The Tooth about Dental Implants

If you're missing a tooth and have been to a dentist recently. Chances are your dentist will have recommended having a dental implant. Theres a lot to say about implants but I'll go over the basics that will allow you to make the right decision for you.

DOES GETTING AN IMPLANT HURT? No. The implant placement procedure is about as painful as getting a filling. Very little pressure or sensations. Just lots of water and noises. Sit back and watch a movie. You will be sore after you go home so read my post on extraction to get some tips to help!

WHAT IS A DENTAL IMPLANT: A dental implant an artificial tooth made to be placed in the original spot of a missing tooth. It is made out of 3 pieces:

1. The replacement root or "Fixture". This is the part that involves surgery. After an old tooth is removed. The hole that it leaves is filled in with bone by your body. In order to put a new root in the spot, that bone needs to be removed to make space. The "fixture" is made out of titanium because that is the strongest material that the body does not reject. Most other prostheses in other parts of the body are also made from titanium.

2. The replacement tooth head or "crown" which is the part you will see and chew on. It is very similar to a crown that you get when you get a root canal or when you broke a tooth. It is typically a gold-metal hybrid coated in porcelein but sometimes it is made in all porcelein.

3. The abutment is the piece that connects the pieces 1 and 2. It is hand screwed into the implant. This is the piece that tends to get loose after several years of use. If you find that your implant is loose and moving, this is typically where the problem is. Its not a big problem, the dentist just needs to cut a whole through the crown to find the screw, tighten it with a wrench, and fill the whole. This usually does not have any pain associated with it.

WHY SHOULD I CHOOSE A DENTAL IMPLANT? To answer this question you basically have to understand the drawbacks of the other options. Whenever you need to replace a tooth you have 3 main options:

1) Partial Denture:  This prosthesis is typically bulky. It has clasps to hold onto other teeth and fake teeth to replace your missing ones. Because of its size, it tends to get in the way of your tongue and other tissue. It can generate sores. It can cause your jaw bone to receed from long term stress. It will catch food underneath. Overall its not sometime I would will on any of my friends or family. Its an affordable solution and something is better than nothing, but I would rather save my money for something more comfortable.

2) Bridge:      A bridge is basically putting a crown on the two teeth adjecent to the open space and attaching a fake tooth to them effectively "bridging" the gap. The best things about this solution are a) it feels very similar to having real teeth, since you are using  other teeth to support it, you still have similar chewing and sensations, b) its fast: the dentist can have this back to you in about 2-3 weeks. Whats the problem? Well as you can see, those two adject teeth are ground down quite a bit to what they used to be; and if they were perfectly good teeth, you just ground down about half of each healthy tooth. The other reason is this is a 3 piece unit which means that if any of these pieces fail, the whole thing fails. If you get a cavity on one of these teeth, you have to do it over again. If you lose one of the teeth to periodontal disease, you have to lose the whole bridge. SO its a good solution for the short term, but long term is has problems.

3) Implant: So basically the best thing about the implant is that its a stand alone soluation. No other teeth need be damaged and it relies on no other teeth. If you take care of it, you can take it to your grave. The only real problem with the implant is that it takes time. Usually somewhere between 3-9 months of treatment time. What are the factors that make up the time difference?

- Time to heal: The implant needs time to heal and "integreate" into your body. If you started to chew on it immediately, there is a good chance that it will never form bone around the implant and it would fall out.

- Do you have enough bone? If the tooth is lost for a long time the bone with atrophy away. This means the dentist may need to add some artifical bone around the implant to support it. This requires additional healing time

- Are you in good health? The implant site heals just like any other part of your body. Having health problems like diabetes can impair healing , requiring extra healing time.

-Do you smoke? If you smoke you can cause your gums and bone to not heal during this time. The dentist will tell you not to smoke, but not to say you will definately fail the implant if you do; it just really helps if you dont.

Jeffrey Chung DDS

The Tooth about Pulling Teeth

Its been a while since I had posted I apologize, I'll keep more regular update as much as possible!

"Pulling Teeth" or dental extractions get a lot of bad press just like root canals. The term "hard like pulling teeth" makes it seem like its a long painful process. Lets delve into what goes into a dental extraction so you understand the basics shall we?

DOES IT HURT TO HAVE YOUR TEETH EXTRACTED? Lets get the most pressing question out. No you should not feel pain during the actual extraction. Just like how root canals get a bad repuation, the history of pulling teeth being painful came from a time when our anesthetics were not as good as they are today. You should be completely numb during the time of the extraction and you should always ask for more anesthetic if you feel a sharp pinch. Don't worry after the initial pinch from getting numb you should not feel a 2nd, because the gums numb a lot more easily than the tooth.

Now for the confusing part.... where you won't feel pain, you will feel a lot of PRESSURE. Anesthetic cannot remove the pushing feeling of trying loosening and finally removing tooth. I'll go into whats actually happening next.

HOW DOES A DENTIST REMOVE A TOOTH? The term "pulling" a tooth is actually very misleading because there is very little pulling of the tooth. In fact if you were to attempt to pull your own tooth -- and you literally took a pair of pliers and pulled on the tooth, you would find that it does not come out unless you bench 250. Why is this? Because a tooth is held into your jaw by tiny fiber ligiments that attach directly into the bone. So basically the tooth is glued into the bone. If you want to remove something that glued shut, you don't just grab it and yank, you'll destory it and some of it will probably still be stuck! You want to loosen up the glue until its much weaker and then tease it our gently. This is how dentists remove teeth.

The process of extracting a tooth involves two things: loosening up those fibers and expanding the jaw bone. Bone is actually a little flexible (especially the upper jaw) and by wiggling the tooth or wedging an instrument between the bone and the tooth will allow it to "give" a little. While its wedged this is where you'll feel a lot of the pressure I was referring to before.

WHY ARE SOME TEETH HARD TO PULL? Okay, so while 90% of all teeth come out without much fuss, theres still 10% of them that put up a fight. So if your dentist is taking more than just 15 minutes getting your tooth out you probably have one or more of these:

- Highly decayed tooth below the gum line: nothing to grab on to, nothing to wedge against
- Very dense and unflexible bone: particularly common in african americans and the lower jaw
- A tooth that had a root canal and highly decayed: its brittle so it tends to shatter
- Curved roots - Try getting a crow bar out of cement and you'll understand
- Long Roots - More root = more fibers

WHAT DOES THE DENTIST DO WHEN TEETH DON'T WANT TO COME OUT? Okay STOP reading if you don't like details. At this point the dentist has realized this tooth is not going to simply loosen and come out, so he has to go to plan B. Usually plan B consists of moving the gums out of the way to see better, cutting the tooth into a few pieces so hes not trying to tackle all of it at once, or removing some of the jaw bone around the tooth so he can gain some extra tooth to lean on. Bottom line is you will be a little extra sore after the procedure is done.

WHAT IF THE TOOTH DOESN'T COME OUT? Now we're into the 1% probability range. Very rarely the dentist cannot get the tooth out because its either fused into your bone of the piece is so small, but when it does happen the dentist will usually choose to leave it in. Why? Because the damage he would need to inflict to you in order to get that little piece out is much worse than everything up to that point. What will happen? Either a) the body will just pretend its a piece of bone and intergrate it into your jaw, or b) you body will just gradually push it out until it comes out on its own.

TIPS for getting a tooth pulled:

- Take Ibuprofen 600 mg 4x a day 2 days prior to treatment (if you don't have health problems taking Ibuprofen. This will decrease pain and soreness during and after the treatment.

- If you feel any pain, ALWAYS ask for more anesthesia, don't "tough it out"

- Give yourself a few days to recover just to take it easy

- Don't feel that its going to be a big deal. Most of the time its a fairly simple procedure with minimal discomfort

Jeffrey Chung DDS