Tag Archives: tooth replacement

Dental Implants

Can a Maryland Bridge Attach to a Dental Implant

I have two dental implants that had a natural tooth between them. Now that natural tooth needs to be removed and my dentist is recommending a Maryland Bridge. Is it possible to attach a Maryland bridge to the dental implants? I was concerned about attaching the metal to the porcelain. Have you seen this successful?

Charlie

Dear Charlie,

Illustration of a Maryland Bridge

The short answer is yes, it is possible to bond a Maryland Bridge to a dental crown. That being said, it is tricky. The ideal bond is metal against enamel, not metal against porcelain.

It would have been better if your dentist had anticipated that when you have two dental implants on either side of a natural tooth it is very likely that the tooth will eventually need to be replaced. With that foresight, he could have placed the abutments parallel to one another so that you could have changed two screw-retained crowns to a dental bridge with little trouble.

As it is unlikely that your dentist planned ahead, I would suggest your best option will be to place a third dental implant in between the two others, if there is room.

If not, then you can try the Maryland Bridge, but it will take some preparation of the crowns to make it work.

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

Emergency Dentist

Perforated Sinus with Tooth Extractions

Can you help advise me? I had ten teeth extracted by an emergency dentist. With one of the upper molars, he perforated the sinus cavity. He placed a compound in it to increase the clotting, but I can feel air flowing through it even when I am at rest. There is air blowing into my mouth and it feels quite weird. He also gave me a ten day course of antibiotics. Should I be concerned about this?

Emilio

Dear Emilio,

Man holding his jaw in pain

Usually, when a patient sees an emergency dentist they just get the patient out of pain and do the minimal procedure necessary than have you reschedule with your normal dentist. I am a little surprised that this dentist removed ten of your teeth in one appointment. While he was right to get the clotting started, he should also have closed the hole. Will it heal without that? Possibly, but it will take a long time and you are at risk for infection while you are waiting for the healing. In your place, I would see an oral surgeon to have them graft some bone there to close and heal the area.

Another issue I am concerned about is the number of teeth you’ve had removed. It is important that they are replaced as soon as possible. Otherwise, you will begin to lose your bone structure in those areas as well. Without that, you could end up with a condition known as facial collapse. I’m going to recommend that you have them replaced with dental implants because these will preserve your bone.

Sometimes we have found that patients who end up with dental emergencies have a fear of the dentist that keeps them away until they are in too much pain to avoid it anymore. I want you to know, just in case that is a situation you find yourself in that there is a solution. I’d like you to see a sedation dentist. They have medication they can give you which will allow for you to have a pain-free/anxiety-free appointment. Dentists who offer sedation are used to patients with anxiety and can help put you at ease.

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

Sedation Dentist

Twelve Shots to Get Numb?

I recently had a lower second molar extracted. The appointment was a nightmare. First, it took twelve shots for him to get me numb. How he could miss the area that many times is beyond me. Then, I had a bone spur in the area that took the dentist over thirty minutes to get. Now, I seem to have a sharp edge on the extraction site. I’ve sort of lost confidence in this dentist. Can you tell me if this is normal or if I need to have another procedure done to deal with this?

Cassidy

Dear Cassidy,

Woman holding her jaw in pain

I would find it hard to think any dentist would actually miss the spot that many times. The more likely scenario is that you had some dental anxiety going in and, as a result, your body was fighting the local anesthetic.

Unfortunately, not enough dentists currently understand the connection between dental anxiety and the inability to get numb. I am going to recommend for your next appointment where you need any work done you see a sedation dentist. Even just some nitrous oxide will help relax you, which in turn enables the anesthetic to do its work.

For those with a more severe level of anxiety, I recommend oral conscious sedation. While it is administered by a pill, it is so strong that you will need someone to drive you to and from your dental appointment as well as stay with you for a few hours afterward until you are lucid and steady on your feet again. Most people who use oral conscious sedation sleep through their appointment.

As for the bony ridge. sharp edges do show up during the healing process. You don’t notice them at first because your gums are swollen. As the swelling goes down the ridges appear. If it stays a problem, your dentist can clip it.

One thing I want to make sure your dentist addressed is the need to replace that second molar. If you leave the space open, your other teeth can drift or tip into the space, which will throw off your bite. That can lead to painful TMJ Disorder.

If you want the best tooth replacement, I’d look into a dental implant. However, you do have other options.

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

Emergency Dentist

Can’t Afford My Wisdom Tooth Extraction

I have an infected wisdom tooth. It has been bad for a while and the teeth around it are starting to get holes in them. Tonight I noticed I have pressure and a yellow streak leading up to my eye on the same side as the tooth. Now there is pressure behind my eye. I really can’t afford a dentist right now. Can I just visit the ER to get an antibiotic to treat this and then get to the dentist later when I can afford it? I’m starting to get concerned.

Brad L.

Man in pain holding his jaw

Dear Brad,

I want you to understand how serious this is. Your infection has already reached your eye. Your brain is not that far away and this can turn life threatening quickly. Believe it or not, people still die from tooth infections.

An antiobiotic will not solve your problem. What it can do is slow down the infection, but once you are out of the medication (and this is assuming they prescribe the right antibiotic for this particular infection to begin with) it will flare right back up and continue to spread.

The only way to deal with this is to have the tooth extracted…and soon. I would consider this a dental emergency.

Most dentists went into their field because they wanted to help people and make a difference. I would call around and see if there is a dentist who is willing to work with you on payments.

Whatever you do, take it seriously. The good news is a wisdom tooth does not have to be replaced. However, if you delay and the other teeth get so far decayed that they can’t be saved, you’ll also need a tooth replacement for them or your teeth will shift, throwing off your bite. This can lead to painful TMJ disorder.

Call around. There is bound to be a dentist in your area willing to help.

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

Pediatric Dentist

Adult Teeth Behind Baby Teeth

Can you help me? I am 16 years old. I’m with a new foster family who wants to help me with my dental care and we’re trying to figure out what to do. I asked my foster mom if I could research. She agreed so I thought I’d start here. I have both baby teeth and adult teeth but my adult teeth all came in behind my baby teeth. It’s been like this for a long time and it is very embarrassing. Is there a good way to fix this?

Celia

Dear Celia,

Young woman smiling

I am glad to hear you have a foster mom that is being proactive with your oral health care. I’m sorry you had to wait this long for it to happen. Had you been under the care of a good pediatric dentist this would not have happened to you. The good news is all of this is repairable.

The first thing they’ll want to do is extract all of your baby teeth. I know you had no control over this, but for the sake of parents out there reading this, I want to discuss what to do when you have adult teeth ready to erupt when the baby teeth are not coming loose.

The best thing to do in that case is to simply extract them, as I am suggesting to you. However, sometimes you have retained baby teeth when there is no adult tooth to come in. This is called a cogenitally missing tooth. In that case, there is a different plan of attack.

In that case, there are two scenarios. If it a molar or premolar. It is helpful to maintain those as long as possible and then when they finally fall out, you can replace them with a dental implant.

If they are not molars, we usually will extract the baby teeth and separate them with orthodontics in order to make the appropriate space. Then, depending on your age, you can replace it with a dental flipper (which is removable and inexpensive). Then, when your jaw is fully developed replace those with a dental implant as well.

Once Your Baby Teeth are Extracted

Now, back to your case. Once you have your baby teeth removed you will want to straighten the adult teeth. You sound like a very responsible young woman. With teens like yourself, I tend to recommend Invisalign teen. It can straighten your teeth comfortably and invisibly. It is removable so it requires patient compliance. I don’t think that will be a problem for you.

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

Emergency Dentist

Root Canal FAilure

I’m a bit worried about something. I had a root canal treatment done about 3 years ago. About a month ago it started hurting. My dentist did a retreatment. A week later the pain increased quite a bit. I called him and he prescribed an antibiotic. It started to feel a bit better but now it is worse again. I called his office again and he said to give it time, some people take longer to heal than others. I am in tremendous pain. Is he right about this? If so, how much is a reasonable amount of time to give it?

Nicole

Dear Nicole,

Something isn’t right with how your dentist is handling this. It appeared like you said that your pain went down and then started back up. This is a clear signal you still have an infected tooth.

Though root canal treatments are successful about 95% of the time, when it does fail, the chances of a re-treatment being successful go down with each successive try.

That doesn’t mean it isn’t worth trying. It is always better to save a tooth whenever possible. I would consider your situation a dental emergency. This infection will continue to spread. Dental infections can turn life-threatening because they are so close to your heart, brain, and lungs.

Because of the severity of your situation, I am going to suggest that you call a prosthodontist. These are root canal experts. Explain the situation when you call. They will likely try to get you in right away. If they can’t, make sure they call in a new, different antibiotic for you.

If it turns out the prosthodontist tells you the tooth can’t be saved, then extraction will be the only option. When that happens, you will need replace the tooth. Ideally, you’d get a dental implant for that as it will help preserve the underlying bone structure.

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

Dental Implants

Diabetes and Dental Implants

I have type 1 diabetes and need to replace a tooth. I was hoping to get a dental implant. Is that possible for me or is my condiation a contra-indication?

Aubrey

Dear Aubrey,

Diabetes is not a contraindication for dental implants, but you do need to be aware that it is a risk factor. A significant one. You will need careful diagnostics ahead of time. Don’t skimp on them. Make sure you get a CT scan.

You will also want a dentist who has done a LOT of dental implants successfully. Ask how many dental implant procedures they’ve done and what their percentage of successful cases is. It shouldn’t be less than 98%.

Ideally, the dentist will do the surgery and the placement. However, if they refer you to an oral surgeon, make certain your dentist makes the decisions about the placement and there is close coordination between the two of them.

Cosmetic Considerations

You did not mention where the implant was being placed. If it is on a visible part of your smile, you will want to think long term. If you are considering teeth whitening, you will want to do it before you get the porcelain crown that will go on the implant.

This is because, while the color of the crown can be made any color, the color is permanent. If you whiten later, your natural teeth will brighten, but the crown will remain the same color. If you want it to match your teeth, you will have to replace it. Getting the whitening done ahead of time means you will save money.

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