Another Dental Thread...What To Do

[dixonge]

Quote:

Originally Posted by TrvlBug Long story short, does it make sense to do the bone graft now? Why can't I wait and if I decide I absolutely have to have a tooth back there, do the bone graft at that time?

If you get the bone graft now and you need an implant later, you will get the post, then wait six months, then get the tooth (depending on the technique used)

If you don't get the bone graft now and you need an implant later, you will have the bone graft, wait six months, then get the post, then wait another six months, then get the tooth.

Also keep in mind possible changes in your dental coverage.

Additional thought - your bone graft should be cheaper while your gum is already open due to the extraction. More hassle/expense if performed later as a separate procedure.

[MichaelB]

A quick question regarding bone grafts and implants. Can a dentist determine if there is enough bone for an implant before removing the offending molar, or is that assessed only after removal?

[HadEnuff]

As a retired dentist I can tell you that the line between over-treatment and under-treatment is a fine one. Even with the best, most honorable intentions, a dentist's ability to know what the future holds for a raggedy looking tooth full of raggedy looking fillings is a guess. I've seen small innocent looking cracks turn into tooth destroying vertical fractures, and I've seen restorations I thought wouldn't last a week last for years.
I've seen the smallest of holes in teeth, barely big enough to stick the sharpest of explorer tips, turn into deep decay as I got into them, wondering to myself if I was "over-treating" just by endeavoring to undertake the most conservative of treatments.

It is definitely an issue that could lead to a loss of trust. I can't think of a dental care delivery system that would eliminate the conflict, however. The vast majority of patients are not within a practical distance of a dental school.
And don't think that there is no scenario for conflict in the dental school environment. Schools need to graduate dental students, and dental students need to do a certain number of procedures to graduate. That can lead to an influence on treatments.

[athena53]

Quote:

Originally Posted by MichaelB A quick question regarding bone grafts and implants. Can a dentist determine if there is enough bone for an implant before removing the offending molar, or is that assessed only after removal?

My oral surgeon always did a panoramic scan first and then viewed it in 3-D, rotating it at all angles, before he decided on treatment. I think that would give the surgeon an answer although, as I said, mine always used a bone graft and I was OK with that.

Another point I wanted to make: the last implant was one done when I said I wanted it handled that way- no hard sell at all. Dentist had been "watching" that tooth for a year because he saw a thickened ligament and thought it might eventually need a root canal. When I started developing pains he couldn't find anything in the X-rays and thought it might be a hairline crack in a root. He was going to go in and drill to see what was going on but the more I thought about it- if it was a crack in a root he couldn't fix it and it might need a root canal anyway...I said I'd rather just replace it with an implant. The oral surgeon reported that it WAS a cracked root. I made the right decision.

[mn54]

i am a retired dentist who teaches at a local university. when you say it is your last tooth, does that mean it is your 3rd molar, 2nd molar, 1st molar? this would make a difference in deciding if you need the implant. also realize that that opposing tooth on top will drop down, as was mentioned, and may eventually be lost. but since you do not chew with this tooth it may only be a cosmetic problem. while there are bad apples in every profession, i have a problem with old shooter saying that a dentist would recommend treatment not in the patients best interest. it is in the dentists best interest to treat their patients well to keep them as patients for the long haul. i, and all the dentists I know, would never recommend treatment that was not in the patients best interest. maybe you had a bad experience with a dentist, i don't know, but i am truly offended by this statement.
as far as Michael's question, on a regular x-ray it can sometimes be misleading to tell how much bone is there. on a cbct x-ray it is much easier to tell this information. of course if there is any infection present this must be removed which can effect how much bone is left.

[mamadogmamacat]

Very informative thread. Thanks for posting.
have not had any bone grafts or implants yet at age 58, but expect they will be in my future at some point.

I have had, over the past 47 yrs, a total of four teeth extracted. The last was over a decade ago. never once was given "the opposite tooth will drop down and there will be problems as a result" argument. My first extractions were both lower third from the back teeth, and this was done at age eleven due to severe decay. Never had a "drop down" issue as a result, in 47 years. One can see the roll over of the two teeth to the rear of each extraction, on both sides, in my x-rays. This while interesting, has never caused any problem, and one cannot see it when I look in a mirror.

On the other hand, if you for whatever reason, be it cosmetic or just for peace of mind, do think you will want implants, why not go ahead with the bone graft, if they are only a relatively small add on to the cost you are already paying.

[DeborahB]

I have had excellent care from my dentists for decades. I haven’t lost any teeth, but about ten years ago I had all my silver fillings replaced with amalgam (is that the word? Tooth colored.) it took a long time but my 25 year old fillings were getting replaced one by one. It was partially covered by insurance but I paid a lot. I haven’t had anything but cleaning done since. And my smile is prettier.

[RE2Boys]

Quote:

Originally Posted by gerntz I need a lower wisdom tooth removed shortly. Dentist says the upper needs to come out too due to the drop down effect you describe. So that part seems real to me.

Thirty years ago I had both lower wisdom teeth removed. One of the upper wisdom developed a cavity, had it removed. Still have one upper wisdom tooth remaining and solid.

[Turbo29]

Eleven years ago I had an upper wisdom tooth removed. Six years after that the dentist that did the extraction sold the practice. New dentist told my, "You'll probably be able to keep all your teeth for life." Five years in and he decided to partner with an oral surgeon who would use his clinic on Saturdays to remove wisdom teeth. All of the sudden, my remaining three wisdom teeth had to come out. He bugged me every six months, when I said "no", he would get a disgusted look on his face.


Finally he sold the practice and retired. New dentist has seen me twice now and hasn't mentioned my wisdom teeth once.



This is why people don't trust dentists. (Won't go into the dentist that told me 44 years ago at the age of 19 that I had 8 rotten teeth that had to come out. Currently, at the age of 63, I have a grand total of 4 fillings.)

[mamadogmamacat]

I wonder if we were as removed from the actual cost of dental care as we are with other types of health care, and did not have to pay for it on our own because either we do not have dental insurance or we quickly reach our plan limits, would everyone have all shiny new implants by the age of thirty, needed or not?

Just a stray odd thought as I wait for the bag of subq fluids to warm up so I can infuse my cat.

Now don't go asking the cat what she would think if vet care was as highly subsidized as human health care

[N02L84ER]

Quote:

Originally Posted by Z3Dreamer Second complaint is that there is a massive gap between the crown which is installed on top of the implant and the gums. After every meal, large amounts of food are stuck in this food trap. Current dentist says there is nothing that can be done. I have to carry dental brushes everywhere I go. Does anyone else have this?

I have an implant and used to get lots of food stuck between my teeth. Flossing never seemed to get it all out and my gums were invariably inflamed. Now that I am retired, I use a water pik every day after my two main meals. The amount of debris removed is a lot less now after 7 years of retirement and my gums are probably in the best shape they have been in 40 years. I also got a traveling water pik so I can use it on when away from home.

[Richard4444]

Third retired dentist reporting in.

I concur with HadEnuff and mn54 as well.
- I would rather be treated by an experienced dentist with a good 'gut feel' for what needs to be done. Experience goes much farther than being treated at a dental school with many well intentioned conflicting opinions and the desire to perform the latest techniques.
- I lost my last upper molar (#2 - the one in front of the wisdom tooth) about 10 years ago and chose to not replace it with an implant. Had this been a lower tooth, I would have had the implant as the opposing upper tooth has a much greater tendency to drift down and cause other problems. The lower opposing tooth doesn't drift up, but might tilt a small bit and in 10 years mine hasn't moved at all.

Rich

[athena53]

Quote:

Originally Posted by mamadogmamacat I wonder if we were as removed from the actual cost of dental care as we are with other types of health care, and did not have to pay for it on our own because either we do not have dental insurance or we quickly reach our plan limits, would everyone have all shiny new implants by the age of thirty, needed or not?

I agree. I get FB ads on "Affordable Dental Plans for Seniors" and they're always followed by a ton of comments lamenting the lack of dental coverage in Medicare (except a few Medicare Advantage Plans). Most of the comments say that dental care should be "free" to seniors. I guarantee that there would be a lot more implants if there were no out-of-pocket cost!

I'm grateful that I can choose an implant when it makes sense.

It also occurred to me that most people with ACA coverage have high deductibles and DO have to weigh cost decisions. The dental business is at least transparent and up-front about costs. I've never had a surprise bill from a dentist or oral surgeon.

[EarlyBirdly]

Huh...? My ACA plan has a $125.00 Deductible for a $61.00/mo premium.

I also have private dental insurance that runs me $22.00/mo.

Easy-Peasy.

[athena53]

Quote:

Originally Posted by EarlyBirdly Huh...? My ACA plan has a $125.00 Deductible for a $61.00/mo premium.

I wish. In the 4 years between ER and Medicare my premium doubled (to over $900/month in the last year for just me) with a deductible of $6K and ever-crappier networks. No subsidies.

[EarlyBirdly]

Ouch !?

[ncbill]

Quote:

Originally Posted by DeborahB I have had excellent care from my dentists for decades. I haven’t lost any teeth, but about ten years ago I had all my silver fillings replaced with amalgam (is that the word? Tooth colored.) it took a long time but my 25 year old fillings were getting replaced one by one. It was partially covered by insurance but I paid a lot. I haven’t had anything but cleaning done since. And my smile is prettier.

your amalgam (silver-colored) fillings are being replaced with composite (tooth-colored)

might want to stay away from hot drinks like coffee...I've had very bad luck with composite because of that habit...they are supposed to last 8-10 years but I've only gotten half that life.

OTOH, I have amalgam fillings that are decades old...so whenever I need a new filling I tell the dentist to use amalgam instead of composite.

I switched dentists to another dentist older & much more conservative after my previous dentist sold his practice to a couple of young turks.

the young turk to which I was assigned at that practice told me I needed a crown (which they conveniently print in their office) nearly a decade before I actually needed it.

[Walt34]

Quote:

Originally Posted by Z3Dreamer I wish to weigh in on dentists being some sort of salespeople. I found that every time I went to see this young dentist, he wanted to do something that was costly.

This is one of the reasons that we appreciate the dentist we go to here in WV. No one in that office has ever tried to "upsell" us on any product or service that was optional.

And the dentist we see flat-out said he moved here because he likes the more laid-back culture, lack of heavy traffic, and the local opportunities for hunting and fishing that he enjoys. The only downside is that getting an appointment during deer season can be problematic.

[OldShooter]

Quote:

Originally Posted by Richard4444 ... I would rather be treated by an experienced dentist with a good 'gut feel' for what needs to be done. Experience goes much farther than being treated at a dental school with many well intentioned conflicting opinions and the desire to perform the latest techniques. ...

Well, that is not my experience. Is it yours or are you just speculating?

I get treated by a student dentist who has had IIRC four years of school and a year or so in the dental clinic. He is supervised by a dental school professor, who certainly has more and better experience than most solo or small group practitioners. If necessary, I suppose the professor will call in others for opinions but I have not had anything complicated enough to warrant that. I am glad that the option is available, however. In your local dentist office it is not.

My general point is that there is no independent way to judge the necessity or the quality of the work by a private practice dentist. I have the dental school professors to provide this. I think that's a big advantage.

[TrvlBug]

OP here. Gone a few days and want to thank all for your input. Lots of questions and I'll try to remember and answer every one. I did forget to mention that one of my concerns with getting the bone graft now was infection. Extraction is tomorrow and one month from then I'll be on a cruise ship in Europe! I do not want to deal with any type of infection while out of the country.

The problem was discovered when I had slight jaw pain and went to my dentist. The back molar (#2 molar I believe; it's the one just in front of the wisdom tooth) gum area was severely infected with 9mm access. I'm still trying to wrap my head around why the hygienist didn't discover this about 6 weeks prior. Dentist said due to severity of infection and 9mm access, this has been going on for several months and didn't just happen. The infection was successfully treated, however, some sensitivity to hot still remained. Specialist was consulted who took add'l x-rays which determined the tooth was fractured. He's the one that also determined there was bone loss. I'm a wuss when it comes to dental work although it's always immediately done so was questioning the need for an implant based on the location of the tooth. I have decided to go ahead with the bone graft as it will take 3+ months before assessment can be made as to the success of the graft and then decide whether I want an implant.

Unfortunately, being retired we self insured until recently. Signed up for dental coverage, however, I'm still under the 6 month waiting period plus implants aren't covered. The crown will be.

That's it for now...am not looking forward to tomorrow and DH will be driving me!