Pain and dentistry in CM

[elektrified]

I have used Payon Dental Cinic - Chaiyapoom Road - Dr J - for the last two years.

Very satisfied.

Trust me on this one... If you have issues with pain and anesthesia (like I do), DON'T GO THERE!

Is this where you got out of the seat?

No that was the young, inexperienced male Dentist at Empress who was angry at me for demanding anesthesia. I had faith in the above-mentioned Dentist but he let me down in a big way.

[uptheos]

I have used both Elite Smile and Grace Dental Clinic and have been very pleased with the pain management. I needed a root canal in May and I returned to Elite Smile for the completely painless procedure from the USA. In my attempt at humor I called my dentist "Dr. Painless" and tried to explain the television series Mash.

Price, quality, and timely service are far superior to what I have experienced in the USA.

Hardly true. There may be some dentist here that do fine work but superior to the usa, NO WAY.

The best dentist I have ever had by far, was in London, Ont, Canada. His skill and manner was absolutely the best ever.

[jaideeguy]

Never had any issues with getting dentists to use topical anesthetics here when doing the work, but I do find them quite reluctant to issue any thing stronger than paracetamol for post treatment pain.

[zippydedodah]

and what is the big deal about Nitrous ?.. hell, i used to get nitrous in USA when i went it to pay my bill - now THAT was painful!

joking aside... my personal experience was that nitrous gas will lower my need for needle injections... never replaced them, but instead of needing 4 injections for a painful procedure, i might only require 2... then my oral recovery time was quicker.. and nitrous, 2 mins on oxygen and my head was perfectly clear....

but i have only tried a couple of dentists here and they tell me that only Grace offers nitrous... and charges you per use... grace ain't cheap to begin with... can't imagine going in and getting nitrous for my cleanings, root canals, cavities... it would make a hole in my wallet!

[uptheos]

and what is the big deal about Nitrous ?.. hell, i used to get nitrous in USA when i went it to pay my bill - now THAT was painful!

joking aside... my personal experience was that nitrous gas will lower my need for needle injections... never replaced them, but instead of needing 4 injections for a painful procedure, i might only require 2... then my oral recovery time was quicker.. and nitrous, 2 mins on oxygen and my head was perfectly clear....

but i have only tried a couple of dentists here and they tell me that only Grace offers nitrous... and charges you per use... grace ain't cheap to begin with... can't imagine going in and getting nitrous for my cleanings, root canals, cavities... it would make a hole in my wallet!

I think a few places offer it at around 1,500 baht extra.

[Ulysses G.]

RAM Dental Clinic have nitrous gas - at least they did a few years ago.

[Mapguy]

Helium is more fun!

[connda]

To clarify my initial post, I've just schedule an appointment with my sixth dentist here in Thailand; my first two dentists were in Korat and the last three here in Chiang Mai (I obviously changed dentists once because I moved).

From another forum, a Thai member posted this to me: "As far as I know, from my experience watching my Dad as a dentist working, Thai dentists use anesthetic only when 'necessary' (depends on what kind of procedure is performed). They don't use it in such a simple procedure as filling teeth."

So, I'll concede that there are cultural differences between America and Thailand in the use of palliative medicine in dentistry (and the medical field). It is just common practice in America to use local anesthetic unless the patient "asks" that it not be used (my own father never used Novocaine or pain relief for dental procedures). Here in Thailand it seems that it is common practice NOT to use local anesthetic unless the patient "asks" that it IS used. But, imho, there still is a strong cultural bias on the part of Thai dentists NOT to use local anesthetic even when asked, especially if the procedure is deemed "simple" by the Thai dentist. For me, this is where the arguments start with the dentists I've had. They want to drill; I want anesthetic; they consider the procedure "too simple for anesthetic"; I insist it will hurt; they insist it won't; I give in because I dislike confrontation about as much as I dislike pain; they hurt me; I endure, and then I find a new dentist.

This won't happen again. My wife and I have talked to the owner of the dental practice I've booked an appointment with. My wife is coming with me to ensure we have no communication problems with that fact that I will require the dentist to use local anesthetic for all procedures except an inspection and simple cleaning (which I consider painful, but I can generally sit through unless they start poking around underneath the rim of a crown). Hopefully we can come to an understanding with the tech doing the periodontal cleaning and the dentist regarding the use of anesthetics. We'll see...

[uptheos]

To clarify my initial post, I've just schedule an appointment with my sixth dentist here in Thailand; my first two dentists were in Korat and the last three here in Chiang Mai (I obviously changed dentists once because I moved).

From another forum, a Thai member posted this to me: "As far as I know, from my experience watching my Dad as a dentist working, Thai dentists use anesthetic only when 'necessary' (depends on what kind of procedure is performed). They don't use it in such a simple procedure as filling teeth."

So, I'll concede that there are cultural differences between America and Thailand in the use of palliative medicine in dentistry (and the medical field). It is just common practice in America to use local anesthetic unless the patient "asks" that it not be used (my own father never used Novocaine or pain relief for dental procedures). Here in Thailand it seems that it is common practice NOT to use local anesthetic unless the patient "asks" that it IS used. But, imho, there still is a strong cultural bias on the part of Thai dentists NOT to use local anesthetic even when asked, especially if the procedure is deemed "simple" by the Thai dentist. For me, this is where the arguments start with the dentists I've had. They want to drill; I want anesthetic; they consider the procedure "too simple for anesthetic"; I insist it will hurt; they insist it won't; I give in because I dislike confrontation about as much as I dislike pain; they hurt me; I endure, and then I find a new dentist.

This won't happen again. My wife and I have talked to the owner of the dental practice I've booked an appointment with. My wife is coming with me to ensure we have no communication problems with that fact that I will require the dentist to use local anesthetic for all procedures except an inspection and simple cleaning (which I consider painful, but I can generally sit through unless they start poking around underneath the rim of a crown). Hopefully we can come to an understanding with the tech doing the periodontal cleaning and the dentist regarding the use of anesthetics. We'll see...

At this point I would walk out.

Edited July 9, 2013 by uptheos

[Chiengmaijoe]

Fortunately I've never had the slightest pain using a dentist in Thailand and generally found them overly sensitive to pain. I've used Chiang Mai Dental hospital on the superhighway and though it's a little expensive I think I'll stick with it. If you suspect a dentist may be a bit rough the best solution is before he starts, grab him by the balls and say "we're not going to hurt each other are we?".

[zippydedodah]

and what is the big deal about Nitrous ?.. hell, i used to get nitrous in USA when i went it to pay my bill - now THAT was painful!

joking aside... my personal experience was that nitrous gas will lower my need for needle injections... never replaced them, but instead of needing 4 injections for a painful procedure, i might only require 2... then my oral recovery time was quicker.. and nitrous, 2 mins on oxygen and my head was perfectly clear....

but i have only tried a couple of dentists here and they tell me that only Grace offers nitrous... and charges you per use... grace ain't cheap to begin with... can't imagine going in and getting nitrous for my cleanings, root canals, cavities... it would make a hole in my wallet!

I think a few places offer it at around 1,500 baht extra.

Could you name those "few places" please?

[uptheos]

and what is the big deal about Nitrous ?.. hell, i used to get nitrous in USA when i went it to pay my bill - now THAT was painful!

joking aside... my personal experience was that nitrous gas will lower my need for needle injections... never replaced them, but instead of needing 4 injections for a painful procedure, i might only require 2... then my oral recovery time was quicker.. and nitrous, 2 mins on oxygen and my head was perfectly clear....

but i have only tried a couple of dentists here and they tell me that only Grace offers nitrous... and charges you per use... grace ain't cheap to begin with... can't imagine going in and getting nitrous for my cleanings, root canals, cavities... it would make a hole in my wallet!

I think a few places offer it at around 1,500 baht extra.

Could you name those "few places" please?

Laughing gas

To relieve stress and anxiety, laughing gas is available at

DENTALWORLD. Laughing gas or nitrous oxide has been used as a

sedation technique since 1772 and, mixed with 30% oxygen, is

perfectly safe for both child and adult patients.

http://www.dentalworldchiangmai.com/technology.php

I just looked at two others who used it, but I see it's no longer listed....I think there is a regulation about having an anesthetist present, so might not be cost effective,

[ARISTIDE]

I wish I haven't read this forum as I'm having two dental implant soon and I might die of pain !

Edited July 9, 2013 by ARISTIDE

[FolkGuitar]

I find this thread somewhat surprising. I've used Chiang Mai Dental hospital on the superhighway for years and have always been satisfied with the work and with the procedure. They always use more than enough anesthesia, both injected and topical (I don't particularly like nitrous oxide,) and if I request it while in the middle of things, they will give me more injected anesthesia. I wouldn't let anyone near my mouth who withheld pain relief. I am NOT on this planet to suffer...

[elektrified]

To clarify my initial post, I've just schedule an appointment with my sixth dentist here in Thailand; my first two dentists were in Korat and the last three here in Chiang Mai (I obviously changed dentists once because I moved).

From another forum, a Thai member posted this to me: "As far as I know, from my experience watching my Dad as a dentist working, Thai dentists use anesthetic only when 'necessary' (depends on what kind of procedure is performed). They don't use it in such a simple procedure as filling teeth."

So, I'll concede that there are cultural differences between America and Thailand in the use of palliative medicine in dentistry (and the medical field). It is just common practice in America to use local anesthetic unless the patient "asks" that it not be used (my own father never used Novocaine or pain relief for dental procedures). Here in Thailand it seems that it is common practice NOT to use local anesthetic unless the patient "asks" that it IS used. But, imho, there still is a strong cultural bias on the part of Thai dentists NOT to use local anesthetic even when asked, especially if the procedure is deemed "simple" by the Thai dentist. For me, this is where the arguments start with the dentists I've had. They want to drill; I want anesthetic; they consider the procedure "too simple for anesthetic"; I insist it will hurt; they insist it won't; I give in because I dislike confrontation about as much as I dislike pain; they hurt me; I endure, and then I find a new dentist.

This won't happen again. My wife and I have talked to the owner of the dental practice I've booked an appointment with. My wife is coming with me to ensure we have no communication problems with that fact that I will require the dentist to use local anesthetic for all procedures except an inspection and simple cleaning (which I consider painful, but I can generally sit through unless they start poking around underneath the rim of a crown). Hopefully we can come to an understanding with the tech doing the periodontal cleaning and the dentist regarding the use of anesthetics. We'll see...

Did you ask what anesthetic(s) they will have available and will they be mixing up a couple different ones for you? There is an art to dental anesthesia. The dentist I went to one time which was named above only stocked one medicine, it was absolutely useless, and he said he did not use it very often.

[amykat]

I would just go to Grace Dental. I have had only good experiences there. One time I tried to go to a regular dentist here, just for a cleaning, and they said I had a cavity, which I have had a total of two in my life, so wonder if it was even real, and he suggested no novacaine (much to my shock). It was painful as hell so I stopped him and made him give me the injection. He did it, but in a strange way, that made almost my whole head numb, my chin to my forehead, I was worried I was going to choke.

I think they really don't know what they are doing with these injections, for some reason. My bill was a whole $2-3 more with the injection so why would a person go without? Just go to Grace, pay on the high side, and you won't have problems.

[BB1955]

I ve used the dentist in Hang Dong on 108 just beofre the market. Had one tooth pulled did very well even called the next day to check on me ....

[OldChinaHam]

I've only had one bad dental experience here, and it was a doozie. The dentist at Bangkok-Pattaya Hosptial was removing a tooth and somehow shattered it, causing it not to come out right. "Oh hoooo, mai dee" is what he said when it cracked. Then the next 20 or 30 minutes was more or less a nightmare. All the rest have been overall good.

Shattering of the tooth during extraction is always a risk that cannot be completely avoided no matter the skill of the technician. I had one fracture recently in Taiwan and the doc just must dig it out piece by piece. No one likes this when it happens.

My Taiwan doc has 20 years experience and is a professor at Taiwan University Dental School, the best in the country and U.S. trained with a PhD.

I wish I could find some doc in CM just like him and his associate who is number one in endodontic therapy. Not only do you need the expertise and experience, but the best advanced equipment is important too.

If there is one in CM that is U.S. trained and really as good as my guys in Taiwan, please PM me, I have 240,000Baht of work outstanding, including unfinished crowns and, one endo.

BUT you must be PAINLESS like the M.A.S.H. guy.

If you fracture a tooth during extraction I will forgive you if I know you are good.

But if you break off an anesthesia injection needle somewhere below my gum line due to your stupidity or carelessness, that is another story. I will be headed for surgery in the hospital.

**Keep in mind, also, that heavy users of alcohol will have difficulty getting and staying numb, no matter what is done by the dentist.

Edited July 10, 2013 by OldChinaHam

[OldChinaHam]

Regarding pain and anesthesia during dental procedures, one factor to consider is that there can be quite a waiting period after the injection before the anesthetic takes full effect, for some patients this can make a difference. If you have a very busy dentist he may not wish to wait.

The skill of the dentist is important when placing the needle during anesthetic injection, especially for those whose jaw may be shaped different and the nerves positioned atypically.

Some dentists who are not good at giving anesthetic injections may be scared of the procedure themselves and botch the job. I had one doc who would call in her husband who was also a dendal surgeon to administer the needles. But that pair turned out NG in all dental departments.

[Thighlander]

I had novacaine for a root canal, and deep cleaning, done in three sessions. They are stingy with the percocet. I've had two dentist at Funsabai, the endo-dentist, and Dr. Supatra for deep cleaning. All are grade A, and as good as what you get in the US for four times the money. Mexico is hideous.

[Ulysses G.]

Are you sure that it was percocet? I have seen a lot of claims that it is not available in Thailand.

[uptheos]

I had novacaine for a root canal, and deep cleaning, done in three sessions. They are stingy with the percocet. I've had two dentist at Funsabai, the endo-dentist, and Dr. Supatra for deep cleaning. All are grade A, and as good as what you get in the US for four times the money. Mexico is hideous.

Maybe because percocet is oxycodone, which is is not available in Thailand, there is no registered brand of it.

[elektrified]

Are you sure that it was percocet? I have seen a lot of claims that it is not available in Thailand.

I also think his information is incorrect. They usually only want to give Paracetamol or Ibuprofen unless you really make a scene about it and they will give Tramadol which is not very effective unless you take the maximum dosage. You can buy it at the pharmacy without a prescription. The next step up is the patch - Fentanyl? or MS which a dentist won't (can't) give.

[OldChinaHam]

My best advice for all you dislikers of pain out there:

And this is also my gift to you:

You really should be using Ibuprofen in the liquid gel or liquid suspension capsules (The Liquid May Work Faster). Take the highest dosage recommended by your doctor.

You may not believe it, but if you truly read carefully the pain studies or trials, then you will see that Ibuprofen is extremely effective at dental pain and inflammation reduction.

I know, you think you need an opioid. Opiods make you feel good. So does alcohol. But you really should not take alcohol to self medicate. My advice, if you are really uptight and out of sight over the whole procedure and recovery, is to ask your doc for two days of some tranquilizer like Valium. Two days of Valium won't harm you. Try 5mg 4 times per day. If you like, and you are not driving or walking around in the subway, then why not try 10 mg one or two times when you are feeling very uncomfortable.

Since you are already getting the Ibuprofen pain and anit-inflammatory effects for the physical pain and swelling, then you can reduce your anxiety which will also help your pain. Maybe a one time higher dose of Valium when you first get home would be good. Whatever your doctor will allow.

My advice is to try it.

Of course I am no doc or medical pro, but I am a long time sufferer of dental tortures.

I have read the pain studies and trials.

In a double blind placebo study paired with opioids and also Nsaids, Ibuprofen comes out looking pretty dam_ good.

This is worth thinking about anyway.

Just my two cents which I hope might help someone.

**Please look for the LIQUID Ibuprofen. This is what My SuperDentist in Taiwan always gives me.

(Honestly though? What I did when I could? When I got back from a tough root canal surgery I sometimes would just drink a bottle of very expensive COGnac, Remy Martin or something similar, the good stuff. Cost almost as much as the root canal, but it was worth it. I felt very little pain, even the next morning. But some of us now do not have the time for this type of COGnac therapy. So the next best thing is Ibuprofen and Valium. STAY AWAY from the Narcotics and Opioids my friends, this is a very slippery slope! For dental pain, even Narcotics are not so effective, so it is not worth trifling with them, and I do not.)

If it seems like I am partially joking here, I actually am not.

I hope this will really help someone.

Pain is NO Fing Joke.

It can be VERY debilitating.

And we all must endure it many times in our lives.

Painlessness Be With You Fellow Members!

OC Ham

[elektrified]

Ibuprofen is an extremely effective pain/anti-inflammatory medicine if you take a high dose. A Doctor friend in Los Angeles insisted when I cut my foot open once to take Vicodin one dose and Ibuprofen 1,200 mg. the next dose and honestly tell him if the pain relief was better with one against the other. I would honestly say that the Ibuprofen was just as effective as the Vicodin. The only thing that was missing was the euphoria that Vicodin gave.

[OldChinaHam]

Ibuprofen is an extremely effective pain/anti-inflammatory medicine if you take a high dose. A Doctor friend in Los Angeles insisted when I cut my foot open once to take Vicodin one dose and Ibuprofen 1,200 mg. the next dose and honestly tell him if the pain relief was better with one against the other. I would honestly say that the Ibuprofen was just as effective as the Vicodin. The only thing that was missing was the euphoria that Vicodin gave.

G Damj_ Electrofied, you really hit the nail on the thumb this time. THANK YOU for BACKING me UP on this! I ain't Shipping anybody! And I just hope to help someone who feels like I have often felt in my life when I had spinal related pain, broken bones compressed nerve roots, excrutiating sciatic nerve compression, you name it.

Trust Ibuprofen to help 80 to 90 percent with the pain, compared to some super duper narcotic or opioid.

THEN match this simultaneously with about 10 mg or maybe even more, whatever your doctor MD will allow of Valium for the euphoria and reduction of anxiety.

Valium is FAR FAR safer than narcotics, (IMHO). Don't take more than you need to, and DON'T take it for more than 1, 2 or max 3 days, ONLY WHILE the pain is not bearable.

Everyone has heard the horror stories about Americans being strung out on drugs like perscription meds, and it is true.

America is also FAILING its next generation by not spending MUCH more money on drug counceling. and education when it is most effective.

SO do not trifle with these narcotics. The GD Drug Companies LOVE to make money by stringing us out, They are the new age PUSHERS.

Do not get into the Narcotics trap over dental pain! Listen to this when the pain is bad. It might keep you from gettin hooked: https://www.youtube.com/watch?v=1o9LGuaxHfM

Please do not think I do not know what pain is.

A number of major surgeries and much more behind me.

So trust ELECTRIFIED: Do not trifle with Narcotics of Any type.

Remember IBUPROFEN and F the PUSHERS. Don't let them make money off your pain and get us hooked on products which destroy us while making them rich.

Sorry, but I do feel strongly about this subject.

There truly is about a 4 to 10% incidence of Psychopathy in American Big Business today at the upper managerial levels.

Do you think they care what they sell you?

No.

So please try IBUPROFEN and and stay healthy!

(And GD The PusherMen)

[uptheos]

I agree with everything you say about Ibuprofen OCH, but you really do need a high dose if you are in pain.

Not much chance of trifling with Narcotics over here, though I know Tramadol is similar, being a synthetic opioid, which I have found to be quite ineffective plus causing nausea in the past.

[OldChinaHam]

I agree with everything you say about Ibuprofen OCH, but you really do need a high dose if you are in pain.

Not much chance of trifling with Narcotics over here, though I know Tramadol is similar, being a synthetic opioid, which I have found to be quite ineffective plus causing nausea in the past.

Tramadol is NOT for the dogs either! I think it will poison them if I recall correctly from my reading.

Yes! you are correct about Tramadol being almost completely useless for pain. I am recovering from major surgery and had my share of pain recently. The ULTRACET the hospital gave me in Taiwan at the University Hospital was USELESS! The only thing that works is a Morphine Pump which I had for 72 hours. It was OK, but I did NOT use that much and went sparingly not wanting to cause myself to barf on the nurse.

Then when they removed the Pump, I took some Ultracet which is 37 mg Tramadol and about 375mg of acetaminophen (same as Tylenol) Pretty useless, NO Utterly useless!

I spent 3 nights just waiting for the daylight sort of hoping we would have another major earthquake and my building would cave in on me.

Anyway, you are right, too about increasing the IBUPROFEN as much as your doctor will allow! Be FIRM with your doctor. Tell Him it HURTS like a M...........!

Get him to OK the maximum dose of Ibuprofen, and also the Max dose applicable for Valium, then don't walk around too much or do things that might be dangerous, like working in a Nuclear PowerPlant moving around spent fuel rods!!!

You know, I REALLY HOPE that this helps a few who read it.

If it does not, then you can always resort to the old COGnac Therapy which is Personally my Favorite.

Wishing you all, Happy and Pain-free Daze!

[OldChinaHam]

Sorry if I got a bit carried away with some of my Pain Med Related Comments,

But I honestly feel that it is so easy to slide into the Pain Med trap.

**And I saw all the comments about Percocet this

And Oxy that.

I also come from Florida.

And down there, you got drug runners buying in bulk in Florida and then muling it up to the Appalachian areas in the SE USA where people with very little hope self medicate themselves to endure the pain of their lives, just waiting for death I suppose. But I digress.

Let us not treat these Drugs such as Codeine and other meds which are isolated from Opium lightly!

Once you so easily and unthinkingly slide down this slippery slope, the drug has got you.

Maybe 10 percent of the population are at risk of sliding down this slope.

So why risk it if we do not know our genetically related propensities?

Stay away from the Opioids when you really do not need them for pain.

If we have cancer and it is stage 4,

Then who the F cares anyway,

Might as well use anything to slightly mask the pain.

Even Heroin or Methadone.

BUT, if we have something to live for, and we have the days,

Then do not risk the possible consequences of using Opioids for a temporary bout with pain, JUST DUE TO A DENTAL PROCEDURE.

Edited July 12, 2013 by OldChinaHam

[Thighlander]

Are you sure that it was percocet? I have seen a lot of claims that it is not available in Thailand.

How would I know, I was never given any, just using it as an example, because it is common in the US. I believe percocet is still an opiate, as opposed to oxy, which is an opioid. Tramadol is also an opioid, but when I got the root canal, they were singing the paracetamol song, and I really thought I would get a better lollipop than that.