What Do Patients Think About Dental Implants?

“Have you ever seen this stat before?” Dr. V recently asked, showing us an image he’d recently seen on Facebook.

A survey conducted by the American Academy of Periodontology found that over 70 percent of respondents reported being “pleased” or “extremely satisfied” with the results of their dental implants.

dental implant x-rayConsidering the relationship between implants and chronic illness – and as Dr. Doug Swartzendruber has put it, “Anything implanted into bone will create an autoimmune challenge. The only difference is the length of time it takes for a disease to appear.” – we wonder what the other 30% might have to say about the matter.

Another funny thing: The web page this stat comes from is ostensibly on “Dispelling Myths About Gum Disease”, yet it perpetuates some of its own. For instance, their claim that “dental implants have a 98 percent success rate” is belied by findings published in the Journal of Dental Research. As Dr. Bicuspid reported,

“Evidence exists that the loss rate of implants is higher than that of natural teeth in clinically well-maintained patient,” they wrote.

* * *

“Based on the critical evaluation of published data and methods used in clinical studies, reported outcome rates for implants may be greatly inflated….”

In addition, the researchers found a lack of funding disclosures in 63% of industry-sponsored implant trials, while 66% had a risk of bias. The authors warned against using a success or survival rate of more than 95% for implants as a promotional tool….” [emphasis added]

Which brings us to an interesting study on patient “perceptions and expectations” about dental implants, published last month in Clinical Oral Implants Research. Among their findings was the fact that while almost 63% of participants felt they were generally informed about implants, less than 20% – 17.7, to be exact – “felt confident with the information they had.”

If you’re not sufficiently informed about a procedure, how could you possibly give informed consent?

The study also noted that about one third of participants “appeared to maintain dangerous misperceptions” about implants. Earlier research has noted this, as well. Among the “misperceptions” noted in this study:

  • Dental implants require less care than natural teeth. (FACT: They require special care.)
  • Treatment with dental implants is appropriate for all patients with missing teeth. (FACT: They’re not. Our position is that they’re never appropriate due to their tendency to become oral foci. But even conventional dentistry holds that bone density, pre-existing health conditions, and lifestyle factors may make implants a bad choice for some people.)
  • Treatments with dental implants have no risks or complications. (FACT: Every surgical procedure carries some degree of risk.)

It’s not hard to see how such misconceptions can arise from the way implants are marketed. Constantly, we’re told they’re “the best option for replacing natural teeth,” that they “look and work just like natural teeth,” that placing them is a snap. Heck, there’s even a website called “Implants for Everyone” (beware the flashing graphics).

What you don’t hear so much about are the potential drawbacks and limitations.

And again, if you don’t know that, how can you possibly give informed consent? Informed consent depends upon your awareness of both benefits and risks, as well as treatment alternatives – including the option of no treatment at all.

As health care continues to be treated as a consumer good rather than a support for your well-being, the more crucial it becomes that you become fully informed about your options. If a doctor doesn’t provide the info spontaneously, you need to ask: How will this help me? What are the risks? Are there other ways of achieving the same goal? Will I need to do anything special after treatment to maintain the benefits you say it will give me?

It’s your right to get the answers you seek.

After all, it’s your mouth and body. After all, you are the author of your own health and well-being.

Image by DRosenbach, via Wikimedia Commons

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Fluoridation in Action

The ADA:

The American Dental Association unreservedly endorses the fluoridation of community water supplies as safe, effective and necessary in preventing tooth decay.

The CDC:

Fluoridation of community drinking water is a major factor responsible for the decline in dental caries (tooth decay) during the second half of the 20th century. The history of water fluoridation is a classic example of clinical observation leading to epidemiologic investigation and community-based public health intervention. Although other fluoride-containing products are available, water fluoridation remains the most equitable and cost-effective method of delivering fluoride to all members of most communities, regardless of age, educational attainment, or income level.

* * *

Water fluoridation is especially beneficial for communities of low socioeconomic status.

A recent report on the state of California’s “dental safety net”:

California faces an “epidemic of tooth disease in which toddlers by the thousands have mouthfuls of cavities, children and adults are plagued with toothaches, whole counties have no Denti-Cal providers and families don’t understand basic preventative dental care,” the report said.

facepalm

On actual prevention

And more

Image by Suzanne Hamilton, via Flickr

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Best. Toothbrush. Ever?

We don’t often write about, let alone recommend, specific products on this blog.

But sometimes a product impresses us so much, we can’t imagine not telling you about it.

Case in point, a new toothbrush that was recently recommended to us by a couple of periodontists Dr. V knows through one of his study clubs.

Meet the Nimbus:

Nimbus toothbrush

There are a few things that make this periodontist-developed brush special, starting with its extremely soft fibers. Think of a softness like fleece. Or velour. Or, as its name suggests, think of fluffy white clouds.

Because the fibers are so soft and the extra long bristles gently surround your teeth, even as they reach down far enough to clean hard-to-reach spots. Meantime, the shorter, fine support bristles help remove plaque effectively.

All together, these qualities make it the perfect brush especially for folks dealing with issues like gum disease, gum recession, and tooth sensitivity. More than one person has mentioned that they actually look forward to brushing again just as soon as they’re done – the brush is that comfortable. Considering how critical regular hygiene is to preventing both decay and periodontal disease, this is no mean perk.

Priced about the same as other manual toothbrushes, Nimbus brushes can be bought directly from the manufacturer. Both adult and child sizes are available.

Give ’em a try and see what you think – and then let us know in the comments!

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Putting the Gum Disease-Cancer Link into Perspective

chronic periodontitisIf you smoke, you’re pretty much guaranteed gum disease. And, of course, your risk of a whole host of chronic, systemic illnesses soars.

But just because you’re a nonsmoker, your gums don’t necessarily get a free pass. Despite smoking rates dropping for decades now, periodontal disease remains a problem for as much as 75% of the adult population.

We have poor diet, chronic stress, insufficient sleep, and other new norms of modern lifestyles to thank for that.

And it’s far more than just a dental problem. For decades now, science has sussed out its relationship with many other health problems marked by inflammation – for instance, heart disease, stroke, diabetes, Alzheimer’s, kidney disease, rheumatoid arthritis, cancer.

Earlier this year, a study in Annals of Oncology offered some numbers that put the perio-cancer relationship into perspective. Data from nearly 20,000 men who had never smoked was gathered across 26 years total. Analysis showed “a 2.5-fold increase in smoking-related cancers among never smokers.” Though gum disease wasn’t linked with the three most common cancers among participants,

a 33% increase in risk was observed for smoking-related cancers (lung, bladder, oropharnygeal, esophageal, kidney, stomach and liver cancers…).

And for those with advanced periodontitis? There was a 45% increase in the risk of developing any kind of cancer.

Need another reason to work harder on keeping gum disease in check?

Image by Parveen Chopra, via Flickr

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Root Canals Are Nothing to “Celebrate”

Another year, another National Root Canal Awareness Week…and rather than rehash – because what’s there to say about this auspicious event that we’ve not said before? – we want to share with you what remains one of the best documentaries we’ve seen on the problems root canal treatment poses to human health:

But there is one point we want to re-point simply because 1) it doesn’t get stressed often enough, and 2) a lot of people naturally freak out about their root canal teeth after learning the truth about this not-so-benign dental procedure: You don’t want to just rush out and get all your root canal teeth removed fast as possible.

In fact, one reason why Price’s work on focal infections came to be discounted was dentists naively extracting root canal teeth from patients whose health did not improve one bit afterwards. It wasn’t the theory that was wrong; only some of the actions it inspired.

Simple extraction is seldom if ever enough.

If healing is to happen, the health of the extracellular matrix – the biological terrain – MUST be addressed first. For just as its condition dictates the course of disease, it also guides healing. Addressing the terrain means supporting and strengthening the body’s self-regulating abilities so that when it comes time to address specific dental issues – root canal teeth or otherwise – the body will be able to respond positively and move toward health.

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Crumbling Teeth & the Need for a Comprehensive Biological Approach

If dental nightmares are your thing, the news has been feeding you plenty lately.

First came “the horror dentist,” on trial for intentional violence and fraud. “Scores of people” have filed “complaints ranging from multiple healthy teeth removed, pieces of tools left in teeth, abscesses, recurrent infections and misshapen mouths between 2009 and 2013.”

Yikes!

Then came the tragic news of a 4 year old who suffered brain injury after being strapped to a papoose board and given a cocktail of sedatives over 7 hours for “a routine dental procedure.” The girl experienced multiple seizures. She can no longer speak or get up.

crumbling teethAnd then there’s the “mysterious” case of the young woman whose teeth are crumbling away in her mouth. Some think it’s an effect of her type 1 diabetes. Others beg to differ. A BTA would surely help clarify the situation. This type of test would open the door to her physiology, which always leads to histopathology – study of microscopic changes in tissues caused by disease. That’s the investigatory path of German Regulative (Biological) Medicine.

But crumbling teeth is only part of the horror. There’s also this:

Dentists say the only treatment available to her on the NHS is to have all of her teeth extracted.

But she will still need to pay £20,000 for implants, as they are classed as cosmetic dentistry.

It’s not the price of the implants that’s so terrifying – though it is crazy-high. No, it’s the implants themselves.

Considering the amount of diseased tissue involved and the likely disorder in the extracellular matrix, implants would only add to the burden this young woman is currently dealing with – with their propensity to trigger an autoimmune response and confound the energetics of the meridian system. It also appears she has quite a few amalgam fillings, so it would be surprising if she were not already extremely mercury toxic, as well.

And you want to add yet another burden to an already stressed out system?

As Dr. V says,

If a regulatory deficiency is already present in a patient, then any dental operation (implants, e.g.) can be contraindicated. This is especially true for incorporating new dental substances – even fillings – because the individual can no longer compensate for additional burdening stimuli. As a result, functional regulatory disruptions may develop that can become disease-producing processes.

Yet the article acts as if implants are her only option for replacing teeth. They aren’t. As last week’s guest post noted, dentists continue to be urged to “educate” their patients until implants become not an option but “an assumption.”

This “rush to dental implants as a solution to the dental needs of today’s trusting patients,” says Dr. Ron Carlson, “is overstated, overused, ill advised, and very often much abused.” (Read more about the selling of implants.”)

Valplast partial dentureThough no one likes the idea of dentures, when many teeth need to be replaced, they remain the better option. They’re certainly more economical, and they can be made with lightweight, flexible, biocompatible materials. Modern materials properly constructed and fitted are nothing like the “Roebuckers” image you may have when you hear the word “dentures” – big, fake-looking, ill-fitting plates. Yes, they do involve special care – but so do implants.

But, still, what about her teeth? you might be wondering. What could make them crumble like that?

One possibility: amelogenesis imperfecta nephrocalcinosis syndrome – a rare disorder which causes teeth to be small, discolored, pitted or grooved, and prone to rapid wear and breakage. You can see pictures of it here and read a case report here.

Or it could be something else. A full biological evaluation is needed to know for sure – and point the way toward better solutions. When something like this is going on, replacing the teeth does everything for aesthetics but nothing to treat the underlying cause.

Mouth image via Help me smile again…;
partial image via Glidewell Laboratories

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Guest Post: Hey, Tooth, You CAN Be Replaced!

Our thanks to Dr. Michael Rehme for letting us share this recent post from his office blog on ours…

If a tooth’s viability is compromised from deep decay, advanced gum disease, or trauma, you may find yourself faced with the decision to extract it. Likewise if you have a root canal tooth shown to cause problems.

And as if that decision isn’t difficult enough, you’ll also need to decide how you’ll replace it.

If the tooth’s in the back, not between two teeth, you may not need to do anything. Otherwise, some kind of replacement will be recommended. Without them, your teeth may drift into the newly open space. This can affect your bite, your appearance, and your speech.

Bridging the Gap

One option is to replace the tooth with a fixed, metal-free bridge. It will look, feel, and function like natural teeth.

fixed bridgeNon-metal bridges have a long and good track record, but there’s a downside.

A bridge replaces a missing tooth by anchoring onto the two teeth on either side. If those teeth are currently healthy, they’ll need to be reduced and fit for crowns that abut the false tooth. While newer designs such as Carlson and Maryland bridges drastically reduce the amount of natural tooth structure lost, you’re still having to do procedures on healthy teeth in order to place the bridge.

Additionally, some craniosacral therapists believe that bridging the teeth together prevents the natural ebb and flow of teeth. Restricting the movement can stress the teeth and their related meridians.

When the Whole Solution Is Partial

partial denture on modelAnother option is a metal-free removable bridge, A/K/A a partial denture.

As their name suggests, removables can be taken out for cleaning. A single removable bridge can replace several missing teeth, on both sides of the mouth, which makes it ideal for people missing multiple teeth. It’s also a good option when there’s severe bone loss or lack of gum, lip, and cheek support due to missing teeth.

The materials used to make today’s partials are increasingly lightweight, flexible, and biocompatible. With some, even single-tooth partials are an option.

What’s Trending Now: Implants

dental implantMade from titanium or zirconium ceramic, implants are trending as the “popular” recommendation of conventional dentists. Placing them is a surgical procedure and, thus, not a decision to take lightly, no matter how hard a dentist may try to sell them. More and more, professionals see articles like this one, where implant dentistry isn’t presented so much as a treatment option but a lucrative growth opportunity for any practice. You just need to have “excellent scripting…to motivate patients,” they say.

The best time to educate patients about dental implants is before they actually need them. It then becomes an assumption rather than a decision.

We don’t think patients should assume anything about any treatment. We don’t believe in scripting to sell dentistry. We believe in sharing information, all of it, and empowering you to make the best choice for you.

Are implants ever a good choice? They do look and function like natural teeth. They may even enhance chewing function in some cases. They don’t require the sacrifice of healthy teeth as a bridge does. Ceramic implants appear to be broadly biocompatible and have a low affinity for plaque formation. Because they’re metal-free, they can’t generate galvanic currents.

Yet most implants placed today are metal, which can corrode and appear dark at the gum line. This may also lead to reactivity. As one 2013 paper noted,

Although titanium is the preferred choice for dental implants as it is an inert material, if used in oral implants, it may encourage toxic or allergic type…reactions. Allergy due to titanium might be accountable for the failure of implants in come cases.

Furthermore, the insertion of titanium implants and their presence in the human body may also cause internal exposure which ultimately leads to titanium ions to concentrate in tissues, regional lymph nodes, and pulmonary tissue.

Additionally, there is some concern that implants of any kind – titanium or ceramic – place stress on the dental meridians. Research by Hal Huggins, among others, has suggested that any foreign body tends to produce autoimmune responses. According to Professor Doug Swartzendruber of the University of Colorado, “Anything implanted into bone will create an autoimmune challenge. The only difference is the length of time it takes for a disease to appear.”

9 Tips to Bring the Best Option into Focus

So what to do? How to choose? In the end, the best decisions are made by gathering good information and then trusting your own careful wisdom. Some tips:

  1. Do the research. Gather all the information you can.
  2. Weigh the pros and cons of each option for use in your particular situation.
  3. Know the percentages of success and failure over time.
  4. Evaluate all the materials that will be used.
  5. Take your health history and long-term health goals into consideration.
  6. Keep asking questions that are important to you.
  7. Don’t rush into a decision. Your socket needs time to heal anyway.
  8. Trust your gut. You know yourself better than anyone.
  9. Talk to your doctor, but when in doubt, get another opinion.

Partial image by Justin Marks;
implant image by Andrew55austin, via Wikimedia Commons

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