Q: As I hit my fifties, I’m realizing I’m my own worst enemy. It seems that at every fork in the road I’ve taken what looked like the easiest and the one with the most personal fun or relief or escape.
That confession behind, I have terrible dental problems. I have always done dentistry by emergency. Yes, I hated going and I just hated spending money that wasn’t for fun, but you know a toothache is the worst so when I got one, I reluctantly trudged off to whoever could take me.
Sometimes I’d be all swollen up and need antibiotics before they could yank the tooth or root canal it. I have to say in self-defense that I didn’t get the best set of teeth to start with. They were crooked and hard to clean so I really gave up. It took too much time and reminded me of something I didn’t like about myself but couldn’t do anything about.
That brings me to today with six teeth left on top. I can’t smile. I look gross. I know I need dentures or implants so I’ve done a little investigating. I’ve seen several dentists, enough to know I can’t afford implants.
When I talk to dentists, I get several stories. One is I can have the teeth yanked and a denture put in. One said I should get the teeth out and the sockets filled up with bone so my remaining bone doesn’t dissolve away.
Another said save the teeth, have them root canaled then cut them off at the gums so the stumps that are left support the denture and the bone. I think I understand that I need to save my bone so I like the idea of doing whatever preserves it, but won’t I just get decay in the stumps that are left?
What happens then? I’ve already been told that all my teeth, all six, have decay and three are already broken off at the gum line. See, being confused is another reason I didn’t do needed treatment. I just didn’t know the best treatment. Any ideas?
A: When teeth have reached their terminal limit, the historical solution has been to have them extracted and a denture placed. When teeth are removed, the bone shrinks (it’s resorbed by the body). Over time, denture relines are required as the bone shrinks.
Bone grafting is helpful, especially a bone graft that contains bovine bone that the body accepts but doesn’t resorb. Keeping teeth as stumps under your denture is excellent (called an overdenture) but you’re right, decay can set in.
A technique not employed commonly but one that is extremely effective is to submerge the roots in the bone under the gums.
This requires the dentist be comfortable with surgical procedures. In the end, the gum heals over the submerged roots preventing the decay problem and the roots acting as natural grafts supporting the bone.