• Missing teeth? Do You Know Your Options?

    by Team Loev
    on Feb 21st, 2018

Many of us remember a grandparent or great-grandparent that wore a denture. Lack of access and knowledge about dental care made this a pretty common option for older generations. While dentures are still an option and will be mentioned in our list below there are many more optimal options. We have put together a list of 5 key Dental options as composed by San Francisco Cosmetic Dr. Edward L. Loev, DMD, and his team.

Option 1: Do Nothing: Yep, we said it. Patients have the option to not replace teeth that fall out or are removed. This isn’t the ideal option both from an aesthetic, functional or overall health option but it is an option. If a tooth is missing for a prolonged period of time, other teeth that are adjacent to or opposite from it (think top to bottom) may shift and change the bite. If an upper tooth, for example, doesn’t have another tooth to rest against it can continue to grow down creating a “vampire fang,” conversely a lower tooth can do the same thing causing what Dr. Loev, lovingly calls a “bulldog bite.” Neither option is ideal functionally or for most considered very attractive. In addition, when a tooth is missing it often makes other teeth work harder to compensate for the missing tooth. People either start chewing on the other side or shift their bite so that teeth make contact when they wouldn’t otherwise.

Another drawback of doing nothing is that our jaw bone is made of a bone that reacts to stress and activity. Without pressure on it, one runs the risk of losing bone density which can not only lead to additional bone loss but also to a change of structure in ones face. Most of us remember seeing old fairytale pictures of witches and old ladies with curled up lips and sucked in cheeks. Our teeth and bone support our skin and face, without it we appear more wrinkled, drawn and saggy. In addition to the esthetic impacts of not replacing a tooth, doing nothing can compromise one’s ability to effectively use that side of the mouth for chewing. Loss of bone can make replacing a missing tooth at a later date much more difficult or even impossible as bone is required to hold both a denture and a dental implant.

I guess if one looks on the positive side, not replacing a missing tooth means fewer teeth to keep clean and more space around remaining teeth to use floss.

Option 2: Traditional Bridgework: A dental bridge was the best dental treatment for replacing teeth for many years and they are still a fine option in many instances. Bridges work by doing just as their name implies bridging a gap. A support, generally a tooth on either side of the gap is prepared to hold an abutment( a crown that supports a fake tooth) crown. In between abutment crowns is a fake tooth or a pontic as it is called in dentistry. While bridges are still a strong, long-lasting treatment option they are not great in all situations and they have some drawbacks. Positives first: 1) Bridges can be placed immediately after a tooth is lost or removed eliminating essentially any time without a tooth. 2) Dental bridges can usually be completed very quickly without healing time in about 2 visits over the course of a week or two. Negatives: 1) Dental bridges generally require the removal of tooth structure on teeth on either side of the missing teeth. If the teeth on either side of the gap need treatment or if they already have old crowns or fillings that can use update it’s no big deal but. If the supporting teeth are healthy and would otherwise require no treatment it is a shame to cut down healthy tooth structure just to support a single prosthetic tooth. 2) Because all of the teeth in a bridge are connected if one tooth in the bridge is compromised then all teeth in the bridge will need to be addressed/treated at a much higher ultimate expense. 3) It can be difficult to floss under and around a bridge. Often time special tools and devices such as floss-threaders or water-piks are suggested by dentists to keep the areas under and around the bridge area clean. 4) 2 teeth are often required to carry the load otherwise taken on by 3 teeth. Most bridges are supported under the porcelain by a metal-framework to help support and distribute the additional load but in this case, we figure that ultimately 3 teeth are probably better than just 2.

Option 3: Denture:  Dentures come in many different materials and formats. Full dentures, for example, can be made of heavy plastic resin or of metal with porcelain and rubber on top of the framework. Full dentures can replace an entire arch or missing teeth and are usually either held in place with adhesive or suction. Partial dentures like full dentures can be made using plastic or a plastic/metal hybrids but replace only a few teeth rather than an entire arch full of teeth. A lot has changed since President Washington and his famous denture but a lot still remains from hundreds of years ago. Dentures, for the most part, are removable, so one must contend with possible loss or breakage every time they are removed. In addition, caution must be used when eating with them as they can break, fall out, or trap food. Full dentures and some partial dentures cover one's pallet which can impair one’s ability to taste food. Overtime full dentures need to be relined with a soft material to reduce discomfort on pallet and gum tissue. Dentures come in many forms and while they certainly have their place as a solution for some individuals for certain periods of time; they like the “do nothing” option do not stimulate the bone in the jaw and may over time lead to bone loss.

Option 4: Snap-on smile/ Resin bridge: Snap-on smile is a brand name for an esthetic smile solution. Like a resin bridge, it is made of specialized plastic that can be used to simulate teeth and gums. It can be a quick fix for a special event or photos but while the ads often say that it can be left in when eating most dentist will agree that it isn’t strong enough to be used long term that way. Like the snap-on smile, a resin bridge has a place as a short-term solution but since the human jaw is one of the most powerful muscles in our body resin which a type of plastic just isn’t strong enough in most cases to be a long-term solution. In addition, resin composite is porous and can easily stain over time.

Option 5: ClearChoice Implants and Dental Implants: Clear-choice implants are just implants. “Many patients come into my office asking for Clear-choice implants,” says San Francisco Dentist Dr. Loev. “Clear-Choice is a company that has a done a very good job of marketing its dental implant centers, it is not a specific type of implant.” Dental implants are surgically placed artificial tooth roots that allow a dentist to restore missing teeth without having to treat surrounding teeth. In addition to allowing dentists to replace just 1 tooth, they can be grouped to act as a permanent base for full pallet-less dentures, bridges, and crowns. They allow for a long-term solution to tooth loss. They can often provide the benefits of the aforementioned treatment options without the drawbacks. Dental implants look and feel like natural teeth and can often last a lifetime, second only to natural teeth. Technological advances in both material and the art of placement/restoration of dental implants has made implants a favorite of both dentist and patients. However, like the other options, we reviewed they have pros and cons as well. Pros: 1) Can usually last a lifetime 2) Provide stimulation of jaw bone to prevent bone loss and “fairytale witch face.”3) They allow for replacement of a single tooth without impacting adjacent teeth 4) Dental Implants can allow for full arch tooth replacement while still allowing for easy cleaning and flossing between teeth and while not impairing food enjoyment. 4) Cons.: 1) Dental implants can be expensive 2) Once implant is placed, full healing and bone integration can take from a few months to over a year 3) Works best when placed in healthy, infection-free, dense bone 4) Because implants don’t need to involve other teeth, if adjacent teeth need dental treatment it will be a separate process. 5) Some general dentists have begun to place the surgical portion of the dental implant but most of the time either an oral surgeon or periodontist will do the surgery. All this means is that you will have one more healthcare provider in your telephone book.

Now that we have reviewed some tooth replacement treatment options, it is important to think about what is important to you. Talk to your dentist and find out what they think is the best solution for you. They can help guide you toward a solution that best meets your dental needs. Cost is often a consideration for many patients but don’t just look at a short-term cost comparison. Evaluate the long-term cost of a treatment and in some cases the long-term maintenance cost of treatments. “My team and I want patients to choose the best option for them regardless of cost. In my office, we offer a number of extended and interest-free payment options to make it easier for our patients to weigh pros and cons of treatment rather than just cost. In addition, we try and guide them in getting the most out of any available dental insurance or flexible spending accounts so that the can maximize the benefits that many of them are fortunate enough to have.” Says Dr. Loev

Ask questions and do your research before you make any treatment decision. Many dentists offer complimentary consultations. If you are aren’t getting the answers that you want reach out to another dentist and see what they have to say.

Cosmetic Dentist Dr. Edward L. Loev, DMD has been practicing dentistry in his Downtown San Francisco dental office for over 4 decades. He has surrounded himself with an amazing team of individuals who are committed to patient care and service. Call them today at 415-392-2072 to set-up a complimentary cosmetic consultation or even just a new patient visit if you are in need/want of a new dentist.

Author Team Loev Team Loev is comprised of highly dedicated professionals who along with San Francisco Cosmetic, Restorative and Implant Dentist Dr. Edward Loev are committed to educating and hopefully entertaining in-person and virtual patients and making their lives a bit healthier and brighter

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