Chipped tooth but in Souh America!

EamoS

As the title suggests Im in South America a the moment. Ive been having some light pain from my wisdom teeth coming up. I was just walking and felt my tooth feel a bit jagged and hough I felt a bit of tooth in my mouth. On inspection I noticed a bit of one of my bottom molars was missing at the back. I think the cavity has started again, because there is a slight yellowy brown ring between the filling and the tooth. Its not painful, well a little when I eat but it feels moer like my wisdom tooth.

Obviously if I was a home I would ge i checked out. Im not really sure wha to do, Im in Argentina a the moment, Im not really sure how much its going to cost because I don know what they will have to do. Im going to Bolivia then Peru and Coumbia then back to Argenina in December. So Im not sure if I should leave it and if it gets worse take my chance with a Bolivian dentist (which may alos be cheaper). Or I could wait till I get back to Argenina where I would trust he dentists a bit more. Or could I even wait till I go back to Ireland in February?

My main concern is the cost, what type of work does this suggest? I could afford a filling I think but not a crown or anyhing like that.

Any help would be greatly appreciated!

hmmm

EamoS wrote: »

Any help would be greatly appreciated!

I had to go to the doctor in Argentina & it was better than back home - I went to the local clinic, it was clean, well run and very cheap. I would be very very nervous about getting any sort of medical work done in anyplace other than Argie or Chile, the standard of hygiene in Peru & Bolivia is awful. I haven't been to Colombia, but it has some very rich people so I imagine it has good private dentists. I'd definitely want to have had my hepatitis shots, even then I shudder thinking about it!

If it was me I'd go to a dentist in Argie. Your hotel (if thats where you are!) can advise on costs, or you can ask them yourself at the clinic.

mdebets

have a look at the website of the embassy (Irish or any EU or US). They might have a list of English speaking (or even EU or US educated) dentists.

HammerHeadGym

check out whatclinic.com They are a directory of worldwide, english speaking dentists

How Strange

Having been to Argentina, Chile, Peru and Bolivia I'd def feel confident going to a dentist in Argentina. It's a very European country in a lot of ways. Peru perhaps near a big city but I'd never ever go to a Bolivian dentist unless it was an absolute emergency.

badboyblake

I went to the "no names allowed" clinic in Buenos Aires and I would absolutely recommend them.
They have branches all over this city, I went to the palermo branch and was very satisfied. Prices are very inexpensive and the work was top notch. (and they are open all day on Saturdays).


I enquired about the price of a crown and implant and with the conversion of six pesos to one euro at the time (January of this year) It worked out at 300 Euro for both -bargain!.
A cleaning worked out at 7 Euro a time - I got my teeth cleaned every month!
BA is deffo the place to get anything done, the city's (female) inhabitants as you probably have noticed are very image obsessed - lots of plastic surgery etc esp in the reteiro and palermo parts of town, consequently this means greater competition and high standards in the beauty industry and that includes the standard of Dentistry. IMO You'd be mad not to take advantage of this and grab your self a bargain.

PS If you are in pain get your self to a Farmacia (Pharmacy) thousands of them all over the place and get some advice about suitable painkillers from the Pharmacist.

Mod edit....this is not professional advice, no names allowed, complex work best done close to home where aftercare is available, dentistry is not a beauty industry it a healthcare profession, be sure you know the type if implant being inserted into your body, this is more important than you think in the future.

Badboy Blake edit....Mod, come on now can you take it easy with the censorship?
Try not to make yourself look any more silly - Spanish101; "Farmacia" is Spanish for Pharmacy.

badboyblake

Mod...I never said Dentistry wasn't a healthcare profession.
We can argue the toss about whether cosmetic Dentistry is a beauty treatment or not, IMO it is.
If I was spending a couple of months in SA and I needed crowns and implants (or any other work) I would not hesitate in getting the work done in Buenos Aires.

btkm8unsl0w5r4

Eh I didn't edit the word Farmacia out of your post only the name at the top, you did edit it 7 times though from Pharmaceutica (Pharmacy) to Farmacia (Pharmacy), so maybe its your spanish that need a brush up?

I can see the entire edit history so dont make yourself look silly now please.

You advised people to take dental advice from a pharmacist
"PS If you are in pain get your self to a Pharmaceutica (Pharmacy) thousands of them all over the place and get some advice about suitable painkillers from the Pharmacist."

Also dental implants take at least 4 months to complete, so dont be such a smart arse.

badboyblake

Yep Pharmaceutica is the Spanish for Pharmacist I'm well aware also I know it can take several months for crown and implant treatment That's why I said/implied "if I was in SA for a couple months".
I hope my understanding of "couple" doesn't upset you, I really don't.

I've pm'd the OP with the name and a web link of that clinic in BA and in the interests of free speech if anybody else wants the name and link to that clinic I'll gladly supply it by pm of course.
Have a nice weekend.

Thoie

EamoS wrote: »

My main concern is the cost, what type of work does this suggest? I could afford a filling I think but not a crown or anyhing like that.

Call your travel insurance company, tell them you've chipped a tooth in Argentina and there's a little sensitivity, and can they tell you what to do. They should be able to put you in touch with a dentist that they'll pay for. If they say "Ah sure, just go anywhere", note the time and date and who you're speaking to.

badboyblake

Toby Bewildered Glassware wrote: »

You advised people to take dental advice from a pharmacist
.

Have you got a problem with that also?
In fact I was quite obviously advising on pain relief - Pharmacists know quite a lot about those things you know.

Cavehill Red

badboyblake wrote: »

Have you got a problem with that also?
In fact I was quite obviously advising on pain relief - Pharmacists know quite a lot about those things you know.

In fact, that's what you're advised to do here in Ireland: http://www.ipha.ie/alist/ask-your-pharmacist-about-pain-relief-campaign.aspx

Big_G

Eh, that's not what that link says at all. In fact what it says is to ask your pharmacist's advice about the safe use of painkillers particularly codeine. It says nothing about going to your pharmacist if you're experiencing dental pain. The most appropriate place to go if you're experiencing oral or perioral pain is the dentist, and that is that, there are no arguments that can be made against that that I will accept.

btkm8unsl0w5r4

Couple = two
Putting the English in brackets kind of gave it away.

Cavehill Red

Big_G wrote: »

Eh, that's not what that link says at all. In fact what it says is to ask your pharmacist's advice about the safe use of painkillers particularly codeine. It says nothing about going to your pharmacist if you're experiencing dental pain. The most appropriate place to go if you're experiencing oral or perioral pain is the dentist, and that is that, there are no arguments that can be made against that that I will accept.

http://www.ipu.ie/more-news/508-ask-your-pharmacist-first.html

The purpose of the commercials is to encourage people to make their local pharmacy their first port of call for their health and increase awareness of the fact that the local pharmacist is the most accessible health professional.

badboyblake

Big_G wrote: »

The most appropriate place to go if you're experiencing oral or perioral pain is the dentist, and that is that, there are no arguments that can be made against that that I will accept.

Any evidence to back up that statement?

What if you're not near a Dentist/can't get an appointment to see one?

Big_G

badboyblake wrote: »

Any evidence to back up that statement?

What if you're not near a Dentist/can't get an appointment to see one?

That is totally besides the point. You should not substitute another healthcare professional for a dentist in the case of oral or perioral pain. OBVIOUSLY if there is no dentist you should see another healthcare provider.

Compare the curricula for undergraduate pharmacists, physicians and dentists. Dentists spend 5 years studying the oral and perioral tissues, their diseases and management of those diseases. All we look at all day everyday is the mouth.

I have the utmost respect for my physician colleagues, but I have seen every misdiagnosis in the book from GPs when it comes to diseases of the mouth up to and including a false diagnosis of oral cancer. WOW. And the accompanying wrong treatment plans.

Big_G

Cavehill Red wrote: »

http://www.ipu.ie/more-news/508-ask-your-pharmacist-first.html

Well I would like to respectfully disagree with the IPU. Pharmacies are not primary care providers. Pharmacists are not trained in the diagnosis and treatment of oral or perioral pathologies.

Cavehill Red

Big_G wrote: »

Well I would like to respectfully disagree with the IPU. Pharmacies are not primary care providers. Pharmacists are not trained in the diagnosis and treatment of oral or perioral pathologies.

Forgive me for trusting the representative body of Irish pharmacists (whose campaign incidentally was fully supported by the IMO, if I recall) over yourself.
To address the OP's issue, as this arose for a friend of mine in South East Asia earlier this year, the answer is simple:

Go to the pharmacist.

They can provide initial pain relief AND advise on where to go to obtain corrective treatment.
The guys in your hostel won't have a clue, and your hotel receptionist or tour guide cannot be relied upon to refer you to the optimal health care provider. But the pharmacist can and will address your needs, if asked.

btkm8unsl0w5r4

Eh lads, if you have dental pain go to a dentist. Pharmacist are not there to tell you what you should be taking. No more than the dentist is there to tell you how to take your prescription drugs. What do you do if the pharmacy is closed.

Cavehill Red

If the pharmacist is closed, you can bet the dentist is too.

Earlier this year, my mate needed emergency dentistry in Cambodia. He went to the pharmacist, and got some pain relief. The pharmacist was able to refer him to the nearest English speaking European standard dentist and arrange a tuk-tuk to take him directly there.

None of this could have done on his own. There is a genuine risk in many countries, where dental standards are not good, of being treated by a dentist who is poorly trained, under unhygienic conditions.

A pharmacist will send you in the right direction. That's why they should be first port of call.

Big_G

Cavehill Red wrote: »

Forgive me for trusting the representative body of Irish pharmacists (whose campaign incidentally was fully supported by the IMO, if I recall) over yourself.
To address the OP's issue, as this arose for a friend of mine in South East Asia earlier this year, the answer is simple:

Go to the pharmacist.

They can provide initial pain relief AND advise on where to go to obtain corrective treatment.
The guys in your hostel won't have a clue, and your hotel receptionist or tour guide cannot be relied upon to refer you to the optimal health care provider. But the pharmacist can and will address your needs, if asked.

That's fair enough, I think that you've misunderstood the message that the IPU were trying to get across, which is that people shouldn't be annoying overworked A+Es and GPs with minor illnesses. This is the one problem that I have with that campaign is that people such as yourself might misunderstand the message.

My message is clear if you have dental pain, get thee to a dentist.

The advice about seeing a pharmacist for where to attend a dentist is valid. The other thing about dental pain, as anyone who has experienced it will tell you, is that often it is not relieved by over the counter or even prescription analgaesics.

Cavehill Red

Big_G wrote: »

That's fair enough, I think that you've misunderstood the message that the IPU were trying to get across, which is that people shouldn't be annoying overworked A+Es and GPs with minor illnesses. This is the one problem that I have with that campaign is that people such as yourself might misunderstand the message.

I haven't misunderstood the IPU's message. It's perfectly clear. A pharmacist is the most easily accessed health professional and should be your first port of call.

Big_G wrote: »

My message is clear if you have dental pain, get thee to a dentist.

Which is not good advice unless you can be sure of a quality standard of dental treatment from that dentist, which is not always possible if you find yourself in a foreign country, where they speak another language and where health and medical standards are not the same as here.

Big_G wrote: »

The advice about seeing a pharmacist for where to attend a dentist is valid. The other thing about dental pain, as anyone who has experienced it will tell you, is that often it is not relieved by over the counter or even prescription analgaesics.
And, by the way, the OP did not say he had any pain, but a broken tooth.

Depends on the pharmacy and the country. I've seen diamorphine handed out without a prescription in Asia. That would do the job for most dental pain, I'd imagine.

Big_G

Cavehill Red wrote: »

I haven't misunderstood the IPU's message. It's perfectly clear. A pharmacist is the most easily accessed health professional and should be your first port of call.

If that is what you feel the message is (I don't), then let me just say I vehemently disagree with that.

Cavehill Red wrote: »

Which is not good advice unless you can be sure of a quality standard of dental treatment from that dentist, which is not always possible if you find yourself in a foreign country, where they speak another language and where health and medical standards are not the same as here.

Again true, we are continuously advising people to not travel just for dental treatment. However, and this is admittedly off topic, you were talking about advice that the IPU is giving patients in Ireland, which I am disagreeing with.

Cavehill Red wrote: »

Depends on the pharmacy and the country. I've seen diamorphine handed out without a prescription in Asia. That would do the job for most dental pain, I'd imagine.

Yes, because diamorphine is an appropriate, non-palliative treatment for dental pain, without any significant side effects. /sarcasm. In fact, dentists use pain as an aid to diagnosis. So if this patient had taken diamorphine, and was in a depressed conscious state, and had decreased symptoms, an appropriate diagnosis may not be possible if he/she decided to attend a dentist. Not to mention an inability by the patient to give informed consent to any treatment. You've said you may not be able to be sure of the quality of dental care, but you can be sure of good care if a pharmacist gives you diamorphine. That makes huge sense.

Cavehill Red

Big_G wrote: »

If that is what you feel the message is (I don't), then let me just say I vehemently disagree with that.

Here's what they say:

The purpose of the commercials is to encourage people to make their local pharmacy their first port of call for their health and increase awareness of the fact that the local pharmacist is the most accessible health professional.

And I for one think it's very sensible advice.

Big_G wrote: »

Again true, we are continuously advising people to not travel just for dental treatment. However, and this is admittedly off topic, you were talking about advice that the IPU is giving patients in Ireland, which I am disagreeing with.

Again, I gotta go with the IPU rather than yourself on this one.

Big_G wrote: »

Yes, because diamorphine is an appropriate, non-palliative treatment for dental pain, without any significant side effects. /sarcasm. In fact, dentists use pain as an aid to diagnosis. So if this patient had taken diamorphine, and was in a depressed conscious state, and had decreased symptoms, an appropriate diagnosis may not be possible if he/she decided to attend a dentist. Not to mention an inability by the patient to give informed consent to any treatment. You've said you may not be able to be sure of the quality of dental care, but you can be sure of good care if a pharmacist gives you diamorphine. That makes huge sense.

I was just addressing your suggestion that a pharmacist couldn't alleviate dental pain. Of course they can.
When I last had dental pain abroad, I got given Ponstan by a local pharmacist and that did the trick perfectly.

Big_G

Cavehill Red wrote: »

Here's what they say:



And I for one think it's very sensible advice.



Again, I gotta go with the IPU rather than yourself on this one.



I was just addressing your suggestion that a pharmacist couldn't alleviate dental pain. Of course they can.
When I last had dental pain abroad, I got given Ponstan by a local pharmacist and that did the trick perfectly.

Fair enough, we'll agree to disagree about the IPU.

With regard to ponstan, I've found mefanemic acid to be not a very effective painkiller when it comes to dental pain, neither have my patients. Compound analgaesics are more effective.

The main point is that the pharmacist can only provide temporary relief in the case of pain of odontogenic origin, and that is a best case scenario. The best they can provide is treatment of symptoms, not treatment of cause, which is called palliative treatment.

badboyblake

Big_G wrote: »

Fair enough, we'll agree to disagree about the IPU.

With regard to ponstan, I've found mefanemic acid to be not a very effective painkiller when it comes to dental pain, neither have my patients. Compound analgaesics are more effective.

Big G you are wrong, you say "I've found mefanemic acid to be not a very effective painkiller when it comes to dental pain". Well Clinical evidence says otherwise; the class of drug NSAIDS - (Non steroidal anti inflammatory drugs) to which mefenamic acid (Ponstan) belongs to, is actually the pain reliever of choice for most Dental pain.
Cavehill Red happens to be right.

"Nonsteroidal anti-inflammatory drugs (NSAIDs) are generally regarded as the analgesic of choice, given the inflammatory aetiology of most dental pain (being caused by factors such as infection and trauma) [Dionne and Berthold, 2001; Canadian Collaboration on Clinical Practice Guidelines in Dentistry, 2004; Hargreaves and Abbott, 2005; Mickel et al, 2006; BNF 54, 2007]."

Of course never let your subjective views get in the way of medical evidence right?

btkm8unsl0w5r4

This is total crap lads, the pharmasist should not be the first port of call, dental pain is fixed by dental work like fillings, extractions or root canals, drugs only mask symptoms of make them worse in the long run. Dental pain does not resolve like most somatic pain. Ponstan does SFA for dental pain, Big_G has written more prescriptions than you have had hot diners badboyblake and I think he knows what NSAIDS are and how they work. I have been a dentist for 10 years and also find ponstan useless.And most pain specialists I know find it useless. NSAIDS are a group of maybe 30 drugs not all of which are good for dental pain. You only know how to use pubmed and google so dont start this tripe, dont be a know it all when you obviously know nothing about this

. I have had enough of this thread anyway.

THE ADVICE ON THIS THREAD IS RUBBISH AND SHOULD BE IGNORED. CLOSED

Big_G

My how this thread has been dragged off topic by a few know-it-all, know-nothing posts.

For your information, Badboyblake, compound analgesics usually contain two or more drugs, one of which is usually an nsaid and one of which is usually an opioid. Mefenamic acid is an nsaid, and one with weak analgesic properties. In fact some studies have found ibuprofen, which is available over the counter, to be superior.

Here is a study comparing a compound analgesic with ponstan for dental pain: ponstan for dental pain?
here is the definitive league table of analgesics for acute pain: Oxford league table which shows a compound analgesic at number 5. Ahead of many nsaids. In fact it is one that is commonly prescribed in dentistry: solpadol/tylex.

An analysis of the studies you provided:

Dionne and Berthold 2001 - analyses studies which use the oral surgery model of comparing analgesic modalities, therefore irrelevant in the case of irreversible pulpitis, the most severe and difficult dental pain to treat with analgesics. Also mentions compound analgesia should be reserved for cases where the nsaid alone is ineffective.

Canadian collaboration - included only one study on compound analgesics

Hargreaves and Abbott - reads like an opinion piece but says that dental treatment before painkillers is the most appropriate way to treat dental pain, which is what I was saying above. Makes no mention of how effective compound analgesics are, just mentions that codeine has side effects. Big news, nsaids have side effects too.

Mickel et al - a survey study? Really? Poor show. Ask 5 different dentists and you'll get five different opinions. Not great science, really.


BNF 54 - I was unable to access this one. But the search you made was under dental abcess. Not the only form of dental pain, nor the most difficult to obtain pain relief. That is reserved for a hyperaemic pulp/irreversible pulpitis.

btkm8unsl0w5r4

Owned...dont mess with the G