Should I Save My Last Two Upper Teeth?

I have all of my bottom teeth and they are still healthy. My upper teeth, on the other hand, are a complete disaster. I only have my two front teeth left of those. Currently, I’m wearing two upper partials, but they’re uncomfortable and make it hard to speak. Because I don’t like them, I am only wearing them when I have to chew things that require grinding, such as meat and nuts, etc. Recently my dentist mentioned he thought I’d be happier with a full upper denture. I’d always thought it was better to save your natural teeth, but I’m all for being happier. Which is the way to go? One other piece of information that may be helpful is I have an underbite.

Danny

Dear Danny,

completely removable dentures

First, my disclaimer: I have not examined your bite and therefore can only give general guidelines. As you mentioned earlier, under most circumstances, saving your natural teeth is the ideal. However, you are using those last two teeth for most of your eating. Combining that with your underbite means those two teeth are under a lot of stress and not likely to last much longer, even if they are healthy now.

The idea solution, in that case, is to remove those last two upper teeth and get implant-supported dentures. These place dental implants into the arch which mimic the roots of your teeth and help prevent facial collapse.

However, having implants isn’t nearly as important on your upper arch as it is your lower arch. Upper dentures are held in by suction and don’t have a lot of movement.

Lower dentures just rest on the ridge of your jawbone. The longer you are in dentures, the more your jawbone shrinks, hence the facial collapse I mentioned above. Eventually, there isn’t enough jawbone to retain your dentures.

In my mind, the priority would be to keep the lower teeth as healthy as possible. Having dentures on the upper arch will actually create less wear on the lower arch and will help preserve those lower teeth, so long as you are keeping up with adequate oral health habits.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Dental Horror Story

I need some help and advice. I had 20-year-old porcelain veneers I wanted to replace. My dentist decided my bite needed to be opened up as well so people could see my teeth so in addition to 8 veneers he added two dental bridges to the mix. The whole time I was in temporaries I was miserable. I would literally call every couple of days to tell them how much pain I was in. I felt like they weren’t taking me seriously. Then the day came for the permanent ones and he placed them in under an hour. They felt as bad as the temporaries. All the dentist will say is all his checkpoints are textbook and it is just a matter of me adjusting to the open bite. Aside from the pain, my mouth is so dry my lips are sticking to my teeth. I’ve been sucking on popsicles and drinking water and soda all day long just to keep my mouth moist. I’m miserable. What do I do?

Lydia

Dear Lydia,

This is an absolute disaster and none of it is your fault. Let’s start with the fact that he wanted to open your bite. The only way to properly do that is to crown at least every tooth on one arch, so he’s already going about it wrong. While he did do temporaries, which is good and necessary, the purpose of them is to make sure the teeth occlude properly and the patient is comfortable, which by definition includes pain-free.

He didn’t pay attention to one of your complaints and based on your description, you brought your pain to their attention quite a bit and he plowed right onto the permanent restorations without any regard to what you were experiencing.

It is obvious that he opened your bite too much, which is why you are facing all these issues with dry mouth. All his guff about meeting the checkpoints is nonsense. A key checkpoint is that your mouth closes naturally when at rest. If yours were doing that you wouldn’t be having these dry mouth issues. So he’s not being honest there.

On the note of your dry mouth. Please don’t eat popsicles and drink soda to keep your mouth moist. This is decay waiting to happen. The water is okay.

What to Do Next

He’s caused serious damage to your bite. While bad news, it is also good news. Because your case lacks proper form and function, you are entitled to a refund. However, what I’d like you to do is ask for him to pay for the repairs with a dentist of your choosing.

You need a highly skilled dentist in both occlusion and cosmetics to make this right, especially with the damage he did. The top cosmetic dentists are AACD accredited. For the occlusion of your teeth, I’d look at someone with significant TMJ training.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Bone Grafting Didn’t Work

I have a dentist who has done many dental implant procedures in his career. When he went to do mine, he decided there wasn’t enough bone structure for it to be a viable case. He told me we’d need to do some bone grafting to be certain the case wouldn’t fail. I agreed because I wanted the best chance of a successful case. We did the bone grafting, waited for healing, then attempted to do the dental implants again. Again he felt that I didn’t have enough bone structure. Now I’m three procedures in and still have nothing. He’s now suggesting we just do a dental bridge. I will if I have to but is there any way I can still get a dental implant? Should I have gone to a dental implant specialist?

Melissa

Dear Melissa,

illustraition of a dental implant next to natural teeth

You’ve certainly been through the ringer with these procedures. While there isn’t actually a detnal implant specialty that is recognized by the American Dental Association . However, there are obviously going to be dentists who invested more in training (which all has to be done post-doctorally) and have more experience as well.

It sounds like your dentist may be experienced at the dental implant procedure but new at the bone grafting part. The good thing this tells me about your dentist is he is continuing to learn the new technology and add to his skill set in order to better help his patients.

Another thing I like about your dentist is his integrity. Some dentists, not wanting to embarrass themselves over a failed procedure would have just gone ahead and placed the implant without the ideal amount of bone in place. The dental implant would have lasted for a while and eventually failed, you would never have known it was because of the bone. Your dentist cared more about the quality of your care than his own pride.

Can you still have a dental implant? Yes. If you’ve got the stamina to try again, I certainly think you can. But, in all likelihood, you will need to have the bone grafting done with a different dentist. I don’t think your dentist will be at all offended about that given what I’ve learned of his character and ethics thus far.

If you decide you don’t want to go through all of that again, then getting a dental bridge is an acceptable option.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Did Dentist Damaged My Porcelain Veneers

I had six porcelain veneers made. I liked them but noticed a small scratch on one. I called the office and he had me come in the next day. He did something to get the scratch out of it. It looked fine at first, but then I noticed the next day (why is it always the next day instead of in the office?) that the spot where he removed the scratch is a bit less dull than the rest of the tooth. I’m worried this part is somehow damaged. Will this be a problem?

Karlie

Dear Karlie,

porcelain veneer being placed on a tooth

Yes, this is a problem. It sounds like your dentist removed the scratch by simply grinding down the veneer and removing the glaze with it. This is quite an amateur move on his part and it leaves your porcelain veneer susceptible to staining in that one spot.

The glaze is what protects your porcelain veneers from picking up stains. This needs to be repaired. Your dentist has two choices at this point:

  • His first option is he can polish the veneer where he damaged the glaze in order to restore it. However, this requires some equipment he may not have. We’ll talk about how he can do this in a moment if this is what he chooses.
  • His second option is simply replacing the damaged porcelain veneers at his expense. This is costly, so my guess is he’ll choose the polishing option.

Polishing a Damaged Porcelain Veneer

What I recommend he gets if he doesn’t already have the equipment is Brasseler’s Dialite porcelain polishing system. He will start off with a polishing paste, but then will need to end with the ultra-fine diamond polishing paste.

Often family dentists just dabble in cosmetic dentistry so they have some basic skills and not the expertise needed to do a fantastic job.

It sounds like you are at least happy with the look of your porcelain veneers before he damaged them. Others aren’t so fortunate. We’ve had quite a few new patients in our office who came in simply because their dentist provided them a disastrous smile makeover and they needed the entire thing re-done by a more experienced dentist. Even worse, it is totally up to the dentist whether or not they are willing to provide a refund.

If you have a friend who is also wanting a smile makeover, you would be a great friend to them by recommending they go to an AACD accredited cosmetic dentist to have theirs done. I guarantee the results will be stunning. These are the dentists who have invested in a lot of cosmetic training and have developed their artistry and technique.

This blog is brought to you by Salem, MA Cosmetic Dentist Dr. Randall Burba.