Dr. John Thousand

IMPLANT VS. TRADITIONAL RESTORATIVE OPTIONS

The screw-shaped (root form) dental implant we see today was first introduced in 1965. However, the technology didn’t become popular until the 1990s and 2000s. Before that time, the restorative options available included the crown and bridge that replaced a single tooth or a few missing teeth, and the removable partial or full denture, which usually replaced a few to a full set of upper or lower teeth. Bridges and dentures are still commonly used today as cost-effective restorative options, as they do not require surgery and their initial costs are significantly lower than dental implants. However, the technology behind bridges and dentures is simply not as advanced as the dental implant. They often impair function and taste, and they generally have shorter lifespans than dental implants.

IMPLANTS VS. BRIDGES

If you look at the data on complication and failure rates, implants and bridges are almost the same. It’s not necessarily better to have an implant than it is to have a bridge, from a longevity standpoint. What is better, though, is that dental implants replace the roots of missing teeth, so it’s as if you’ve gained a tooth back. This makes it easy to floss and keep clean, just like your natural teeth. A bridge is tough to keep clean because the teeth are fused together and require special floss threaders to get underneath it. Additionally, by choosing a dental implant instead of a bridge, you will reduce the risk of tooth and root fracture by decreasing the biting force on the remaining teeth. By replacing the missing tooth or teeth with implants, the chewing forces will be evenly distributed between your teeth and implants, bringing equilibrium back to your bite. When you opt for a bridge, the teeth adjacent to the missing tooth are “prepared,” which means they are whittled down into smaller nubs or spikes to receive new crowns (see photo above). The bridge, which holds the new tooth, is set over the top of these prepared teeth. Now two teeth have to support what three teeth used to do. That is a lot of force exerted onto your remaining teeth, especially if the bridge is sitting at the back of your mouth where your molars are. To put it another way, if you take a pair of scissors, for example, and try to cut a piece of paper, you’ll find that the scissors cut best near their hinge, where there is the most force. If you use the tips of the scissors to try to cut the paper, you’ll find that they don’t cut as well. The same thing happens in your mouth, where chewing with your back teeth is like cutting at the hinge of scissors. That much force can break the roots under your bridge and may result in the loss of even more teeth!

By replacing the missing tooth or teeth with implants, the chewing forces will be evenly distributed between your teeth and implants, bringing equilibrium back to your bite. When you opt for a bridge, the teeth adjacent to the missing tooth are “prepared,” which means they are whittled down into smaller nubs or spikes to receive new crowns (see photo above). The bridge, which holds the new tooth, is set over the top of these prepared teeth. Now two teeth have to support what three teeth used to do. That is a lot of force exerted onto your remaining teeth, especially if the bridge is sitting at the back of your mouth where your molars are. To put it another way, if you take a pair of scissors, for example, and try to cut a piece of paper, you’ll find that the scissors cut best near their hinge, where there is the most force. If you use the tips of the scissors to try to cut the paper, you’ll find that they don’t cut as well. The same thing happens in your mouth, where chewing with your back teeth is like cutting at the hinge of scissors. That much force can break the roots under your bridge and may result in the loss of even more teeth!

IMPLANTS VS. DENTURES

As for dentures, they are one of the oldest techniques we have available for replacing teeth. George Washington
had dentures! But in the modern age, we have better
technology and more options for replacing missing teeth.
Implants can often be used to improve upon the function of the traditional denture. In these instances, implants can be used to achieve more stability for dentures. These modern types of dentures are still removable, but they can be locked into place with implants. The great thing about the removable implant denture is that we can streamline the shape and size to be more comfortable in the patient’s mouth.

A traditional denture is cumbersome because it relies on suction. The more surface area the denture has to contact tissue, the better the suction. To illustrate this point, imagine that some water has been spilled on the table and you accidentally set your phone down on it. You’ll find that it’s harder to pick the phone up off a wet surface than a dry one. A denture works similarly. It uses your saliva to stick to the roof of your mouth like a suction cup. The problem, though, is that the denture’s extra surface area makes it cumbersome for you to talk or eat. And the denture covers up tissue that has some of your taste buds in it, which may reduce your ability to enjoy your favorite foods. Dentures also reduce your mouth’s chewing capacity to just 30 percent of what you had with all of your teeth. Now, if you have lost your teeth and replace them with dental implants, you may be able to get back to 85 percent of your natural chewing capacity. That’s a huge difference.

BOTTOM LINE

1. Implants are the most natural way to replace a missing tooth.
2. Implants don’t get cavities.
3. Implants have to potential for the greatest long-term value because they have the highest success treatment success rates.
4. Implants don’t compromise the health of the adjacent teeth like bridges (remember you have to cut down the adjacent teeth for the bridge) or removable prosthetics (these loosen up the adjacent teeth when you take them in and out).
5. Implants replace what you’re missing instead of overworking the remaining teeth as you would if you had a bridge.
6. Implants don’t move when you talk, laugh, or eat like removable restorative options.
7. Implants are generally are generally easier to clean. They don’t require special floss threaders to clean up under them like bridges (Cavities under the bridges are the most common reason they fail… implants don’t get cavities..)

    We have to take the mouth and body as one. The funny part about education as medical professionals is that we go through school as either a doctor or a dentist. But the body isn’t separated that way. It’s not separated at all! It’s all connected. Along with my private practice, I also work on staff at a local hospital. I am frequently called in to evaluate patients who are in need of cardiovascular surgery. The vast majority of these patients have infections in their mouths they didn’t know about. Dental disease, more often than not, is completely painless. When I perform these hospital evaluations, I routinely discover abscessed teeth and periodontal disease that produced no signs or symptoms at all!

    The American Heart Association recently circulated a comprehensive statement that included studies that examined the relationship between cardiovascular disease and periodontal disease.  In another study, researchers took DNA samples of the plaque masses built up in the patients’ arteries and veins and found that 78 percent of the masses had dental pathogens associated with abscessed teeth, and 35 percent carried pathogens related to periodontal disease. The plaque found in both the body and the mouth also raises a chicken- and-egg paradox: Was the plaque there first in your arteries, before moving into your mouth? Or did the plaque originate in your mouth, before moving into your arteries?

    Everything comes down to systemic inflammation. The word systemic, in medicine, is used to describe that which affects the whole body, including multiple organ systems. And, yes, this includes your gums. The word inflammation refers to a process that occurs when your body is fighting against something that is harming it. The result is the release of chemicals designed to kick your immune system into gear. If the cause of inflammation is resolved, then the body stops production of these chemicals. If the cause is not resolved, as is the case with plaque and periodontal disease in your mouth, these chemicals will linger. The longer these chemicals continue floating around in your bloodstream and tissues, the more likely they are to cause the breakdown of other systems in your body. These include your heart, arteries, joints, reproductive organs, endocrine systems, and central nervous system. The severity of your inflammatory response to the plaque and bacteria in your mouth has a lot to do with your diet, your lifestyle, and your predisposed health conditions, which are governed by your genetics.

    Simply cleaning your gums improves the overall health of your mouth and your body by decreasing systemic inflammation. You may not have heard the term adult prophylaxis, but you’re most likely familiar with its colloquial name, “dental cleaning.” The meaning of the word prophylaxis is “to prevent,” and routine cleanings should be done every six months to protect your teeth from disease and decay.

    Keep in mind that the best way to treat periodontal disease (frequently referred to as periodontitis) is prevention. It’s essential that you maintain a habit of brushing and flossing your teeth twice a day to prevent the buildup of bacteria. If enough dental plaque builds up on your teeth, bacteria can eventually inflame your gum tissue to cause gingivitis, which is characterized by a puffy, red appearance in the gums and bleeding when brushing or flossing. Gingivitis can be reversed by removing the plaque, but if left untreated, it can progress to periodontitis—an infection of the gums. Patients who show signs of periodontitis have “pockets” around their teeth from where the body’s response to bacteria has destroyed the supporting tissue and bone.

    Don’t forget that under your gums are your roots and the sup- porting bones. Deep inside these supporting structures lies a vast network of arteries and nerves that provide nutrients and sensation to the teeth and gums. These structures are not visible without radiographs! Just like you, I try to avoid excess radiation whenever possible. But when a doctor has reason to suspect a problem, I take the darn X-ray. The same is true in dentistry. If a dentist has reason to suspect periodontal bone loss or an abscessed tooth, a radiograph should be taken to evaluate the situation. Would you want bacteria from periodontal disease or a dental abscess floating around in your bloodstream clogging up your arteries, joints, and brain? No way, kemosabe! What if you had a root canal a few years ago that wasn’t completely successful and bacteria was living up inside your jawbone, and you didn’t know about it? Every time you chew, you are pumping bacteria into the jawbone like a piston in a car engine, flushing bacteria throughout your entire body. Personally, I find this quite disturbing.

Just this past month my wife and I had the opportunity to provide much needed dental care to children in Kathmandu Nepal.  None of this would have been possible without Global Dental Relief.  What an incredibly humbling experience.  It’s difficult to describe our adventure through words but I’m going to give it the ole college try.

From the remarkable children we served, to the incredible doctors we served beside, this mission plucked at the strings found deep within my anthropomorphic core.

Amidst the chaos of modern life, I am still very much proud to be a part of the human race.

Here are a few photos from our trip:

           

 

Being a dentist in Florida, I treat an older patient population. Recently, I’ve noticed a number of patients in my practice exhibiting dental decay and a common complaint of having a dry mouth. With age often comes a deterioration in general health resulting in the use of multiple prescription medications. Some of these medications, unfortunately, are a double-edge sword. On the one hand, these medications are necessary to keep the patient alive and functioning. Conversely, these medications can cause a dry mouth condition known as xerostomia. And xerostomia is a big problem.

A healthy mouth requires the production of saliva. Saliva plays many protective roles in the mouth. It maintains antimicrobial activity, provides enzymes involved in the breakdown of food, and physically rinses the teeth to remove bacterial plaque. Without saliva the mouth is dry. It looses it’s immune fighting function as well as the ability to wash plaque away from the teeth. As dry mouth syndrome continues, more bacterial plaque can build up on the teeth. The result is tooth decay at the gum line on susceptible soft root surfaces. Quite often an older patient will have had quite a few dental restorations like fillings and crowns in their mouth. These restorations do NOT make a tooth any less susceptible to decay. In fact, they may make decay MORE likely! Older fillings and crowns might have defective edges that often trap plaque eventually decaying the tooth. Decay of this type can be very difficult to detect. If the decay occurs below the gum line it is tough to visibly locate. Decay occurring under a filling or crown is harder to see even on an X-ray. So what can you do to prevent this from happening to you?

If you suffer from dry mouth the first thing you need to do is increase your water intake. Have a water bottle with you at all times and regularly rinse or sip. There are prescription and over the counter products that can be used in addition to water. For information on these you should ask your dentist.

In addition to water, try reducing carbohydrates in your diet. Bacteria use carbohydrates, especially sugar, to produce an acid that dissolves tooth structure. By reducing the food sources that these bacteria consume, you can reduce the acid they produce and thereby decrease the amount of decay on your teeth.

Another way to manage your risk is to make sure to see your dentist on a regular basis. It may be in your best interest to see the dentist more than twice a year if decay is constantly occurring. This will allow early detection of decay that can often be treated before you need expensive dental care or a tooth extraction. Even if you already see your general dentist regularly, there are a few extra things they can help you add to your daily routine.

Lastly, it may be worth consulting with your physician. It might be possible that alternative medications can be prescribed which do not cause dry mouth. Perhaps you and your physician can develop a plan to reduce the overall number of medications you need. I want to be clear that I am not advocating that patients cease completely their prescription medications. I am only suggesting that all methods to maintain or increase salivary flow are explored. Try having a conversation with your physician prior to making any decisions on your own.

To wrap things up let’s highlight the most important facts to take away:

1) Dry mouth is often caused by the use of prescription medications.
2) Dry mouth can lead to rapid decay and tooth loss.
3) Non-restorable decay and tooth loss can be decreased on your own by keeping your mouth wet and by altering your diet consuming fewer carbohydrates.
4) Early decay can be restored and expensive treatment or tooth loss can be prevented by seeing your dentist more frequently.
5) Dry mouth may be decreased with help from your physician by changing or reducing your prescription medication use.

With patients living longer due to increasingly effective medications, dry mouth is a problem that is here to stay. Therefore, we need to do all we can to protect our teeth.

 

Dr. John

Dear Human,

I have to be the luckiest guy on earth! Through the world’s good graces I’ve had the opportunity to train with some of the most brilliant minds in the dental field. With love and patience, they have provided me with the knowledge and skillset to truly make a difference in this world.   I feel obligated to give back to you what has been given to me. So I’m going to lay it out right here:

The mouth is much more than just a hole for you to stuff nutrients into. It is an incredibly complex environment that is connected to your ENTIRE body. Everyday, new literature is being published on links between the oral environment and the rest of the human body. As the number of these links continues to grow, we are finding out just how important your oral health is!

Periodontal disease has been shown to be associated with increased risk of cardiovascular diseases, respiratory diseases, cognitive diseases, autoimmune diseases, cancer, diabetes, erectile dysfunction, infertility and premature birth! To make matters worse, periodontal disease and tooth loss can lead to chewing difficulty resulting in malnutrition and decreased physical performance. But it doesn’t stop here!

Dental diseases affect your physical wellbeing, as well as your mind. Unhealthy gums and tooth decay can lead to missing teeth and changes in facial structure that make you appear older than you really are. All of this can have serious social side effects that take their toll on your self-confidence and self-esteem.   But the great news is… its preventable and treatable.

Therefore, my goal is to protect and restore your mind, body and mouth.