Saturday, 5 June 2010

Blame it on the 'betes!

Around a year ago, I started to notice the smallest gap appearing between my two front teeth (think Madonna....). This didn't really bother me as it was barely visible and hardly enough to worry about, but I was a little curious about how there could suddenly be room in there for teeth to be moving around. I had a tooth taken out right at the back of my mouth about 2 years ago due to a recurring abscess, and I was fairly confidnet this was the cause, but the gap didn't happen for a full year after, so I thought it was time for a visit to the tooth doctor, just to check everything was ok.

I was seen by a very well spoken, middle class (and he certainly knew it) dentist who was confident, friendly and seemed very knowledgable. I arrived and gave him a quick run down of why I was there and explained that I would like to know what was causing the gap. He explained that after the tooth being removed, there was probably just enough room for the teeth to 'shift' a little. This had been my initial thought, but bearing in mind the teeth at the back of the month are pretty big, I wanted to know just how much the gap would grow. Not to be vain, but I didn't want to look like I was losing teeth left right and centre.

I sat back in the chair while the dentist and two students poked around and looked at the teeth. He explained that everything looked fine - the gums were healthy, teeth in good shape and nicely aligned and that he thought it was probably just because teeth have a tendancy to move as they are not 'fixed' in the jaw.

After telling me this, the student who had been sat looking through the computer records detailing my every visit in the form of a databse entry, piped up, "She's a type 1 diabetic".

Everything changed.

The dentist then looked again and seemed to find a million things wrong. He pointed out to the students things he thought were wrong with my teeth and gums. Some bleeding here, some movement there.

Meanwhile I am sat there panicking about what was going on.

He advised me that the shift was "Probably down to periodontal disease, have you heard of that?"

"No." I replied, a little scared to ask what it was.

Turns out I didn't need to, he jumped on in.

"Periodontal disease is weakening and deterioration of the bones which hold the teeth in. Your diabetes is most likely the cause and the drifting of the teeth is a very definate sign. It's likely this will result in the loss of those two front teeth if you are not very careful. How is your control?"

"OK I guess, it's never been great but I do try. I'm getting a pump soon."

"Great", he answered. "The pump will slow down the damage provided you get excellent control. We will book you in for some thorough periodontal treatment to see just how much damage there is. X-rays will determine how much bone loss we are looking at at this time."

I felt numb. Lose my two front teeth - I'm 27 years old.

He proceeded to book me in for the periodontal treatment and gave me a leaflet to take away and read. The leaflet in itself was enough to bring anyone to tears. Pictures of misaligned teeth looking as though they were on the verge of falling out. Teeth missing, bleeding and receeding gums. Not very reassuring thats for sure. I'm sure there was some educational advice in there, but I couldnb't get past the pictures. I don't remember a single written word.

I drove away from the dentist that day with tears streaming down my face, imagining myself avoiding smiling, difficulty eating, a mouth full of dentures and painful gums.

I got home and cried into Jamie's shoulder for a good half an hour. He tried to console me telling me they always give you the worst case scenario, that this may be something they are telling about which will happen years down the line. He was grabbing every last option to try and make me feel better. But to me it didn't a difference if it was now, in ten years or twenty years. Diabetes, as always, had taken yet another thing from me.

I have always cleaned my teeth properly, flossed, used interdental brushes and mouthwash. Yes, I did smoke as a rebelling teenager and yes, I do like the odd diet coke, but this was something people are diagnosed with after years of ignoring proper dental hygeine or smoking 20 a day and eating sweets washed down with daily fizzy drinks. I had always taken good care of my teeth - my parents had always told me to look after them and I thought I had.

I couldn't get over his comment. "Your diabetes is most likely the cause." My diabetes, like it is something I proudly own or would fight to keep hold of. It's not MY diabetes, I belong to the diabetes. That's how I felt at that moment anyhow.

A few weeks after the first appointment, I went back to the clinic for my first set of periodontal treatment. I had some x-rays taken and waited nervously in the waiting room while the dentist mulled them over, no doubt picking out which teeth would drop out first.

I was called into the examining room and saw that there was a new dentist there. I did't want to have to explain why I was there. My notes should say it all.

"Well, the bone looks good to me, some very slight loss at the back, but those areas are much harder to reach."

"Um, I'm sorry what do you mean they look good. I thought I had periodontal disease and could lose my teeth." I stated, confused and wondering if my x-rays had been mistaken for someone elses.

"Well, there is some slight gum disease, which will never go away, but it looks to me as though you have good bone density and your gums look well cared for. I wouldn't say your teeth are 'at risk'. Provided you keep your oral hygeine good and your levels acceptable, those teeth should be just fine."

I was still confused. How two dentists could give such a different diagnosis only weeks apart seemed strange to me. Not to mention how pissed I was that I had been mourning the loss of my teeth before I even lost them. Kowing how tough it had been to ever maintain anything that resembled control, I had already decided the diabetes would never be good enough to ensure my teeth would be ok.

Over the next few weeks I attended every few weeks to have any calculus removed, check my cleaning techniques and look at the gums, and every time I was told how excellent my oral hygeine was and how great my gums looked. Each time I felt slightly better about what they were saying, but more and more confused about my initial concerns. The gap.

One day, the student hygienist who had been carrying out the cleaning, told me that she had asked an expert in periodontal treatment to look in while he was in clinic. I was happy with this as anyone who was an expert in periodontal treatment who was prepared to offer advice about how I can slow the devastation down, was very welcome to look at my case any time they wanted.

He came over and introduced himself and explained that he had some suspicions that what was going on in my mouth was not necessarily easy to diagnose, and that he would like to look at my teeth.

OK, again I was a little dismayed that there could be another (potentially worse) diagnosis, but at the end of the day each time I went I would find out something else I could do to help myself, so figured it was worth a listen.

As soon as I showed him my pearly whites, he called the student over.

"Can you see this? Her canines are worn away, probably from grinding. When she closes her teeth, there is a lot of pressure on the front teeth in all four quadrants."

"Oh yeah, I wonder why the dentist didn't notice that?"

I was listening eagerly and making all sorts of odd facial expressions as they asked me to do this with my jaw and do that with my jaw.

Eventually they concluded that because I grind my teeth, I have worn away the canines, which usually take a lot of pressure away from the very front teeth. That means that whenever I had been eating, grinding or even smiling, the front two teeth were having a great deal of pressure on them. This had caused the gum to become enflamed and started off the gum disease. Plaque had been able to get under the gum, where there was now a little room, and this meant that the teeth had also drifted a little.

I was stunned. "So it's not the diabetes?"

"I wouldn't say so. Any healing is slowed down a little when your sugars are unstable, but the gap itself may well sort itself out if we add some layering to the back of your canines, meaning they will start to take a load of those front teeth. We'll book you in for a couple of months time to see what we can do. Otherwise your gums area a great pink colour, you obviously look after them well."

The gap will sort itself out. It's not the diabetes. My canines are to blame.

I felt thrilled.

They explained that the gum disease was there and would never leave, but that if I looked after my teeth as I had been and maintained regular dental appointments, it was very doubtful it would progress and I will most likely keep these teeth for life, unless something else goes amiss.

Again, I felt thrilled.

My appointment to have the work done was 2 days ago. The specialist who had given me the good news last time was the one to carry out the work which make me happy. He added a material to the backs of my teeth which they use for the white fillings you can have. I admit it feels weird, almost as though I can't close my teeth completely, but I can already feel when I clench my jaw that there is a lot less contact with the upper and lower front teeth.

This morning, I got up and cleaned my teeth and already the gap (which had been getting bigger and more noticable lately), had closed a little. You probably wouldn't even call it a gap anymore as the teeth are aligned and almost touching.

But this led me to think about just how many times diabetes gets blamed for something which turns out to have a totally different cause.

Yes, I do have a big of gum disease, many people do. But the cause was not diabetes. It was something as simple as grinding my teeth and having too much pressure. The gaps that appeared in my teeth appeared because of inflamed gums, meaning meant that plaque was able to get in there and cause havoc. But this havoc is manageable and if I keep looking after them, it will not cause me to lose my teeth.

It had NOTHING to do with diabetes. It WAS something I could take control over. It WAS something I could do something about. Yet the initial diagnosis was all doom and gloom. Twenty three years without complications and finally I was about to pay the price for having diabetes.

I still find myself thinking about how frustrating it is that someone turned something which was not even related to diabetes, into a diabetic complication. Into something which was inevitable and all down to a matter of time.

It makes me wonder how many other people have been told that the diabetes has caused whatever it is they are suffering from.

I wonder how many so called professionals have fallen into the habit of diagnosing everything as a complication of diabetes.

I bet there are quite a few.

I bet my dentist won't be the last.

I bet next time, I will seek a second, third and even fourth opinion.

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