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A Collapse Bite Requires You Choose Your Dentist Carefully

My smile humiliates me. I have to work extraordinarily hard for people to see my teeth. It looks unnatural. Plus, my jaw hurts. My dentist has me wear a night guard for that. It does help and my lips and teeth look more natural when I do. I think it may be that my teeth aren’t big enough. In that case, would porcelain veneers help?

Mary

Dear Mary,

Woman covering her mouth

Based on what you’ve mentioned, it sounds like you have a combination of a collapsed bite along with TMJ issues. If that is the case, porcelain veneers aren’t your solution. However, I do have one for you.

I’m actually relieved you wrote before moving forward. There are too many times we hear from people only after a dentist without the requisite training completely destroyed their bite.

In order to fix what is going on, they will have to open your bite with dental crowns. It will have to be done carefully and methodically with a dentist who knows how to do a full-mouth reconstruction. It will take restoring your bite with provisional restorations first.

This is necessary so that it is reversible until the provisionals are successful. This will mean you are completely out of pain, your upper teeth show normally, you have no speech difficulties, and you are pleased with the appearance of your new smile.

This is a tall order and there are only a small minority of dentists who are able to accomplish this. You’ll want someone who has done extensive post-doctoral work at one of these institutions:

  • L.D. Pankey Institute
  • The Dawson Academy
  • The Las Vegas Institute for Advanced Dental Studies

These are the top schools for this sort of procedural training. Anything less and you’ll end up with an even more serious problem than you are facing now. The good news is, those dentists are out there. You have hope.

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

Are Dentures as Attractive as Dental Implants?

I’m 39 years old and need to get dentures. My dentist really wants me to get dental implants because they are better, but dentures are much more affordable. Can dentures be made as attractive as dental implants or do I have to get implants for a pretty smile?

misty

Dear Misty,

An illustration of both a denture and a dental implant

It is a shame you are having to lose your teeth at such as young age. Have you had a second opinion to see how many of your teeth can be saved?

While dentures can be made as beautiful and natural looking as dental implants, it is not their appearance which makes dental implants the better option. In fact, at your age, it is even more important. Let me explain.

Dental Implants Prevent Facial Collapse

When your teeth are removed, your body recognizes this. Without having teeth roots in your jawbone it feels the minerals there are of better use elsewhere. Trying to be efficient, it resorbs those minerals to use elsewhere. While useful to the parts getting the minerals, it has the unfortunate effect of shrinking your jawbone. Eventually, you won’t have enough jawbone left to even keep your dentures in. This is known as facial collapse.

With dental implants, a prosthetic root is surgically placed into your jawbone. This signals to your body that the bone is still necessary and preserves its structure.

If You Can’t Afford Dental Implants

When talking about a full set of dentures it is too expensive to do a one-to-one ratio of teeth to implants. Because of that, most patients will get implant overdentures. This uses between four and six implants and then fixes your dentures to them. This simultaneously protects your jawbone while saving you some money.

For some patients, even this is out of reach. In that case, my suggestion is to get snap-on dentures. This can use as few as two dental implants. It will keep the dentures from falling out and preserve at least some of your bone.

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

Will This Smile Makeover Be Bad?

I’m a little concerned. For our 25th anniversary, my husband and I decided to get smile makeovers together. Our dentist is preparing Lumineers for us. We’ve already paid our money and they were designed. She said they’d be back from the lab in two weeks. Two weeks later, she did call us but only to tell us the impressions were bad and we need to re-do them. Are we being taken? She’s already got our money. How can we be certain we’ll actually get our Lumineers?

Missy

Dear Missy,

A single porcelain veneer being placed

Having to re-do impressions is not unheard of. So, that’s okay. However, I do have some concerns. My concern isn’t that you’ll not get your Lumineers. It’s that you’ll get them and be disappointed. I’m reading into some things here, but think I’m on solid ground and want to give you a way to protect yourself.

It seems to me like your dentist may be in over her head. Here is what makes me think that. First, she didn’t notice the impressions weren’t good. Instead, the lab had to call and tell her. The fact that it took the full two-weeks, makes me think that she didn’t want to admit the impressions were bad because it could be embarrassing. She likely asked them to try anyway. At which point they likely did and had to call her back saying they were unworkable. Plus, it wasn’t just one impression, but both were unusable.

Combine those issues with the fact that she is using Lumineers instead of another brand of porcelain veneers has me concerned. The Lumineers brand are heavily marketed to inexperienced cosmetic dentists.

Protecting Yourself From a Bad Smile Makeover

You’ve already paid and had this work done, so let’s see if we can avoid having to switch dentists. When the Lumineers come back, I’d like you to insist, and I do mean insist, she puts them on with a temporary try-in paste first. If she doesn’t have any, tell her to get some and then get back with you.

This is a water-soluble gel which allows the patient to see exactly what the veneers will look like on their teeth. Make sure your husband gets a good look at yours and you at his, as well as both of you getting to see them in various lightings. If you don’t like them, really like them, ask her to send them back and have them re-done. This is a common thing and she shouldn’t balk at it.

Don’t let her try to convince you they’ll look different once they are permanently bonded on. They won’t. This is a common tactic some less skilled cosmetic dentists use to get the case done. If she can’t get them to where you are thrilled, DO NOT allow her to bond them on.

Instead, that would be the time to switch dentists. She is ethically obligated to cooperate and give the new dentist all the impressions, as well as all other information.

If it comes to that, go to see an AACD accredited dentist. These are the top of the line dentists in the cosmetic field. They can give you a stunning smile.

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

What If Dentures are my Only Option?

I’m in a pickle. I’ve had four pregnancies in six years which kept me vomiting every day, multiple times a day. Then, when I was done with that, I was diagnosed with cancer. My teeth are an absolute wreck as a result. Many of them are literally crumbling. I think the only thing I can afford is dentures. I’m about to completely lose it. I keep hearing dentists say dentures are the worst thing I can do but I’m not sure I have a choice. I’ve no money left and am still paying off tens of thousands of dollars for my treatments.

Emily

Dear Emily,

An illustration of both a denture and a dental implant

You have been through a lot and I don’t want you to beat yourself up. Sometimes, our health (even the health of our teeth) are beyond our control. In your case, I’m going to make a couple of suggestions to see if we can help you get the health you need for your jaw as well as a beautiful smile.

You mentioned dentists have warned you against dentures. The reason for that is the danger of facial collapse. Your jawbone slowly shrinks. Eventually, there is not enough money to even keep your dentures in place. The upper dentures are held in by suction, so those are a bit safer. The bottom ones just sit on the ridge of your jawbone.

If at all possible, I am going to suggest you get snap-on dentures on your bottom arch. This can place as few as two dental implants into your jawbone and keep your dentures from falling out. Plus, it will preserve the bone where ever you have an implant. From there, you can save up for other implants as you are able.

Getting Beautiful Dentures

Regardless of the type of your tooth replacement option, you want to make certain, the dentist who prepares them will create a beautiful smile for you. This is one of the few upsides for your particular situation. After years of damage to your teeth, you can now have the smile of your dreams.

Not all cosmetic dentists are equal in skill. It’s not a recognized specialty by the American Dental Association, so it is up to the dentist how much time and training he or she invests in learning how to make beautiful smile makeovers. There are two sources where you can find dentists capable of giving you a gorgeous smile.

The first is the American Academy of Cosmetic Dentistry website. They have a link where you can find a cosmetic dentist. When you list your area, make sure you check that you’re looking for an accredited dentist. These are the ones with expertise and artistry. The second source is mynewsmile.com. They also have a “Find a Cosmetic Dentist” link. Not all of them are accredited. However, each one of them has been screened for their technical and artistic skill.

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

should I have to pay for a dental implant again after two years?

I had a dental implant placed a couple of years ago. It’s feeling loose and I’m kind of worried I’ll have to pay for another one. I heard these were supposed to last a long time. Will I have to pay all over again?

Tracy

Dear Tracy,

You’re right that it shouldn’t be loose after this short a period of time. However, there can be a lot of reasons for this to happen. Some of them are easy fixes. Before you give up, contact the dentist who placed your dental implant and let him know what is going on.

Why a Dental Implant Can Be Loose

Three parts of a dental implant
The three parts of a dental implant

Not every loose dental implant is a disastrous fix. Sometimes it is something simple. There are actually three parts of a dental implant which can struggle for one reason or another.

The Implant Crown

Sometimes it can just be the porcelain crown, which your dentist placed over the implant which has come loose. Repairing that is just a simple matter of re-bonding it on again. Many dentists will even fix this without charge.

The Abutment

This is a piece which fits between the implant and the crown. Maybe it has come loose . If it turns out the abutment was faulty, the dentist can contact the manufacturer and get a replacement at no cost to you.

The Implant Fixture

If it is the dental implant fixture which is loose, that can be more serious. Sometimes it is coming loose because of an infection. There is a chance that can be saved, but you need to get to your dentist right away. Even when a dental implant isn’t a factor an infection is considered a dental emergency.

If it is loose because it hasn’t integrated with the bone, there isn’t much that can be done. Even when everything is done perfectly, a dental implant procedure can fail. When done by an experienced, skilled cosmetic dentist it’s a rare occurrence, but they can still fail through no fault of either you or the dentist.

This blog is brought to you by Salem Dentist Dr. Ruandall Burba

Does it matter who does your crowns?

I have been diagnosed with TMJ Disorder. My dentist said he’d like to do what he calls a full-mouth reconstruction to repair it. As he explained it, that means crowns on every tooth. I’ve had a single crown done before. Does it matter that I’m getting all crowned for a TMJ problem? Does that require a specialist?

Sara

Dear Sara,

Woman giving thumbs up in a dental chair
How do you know if you have the best dentist for your needs?

One of the problems patients in your situation run into is there aren’t recognized specialties in either TMJ, recognstructive, or cosmetic dentistry. All of those of important areas of knowledge and skill for a dentist to do a full-mouth reconstruction.

This is a serious procedure which costs a great deal of money. While some pretty severe cases of TMJ Disorder do require drastic treatments, I always recommend you get a second opinion from a dentist with a lot of TMJ training before moving forward to see if this is really what you need.

Finding the Best Dentist for a Full-Mouth Reconstruction

As I mentioned earlier, the best dentists for a full-mouth reconstruction have expertise in TMJ, occlusion and restoration, as well as cosmetic work.

The occlusion, TMJ, and restoration is to make sure the bite is technically correct. You need the bite to line up correctly in order to help aide in the healing of your TMJ disorder. Look for dentists who’ve studied these type of topics at one of the following school:

  • The Dawson Academy
  • The Las Vegas Institute of Advanced Dental Studies
  • The Kois Center

There are other great ones as well, but these are three of the best.

The cosmetic work is important so you’ll have a smile you’re proud of. In reality, it’s a great opportunity to get a stunning smile. If you are looking for the top of the line cosmetic dentists, you want to find a dentist who’s reached accreditation with the American Academy of Cosmetic Dentists. They are in the top 1% of cosmetic dentistry in the country.

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

Flipper to Help teeth look straight

I don’t want braces. They take forever, look ridiculous, and from what I’ve heard from every middle-schooler, feel horrible. I have three teeth which stick out and are crooked. I wonder if a dental flipper can make them look straight. What do you think?

Ben

Dear Ben,

A woman putting in her Invisalign aligners in two stacked images
Invisalign: The Modern Orthodontic Solution

A dental flipper isn’t the solution you think it will be. It’s actually designed to be a temporary replacement for missing teeth and uses wires to clasp onto adjacent teeth.

There is something called snap-on smile which can snap over your teeth to make them look straight. They’re acceptable looking but not stunning. Because they snap over your teeth, some people have found that they look a bit bulky. If your teeth are sticking out they might look even more bulky.

Invisalign: A Great Alternative to Braces

You don’t have to get braces anymore. These days we have alternatives. Invisalign uses clear aligners to straighten your teeth. They’re completely invisible even at a conversational distance. This means you don’t have to worry about unsightly metal wires and brackets.

Because of that it is also comfortable. Plus, it works in about half the time of traditional braces. You can have naturally straight teeth sooner than you realize.

A Surprise Benefit to Invisalign

Many people don’t realize that the aligners Invisalign used to straighten your teeth can also double as teeth whitening trays. This means you can simultaneously whiten and straighten your teeth at the same time.

It’s like getting a mini smile makeover. You’ll feel confident and look years longer.

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

Adult tooth knocked loose

Is there anything which can be done about an adult tooth which is loose? I had an accident and dropped a hammer on my mouth. I thought everything was fine except for a fat lip, but this morning I can swear the front tooth feels loose. I thought I was imagining it at first, but now I’m pretty sure. It’s wiggling. Is this a lost cause or can it be saved?

Lizzie

Dear Lizzie,

Woman holding her jaw in pain from TMJ

Before I go over anything else, I’m going to encourage you to stop wiggling the tooth no matter how tempting it is to check. There are ligaments on your tooth which help keep them secure. Often when there is some trauma to the tooth those ligaments get stretched. However, if you keep wiggling it, the ligaments could snap, putting your teeth at greater risk.

Now that I’ve warned you about the wiggling, I can have some sympathy. Ouch! I can’t imaging how much it hurt to drop a hammer on your mouth.

It’s possible the tooth can be saved, but this is considered a dental emergency and you need to see your dentist right away. If you don’t have one, do an internet search for an emergency dentist. They are simply general dentists who are willing to see non-established patients quickly in situations such as yours.

Saving Loose Adult Teeth

The dentist will examine and do x-rays of the tooth. The x-rays are to establish whether there’s been any internal damage to the tooth. If there has, you’ll need a root canal treatment and possibly a dental crown.

If there hasn’t, and it’s just a matter of the ligaments being stretched, your dentist will stabilize the tooth with some type of splint to keep it secure while the ligaments heal.

Don’t put this off. Get it looked at quickly so you don’t risk loosing the tooth.

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

Notches & Erosion at gumline

I have notches on my teeth at the gumline a type of erosion from brushing too hard. I’m thinking of getting porcelain veneers as a means of covering it. As long as I don’t brush too hard, they should be fine, right?

Lisa

Dear Lisa,

A pretty blonde with a pretty smile.
The best cosmetic dentists create beautiful smiles

I’m glad you wrote. It’s true that we used to think the kind of erosion of teeth you’re dealing with was caused by brushing too hard. We no longer believe that to be the case.

While it is still believed to wear away your gums, the notches and erosion on your teeth are now believed to be caused by bruxism. This is when you clench and grind your teeth. So, let’s see if I can’t help you with both issues.

Porcelain Veneers

Yes, you could get porcelain veneers and it will cover those notches. Whether or not you get a gorgeous smile with those veneers depends on the dentist who creates the smile.

Smile makeovers aren’t taught in dental school. It’s something a dentist will choose to study afterward if they’re interested. Some invest more in time and training than others. Some have an artistic eye and some don’t.

If you want a gorgeous smile, you need to look for an expert cosmetic dentist. Go to the website of the American Academy of Cosmetic Dentistry (aacd.com) and do a search for an accredited dentist in a realistic distance from you. AACD accredited dentists are of the highest caliber.

Bruxism and TMJ

Bruxism is biting stress on your teeth. When you grind your teeth or even clench them, it causes stress at the neck of the tooth leading to the problems you currently have, as well as weakening and cracking them. It will also lead to problems with your temporomandibular joint causing TMJ Disorder.

Even if you get porcelain veneers, this will need to be dealt with. You will continue with this habit without realizing it. Most people do it in their sleep. My suggestion is you see a TMJ dentist and get fitted for a nightguard as soon as your porcelain veneers are bonded.

If you’re not getting your smile makeover right away, be sure to get the nightguard now so you don’t do any further damage to your teeth.

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

snap on dentures: a middle ground

I have been struggling with my dentures. Really struggling. I talked to my dentist about it and he suggested dental implants, but the price was way over anything I can afford. I don’t really want to continue with the dentures, but I just don’t like how they move around. I do use adhesive. It helps some. Not a lot. Unfortunately, it also feels kind of gross. Is this just something I’ll have to adjust to or is there another treatment option I’m overlooking?

Diana

Dear Diana,

Salem Snap on Denture
Snap-on Dentures

I hate to hear that patients are left grappling for answers when their dentists should be giving them all their options. And, you do have some options here.

While some people adjust to dentures, others never do. You didn’t mention how long you’ve had your dentures. If they’re fairly new, they shouldn’t be sliding. Your dentist needs to adjust them. Free of charge.

However, if you’ve had them for several years, you could be at the early stages of facial collapse. The longer you wear dentures, the more your jawbone shrinks. Eventually, you won’t have enough jawbone left to even keep dentures in.

This is why your dentist mentioned dental implants. The implants provide prosthetic tooth roots which your body interprets as you still needing your jawbone, leaving it intact.

Alternatives to 1 to 1 Dental Implants

I don’t know if the price quoted to you for dental implants was a single implant for every missing tooth or for implant overdentures. However, implant overdentures are significantly more affordable.

This uses four to six dental implants on each arch and anchors your dentures to them. They are completely secure and will also prevent facial collapse.

In some cases, even implant overdentures are still out of reach. That’s okay. Everyone has a different budget to work with and dentists should never pressure patients to extend themselves beyond their means.

In those cases, we often recommend snap-on dentures. They are a good starting place. There is a picture of them at the top of this post. It uses just two dental implants. While there is some movement, they will not fall out. The snaps keep them in place.

This also allows you to save up to get more implants at a later date if that is what you desire. It will also protect against bone loss, but just in the areas there are implants.

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