgery, it suddenly becomes a (very expensive) medical problem and will be covered.
A person I once knew thought he would have to pay US$1200 for a dental problem. Goes to Bulgaria with his wife to visit her family, another dentist there said he could do the same operation for $80 in our money. Friend has no problems to this day he told me.
Hi Whitecoat,
At the outset of winter each year I would have a gum abscess flare up under the current weaker side – could be left or right.
I had teeth pulled because of it left, right and centre. After I had four teeth pulled on the left lower side an eruption started on the right side.
During Remedial Therapy training I made a conscious decision that the lymph system was the most influential management tool for correcting muscular disorders, organ disorders, head and brain disorders.
Tight neck passages restrict neural, hormonal, spinal, vascular and lymphatic circulation.
The lymph nodes block and sinusitis, memory loss, gum disease etcetera, manifest themselves courtesy of stagnant circulatory systems.
When I first started self massge of the neck with a massage machine I bought, the gum disease started flaring up quite haphazardly. I’d dig the point into the lymph nodes under the jaw and slowly lymph movement started improving and the jaw rehabilitated to where I am today – no hot or cold sensitivities – no debilitating toothache.
The teeth have just kept breaking down where excess drilling had undermined the structure of the tooth and I’ll lose a point every six months or so. My plan in about five or ten years is to have stem cell transplants to grow some beaut little baby teeth at about 70 years of age – aint science great.
With this lymph management program I am now able to side step toothache, the toxic lymph environment at the root of the teeth where tooth decay starts.
I hope this helps someone.
Francis
I have been seeing a dentist, and two specialists for my abscess. I have been waiting two months to have the tooth pulled and in pain every night. I already had a root canal on the bad tooth and now I am going to lose it. So how the heck can really poor people pay all this money!!! I had to take it from my now non existant savings account. Total as of today 1600, plus another 300 to have it pulled!
I spent $1500 for a crown (not including insurance), $800 for a root canal (not including insurance), $800 for another crown to replace that which was broken during the root canal (yeah, not including insurance), and now that root canal has failed and I need to have that tooth removed and an implant inserted to the tune of approximately $4,000.00. My insurance will cover 10% of this cost. So I wait. In the meantime, stuff is oozing out of my gums, and my eye has developed a constant twitch. Today my tongue started swelling. I’m starting to feel like a freakish zombie. What makes me angry is the outrageous cost of this treatment and the fact that, even though I am paying high amounts for insurance coverage, the insurance barely covers the cost of this treatment. I wonder how much they’ll pay when the infection spreads to other parts of my body. I’m so angry with our (U.S.) medical system. My friend had the same dental problem as I and went to Mexico to have a bridge done (cheaper than just one crown) for about 80 bucks. This tells me that our U.S. dentists can pretty much charge what they want. This is wrong.
Yes! You ARE a bad person! Why didn’t you give the man a PCA pump, isn’t that why we are all here?? SERVITUDE, dammit……..we have to have GREAT PRESS GAINEY SCORES! (ps-is this Sumdood’s brother?)
What is with you people? The guy is obsiously in a lot of pain, the alone severly limits his rationality and ability to do anything constructive at all. I’m guessing he was probably homeless, shined up maybe to come in to better his chances at treatment and a script. Than goes out, buy some liquor to potentiate the pills cause Vicoden aint’ nothin’ for “moderate to severe pain” – like abcessed tooth pain, I don’t care what miss below the realm of believable tolerance says about “How can you take Vicoden – EUUIIIEEE.” He is also probably very tolerant to narcotics from the years of using (or as you would say abusing them), but at least he can maybe get more than a few hours sleep under the railroad tracks, and maybe enough food for the next day and after panhandling, invent a new invention that everybody must have like the microwave, use his change from the subway shakedown to patent it, start his own corporation and get some dental insurance for himself and the rest of the skid row as well out of the kindness of his heart. I understand how infuriating it is to treat someone you for whom you think simple answers would help if they would only listen, and the ER is no picknic when half the peopler there are for pain meds and have no insurance and you must treat them by law. But geez, have your hands grown that callous through sheer handling of patients? It is called burn-out. And yet you march on everyday and I admire that. But believe you me, should things ever go South, you lost your job, your investments shrink to nothing. YOu sell the house, the care and everything else not nailed down and it is still not enough to pay your premiums. Than you find yourself hovering around where this guy went down the drain. And these day it is perhaps not so far away as most would think. I also know people need to vent in all occupations, especially critical ones. But I would ask you remember the Joad family, and not everyone fits the “frequent flier” list you so highly down which I find left of insane and less than zero in the morality department. And all you can do is worry about some guy who got narcotics LEGITIMATELY and the MD ended up getting sued because he forgot to tell him he shouldn’t operate heavy machinery? Isn’t that on the freaking bottle. Get up! Stand up! For your rights and change this crap. Gut the med mal as it has been done in other states. My girlfriend died because her incompent Kaiser Permenente screwup physician removed the wrong lymph node for her cancer and refused to even examine her complaint later on about all the swelling under her arm. He is safe for now in Switzerland, but as I am eligible for Swiss citizentship now, maybe not.
Anyway, is it just me, or do you all come off sounding like a bunch of wealthy trustfund babies who go “slumming” on the job by treating such “distasteful and stupid” people?
It’s just you.
If he has money for cigs, he has money for a dentist.
To the person that posted:
Gross. Has this guy ever seen that new invention, the toothbrush?
I think that is a very harsh statement. I too had a tooth infecttion that I had to leave untreated for a extensive amount of time. It was horrible and dental insurance only paid a fraction of the cost in the end. The cost of dental care is insane. The worst part is I have great oral hygeiene.(My husband says that I am compulsive with my teeth as I brush a minimum of five times a day) I was shocked to discover I had such bad teeth. Please do not pass judgement you can;t imagine how horrible it is to suffer with a tooth infection and how embarassing it is.
Oh yuk
we have endless ‘ dental pain’ patients though my ED.
And they all reckon they have no money and can’t afford a dentist – shame they didn’t hide those ciggies away before they came in the door
“f he has money for cigs, he has money for a dentist.”
Of course, because, as we all know, a root canal costs about the same as a carton of Marlboros…
Riiight.
If you’re burned out and dislike your job, then move on. I understand that we are all human and we all get tired, but does that really constitute using assumption to pass judgment on someone, without even really knowing ANYTHING for a fact about this person?
I am in my 20′s now and have had some tooth and gum issues which started only a few years ago. Before that, I never had a single cavity. I brush and floss multiple times daily. Still, I have the tooth and gum problems.
I work full time and attend college. I do not have insurance available through my employer. I am not eligible to receive any state (or otherwise) benefits. I have a son to provide for and all the usual “cost of living” bills to pay. I don’t make enough money to save even a dollar a day. So, where does this leave me and my teeth?
In pain…
…a lot of pain.
It makes me so sad and embarrassed. I had such great teeth. Now, I can only become frustrated and panicked as my once great teeth get worse… and I can’t do a thing about it.
You can;t see all tooth abscesses. If he were in pain they probably WERE infected. Cheaper to get antibiotics and what a dentist would give anyway as first step in treatment
I have to say in all fairness i live in canada and if i got shot it would cost me nothing other than the cost of aftercare pain meds and antibiotics.
However for some reason it seems the govt thinks its perfectly ok to neglect dental need. I can understand cosmetic dental being at our own expense but some of us just cant afford dental. The cost of cavitiy filings and cleanings and xrays is expensive especailly for those who dont have a full time job or work multiple jobs to make endd meet and dont have dental coverage.
I knoe becuz im one of them. Ive had an abscess for six years becuz i live check to check and cant afford dental.
Tomorrow im getting an extraction. I hope ppl can have some sympathy for those who may just be in a bad situation. The crazy overhead prices makes it difficult for the working class to havr dental period.
I also have had an absess for about 1 and a half years and no one will see me either because of no insurace. How can I? should I just show up to the hospital or something? I do brush my teeth also… but I havent chewed out of my left side for like 2 years. What can I do? just let it spread..?
I’ve had several actual dental abscesses for 7 years. I know this because it was confirmed by several dentists (which is cheaper then getting the work done, and the funds were donated by family who can’t afford to spare several thousand more dollars), and the abscesses left scars where it burst and drained from the gums (called fistula).
The most severe pain goes away for the most part after 6 months to a year (if the nerve “dies”) but the swelling causes related pain in adjacent areas, sinuses etc. It never heals by itself. Losing the tooth doesn’t heal it. Taking antibiotics doesn’t heal it (it gets reinfected quickly, and now it’s resistant).
To fix the tooth, it can cost several thousand dollars (more is needed then just a root canal) or the tooth needs to be extracted, but also treated (they have to clean out the bone itself, which is the expensive part I can’t afford).
I’ve got crap-all for insurance and my bills are slightly more then my income: saving a dollar a day isn’t actually possible, but you won’t believe it.
Half of all Americans are in the situation of “drowning” slowly in bills and have no wealth, or negative wealth (do a Google search). Pain is cheap. Death is cheap (for the dead anyway). Insurgence is expensive, and dental work is more expensive. As much as I’d like to “suck it up” and “take care” of myself, I literally don’t have the money.
Note: Nicotine is a chemical addiction, and not necessarily related. Abscess pain is one of the most severe pains a human can experience.
To answer you and the libertarians here, yes, you are all bad people. I hope you all experience at least a single day’s worth of abscess pain to understand what poor people deal with all day, every day.