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The Importance of Teeth

            About two months ago I went to see an oral surgeon, sent by my regular dentist, to see what my options might be in treating my Lichen Planus (an autoimmune disorder that impacts the tissues of my mouth, causing gum recession and bone loss and resulting in loose teeth). I had expected my old dentist to have a plan to help me, because he’d said he had one, but then he retired, without telling me his plan, and his replacement suddenly wanted me to go to an outside expert for advice, without saying what that advice might be.

            I had no idea what to expect at the appointment, but my new dentist had praised the oral surgeon for his ability to deal with autoimmune patients like me, and she seemed to believe that he’d have better treatment options than what she could think of herself, or what my previous dentist had left behind in his notes. She made it sound like there could be a way to slow the tooth loss, and to treat the Lichen Planus more effectively than the oral pathologist had been able to manage for years now.

“Who me, skeptical?”

            So when I walked into the oral surgeon’s exam room, after a full x-ray of my mouth, and he immediately began his spiel about how he would remove all of my upper teeth and replace them with an implant that would be anchored into my cheek bones, because I don’t have enough bone for regular implants, and he doesn’t think bone grafts are stable enough, and a partial implant would be a waste of time and money, and the whole thing would cost $40,000, and none of it would be covered by my health insurance.

            I had no idea what to say, or do. I couldn’t talk to anyone in the aftermath. Even talking to my Mom just turned into hysterical crying. Mom called the dentist for an explanation of what the oral surgeon was proposing, and the dentist said that my situation was much worse than my now retired, dentist had told me, though he had noted it down in my chart. The dentist said that she would consult with the oral surgeon, and with the oral pathologist, and get back to me with an explanation of the options available.

            She didn’t call back though, and I didn’t have the courage to call her myself. I didn’t want to be on the phone with a relative stranger, crying and feeling helpless and inarticulate, especially when I couldn’t even figure out why it was all so overwhelming. I just couldn’t think at all.

“I know the feeling.”

            My therapist wasn’t really concerned. She said I should just get a denture instead, because it would cost less and be just as good. I was wearing my face mask at the time so she couldn’t see the look of horror on my face at the idea of dentures. She also expected me to be able to call the dentist and talk through the options, even though I kept trying to tell her that I couldn’t do it; that I couldn’t even pick up the phone, let alone dial the phone number or, god forbid, talk.

            But then Mom got the news that she’d have to have hip surgery (first on one hip and then, three months or so later, on the other), and I found out about two possible diagnoses that might explain my various medical issues, and I got distracted with going for more tests and making appointments with new doctors, and Mom and my therapist got excited about the possibility of my finally getting a diagnosis, and the whole question of my teeth was forgotten. Except that I kept looking in the mirror at the two precariously loose teeth, close to the front of my mouth, that could become infected or even fall out at any time, leaving me feeling like a hobo, unable to go out in public or show my face on Zoom, and with no plan for what to do.

“I make missing teeth look cute.”

I wrote down my questions for the dentist, and a long list of questions for myself about why I was getting so stuck, but then I put my notebook aside, because not only couldn’t I think of any answers, I couldn’t even stand to look at the questions.

            But now I’m getting closer to my next regularly scheduled appointment with the dentist, and I know I need to prepare myself, but it’s still too freaking hard.

            I know that the money issue overwhelms me. I feel selfish even considering this zygomatic (cheek bone-anchored) implant, which would require a student loan-sized debt, on top of my existing debt, instead of accepting the idea of a denture. I don’t even know if there is a way to borrow the money for such a thing.

            And I’m angry that this is happening, given how much effort I’ve put into taking care of my teeth, and how much effort I’ve put into trying to deal with the medical issues that caused all of this, and I am angry that my health insurance doesn’t cover dental issues even when they are directly caused by medical issues. And I am so angry that my previous dentist, who was my dentist for more than twenty years, didn’t prepare me for this in some way; didn’t even tell me to put money aside, just in case. He just kept telling me to trust him, that he’d take care of things, and that we’d make a plan when the time came. But when he announced his upcoming retirement, and I asked him about that plan, he didn’t make time for me, just sent me on to his replacement.

            And I’m angry that basics like dental care, hearing aids, and even glasses, aren’t covered by health insurance. They’ll cover the eye exam, but not the glasses that are prescribed. They’ll cover the audiologist, but not the hearing aids. And they’ll pay for my visits to the oral pathologist to treat the Lichen Planus, but they won’t cover the damage the Lichen Planus does to my teeth, or more accurately, to my gums and bone, which hold my teeth in place.

            I’m afraid of how a denture or an implant will change the way I look, or eat, or talk, or sing. And I’m afraid of being in even more debt. I’ve already paid off two masters’ degrees in writing, and I’m about halfway through paying for my third, very expensive, master’s degree in social work. And I’m afraid of losing the two loosest teeth, the ones that are visible in the front of my mouth, before I figure out what to do.

            I don’t know how to make a decision while I’m still feeling too humiliated to even ask the dentist the most basic questions.

            I guess the humiliation is at the core of all of this, as usual. But knowing that doesn’t change how overwhelming it feels. I feel guilty and worthless and small and unimportant, again and again. But it’s possible that being able to write all of this down is a sign that I’m getting somewhere. I hope.

“I believe in you, Mommy.”

If you haven’t had a chance yet, please check out my Young Adult novel, Yeshiva Girl, on Amazon. And if you feel called to write a review of the book, on Amazon, or anywhere else, I’d be honored.

            Yeshiva Girl is about a Jewish teenager on Long Island, named Isabel, though her father calls her Jezebel. Her father has been accused of inappropriate sexual behavior with one of his students, which he denies, but Izzy implicitly believes it’s true. As a result of his problems, her father sends her to a co-ed Orthodox yeshiva for tenth grade, out of the blue, and Izzy and her mother can’t figure out how to prevent it. At Yeshiva, though, Izzy finds that religious people are much more complicated than she had expected. Some, like her father, may use religion as a place to hide, but others search for and find comfort, and community, and even enlightenment. The question is, what will Izzy find?

About rachelmankowitz

I am a fiction writer, a writing coach, and an obsessive chronicler of my dogs' lives.

103 responses »

  1. Wow, Rachel! I hope you feel better after writing all this. There is an herb called horsetail, or Equisetum hyemale, that is supposed to strengthen bones and teeth. I don’t know if it would help you, but it’s worth exploring. I hope you find an answer that you can afford.

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  2. Jennifer Barraclough

    I am so sorry about this Rachel. I do hope a viable solution to your dental problems can be found

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  3. Rachel, have you considered a second opinion from a nearby dental school. Often the charges are much less as trainees are involved under capable supervision. The various options could be explored via the Professor and the charges for each option explored. You might be more comfortable in an academic setting as people there would likely be closer to your age and you might relate well. Just a thought…
    I am sorry for your dental challenges. I wish you the very best.
    Warm Regards
    Tom Hutton, M.D.

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  4. I agree with Tom. Right away, as I read, I thought – you need to get more input from professionals on this before making a decision.

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  5. Oh my, Rachel, you certainly have every right to be angry about all those things. I am so sorry about these health and financial issues you’re facing combined w your mom’s hip surgeries. When it rains, it pours, huh!? You’re in my prayers. May you find solutions that are ok and affordable. And may your mom’s surgeries be successful! Bless you!!

    Sent from Jan’s iPhone

    Sent from Jan’s iPhone >

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  6. Goodness sakes! I cannot even imagine the discomfort. Your nightmare is inconceivable. It would be good to get second, third, maybe fourth opinions.

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  7. With the cost of this, I think your dentist expects you to have questions, Rachel. I’d bring that list with you; tell her you are shell-shocked and hope she can provide some help to you. I don’t think she will be surprised you have questions. I think she’d be more shocked if you just went ahead with everything without questions. $40,000?! That’s nuts!!

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  8. Rachel, I am sorry you had the wind knocked out of you at the dentist visit. I agree that you need another opinion. The doctor would be less than good if they didn’t expect tons of questions from you.
    I too, would have felt betrayed by my old doc as well as the insurance companies not taking care.
    You did an amazing job writing this out. I feel your pain and angst. You will need more info before making the hard decisions.
    G-d willing, you will find the best option for you.
    Sending you strength as you move through this.

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  9. Oh dear. I’d feel the same way as you! Even without your more serious condition, I hate going to the dentist as at my age it almost always means a crown or root canal as everything else has already been done! I like the idea of getting a second opinion or visiting a dental school for more options.

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  10. I see that Tom Hutton has given some great advice. I hope things work out well and more economically.

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  11. Sorry to hear about the problems you are having even though sorry doesn’t help, someone is hearing you. So true that insurance pays for many mainstream unnecessary things without paying for many things that are truly necessary

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  12. Oh, Rachel, I’m so sorry you’re having to go through this nightmare. A second opinion seems imperative. My thoughts are with you.

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  13. Oh my goodness! That oral surgeon specialist is a jerk! Sorry but you just can’t wallop a patient with that kind of diagnosis and that monumental cost all in one go. I hope you can find a reasonable solution to this. And you have every right to be angry and just let that out if the opportunity arises. Courage!

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  14. This so resonates with me. I have Hashimoto’s and between that and osteoporosis/bone loss, I also started losing teeth, and at a very rapid rate. I was devastated, but they were all molars and I learned to deal with that. Then about 2 years ago, it was 2 teeth in the front. Of course, I had a meltdown. Please explore your options, and if you decide to go with dentures, know they aren’t all that bad. You are fitted for a “flipper” which is a temporary denture until your gums heal. You can go out in public. No one will know. After your gums heal, you will receive a permanent denture. I think mine looks natural. It does change how I bite into food, but I can eat with a few modifications, and I can live with that. Explore your options and make your own decision, just know that it hasn’t changed the way I look, eating required a bit of a change, and I talk the same. While I wished it never happened, it’s not as bad as I thought it would be. In the end, it wasn’t as bad as I imagined, and I hope the same for you!

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  15. I understand the extreme stress of severe medical conditions. I hope you find ways to relieve the anxiety. Health insurance is a real problem. It never covers enough. Take care!

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  16. This is a nightmare for which I don’t envy you

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  17. chriswriterbuerki

    do you know anyone looking for a service dog?

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  18. Rachel, best wishes. I am sorry this caught you off guard. The only advice to give is figure out the best path and take it a step at a time. Forget the humiliation part, as we get older we will have more opportunities to have to reveal to or be told things by doctors. I know I have. A dentist friend said one’s teeth are critical to a healthy life, especially as we age. Take care of you. Keith

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  19. What a horrible situation. I have a good friend who has gone through similar here in UK. She now has dentures – cheek implants weren’t even mentioned – which took some getting used to but she gained much relief from the pain of her wobbly teeth and the associated infections they caused. She looks amazing (to be fair I always thought she did) but it was on several occasions overwhelming. I hope you and your dental people can work together for and affordable solution in the gentlest way possible. Thinking of you. Mxxx

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  20. One of my friends had dental implants in the UK. It cost £1,000 per tooth. I can see how the $40,000 came to be. Maybe there is a way to avoid getting all the teeth out, after all only two are wobbly right now.

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  21. The health issues that creep into our lives as we get older should be covered by universal health plans which include dental, vision, and every other possible part not now recognized by current insurance. Too liberal?
    Oh, well. Seems reasonable to me.

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    • I had to do a research/advocacy project for my MSW and I focused on how crazy the Medicare/Medicaid system is in the US. So many seniors have to hide their assets in order to get Medicaid-covered nursing care that would otherwise bankrupt them. But Medicare is meant to cover healthcare for the disabled and over 65, so why would such essential services be covered instead by Medicaid, which is meant to be healthcare for the poor, especially children.

      Reply
    • Not too liberal, totally human ❤

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  22. Oh, Rachel, I’m so sorry that you’ve worked so hard to keep yourself as healthy as possible and yet, problems keep rising up. Your old dentist deserves much of your anger, in my opinion, for not being open and upfront with you about everything he was putting in your chart.

    As for dentures, you see faces you never even know are wearing dentures! They actually make the teeth look like your teeth look! And I should know – I have full dentures top and bottom! I have friends who have also gotten full dentures, and none of them look like the teeth in their mouths aren’t really their teeth!

    I’m not even going to start on my opinion of health insurances…

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  23. You are a good writer, have you considered writing a letter to your dentist? Combine some back story about your concerns mentioned in this post and your list of questions. If she has that before your appointment she may be able to get some answers ready ahead of time, but at least she will know your questions and concerns. You might also ask for an appointment that isn’t regular cleaning and bring your mother. We did a consultation like that when they suggested surgery for my son.

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  24. I don’t have words. My sincerest condolences. Post-Covid medical care is something new, something unthinkable (IMO). The providers, whether medical or dental appear to have stopped caring about their patients. Sure, they’ll take your money and suggest wildly expensive options for treating things, but they don’t seem, to me, to do any WORK around finding out those better priced options. Worst thing of all? They’ve stopped keeping the patient in the loop about their own care. That’s unacceptable. I recently went through a six week debacle of the sort you are experiencing, save it was medical, I wasn’t afraid to get in the doctor’s face, and I wasn’t even seen for an examination. From one of the previously ‘best care teams in Utah” for treating my condition. They’re getting a strongly worded letter from me (not that I think it’ll matter) and word of mouth about them to anyone I can tell.

    The whole world has been impacted by Covid, but that is no excuse for suddenly doing a shoddy, careless job; particularly in the health care field. If I were in your shoes, I’d explore other options for treatment; other providers. It doesn’t sound like what you have is going to help and anxiety around even dealing with them isn’t doing you any good. My hope for a better outcome in the future.

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  25. I am so sorry this has happened to you. Maybe you should get your dentist to read this post! And yes also get a second opinion. xxx

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  26. That’s a lot of money Rachel! Way out of my league. One of my biggest fears is losing my teeth. I joke about teeth on the window sill in a jar smiling at me, but the thought makes me shake. I have gum recession and not that many teeth left, but I want to hold onto them for as long as possible. Good luck.

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  27. Oh Rachel! What an absolute nightmare of a situation. My thoughts are with you as you search for the strength and wisdom to deal with all the issues. Best wishes for your Momma too!

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  28. Sending so much love.

    All of your feelings and reactions are legitimate. I identified with everything you wrote, thinking “I would feel/react exactly the same way, probably” as I read your words.

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  29. Rachel, this is not a good situation. As one with years more experience than you (I am 77 years old and take very good care of my teeth), I have a few suggestions: 1)Get a different dentist. It doesn’t matter that your retired dentist recommended her; 2) If necessary, get a third opinion; 3) Spending $40,000 on implants is crazy (I recently had my first implant and I think the total cost was somewhere around $4000, not sure.) 4) Dentures isn’t the worst thing that could happen to you. The cost will be more reasonable, plenty of people wear them and nowadays I’ll bet they’re less noticeable and more fitting than they were in the past; 5) You might check out a dental school; care can be obtained there at much lower cost. Regardless, have faith, stay on it but for sure, seek another opinion! Good luck.

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  30. I have lost one tooth. It was nearly two years ago now and a baby tooth, I think I ate it, lol. Don’t be scare of dentures ❤ I know that I've only got one, and I do feel like a hobo, when I realise that I forgot to put it in. It's only one, it happens a lot, lol. Also one of the reasons I love masks. My Uncle lost a lot of his teeth and he went to Bali…or Thailand to get his fixed. I would recommend it, but he's had problems ever since. He wanted it on the cheap.
    The thing with dentures is that it's a total social thing, people lose teeth. Not everyone can afford to get those pretty porcelain, or whatever there are. Don't be scared of dentures ❤

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  31. If a doctor or dentist makes you feel uncomfortable, it’s likely they’re not the right person for you. I now have a some doctors (primary care, dentist) that I like after “shopping around” and it makes a difference. And don’t get me started on the cost of medical care. Good luck, Rachel!

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  32. Has anyone ever mentioned gum grafts? If receding gums are the problem that seems like a better solution than pulling all your teeth. It’s not cheap, but probably far less expensive than removing and replacing teeth would be. Gum grafts can be done either by harvesting tissue from the roof of your mouth if you have enough there to spare (painful) or using lab grown tissue (far less painful.)

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  33. Sounds like a rip off– to me. Considering that some brand new cars cost that much. I would certainly shop around, if I were you. Good luck with all that, Rachel.
    Art

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  34. So sorry to hear this news, hope you will at least be able to get a second opinion about the proposed treatment (which sounds extreme)…and maybe find a Dr. you feel comfortable with. The dental care/insurance issue is very frustrating!

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  35. Like everyone else, I totally understand why it’s overwhelming. However, since I work in the dental field, I can answer any questions you have, except about your own teeth. But general questions I can certainly help with, because I’ve been doing this for 25 years.

    Usually an upper denture is an easy fit, whereas a lower denture is not so much. So if you can tolerate it and eventually accept it, then you should be fine.

    If, on the other hand, you want to have permanent “teeth” and get several other opinions, AVOID any doctors who give you treatment plans that just sound too good to be true. Because you will regret it. Yes, there are crappy dentists and doctors out there, just waiting to make a quick buck. If they promise to save your teeth, they’re lying. They can’t. The most they can do is prolong the inevitable. Yes, get opinions, have your xray sent to those offices too so they don’t have to re-take it each time. There might be various options, not just the one.

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  36. I so feel for you. I went through a similar problem a couple of years ago after my teeth were ruined by many years of wearing a bipap at night. There is something called Care Credit for medical and dental care that you can check into. I had bone grafts for my 3 implants and they are fine, but your situation may be different with the condition you have. Good luck.

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  37. Wow. What a shock. Definitely worth a 2nd opinion, and 3rd, and 4th. Sooooo expensive. A LOT of people have dentures. Certainly a quandary. I have 3 or 4 implants. I was advised to keep my natural teeth and bones as long as possible, but everyone has different circumstances. Good luck 🍀!

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  38. My heart goes out to you, Rachel. May God give you wisdom.

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  39. This was a bit difficult for me to read. Like some of your articles this hit, or is it bit, close to home. I lost my dental insurance in 2007 and after a stroke in 2012 could only work part time.
    Starting in 2013 my teeth problems began to manifest. Now in 2022 I have dental insurance and I am getting dentures. A not so happy out come but better than the stares and frowns I get with missing teeth.
    Of course I could just continue to wear a mask everywhere and no one would ever know. I am OK with eating soft food the rest of my life. And I love soup. ❤️

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  40. Perhaps it would be helpful to consider the pros and cons of these advanced treatments in the contact of your future plans to teach in the future. Does facing kids make you think too much about how you should look to them? Is there a support group at your school that might be helpful to you?

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  41. I realize that youre going through a lot of pain. I hope you can make the right decisions. 💜

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  42. Very relatable, I had a procedure on 6/10 and they almost couldn’t because my BP shot up on stress. It helps to hear your experience, hope it helps you to share it!

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  43. Your comments about insurance are so true – how can insurance pay for the diagnosis but not the treatment (glasses, hearing aids, implants!) Its’ so frustrating – I love how you tell your story and add humor with your pups – Hard decisions – I hope you let your readers know which way you choose to go….

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  44. I’m glad Cookie believes in you, as do I believe in you. I think I would feel as you feel, right down to not wanting to pick up the phone. I am also angry that you can’t get the financial help you need to have the implants and-or better care, overall.

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  45. It’s so pricy and so hard to wrap your head around this. Hang in there and good luck!! 💖

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  46. It’s hard to like this blog when you’re going through such a hard time. I’m so sorry. Loads of people get dentures and are happy with them, so don’t rule that out. Meanwhile, I’ll pray for you. It says in Isaiah that Jesus bore our griefs and pain and took them to the cross and that by His stripes we are healed. Jesus, please touch and heal Rachel and give her a new life experience, new hope, new health. By Your stripes we are healed. Thank You, Lord Jesus, Amen,

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  47. I hope you are able to resolve this issue with the least possible discomfort and expense. Maybe getting a second opinion would be a good thing. As far as I’m concerned, getting any kind of dental treatment is a nightmare so I can sympathize with your situation. I wish you all the best.

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  48. How upsetting! I’m so sorry, Rachel. Do you have an eye on a social work job when you finish your degree? You could make dental coverage your priority. UGH. I hate this for you.

    The province i live in has the highest dentist rates in the country, and our insurance coverage is abysmal. I am breaking all my back teeth due to bruxism and have to have crowns put on everything, so i relate a little. We’ve just saved enough for 2 crowns, which i’m getting next week.

    But $40K US? I cannot even imagine.

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  49. Oh Rachel! So sorry to hear you’re going through this. The financial shock alone is enough to give you a heart attack and then there’s losing your teeth. People’s teeth seem to be very important to them and I hear stories of elderly people clinging onto what they have left.
    I just went off and did a bit more reading and wonder if the bone loss is due to gum disease which is possibly intensified by your auto-immune condition. The other thing is to talk to the dentist about replacing the bone and encouraging bone growth. Perhaps, it is too late but worth looking into.
    I have had an acute phobia of false teeth all my life and so I can understand your concerns about this. You will come to terms and deal with what comes to pass once it’s happened but it’s still a huge shock and hard to factor into everything you’ve got going on, especially wth your Mom.
    Will be thinking and praying for you.
    Bes wishes,
    Rowena

    Reply

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