Durable as well as life-like, dental implants are by far the preferred method for replacing missing teeth. But they can be costly and, although not as much, so can traditional bridgework. Is there an effective but more affordable means to replace a few missing teeth?
There is: a removable partial denture (RPD). In fact, RPDs have always been the less expensive alternative to bridgework and implants. Today's RPDs are usually made of vitallium, a strong but lightweight metal alloy. Because of the metal's characteristics, we can create an appliance that precisely matches the contours of your gums, is thin and hardly noticeable. We anchor prosthetic (false) teeth made of porcelain, resins or plastics in acrylic or nylon that resembles gum tissue.
The most important aspect of an RPD is to design it to produce the least amount of movement in your mouth as you eat or speak. A good design will minimize pressure on both the underlying bone (which can accelerate bone loss) and on the remaining teeth that support the RPD. Although a little more costly, it may be advantageous to use a dental implant to stabilize a lower partial denture when no end tooth is available for support.
To get the most out of your RPD — and to prevent dental disease — it's important for you to practice diligent daily hygiene. RPD attachments can make remaining teeth more susceptible to plaque accumulation, a thin film of bacteria and food particles that can cause tooth decay and periodontal (gum) disease. To avoid this you should remove the RPD and thoroughly brush and floss your remaining teeth. You should clean the RPD every day with recommended cleansers. You should also take it out at night while you sleep to discourage further bacterial or fungal growth.
Besides daily care for your RPD and natural teeth, be sure to visit us for cleanings and checkups at least twice a year. Taking care of both your appliance and your mouth will help ensure your RPD serves you for many years to come.
If you would like more information on removable partial dentures or other restoration options, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Removable Partial Dentures: Still a Viable Tooth-Replacement Alternative.”
Placing a dental implant within the jawbone requires a surgical procedure. For most people it’s a relatively minor affair, but for some with certain health conditions it might be otherwise. Because of their condition they might have an increased risk for a bacterial infection afterward that could interfere with the implant’s integration with the bone and lead to possible failure.
To lower this risk, dentists for many years have routinely prescribed an antibiotic for patients considered at high-risk for infection to take before their implant surgery. But there’s been a lively debate among health practitioners about the true necessity for this practice and whether it’s worth the possible side effects that can accompany taking antibiotics.
While the practice still continues, current guidelines now recommend it for fewer health conditions. The American Dental Association (ADA) together with the American Heart Association (AHA) now recommend antibiotics only for surgical patients who have prosthetic heart valves, a history of infective endocarditis, a heart transplant or certain congenital heart conditions.
But patients with prosthetic joint replacements, who were once included in the recommendation for pre-surgical antibiotics, are no longer in that category. Even so, some orthopedic surgeons continue to recommend it for their joint replacement patients out of concern that a post-surgical infection could adversely affect their replaced joints.
But while these areas of disagreement about pre-surgical antibiotics still continue, a consensus may be emerging about a possible “sweet spot” in administering the therapy. Evidence from recent studies indicates just a small dose of antibiotics administered an hour before surgery may be sufficient to reduce the risk of infection-related implant failure with only minimal risk of side effects from the drug.
Because pre-surgical antibiotic therapy can be a complicated matter, it’s best that you discuss with both the physician caring for your health condition and your dentist about whether you should undergo this option to reduce the infection risk with your own implant surgery. Still, if all the factors surrounding your health indicate it, this antibiotic therapy might help you avoid losing an implant to infection.
If you would like more information on antibiotics before implant surgery, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Implants & Antibiotics: Lowering Risk of Implant Failure.”
It's no secret that many of Hollywood's brightest stars didn't start out with perfectly aligned, pearly-white teeth. And these days, plenty of celebs are willing to share their stories, showing how dentists help those megawatt smiles shine. In a recent interview with W magazine, Emma Stone, the stunning 28-year-old star of critically-acclaimed films like La La Land and Birdman, explained how orthodontic appliances helped her overcome problems caused by a harmful habit: persistent thumb sucking in childhood.
“I sucked my thumb until I was 11 years old,” she admitted, mischievously adding “It's still so soothing to do it.” Although it may have been comforting, the habit spelled trouble for her bite. “The roof of my mouth is so high-pitched that I had this huge overbite,” she said. “I got this gate when I was in second grade… I had braces, and then they put a gate.”
While her technical terminology isn't quite accurate, Stone is referring to a type of appliance worn in the mouth which dentists call a “tongue crib” or “thumb/finger appliance.” The purpose of these devices is to stop children from engaging in “parafunctional habits” — that is, behaviors like thumb sucking or tongue thrusting, which are unrelated to the normal function of the mouth and can cause serious bite problems. (Other parafunctional habits include nail biting, pencil chewing and teeth grinding.)
When kids develop the habit of regularly pushing the tongue against the front teeth (tongue thrusting) or sucking on an object placed inside the mouth (thumb sucking), the behavior can cause the front teeth to be pushed out of alignment. When the top teeth move forward, the condition is commonly referred to as an overbite. In some cases a more serious situation called an “open bite” may develop, which can be difficult to correct. Here, the top and bottom front teeth do not meet or overlap when the mouth is closed; instead, a vertical gap is left in between.
Orthodontic appliances are often recommended to stop harmful oral habits from causing further misalignment. Most appliances are designed with a block (or gate) that prevents the tongue or finger from pushing on the teeth; this is what the actress mentioned. Normally, when the appliance is worn for a period of months it can be expected to modify the child's behavior. Once the habit has been broken, other appliances like traditional braces or clear aligners can be used to bring the teeth into better alignment.
But in Stone's case, things didn't go so smoothly. “I'd take the gate down and suck my thumb underneath the mouth appliance,” she admitted, “because I was totally ignoring the rule to not suck your thumb while you're trying to straighten out your teeth.” That rule-breaking ended up costing the aspiring star lots of time: she spent a total of 7 years wearing braces.
Fortunately, things worked out for the best for Emma Stone: She now has a brilliant smile and a stellar career — plus a shiny new Golden Globe award! Does your child have a thumb sucking problem or another harmful oral habit? For more information about how to correct it, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine article “How Thumb Sucking Affects the Bite.”
Not long ago, the most affordable option for total tooth loss was a removable denture. Dentures, prosthetic (false) teeth set in gum-colored acrylic plastic bases, can effectively restore function and appearance. But the appliance continues to have one major drawback: it can accelerate bone loss in the jaw.
Like other living tissues, older bone cells die and become absorbed into the body (resorption). Normally they're replaced by newer cells. The forces generated when we chew our food travel through the teeth to stimulate this new growth. This stimulus ends when we lose our teeth, and so cell replacement can slow to an abnormal rate. Eventually, this causes bone loss.
Removable dentures can't provide this stimulation. In fact, the pressure generated as they compress the gums' bony ridges can even accelerate bone loss. That's why over time a denture's fit can become loose and uncomfortable — the bone has shrunk and no longer matches the contours of the dentures.
In recent years, though, a new development has been able to provide greater support to dentures while at the same time slowing or even stopping bone loss. We can now support dentures with dental implants.
Implants are best known as individual tooth replacements: a titanium metal post replaces the root, while a life-like porcelain crown attaches to the post to replace the visible tooth. In addition to providing a longer-lasting alternative to removable dentures, implants provide a very important health benefit: they improve bone density because they mimic the function of natural teeth. Bone cells are naturally attracted to the titanium; they adhere to the titanium post and are stimulated to grow through the action of chewing, increasing bone density and securing the implant's hold in the jaw.
Using the same technology we can support removable dentures, or even full fixed bridges. Rather than rest directly on the bony ridges, a denture can make a secure connection through a coupling system with just a few strategically placed implants. We can also permanently attach a full bridge by fastening it to a few implants with screws.
Not only do we eliminate the pressure from dentures compressing the gums and bone tissue, we can actually stimulate bone growth with the implants. Although more costly upfront than traditional dentures, unlike traditional dentures which must be replaced every five to seven years, long-lasting implants may be more cost-effective over the long-run.
If you would like more information on implant-supported tooth replacement, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “New Teeth in One Day.”
Although usually an orderly process, some permanent teeth don't come in as they should. In fact, they may not come in at all and remain hidden in the gum — a situation called impaction. This creates multiple problems for function, health and, in the case of front canines, appearance.
Canines are the longer and more pointed teeth on each side of the front-most incisors. They help tear and cut food during chewing, a function impaction eliminates. Besides a higher risk for developing abscesses (isolated areas of infection) and cysts, they can also put pressure on neighboring teeth and damage their roots or cause them to erupt abnormally.
Dentists often remove impacted wisdom and other back teeth to lessen these potential problems. Removing canines, though, has additional considerations: besides compromising ideal chewing function, missing canines often create an unattractive smile.
But before considering removal, there's another technique we might be able to use to save the canines and actually draw them down through the gums to their correct position. It's usually part of an overall orthodontic plan to correct a poor bite (malocclusion).
After pinpointing their exact position with x-rays or CT scanning, a surgeon surgically exposes the impacted canines' crowns through the gums. They then bond small brackets to the crowns and attach a small gold chain to each bracket. They fasten the other end of the chains to orthodontic hardware that exerts downward pressure on the impacted teeth. Over several months this pressure can help move the teeth into their normal positions.
Unfortunately, this technique isn't always advisable: one or more of the impacted teeth may be in a difficult position to attempt it. It's usually best in these situations to remove the teeth, usually sooner rather than later for the sake of neighboring teeth.
Fortunately, with today's advanced restorative techniques, we can eventually replace the canines with dental implants, although that's best undertaken after the patient enters adulthood. In the meantime, we can utilize orthodontic means to preserve the open space and provide a temporary restorative solution.
Whatever route taken, these teeth don't have to become a source of problems, especially for your appearance. Whether through orthodontics or restorative dentistry, impacted canines don't have to ruin your smile.
If you would like more information on various orthodontic procedures, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Exposing Impacted Canines.”
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