Taking Your Lumps

Question:

Dear Dr. Crapo: A year ago I decided to get my teeth capped. I had the dentist cap my six upper front teeth. I wanted to get the lower front six done too but the doc said I had some gum and bone problems, which I kind of knew because a couple of the teeth were a bit loose, but what the heck, I figured yank those and put in a bridge. Well, we decided to do just the top to start. My teeth were always a bit rectangular and flat. When the new teeth came in the doc said they looked real good and I’d like the new lighter color. He put them in and then showed me the new teeth. The color was great but they didn’t look like me. They looked rounded on the edges and there was this lump on the front up by the gums on each tooth. When I asked the doc about that, he said it was part of the natural tooth anatomy that the lab man had put in. He said in a few days you’ll get used to them and love them. When I left the office I felt like I had a fat lip. I thought maybe I’ll get used to it but I didn’t, so I went back to have him check them. After several visits I gave up – but a year later my lip still feels like it’s sticking out. What do I do? My lowers need attention and those two teeth are getting looser.

Answer:

There are times when making a transition is very difficult. After a year of feeling the same you may have to come to the realization that the dentures need replacing even though they’re only a year old. Proceed carefully by having your dentist shave the “lumps” down to mimic your natural teeth. Have him shave just the two front teeth first and have him square the sides so they look and feel more like your own teeth. If your lip feels natural, you may need to replace just those two. If you need more, have the side teeth (lateral incisors) treated in the same way. This is irreversible and will affect strength and color, but the benefit is finding exactly what feels good. That information will help the lab tech make the new crowns.

Lower front teeth that are loose may have to be removed. If you go with a bridge, make sure the extraction sockets are grafted with bone so that you prevent shrinkage of the bone. Wait three or four months so that the bridge can be constructed to the healed gum and bone level.

You might think about implants in the sockets of the extracted teeth. They will give you great service and save cutting down of other teeth for a bridge.

If we can help, we’d like to. Call 778-410-2080 for a consultation. Back to the column

“Back Breaking” Challenges

Question:

Dear Dr. Crapo: Two years ago I was in a terrible accident where my back was broken in three places. Fortunately I survived the accident with no physical impairments – it was quite miraculous. As time has gone by other problems have cropped up, the most recent being a broken eyetooth. At first, because I was dealing with other things, I just left it – a space at the upper right corner of my mouth seemed no big thing but last night the tooth began to ache. It was bad most of the night. I saw an emergency service but was told that it was a difficult type of extraction and because it was infected it might get worse if freezing was put in and an effort made to get it out.

I asked them about options and they said get it out and then see what could be done. I didn’t think about it much because I was in pain. They gave me antibiotics and thankfully the pain is gone but now what to do. My approach is to not spend a lot of money and get a flipper. My regular dentist said that would be okay but I should think about a bridge or implant. I know that is going to be expensive so now I’m stuck – what to do?

Answer:

The eyeteeth are the most important teeth in our dentition as far as mechanical guiding function is concerned. They characteristically have the largest and longest roots of all the teeth and take the greatest shear forces placed on the teeth. When necessity forces us to remove an eyetooth, important provisions must be made.

The best solution is to remove the root a-traumatically and place a large, long implant. That is the best treatment. If a bridge is contemplated it is important to graft the eyetooth socket and place a temporary bridge until healing is complete. If this is done the teeth on either side of the missing eyetooth must be very strong because these bridge supporting teeth must withstand the shear forces normally carried by the eyetooth.

It is very important that the bone be preserved, I can’t overstate that and the least expensive way of doing that is to have the root that’s left, filled with root canal filling material. This treated root will maintain the bone until you can afford an implant. A flipper (a removable tooth, friction-fitted to a pink “plate”) will serve for cosmetic purposes but know it will not provide good function and the teeth in that area may suffer damage or breakage themselves.

This information, underpinned by preserving bone, will allow you and your dentist to develop a long term plan that will produce an excellent result.

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

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