Dr. Cohen’s Implant Dentistry Blog

There is a new post on the mynewsmile.com blog where a patient from Chicago was asking where to go for help with her dentures and dental implants. Dr. Hall, the author, mentioned that when he lived in Iowa, he would drive to Chicago to see Dr. Cohen, and he recommends that she see Dr. Cohen. See the posting for August 18, 2010.

I am currently a 23 year old female who has just gotten out of college. Growing up my family didn’t put any pressure on me to brush and we didn’t have any insurance so I wasn’t able to go to the dentist except once to get impacted wisdom teeth out. Now I have bad decay in the front of my mouth and three of my molars likely aren’t going to be able to saved. One is completely gone and two of the others are almost completely gone I know I have to have surgery to remove at least one of them. I really don’t want to get dentures but I am not sure there is anyway to save my teeth. I have tons of student loans so I don’t know how in the world I am going to pay for it even with the dental insurance that I have. I know my teeth are keeping me from moving forward at work. What I am wondering is there any charities or other programs that might help me with this that you know of? I just want to be able to smile, and look at myself in the mirror without hating what I see in my mouth. My teeth have depressed me for most of my life and I want to change that if I can. I was also wondering if a whole bunch of dental work can be done in one surgery? I would like to get as much done at one time as I can.
- Dana from Virginia

Dana,
If you want to get really depressed, then having all your teeth extracted and getting dentures is a good way to get there. What most dentists don’t really discuss when you have all your teeth out, because it is so slow to happen, is that will cause facial collapse in ten to twenty years. With no teeth, your jawbone starts to dissolve away. After enough time, you will be a dental cripple, unable to wear your denture, ashamed to appear anywhere in public, and unable to eat. The only answer at that time will be expensive jaw reconstruction surgery and dental implants.

Yes, there are charities and programs to help people who need serious dental care. You’ll have to hunt around for them. Check with dental schools and dental societies.

For teeth that can’t be saved, you can have them taken out. For teeth that have large cavities but aren’t infected, you can have temporary glass ionomer fillings that can keep them saveable for several years. For missing or otherwise unattractive front teeth, there is a relatively economical treatment called the Snap-On Smile that is just becoming popular. So there are options other than becoming a dental cripple. You might have to call around to find a way to get answers and find the right program or right dentist to help you.

We wish you the best,
Glendale Center for Dental Excellence

Dear Dr. Hall, I’m 73 years of age and about to receive dentures, both upper and lower, but reading to learn as much as I can FIRST.

I have worn an upper partial or flipper for six years and realize I may have a problem with gagging as I had the dentist “shave” back the hard plastic that goes back into upper roof of my mouth. I am considering mini implants, but would also like to know about the soft denture liner. My question is – does the soft denture have to go as far back in roof of mouth? Would I do much better seeing an oral surgeon? My dentist did not give me any options.
Sincerely, Sarah from Texas

Sarah,
Your dentist should give you the option of dental implants, and if he or she hasn’t, I would suggest getting a second opinion, because you need to consider that option and know all about it in order to make an intelligent choice. But I don’t recommend going to an oral surgeon to consult about the implants. While oral surgeons are often the ones that place the dental implants, the planning of where they are to be placed and how many and what kind you need should be done by the restorative dentist who will be the one eventually placing the teeth and taking responsibility for the success of your case. Without direction from a restorative dentist, those implants are often incorrectly placed.

In order for a complete removable denture to have enough suction to stay firmly in place, it needs to cover your palate, and it’s best if it goes all the way back to the start of your soft palate. Now even with covering the full palate like that, your chewing efficiency is going to be cut in half. Yes, the upper denture can be cut back, but the more you cut it back, the more unstable it is going to be.

Using a soft denture (a regular removable denture with a soft liner in it) usually improves the suction and the stability a little, and it definitely improves the comfort. But it is still best that it cover your entire palate.

Using dental implants can help stabilize the denture and make it so that you don’t need to cover the palate at all. Mini implants aren’t very sturdy, and many implant dentists won’t use them, but it they may stabilize your denture a little bit. For solid stability, you should have full-sized implants placed.

I would definitely recommend that you get an opinion from a dentist who has a lot of experience with dental implants before you go ahead. I’m basing that on your statement that your dentist didn’t give you any options. You need to know all your options. Especially with your gagging problem – you could end up with a denture that you simply can’t wear.

Dr. Hall

I had six extractions and immediate dentures placed a few days ago. Everything was going well, but then when I took the denture out this evening, I felt around the sorest area in my mouth and was applying oragel when I felt there was still some bone there where one extraction was. Any suggestions about what to do about the bone still in my gums?
- Richard from Florida

Richard,
After extractions, especially when there are multiple extractions, there often are sharp and thin pieces of bone between the teeth that are left. Eventually your body smoothes these over and fills in the sockets with new bone. When you’re having a denture made, any sharp edges that poke out and will make wearing the denture uncomfortable are trimmed. This procedure is called an alveoloplasty. But dentists don’t like to trim away too much bone, because the more bone you have, the more solid and stable the denture is.

If you have pieces of bone under your immediate denture and they aren’t causing you discomfort, I’d leave them alone.

And I don’t know what your dentist told you, but you have to be very careful to follow instructions after having an immediate denture placed. If you take it out when you aren’t supposed to, you may not be able to get it back in. It can be a week before it’s safe to take it out.

Other information:
Read about implant dentures – more secure and stable than removable dentures.
Read more about complete dentures from mynewsmile.com