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The risk factors that increase the chance of developing Periodontal Disease (PD) are many. Some of the major ones are:
**Genetics – Some people have a greater genetic predisposition to developing a more aggressive, severe type of Periodontal Disease. People with a family history of tooth loss and dentures should be diligent in their efforts to control PD.
**Tobacco – People that chew or smoke tobacco have a greater chance to develop PD, and the effects are usually greater – deeper gum pockets due to increased amounts of plaque and tartar; more loss of bone and soft tissue that support the teeth.
**Medical Conditions – Systemic (the whole body) diseases such as diabetes, cancer, HIV, blood cell disorders, and AIDS, and the treatment for some of these, can lower one’s resistance to infections, making PD more severe.
**Stress – Stress reduces the body’s natural defenses, including the ability to fight off infection. Thus, when under stress, you have an increased chance of developing PD.
**Medications – An increasing number of drugs (antidepressants, steroids, blood pressure drugs, cancer therapy drugs, some heart medications, some anti-epilepsy drugs) can decrease the saliva flow creating a drier mouth than normal. Saliva has a cleansing and protective effect on the gums and teeth. A lack of saliva allows plaque to accumulate on the teeth and gums and cause inflammation and decay.
**Hormonal Changes in Females – Puberty, pregnancy and oral contraceptives change the body’s hormone levels. These changes cause the gums to become hypersensitive to the slightest levels of plaque and tartar.
**Ill-fitting Dentistry – Old fillings, crowns, and bridges may harbor more plaque and increase the liklihood of developing periodontal disease.
**Crowded Teeth – The tongue rubbing on the back side of the teeth, and the cheeks and lips rubbing on the front side of the teeth, have a self-cleansing effect on the teeth. When the teeth are crowded and overlapped, this self-cleansing doesn’t happen very well, and there is an increased chance of decay and gum problems due to plaque retention.
**Insurance Dependency – People that count on their insurance for all the answers are often the patients with the most problems – gum problems, decay problems, and missing teeth problems. The insurance companies write the rule on whether they will have to pay out some of your premium dollars to help get you healthier. If you need to have your teeth cleaned 4 times a year and your insurance only pays for 2 times a year, it does NOT mean you can only get your teeth cleaned twice a year. DON’T be insurance dependent. In today’s market you want to maximize your insurance. But, insurance allowance is a help in covering some of the cost of treatment, not a pay-all.
Dental Implants
Dental Implants are now a predictable way to replace a missing tooth or missing teeth. Dental implants have moved from the exotic to the mainstream practice of dentistry.
Dental implants provide an excellent way to replace a missing tooth without compromising the adjacent teeth or to convert traditional removable partial or complete dentures into stable, implant supported partial or complete dentures.
Dental implants are man-made artificial roots (usually titanium) that are surgically placed in the upper or lower jaw bone and allowed to heal for three to six months. We then place the tooth portion (abutment) over the top of the dental implant(s) and create a crown, bridge, or implant supported partial or complete denture. The crowns and bridges are cemented in place (non-removable), while the partial or complete dentures are cemented in place (non-removable), bolted in place (removable by dental implant office) or are snapped over the dental implants (removable by patient for cleaning purposes).
Benefits of Dental Implants
1. Implants will not decay or abscess, and are less likely to fracture, and will resist perio-like disease better than teeth.
2. You can replace one or more teeth without affecting the adjacent teeth.
3. A single tooth implant has better than 97% success rate at 10 years. Whereas, a three unit bridge to replace a missing tooth has a mean life span of 50% survival at 10 years. Decay to one or more of the support teeth are the most common cause of failure, while 15% of these teeth will require root canals.
4. Dental implants stimulate the bone to maintain its volume and density. The presence of teeth also provides this stimulation. With teeth missing, a removable partial or complete denture does not stimulate and maintain bone, it accelerates bone loss!
5. Implant supported dentures have a level of function close to that of a full complement of teeth. Traditional dentures have about a 60% function of natural teeth.
6. Implant supported dentures. Like teeth, stimulate and maintain bone to keep its volume and dimension resulting in no facial esthetic change. Traditional dentures, by comparison, cause the bone to resorb (dissolve away) leading to irreversible facial esthetic changes.
7. Implant supported dentures have no soft tissue contact and thus improved oral comfort. Traditional dentures, by comparison, rest on the soft tissue, causing the tissue to thin and the salivary flow to decrease, leading to unstable or unretentive dentures.
Implants Are Not Teeth
Most dentists have not completed a structured, supervised program specific for implant restorations. I have completed such a program with the Misch International Implant Institute, and have received my Fellowship in Implant Dentistry with the International Congress of Oral Implantologists (something fewer that 5% of the dentists worldwide have accomplished). Implants are not teeth and should not be treated as such. Implant restorations (crowns, bridges, and dentures) are not the same as crowns and bridges on teeth and traditional dentures. The treatment plan, the fabrication of restorations, the occlusion, the maintenance, and the treatment of complications (screw loosening, crestal bone loss, prosthesis fracture, or implant failure) are unique to implant dentistry.
Call today for a no-charge implant dentistry consultation with me at 858-454-3221.
An Implant Smile
Lately, we’ve been discussing dental implants. We recently finished a beautiful smile on a patient that came to us about five or six months ago. She was missing her four upper front teeth, but they were replaced with an implant supported fixed bridge that was ten or twelve years old. In her mid sixties, her teeth, her implant bridge, and her other crowns were that “natural” yellow that dentists liked to do in years gone by. She came to us because she found our website on the internet (www.lajolladental.com) and discovered we restore implants and perform cosmetic dentistry.
We used the existing implants and created a new framework with nice white more-modern looking porcelain. We fabricated porcelain veneers on her cuspids and replaced the yellow crowns on her cuspids with white all porcelain crowns. She looks more youthful with a rejuvenated smile. She didn’t have to do this, but she wanted to do it, and she can’t stop smiling.
The American Academy of Implant Dentistry
I spent part of last week and weekend at the annual meeting of the American Academy of Implant Dentistry (AAID), at the Manchester Grand Hyatt in downtown San Diego. It was a great gathering of international dentists, surgeons, and team members. We were treated to some outstanding lectures by world class clinicians, as well as panel discussions with some of these same people. There were also live surgeries broadcast from remote sites for all of us to experience in living color on screens about 20 feet high.
Between lectures there was a large ballroom full of manufacturers showing their different instruments, supplies, and equipment. We could touch and feel and have the reps tell us about all the various items they had to offer. And, of course, there were the social events. Wednesday night was the cocktail party where we got loosened up and had a chance to get to know each other. I was able to reconnect with some friends from other parts of the country that I know from other dental courses. Saturday evening was the grand banquet for all of us to get dressed up. It was a delightful event with all its pomp and circumstance.
All in all, the AAID put on a spectacular show where all of us could learn and be educated, and reconnect with colleagues as well as make new acquaintances.
The Hygiene of Dental Implants
Implants need to be cleaned regularly at the dental office and at home. Depending on the number of implants present and their physical relationship to any existing teeth will indicate what you do at home for cleaning
A single tooth implant with a crown placed among an otherwise full set of teeth should be treated as you do your teeth – floss, brush, and rubbertip. If the space at the gumline adjacent to the tooth on either side of the implant is large compared to the other gumline spaces, use a small proxabrush, stimudent, superfloss (a furry floss), or waterpik. An implant supported bridge with two or three implants supporting crowns attached together should be cleaned the same way.
For an implant supported removable denture, remove the denture and clean it and brush the implants thoroughly. There should be six to eight implants, so they are not so close together you can floss. Even wiping them well with a tissue or washcloth will help.
For those folks with implant supported dentures that are not removable, a waterpik is particularly helpful.
At the dental office, the implants are cleaned with special instruments. If there is a removable denture, we inspect the denture, the fittings inside the denture, and the implants themselves. If anything is loose, we tighten them up and clean both the implants and the denture. For those patients with bridges or dentures that are screwed into place, at least once a year we unscrew the appliance and clean it and the implant components. We can also check the tissue under the appliance.
Implants are unique unto themselves. How they are treated by you and by us is crucial to the long term success of both the implant and the implant supported restoration.
