Tag Archives: Facial Collapse

Sedation Dentist

Dealing with a High Resistance to Novocaine

I am 27 years old and have horrible teeth. Dental work is almost impossible for me because I have a high resistance to Novocain which makes it almost impossible to get numb. I’m thinking my only option is to remove my teeth and get dentures. I want to move up in my career and feel my smile is really holding me back. I am assuming that I can get the teeth removed with anesthesia, right?

Amelia

Dear Amelia,

Woman with beautiful smile

Before you do anything drastic, like remove all your teeth, I want togive you a solution that will allow you to keep your natural teeth, have a beautiful smile, and not get tortured at the dentist because of your high resistance to Novocain.

There is a huge connection between the inability to get numb and dental anxiety. Given your traumatizing experiences with dental care, I would not be surprised if you had a very high anxiety level.

This anxiety amps up your metabolism, which burns off the numbing medication before it can do anything. I recommend you see a sedation dentist who offers oral conscious sedation.

This is administered by a pill which will completely relax you. In fact, it is so strong that it has been dubbed sleep dentistry because most patients just snooze through their entire procedure. You will need someone to drive you to and from your appointment as well as stay with you for a few hours until you are lucid and steady on your feet again. But, this will change your life and you’ll be able to get that work done on your teeth without pain or anxiety.

Why You Don’t Want Dentures

images of before and after facial collapse
The result of facial collapse

When your teeth are removed,  your body recognizes that and immediately begins to resorb the minerals in your jawbone to use elsewhere in your body. In about ten or so years, you will no longer have enough of your jawbone left to retain your dentures. Dentists call this facial collapse. You are only 27 years old, this is NOT what you want.

While there is a way to prevent this, it is expensive. You could have dental implants placed that your dentures would anchor to. The implants are like prosthetic tooth roots, so your body recognizes that you have teeth there and leaves your jawbone intact.

Before you go this route, I think trying dental sedation will truly solve your issue.

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

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.

Dentures

Can I Get Gold Teeth on Dentures?

I’m only 49 but I’m about to get dentures. I’m tired of these teeth hurting me, I’m ready to be rid of them! I’ve never had dentures before, so I’m kind of excited at the thought of looking good. I was wondering though, do they ever make them with gold-outlined teeth on the front? I just want the upper front two done. I love how that looks but I haven’t seen anyone with that in their dentures yet. So I didn’t know if it was something I could even have done.

Sasha

Dear Sasha,

Dentures

I’m glad you wrote. The short answer is yes, you can have gold teeth set in your new denture. There are a number of variations, from full gold crowns to small amounts that hardly show at all. It will be important that you are very specific with your dentist regarding exactly what your expectations are. The safest option would be to bring in a photo of what you want the teeth to look like to avoid any miscommunication.

As you might guess, adding gold to the denture teeth adds extra expense and your fee will be higher than that of a typical denture. This fee will vary according to the amount of teeth involved and the gold required to cover them.

Understanding Dentures

Before and after facial collapse
Before and After Facial Collapse

I know your teeth are killing you and you are ready to be rid of them, but I want to make sure you understand what you are getting into with dentures. Even the best-fitting dentures will reduce your chewing capacity by 50%.

However, the bigger issue is bone resorption. When your teeth are removed your body recognizes that and immediately begins to resorb the minerals in your body in order to use your resources most effectively. While great stewardship for our body’s resources, it will have the unfortunate effect of shrinking your jawbone. After ten or so years, you will not have enough jawbone left to retain your dentures. Plus, the loss of bone makes you look a couple of decades older than you are.

There is a Way to Prevent Facial Collapse

If you have dental implants placed then your body will interpret that as you still having tooth roots there which need the bone to keep them secure. This will prevent the bone loss from occuring. You can have implant supported dentures placed. This uses a minimum of four dental implants and then when the bone has had time to integrate with the implants a denture can be anchored to them. Not only does this prevent facial collapse, but it is completely secure. You will have no slipping or falling out. You can eat anything you want.

If you absolutely cannot save your teeth. This is what I’d recommend. Because of how young you are, completely removable dentures will be a disaster for you long term.

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

Sedation Dentist

Discouraged About My Teeth

I have had trouble with my teeth my entire life. I started needing root canal treatments in my teen years. My dentists always assumed I was not taking care of my teeth. This was absolutely not true. I brush my teeth twice a day AND floss. I have done this since I was a kid. Despite that, I always have tons of cavities. Yet, friends of mine that hardly care about their teeth seem to skate by cavity free. One of my low points was my sophomore year of college. One of my front teeth had a root canal treatment in my teen years. However, my parents could not afford to get a crown put on it. Here I am, year two in my university with a tooth which had turned gray. As if that wasn’t bad enough, my tooth literally crumbled. I was humiliated with half a tooth in the front of my mouth. I was afraid to speak and never smiled. Eventually, I saved up enough to get a dental crown from a dentist within walking distance of my dorm. But, the crown doesn’t match any of my other teeth and looks obviously fake. Fast forward. I’m married and my husband has some dental insurance. I went to see a dentist and he said that my mouth was a mess and I should consider just extracting my teeth and getting dentures. I’m only 27 years old and have spent the last two days crying at the idea. Is there no other solution for someone in my situation?

Callie

Dear Callie,

Woman with beautiful smile

I am sorry you have been faced with either lazy or judgmental dentists. Believe it or not, most dentists went into their field because they want to help people. You’ve seemed to have gotten a couple of duds. I am going to be honest with you and say that your current dentist is not going to be the best dentist for you.

Some patients, like yourself, can do everything right and still end up with high maintenance teeth. It’s the genetic lottery and you didn’t get the big prize. However, there are a few things you can do to help yourself.

Do NOT Get Dentures

before and after facial collpase
Before and After Facial Collapse
Whatever you do, please do not get your teeth extracted and get dentures. Once your teeth are removed, your body will immediately begin to resorb the minerals in your jawbone to use elsewhere in your body.

This will have the side effect of shrinking your jawbone. After ten or so years, you will no longer have enough jawbone left to keep your dentures in place. Not to mention that it will age your appearance by decades. This is totally avoidable and I don’t want you to have to face such severe consequences when there are options.

Find a Sedation Dentist Willing to Invest in Your Teeth

The first thing I want you to do is find another dentist, one who is totally willing to invest as much work as necessary to fix your teeth. Ideally, you should look for a sedation dentist. The benefit to this, aside from anxiety-free/pain-free appointments, is that it will allow you to get more work done during each appointment. This enables you to catch up faster.

A Simple Step You Can Take

Most people think oral hygiene is all they need to keep their cavities at bay. The truth is, however, that brushing generally only gets to the smooth surfaces of your teeth. In order to get into all those cracks and crevices, you need your saliva to have time to do the beavy lifting. Our saliva is loaded with bacteria fighting minerals. However, if you snack a lot it doesn’t have enough time to do the work. If possible, limit your eating to three times a day and only one snack. This gives your saliva more time to work. Doing this simple step will allow you to reduce your chance of cavities.

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

Dental Implants

Should My Husband Get All-On-Four Dental Implants?

My husband needs to replace his bottom teeth. His upper teeth have been gone for a while and he has dentures there. We were told that you shouldn’t do dentures on bottom teeth because they won’t stay in the way the top ones do. Our dentist said he needs to get all-on-4 dental implants. I just want to explore if there are other options before we make a decision?

Pricilla

Dear Pricilla,

All-on-4 Dental Implants

I am curious why that is the only option he gave your husband. A dentist is ethically obligated to give his or her patients all of their options. He is correct that dentures are a bad idea on bottom teeth. While it is true that dentures will struggle to stay in on the lower arch, that does not happen right away. This is an issue because of bone resorption.

When his teeth are removed, his body recognizes that and begins to resorb the minerals in his jawbone in an effort to be as efficient as possible with his body’s resources. The big problem with that is after ten or so years, he will no longer have enough jawbone left to retain his dentures. This is known as facial collapse.

This bone structure is important no matter what tooth replacement option he chooses.

All-on-4 Dental implants (pictured above) are what dentists will sometimes offer to patients who have lost some jawbone structure but still want dental implants. However, there are other options.

Implant-supported denture

The first thing to find out is whether or not he has lost bone structure. If he hasn’t, then his best option is to get an implant overdenture. This uses between for and six dental implants and then anchors a denture to them.

If he is missing bone, depending on the amount, he has two choices. First, he can have the all-on-4 procedure his dentist suggested, as long as he hasn’t lost too much bone. The one downside to this procedure, however, is that if one implant fails, the entire unit has to be redone. A second option, no matter how much bone he’s lost, is to have a bone grafting procedure done to build it back up. Then, he can do implant overdentures if he wants. He could get a denture too, but bear in mind he will end up with facial collapse. Having dental implants in the jaw bone, prevents that from happening.

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

Dental Implants

Dental Implants After Ten Years in Dentures

I have been in dentures for a little over ten years. To be honest, I have hated them the entire time. I knew fairly quickly after getting them that I would need to switch to dental implants, but just didn’t have the budget for it yet. I’ve finally saved up enough. Is it too late for me? My dentist retired and the new one said I’ve been in dentures for too long to switch.

Avery

Dear Avery,

Implant overdentures

Technically, it is never too late to get dental implants. That being said, there could be the possibility of needing one procedure to get your mouth in the right condition for dental implants to have a chance to succeed. If that is the case, why did your dentist tell you it is too late?

During Dental School, students are taught that it is important patients are confident in them. Because of that, many dentists do not want to admit when there is a procedure they are not comfortable doing. Instead of risking the patient’s respect by admitting they can’t do something, some dentists will simply steer their patient’s to another procedure they are more comfortable with.

It is never a good idea to pressure a dentist to do a procedure that is out of their comfort zone. The results are usually disastrous. This is especially true with dental implants, which is a very advanced procedure. The training required to do this well has to be done in a post-doctoral setting. Not many dentists invest in enough of it, which is probably why it is one of the procedures that tops the malpractice suit list. I’m going to recommend, you find a different dentist to do your porcedure.

Dental Implants and Facial Collapse

The consequences of years in dentures.

When your teeth were first removed for your dentures, your body recognized you no longer had tooth roots and, therefore, didn’t need any of your jawbone to help keep them in place. Our bodies are always striving to be as efficient as possible with its resources. To help with that goal, it will resorb the minerals in your jawbone to use elsewhere in your body.

While remarkable, this will have the unfortunate side-effect of slowly shrinking your jawbone. Eventually, there will no longer be enough jawbone to even support your dentures. This is known as facial collpase (pictured directly above).

For dental implants to be retained, they need the surrounding bone to integrate with it and keep it secure. If you don’t have enough bone to start with, that is impossible. You have been in dentures for ten years, which is enough time for significant bone loss.

The good news is there is a fairly simple solution. You can have a procedure done, known as bone grafting. It will build back up the bone in your jawbone. Once you have healed from that, you can have your dental implants placed and then anchor your new denture to them–a procedure known as implant overdentures.

You will have the secure smile you’ve always wanted with none of the problems and consequences that come with removable dentures.

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

Dental Implants

Is it Possible to Get Dental Implants after 30 Years?

I’ve had dentures for around 30 years. I’ve never been crazy about them and always wanted to switch to dental implants. Now, I’m having trouble even keeping them in. I think this may be a perfect time to switch, but I don’t know if I waited too long. Is it still possible? If not, how do I get my dentures to stay in? Not even those nasty adhesives are working.

Marilyn

Dear Marilyn,

dental implant diagram

Technically, as long as you are in reasonably good health, you can get dental implants. Though, in cases like yours, an extra step will be needed. As you can see from the image above, your dental implant will need to be surrounded by bone in order to stay in place. This bone is also what holds your teeth in place as well, along with some ligaments. After this length of time with dentures, you are missing that bone.

You’re Dealing with Facial Collapse

When your teeth were removed 30 something years ago, your body immediately began resorbing the minerals in your jawbone to use elsewhere. It does this in an effort to be efficient with your body’s resources. It knows you don’t have teeth anymore and assumes that you won’t need the bones in your jawbone to hold them. True. However, your dentures rest on the ridgeline of your jawbone. As that shrinks, there is less and less of a ridge to hold your dentures in place.

After ten years, you likely noticed them starting to slip. By thirty years, it is almost impossible to keep them in. This is known as facial collapse. You’ve probably also noticed your jawline shrinking,, which makes you look much older than you really are.

There is a procedure to help with this– Bone grafting. You can have either natural or synthetic bone built back up in the area so that you’ll have enough bone there to integrate with your dental implants and keep them in place.

Implant Overdentures

implant-overdentures
Implant Supported Dentures

Once the bone grafting is complete, then you will be able to get the dental implants you hope for. You won’t want to do a one-to-one replacement for your teeth. That is way too expensive. Instead, you’ll get implant overdentures. With these, you’ll have four to six dental implants placed in each arch and then have a new set of dentures anchored to them.

Your dentures will be completely secure and will protect you from facial collapse in the future.

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

Uncategorized

Is it necessary for my son to get all of his teeth pulled?

My son is 23 years old. He is a drug addict who is in recovery, and his teeth are completely ruined. The dentist at the clinic says he should just have all of them pulled and replace them with dentures.

Right now, I recognize that this is the only avenue open to us. The teeth have to come out. He is only able to chew with a couple of teeth towards the front of his mouth.

My question is whether or not all of this can be done in one visit. It seems like a lot–he has 26 teeth that need to come out. Would they be able to fit dentures when they’ve just removed all those teeth? It doesn’t seem like they could do that until after his gums heal

Any advice you can offer would be appreciated. This has been a long, hard road.

Serena in Overton

Dear Serena,

This treatment plan is too extreme. It may seem like the easiest solution to the dentist, but it means a lifetime of dental trouble for your son. He is much too young to have all of his teeth removed.

As soon as all his teeth are removed, your son’s jawbones will start to shrink. When a tooth is lost, the body reabsorbs the bone of the jaw at the location of the missing tooth. When ALL the teeth are removed, eventually that person will experience “facial collapse”. You have probably seen pictures of people whose faces look as if they have collapsed inward. This happens when the jawbones deteriorate to the point that the patient cannot wear any kind of denture at all.

If he is in his early 20s now, this could happen by the time he is 40. He will be unable to eat normal foods, and at that point the repairs are much more complicated and expensive.

If at all possible, the goal should be to retain as many of his natural teeth as possible. They may not be in perfect condition, but every tooth that can be saved represents a more stable jawbone. Those remaining teeth could be used to anchor partial dentures or dental bridges.

If in fact none of his teeth can be saved, dental implants will work just like natural teeth to preserve the structure of his jawbone. The least expensive option would be mini-dental implants, where two implants per arch are placed and used to anchor dentures. Having ALL the extractions done in one sitting is too much. The amount of Novocain required to numb the upper jaw for a full set of extractions is significant, and poses a correspondingly significant risk.

It is time to get a second opinion. We recommend looking for a dentist that really makes you feel like he cares about your son, and your situation. Your son is on the road to recovery, and needs compassion to get the care he needs.

This blog is posted courtesy of Lafayette Louisiana cosmetic dentist Dr. Mike Malone.