How Far Should I Go?
Question: Dear Dr. Crapo: I’m a sixty-seven year old woman. In the past fifteen years, I’ve suffered with a very shaky case of Parkinson’s disease. I cannot control, with any degree, the movement of my hands. Brushing my teeth is a sloppy mess every day, and flossing – well forget about it. Six months ago I was in a motor vehicle accident in which I suffered two broken teeth. They had received a lot of work, root canals I think, and crowns. I really haven’t been able to deal with them in the past six months because of the trauma of the accident. In that time I have wondered what to do. My two front teeth seem okay, but it’s the ones beside them that broke off. After some thought, I’ve decided I want my four front teeth taken out and implants put in because my two front teeth have had a lot of work and with my not being able to floss, I know they’ll go too. I thought I’d get the whole problem solved so I’d have something strong and wouldn’t have to worry about decay. Would you do that for me and what do you think, given my inability to floss and take good care of my teeth?
Answer: It sounds as if you’ve really thought this through. The answer to can it be done, is yes. Should it be done given you’re dexterity challenges, may be yes too. Certainly replacing the broken lateral incisors (teeth beside your front teeth) seems straight forward enough. Taking out your centrals and replacing them with implants and crowns should be considered with x-ray information as well as the general decay in your mouth. Every day I see people who don’t eat refined carbohydrates, with a good deal of plaque and no decay, and only slight inflammation in their gum tissues. If you fall into that camp, a careful discussion should take place before removing your front teeth as you’ve indicated. How this proceeds needs careful weighing as well. If there is absolutely no disease around the roots of the teeth and if you’re replacing two or four, the implants can be placed at the same day as the extractions provided you have a low lip line. That means you don’t show gum like a neighing horse when you smile. Immediately placed implants in the upper anterior of your mouth will show darkness through the gum.
If there is disease around the roots, bone grafting may have to be done first. Loading the implants, meaning putting teeth on them, should wait 4-6 months, so you would have to wear a removable partial denture not to look toothless. As you can see there are a number of things to discuss before you proceed and I’ve only mentioned a few.
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