Do I have to replace a missing tooth right away?

I just had to have one of my teeth extracted. What is the recommended timeline after a tooth is pulled to get some kind of replacement put into place? I am worried that everything will start moving around and start causing me more problems. My Dad had some teeth extracted, and he had nothing but trouble after that.

Thanks for your help on this,

Max in Oregon

Dear Max,

You are right to be concerned about getting at least something in place before too much time passes, even if it is just a temporary partial denture (also called a dental “flipper”). In as little as a week or two, your teeth could move significantly. I am a little surprised that your dentist did not give you some kind of appliance to wear while you decide on a more permanent solution.

Even just a single missing tooth can wreck havoc in your mouth. The teeth adjacent to the empty socket tend to “tip in” to the space, and the corresponding tooth in the opposing jaw will “super erupt” to try and meet a tooth that is no longer there. All of these movements can cause a misalignment in your bite, which can lead to TMJ problems including headaches and facial pain. You are also at increased risk for gum disease, which could threaten the health of all your remaining teeth.

Usually you have two options for replacing a single missing tooth. You can do a dental bridge, which is two crowns with a false tooth suspended between them, or you can do a dental implant.

Posted in Dental Implants, TMJ Disorders | Comments Off

Should I let Clear Choice extract all my teeth?

I had a disturbing appointment with a clinician at the Clear Choice clinic in Salt Lake City.

I wear an upper bridge, which is anchored by two dental implants I had placed by my former dentist (he retired). I was thinking I needed at most two more implants with crowns to cover my missing teeth (seven in all). But when I tried to explain to them what I wanted, the clinician quite literally waved my opinion aside. I started to explain, and she cut me off and waved her hand as if to indicate that my opinion had no value, and said, curtly, “We will need to just extract your remaining upper teeth to go forward with our treatment plan.” And then the push was on to schedule surgery.

The more I think about it, the more upset it makes me. She was so condescending! She did not care at all to hear what I had to say about my own treatment.

I went to Clear Choice because they have a reputation for being the best, but now I am starting to think that they just have the best marketing department. The two implants I have and the bridge cost me over seven thousand dollars. Clear Choice didn’t care at all about working with me for my individual situation. All they wanted to do was get everything out of the way and do it their way, regardless of the expense, or of what I wanted.

Dylan in Cheyenne, Wyoming

Dear Dylan,

Sadly, your story is not uncommon. I’ve had many patients tell me that they came away from an appointment with a Clear Choice clinic feeling like they were not being offered any choices at all.

Each patient, each situation is unique. One-size-fits-all dentistry is never the answer. I hope you will seek a second opinion for your additional dental implants. Did your former dentist leave a referral list, or have a partner? That might be a great place to start. Be very careful that you choose a dentist who is fully trained and experienced with dental implants. Of all dentistry procedures, dental implants have perhaps the most potential to go seriously awry if not performed by a qualified expert.

Good luck to you.

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How long do I have to get an implant after an extraction?

One of my molars needs to be taken out. The endodontist my dentist referred me to says it has rotted below the gumline, and there is no way to save it. After the tooth is removed both my regular dentist and the specialist have advised me to get an implant to replace the tooth. At best, this procedure is going to cost me a little over $1,500, and my dentist has warned me that it could very well be more. I do not have dental coverage, and am on a fixed income. I know this is important, but it will take me some time to save up what I need for the implant. How long can I wait between the extraction of the tooth, which needs to happen quite soon, and the surgery to place the implant?

Gemma in Portland

Dear Gemma,

A dental implant is certainly the best choice to replace your missing tooth. With an infection present in the tooth and socket, you would have to wait for the area to heal before any surgery could be performed to place the root surgery. The root form also needs time to integrate with the bone before the crown can be placed on top of the root form.

You really do not have very long to get some kind of replacement tooth in place after the extraction of your infected tooth. Within a few weeks, the teeth surrounding the empty socket will start to “drift” into the space. If you allow this situation to continue, your dental issues will get a lot more complicated, and a lot more expensive to fix. If you do not do something to replace the missing tooth, the resulting teeth movements could lead to bite alignment issues, which could in turn result in TMJ disorder, and headaches.

Your dentist will need to fit you with a flipper, which is a temporary partial denture, to help maintain the current spacing of  your teeth. While a flipper is not meant to be permanent, it could work to keep your teeth from moving too much while you save up what you need for the dental implant surgery. The same flipper can be used after the root form has been placed, while you are waiting for the area to heal before the placement of the crown.

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Considering Clear Choice Dental Implants for my awful teeth

My whole mouth is in horrible shape, I have very few good teeth left. I’m embarrassed to smile, talk, and have a hard time chewing. The worst part is I’m a 30yr. old single man that has no confidence in myself due to being embarrassed by my teeth. I was considering Clear Choice Dental Implants because I like the idea of having all my teeth replaced with a more permanent solution and hate the idea of dentures at my age. I called for a free consultation and they warned me it would probably run $25,000 to $35,000. I can’t afford that! My parents set back some money when they sold a house to pay for my teeth to be fixed but not that much. Do you have any suggestions for me that will help me?
- Brad from Georgia

Brad,
That seems almost criminal to take all your teeth out at age 30 and place implant-retained dentures. And going to Clear Choice - they usually use the short-cut all-on-four dental implants technique, which puts all the implants in the front and leaves the back of your jaw so that it will eventually atrophy. By age 50 you will have practically no jawbone left in the back of your mouth.

My suggestion is to find a dentist who will work with you and your finances and phase the treatment, and save what teeth you can. If your financial resources are limited, just have the most essential things done now, and work at it gradually, so that over a period of years you get back into good shape.

Then while you’re doing that, try to focus also on preventing further deterioration of your teeth by eliminating snacking. A lot of people don’t realize that when they get a lot of cavities, it’s often because they’re snacking all day long. If this applies to you, you can save yourself a lot of future grief by severely limiting the snacking. No amount of brushing can keep your teeth clean enough if you’re snacking all day long.

Posted in Dental Implants, Tooth Decay | No Comments »

Question about dental implants and dental insurance.

I’ve worn full upper dentures for many years, but they are not working for me anymore. My dentist says my jaw bone has deteriorated, and is recommending dental implants. He quoted me a number that took my breath away! There is just no way I can afford the cost of replacing all my upper teeth with dental implants, not without help. Do you know of any dental insurance companies that  would help pay at least part of the expense?

Heather in Raleigh

Dear Heather,

You are in a difficult position. If you have worn a full upper for many years, then your upper jaw bone has probably lost quite a bit of bone mass. Part of that “breath stealing number” might be for bone grafts in your upper jaw, which may be necessary if your jaw has deteriorated to the point that it can not support the dental implant root forms. Sadly, many people do not realize when they you lose teeth, you also lose bone at the site of the lost tooth. Your body reabsorbs the bone for use elsewhere in the body. If you’ve lost all your teeth, your jaw bones can deteriorate until you are unable to wear dentures of any kind, and you may develop a condition called “facial collapse.”

Your dentist is recommending dental implants in part to help halt this bone loss, and likely because it may well be the only option left open to you. Sadly, you will not find a dental insurance company that will pay for dental implants.

If you think about it from the insurance company’s position, it does make sense. Why would they sell you a policy and then turn around and pay for a treatment worth many, many times the value of that policy? It wouldn’t make sense, and they would not be in business long.

Most dental insurance policies will only cover the cost of the least expensive treatment. In this case, they would pay for a different set of dentures, but never dental implants. Even a policy through an employer, which is generally better than what you could purchase on your own, would have an annual maximum of between $500 and $1,000 payout for dental care.

Dental insurance works best when the dental insurance company sells to an employer. The dental insurance company passes on the cost of the dental benefits they pay out on to the employer (plus a little profit for the insurance company), and the employer pays the expenses with pre-tax dollars, as a benefit of employment.

Your challenge now is to find a way to get at least some dental implants in place, to help stop any more bone loss and perhaps provide an anchor for a new denture. Hopefully, your dentist can talk frankly with you about all your options, and will assist you in seeking financing. Best of luck to you.

Posted in Dental Implants, Dental Insurance, Dentures | No Comments »

Her gums are uneven across the front

Dr. McKay,
I recently had a dental implant replacing a single front tooth. But now the gumline is higher for the implant and the tooth sticks out like a sore thump. I’m wearing a temporary now. Should I expect the temporary to look like the final result I want.
- Marilyn from Saskatchewan

Marilyn,
Many dentists use temporary crowns only as a temporary physical protection of the tooth between appointments. They cut down the air sensitivity of the tooth and keep your bite straight.

But with dental implants, you really need to plan ahead carefully how you want them to look, so we would do what we call a “prototype” crown - made out of plastic for ease of manufacture and ease to work with it.

Expecially when there is a problem with the height of the gums. That can be a tricky one to solve. I don’t know that they would grow back or not. If they show when you smile, I’d pay really close attention to the position of the gums. If they don’t show during a normal, wide smile, I wouldn’t worry about it. But placing a well-made temporary crown here is the best thing for trying to get the gums to grow back normally.

So in your case, I would make sure that the temporary looks the way you want it to before going ahead with placing the actual false tooth onto the tooth root.

If you have any trouble, I’d consider getting a second opinion from another dentist.

- Dr. McKay

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Read about snap-on-smiles for a compete smile that’s temporary.
Click here to read more about Dr. McKay’s beautiful cosmetic dentistry.
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I’m worried about my dental implants appointment

I am having implants - a complete set of teeth - done on the 31st. I’m going to be under for this, and being under for 4 hrs has me worried. They are removing a torus from my lower jaw and the rest of my teeth are being taken out and a first set of dentures put in. Is this common to take this long? How is this removal done? I will be under and am worried about this the most.
- Carol in Indiana

Carol,
First let me congratulate you for getting dental implants to replace your teeth that are being taken out. This is by far the best way to replace missing teeth. When your dentures are fixed with implants, they are stable and you can eat normally. With removable dentures as opposed to implant-retained dentures, your chewing efficiency is reduced seriously, and this contributes to a poor diet and a deterioration of your health. So it looks to me like you are doing the best thing for yourself.

And taking out that many teeth and replacing them with dental implants is a lot of work. It isn’t complicated, but it would take a fair amount of time.

Being in the office for four hours sounds reasonable for what you are having done. A torus is a benign growth of bone that often occurs on the tongue side of lower teeth and on the cheek side of upper teeth. It can cause problems when you have a denture because it interferes with the fit of the denture and the skin over the torus can easily become sore. Removal isn’t complicated. The bone is usually just shaved down.

And being “under” for four hours doesn’t seem like a real concern to me. Once you’re under, maintaining that for four hours isn’t difficult. I’m confident you’re in good hands.

Read about Dr. McKay’s drop-dead gorgeous dentures.
See the main web site of Seattle cosmetic dentist Dr. Brian McKay

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Can they add porcelain to my crown without damaging it?

I broke my front teeth in an accident years ago. After years of suffering with tooth pain, I had them pulled and dental implants placed. That procedure went fine. But I am having trouble with the porcelain crown (and the veneers on the adjoining teeth which I was told to have done to assure a consistent looking smile). My first dentist did a horrible job. But now I’m concerned about the work of the second dentist. The crowns and veneers are too white, and the crowns don’t have the shape I requested. My dentist said the color can be changed, and that they can add some porcelain to the crowns to shape them properly. As a layman, it doesn’t seem like the color can be changed after they are already done, and I’m afraid that the “added” porcelain will chip off. Should I refuse delivery on the crowns and veneers and require them to be re-made, or can they be fixed as my dentist represents? Thank you for any insight you can provide.
- Jayne in Virginia

Jayne,
As long as the crowns haven’t been cemented in your mouth, they can be changed in any way without harming their integrity. They can have porcelain added or taken away, the color can be lightened or darkened, or they can have any other change. Then the porcelain is put back in the oven and baked, and it all melds together into one cohesive restoration.

Most general dentists would not let you look at your porcelain crowns and porcelain veneers so closely before cementing on the crowns, so I would commend your dentist for his or her care in this. We are taught in dental school that the dentist knows best, and many will not seek the patient’s input as much as it appears your dentist is. So I’d stick with this approach and hopefully you’ll end up with the shape and color you want, and a beautiful smile.

What you are experiencing is often standard operating procedure when a dentist is fussy about the appearance of porcelain work. We do the same kind of thing in our office when the work comes back from the lab and the patient isn’t fully satisfied with how it looks.

Posted in Dental Implants, Porcelain Crowns, Porcelain Veneers | No Comments »