Q: Dr. Crapo: Last week I saw my dentist after ten years
absent. I came only because I was forced too. I have terrible decay! One upper front tooth is decayed, broken off and black, another is almost broken and black and two others are black and still standing. These are my front teeth; the eye teeth seem fine. When my dentist saw me, he just said there’s nothing I can do but a denture because some of your back teeth are rotten too. I smoke
and he said I had some bone loss because of it. My problem is my terrible fear
of anything done in my mouth and I can’t be in small spaces of any kind. Just
sitting in his dental chair made me feel smothered. I almost bolted before he
got to me. I work in the public and though I’m in my sixties, I don’t see
retirement anytime in the future. I need my teeth and I need help to get
control of my fears – do you think you can help me?
A: Yours is a particular challenge. Your fear and claustrophobia can be taken care of with a combination of oral and I.V. sedation. Knowing this, the next is to decide if you are devoted to smoking or not. Some folks love to smoke and they are not going to change. If that’s the
case it’s important you confront that with your dentist. Placing implants or
bone grafting in smokers is not predictable and failure is very real. If
implants are out and you must save your teeth, there are some older techniques
that may work for you. You’ll need to find someone who is comfortable doing
root canals, surgery and bridgework, all at the same appointment.
Roots of teeth that are the only remaining remnant of your teeth or in cases where
the teeth cannot be used in a bridge, may be root canaled and then submerged
below the gum. This will preserve the bone that would otherwise be readsorbed by
the body after extraction (faster in smokers).
Because you’ve shown aggressive decay and because you’ve neglected your teeth out of
fear, I would suggest that before a final bridge is constructed, small metal or
porcelain thimbles be placed over your anchor teeth to help prevent future
decay. Covering the anchor tooth with a very thin layer of metal or porcelain
constructed to fit your anchor tooth stumps, will prevent decay in the event
that the bridge comes loose on one or more of the anchor teeth.
When a bridge gets loose on one of its many anchor teeth, leakage can cause failure
of the bridge by way of new decay.