You DO Have Enough Bone for an Implant

It happened again. A patient comes into my office and says that she was told that she doesn’t have enough bone for a dental implant. There may have been a reason to say that 20 years ago. But now?

There are two major advances which make a lack of bone a thing of the past: 1. The method of x-ray diagnosis and 2. The graft materials to help you to replace missing bone.

Let’s look at the x-ray first. The traditional x-ray views your mouth in two dimensions. It can see height and width. It can’t see thickness, the most important third dimension. The way we see that third dimension is with a CT-Scan. Yes, there are dental CT-Scans, made specifically to determine bone availability for dental implants. There are several dental CT-Scans in dental offices throughout Brevard County. There’s even a mobile dental CT-Scan van that will go to dental offices that are without that technology. And what is really great is that dental CT-Scans produce only about 2% of the radiation of a medical CT-Scan. CT-Scans give us a complete surgical view of your bone before we do the surgery. I can’t tell you how often I find good dental implant-supporting bone in a CT-Scan that I am unable to see in traditional dental x-rays.

What’s even better is that we can do your dental implant surgery first on the computer, and design a template from that virtual surgery that we place In your mouth, making your actual surgical procedure easier and faster.

While dental implants have made improvements since the basic design was introduced in 1982, the monumental improvement that has occurred is in the materials available to graft bone. There are dental bone powders that are used to fill extraction sites to prevent bone shrinkage. There is bone putty that we place on your existing bone to increase its thickness. There are blocks, and wafers, and sponges all designed for the same function, to restore missing bone. There are methods to harness the growth factors from your blood to increase the speed of bone healing. And there are liquid grafts that recruit your own stem cells from surrounding tissue to produce new bone as well as grafts that have “built-in” stem cells.

So whether your sinus is too low or your bone has diminished, or you’ve been told that you don’t have enough bone, there are answers for you.

No bone? Get a dental CT-Scan. Once the diagnosis has been made, the answers are simpler and more predictable than ever before.

Dr. Lee Sheldon practices dental implant and periodontal therapy in Melbourne. He is an associate clinical professor at the University of Florida. Dr. Sheldon is a featured guest on “The Elder Hour” on WMEL radio and “Aging with Dignity” on WBCC television.

Don’t De-liver-ate

Can your liver deliver? When was the last time you saw an ad that emphasized your liver? We don’t even serve liver and onions any more. Your poor, ignored liver. It sits there as the ultimate filter for the bad things we eat, it makes cholesterol, it stores some vitamins, produces substances that break down fats, and converts blood glucose into glycogen so that it can store carbohydrates that we eat, and it converts sugar into triglycerides. It’s that sugar to triglyceride conversion that we’re going to concentrate on. Because it is what is causing us to be FAT.

“Right,” you say sarcastically. “I never heard that. I’m on a low-fat diet, I use fat-blockers, I buy low-fat eggs, ice cream, yogurt, cakes, cookies, pies, etc., etc.” Boy, have we been sold a bill of goods. Now do you really think that something that is called “low fat” really creates low fat? We’re buying a lot of “low fat” products. And I hear that the scale near the doorway of Publix is calling for reinforcements.

So here’s what happens when you eat “low-fat.” Unless you’re eating cardboard, (even rice cakes are high in sugar) you’re eating high sugar. I know. They don’t tell you that. They also don’t tell you that a review of 21 studies found no clear link between the consumption of saturated fat (found in meat and dairy products) and a higher risk of developing heart disease or stroke. (Am J Clin Nutr 10;91:535-546) They don’t tell us a lot of things.

High levels of refined carbohydrates causes our blood sugar to be elevated. And when that occurs, the liver works to convert that sugar into something that it can store. It can’t store carbohydrates to much of a degree. So if we eat a lot of carbs, insulin is produced by the pancreas and attaches itself to the sugar and moves it to the liver. The liver converts that sugar into triglycerides, a component of fat. As you know, we have an unlimited capacity to store fat.

The liver does more with triglycerides. It turns them into something called VLDL’s, very low density lipoproteins. You’ve heard of LDL’s, the bad cholesterol? VLDL’s are worse. They produce the most dangerous lipoproteins which then result in inflammation and plaques in your arteries. They deplete the body of HDL’s, the good cholesterol. By the way, HDL 2B is the most beneficial cholesterol.

A complete blood test panel of factors is available from your doctor. It comprises much more than the old total cholesterol, and HDL/LDL ratio.
What’s neat is that you can lower your triglycerides, and thus your risk of heart disease and stroke. How? Stop looking for low-fat. Stop looking for that panacea. Start reducing your refined carbs. Go for the whole foods. Your liver will be happy, and so will your heart.

Lee N. Sheldon, DMD

The material in this article is meant for overall information only. The author and publisher assumes no responsibility for the correct or incorrect use of this material, and no attempt should be made to use any of this information without the approval and guidance of your doctor.

Before You do the Root Canal...

Here’s the scenario:

You’re in the dentist’s office. You have a cavity. You’re numb. The dentist starts the procedure drilling away the decay. He or she finds the decay hits the nerve. The next statement might be, “I’m sorry, but the decay has gone too deep. You need a root canal.”

Here’s another scenario:

Your dentist takes an x-ray. It might be a routine check, or you may have a toothache. He/She finds an abscess or a trapped infection that is located in the bone. It’s plainly visible on the x-ray. He/She says, “You need a root canal.”

On the inside of every tooth root, there is a hollow tube or canal. Inside that tube are small blood vessels that nourish the tooth and nerves that allow us to feel cold sensation. The blood vessels and nerves are sensitive to bacteria, so if a bacteria-filled cavity comes close to the nerve, you may feel some pain. That bacteria may also infect the blood vessels and nerves, causing them to die. That’s where the term, “dead tooth,” comes from. The bacteria doesn’t just stay in the tooth. It can travel up though the canal and infect the bone that surrounds the tooth. A root canal procedure removes the nerve from the tooth, and cleans out the infection from within the tooth. It is very successful at controlling such infections.

So it would seem logical that if there is an infection in the tooth, or if decay has reached the nerve, that a root canal should be done. But hold on. Not so fast.

Root canal procedures are very successful, but the long-term success of the entire tooth has very much to do with the strength of the remaining tooth structure. In other words, if you have a tooth that has been badly broken down by decay or has substantial filling material in it, then that tooth is a weakened tooth. The more tooth structure that has been lost, the more decay that is in the tooth, the more filling material that is in the tooth, the weaker the tooth is. And the weaker the tooth is, the more it’s prone to fracture.

There is one other factor involved. The blood vessels in the canal provide moisture to the tooth root. A tooth without those blood vessels becomes brittle. . What happens when you lose moisture in your skin? That’s right. It cracks. And a root canal treated tooth is exactly the same. While it does save the tooth, the tooth is more likely to crack.

Therefore, the question that you as an informed consumer should ask is, “How restorable is the tooth?” Is there sound, healthy tooth structure above the gum line? What are the chances that if I save the tooth with a root canal, that the tooth will remain sound?

If the tooth is not easily restorable, a dental implant is often the most reliable alternative.

Dr. Lee Sheldon

It’s not the Denture

It happened in our office again just last week. And seemingly, it happens almost every week. Here’s the line—“I’ve just had a denture made, and it doesn’t fit right.” I check it, and it fits as well as it’s going to fit. What’s the problem? Often, it’s not the denture. It’s you.

Now this is not an excuse for a denture that doesn’t fit right. That sometimes happens too, and with minor corrections, that can be remedied. This is for the person who says, I’ve never had a denture fit as well as the first one.

Now why would that be? Denture materials, if anything, have improved over the years. The impression materials that we use likewise have improved. The denture impression procedure is critical, and this is a skill that most dentists master in dental school. It’s one of the fundamental procedures that we learn before we ever get into practice. So if it’s not the materials, and it’s not the dentist, what could be the problem?

The minute the teeth come out, the bone that held the teeth shrinks away. For some, it’s a gradual shrinkage. For some, it’s more dramatic. For almost all, the shrinkage continues over time, simply due to the pressure of the denture on the ridge. Every time you bite down, every time you clench your teeth, you are placing pressure on the ridge. And that pressure results in shrinkage of that ridge. We call it “ridge resorption.” Did your dentist tell you to take your dentures out at night? It was to help prevent shrinkage of the ridge, because we often clench our teeth at night.

The ridge shrinks, and of course the denture doesn’t. So what else happens over time? Do you notice that the lower third of your face is shorter? That your chin is closer to your nose? That’s because of ridge resorption. Do you notice that your lower jaw juts out when it didn’t before? Same thing—ridge resorption. How about your nose sticking out farther than it used to because your upper lip puckers in? Ridge resorption again.

Here are some methods that help limit ridge resorption.
1. Save your natural teeth, if you can predictably.
2. If you wear dentures, take them out as much as possible and certainly at night. 3. Get dental implants, preferably as closely as possible after you lose your teeth.

Resorption starts on the first day that you lose your teeth. Denture wearers are often the people least likely to see the dentist on a regular basis. But the need for dental care never stops. Your dentist can check for resorption, reline or remake your dentures, and adjust your bite to minimize the damage that may otherwise occur. Don’t let the loss of your teeth stop your dental visits. Just as you need your physician to monitor your health, you need your dentist to monitor your oral health.

Does Your Lower Denture Wobble?

One of the true enjoyments many of us have in life as we age is eating. We have more time to cook or we just look forward to going out to eat. But some of us enjoy eating more than others. Why? For many, they have a lower denture that wobbles. And no matter what they do, that lower denture just doesn’t feel right.

It’s problem for denture wearers and the question usually goes like this: Why does my upper denture feel secure but my lower denture doesn’t?

The answer is in your anatomy. You have a palate on the upper, a large area where your denture rests. And because of that, the upper denture fits like a suction cup. The lower doesn’t work that way, because your tongue is in the way. The lower denture just doesn’t stand a chance with a tongue whose muscles move when we talk, when we swallow, and when we eat.

In previous columns, I’ve talked about dental implants to replace an entire arch (upper or lower) of teeth with teeth that are fixed in place. They are great, but may not be affordable for some. However, there is a solution that may do just enough to make you comfortable and start enjoying your food again. It’s the two-implant “snap.”

A two-implant snap works this way. Two implants are placed into the front part of your lower jaw, spaced about an inch apart. Included in those implants are receptacles that hold a snap, the same kind of snap that holds a jacket together, the same kind of snap that holds an infant’s clothes together. The other part of the snap is then attached to the inside of the denture. So instead of the denture floating up and down, it now snaps into place. Two snaps are the minimum. A good candidate for the two-implant snap has some remaining lower ridge and has enough room in the existing denture to hold the snap. If you want additional snaps in the back for even more stability, they can be placed at the same time or added later on.

The surgery for the two-implant snap is minimal, sometimes not even requiring an incision. And it won’t break the bank, costing $5-7000 depending on the quality of the lower ridge and the usability of the existing denture.

Our bodies thrive when we eat the correct foods. If you are changing your food choices because your dentures just don’t do the job, think “snap.”

Thin Gums Lead to Sensitive Teeth

When you eat ice cream, do your teeth feel so sensitive that you dare not take another bite?

Gum recession can become a gradually worsening problem as we get older. It occurs because the underlying gum tissue on the bone may be thin and have a poor blood supply.

So while our gum tissue stretched over our teeth when we were younger, the tissues get thinner and thinner as we get older and gradually go away, producing exposure of the root surface.

This can present a number of problems.

First, the root exposure gives you that "long in the tooth" look. Second, the root exposure often produces tooth sensitivity.

Very simply, the top part of our tooth is covered with enamel. Enamel provides a nice thermal layer, like a blanket. But the root doesn't have enamel, so when we eat cold or sweet things, we feel it right into our roots and sometimes right into our bone.

Third, because the root surface is not covered by tough, hard enamel, it tends to wear away.

You can feel that yourself if you have recession. Put your fingernail on your root surface (if it isn't too sensitive) and you may feel your root actually is gouged. And the deeper the gouge, the more sensitive the tooth may be.

And, of course, the deeper the gouge, the weaker the tooth may be.

Yes, I have seen teeth that have been gouged so deeply that the tooth eventually broke.

What can be done about that? There is a procedure called soft-tissue grafting. Soft tissue is placed underneath your thin gum tissue to make it thicker. Thicker gum tissue has a better blood supply. And if your tissue is thicker, it is more likely to cover your exposed roots.

For years we took soft-tissue grafts from the roof of the mouth, but we don't have to do that as much anymore. There are specific tissues that come from a tissue bank, perfectly safe, that can be used to replace your missing gum tissue.

The second change is that we can extract growth factors from a small amount of your blood to speed healing.

Long in the tooth? It can be corrected, improving sensitivity and your smile.

My Teeth Continue to Have Cavities!

You thought the days of cavities were over when you were a kid. But what happens as we get older? We get cavities again--one of those miracles of aging gracefully.

The problem with cavities in an adult is that they happen in the most inaccessible areas, usually on the exposed root at the gum line. Those cavities are difficult to treat. There is no dentist who enjoys treating those cavities and they tend to recur because the problem that caused the cavities remains.

What’s the problem? When we were young our saliva had a neutral pH. That means the mouth generally wasn’t acidic. Our saliva glands don’t work as well as they used to and many of the medications that are taken for the chronic diseases that we are treated for cause dry mouth. People with dry mouths get a lot of cavities.

Here’s what you can do about it: 1) Talk with your doctor and determine whether you might be able to withdraw from some of those medications.. 2) Reduce the sugar in your diet. Sugar comes in many forms. Processed food has sugar. Candies, cakes, sweets? You know them all. Sugar increases the incidence of decay. 3) Measure the acid level of your mouth. Your dentist may be able to help you with that, or you can go to the drugstore and buy nitrazine test paper. Put a small piece of this acid-detecting paper in your mouth. Once the paper is wet, it will turn a certain color and you can measure the color of the paper against a color chart and determine your pH (acid level).

Here are some new approaches: One is xylitol. Xylitol is a sugar. You can buy it in any health food store. Xylitol has been shown to remineralize decaying tooth structure. The second is a rinse which neutralizes the pH. If you don’t produce enough saliva, you can buy a rinse that does. Your dentist will recommend one to you or your pharmacist will. You are looking for a rinse with a pH of 7.0 or as close to that as possible. A simple home remedy is to use baking soda rinses. Their pH is higher, but will neutralize acids very fast. Take a tablespoon of baking soda, mix it in 8 ounces of water, and just rinse with a mouthful of it and spit out. Most only need do this 3 or 4 times a day. The third is to eat more raw vegetables. The fourth is to use the new calcium phosphate products which assist in the remineralization of enamel. You can look them up on the internet.

With diligence to detail, you can reverse the trend of tooth decay in your own mouth, saving money, discomfort, and tooth loss.