Dentures: Holding On or Letting Go?

Dentures: Holding On or Letting Go?

I’m willing to bet that many people have a favorite pair of shoes – worn, comfortable, familiar. But what if those shoes start causing more harm than good? The same can be true for dentures, especially when we cling to them long after they’ve overstayed their welcome. In my years as a dentist, I’ve seen countless patients holding onto ill-fitting dentures. Often, the only reason they were I my office at all is that they were brought in by concerned family members who noticed that their dentures looked more like dancing puppets than teeth.

Holding on to dentures for too long is like driving a car with bald tires. You might convince yourself it’s okay, but the risks lurk beneath the surface. Over time, dentures lose their fit as bone recedes, causing instability and potentially painful sores. And let’s not forget the impact on digestion and even your appearance. That sunken profile you’ve gotten used to? A new, properly fitted denture can restore it, sometimes even shaving years off your look.

The American Dental Association recommends a refresh about every five years. That could be a reline or a remake, to keep your dentures in harmony with your changing mouth. Some scoff at that, claiming their ten-year-old choppers are doing just fine. But here’s the secret: small, incremental changes are much easier to swallow than a giant leap many years down the line. When you update regularly, the transition is seamless, like slipping into a well-worn but freshly polished pair of shoes. When you wait fifteen, twenty, or twenty five years before replacing dentures, getting use to the new set can seem impossible.

Implants offer a revolutionary option for some, anchoring dentures like sturdy roots. But not everyone can or wants to go that route. For them, the choice boils down to two paths: hold on to the familiar, wobbly comfort, or take a leap of faith with new dentures.

Today, I wear a different hat. Experience has taught me to read the situation, to gauge whether my efforts will truly benefit the patient. If stubbornness trumps logic, it might be time to let go of the case, especially if it doesn’t appear that any help will be well received. But for those open to rediscovering the joys of proper fit, improved digestion, and a revitalized smile, I am ready to guide them on that journey.

Holding onto old dentures, like those worn-out shoes, can be tempting. But remember, comfort shouldn’t come at the cost of your health and well-being. Talk to your dentist, explore your options, and embrace the possibility of a brighter, healthier smile. After all, sometimes, letting go is the best way to move forward.

How Long Do Dental Crowns And Bridges Last?

How Long Do Dental Crowns And Bridges Last?

How long do dental crowns and bridges last? 

I haven’t written anything to the blog for some time now.  Like so many people I know, I have been busy with other projects.  Every now and then, though, something will come up and I find I tell myself, “I need to write about that”.   Recently, an exchange with a patient prompted me to write on the subject of how much time a patient might expect from a crown or a bridge. 

What I found interesting was this patient’s viewpoint about something that was happening with her relative. It seems that this relative was experiencing a problem that required she/he have a crown re-made.  My patient, made an off-hand comment to me along the lines that her relative’s dentist might not have been so great because the crown was having to be redone.   

I’m thinking: Oh, it must have just been placed recently. 

She’s thinking:  After about twenty years. 

Granted.  My patient has not (yet) had to replace any of her dental work and she has been with me nearly twenty-five years.   

But here’s the thing: as a dentist when I hear that a crown lasted twenty years, I think – “Sounds like that dentist did a pretty good job.”  It seemed to me, my patient had an entirely different impression. 

I asked her: “Did you realize that the average life for a crown or bridge is only between 5 and 15 years?”  My patient seemed a little alarmed by that, but acknowledged she did not realize it. 

There are so many factors that can go into how long a crown or bridge may last, that this can be really difficult to predict.  The five- to fifteen-year figure often cited by dentists is based upon university studies and insurance company estimates of how frequently they need to be replaced.  Most insurance companies will pay for a new crown after five years, although, a number of them have recently extended that replacement date to 7 or even 8 years.  

In all fairness, sometimes crowns can fail due to manufacturing errors.  But the reality is that this is very seldom the case.  More often it is the patient that fails the crown.   

How so?  There are two main reasons:  decay under a poorly maintained crown and tooth clenching and grinding. 

But here are a few other ways a crown can break – 

  • Removing bottle caps 
  • Biting fingernails 
  • Cracking crab claws 
  • Holding roofing nails 
  • Tearing open cellophane packages 

Inappropriate use can cause porcelain that is veneered onto a metal base to break off.  Using common sense is important.   

 

Provided a crown is manufactured to high standards, after choosing the right material for you, and having it fitted correctly to your bite it has the potential to last a lifetime. 

 

Home care has something to do with it too. 

In my twenty-five years of practice, I have seen this repeatedly.  For me, two cases have illustrated it best: 

Earlier in my career, I had a patient who needed a lot of dental work.  He already had a lot done, but much of it was pretty old and, frankly, it didn’t look very good.  It’s actually uncommon for me to see work that I believe wasn’t done carefully, but if any situation fit that bill, this was it.  His crowns fit like “socks on a goose.”  I don’t know where he had it done and, at this point, it really isn’t the moral of this story.  The important thing is that this work was, apparently, what he could afford at the time.  What amazed me was that these crowns were still functioning after more than twenty years.  There was no reason they should have.  They fit that badly. So, why were they working?  This patient’s home care was excellent.  He brushed and flossed after every meal.  He knew that getting new dental work was going to be costly for him, so Mr. Flosser he made sure that what he had lasted him.  I was impressed. 

 

Not too many years thereafter, I saw a different patient for a new patient exam. This man had bridgework from ear to ear.  Honestly, it looked great.  Pretty much everything about his crown and bridge work was technically correct.  The bite was good, they were esthetic, and when I took his diagnostic x-rays, I noticed that the critical areas fit perfectly.  Someone obviously took a great deal of care to make sure that they delivered a great product to this patient.  I would have gone to that dentist. 

 

But another thing that I observed when I reviewed the films was that there was decay all over the place.  So much, in fact, that the only way to correct it would have been to remove the bridges, clean out the decay and replace everything. 

 

The likelihood that his dentist would have left behind that much decay is nearly zero.  No one who took that much care into crafting his work would have allowed it.  But the real reason I know that is this:  during the course of my exam, I observed that this patient has so much plaque and garbage in his mouth, I doubt he ever brushed his teeth.  It looked like he had just finished eating cottage cheese before he came in.  The plaque was that heavy. 

 

This man’s dental work was only between two and three years old. He probably paid a small fortune for it.  It was that extensive. 

 

Now, I had the unpleasant task of telling him my findings.  To make a long story short, I never saw him again.  Mr. Cottage Cheese probably thought I was trying to put one over on him.  Nothing bothered him (yet!), and it was most likely inconceivable to him that he should have anything wrong in so short a time.  And yet, it was not a promising scenario. 

 

Today, however, an equally common cause of crown or bridge failure is tooth clenching and grinding.  I have written about this epidemic elsewhere.  But, if you grind or clench your teeth, things are just going to wear out a lot faster.  It’s just common sense.  If you had a choice of parking your car in the middle of a golf driving range or outside of the driving range, under which conditions is your car likely to end up with the better paint job? 

 

Some people can place amazing forces on their teeth.  When they do, if a tooth was in really bad shape before it was restored, the crown probably won’t survive the weak tooth.  You need something of a substrate to support and retain the crown.  The cement can’t be relied upon to do the entire job.   

 

Also, to put things into perspective, the average force on a back tooth is typically around 75 pounds per square inch.  When we chew, that goes up a little – maybe, to 80 or 90 pounds per square inch.  Remarkably, some people have been recorded as having applied as much as 3,000 pounds per square inch on their teeth while sleeping. That can crack a virgin tooth, let alone one that has had any work done to it. 

 

In the end, there really isn’t a simple answer as to how long a crown should last. It can vary.  With all other factors being equal, I would hope for no less than seven years and consider anything beyond fifteen years “good.”   

 

Many of my patients who are still with the practice after 25 years and that I still have the opportunity to examine, continue to have their original crown and bridge-work.  But some have moved to other states, and others have passed away in their older years.  Yet, much of what I can see looks pretty good.  Some old crowns and bridges could use a face-lift. That usually means replacing it. 

 

Every now and then, I wonder about those two patients I mentioned above:  Mr. Flosser and Mr. Cottage Cheese. 

 

Mr. Flosser may still be running around with those old crowns. 

Mr. Cottage Cheese is probably wearing dentures by now. . . . 

 

 

 

http://www.realself.com/question/dental-crowns-last 

Oral Bacteria and General Health

Oral Bacteria and General Health

Did you know that there are way more bacteria in your mouth than there are people on the planet? By some estimates: 120 BILLION bacteria can grow in 24 hours!

That’s really a lot of bugs!

Germophobes might get a little skittish reading this, so it may make you feel better to know that most of them are harmless.

Typically, the body’s natural defenses and good oral health care — such as daily brushing and flossing — can keep these bacteria in check. However, without proper oral hygiene, bacteria can reach levels that might lead to oral infections, such as tooth decay and gum disease.  After more than twenty years of practice I have also observed that oral health can act as a window to your overall health.

For example, your oral health might be affected by, may itself affect, or may contribute to, various diseases and conditions — including:

  • Cardiovascular disease. Some research suggests that heart disease, clogged arteries and stroke might be linked to the inflammation and infections that oral bacteria can cause.
  • Endocarditis. Endocarditis is an infection of the inner lining of your heart (endocardium). Endocarditis typically occurs when bacteria or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart.
  • Pregnancy and birth. Periodontitis has been linked to premature birth and low birth weight.
  • Diabetes. Diabetes reduces the body’s resistance to infection — putting the gums at risk. Gum disease appears to be more frequent and severe among people who have diabetes. Research shows that people who have gum disease have a harder time controlling their blood sugar levels.
  • Osteoporosis. Osteoporosis — which causes bones to become weak and brittle — might be linked with periodontal bone loss and tooth loss.
  • HIV/AIDS. Oral problems, such as painful mucosal lesions, are common in people who have HIV/AIDS.
  • Alzheimer’s disease. Tooth loss before age 35 might be a risk factor for Alzheimer’s disease.
  • Other conditions. Other conditions that might be linked to oral health include Sjogren’s syndrome — an immune system disorder that causes dry mouth — and eating disorders.

Because bacteria can proliferate as quickly as they do, we now provide our patients with a way to minimize bacterial risks during their cleaning appointments.  We have the ability to use a laser decontamination process that dramatically reduces bacterial levels in your gum pockets painlessly, without the need for anesthesia, and in as little time as 5 to 10 minutes.  Better still, the lowered bacterial levels are expected to continue for six to eight weeks.

Unfortunately, dental insurance still tends to be a little behind the times in terms of their coverage for the procedure.  We have kept the cost low, however, in order that most patients can benefit from this exciting new technology.  You can read more about it by clicking HERE.

Don’t Bother Flossing

Don’t Bother Flossing

What?! Is the sky falling? What dentist would dare utter such blasphemy!

Stick with me for a moment. You may learn something about flossing.

Here are the facts as I see them after more than twenty years in dental practice:

Most patients don’t floss.
Most patients don’t like to floss.
Most patients won’t floss even if you explain the benefits of flossing at every checkup visit for ten years.
Most patients are convinced flossing makes their gums bleed and is uncomfortable to do.
Most patients will tell you they floss, but “probably not as much as I should.”
So really, why bother?

Another observation I have made about flossing regards what people think flossing is. I will sometimes hand a patient a piece of floss and ask them to show me how they floss.  Without exception, I have seen patients pass the floss between their teeth and then pop it back out.

That sounds right, doesn’t it? Special effects department please sound the buzzer. That’s not flossing.

Add to this the fact that most patients will only perform this routine once in a while. If you call that “flossing” I say don’t lose sleep over the fact that you are not flossing regularly. That can be effective at pulling food out from in between your teeth, though, so feel free to do so. But if that’s not flossing, just what is it, really?

Flossing is the action of taking a length of floss – either the conventional “string” kind or pre-threaded on a fork-like device – and then passing it between your teeth while holding it in a “C-shape” against the side of the tooth. You then take the floss and rub the edge of the tooth, sliding it all the way under the gum-line in an up and down motion. How often can one do this? After every meal would not be too much. But if people did this at least once a day, the average case would see dramatic results after an average of two weeks of daily flossing.

If you haven’t been flossing regularly here is what you can expect: your gums will bleed when you start to floss. It is also likely to be a little uncomfortable at first. But over time, the bleeding should stop. If you haven’t had a dental checkup and cleaning for a while, it is a good idea to do so this first. Flossing against existing tartar will be an unending battle. Once the teeth are clean, however, daily flossing will usually result in pink, firm and healthy gums that don’t bleed. Other benefits? Fresher breath and reduced inflammation – which also means a lowered chance of heart attack and stroke.

If you only floss once in a while, though, inflamed gums will likely never get up to a point where the occasional activity makes any difference. So, if you don’t make it a discipline, why bother? But if you would like healthy teeth and gums for a lifetime, start flossing today!

 

The Most Affordable Dental Insurance

The Most Affordable Dental Insurance

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. . . .

Richard Walicki, EzineArticles Basic PLUS Author