OK. So let’s say it has been decided: you are a candidate for an implant.
Now what?
You may have heard that getting an implant can take a long time. By contrast, you can have a bridge to replace your missing tooth in about two weeks or less. Isn’t that better?
Not so fast. It all depends.
Let’s look at a couple of scenario
s. If you are replacing only one tooth and have two adjacent teeth here is what you should consider:
In order to place a bridge, you have to shave down those teeth so that they will support the bridge. This limits their longevity and may open the door to the need for additional work, such as root canal therapy in the future.
You should also understand that bridges don’t last forever. The national average, according to university studies and insurance company estimates, is only five to fifteen years. If, you are in your twenties, a bridge can turn out to be much more costly over your lifetime.
Let’s see how this plays out:
For the sake of argument, consider that a person has lost their first molar. The 2013 national average price for crowns (the individual units that make up a bridge) was about $1160. Since our hypothetical bridge has three units, that adds up to $3,480. If existing fillings need to be replaced due to decay, it could cost another $500. And if a root canal is needed because the filling is now closer to the nerve, this can cost as much as another $1,100 for a molar. Suddenly, the total bill can exceed $5,000 using our example.
In five to fifteen years the bridge may need replacement. Let’s be generous and say it lasts fifteen. Between the ages of 25 and 85, that’s four replacements – nearly an additional $14,000 – if nothing else is needed.
In the long run, replacing one tooth using a bridge can cost nearly $20,000 over your lifetime. And that’s assuming it is still in a condition that permits a new bridge.
What if instead we replace the tooth with an implant? At today’s rates, a traditional root form implant runs between $1,800 and $2,000 in my area. An abutment (that’s the part which ties the implant and the implant crown together) will range in price from an average of $850 to $1,200. Prices for implant crowns vary widely – though many dentists charge the same fee as they do for regular crowns. In this example, we’ll use the fee given above, so $1,160.
If we take the higher estimates here, we’re up to $4,360. That’s only $880 more than our bridge in the earlier example’s “best case” scenario.
The difference? That implant (barring situations like an accident causing physical injury to the implant) has a good chance of lasting a lifetime. That’s a lot less than $20,000 over time if you go the bridge route.
I have had patients react in various ways to this analysis. Some tell me “I really don’t want to wait three to nine months, while wearing a temporary partial, for the implants to be ready.” Others have said, “Well, if I’m going to have to replace a bridge down the road, or even end up with an implant later anyway – I might as well just do it now.”
Both arguments have their merits. But at least now you have some information that can help you make an informed choice.
We hope we will never lose a single tooth. Unfortunately, it happens sometimes. We can lose a tooth for many reasons. I won’t delve into them in this article. The purpose here is to help you to decide between a bridge and an implant, in the event that you have to make that choice.
Just so we are clear: No two situations are completely alike. I have neither seen nor evaluated your case and am simply discussing general principles. You should always consult a comp
etent and licensed professional to assess your specific circumstance before making a decision that will affect both your health and finances. Nevertheless, here you are. Either a tooth has been compromised and is lost already, or it is about to be extracted. If the idea of dental implants has crossed your mind, your dentist first has to determine whether you are a good candidate for the implants. The criteria can be broken down into three broad categories:
Do you have any medical issues that may prevent successful placement of an implant?
Do you have sufficient bone?
Will your existing bite allow it?
So let’s get into it:
1. Medical Issues. Health conditions that could prevent an implant being placed may include, but are not limited to:
Diabetes
Recent heart attack or stroke
Immunosuppression
Drug abuse
Active treatment of malignancy
Intravenous bisphosphonate use
You should disclose anything you think could be a matter of concern with your dentist. The success rate with dental implants is very high, but careful case selection is the key to success.
2. Sufficient Bone. Again, this needs to be determined by the implant surgeon. Your bone needs to be high enough and wide enough to accommodate the implant. If it isn’t, you may still qualify for a dental implant, but will likely require an additional procedure called bone grafting. Your dentist or implant specialist will determine your specific needs.
3. Your Bite. What does the bite have to do with anything? There was a tooth there to begin with, right? Both implants – and natural teeth – survive longer when your teeth and jaw are in harmony. If your bite has collapsed – meaning the upper jaw and lower jaws are now too close to each other – there may not be enough room to place an implant without orthodontic (braces), or surgical, intervention.
Starting to sound a bit complicated? Don’t worry, in most cases, the dentist can tell you pretty quickly if he feels implants will work for you. Sometimes, he needs additional screening tools to make the final call but, if he does, he’ll let you know that too.
As the year’s end approaches, I am taking this opportunity (yet again) to share a tip that can help you take full advantage of any dental insurance benefits you may have.
While some patients well understand how their insurance operates, I have learned that others do not. So let’s undertake a quick review:
The way your dental insurance benefits work is that you are provided with a certain dollar amount of benefits each year. If you do not use those benefits you will lose them! (Unused benefits do not carry over to the next year). Many people do not realize this and allow hundreds (sometimes even thousands) of dollars worth of benefits to remain right in the insurance company’s bank account. While treatment should never be dictated by insurance, if you have any treatment that remains to be completed, or you have any dental concerns at all, it would be very useful for you to come in before the end of the year.
Our goal for each of our patients is to help them enjoy the best oral health possible for their circumstances. For you, that probably means that you look good, you feel good, you have strong teeth and gums, and you enjoy the benefits of a healthy, attractive smile over your lifetime.
If you would like to make an appointment, just give us a call and we will find a time that is convenient for you. Just remember that when the clock strikes 12 midnight on December 31st, you will lose unused dental benefits. We will be happy to help you get the full benefits to which you are entitled under your dental benefits policy. If you know you’ll need more than one visit, give yourself enough time to have your work completed with whatever benefits you have remaining, so call today.
Lasers are familiar to many of us from science fiction (think of the Star Wars light saber) to comedy (remember Austin Powers’ Dr. Evil?). The fact is that lasers surround us in every-day life. For example, in the home you will find them in CD players, while industry uses them for high-speed metal cutting machines and measuring devices. Hair replacement, tattoo removal, dermatologists, eye surgeons — they all use lasers.
So do dentists. And so does our office.
This begs the question, just what is a laser? How is it different from any other kind of light? “If Dr. Evil planned to destroy the world with one, why won’t it hurt me when you use it on my gums?!” Actually, that’s three questions . . . .
Anyway, let’s try take them in order:
The word “LASER” itself is an acronym that stands for light amplification by stimulated emission of radiation. This concisely describes exactly how a laser works. The laser is a device which controls the way that energized atoms release photons (a quantum of electromagnetic energy). When we say “radiation” however, we are not talking about ionizing radiation — such as would be produced by an x-ray.
Laser light is very different from normal light or radiation emitted by an x-ray. Laser light has the following properties:
The light released is monochromatic. It contains one specific wavelength of light (one specific color). The wavelength of light is determined by the amount of energy released when the electron drops to a lower orbit.
The light released is coherent. It is “organized” — each photon moves in step with the others. This means that all of the photons have wave fronts that launch in unison.
The light is very directional. A laser light has a collimated (very tight) beam. This makes it stronger and concentrated. A flashlight, on the other hand, releases light in many directions, and the light is very weak and diffuse.
Why won’t it burn you to a crisp when we use it on your gums? Clearly, we’re using a controlled power setting (in our office we use a diode laser) — in fact, most patients tell us they don’t feel anything when we use it in conjunction with their dental cleanings. But that doesn’t mean it isn’t effective!
Watch the video below for a demonstration and explanation of how a dental laser is being used during a routine cleaning.
If you would like to read more about how we use a dental laser in our office and how it can benefit your health, check out the following article posted in the Services section of our website:
Very often patients ask me about what toothpaste they should use. Seldom, however, am I asked about the best technique for cleaning teeth, when brushing should be done, how often they should brush, or for how long.
The subject of tooth cleansers can be confusing. There are pastes, powders, cavity-fighting and gum-protecting formulas, as well as whitening varieties. Most toothpastes use some form of mild abrasive to clean teeth, while others rely on enzymes to lift the stains out of your teeth. Some are foaming and some are not. Most contain fluoride, while others don’t.
While I do have a personal favorite toothpaste, I honestly believe that an effective job of cleaning can be accomplished with the vast majority of toothpastes available on the market. Why are there so many out there? In a word: marketing. I’m pretty sure toothpaste companies have discovered that if a toothpaste has the word “whitening” on it, they are likely to sell more than if it is omitted — even if the whitening benefit is small.
Some people have even taken to the idea that almost anything will work to clean your teeth. Even soap. Here is a short video I ran across recently that discusses this, and also why you may not want to wash your mouth out with soap. I tend to agree that you should use the right product for the correct purpose.
Click on the toothbrushes below to view the VIDEO:
For the curious, here is an earlier posting that answers some of the other questions discussed above, including how often you should brush.
Just last week I encountered another case of a cracked tooth needing to be extracted. I can’t say this is uncommon. Yet something about this one stuck with me . . . probably because I felt it was avoidable.
Cracked teeth as a result of the grinding and clenching of teeth — also known as bruxism — appears to be reaching epidemic levels. Frankly, that wasn’t the only case of of problems I saw as a result of tooth clenching that day.
The patient I treated right after him had a series of problems connected to clenching as well: among them, bone loss — (with at least one tooth that will have to be removed as a result), front teeth that were chipped, and another that that developed an abscess. Yes, all of these problems had direct connections to the patient’s habit of clenching his teeth.
But let’s return to original patient for a moment. When he first came in and saw me for his initial consultation six months earlier, I pointed out that there was evidence of bruxism. I recommended doing something about it at that time.
The patient looked at me funny — it was clear that he didn’t think he had that problem. I explained why I thought he clenched his teeth and pointed to several things that indicated that condition. He handled a few other problems, but decided to let this one go (“for now”). I’m not going to put a gun to anyone’s head when it comes to my recommendations, but inwardly I wished him good luck.
While conducting my follow-up exam I observed a crack running through his root. Given it’s size and location, his only option is removal. It didn’t hurt him as much as it could have because the nerve had already been removed, but I couldn’t help thinking this was a shame. Had we followed the recommendations I made six months ago, we probably wouldn’t be dealing with this now.
It’s too late for that patient, but the underlying message here is simply this: if a dentist tells you there is a body of evidence suggesting you grind your teeth — don’t ignore it. Most people simply don’t know if they grind because they often do it while they are sleeping. What is more, they don’t do it consistently. Remember, damage can occur in many different ways. It can be slow and steady, like wind erosion wearing down mountains or very quick and short-term, like a bullet to the head. Either way, there is visible change in the end.
Here is a link to an earlier article I wrote about grinding. If a dentist has ever told you that you might grind or clench your teeth, take it to heart. You may be saving yourself a few dollars . . . as well as a few teeth.
I might also give this article the byline: “The Daily Grind.” But I wouldn’t be talking about work. For millions of people, the daily grind is happening to their teeth — and they are often working them to death. I’m not talking about the normal work you would expect, such as that which is associated with eating.
I’m talking about the grinding and clenching of teeth, known as bruxism.
“Bruxism.” It even sounds grating. And, believe me, it literally is. The word itself is taken from the Greek “brugmos,” which means the “gnashing of teeth.” Many people are surprised to learn that it is considered to be one of the most common sleep disorders.
While grinding and clenching can occur either during the daytime or at night, it is bruxism during sleep that causes the majority of dental and health issues — and it can even occur during short naps.
Unfortunately, all of the causes of bruxism are not yet well established or understood. There are several theories, but by most accounts it is classified as a habit. Among the theories that prevail are that some medical conditions such as digestive ailments or stress can contribute to the condition. Others speculate that changes to the bite, such as might occur following tooth loss is a contributory factor. Still other concepts include spinal misalignments (following accidents) or nutritional deficiencies (thought to be calcium, magnesium, and pantothenic acid) as being causative factors.
Some of the activity that occurs when people brux is rhythmic (like chewing) and some is sustained (like holding the teeth together tightly). Both can cause significant damage to the teeth and underlying bone.
It is interesting to note that almost everyone experiences bruxism at one time or another. Until recently, dentists found that only a relatively small percentage of patients would go on to develop symptoms alerting either the patient or the dentist to the problem. Commonly, this would be headaches or jaw pain that might prompt treatment. At other times it might appear as wear patterns on the biting surfaces of the teeth, cracks in the enamel, chipped fillings or crowns, abfractions (notched-out areas of teeth typically found at the gum-line), receding gums or loose teeth.
What is particularly alarming, though, is that over the last several years, bruxism is being reported by dentists as an increasingly common occurrence. One recent report that I read suggested that as many as one in four patients seeking routine dental care grind or clench their teeth.
Most bruxers are not aware of their condition. In fact, many people will insist that they don’t grind their teeth. Spouses or “significant others” often reinforce this by suggesting that they watch the person while they are sleeping and notice the individual snores or has their mouth open. This is difficult to dispute (unless an actual, controlled sleep study is conducted) but it unfortunately can cause dentists to defer intervention while still more damage can occur. And, over time, it usually will. Keep in mind that with sufficient force, the contact does not have to take a long time to do damage. Think of a bullet, for example. It’s a small object and has very brief impact, but the velocity is sufficient to cause harm.
Certain sleeping positions will cause more stress than others. People who sleep on their stomachs usually experience the highest levels of stress. Again, remember, one doesn’t have to be in this position all night for damage to occur. People who have broken teeth or dental restorations while sleeping sometimes report hearing a “pop” and then feeling a loose fragment in their mouth. This is a momentary occurrence. Of course, one typically sleeps every night, so if outright fracture doesn’t occur right then, it doesn’t mean physical stress isn’t being applied.
Here are a few other factors associated with bruxing that may be subject to your control:
Relatively high consumption of caffeine, such as is found in coffee, colas, and chocolate
Smoking
High levels of blood alcohol
Drug use, such as SSRIs (anti-depressants) and stimulants like Ecstasy, MDA, and other amphetamines, including those taken for medical reasons.
High levels of anxiety and stress, irregular work shifts, and stressful professions or relationships
Disorders such as Huntingdon’s and Parkinson’s Disease
Keep in mind that other habits in combination with bruxism can accelerate the problem — such as consumption of abrasive foods and acidic soft drinks. These can weaken the enamel mechanically or chemically, thereby accelerating the process of wear.
So far, there is no single accepted cure for bruxism, but it can be reduced or even eliminated if you treat the associated factors successfully. As far as repairing the damaged already caused, typically a dentist will replace the worn natural crown of the tooth with prosthetic crowns. In the event of tooth loss (following cracked teeth) implants may be advised. The materials used will vary by location in the mouth. To protect the new crowns and dental implants, a professionally fabricated custom occlusal guard should be made for wearing while asleep.
Most over-the-counter night guards (while very inexpensive) are deemed ineffective by dentists and in some cases may contribute to problems with the jaw joint, the TMJ. Professional treatment is medically recommended to make sure that the bite has remained stable, to check the device for proper fit and to make any ongoing adjustments, if needed. Monitoring the night guard is suggested at regular visits. It is also important to note that night guards, are simply a first response to bruxism and do not cure it. Their general goals, however, are to:
Minimize the damage to the jaw joint (the TMJ) which at times can be severe and may even require surgery.
Stabilize the wear patterns on the teeth that at first occur gradually, but progressively alter the bite to a point where the change becomes more rapid.
Prevent tooth damage, including damage to existing dental work.
Allow the dentist to evaluate (broadly) the extent and patterns of bruxism by physical examination of the patterns on the surface of the night guard.
Frankly, bruxism can be difficult to diagnose because it is not the only source of tooth wear. Compound this with the fact that the effects of bruxism can be very advanced before the patient is even aware of it, and one has a formula for trouble. In one of the most severe cases of bruxism that I have treated, what brought the patient in to my office for the first time was that he had worn down his front teeth to the point where the nerves were actually exposed. That’s severe. Tooth sensitivity can occur way before then, however.
The most reliable way to diagnose bruxism is through a sleep study performed in a hospital. In my experience, relatively few patients are willing to do this, but the results are difficult to refute.
If you notice changes in your bite or your teeth that you suspect are caused by bruxing, you should point this out to your dentist so that he can evaluate the cause. The sooner the better.
Dr. Richard Walicki is a dentist practicing general and cosmetic dentistry. While we hope you find the information contained herein interesting and useful, this blog is for informational purposes and is not intended to diagnose any oral disease. Dental conditions should be evaluated by your dental health professional or a qualified specialist.
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