Valerie,
Yes, there is a lot that can be done, either with better removable partial dentures or dental implants, to give you a normal smile.

There is a great deal of variation in partial dentures. To keep costs down, a partial can be made of a simple piece of acrylic with plastic teeth embedded in it. This is one end of the spectrum. The dentist just has to take a simple impression of your teeth and send it to the dental lab. At the other end are sophisticated designs using carefully crafted metal frameworks. Models of your teeth would be placed on a machine called an articulator that duplicates the positions and movements of your teeth when you chew.

And then, having dental implants placed is just like having your own teeth back, like they were never missing.

I would recommend going to a dentist in the states. I think you’ll find much higher quality of work there than in Bermuda. I would suggest finding a dentist who is accredited with the American Academy of Cosmetic Dentistry, if the appearance is of concern to you, as well as the function.

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

Gum disease is a long-term degenerative disease that can’t be cured with what we know now, it can only be controlled and slowed. And when the teeth begin to get loose, they also can begin to drift. So you have this one tooth that has begun to drift – that is a common occurrence with advanced gum disease.

One treatment is that the teeth can be splinted together. That will prevent the drifting, and it strengthens the weak tooth. Yes, there is a risk that the two teeth on the sides that are being used to support the weaker tooth in the middle will be stressed too much, and it can weaken those. But it’s a calculated risk based on your dentist’s assessment of the overall condition of your mouth.

The best weapon in your long-term battle with gum disease is your own home care. Floss every night, faithfully, without missing a night. With the teeth splinted together, you have to use a floss threader to get those areas clean – be sure you do this. The second best weapon is faithful professional care. Often, with serious gum disease, it is recommended that you have your teeth cleaned every three months. Don’t miss one of these appointments. And even though gum disease is an infection, antibiotics won’t stop it. It’s more complicated than that. Keeping the teeth clean is what you need to do.

Links:
Read about your options for replacing missing teeth. They can be replaced with dental implants or with removable partial dentures.

I am in the process of seeking other opinions and am looking for guidance on what to look for, what information can you give me on the age or bone structure for possible implants? thank you for your time and input.
- Susan from Ohio

Susan,
You will probably be able to find a dentist who will be willing to rush this process of getting the dental implants, but I would advise against that. Even if your son’s bone were matured enough now that he could get the implants, he would have to wear temporary teeth while the implants healed.

Maybe he has temporary teeth now. If not, that’s what I would advise doing for him. Done well by an excellent cosmetic dentist, the temporary teeth can look very realistic and natural, and people won’t know that they’re not real.

What happens if the teeth are placed before his growth has stopped is that the natural teeth may continue to grow while the implants stay in the same place, leaving the front teeth mis-matched in height in a couple of years.

Realize that the oral surgeon is advising you out of integrity. His or her financial interests would be in doing the work now and getting paid for it. By the time you realized that this was a mistake, you would be long gone and would never see the surgeon again. It is concern for the long-term welfare of your son that is causing him or her to advise that you wait.

And my advice would be to have input from an excellent cosmetic dentist in this process. I doubt that you would have any excellent cosmetic dentists in Ashland, as these dentists are uncommon in smaller cities. There are some excellent ones in the Cleveland area and in Columbus. Getting direction about where the surgeon should place the implants, exactly, and then getting the teeth perfectly matched when they are placed is a very specialized skill that few general dentists will have.

I hope this is helpful.

Links: Read our page: Are you a dental implant candidate?
Read about the choice between a dental implant and a bridge.

Question, 1st how can I have pain after a root canal? And 2nd should I have the tooth extracted and then have an implant? I am at a loss as to what to do. we were getting ready to put a crown on it but I don’t want to spend the money if I am going to have problems with it. thank you.
Frances from New York

Frances,
You’re smart to be concerned about this tooth. The root canal question needs to be settled before you put a crown on it.

A root canal treatment removes all the living tissue inside a tooth. After it is completed, there will be no sensation to hot or cold, because those sensations come from the nerve that should be gone. There can be sensations of pressure or pain to pressure, because those sensations come from the ligament that attaches the tooth to the bone, and that ligament is still alive.

So that means that there was living tissue still inside your tooth. That could possibly be from an extra root that the dentist missed when the root canal was first done. This isn’t uncommon for a lower second molar. The “standard” number of canals in a lower molar is three, but there are often four, and in rare cases there can be more. The pain to heat indicates that the tissue was still alive, but barely. The pain to pressure now could indicate that this tissue has died and now infection is spilling out into the ligament that attaches the tooth to the bone.

I would ask your dentist to refer you to a root canal specialist. My advice would be to save the tooth. After all you’ve invested in the tooth already, it would seem a shame to give up on it now. Yes, you could have it extracted and do a dental implant. But fixing this tooth shouldn’t be complicated. This is the kind of work that root canal specialists do all the time. And I wouldn’t be too hard on your dentist for missing this fourth canal, if that’s what your problem turns out to be. Root canal failure isn’t that uncommon a problem.

Gary,
Before getting dental implants, sometimes sophisticated diagnostics are needed, to help insure that the implants aren’t placed where they would interfere with nerves, or sinus cavities, or cause other problems. If you have no teeth at all, it is generally recommended to have a three-dimensional CT scan, which can run one or two thousand dollars. If it is just one implant, sometimes a panographic x-ray may do, and that is considerably less complicated and may cost around a hundred dollars.

But it wouldn’t cost that much to find out if you are a candidate for one or more dental implants. A simple medical history and a quick examination could give a rough idea. In our office, we will even let you come in for free and give you a rough idea of whether or not you seem to be a candidate. Read more about how we try to help dental implants be affordable.

Other links:
Dr. Thein and his Los Angeles dentures.

Special offers include:

• Free Financing
• Free Zoom Whitening after treatment is completed
• Free beauty makeover
• Free initial consultation
• Free cosmetic records (photographs, x-rays, impressions).

Date: Tuesday, May 11, 2010
Time: 10:00 am to 7:00 pm
Place: Glenview Dental Excellence, 2222 Chestnut Ave., Glenview, IL 60026

I am very upset by this and do not want my son to go without a front tooth this long. He is in the fifth grade and will be entering middle school in the fall. Someone at school has already called him a hillbilly. I live in Fort Lee, NJ and I am right next to NYC. Could you possibly recommend someone to me. I have many well intended people telling me to go to their dentists, but I do not want to put my son through unnecessary visits, if the Doctor is not qualified. I would love to know your opinion. Thank you in advance for your help.
Maureen from New Jersey

Maureen,
You’re smart to look for an expert cosmetic dentist, and that’s what I would choose here. You don’t want a general, family dentist. This is an esthetically demanding situation and I believe that your son needs to be brought back to normal as much as possible. You are sensing that, and your instincts are good here.

There are options. The dentist you were visiting at least admitted that he wasn’t interested in helping your son. I think that’s the reason that, in his mind, every possible solution had too many negatives so that he didn’t even want to try. Yes, your son’s age and the status of his other teeth add some challenges, but this is a very treatable problem, and there are several good options for you.

And then you need to understand that when he gets older, you’ll probably need to have this re-done. His permanent teeth are coming in, and they aren’t all in yet. Their positions are going to change over the next ten years, so what looks right now won’t look right when he’s 20.

I would recommend finding an accredited cosmetic dentist near you. Any dentist that has passed those accreditation examinations of the American Academy of Cosmetic Dentistry will be expert enough to do very well for your son. Dr. Cohen is accredited by the AACD, and I know it is a very difficult test. So you can be confident that a dentist with that credential knows what he or she is doing.

Teresa,
There are various options for you, but they are all going to cost at least a little bit of money. Part of what I’m going to recommend to you is adjusting to the idea that you are going to need to pay for your care. While free care through some government program is nice, it can create a feeling of dependency, and then you feel lost when that free care isn’t available to you any more. There is a good feeling in being independent to the extent that you can provide for yourself.

The good news is that there are a wide range of options for getting your teeth fixed, ranging from downright cheap to expensive. A simple flipper partial isn’t very sturdy, because it’s made of plastic, but it is quite economical, and it can be made to replace missing front teeth. Or you could get a more sturdy removable partial denture with a metal framework for several times the cost. Or, you could get dental implants for first-rate care.

Click here to read more about affordable dental implants.