Hope Restorative & Cosmetic Dentistry

Dental Implants with Metal Allergies

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I have a pretty severe allergy to Nickel and mildly to mercury. Recently, I lost two teeth that I’d like to replace with dental implants but they are made of metal. Is it still possible for me to get the implants or will I need to get a different procedure?

Marv

Dear Marv,

dental implants

Here is the good news. The metal in dental implants is titanium. Not only is that not one of the metals you listed, but titanium is very biocompatible. It has been used in prosthetics for decades. I don’t think you will have any trouble with traditional dental implants.

There is an alternative to metal dental implants, if it does become necessary. More dentists are now willing to use zirconia implants. These are completely metal-free and zirconia, nicknamed ceramic steel, is strong enough to serve you well for many years.

Not every dentist is using them yet. This is mostly because the titanium ones have decades of data documenting their longevity. There isn’t the same data on the zirconia option. That doesn’t mean they won’t last as along. They simply haven’t been around long enough for the data to be available.

The Most Important Consideration with Dental Implants

More important than whether you use titanium or zirconia is who does your dental implants. Implantology is one of the leading sources of dental malpractice suits. You will want a dentist who has done extensive post-doctoral training in implantology. The best implant dentists are fellows with the International Congress of Oral Implantologists.

Additionally, it is always better if you have a dentist who can do both the surgery and the restoration. Too many dental implant cases suffer because of miscommunication between the dentist and the surgeon. Having the same person do both eliminates that risk.

This blog is brought to you by Tulsa Dentist Dr. Jerome Cha.

Am I Condemened to Ugly Teeth because I’m Not Wealthy?

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I am losing my teeth. It can’t be helped and has little to do with my oral health care. My dentist wants me to get dental implants. When he told me the cost per tooth, I almost choked. There is no way I can afford that. I can afford dentures. When I mentioned that to him, he said my smile would not be pretty. What am I to do? Sell a house I don’t even own? Is there any way to get a pretty smile without dental implants.

Karyn

Dear Karyn,

implant overdentures

First, I want to assure you that whether or not you have an attractive smile is more up to the dentist than whether or not you have dentures or dental implants. It’s the skill and artistry of the dentist which makes the biggest difference here. If he’s implying that dental implants are more beautiful than dentures, that is an unfair pressure tactic and speaks more to his investment in doing beautiful work no matter what the procedure than anything else.

The one thing he could be referring to, which is honest, is a rather serious issue that comes with dentures known as facial collapse. When your teeth are removed, your body immediately begins resorbing the minerals in your body to use elsewhere. It does this because it recognizes you no longer have any teeth roots. Without roots, you don’t need that bone to keep your teeth in. So it decides to use the minerals in that bone elsewhere. In as little as ten years, you will no longer have enough jawbone left to keep your dentures in place. Not only that, the shrinking of your jawbone, gives you an aged appearance. This is known in dental circles as facial collapse. It may be what your dentist is referring to by an attractive smile.

Getting dental implants prevents facial collapse because the implants serve as prosthetic teeth roots. This signals to your brain that you still have teeth there and therefore need that jawbone.

Implant Overdentures

implant overdentures

You mentioned the cost per tooth. You may be under the impression that you have to get a dental implant for every single tooth. You don’t. That would be too expensive for just about anyone. Instead, what you would get is four to six dental implants and your dentist will anchor a set of dentures to them.

Doing it this way cuts the cost significantly all while having the same benefits of dental implants. As I mentioned to you in the beginning, the dentures themselves can be beautiful if the dentist knows what they’re doing. You have a two-fold mission now.

First, find a dentist with significant training in dental implant procedures. It’s an advanced procedure, so make certain they received post-doctoral training in them. Second, once you have a list of implant dentists, ask to see their smile gallery so you can get an idea of what type of skill and artistry they have. If you are having trouble finding someone who both can do dental implants and does beautiful restorative work, you can check with the American Academy of Cosmetic Dentistry. Do a search on their website for an AACD accredited dentist. These are in the top 1% of cosmetic dentists in the country. I’m certain you’ll be able to find one who can do your work and give you a smile you are proud to share.

This blog is brought to you by Tulsa Cosmetic Dentist Dr. Jerome Cha.

Temporary Tooth before Dental Implants

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My daughter has a genetically missing lateral incisor (#10). We’ve finally finished most of her orthodontic work to open up the space, however she is too young for a dental implant and it will be another five years or so. We needed a temporary replacement. Our dentist fitted her for a Maryland Bridge with non-metal wings. We had to go in for a retainer fitting and the bridge fell off. The dentist decided to try a different type of cement. But, the bridge fell off again. Now she’s wants us to come back in for another fitting and this time she’ll use metal wings. Here are my questions:
1. Will the metal wings show?
2. Will metal bond better?
3. Will metal damage the adjacent teeth?

Thank you,
Carol

Dear Carol,

Maryland Bridge

A Maryland Bridge is NOT a temporary tooth replacement while waiting for a dental implant.

It sounds like your dentist is doing her best, but doesn’t really understand how a Maryland Bridge works. When the first one fell off she thought maybe the problem was the bonding cement, so she tried another brand. That didn’t work so now she wants to try metal wings. That’s probably not going to work the way she’s doing it either.

I’ll go through your questions and then give some additional, helpful information.

Will the Metal Wings Show?

While you won’t be able to see the metal wings, they will darken the adjacent teeth. This is why more and more dentists are going to the zirconia wings, which are strong, but will match the color of the teeth thereby not darkening them.

Will the Metal Bond Better?

No. In fact, metal is harder to bond than the zirconia she was using.

Will the Metal Damage the Adjacent Teeth?

Tooth preparation for a Maryland BridgeYes. The reason for this is the tooth has to be properly prepared. Your dentist likely hasn’t been doing this which may be a large part of the reason hers keep falling out.

If you’ll look at the image to the left, you will see there are grooves cut into the adjacent teeth. It is this combined with the cement bonding that keeps a Maryland Bridge in place. Whenever you are removing tooth structure, that doesn’t spell temporary replacement to me. Those teeth have permanent damage.

While your choice of replacing her tooth with a dental implant is spot on and the best tooth replacement available, the “temporary” replacement she chose is not a great course of action. Anything that damages tooth structure is not temporary. Instead, I would get her a dental flipper. This is significantly less expensive as well.

One other issue. I’m hoping her dentist or orthodontist did a splint on the back of her teeth. This will keep her teeth from drifting back into that open space causing her to need a second round of orthodontics.

This blog is brought to you by Tulsa Dentist Dr. Jerome Cha.

My Tooth Fell Out

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I used to have nightmares about my front teeth falling out. Well today one of my back teeth fell out. I’m not sure what happened. It had been hurting for a while, but then stopped. I’m worried this can happen to the rest of my teeth. The problem is I’m terrified of the dentist. Is there anything I can do from home to help this.

Brandon

Dear Brandon,

hockey player with a knoced out tooth

In general, there are two reasons that will cause your teeth to suddenly fall out. One is trauma. This is what likely happened to the hockey player above. When a tooth gets knocked out, it is imperative you get to the dentists withing 30 minutes. This gives the dentist the best chance of saving your tooth. You’ll want to hold the tooth by the crown and not the root. Be sure to keep it moist, either by keeping it between your cheek and gums or by placing it in a cup of milk. Hopefully, the dentist can reattach it. If not, then the dentist can help you understand your tooth replacement options.

The second reason for losing a tooth suddenly can be more serious and I suspect this may be what you are facing. It is the result of advanced gum disease. This causes bone loss and gum recession, leading to your teeth coming out. This will require interventive treatment to keep more teeth from falling out. Once you’ve got that under control, then you’ll be able to begin replacing the teeth you’ve lost. The best tooth replacement option is dental implants. You won’t be a good candidate for that until you have your gum disease completely under control.

When You Have Dental Anxiety

I know you were hoping for treatment you could do at home and avoid the dentist. Unfortunately, there is no way to treat either of these issues from home. The good news is, I have a way for you to have anxiety-free appointments. I want you to see a dentist who offers dental sedation.

There are varying levels of sedation available. The lightest range is nitrous oxide. This is sometimes called laughing gas. It will help relax you and enable the local anesthetic to work more efficiently. I suspect, because of your level of anxiety, you will require the next level of sedation— Oral conscious sedation. This is administered with a simple pill. However, it is so strong that you’ll need someone to drive you to and from your appointment. You’ll likely even sleep through the whole thing.

This blog is brought to you by Tulsa Dentist Dr. Jerome Cha.

Husband Can’t Wear His Dentures

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I’m worried about my husband. He got dentures, but he can’t wear them. We’ve been back several times for refittings, yet nothing seems to work. I don’t know how to help him. He’s miserable and can barely eat without his bottom teeth. Do you have any advice?

Carolyn

Dear Carolyn,

illustration of dentures beside a dental implant

It sounds like your husband is really suffering. It is not uncommon for patients to have an adjustment period to dentures. For some, it’s quite difficult. Usually making adjustments helps. Others never adjust. This is a chance to evaluate what his next steps are.

If he’s determined to stick with dentures, he could go to a different dentist to try someone else’s hand at refitting his dentures. Another option is a prosthodontist. They have more experience than some of your local dentists, depending on where you live.

An Alternative to Dentures

If he just can’t adjust, he has another option. Dental implants are a fantastic tooth replacement option. These put prosthetic tooth roots into his teeth. He will no longer be in pain. It’s more like having healthy, natural teeth back.

However, there is an even better reason to get them. When his teeth were removed, his body started slowly leeching the minerals out of his jawbone to use elsewhere in his body. It does that to be efficient. This is causing his jawbone to slowly shrink. Eventually, there won’t be enough jawbone left for his denture to stay in place. Dentists call this facial collapse.

Getting dental implants prevents this from happening. Because the prosthetic root is placed in his jawbone, his body interprets this as him having teeth and needing his jawbone. This will change his life. He’ll be able to eat again. In fact, he can eat anything he wants, even steak.

If you decide to go the implant route, make sure your husband sees an experienced and qualified implant dentist. It’s an advanced procedure and requires significant post-doctoral training. For instance, Dr. Cha took every course on it the Misch Institute offered and is a Fellow at the International Congress of Oral Implantologists (ICOI).

I wish you both the best.
This blog is brought to you by Tulsa Dentist Dr. Jerome Cha.

Teeth Whitening and Pot Stains

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Can you tell me if teeth whitening can get rid of pot stains? If so would someone use the tray teeth whitening or the Zoom? Asking for a friend….

Dan S.

Dear Dan,

an attractive white smile

After Teeth Whitening

Here’s what you can tell your friend…

You can imagine there haven’t been any clinical studies done on this to date. Not only is a brand unwilling to give patients marijuana, they’re not likely to align their brand with it either. Though, my guess would be this will change because more states are legalizing its use.

Even without the studies, I can tell you that teeth whitening can remove marijuana stains because of the nature of THC stains that have been observed in patients. That being said, there are some things you should know first.

Any teeth whitening needs to be done on clean teeth. If you haven’t had your teeth recently cleaned, the whitening gel will not distribute evenly which will give you blotchy teeth. Not an attractive look.

As to whether to use take-home whitening or Zoom whitening, it will completely whiten your teeth in one appointment. Dr. Cha is quite familiar with Zoom but he prefers KöR® Deep Bleaching™. Why? KöR has several advantages over Zoom:

  • It doesn’t use a light to accelerate the gel. The light dries out teeth and makes them sensitive.
  • The system KöR uses gel to condition and hydrate your teeth.
  • It significantly lightens tetracycline and fluorosis stains, which other brands can’t do.

With take-home gel, you gradually see the results. Although your teeth can be as brilliant as an in-office treatment, it will happen over a period of weeks instead of the same day.

Before You Whiten Your Teeth

Are you certain your friend’s stains are from marijuana? THC stains are usually very easy to remove so if your friend regularly brushes his teeth and gets check-ups there really shouldn’t be that much staining, at least not from that.

It could be that he’s assuming it’s from that but they’re actually stained from things like cigarettes or coffee/tea, etc. Those will need professional whitening as they are harder to remove and get into the pores of the teeth more readily.

Pot Smoking and Oral Health

Something else to be aware of. People who smoke marijuana have a much higher rate of gum disease and decay. Most of that has to do with the effects of THC on the gums. I would also venture to guess that when someone is high, they’re binging on lots of food because of the “munchies”. That’s more likely to be things like carbs, sugary snacks, and sodas than it is to be carrot sticks and other healthy snacks. Plus, it’s highly unlikely brushing and flossing after snacking like that is going to be high on their priority list if they happen at all.

Let your friend know how important it is he brush carefully afterward, and also see a dentist regularly. Otherwise, he will develop gum disease which leads to tooth loss. Then he’s looking at expensive tooth replacement options such as dental implants.

Some recreational users avoid the dentist out of fear of being turned in. That’s really not a legitimate fear. They won’t turn him in, with the possible exception of if he came to the office high and was trying to drive himself home. That would make him a public danger.

This blog is brought to you by Dr. Jerome Cha.

Please Tell Me I Have Options Other Than Dentures?

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I’ve stopped crying long enough to write you. I’m 28 years old. My parents never took me to the dentist. I didn’t really think about it much until last week when my new job told me I had dental insurance. That was kind of exciting. So, I was thrilled to get to go to the dentist for the first time. That feeling quickly turned from elation to despair. He told me that my teeth were a wreck and he should pull them all and replace them with dentures. He really pressured me to do it right then. I was in shock. Dentures! At my age! I burst into tears. That’s when he grew impatient and said, “What did I expect when I neglected my teeth my entire life.” I got angry and walked out. I haven’t neglected my teeth. I brush AND floss everyday, which people who have been to the dentist don’t do. Also, how was it my fault my parents couldn’t afford to take us to the dentist? Is there any chance he’s wrong? I’d think if my teeth were in that bad of shape, I’d know somehow. Wouldn’t I be in pain or even see cavities? If he’s not wrong, are dentures my only option. Please help me!

Annabelle P.

Dear Annabelle,

Tulsa Dentures

Wow! I’m not sure what to say. Mostly, I feel sorrowful that your first experience with the dentist was this negative. Not all dentists are as grumpy as the one you experienced. And they certainly would not have such a pessimistic attitude about your dental health.

You may not feel this way right now, but there is hope. In fact, I’m pretty sure you won’t need dentures at your age. I have no idea why your dentist just jumped right to dentures. That’s generally an absolute last resort, even if you do have to remove all of your teeth.

The first step for you is to get a second opinion and see what the true condition of your teeth is. Most dentists will make it their first priority to save as many teeth as absolutely possible. If you do need to have some teeth removed, dentures won’t be their top recommendation.

Alternatives to Dentures

There are several alternatives to dentures. Most of which are a better option.

Dental Implants

Tulsa Dental implant

This is the ideal tooth replacement. As you can see from the image on the left, this puts a prosthetic tooth root into your jawbone to stabilize a dental crown. The crown serves as the visible part of your teeth. The stability of the implant allows you to eat, drink, and care for your teeth as you normally would.

A Dental Bridge

Tulsa Dental Bridge

Another good option is a dental bridge. It uses the teeth on either side of the extracted tooth to anchor your new false tooth. These are especially useful when the adjacent teeth are needing crowns to begin with. It’s a little less expensive than dental implants as well.

This blog is brought to you by Dr. Jerome Cha.

Are Dentures “Really” the Worst Thing I Can Do?

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I have teeth which have been a constant problem my whole life. It seems like every couple of months I’m back with a new problem even though I brush and floss as instructed. I told the dentist on this last visit that I’m just tired of it and want to just get dentures. He pretty much shouted that’s the worst thing I can do, and suggested I take better care of my teeth. I don’t know what else to do besides brushing and flossing two times a day.  Are dentures truly my worst decision?

Steve O. – Pennsylvania

Steve,

Admittedly, that wasn’t the best way for your dentist to handle the situation.  Like in every other profession, sometimes dentists lack in people skills.

You can be doing everything you’re supposed to with your dental care and still struggle with your teeth. Your dentist should know this, too. Sometimes our genetics work against us and our teeth will be a problem no matter what. There are some extra steps your dentist can take, such as fluoride treatments.

As to whether dentures are your worst possible decision, it depends. If you’re losing your teeth and cannot afford a better option, then dentures are better than nothing.  In your situation, here are the steps I’d recommend.

First, I’d try to save any teeth you can. Natural teeth are truly your best option. Even the top of the line tooth replacement, dental implants, which are like having natural teeth, have risks that you won’t have with your natural teeth.

Second, get crowns or implants on the teeth which can’t be saved. If you get to keep part of the tooth, get a porcelain crown. If the tooth is extracted, get an implant.

I realize that not everyone can afford a dental implant. In that case, I would say a removable partial denture would be okay. However, there is a downside to dentures.

When your teeth are removed, your body recognizes the roots of your teeth are gone and automatically begins reabsorbing the minerals in your jawbone. Eventually, you won’t have enough bone structure there to retain dentures. This is most common when you have a full set of dentures. You’ve likely seen patients in this situation. Their face has a sunken, aged appearance.

Implants solve this problem because it places a prosthetic root into your jawbone, so your body recognizes those minerals are still necessary.

The key here is to save what you can. Then, when you can’t, go down the list for the best replacement you can afford. I’d also talk to your dentist about getting some extra fluoride.

Another trick for fluoride is to make sure you’re drinking tap water and not bottled water. Bottled water is defluorinated. Your tap water should contain fluoride.

Also, don’t beat yourself up about your teeth. Sometimes, you can do everything right and still have problems with your teeth. You can’t change your genetics.

This blog is brought to you by Dr. Jerome Cha.

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