A Full-Mouth Reconstruction Causing Problems

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I am in the middle of a full-mouth reconstruction, and things are not going well. It’s a bit of a mixed bag with two dental implants and the rest are crowns and bridges. I am a bit worried, because the first round went well and I thought I would be good to go. Unfortunately, that has not been the case. Once the permanent ones were bonded on things went really wonka-donk. The teeth are not meeting together the way I had always considered normal. I thought at first maybe it felt different because I was used to it the wrong way. But, now I’m having trouble chewing both because of the way the teeth are meeting (some of them don’t even touch) and the fact that my jaw isn’t moving properly. I don’t think this is because it is unfamiliar to me. Do you have any advice? I’m in quite a bit of pain.

Sandy

Dear Sandy,

An image of a woman holding her jaw while in pain.

Bear in mind that I have not examined you. However, if I am getting an accurate understanding of your description, there is a real problem here. First, for those who are not aware of what a full-mouth reconstruction is, it is when a dentist uses crowns, in some form, on every tooth. In this case, there is a mixture of dental implants, along with crowns and bridges.

Doing a full-mouth reconstruction is a very advanced procedure which very few dentists are actually qualified to do. It takes significant post-doctoral training. Based on your description, the way this was done is a serious problem and it sounds like it has completely thrown off your bite and you are now dealing with both poor occlusion of your teeth as well as TMJ Disorder. If that is the case it needs to be fixed as soon as possible.

One thing that puzzles me is the fact that you said the temporary placements were fine. Your permanent crowns and bridges should have been modeled after your temporaries. Also, your dentist should have used a temporary try-in paste and made sure everything still lined up properly. It does not sound like he did that.

I want you to get a second opinion by a dentist with significant TMJ training. Look for someone who has post-doctoral training in TMJ Disorder. Look for training at one of the following institutions, which are known for their great TMJ instruction:

  • The Dawson Academy
  • The Pankey Institute
  • The Las Vegas Institute of Advanced Dental Studies

One word of advice. When you do get your second opinion, make sure it is a blind appointment. That means that you do not tell your dentist who did your full-mouth reconstruction. If they ask, just tell them you want an unbiased opinion and would prefer he or she gave their thoughts without knowing who the dentist is.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

Is There a Way to Get Help Paying for Dental Implants?

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I am only 33 years old and everything about me is healthy and attractive except for my teeth. My dentist is suggesting I just take them out and get dentures, but as I am so young, I really don’t want to do that. I’ve read the horror stories about facial collpase that come with dentures. I’d be happy to get dental implants if I could afford them, but the price is well beyond what I can do. Do you know of a way to get help paying for these. I’d be happy to do commercials or something for a dentist for free after I got the implants. Do you know of dentists who would be willing to do that? If not, is there any other way to get these for less money?

Andrea

Dear Andrea,

Before and after facial collapse

You are in a tough spot but I do have some suggestions for you. First, because you mentioned facial collapse, I’m going to explain it for those who may not be aware of the problem with dentures. When your teeth are removed, your body starts resorbing the minerals in your jawbone because they are no longer needed to keep your teeth roots in place. The unfortunate result of that is in about ten or so years, you will no longer have enough jawbone left to keep your denture in. Additionally, the way it shrinks the jawbone makes you look years older. Having dental implants placed prevents facial collapse because the implants signal to your body that you still have teeth that need support.

I don’t think you’ll find anyone to let you advertise for them in place of paying for the dental implants. It’s too easy for dentists to get people who pay for their treatment to agree to advertising. However, I do have a few suggestions that may help.

Getting Affordable Dental Implants

  • Dental Implant Students: If you are willing to have your dental implants done by a student learning how to place dental implants, you can save a substantial amount of money. They are supervised, so it is not as dangerous as it sounds, but it does take more time because they are learning.
  • There are a couple of affordable dental implant options that you may be able to start with. They’re not as high end as the real thing, but they will protect you from facial collapse. Talk to your dentist about those options and see if they will work in your situation.

It may be worth your time to get a second opinion. Not all dentists prefer to save teeth. Some will just extract them and save themselves the trouble of the constant battle with decay. It may be you have quite a few teeth that can be saved and you just need to go to a dentist willing to put in the work.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

Sometimes You Should Not Trust a Dentist

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I went to a new dentist because I’d been having a bit of tooth pain. I recently was tranfered and my regular dentist is three hour away now. The new dentist did an x-ray and said that there is decay on a tooth that already has a filling. He then proceeded to say that only about 10% of the tooth is viable and it would need to be extracted. He had me schedule the extraction appointment right then and said after the extraction, I’d need to schedule another appointment for bone grafting and a dental implant.

I am all for taking care of dental decay, but I just have a weird feeling that this is overkill. Am I right in thinking that something is hinky here or are my doubts because I am uncomfortable with what is forthcoming? I’ve never lost a tooth before and it would be disingenuous to say that it doesn’t bother me.

Brandy

Dear Brandy,

Man in pain grabbing his jaw.

Bear in mind that I have not examined you, but I do think you have a right to be sceptical here. If the decay and infection had gotten that bad you would not be just now feeling some pain. You would have been having pain for months. An additional issue here is the amount of decay he is saying. If that were accurate, he would not have needed an x-ray to show him. It would be obvious. In fact, it would be very likely that the filling would have fallen into the decayed tooth.

My suggestion is that you cancel this extraction appointment and get a second opinion. There are dentists who will work in non-established patients in the case of dental emergencies the same day. When you do go, make sure it is a blind second opinion. Don’t tell them who the dentist is that diagnosed you or what he said. Just tell them exactly what you told the original dentist. This way their opinion is unbiased.

I suspect you will be able to save the tooth. However, if it turns out the tooth really does need to be extracted, then a dental implant is the best replacement option. Just take some time and make sure you get a qualified dentist to do the procedure. It is not adeqately taught in dental school and does require some post-doctoral training.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

Implant Bridge Does Not Line Up with My Bite

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I recently had two dental implants placed that a dental bridge was attached to on the right side of my bite. The problem I am having is that when I bite down, my right side matches up but my left side does not. Is this a problem in the long run? It is uncomfortable. I talked to my dentist about it and he said it is the surgeon’s problem and fault because he did the work first. Of course he did! How else could the dentist put the restoration on? The surgeon of course says it is the dentist’s fault because he placed the restoration. I don’t know what to do.

Rose

Dear Rose,

A woman grabbing her jaw in pain.

This does need to be fixed. When your bite does not come together properly then it can lead to TMJ Disorder. This can leave you in pain for the rest of your life. I’m a little unclear as to who determined the placement of your dental implants. Whenever you have a dentist and an oral surgeon working on the implant procedure together, it is always the dentist who determines the placement.

If the oral surgeon insisted on determining the placement himself, then he is definitely at fault. It is standard procedure for the dentist to determine the placement, if he violated that he’s to blame. However, if he followed the dentist’s instructions in placement, then it is the dentist who is responsible.

Either way, this needs to be redone. The good news is you definitely deserve a full refund here plus the cost of bone grafting, which we’ll get into in a moment. Once you get that secured, you’ve got to get a different dentist to do this. Unfortunately, you will need bone grafting done first because you will lose bone when they remove the implants. Once the grafting is completed, then you can have the implants done again.

Make sure the person you have do the procedures has a significant amount of post-doctoral training in dental implants. What is taught in dental school is not enough.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

I Can’t Keep My Dentures In

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I am only 60 years old, but have been wearing dentures for 21 years. Lately, I cannot keep them in my mouth. Even using those gross adhesives doesn’t work anymore. Is there anything I can do about this?

Doris

Dear Doris,

before and after facial collapse

The results of facial collapse

 

What you are dealing with is called facial collapse. I don’t know if your dentist warned you about this when you first decided on dentures. Hopefully, he or she did. When your teeth were removed, your body recognized you no longer have any teeth roots. In an effort to be as efficient as possible with your body’s resources, it begins to resorb the minerals in your jawbone that were used to help hold those roots in place. This way it can use them in other places in your body that the minerals can be used. The unfortunate side-effect to this is your jawbone begins to shrink. The number of years you have been wearing dentures means you do not have enough of a jawbone left to retain your dentures.

The Solution to Facial Collapse

implant overdentures

Implant Supported Dentures

Step one in fixing this means building back up that jawbone. You can do this with a bone grafting procedure. Once that is completed, you have two choices. First, you can get new dentures. Bear in mind, if you choose this option the whole cycle of facial collapse will begin again. A second option is to get implant supported dentures. What this does is place between four and eight dental implants in your jawbone, depending on your budget and other factors. Once the bone has had time to integrate with the implant fixtures, your denture will be anchored to them.

Because the implants serve as prosthetic tooth roots, your body interprets them as teeth. It will leave those minerals in place in order to support those root fixtures and you will not have to deal wtih facial collapse again.

This blog iis brought to you by Marietta Dentist, Dr. Cristi Cheek.

 

Replacing Congenitally Missing Lateral Incisors

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My daughter has congenitally missing lateral incisors. Now that she is starting high school, she is quite embarrassed by her baby teeth when she smiles. Our dentist suggested that we extract her teeth and get braces to close up the space. I am afraid that will look weird. Can you tell me if there are any other options?

Dolores

Dear Dolores,

a smile with missing lateral incisors

Missing Lateral Incisors

 

I am glad you wrote. Your dentist is giving you very bad advice. I’m glad you picked up on the fact that it would look quite weird if you followed through with his guidance. As you can see from the image above, this girl had done what your dentist is suggesting for your daughter. As you can see, it does not look normal. In fact, it looks downright vampiric.

The baby teeth do need to come out, but I don’t suggest you use traditional braces. Instead, I think your daughter would be more comfortable with Invisalign. These use clear aligners. None of her friends will even know she is having her teeth adjusted. Then, once the space is opened up enough to fit adult-sized teeth, you can get her the replacement teeth she needs.

 

invisible braces

Invisalign Invisible Braces

 

The best tooth replacement is a dental implant. However, you will have to wait until her jaw is fully developed for that. In the meantime, she can use a temporary tooth replacement in order to hold the spot open for when she is ready for something more permanent. A dental flipper is inexpensive and will serve her well until she is old enough for the dental implants.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

Dentist Wants Me to Pull My Teeth and Get Dentures

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I have had massive trouble with my teeth since I was a child. It seems every year I max out my insurance and still spend thousands of dollars. My dentist is as frustrated as I am and recently suggested that I just have all my teeth pulled and get dentures. I’m only 38 and the idea of that absolutely makes me want to cry. Is this my only option?

Carol

Dear Carol,

implant supported dentures image

 

Please bear in mind that I have not examined you nor have I seen any of your diagnostics. That being said, I would first get a second opinion about which teeth can be saved. Some dentists are better than others at the effort they are willing to put into saving teeth. However, natural teeth are a better option than even the best tooth replacement.

Let’s say, for argument’s sake, that your teeth cannot be saved. Even if that is true, removable dentures are the worst solution for you. When your teeth are removed, your body immediately begins to resorb the minerals in your jawbone in order to use them elsewhere in your body. It does this in an effort to be as efficient as possible with your body’s resources. The downside to that is in about ten or so years you will no longer have enough jawbone left to retain your dentures. In dental circles, we call this facial collapse. You are 38 at the time of writing this. So, before you even turn 50 you could be forced into a liquid diet. Not only that, you will look decades older than you really are. The good news is there is a way to prevent this.

Instead of removable dentures, you can get implant-supported dentures. This will place between four to eight dental implants in each arch, depending on your budget, and then anchor the dentures to them. Not only will this prevent facial collapse, but your quality of life will be significantly better than it would with removable dentures.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

My Mom’s Teeth Are Falling Out

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My 87-year-old mother just had some fillings done last week. Today, one of her teeth just fell out. I don’t know what to do. Shouldn’t the dentist have noticed this? Are her other teeth at risk too?  What would be the best solution for her if they are?

Mary Ellen

Dear Mary Ellen,

Implant Overdentures

 

Yes, your dentist should definitely have noticed there was a problem. To get to the point where her teeth are just falling out means your mother has extensive gum disease. It sounds like your dentist has just been cleaning and repairing and not being proactive about her gum health, This tells me he’s not checking other things either, such as looking for oral cancer.

At this point, yes, you should be concerned about the remainder of your mother’s teeth. They are all going to start all falling out. For your mother, I would just treat her gum disease as best you can and have the rest of her teeth extracted, getting her full dentures. You don’t want to wait until they all come out because she will be self-conscious about her appearance. Even the elderly want to look as attractive as they can. By the way, this advice is ONLY because of your mother’s advanced age. I would not suggest just getting dentures to someone younger for reasons I will explain in a moment.

The Danger of Dentures

When your teeth are first removed, your body recognizes that you no longer have any teeth roots, so it begins to resorb the minerals in your jawbone to use elsewhere in your body where it perceives they will be more useful. Unfortunately, after ten or so years, you will no longer have enough jawbone in your body to even retain your dentures. This is especially true with your lower dentures which just rest on the ridge of your lower jawbone. This is known as facial collapse, it can be devastating not just to a person’s appearance, but their health as well.

The only way to prevent this from happening is to have dental implants placed and anchor dentures to them. This is known as implant overdentures. It will signal to your body that you still have teeth and it will leave your jawbone intact. Because of your mother’s advanced age, I would not invest in these.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

Will Invisalign Work with Missing Teeth?

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I have two congenitally missing lower bicuspids and have grown up with crooked teeth. One of the lower bicuspids had to be pulled because of decay. I’ve spent a lifetime embarrassed about my smile. I don’t think having a mouthful of metal will help with how I feel about my smile. Someone recently told me about Invisalign. I would like to use that but don’t know if it can work around missing teeth. I’ve had an orthodontist say no and a regular dentist say yes. I want to believe the dentist but that may be because I really want a pretty smile. Any advice?

Trina

Dear Trina,

Invisalign Aligners

I’ve often found that orthodontists are more conservative with Invisalign because their training is in orthodontics. Dentists who work with Invisalign have invested more time with it and are more comfortable with it. In fact, Invisalign works well around missing teeth. I’d go with your dentist.

There is a hidden benefit to Invisalign as well that you can’t get with orthodontics. The clear aligners that Invisalign uses can also double as teeth whitening trays. This will give you a mini smile makeover while saving you money on teeth whitening.

Once your teeth are in their correct placement, you will want to replace the missing teeth in order to keep them retained in the right place. There are several options in replacing missing teeth, but in your place, I would want dental implants. They are the most like having healthy natural teeth in your mouth again. Talk to your dentist about all the tooth replacement options available to you and you can decide what is best.

Be aware that not every dentist is trained in dental implants. It is possible you’ll have to go to one dentist for your Invisalign or another for your dental implants. A third option is finding a dentist skilled at both. Whichever way you go, you will be able to have the smile you always wanted.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

A Pretty Smile after 23 years in Dentures

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I’ve had removable dentures for 23 years. A friend of mine recently got dental implant dentures. These look so much nicer than my teeth and she can eat anything she wants. Is it too late for me to have a pretty smile? I’ve spent my lifetime embarrassed by it.

Elaine

Dear Elaine,

Older couple with nice smiles

I’m sorry you have been embarrassed by your smile. The great news is it is never too late for you to get a beautiful smile. The key is in the dentist you choose. Doing a smile makeover is not taught in dental school. As a result, it is up to the dentist as to how much post-doctoral training they receive, if any, in creating beautiful smiles. Additionally, there is some natural artistry that is necessary as well, as with any art.

As to the dental implants themselves, because of the length of time you have been in dentures, there will be significant bone loss. That will have to be addressed in order for you to have a successful chance for true retention of your dental implants. The integration with the bone is imperative. The best way to address this is to have a bone grafting done. This will build back up the missing bone that you will need for osseointegration.

Once that is healed, you can have the implants placed. There will be a second period of healing necessary after the implants are placed. From there, you can have your dentures anchored to the new implants. This is known as implant overdentures, sometimes called implant-supported dentures.

Finding the Right Dentist

With the right dentist, you can have a gorgeous smile you will be proud to share with the world. However, choose carefully. The first thing you will want to do is make sure they have the training they need to place dental implants. Take a look at Dr. Cheek’s qualifications to get an idea of the type of training you want in your dentist.

Once you are assured they are qualified to place your implants, be certain to look at their smile gallery. This will give you an idea of what type of results they can provide you when it comes to creating a beautiful smile for you.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.