Implant Crown Should Not Trap Food

Q:  I recently had my first bone graft and implant completed and am experienced that food gets trapped where the crown meets the gums.  I must floss after every single meal just to get all the food out. Is this normal? ...Mike, via e-mail

A: A crown over an implant should not be a place to store leftovers.

Possible causes to your problem:
• Open contacts: gaps between the crown and adjacent teeth.  Solution: Make a new crown.

• Implant abutment post too narrow.   Solution: Change out the abutment post to a larger diameter unit along with a new crown that will fill in the triangular voids (called embrasures).

• The implant itself is too narrow, resulting in a shelf like void around the crown, trapping debris.   Solution: Have your doctor take a look and sort things out

Flexible Dentures

Q:  I love your column and read it all the time without fail. Has there been any new technology in dentures? They still seem to be quite primitive...S.M. in Pasadena

A:  Thanks for the positive feedback.

An improvement in dentures would be “flexible” dentures such as Valplast dentures. Seldom taught in dental schools or in continuing education courses, this technique can fill a very useful niche of patients. Advantages are: fewer forces on the natural teeth they clip to, fracture resistant, no ugly metal clasps, available in various shades of pink and clear, no metallic taste, non-allergenic and lower cost. Flexible dentures can offer a comfortable and esthetic alternative for those who do not have the financial means for conventional or implant retained prostheses.

Dry Mouth

Q:  My dentist keeps finding cavities along the gum line around old crowns and bridges. He claims that it is due to this dry mouth problem that I have. What can I do about this?....H.J. in Hollywood

A:  Dry mouth is also known as Xerostomia.  Dry mouth is the most common side effects of prescription drugs (especially antidepressants and antianxiety drugs). Dehydration, smoking, cancer treatments, medications for blood pressure and allergies can cause dry mouth as well.

Dry mouth lead to frequent Candida infections, increased periodontal and peri-implant diseases, caries, and bacteria infection caused by the loss of protection from saliva.  Dry mouth also decreases the seal of soft tissue-borne removable prostheses and increases the risk of abrasions and sore spots.

Suggested management:
•  Saliva substitutes
•  Saliva stimulants – such as chewing gum
•  Frequent glasses of water throughout the day
•  Strict control of the diet to decrease cariogenicity
•  Avoidance of tobacco or alcohol products

Bleaching Proved Safe on Enamel

Q:   I am interested in bleaching my teeth. Are there any ill effects that permanently alter my enamel?

A:  The April Journal of the American Dental Association (JADA) contained a study done at a very well respected Italian University’s biomaterial and biomedicine department. They tested real teeth exposed to high-concentration of 38% hydrogen peroxide, commonly used for in-office whitening treatment.

The results showed no roughness alterations of the enamel surface under the scanning electron microscope, even with prolonged and repeated applications.

Several light activated methods are commonly used: Zoom, Rembrandt, Sapphire Whitening, and Brite Smile. Avoid flea market and trade show booth whitening "tents."

Atrial Fibrillation

Q:  I have a heart problem called atrial fibrillation and am worried about starting my dental treatment which includes extractions, implants and bridge work. Should I be worried?...LBJ in Pasadena

A:  Atrial fibrillation (AF) is a cardiac rhythm disturbance arising from disorganized electrical activity in the chambers of the heart. Very often patients are treated with the drug Coumadin to prevent the formation of clots and the possibility of a stroke and beta blockers such as Atenolol to control the heart rate.

Several precautions should be considered: Your hygienist should avoid using ultrasonic scalers during teeth cleanings, but instead use hand scalers. Some local anesthetics containing drugs that constrict blood vessels (vasoconstrictors) need to be used in ways that prevent direct injection into blood vessels. Certain antibiotics, pain medications and anti-anxiety agents prescribed during dental treatment can decrease the effectiveness of the drugs used to treat AF.

You may have all the above needed dental procedures as long as your dentist keeps a few points in mind, starting with a chat with your physician.

Impacted Wisdom Teeth

Q: Do all impacted wisdom teeth need to be removed?  R.R. in Burbank

A: Dentistry is a funny business, with most body parts, doctors would recommend that you should keep them as long as you can.  However, when it comes to impacted wisdom teeth, molars buried under the gum and bone, you may want to consider having them removed as they can cause problems with your teeth and jaw.

Impactions can result in infection, decay of adjacent teeth, gum disease/bone loss and the formation of a cyst or tumor. If you are considering any specialty dental work you may find that your doctor will want them removed. Many orthodontists will want them out before starting braces on the teeth to allow for room in the mouth to correct crowding.

The younger you are when you have them removed the better because of  “softer” surrounding bone in the young jaw. We simply heal faster when we're younger.

Bone quality key in procedure for implants

Q: My friend’s dentist placed a dental implant and attached a temporary crown in the same visit. I now need an implant, but my dentist says I have to wait 4 to 6 months after the implant is placed before he can attach a crown. Why the difference in treatment methods?... Marla in Glendale

A:  Excellent bone quality indicates the ability to load the implant immediately with a temporary crown. Poor bone quality requires time for “osseous integration” which allows your own bone to thoroughly bond to the surface of the titanium implant. Most patients are limited from receiving an immediate temporary at the time of surgical placement of the implant due to bite interferences, oral habits and non-compliance in hygiene.