Hard Decisions

Q: I’ve got missing teeth in both my upper and lower jaw. I’m seventy years old and I’ve been wearing partial dentures for many years. Recently I’ve had decay in several spots, and it seems that every time I go to the dentist, he finds more decay. I’m facing crowns now and as I look at the expense it makes me sick. I don’t want to lose my teeth but I’m afraid of spending tons of money only to have decay start again. I’m afraid of putting something foreign in my mouth like implants, even though that would stop decay. Have you got any suggestions?

A: You’re describing a dental catch-22 situation: a situation that prevents action, with serious and painful ramifications. When I’m confronted with such a crisis it’s because I don’t have enough information to make a decision that I can comfortably live with. In your case you really want to keep your own teeth but spending thousands of dollars on crowns may not do the job long term. If that’s the case, then throwing good money after bad is terribly frustrating. Crowns done well are easier to clean than your own teeth but, if you’ve got dry mouth due to prescription medications, preventing decay will be very difficult. This past month I’ve seen three individuals that have problems similar to yours with one added feature: each of them has lost a great deal of bone width in their lower jaws due to poorly fitting partial dentures. If you must continue with a partial denture after your new crowns are placed, ask your dentist if you have good bone to support it and ask him to show you on an x-ray. If there is not enough, then you need more information about implants. One of the individuals mentioned above had advanced decay, no posterior teeth, and severe bone loss created by pressure from an ill-fitting partial. She chose implants. When her new teeth are placed, all her chewing forces will be supported by her implants. Incidentally this delightful lady is your age. Yesterday as I visited with a gentleman, he discussed his catch-22 challenge in a different way. “I’m in my mid-sixties,” he said, “if I live but a few more years, I’ve got a lot of spending to do. If I live to one hundred I’ve got to be careful with my money.” My counsel to you is to get all the information you can, then spend your money wisely. Without a doubt my happiest patients are the ones that have put their money on themselves and now have a strong, balanced, comfortable bite on teeth supported with implants. Each one is thrilled with their choice of teeth that will last the rest of their lives.

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

Sedation Dentistry

Q: Dr. Crapo: I have a terrible gag reflex – so bad that I can barely get my tooth brush in my mouth. When I go to the dentist or hygienist it’s embarrassing because I almost throw up when they try to take x-rays. When the hygienist tries to clean my teeth it’s impossible – any picking farther back than my upper front teeth and I’m gagging so badly I have to move her hands away and sit up or I throw up. Several weeks ago my dentist said he could give me something to help my gagging. He said it was a pill that would make me drowsy and that would take away my gagging reflex. He called it sedation dentistry. He said it was new and really worked so I gave it a shot. Well it did make me drowsy but boy I almost threw up a lung when he got into the back of my mouth. I was drowsy no more! I was throwing things out of my mouth, sitting up and violently gagging like I’d swallowed a bag of maggots. What am I to do? He said he’d refer me to someone who did hospital dentistry where I’d go under general anesthetic but that takes months to get in and I’ve got a bad tooth now. He said he could also refer me to someone who does I.V. sedation but he doubted that would do the job any better than the pill he gave me. I need help now; can you give me some direction?

A: In the past ten or so years oral sedation for dental procedures has been monikered (named) “Sedation Dentistry” and been advertised under that name. Though a bit misleading in its claims it does help a reasonable number of people. It requires certification by the dentist administering it and done properly requires monitoring with a pulse oximeter (measuring of oxygen content in the blood, heart rate and blood pressure). A fee is attached to this service as extra monitoring by dental personnel and continual training of the dentist is required. The problems associated with oral sedatives are induction time – the degree of sedation control by the dentist, depth of sedation and duration of the sedation. This article can’t deal with these issues in any depth, only to say that I.V. sedation acts almost instantly, can be titrated (measured) to the appropriate depth of sedation necessary for each individual and maintained at that level for the entire procedure. Broader and longer dental procedures can be performed for almost 100% of patients requiring this service, (including gagging of your type). The certification necessary for this service is more rigorous and requires constant certification of the dentist and staff to deliver these services. Requirements to make this a safe modality of treatment are constantly under review by the profession’s licencing authority. A few dental offices offer this service as part of their dental care.

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