Wrestling With Difficult Issues

Q: Dr. Crapo: My mother had a trauma to the head fifteen years ago. Since then her speech has deteriorated to a state that she only can make a grunting sounds when she needs to communicate and then point to make herself understood. She understands everything we say, so we feel grateful for that. The problem is her teeth.

She only has two teeth remaining on top and the remaining nine or ten teeth on the lower are decayed off at the gums. She also now complains of pain in the lower teeth, especially on her right side where there is one tooth left standing. We have taken her to several dentists.

She’s difficult because she’s in pain, so she needs sedation for any cleaning or inspection. She can’t chew her food, so we’re at a loss of how to help her. One of the dentists suggested the remaining teeth be removed and dentures put in.

He did say that at her age – she’s eighty, getting used to dentures will be a challenge. I’m not sure what her tolerance for chewing with false teeth will be like, so we’re very unsure of what to do. She tolerates sedation well, though it’s a bit of a wrestle job to get the line in and going. As her family we want to help her but we just don’t know how to go about it.

A: This is a real challenge! Cooperation is paramount to helping her. If it’s a “wrestle” to get the I.V. started, struggling with a patient is not the way to go, even if you’ve been successful.

Oral sedation would be a way to start, so she’s not resistant to the efforts of those administering the I.V. sedation. If she does well with the sedation, the surgery can be accomplished but when lower teeth are decayed to the gumline, the teeth may have to be removed with more complex surgery. Post operatively there is more swelling so the lower denture is unlikely to fit at all.

People in their senior years adapt more slowly to dentures and if she can’t express herself, fitting a lower denture under a sedation may never produce quality results.

The best solution is to fix the lower teeth with implants – then there will be no concern with movement, sore spots so common with a new denture and the awkwardness of chewing. The most important part of the transition is ease at acclimating (getting used to) to the new teeth. Whereas the denture is nigh impossible – the fixed-to-implants-bridge is almost instantaneous. Once the gums have healed, normal eating (with the exception of hard, chewy or sticky foods for 4-6 weeks) is as easy and efficient as natural teeth.

Adults with dental disasters as you’re describing, are attracted to this solution over all others.

If we can help, we’d like to. Call 778-410-2080 for a consultation or visit us today.

Based on actual patient cases

© Calvin Ross Crapo

Victoria Implant Centre 778-410-2080

www.VictoriaImplantCentre.com

Out of the Deep

Q: Dr. Crapo: I’m a hard working forty year old who owns his own construction business. I’ve been in construction since I was a teenager. When I’m not working and planning, I’m into strenuous sports, biking, hiking and working out etc. Three years ago I saw a dentist and after looking at me he said, “Do you know what you’re doing to your front teeth?” “No” I said. “Have you been sick and throwing up a lot?” he asked. “No” I said. “Well something is eating the inside of your teeth, like acid” he said. Over time he discovered I had a very deep overbite and in all my intense lifestyle activities, I was grinding right through the back enamel of my front teeth, leaving half the thickness of my front teeth. He decided to send me to an orthodontist to see if my deep overbite could be corrected. I went through braces for two years and it’s much better but my overbite is still significant. Yesterday I saw a different dentist who picked up on my history quite quickly and said I was still grinding through my teeth – in fact he thought I might be bulimic – no chance. He said bulimics throw-up and the thick mucus from the stomach is very acidic. He said the person then scrapes their tongue loaded with acidic stomach mucus against the back of their front teeth and that’s what eats their enamel and tooth away – not my problem. But my problem is I’m still wearing my teeth away. Can my overbite be made less and how can I get back my front teeth thickness? He was quite concerned and said if the teeth were protected with crowns I might have to get root canals first. That, I don’t want. Where do I go from here?

A: You have several choices to address the wear. If you are not prepared to treat the situation definitively, managing the situation entails a bite splint system that prevents wear. At first you will need to wear the splint (bite-guard) frequently during the day, as well as at night. Wearing the splint during the day helps you realize when you grind or clench. It helps you educate the conscious mind to not grind. If you clench during strenuous activity you will need to wear it during that activity. This type of management will help you when you treat the teeth definitively.

Your deep overbite can be made less through careful analysis and then “opening the bite”. It’s like placing a modest shim or spacer on your back teeth so that the front teeth come apart. The space gained not only decreases the front overbite but also restores your teeth to their original thickness. New materials are harder and wear better than your own teeth and are very natural looking.

If we can help, we’d like to. Call 778-410-2080 for a consultation or visit us today.

Based on actual patient cases

 Calvin Ross Crapo

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