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Can I Get Dental Implants Instead of Dentures

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I have to replace all my teeth and my dentist wants me to get dentures. I asked him if I can get dental implants instead, but he said because I previously had gum disease that is not possible. Is there any way around this? I really feel too young for dentures. I’m only 42 years old.

Paula

Dear Paula,

Illustration of dental implant overdentures

 

I am sorry you are having to go through this at your age. Before I answer your question I have one of my own. You said you previously had gum disease. Does that mean you have already undergone treatment and no longer have periodontal disease? If that is the case and you are otherwise in good general health then there really should not be a reason you could not have dental implants. If you currently have gum disease, you will need to deal with that first.

It is possible you will need to have some bone grafting done, depending on how much bone structure you lost during your period of gum disease. That can be done outpatient.

Dental implants are an advanced procedure and it really requires that a dentist has post-doctoral training. Often, when a dentist is telling a patient that they can’t have a procedure it is because they are not comfortable doing that procedure. Don’t pressure your dentist to do it, though. There are way too many dental implant horror stories from patients who had the procedure done by dentists without the necessary additional training.

Look for a dentist who has training at one of the following institutions:

  • The Las Vegas Institute for Advanced Dental Studies
  • Dawson Academy
  • The Kois Center

Why Dental Implants Are Important

When your teeth are removed, your body immediately begins to resorb the minerals in your jawbone in order to use those resources in other places in your body that may need them more. It does this because you no longer have any teeth roots there so there is no need for the bone to support the teeth. While an efficient way to manage your body’s resources, it has the unfortunate side effect of shrinking your jawbone. After around ten years, it will become difficult for you to keep your dentures in. Shortly after that, it will be impossible. This is known in dental circles as facial collapse.

At your young age, this would be devastating. Having dental implants placed causes your body to recognize there are still “roots” there for your teeth. Because of that it will leave your jawbone intact.

When you are talking about removing all of your teeth, it is common practice to get implant-supported dentures, also called implant overdentures. This uses between four to six dental implants and then anchors your dentures to them. That amount of dental implants will both secure your dentures and provide the protection you need from facial collapse.

One other word of caution. Make sure your dentist has the cosmetic skills to provide you with beautiful dentures. Look at their smile gallery to see what type of work they do.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Can’t Floss My Porcelain Veneers

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I recently had porcelain veneers placed a week and a half ago. I have a couple of questions because they were a huge investment for me and I want to take good care of them. First, is Oral B Pro Expert Toothpaste good for them? Second, I’m having trouble flossing the porcelain veneers. Is there some special tool for them?

Carol

Dear Carol,

a porcelain veneer being placed on a tooth

Let’s start with the easy one. There is nothing unique or special about the Oral B toothpaste. However, there is nothing harmful in it either. One of the things I do warn against is most whitening toothpastes. This is because they use an abrasive to remove your tooth stains. The big problem with that is that it will scratch your porcelain veneers, which in turn will damage the surface and cause them to pick up stains.

There are exceptions. In fact, there is a toothpaste I specifically recommend to use with porcelain veneers because it is designed to be used with cosmetic dental work called Supersmile Toothpaste. While this is whitening toothpaste, it is not made with abrasives. Instead, it uses a chemical ingredient that causes your tooth stains to attach to a protein pellicle that the chemical breaks down.

The flossing is a more complicated issue. It is important that you should be able to floss your teeth with your porcelain veneers. The fact that you can’t means either the lab did something wrong in designing them or your dentist did by not cleaning off the excess cement. This could lead to you developing gum disease. Your dentist needs to look at this to repair it.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Her Gums Inflammed After Getting Porcelain Veneers

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I’m a little worried about my gums. I had porcelain veneers placed a couple of months ago. Since it happened. my gums have been inflamed and painful. I went back in and the hygienist said she’s never seen it happen before. The dentist came to look and both of them accused me of not brushing enough. I was quite annoyed. I’m a grown adult and know how to brush my teeth. Why in the world would I not brush after spending a fortune on these porcelain veneers? When I went back in for a routine one-month follow up he removed some excess cement. That has helped some but I’m still in pain. What do you recommend I do?

Avery

Dear Avery,

illustraing on lateral incisors inflammed by poorly done porcelain veneers

These lateral incisors are inflamed from poorly done porcelain veneers

When patients have a smile makeover they’re proud of, they tend to take better care of their teeth, not worse. I don’t like it when medical practitioners blame patients for things they don’t quite understand. Please bear in mind that I haven’t examined you so I can only give possibilities.

There are a few possibilities going on here. It can be one or a combination of them. With the first possibility, he could have left some cement in that is irritating the gums. This seems a very real possibility, especially because you said he removed some excess cement a month out from placement. The cement should have been removed right away, while it was still soft. The fact that your gums felt a little better after he finally did remove it. Now it is getting a chance to heal.

That doesn’t mean that is the only thing irritating your gums, though. I say that because It doesn’t sound like your dentist has invested a lot of time in understanding cosmetic dental work. Another option is there is some unevenness or temporary shelving in the margins between the porcelain veneers and the gumline. This is sometimes called bulky margins.

This will cause things to get trapped in between the gums and the porcelain veneers, leading to inflammation and, eventually, gum disease and tooth decay.

There are other possibilities too such as the extended wearing of temporaries, the veneers encroach on the gingival attachment, and, allergies to the materials used in bonding.

Dealing with a Disastrous Smile Makeover

The first thing I suggest you do is get a second opinion. When you do, make sure it is a blind second opinion. Don’t ask your dentist for a recommendation and don’t tell whomever you do see who your dentist was. Most of the time, they know one another. You want an unbiased opinion. What you don’t want is him feeling torn between an honest evaluation and betraying his friend. That’s why a blind second opinion is best.

If it is just a matter of the cement being trapped there, then when your dentist removed it at the last follow-up, that should help as it heals. The second opinion dentist can make sure there isn’t any more there. If, however, the problem is with the margins, the porcelain veneers will have to be completely re-done. Because it puts your oral health at risk, you are entitled to have them re-done free of charge. Though, my recommendation would be to get a refund and have a more experienced cosmetic dentist do this.

Look for someone who is recommended on the mynewsmile.com website. They are highly skilled and they will sort them by area of the country for you.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.