I realize that this sounds kind of silly coming from a dentist who actually enjoys restoring teeth. But you must realize that in a perfect world, there would be no dental decay. Gum disease would be nothing more than a bad dream. The perfect world would be one where no one would need the services of a dentist or dental hygienist. Teeth would be self cleaning, perfectly white and straight and I would be out of business.
It’s fine. I’d find something else to do. I could spend more time working on my podcast.
But it’s not a perfect world. Dental disease is still rampant. People have decay and gum disease. People break teeth and fillings all the time. So we dentists are doing fine.
The “no dentistry is the best dentistry” concept is still pretty great, though. The idea of doing the least to teeth makes me feel better. Every restoration I place, no matter how meticulously crafted and handled is still way worse than what mother nature originally gave you. In fact, I’m just as happy if you have boring teeth as I am with exciting cases!
Each treatment plan that we create takes this into account. If I’m going to propose a treatment to any part of your mouth it’s important that my treatment leaves you better off than when you started. Whether that is the placement of the very first restoration a tooth has ever had or me removing of a sick tooth I want it to improve the health of that patient. Which means we (the patient and I) have to consider how invasive any given treatment is before we embark upon any permanent treatment.
How do we do this? First, I’ll probably take photos, videos or x-rays of whatever condition we’re looking at. I use these images to explain to the patient what I’m seeing, what the condition is (the diagnosis) and whatever treatment options they have. This includes the option of no treatment with my best guess as to what would happen if the condition isn’t treated. This leads to a conversation between the patient, myself and usually our team.
These are “we” decisions, not “me” decisions. When we determine the best option for the patient, we move forward. The best option is almost always the least invasive for the situation whenever possible.
My favorite treatment? Doing an in depth, microscope based exam on a patient that’s making great choices and taking care of themselves in such a way that I can say, “you look terrific! I don’t have any treatment to recommend!”
Did this make you feel minimalist? Did it make you want to floss your teeth? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, or you can “tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.
I recommend a crown or an onlay to lots of my patients. It’s one of the most common procedures we do and we do it very well if I say so myself. A crown is created by a lab and cemented over top of a patient’s existing tooth structure to restore form and function and to reinforce that patient’s tooth. They’re very predictable and work really well.
“How much does this wonderful service cost?” you might ask.
The answer is going to vary by geography but it’s typical for a crown to cost around $1000. A little less in some place, a lot more in others.
“A thousand bucks? You’ve got to be kidding me! That’s a lot of money for one tooth! Who do you think I am, Bill Gates?”
I hear you. $1000 is a lot of money. Who wouldn’t want to spend it on something else. Something fun like a phone, some shoes, a trip or whatever. But let’s take a look at that $1000.
Our office charges slightly less than that $1000, but the math is easier with $1000.
Most dental benefits companies will replace a crown after it’s been in the mouth 5 years. That is not typical, though. My experience tells me that crowns typically last 15 years or more if the patient has good oral hygiene, good saliva flow and has risk factors like dry mouth and high decay rate under control. Lets take 15 years as a reasonable lifespan for a crown.
Now be honest…what other things do you own that have lasted for 15 years? Is your car 15 years old? How about your phone? Your shoes? Bottom line, there’s almost nothing that you spend money on (sometimes a LOT of money on) that lasts as long as dentistry does in a healthy mouth.
A $1000 crown costs you $1000 on the day that you pay for it (or less if you are using a dental benefit…your mileage may vary).
If that crown lasts for 15 years, you’ve amortized your investment in that crown to $66.66 per year. So for $67 you’ve got a beautiful and functional tooth that you probably don’t have to give another thought.
Is $67/year a little too abstract for you? How about this. You’re talking about $5.55/month over 15 years for that crown. One less latte from Starbucks will give you pain-free beauty and function.
OK…let’s get stupid here. 18 cents per day. That crown is three nickels and three pennies per day for 15 years of chewing, smiling and not thinking about it. I’d say it’s worth it in spades.
It actually gets better, though. I’ve seen crowns last longer than 15 years. If you’re really good about taking care of your teeth and watching your diet there is no reason a crown cannot last longer. I’m not going to pretend that ever crown is problem free. To be honest, if we’re trying to restore a particularly broken down tooth, it’s tougher to get that predictability and longevity. Furthermore, some teeth require root canal treatment (again…the more beat up the tooth, the more likely this is). So I don’t want to oversimplify.
The point is to look beyond the price tag that you see in the office and think of the cost over the life of the crown. These restorations feel expensive on the front end, but if you look at the long run they’re a pretty great bet!
Did this make you feel thrifty? Did it make you want to invest in a new crown? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.
Last week I found myself in a spot that I don’t like to be in. A couple of times. I found myself preparing a crown on a tooth that was in much worse shape than I would like. One case was a new patient that I had just started treating. The other patient was one that had waited on treating the tooth until it broke. We had diagnosed an “incomplete fracture” on the tooth some months (years?) before and recommended a crown, but for whatever reason the patient had decided to wait. As I’ve discussed in the past, most dental problems don’t hurt until they’re a big problem.
Crowns or onlays are “indirect restorations.” Which means they are made indirectly from the tooth, by a lab. Direct restorations are made right on the tooth…most people would call these “fillings.” By the time a tooth is in need of an indirect restoration there has probably been a lot of tooth structure lost. Most of these teeth have been worked on before, often having had direct restorations placed. How do we know when a tooth is ready for an indirect restoration? There are a few signs I look for:
cracks: the way teeth are designed is interesting. The outer enamel layer is very brittle and it’s stuck to a deeper dentin layer that is slightly softer which surrounds the pulp (nerve, blood vessel and connective tissue) which is soft and gooey. This is some amazing structural design, but as you age and your teeth are filled, heated, cooled and used for biting…they can develop cracks. Sometimes the cracks are superficial, sometimes they are deep. The good news is that at Mead Family Dental we’re pretty good at finding them. The microscopes that we use throughout the whole office are great at helping us see fractures in teeth…often before they become a big problem.
wear spots: as you age, you wear your teeth. Some people wear their teeth significantly more than others. Just like tires, once you’ve worn your teeth down, they don’t fix themselves!
existing restorations that are failing: What do you mean my filling broke? It’s only been in there for 15 years! I wish every restoration I placed would last forever, but that’s not how it works. Ask yourself this question: has it ever seemed like you justbought a new set of tires and then you see that you actually got them 50,000 miles ago? Yeah…restorations in teeth seem kind of like that, too.
decay under an existing restoration: Your mouth is full of bacteria and your teeth are covered in biofilm…even if you’re a terrific brusher! Those bacteria are tiny and all it takes is a small leak in a filling or crown for them to sneak underneath and start multiplying. It happens to the best of fillings and crowns. Luckily, we can usually fix that decay so long as we are able to catch it early.
Your adult teeth have been functioning in your mouth since you were about 6 years old. They’ve been through a lot. Accidentally biting an olive pit, millions of hot—>cold and cold—>hot thermocyles (have you ever eaten ice cream while drinking coffee?) and hundreds of thousands of acid attacks. Frankly, teeth hold up amazingly well considering what we put them through. There’s no shame in having to reinforce what you were born with. In fact, I would suggest that it’s best to do this as soon as any of those signs start showing up.
Here’s the thing…the longer we let the problem go, the more difficult it is to fix. Ask any dentist and they’ll tell you. It’s much easier to save a tooth before it’s broken than after. Small cavities are much easier to deal with than big cavities. I’d much rather do an onlay on a tooth now than wait until it needs a root canal. I realize this sounds incredibly self serving for the guy who gets paid to fix your teeth to tell you that you should jump on things earlier than later. But remember, I’m a giant wuss when it comes to delivering bad news. I’d much rather place a really well fitting crown on a tooth with a healthy nerve and gums and solid bone to support it. The longer we wait on cracks, decay and failing restorations the worse the outcome is likely to be. No dentist wants to “make the save.” Teeth that have these problems are more difficult to clean up, more difficult to impression and more difficult for the lab to make an ideal restoration.
So, the moral of the story is…don’t wait! Often times I can make the save. But I’d much rather not have to!
Did this make you feel safe? Did it make you want to only eat soft and lukewarm things? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.
A couple of days ago a friend was complaining to me that he had gotten something stuck between his teeth. He’d had lunch at a barbecue joint and wouldn’t you know it he had some brisket jammed between his molars. He was looking for a toothpick or a straw to get it out because it was kind of uncomfortable.
If you’ve ever suffered the same fate you’ll know what I’m talking about. It isn’t necessarily painful, but it’s a kind of persistent pressure that doesn’t really let up until you get whatever is jammed in there out. There are a lot of nerve endings in the gums and the tissues that support the teeth that tell you brain, “hey, something funny is going on here.”
So I whipped out the floss that I carry in my pocket and rescued him. It took him about to seconds to snap the offending piece of brisket out and he was good to go.
“I’m lucky you’re a dentist,” he said as if it’s a given that dentists don’t go anywhere without floss, a toothbrush and maybe a spare dental mirror for good measure. The reality is my dirty little secret.
In a perfect world, the contacts between your teeth are tight enough that normal chewing doesn’t wedge food between them. Too tight makes it so flossing to remove plaque and food debris is difficult or impossible, but too loose means food can become impacted. Food impaction is an inconvenience to be sure, but it can become a problem. A spot where food impacts is more prone to decay simply due to the fact that you cannot remove the debris. The bugs (and by bugs, I mean bacteria) that sit there will metabolize the sugars in the impacted food into acid. When the pH of that part of the mouth reaches a critical level (5.5 to be exact) then the enamel of your teeth will start to dissolve. The longer impacted gunk sits there, the greater the chances that the pH can drop into dangerous levels and cause cavities.
Impacted food can also cause gum problems. I’ve spoken with periodontists (gum specialists) that have removed popcorn kernels from gum abscesses. People with gum disease are more prone to food impaction because their teeth are slightly more mobile than those without bone loss around their teeth. The bottom line is that places where food gets impacted are at greater risk for cavities and gum disease.
Why do we have spots where food gets stuck? Well, some people have naturally loose contacts between their teeth. As I mentioned, people with gum disease are definitely more likely to get stuff stuck in their teeth. If you have a broken or badly decayed tooth they will often be a spot that holds food debris. Finally, dental restorations like fillings or crowns can have inadequate contacts and be a risk factor on their own.
How do we fix it? Well, if you have naturally loose contacts between your teeth I’m not going to “fix” them if they don’t have disease. Those folks need to be extra careful in their brushing and flossing habits. Contacts that are particularly annoying to a patient can usually be “closed” in a minimally invasive fashion if the patient chooses. But if the loose contact in question is caused by decay or worse, the tooth is broken, we better fix it pretty fast!
Dentists probably floss more often than regular folks, but there is no law that requires dentists to carry floss. I carry floss because I have two very loose contacts. Both of them are caused by restorations that have opened up over time. I need to get them fixed and I’ve been procrastinating. That’s my dirty little secret. It may surprise you that dentists are like other human beings…some of us put off treatment that’s necessary, too. But that’s no excuse! Let’s unite in our commitment to close open contacts! No more food impaction!
Did this make you feel ashamed? Do you feel differently about dentists? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.
If you were born in the paleolithic era, you could expect to live to be 33 years old. The global average life expectancy in 2010 was more than double this number at 67 years. Advances in hygiene, food production, medical care are among the reasons for this and we should all be thankful for this.
His hips are the last thing on his mind.
But on the bright side for the cavemen…they didn’t need hip replacements. If you were 35 years old you were likely the oldest person in your tribe and had probably outlived everyone you’ve ever known. But you hadn’t really lived long enough to wear your joints out.
Fast forward to the United States in the early 21st century and you’ll find that 2.3% of Americans have had a hip replaced and 4.6% have had a knee replaced. More than a million joint replacements will be done this year and that number continues to grow. Hip and knee replacements are surgeries that improve a patient’s quality of life in a big way. And we Americans are all about quality of life!
I want you to picture your lower molars. Your lower “first molars” came in somewhere around 6 years old. So for that same 50 year old we talked about above, these teeth have been tolerating chewing, hot coffee, cold ice cream and the occasional unpopped kernel of popcorn for 44 years. Think about that. 44 years! How old is your car? If you’re like most people it’s probably less than 5 years old and maybe 10 on the outside. But if you’ve got your first molars, they’ve been laboring for you since you were 6 years old!
This molar has a long life to live…if it gets a little help.
Teeth wear out, too. If you happen to be particularly kind to them (avoiding sugary or acidy foods, not grinding your teeth, not chewing ice cubes, not smoking, not drinking super hot liquids followed by freezing cold ice cream, etc.) they may well last your entire lifetime. But if your dentist tells you you’re going to need a crown, don’t feel too bad. Crowns are kind of like the knee replacements of dentistry. Dentists can give that tooth a new life with a procedure that’s a heck of a lot easier than a hip replacement! Even more…if you happen to lose a tooth, we can replace that tooth with an implant that looks and functions almost exactly like the real thing!
If you were a caveman, your first molars would have only had to last about 27 years. And since cavemen didn’t have refined sugars in just about everything they ate, most of them did just fine. You are not a caveman. Your life expectancy is very likely well over 70 years old. You are going to wear your parts out. That’s not disease. That’s the awesome nature of living twice as long as a caveman!
The next time your dentist diagnoses you with a cracked tooth that needs fixing you shouldn’t be upset at all. Let it be a reminder that you are benefitting from all the advances that the cavemen didn’t have.
And get that crown done. Those molars have to last a long time yet!
Did you find this post all ageless? Lively? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.
Imagine yourself sitting in the dental chair. The dentist comes in and examines your teeth. She looks at the x-rays, takes another look at your teeth and says, “I think you need a crown here.” What is she looking for? How does she know whether your tooth could use a filling or a crown? In episode 2 of “You Know the Drill” I give a little background on how the dentists determines when a tooth a little help, or some big help!
Did you like this podcast? I’d love to hear about it! You can share any Mead Family Dental podcast or post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title. Better yet, subscribe to the podcast on your iPhone so you can catch Dr. Mead’s weekly podcast automatically!
One of the amazing things about dentistry is that dental procedures are overwhelmingly outpatient surgeries.
You might be thinking, “surgery? I’m just having a filling done! What’s this about surgery?”
Well, having a filling done is actually a small surgery on your tooth. You come to the office, I administer your anesthesia (aka: numb your tooth) and then do the surgery. Since most procedures are done in a matter of an hour or so, that’s pretty quick surgery! Compared to other types of surgery, dental procedures are piece of cake. Mostly because dentists are experts at local anesthesia. And even though having a numb lip and/or tongue is a bit of a drag, it sure beats feeling what the dentist needs to do to restore teeth.
Local anesthetic is an important part of delivering comfortable dental care. Luckily, it’s a very safe drug that can be used without concern on most patients. It works by temporarily blocking the pain signals from a stimulus (aka: someone drilling on your tooth) to your brain. The signals are still sent, but when the anesthetic is in place, these signals never make it to your brain. Local anesthetics can do this without affecting your ability to drive a car or sedating you. Which means dental procedures can be quick and painless!
Every dentist will tell you that some patients are more difficult to get comfortably numb. According to Dr. Stan Malamed, the guy who wrote the book on local anesthesia (no, really. He wrote THE book on it!), as long as you get local anesthetic close to the nerve, it will block the conduction of nerve signals. So what’s happening when we have a patient that isn’t getting completely numb?
First, we may have not put the anesthetic close enough to the nerve. It’s almost always on the lower teeth that we cannot get a patient completely numb. This is often due to the dentist attempting to block the large nerve that runs through the jaw. This is called an inferior alveolar nerve block and if you’ve ever had one, you’d probably remember it. When done correctly, it numbs your entire jaw from your back teeth all the way to your very front teeth on one side of your jaw. It also often makes your tongue, lip and gums numb. It’s a lot of numb! It also happens to be the most difficult and inconsistent injection for the dentist. The nerve canal runs differently in each person, so sometimes we don’t place the anesthetic close enough to the nerve and we don’t get complete anesthesia. Furthermore, some people have extra nerves coming from the tongue side of the jaw. So even if we’re successful with our nerve block, we may not have placed anesthetic in all the right spots.
Secondly, inflamed and infected tissue doesn’t always allow anesthetic to pass into the nerve and thus block conduction of pain signals. I’m less confident of my ability to get a patient comfortably numb on a very inflamed or infected tooth.
So, we can get patients comfortably numb most of the time. But what about the times when we can’t? What if we could “supercharge” our anesthetic to get more patients numb more consistently? Well, funny you should ask!
Local anesthetic solutions are relatively low pH. Which is to say they are acidic. Anyone who has read this blog knows I’ve talked a lot about acidity and pH, but it’s usually in reference to the acid produced by bacteria and in foods that can cause tooth decay. In a previous blog post I explained pH in this way:
pH is a measurement of acidiy or alkalinity in an aqueous (water based) solution. A solution that is high in acidity has a low pH and a solution that is more alkaline has a higher pH. pH is measured on a 14 point scale with 0 being the lowest pH (most acidic) and 14 being the highest pH (most basic or alkaline). A pH of 7 is considered neutral, neither majority acid or alkaline. This 14 point scale is logarithmic, which means that each number on the scale is 10 times higher or lower than number above it or below it. For instance, a substance with a pH of 3 is 10 times more acidic than a substance with a pH of 4 and 100 times more acidic than something with a pH of 5.
The low pH of anesthetic is what can cause a burning sensation when anesthetic is being injected. Furthermore, the molecules of anesthetic actually cross the membrane of nerves more easily if the solution is at a higher pH. You’re probably asking yourself “why don’t we make the pH of anesthetic higher so it doesn’t burn and it’s more effective?” It’s a great question with a simple answer. The chemicals that we use to raise the pH of anesthetic (aka: “buffer” the anesthetic) aren’t stable for a long time. If you’re going to buffer local anesthetic for patient use, you actually have to add the buffering agent right before you use it.
At Mead Family Dental, we’re now able to do that. We recently invested in the Onset System, which can effectively buffer anesthetic for more comfortable injections as well as more profound anesthesia that takes effect more quickly. This means more comfortable injections, faster injections and less pain at the injection site after the appointment. If you’re interested in a technical description of how it works, take a look at this video.
We’re pretty serious about patient comfort. We’ve always been pretty confident about keeping our patients comfortable during dental appointments. The Onset System is one more way we’re make sure our patients have a comfortable experience in the office!
Did you find this post numbing? Maybe a little nerve-wracking?? This dentist in Saginaw, MI would love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.
If you’re looking for a Saginaw dentist, we’re always happy to accept new patients! You can request an appointment online or call the office at (989) 799-9133. And, as always, you can email me at firstname.lastname@example.org. I always answer my own emails!
“Roger. We have a tooth in trouble. We’re going to need a holding pattern. Do you copy?”
“I can’t do it right now, Doc. That’s just more than I can afford right now.”
I’ve heard this before. A lot, actually. Usually after I’ve shown a patient a photo of one of their teeth that is in trouble. Most times the patient understands my concern at this point in the conversation. We’ve probably just reviewed the digital photos that April and I took and beamed over to the iPad. They say that a picture is worth a thousand words, and a high resolution photo of a tooth in trouble usually brings the problem home like nothing else. I’ve recommended a crown that costs just under $1000 and it’s not in the patient’s budget.
So what are the options? Sometimes, we can get away with doing nothing for a little while. The teeth often aren’t causing the patient discomfort but often there are signs of tooth decay that can be seen, either with my eyes or when I review x-rays. Doing nothing means we may be letting an active decay situation get worse.
If a tooth could use a crown or an onlay and the patient can’t afford to do it right away, there is often another option. It’s a kind of middle ground between doing nothing and placing a crown.
Imagine you’re a pilot of a jet liner flying across the country toward Detroit Metro airport. It’s late January. You’ve been following the weather forecasts since you left Los Angeles and it looks like southeastern Michigan is getting some snow. You know that you and the other planes heading toward Detroit are going to have to land sometime soon, but you also know that the snow causes delays while they make the runway safe. So what are you going to do?
The control tower radios in that they’re putting you in a “holding pattern.” This means that all the planes that need to land at DTW are given flight instructions that keep them close and ready to land, but keep them safely away from other planes. So although they can’t land now, they are in a stable flight pattern and they’re ready to land once the runway is clear.
That sounds a bit like what we need for our tooth in trouble. We know that we can’t do our preferred treatment right now, but we need our tooth to be stable and ready for treatment when the time is right. What we really need is a dental “holding pattern.” Is there such a thing?
Absolutely! In most cases we can remove failing restorations, take out existing decay and place a bonded core buildup that will last for a couple of years, if necessary. It’s not a replacement for our definitive treatment, because this core restoration isn’t as structurally sound as covering the tooth. However, it can often last long enough to allow the patient to scrape up the resources to take care of the tooth.
Is there a down side? Actually, there is. First, you’re going to add about 25% in cost to the overall treatment. A core restoration used as a “holding pattern” is less expensive than a crown, but it does add a few hundred dollars to the complete treatment cost. Furthermore, the less times you need to operate on a given tooth, the better. By placing a holding pattern restoration and then going in to make the final crown, you’re operating on the tooth twice instead of once. There is a risk of damage to the pulp of the tooth whenever we operate, so it’s definitely something to think about.
At Mead Family Dental we strive to give our patients the options they need to keep their teeth as well as their budget happy! This Saginaw dentist understands that life is often about compromise, so we offer ways to help sick teeth even when finances are a problem. Most times, we can put a tooth in trouble in a holding pattern so it’s ready for more definitive treatment when we’re able!
Did you find this post loopy? Did it make you take off and spread your wings? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.
Our office will be closed Thursday, June 6th and Friday June 7th because we will be participating in the Michigan Dental Association’s “Mission of Mercy.” This amazing project will be held at Saginaw Valley State University on Friday and Saturday of this week. The goal of the Mission of Mercy is to provide dental treatment to 2000 people in two days…for free! Dentists, dental hygienists and assistants from all over the state will converge on Saginaw to volunteer their time and abilities to provide dental treatment at no cost! This is Michigan’s first Mission of Mercy and the MDA has been planning it for more than a year!
Please spread the word! If you are interested in being a patient you can read more information at the Michigan Dental Association’s FAQ page. Registration for volunteering at the Mission of Mercy has closed, but you can be put on a waiting list by emailing the coordinator here. Include your name, volunteer type (dentist, hygienist, general volunteer, etc.), email address and a phone number so the MDA can contact you at if any cancellations occur.
We’ll be back to normal on Monday, June 10th! Thanks for your understanding!
“Dentures aren’t a replacement for teeth. They’re a replacement for no teeth.”
—a very smart dentist
Some people have enough trouble with their teeth that they decide to have them taken out. Typically these people have been high risk for tooth decay and/or periodontal disease for a long time. The risk factors they had (tough bugs, low saliva flow, pop consumption, smoking, etc) overcame their ability to maintain their teeth. Many of these patients slowly lose teeth over time and finally come to a decision that they’re going to have their teeth removed. Sometimes they have a plan, sometimes they don’t. Most are just tired of what they perceive as a losing battle.
Teeth are supported by bone in your jaw. This bony ridge is called alveolar bone or just the alveolus. The alveolar bone is only there to support the teeth, so once the teeth are removed the bone tends to shrink. It shrinks a lot at first, right after the teeth are removed. Some people tend to lose a lot of alveolar bone after their teeth are removed, some people less. Usually it will continue to shrink away throughout a patient’s life, which will require dentures to be relined or even remade over time.
In the best case scenario, an upper denture fits like a suction cup over the alveolar bone that’s left after teeth are removed. Upper dentures can be very stable when they fit well because they have a lot of surface area to cover. It’s kind of like a snowshoe. The more area you can cover, the more stable you’ll be on the snow. Some patients that have had lots of trouble with their teeth in the past find an upper denture to be a real improvement. Especially if it fits well and looks nice. Often people start their denture experience with the upper and then choose to do the same with the lower. I cannot tell you how many times I’ve had patients that were disappointed by lower dentures even after having a well fitting upper denture made.
It’s like a horseshoe, balancing on a tightrope, in a hurricane.
The lower denture is horseshoe shaped, like the shape of your lower jaw. So already you’re starting at a disadvantage from the upper. The upper has a bunch of surface area to keep it stable. A lower denture doesn’t. The lower is balancing on a “U” shaped ridge of bone with no suction. Furthermore, you’ve got your lips on one side and your tongue on the other side. Your lips and tongue are muscular structures that are constantly moving while you speak, chew, swallow, play saxophone and whatever else you might do. By doing your normal, everyday thing your lips and tongue are constantly working to move your lower denture around.
If you’re getting the feeling that lower dentures are a nightmare, you’re right. I’ve gotten to a point where I won’t recommend them unless the patient is willing to have dental implants placed. Dental implants can be used to hold a hold denture in place or even can be used to completely replace the teeth, with no need for a removable denture.
It’s like this…except worse.
Having an upper denture is like having a full sized spare tire. It’s not as good as the wheel that was factory installed, not even close. But it looks about right and you can learn to get by with it. The lower denture is like a half inflated donut spare. It kind of looks like a wheel, but you can barely function with it. Some folks even adapt to it, but they definitely won’t be going highway speeds.
Did you find this post discouraging? Did it make you grateful to have teeth? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.