Q: Dr. Crapo: At fifty-two I’ve gone as long as I can without seeing a dentist. I’ve lost a few teeth to looseness and the rest are wobbly. My wife has urged me to see a dentist for years but I’ve put it off. Now I’ve got some swelling around several teeth, which feel like they’re going to fall out by themselves. So, three weeks ago I saw a dentist who told me I’d have to have the teeth out and get dentures. He asked if I smoked and of course I am a smoker since age twelve. He said I had to quit or I’d have big problems healing, I’d lose all my bone, the dentures would get loose and I’d be on soup for the rest of my life. He was pretty brutal in his assessment. I thought I would get some implants and I’d have good teeth, but he said I couldn’t have implants if I was a smoker and couldn’t recommend I get implants by his specialist friend, if I didn’t quit. I’m getting pressure from my wife and a no go from my dentist. It seems I’ve got nowhere to go. Do I have to stop smoking forever? I like smoking. I know I should quit but with the exception of my teeth I have had pretty good health. Can you suggest anything, or give me some more options? If I do get implants, will they fall out too!
A: Most people who have smoked from their youth do not have your problems. Smokers, who have a history similar to yours, can have a distinct bone loss pattern, but fewer than five percent lose all their teeth to bone and gum loss. Genetics, plaque and calculus, smoking, clenching and grinding, are the four main reasons adults lose their teeth to bone and gum loss. It seems you have the whole lot.
As to suggestions, here’s what I’ve done in similar situations. At the outset implants will be necessary or you will lose bone more quickly. So that being a fact, I’ll give you two scenarios. If you’ll stop smoking for six weeks and if you’ve got enough bone for six implants on the bottom and six implants on the top, and if the bone is strong enough, same day teeth are possible. If you continue with your non-smoking you’ll have the best chance for success. The teeth must be set so a perfect balance of function can be maintained and a bite guard system put in place.
If you can cut down on your smoking dramatically, implants can be placed, but then you must go through a thorough healing phase so that they take, to ensure there’s no bone loss. I’ve nursed a smoker through this process and only achieved success after two years! Go with the first option, all the sacrifice is worth it. I’ve got several ex-smokers who will concur.