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.
Recently, a great deal of attention has been placed on economizing in all different aspects of life. Some people have even considered cutting back in the area of health care by putting off routine maintenance care. While this is a little like playing Russian roulette when it comes to dental health — for reasons I’ll explain shortly — there may be a better way to dodge the financial bullet. And it may be a much simpler one.
After more than twenty years of practice I have seen people consider all sorts of ideas to deal with rising dental costs. Often, people become fixated upon dental insurance as the primary solution to the majority of their dental needs. Because dental insurance generally tends to be pretty expensive relative to what it pays out, especially if you are buying it yourself, patients that rely on it exclusively often end up worse than when they started. Dental insurance typically has waiting periods before it can be used, during which time existing conditions advance, becoming more expensive.
In these cases, you have to wonder – if the premiums are costing you more than what the company pays you back – what’s the point? Obviously, this arrangement is a much better deal for the insurance company than for the patient. Let’s also consider that when I first started practice, dental insurance maximums averaged $1,000 to $2,000 annually. Twenty years later, they average . . . $1,000 to $2,000 annually. If insurance kept up with inflation alone, the annual maximum should easily be over $5,000. Don’t hold your breath for that one though. Patients would be better off just setting aside the amount they pay for premiums. They usually come out better in the end.
Putting off dental care often becomes more costly to patients for several reasons. Firstly, many dental conditions are actually painless in the early stages. Periodontal disease is a prime example. This is a condition in which the bone surrounding the teeth becomes lost, leading to a variety of circumstances including bleeding gums, loose teeth, bad breath and, eventually, tooth loss. It is the number one reason that people loose teeth world-wide. For the most part, it doesn’t hurt. When it does, if it does, it is usually too late. The tooth or teeth have to come out.
Likewise, dental decay usually doesn’t hurt in the early stage. Actually, I’ve lost count of the number of times it didn’t hurt in the advanced stage either – but this is usually the point at which the patient becomes aware of a problem. A piece of the tooth breaks off, or they actually experience pain. The tragedy of this scenario is that when it reaches this stage teeth often end up requiring more expensive root canal therapy or extraction. Dental costs can very quickly escalate as much as ten times from the cost of a simple filling to what it costs to complete a root canal and crown.
So what do you do? Focus upon prevention.
Here is a true story I hope will leave as big impression upon you as it did me at the time:
When I was a dental student, I recall a lecture give by one of my professors in which he made a powerful point on the subject of prevention. The seminar dealt with the subject of prosthetics – more specifically, the fabrication of crowns and bridges. This professor, however, was one of those rare dentists who actually had two recognized specialties. He was a professor of prosthetics, but he was also a periodontist. While this was a crown and bridge lecture, he taught us a very valuable periodontal lesson.
Here’s what he did. The seminar was pretty informal at this point. The professor told us he was going to put up some slides of patients and have us guess their ages – just by looking at their x-rays and then at pictures of their gums. As a student, I remember thinking this was a refreshing little game and most of the class was doing quite well calling out the ages. Looking at the x-rays, we would evaluate bone levels, tooth eruption patterns, tooth wear, number of restorations and similar factors to make our “guess.” Then we would look at the color and texture of the gums and appearance of the smile and offer up our estimate. The professor would then show us the face of the patient and tell us their age. This went on for a while and we all did pretty well.
He then put up the next slides and guesses rang out: “twenty-five,” “thirty,” “twenty-seven,” went the typical guesses. I don’t think I can remember seeing a single filling on those slides, though there could have been. Nothing changed when he showed us a picture of the gums. They looked like a teen-ager’s. Then he put up a picture of the face. The person pictured was obviously in their late seventies, maybe even early eighties.
Dead silence. Then there was a small commotion and most of the class pointed out that the slides got mixed up.
The professor paused, and said “No. This is correct. Let me tell you how I can be sure. This is a picture of my father. Those are actual x-rays and a recent picture of his gums. How is it that he has such excellent oral health?”
He then went on to tell us how when his father was a younger man, he had a visit with his dentist and he complained to him that whenever he ate, he would get food stuck between his teeth. His father wanted to know if there was anything he could do about it, because it was pretty annoying.
The dad’s dentist thought about it for a second and told him: “Well, I’ll tell you what I do when that happens to me. I go over to my wife’s sewing kit and take out a piece of silk thread and just pass it between my teeth.” As a student, I wondered when floss became invented. Evidently, it just wasn’t popular back in those days.
In any case, our professor went on to explain that his father did exactly that after every meal since he was a young man. His gums, teeth and bone levels were almost unchanged. That’s what he had to show for his efforts.
I filed the image in the back of my mind, but I have to be honest – I didn’t exercise the same level of commitment – just yet.
Oh, sure, I brushed, watched what I ate, and took vitamin and mineral supplements. But my flossing was sporadic. That is, until I really started looking at what happened to my patients and how those who flossed performed against those who didn’t. If you asked me today: do I floss regularly? Absolutely. You can’t buy cheaper dental insurance.
Flossing benefits your gums, your breath, your teeth, your lungs, your heart – in short, you.
Do you know that probably up to a third of the cavities I treat happen between the teeth? This is why regular exams are so important. You simply can’t see this area. For that matter, without x-rays, neither can I in most cases. But my point here is simply this: even if you brush after every meal and snack, without flossing this area never gets cleaned. Why would anyone become surprised that an area that never got cleaned could decay over time?
There are all sorts of reasons people don’t like to floss, but the reasons to do it are actually pretty compelling and very cost-effective. Think it over. Maybe floss is the most affordable dental insurance. . . .
In a previous article, Foods That Are Bad For Your Teeth, I reviewed three broad categories of foods that can be detrimental to your dental health. These were sugars and sweeteners, low fat foods, and foods that contain white, especially bleached, flour.
With this article I would like to spend some time talking about an area that I feel receives entirely too little attention – whether by patients, or dentists, for that matter. Possibly, this comes about for the simple reason that by the time many patients arrive at the dentist they are looking for resolution of a specific problem. In this sense, the market has conditioned both patients and doctors into focusing upon the end-game.
This has its place and fills a need. Patients who are in pain do not generally want to hear about what they should be eating – they want to handle their pain. Yet, knowing what foods can repair teeth may be a key element in establishing their future long-term dental stability.
In today’s economic climate, health care has undergone many challenges and the consumer has been faced with high medical and dental costs. Consequently, health care is not infrequently reserved for the handling of emergencies. This is actually counter-productive, as emergency dental care is also expensive. Couple this with efforts by the patient to reduce costs, and the “treatment” may be a decision to remove the offending tooth. Later, when the patient starts to regret his choice and seeks tooth replacements, he may find that replacement costs are many times more than had they handled the problem once discovered.
Economics can also influence the quality of the food we consume. In an effort to save money many consumers will also select lowest cost items. These are typically quite profitable for the producer but are usually highly processed and very unprofitable for your health.
So what do you need to know?
Let’s start with this simple concept: If what you eat comes out of a box, a jar, a can, or a plastic wrapper, it has been processed.
Your diet is the single most important thing that you can control to create or maintain a healthy mouth. When you eat too many processed foods – especially those that contain sugars and bleached flour – you create effects that may not be immediately noticed by you. For example, the level of blood sugar can become elevated and with it a person can experience elevated cortisol. Cortisol is a hormone produced by your adrenal gland and is responsible for raising blood sugar. It also affects the flow of parotin (a salivary gland hormone) and, in so doing, can lead to cavities. Cortisol also counteracts insulin which regulates carbohydrate and fat metabolism in the body, and it slows down bone formation.
The inability to metabolize fats, in turn, can keep you from benefiting from the healthy foods that can help you to repair your teeth.
So, you see, it is a little like the children’s song “The foot bone’s connected to the ankle bone. And the ankle bone’s connected the leg bone.” The bottom line: what we do – or don’t do – can have unseen and unwanted effects when it comes to our diet and teeth.
Maintaining healthy hormones is very important to your dental health as well as to your general health. The relationship between demineralization and remineralization is balanced when hormones are healthy. When unbalanced, calcium and phosphorus can be pulled out of the blood and create deficiencies in our bones as well as the teeth. It can also create a condition wherein your body becomes excessively acidic. An acid environment is more receptive to the growth of bacteria and fungi. If there is one take-home message that you take out of this article it should be that real food – namely unprocessed food, as nature intended that it be consumed – will not only support your general health, but will also support your teeth.
What foods, then, are good for your teeth?
Proteins: Eat proteins in order to regulate blood sugar. As mentioned above, blood sugar fluctuations are one of the key reasons that we lose minerals. High quality proteins such as grass fed, or wild game are best. While I realize that this may pose a problem for vegetarians, it doesn’t alter the fact that the most productive stores of minerals, protein, and fats are derived from meats. Vegetarians must rely on eggs and cheese for their protein.
Foods with phosphorus: Possibly more important than calcium for your teeth, phosphorus can be obtained from milk and cheese. Raw, unpasteurized milk is best. Unless, strictly vegan, vegetarians should have no trouble getting their phosphorus from these sources. Other good sources of phosphorus include organ meats of both land animals and those from the sea. Muscle meats (most common meats consumed, i.e., not from organs such as liver or kidney, for example) are also a good source, as are beans and nuts. Organ meats have more phosphorus than muscle meats. Although present in some grains, the quantities can be insufficient or difficult to absorb, and this may not be the best choice for your teeth.
Trace minerals are important: In addition to phosphorus, the following deficiencies can also lead to problems with tooth decay – iron, copper, magnesium and manganese. Foods with iron include shellfish and organ meats. Copper is found in liver and mollusks. Smaller amounts exist in mushrooms. Magnesium can be found in fish, nuts, and spinach. Manganese, also important in the regulation of blood sugar, occurs in liver, kidneys (organ meats), mussels, nuts, and pineapple, to name a few sources. Other trace minerals may also play a role, but are too numerous to mention here.
Healthy fats: These are a great source of energy, but are also important to help maintain hormonal function and balance. Among the healthy fats are olive oil, butter, beef, chicken, pork and duck fat. Avocado and coconut oil are also healthy fats, especially if from organic sources. Vegetable fats do not generally contain the vitamins that help to re-build our teeth.
Fat soluble vitamins D and A: Simply put, without adequate stores of these two vitamins, we can’t get the calcium and phosphorus into our bones or teeth. People with tooth decay are typically lacking these two vitamins. Seafood is an excellent source of Vitamin D. If you don’t have easy access to seafood, or if you don’t like it, lard, or pork fat, will help. Suet, or beef fat appears to be more effective, however. Another excellent (and relatively simple) way to get Vitamin D is with daily exposure to sunlight. Consuming fermented cod liver oil is still another easy way to get Vitamin D into your diet.
Eating healthy is the single-most effective action you can take to protect your teeth – and your overall health. It is also one thing that you can control. Take the time to learn which foods can provide you with proteins, phosphorus, healthy fats, vitamins D and A, as well as trace minerals, and you will be well on your way to healthier teeth and gums!
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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