You’ve lost your tooth … Now what?

Despite your best efforts, you’ve lost one of your teeth. Maybe it left a gaping hole in your smile and you want to fix it. Maybe you can’t see the gap, but you’ve read my post on why you should replace a missing tooth and were persuaded. There are two important considerations: how to make the replacement tooth look good, and how to make it as functional as possible.

For looks, ceramic is more tooth-like than plastic (see Bondings vs. Veneers).

In terms of function: when you bite, you’re exerting about 150 pounds per square inch on your teeth. That's a lot of pressure. Fixed teeth are more stable, more efficient, and usually also more comfortable than removable teeth.

The most expensive options are not necessarily the best for everyone; your health and the state of your finances are both legitimate considerations. What are your options?

 

Implants

Today’s top-of-the-line tooth replacements are implants, which have been around for decades. In look and function, an implant is the closest you can get to having your real tooth back. It’s a ceramic tooth on top of a metal post that’s anchored in your jawbone. If we decide you’re a good candidate for an implant, you first need to visit an oral surgeon to have the post set into your jaw. After 3 to 6 months of healing, the post is firmly set. During that time, you have a temporary tooth to fill in the gap. Then you come back to my office to have an impression made for the ceramic tooth, which can be fabricated in about 10 days. The current way to do this is via computer-assisted design / computer-assisted manufacturing (CAD/CAM), which carves the tooth out of a solid block of porcelain, creating a tooth that’s precisely shaped and extremely durable.

A well-made implant will last decades. However, implants are not a good choice if you have problems with your bones or if you have a condition that makes surgery inadvisable. You should also be aware that many insurance plans do not cover implants, because implants are an expensive option that require the services of both a dentist and an oral surgeon. (See my post on insurance.)

 

Crown-and-bridge units

A “crown and bridge” is a ceramic tooth that’s permanently anchored to teeth on either side, rather than anchored into your jaw. (That’s why it’s called a “bridge”.) Depending on how many substitute teeth are between the two teeth that anchor it, it could be a 3-unit, 4-unit, or 5-unit bridge—or even more. To have a bridge made, you must have teeth on either side of the missing tooth whose roots are still solidly attached to the bone. To make one, I create a crown for the top of each anchor tooth, and then recreate the missing tooth or teeth between them. Then the whole unit gets permanently attached to the two teeth on the ends. Years back, a crown-and-bridge unit meant having silver or gold metal showing in your mouth. Today a crown and bridge can be metal free, and almost indistinguishable from your real teeth.

Like the tops of implants, the crowns and the replacement teeth are carved from porcelain blocks. On average, a well-made crown-and-bridge lasts 5 or more years. I have patients who’ve had them for more than 20 years.

You’re a good candidate for a crown and bridge if you have a condition that makes implant surgery inadvisable, or if you can’t afford implants. You’re not a good candidate if you have many teeth missing in a row, or if you don’t have teeth on either end that can serve as strong anchors for the replacement teeth.

 

Removable bridge

A removable bridge is like the crown-and-bridge described above, except that the ceramic replacement teeth aren't permanently attached to the supporting teeth on either end. Instead the rest on the gums and "hold onto" the remaining teeth. This is less expensive than a crown and bridge because it doesn’t require the making of the crowns to anchor the bridge. On the other hand, because it’s not permanently attached, a removable bridge might wobble a bit when you chew.

 

If you have general questions about dentistry that you'd like to see addressed on this blog, feel free to email me at sdurante@earthlink.net or through my website,www.DoctorDurante.com. The information on this blog is presented for general education only: consult a dentist for advice on specific problems, diagnoses and treatment.

 

"Do You Take Insurance?"

People often ask if I take insurance: a tricky question, because it can have two meanings. On the one hand, I'm happy to fill our your insurance company’s forms. In fact, I submit them on line, so that you'll be reimbursed more quickly.

On the other hand, I do not accept any insurance company’s payment as full payment for my services. For most procedures, an insurance company’s payment is well below the price that I usually charge—often barely half of the “customary and usual” fee. The provider is expected to be able to make up the difference through volume, by filling his schedule with other patients referred by the insurance company. You've probably sat for hours in the waiting room of a health-care provider who participates in insurance plans: that’s because the conscientious physician or dentist is struggling to get through a crowded schedule that often allows only a quarter- or half-hour for procedures that should take much longer.

I respect my patients and myself too much to work that way. My fees are not arbitrarily set: they depend on the time required for a procedure, its difficulty, and the materials required. I schedule enough time to do procedures properly. I constantly monitor the dental labs that I use to produce crowns, dentures, veneers, and so on, making sure they produce superior work that often fits perfectly on the first try, and that will last as long as possible. A typical insurance payment will often not even cover the price of good-quality lab work, never mind your time with me.

Can anyone but me tell the difference in quality? Apparently so, since I often see patients who have been to a dentist who participates in their insurance plan, but have come back to me for major work or to fix dental work that was poorly done. Did you know that a simple filling requires up to 15 separate steps? Skimping on any one of them can cause the filling to fail prematurely. Imagine the possibilities if your dentist rushes through the steps of a more complicated procedure—for example, making a crown or doing a root canal—because half a dozen patients are backed up in his waiting room.

So: my fees are what they are for very sound reasons, and I do not accept any insurance company’s determination of what they ought to be. I want your business on mutually acceptable terms: your satisfaction with work well done, and my full price for it. Yes, you will be responsible for whatever part of my fee your insurance company does not pay. But I will be happy to help you find out how much they allow for various procedures, and to discuss a range of treatment plans to fit your budget, so that you can make an informed decision about what you want done.

 If you have general questions about dentistry that you'd like to see addressed on this blog, feel free to email me at sdurante@earthlink.net . The information on this blog is presented for general education only: consult a dentist for advice on specific problems, diagnoses and treatment.

Why Replace a Lost Tooth?

The obvious reason to replace a lost tooth is so you can eat as efficiently as you did previously. If you lose one of your molars, you lose the chewing area between it and the corresponding molar above it: a quarter of your chewing surface. If you lose a canine, you’ll have to tear at that beef jerky with the other side of your mouth.

Besides the loss of function, there is the fact that your other teeth may shift to fill in the gap: that’s what usually happens. Of course, statistics don’t determine what will occur in your particular case, but there’s a reason for the statistics. Teeth push and lean against each other, both within the same arch and from the opposing arch (that is, your upper and lower teeth). If the lost tooth is “missed” by the adjacent teeth or opposing teeth, the teeth that remain will shift until the forces are in balance again. The results of that are unpredictable. Molars may end up not meeting the opposing molars as neatly. New gaps between teeth can become traps for food particles, leading to tooth decay and gum disease, hence to loss of more teeth.

 The most common ways to fill spaces left by missing teeth are bridges and implants. These have different maintenance requirements from your own teeth, but the amount of time you need to maintain them is small, compared to the number of times you probably use the teeth in a day. If you’re a candidate for either one, we can discuss which is best suited to you.

 If you have general questions about dentistry that you'd like to see addressed on this blog, feel free to email me at sdurante@earthlink.net. The information on this blog is presented for general education only: consult a dentist for advice on specific problems, diagnoses and treatment.

Why Get Sealants for Your Child?

When I was a kid, I loved rock candy, which is pure sugar. Sugary candy that you keep in your mouth for a long time and sugary soda that takes a while to drink are just about the worst things you can do to your teeth. Combine them with less than fanatical toothbrushing habits, and it's no surprise that by the time I was 20, I had a mouthful of silver fillings. So did most of my friends.

My daughter may very well turn 20 without a single major cavity. Part of the reason is that we don't keep candy in the house. Part of the credit goes to the sealants I put on her teeth when she was 9 years old. Sealants have been around for about 30 years and have made a tremendous difference in how many cavities kids get. They're a sort of plastic coating over the molars that takes minutes to apply, and lasts for years. The cost is roughly equal to half the cost of filling one major cavity. Best of all, getting sealants put on is a pain-free process that can save a lot of pain down the road.

Of course you should teach your child to brush and floss, but why not give them a little help while they learn to do it efficiently? I have office hours that will allow you to bring your child in without disrupting his or her school or after-school activities, or your work schedule. (Click here for hours and location.)

If you have general questions about dentistry that you'd like to see addressed on this blog, feel free to email me at sdurante@earthlink.net . The information on this blog is presented for general education only: consult a dentist for advice on specific problems, diagnoses and treatment.

Some of My Happiest Patients Are Those Who Have Had Root Canals

The words “root canal” are synonymous with pain: “I’d rather give birth than have a root canal.” Yet some of the patients who leave my office with the biggest smiles are those who’ve had a root canal.

A root canal is a last-ditch attempt to save a tooth by cleaning out infected soft tissue inside the tooth. It's done because saving your own tooth is usually more convenient and less expensive than having the tooth extracted, then replacing it (with an implant or a bridge) so your teeth stay lined up and your bite remains stable. For a long time, however, having a root canal meant a lot of drilling and a lot of pain.

In the 25 years I’ve been practicing, root canal procedures have improved greatly: better pain control, better treatment techniques, better results. When I was a teenager, watching my dentist make people pain-free was one of the things that inspired me to choose a career in dentistry. (More on this on my website.) That's why I always schedule adequate time to let the local anesthetic take effect. (You can also request nitrous oxide, if you wish.) I also use a top-notch dental lab that produces crowns that usually fit on the first try, and that match your own teeth.

Some patients who’ve been seeing insurance-approved dentists for years come back to me for root canals and other difficult procedures. When it comes to such procedures, a dentist who accepts an insurance payment as full payment is at a disadvantage: he is often forced to rush because he's seeing patients in half-hour slots, and he may have to choose a dental lab not because of the quality of its work, but because its lab fee is low enough to be covered by the insurance company’s payment. (Read more about my policy on insurance payments.) I take pride in providing my patients with the finest quality of care, which includes scheduling adequate time for procedures and using the knowledge and experience gained over 25 years in practice to make each visit as pleasant as possible. That’s why some of the happiest patients are those who have had root canals.

If you have general questions about dentistry that you'd like to see addressed on this blog, feel free to email me at sdurante@earthlink.net . The information on this blog is presented for general education only: consult a dentist for advice on specific problems, diagnoses and treatment.