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Dental Implants

How Far Back Should Dentures Go?

I’m new to this whole dentures thing. In all honestly, I never thought I’d be without teeth at my age (42). I need to know how far back they are supposed to go. The problem I am facing is that my lower dentures do not cover the area where my wisdom teeth were and I’m chewing on gums. It’s uncomfortable. I spoke to my dentist and he told me he put them back as far as they go. How do people with dentures deal with the wisdom tooth area?

Todd

Dear Todd,

Man holding his jaw in pain

Dentures have problems. Even the best fitting dentures will reduce your chewing capacity by 50%. While you may never be completely thrilled with your dentures, there are some things your dentist can do to make this as pleasant as possible for you. Fixing this issue is one of them.

Your dentures should go past the wisdom tooth area and into the beginnning of the retromolar pad. Covering the retromolar pad completely is a bad idea because you will end up with interferance with your upper dentures, but going onto the beginning of it is fine and preferred.

So if your dentures can cover your wisdom teeth, why is your dentist acting like it can’t? While I cannot read your dentist’s mind, my suspicion is that he does not want to admit it can be fixed because fixing it means re-doing the denture completely.

If you have already paid for these, you won’t really have any leverage. You could show him this blog post and appeal to his integrity. If that does not work then you can threaten to share your experience on the review sites. This will impact  his business and he’ll know that.

An Additional Problem with Dentures

Before and after facial collapse
An Example of Facial Collapse

I am concerned that you have dentures at such a young age. Hopefully, your dentist warned you about the danger of facial collapse when you wear dentures for years.

When your teeth were first extracted, your body immediately began resorbing the minerals in your jawbone. It does this in order to be as efficient as possible with your body’s resources. Unfortunately, after about ten or so years you will no longer have enough jawbone left to support your denture. This is known in dental circles as facial collapse. The good news is there is a way to prevent it.

Preventing Facial Collapse

Implant Overdentures
Fixed implant bridge

If you place dental implants into your jawbone and then anchor your denture to them, which is a fixed implant bridge, not only will your dentures be completely secure but it will also prevent facial collapse. The implants serve as prosthetic tooth roots and signal to your body that your minerals are needed so that your jawbone can retain your teeth.

This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.

Invisalign

The End of Smile Direct Club

Hi, I am really hoping you can help me. I was a patient with smile direct club. This month, they closed their business and I am only halfway through my treatments. I don’t have everything I need. There are a few other companies that do mail order braces. Do you know if they will finish off my treatment? I’m having trouble getting my information from Smile Direct so I don’t know how to continue. I paid for all of this upfront too and I’m not hearing anything about getting my money back. I’m in tears and don’t know what to do.

Kaycie

Dear Kaycie,

Smile Direct Club Closed

I am sorry this happened to you. For those who are unaware about this situation. SmileDirectClub was a mail order service that was trying to be a cheaper version of Invisalign. The problem was, when patients are not under the care of a dentist a lot of things can go wrong. A LOT. And they did.

However, most potential patients were not aware of the problems because in order to get a refund, SmileDirectClub required them to sign a non-disclosure agreement which forbade them from posting anything negative about the company. In June of this year, a court in the District of Columbia ordered them to stop doing that. The truth about their problems came flooding out. They filed for bankruptcy and when they couldn’t get a buyer just closed their doors.

I am going to be honest with you that you will likely have a hard time getting your money back. You can file as one of their creditors, but it is a long line.

I’m honestly not going to recommend any of the other mail order companies because they will have the same problems as SmileDirect. The one possible exception to this would be Candid because they incorporate care with a dentist into their program. That is a bit safer.

The safest option for you is to go to an Invisalign dentist and explain your situation. They can continue your treatment and may be willing to work with you on payments because of the tough spot you are in.

Again, I’m sorry this happened to you.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

 

CEREC

CEREC Crown on a Front Tooth

I needed a dental crown on a front tooth. My dentist recently got this new CEREC machine and told me that it would give me the crown in just one appointment. We were close to the holidays so I thought that would be a good idea. It was going okay until the next day. I was going to a friends house and the crown literally just fell off as I parked my car. I was absolutely frantic. My friend called her dentist who worked with CEREC crowns. He got me in right away and said that the crown wasn’t bonded on properly. Once it was bonded on, I noticed it is slightly longer than my other front tooth. The color is a bit off as well. I went in to see my dentist the following day and he told me he’d redo the whole thing free of charge. My question is should I trust him or should I just ask for a refund and get this done by someone else?

Patricia

Dear Patricia,

Block of porcelain for a CEREC crown

It would be hard to answer that question precisely because I don’t know anything about your dentist and his specific training. I can tell you the matching a crown on a front tooth is exceptionally difficult even for skilled cosmetic dentists, so I am not surprised it does not match correctly in just one go. Often, it takes several try ins and tweeks before a front tooth is the exact shade you need.

This is even harder with CEREC crowns because these are milled out of a single block of porcelain. A dentist will need advanced skills in working in stains.

Your dentist has offered to redo the crown. This tells me he is honest and cares more about getting it right than getting money. That is a good sign. Wanting to get it right is not always enough though. If you want to give him a second chance on this, I recommend that you tell him you only want h im to place it with a temporary try in paste so you can be sure you are pleased wtih the results before it is permanetely bonded again.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesh.

AACD Accredited Dentist in Lafayette

Dealing with Tetracycline Stains

I am almost 45 and have severe tetracycline stains. I’d really like to improve my smile so I won’t feel embarrassed to smile. However, I’ve been to three dentists and they all want to give me a mouth full of dental crowns. My teeth are very healthy so I hate the idea of grinding them down. Are there other options for my situation or should I resign myself to crowns?

Brenda

Dear Brenda,

porcelain veneer being placed

Tetracycline stains are some of the most difficult type of cosmetic cases there are. If a dentist is suggesting a dental crown for your smile makeover and you do not have a clinical need for them, that is a hint that they are not a skilled cosmetic dentist.

One of the trickiest parts of a tetracycline case is getting the dental work opaque enough to cover the stains themselves, but still translucent enough to look natural.

Inexperienced cosmetic dentists try to get around this by using dental crowns. Unfortunately, that doesn’t really help. Given your unique situation, I would say you need an expert cosmetic dentist. They will be able to cover your tetracycline stains with porcelain veneers, which will give you the gorgeous smile you want without grinding healthy tooth structure down the way your current dentist wants to do.

While there is not a recognized specialty in cosmetic dentistry, the top 1-3% of cosmetic dentists are AACD accredited. The American Academy of Cosmetic Dentistry recognized the dilemma both patients and dentist’s faced. Patients needed a way to find good cosmetic dentists. Dentists needed a way to get the skills needed to do excellent cosmetic work that is not offered in dental school. As a result, they created their accreditation program.

It takes YEARS to get accredited. There are superb cosmetic dentists out there who have not yet received their accreditation, but your situation is quite challenging. I am going to recommend you look for a dentist who is accredited.

While not all dentists in our office are accredited, we do have one dentist in our office who comes in just for those challenging cases.  There is probably a dental practice in your area who has a credentialed  dentist. If there is not, it will be worth it for you to travel to a nearby state if you want to be assured of a gorgeous result.

This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.

Dentures

Is She Allergic to Her Dentures?

Can you help me? I recently received dentures. When I first wore them, I started getting some redness around my eyes and swollen glands. I continued wearing them and went back for a fitting. I am really pleased with how they fit, but the awful symptoms got worse. After a few days, I started having trouble breathing and my entire face was swollen. I discontinued the dentures for a week and the symptoms subsided. When I started them back, within one day the symptoms had returned. I don’t want to give up these dentures because they fit so well. Is there anything that can be done?

Miranda

Dear Miranda,

Dentures

You are definitely allergic to these dentures. I would stop wearing them until you can figure out exactly what you are allergic to. You can go to an allergist and have this evaluated.

Do not mess around with an allergy. You have already had some difficulty breathing. You do not want this to turn life threatening.

There are a couple of possibilities here. One is that you are allergic to the monomer used in the acryllic. This can be dealth with.  The acryllic begins in the liquid form when it is being used in dentures. That is a monomer. Then, a chemical reaction is used to harden it into a solid polymer. Some of the monomer is always leftover in the chemical reaction. You may remember about leftover reactants from your chemistry study days in high school or college.

If that is what you are allergic to, then you can immerse the denture in very hot water for several hours to complete the process from monomer to polymer.

If you are allergic to something else used to build the denture, then there are other materials that can be used, including other resins.  Though, in those cases the denture will have to be remade. Hopefully, if it comes to that your dentist can make sure it fits as well as the first one.

I want to give an additional word of caution. I don’t know if your dentist warned you about facial collapse when wearing completely removable dentures, but I would take this time when you are at a crossroads with your denture to learn about that so you can make as informed a decision as possible. The solution to that would be dental implants combined with dentures.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Dental Implants

Did My Dentist Handle My Sinus Perforation Correctly?

I had a dental implant placed. During the procedure, the dentist perforated the sinus cavity by a few millimeters, which he explained is quite common. The bone never quite filled in so he eventually ended up removing the implant. I was sedated during the procedure and no antibiotics were administered. A few days later I started having congestion in the nose and a crackling sound. I wasn’t feeling well and thought I might be getting an infection. When I went in for my follow up, he told me everything looked fine. He also said that there was no need to repair the perforation and that it would heal on its own. I told him I thought I was getting an infection and insisted he prescribe me an antibiotic, to which he reluctantly agreed. Since then, I have not had any problem with the congestion. Now I am wondering if I should have had antibiotics to begin with. He said we can try again after everything is healed up. Do you know what the time period for that typically is?

Kathey

Dear Kathey,

illustration of a dental implant

Not providing you antibiotics at the beginning, when there was no sign of infection, is not a problem. However, there are a couple of other issues here that I am concerned about.

First, the sinus perforation. While they do sometimes happen, I would not exactly call it common. Even more disturbing was the amount of the perforation. In dental terms, a few millimeters is HUGE. How did this happen? Did he do the appropriate diagnostics, which would include a CT scan? This is important because dental implants are a 3 dimensional procedure, so you need 3 dimensional images. Without that, you not only risk a sinus perforation, but damaging nearby nerves.

A second thing that concerns me is that the bone never integrated with the dental implant. Did he tell you why? Was there even enough bone there to begin with? Again, I’m curious about the diagnostics which would have given an idea about the bone support.

A Second Dental Implant Procedure

Getting your implant redone is not as simple as just waiting for things to heal. Even if you had enough bone to begin with, when the implant was removed, it would have taken some bone with it.

That bone will have to be replaced in order to even attempt a second procedure. You will need to have some bone grafting done. Then, after that has had time to heal you can get the implant done.

He also needs to answer why the implant failed. If he doesn’t know, how can he assure you it won’t happen the second time. In your place, I’d ask for a copy of the original diagnostics and then take them to another dentist for a second opinion on the reason for dental implant failure.

This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.

Emergency Dentist

My Crowns Hurt

I had some dental bonding done years ago on my two front teeth because of an accident. Now, about ten years later the bonding is looking pretty rough so I decided to bite the bullet and get the work redone. My dentist thought doing crowns would be better and did four of them so that my teeth would match. The four teeth do match each other, but not quite the other teeth. That’s not why I’m writing, though. The dental crowns feel really weird and heavy. They hit my other teeth in a way that makes it hurt when I chew. Is it possible that I have a cavity or infection under one of them? Is it a dental emergency?

Emma

Dear Emma,

Porcelain crown being placed on a tooth

A simple x-ray will tell you if there is an infection under one of those crowns, However, you said it hurts when you bite down but did not mention it hurting any other time. This make me think that the problem is the fit of the crowns and not what is underneath them.

I’d like you to get a second opinion on the fit of these crowns. I would not consider it a dental emergency, but I would try to get in as soon as possible simply because you are uncomfortable.

The fact that your dentist gave you four dental crowns to replace dental bonding on just two teeth makes me wonder about his ethics. This was a massive overtreatment.

On top of that, he told you that you needed four dental crowns in order to make them match. That is not true. A skilled cosmetic dentist can even match a single crown to the rest of teeth. Even then, he couldn’t match the four crowns to the remainder of your teeth.

I don’t know if you went back to have your dentist look at these, but the pain could be solved by a simple adjustment. If he doesn’t solve the problem or tries to tell you everything is fine, then I would definitely get that second opinion.

Don’t tell them who provided your dental crowns, just that they hurt when you bite down. Dentists know each other and you don’t want them worried about critisizing a friend’s work. If he or she asks, just explain you want an unbiased opinon. They should respect that.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Zoom Whitening

Will Zoom Whitening Refresh My Porcelain Veneers?

I have had my porcelain veneers for a little over seven months. Everything was fine, but recently I have noticed that they have begun taking on stains. I tried over-the-counter teeth whitening strips, but they do not seem to be helping. My dentist does zoom whitening. Would that help?

Laurie

Dear Laurie,

a porcelain veneer being held up to a tooth

The glaze on porcelain veneers are very stain resistant. In fact, they are more stain resistant than your natural teeth. If they are picking up stains then something has damaged the glazing that protects them.

You mentioned that you have had them for a bit over seven months. This is enough time for you to go in for a check up and cleaning.  It is possible that the hygienist was unaware that using a power prophy jet or acidulated fluoride could damage the glazing.

My suggestion is you ask your hygienist what he or she used during your appointment. If they damaged the veneers then they should be the ones to repair them.

Unfortunately, Zoom Whitening will not help. Teeth whitening only works on natural tooth structure, not dental work. This is also why the over the counter strips didn’t work.

The good news is that there is a way to repair the glazing. If your dentist does not know how, have him cover the expense of having an expert cosmetic dentist do that for you.

Once they are repaired, I recommend you use Supersmile Toothpaste. It is specifically designed to keep dental work in top shape. It can even remove coffee stains without any damage to your porcelain veneers.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Sedation Dentist

Need Advice about a Tooth Extraction

Years ago I had an infected tooth. I avoided the dentist because I have never had a good experience with one. When I could not take the pain anymore, I schedule an appointment. He said the tooth was infected and performed a root canal treatment. I was supposed to schedule a follow-up appointment for the cap, but never did. I probably should have because it seems like the tooth got reinfected. It hurt again and pieces started falling off. I went to another dentist who confirmed the infection. I received quite a lecture about the state of my teeth and not getting regular care. He told me it would be a tough extraction. The best he could offer me was nitrous oxide. If I didn’t think I was able to handle the procedure, he could refer me to an oral surgeon. I was thinking I would go with the oral surgeon. However, it turns out they are a LOT more expensive. Would I be able to get this done with a dentist and it not be an absolute nightmare or do I need to take out a loan and see the oral surgeon?

Imogen

Dear Imogen,

Woman resting in dental chair from dental sedation

I am going to say right off the bat that this dentist you saw will not be the best dentist for you. What you need is compassion and a solution, not a lecture. That does not lend toward helping patients feel comfortable going to the dentist.

You should not have to take out a loan and go to an oral surgeon for this extraction. The right dentist can do this extraction for you. What I think you need is a dentist who offers other, stronger, dental sedations options, such as oral conscious sedation.

They are generally more compassionate with anxious patients than the dentist you just experienced. Let them look at the tooth and tell you whether or not they can do the extraction. My guess is you will find someone. It sounds more like this dentist was out of his comfort level and was trying to push  the blame off on you.

With oral conscious sedation, you are not knocked out, but will be so completely relaxed that you will be able to sleep completely through the procedure if you want to.  Most patients who use dental sedation find it completely changes their life and they are able to get the dental care they have always wanted.

The only downside is, because of its strength, you will need someone to drive you to and from your appointment, as well as stay with you for a few hours after the procedure. They will want to make certain you are lucid and steady on your feet.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Invisalign

Lumineers or Orthodontics?

My nephew is graduating and I promised to get him orthodontics as a gift. His parents are struggling and I know his teeth bother him. However, his dentist told him that he could get his teeth fixed much faster with Lumineers. I looked into it and they are a LOT more expensive. Would these really be a better option for him than straightening his teeth?

Angie

Dear Angie,

Invisalign aligner

I am glad you wrote before moving forward. If the only thing his teeth need is to be straightened, than orthodontics are the way to go. To do Lumineers simply to straighten teeth would be a bit of an overtreatment, and an expensive one at that as you have noticed.

At his age, instead of traditional metal braces, I would suggest you look into Invisalign. This would allow him to straighten his teeth without anyone even knowing because it uses clear aligners.

If there are other things wrong with his teeth, like their shape or size, and you are willing to invest in a total smile makeover, than porcelain veneers would be the way to go.

That being said, I would not recommend the Lumineers brand. This particular brand is highly marketed to inexperienced cosmetic dentists as being easy to place. Additionally, their lab, which they force dentists to use, is not known to produce beautiful results.

Instead, I would look for a dentist who is accredited by the American Academy of Cosmetic Dentistry. They are the most skilled cosmetic dentists in the country and can give your nephew a stunning smile.

I hope this helps you with your decision.
This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.