Too Many Cooks Spoil the Soup?

Question:

My mom is not a complainer but recently she told me of her challenge with her upper denture not staying in. She’s hard on her teeth and is constantly fussing to keep her upper denture in. She uses some kind of denture adhesive so they don’t fall out of her mouth. Even so, she moves her mouth around and if you’re close enough, you can hear her clicking her teeth. She claims to have a disorder of sorts where she’s constantly moving her jaw, so her teeth click. Her problem, though, is that she doesn’t have enough suction for her upper denture.

Two and a half years ago she saw a specialist who took her teeth out. She then went to a denturist for her dentures. She said there were complications with the surgery, and she had to go back a number of times because, the surgeon explained, she had tooth bits or bone sticking out of her gum so the denturist couldn’t make her dentures.

That happened on several occasions and finally she was able to have dentures. Then she was referred to another specialist to put in implants for her lower denture could be secured. That made it possible for the lower to stay in but the upper still was/is a problem. It was then she found out that a lot of bone in the upper had been ground away so that now there’s no bone up there for implants.

The poor woman is having all kinds of problems trying to keep her upper in to eat with and most of the time she has to go without her teeth. How does this kind of thing happen? She had most of her teeth, albeit in poor shape, but that means she had bone, right? Can nothing be done?

Answer:

It’s hard to come into a situation without all the details. When a person gets to the point of full mouth tooth extractions, it’s extremely important to start with a very comprehensive exam and diagnosis. If your mom had teeth top and bottom, there is usually bone enough for implants at that stage. Implants should be put in at the tooth extraction appointment or very soon thereafter or bone grafting done so there’s bone enough for implants. The other reason for thorough diagnosis is that some palates are not deep enough or shaped properly to allow suction of the upper denture to stay in.

A loose lower is a problem. A loose upper is a disaster and CAN BE DIAGNOSED before any teeth are removed – the poor suction potential can be seen before any treatment.

The Solution

In cases like these, sinus grafting has been a solution for over thirty years. Creating bone in the sinus will allow implants to be placed so a fixed bridge can be made. The grafts take six months to mature. Implants at that time can be placed for the future bridge. In some cases, newer implant techniques can not only provide teeth in a day but shorten the timeframe and lower costs of treatment.

Straight from the Horse’s Mouth

Question:

I have strong teeth, well the remaining ones seem strong. They’re only in the front so when I smile it’s a horsey grin because all you can see is front teeth with gaps up top and on the bottom. They kind of look like horse teeth too. When I bite, the edges fit right together or on top of each other. That’s been the way from the beginning. I’m nearing golden age so I’ve worn the teeth down quite a bit.

My dentist has filled the edges many times but that wears down and then chips out. The long and short of it is that my teeth are failing. I was told the last time at my dentist’s that I’ve got another big abscess, though I can’t feel it other than the tooth in question feeling a bit loose, so I’m slowly losing my teeth. Can I keep the ones I’ve got and get crowns and implants? The doc said he didn’t know if I had enough bone, but I had a bone scan and there may be just enough for implants with some bone grafting. It’s not vanity, its function.

Horses nip off the grass with their front teeth then send it way back into the jaw to munch it up on big hidden molars. My horsey grin is all there is – no back teeth to do the munching. I’m getting to the age where there’s still gas in the tank but I can’t go anywhere – at least not with my front grill. So, what do I do? I can still eat I just can’t smile.

Answer:

With your self-deprecating sense of humour I don’t know if people notice your smile, but you do and that’s important. If your remaining teeth are failing badly (abscesses, breaking etc.) it might be time to replace them with implant supported teeth. This could be a one day affair – teeth in a day is a real option and is producing wonderful function and beauty for a great many people.

If you want to save and restore what you’ve got and add implants (if you have adequate bone) that may be alright but you have a bite that is not easy to reconstruct. If you have an end to end or edge to edge front tooth contact bite as your normal bite position, extreme care in crowning your remaining teeth and crowning the implants for reconstruction is a must. End to end positioned front teeth tend to wear first, then back teeth wear. Over time different rates of wear cause greater damage in isolated areas. Often it is the back teeth that sadly enough are lost. If you go this route, excellent maintenance practices will ensure its success.