Several yars ago when you were in Cedar Rapids, you fashioned a beautiful upper denture for me. That was shortly before you moved to Colorado. Well, needless to say, a number of years have passed and I was in need of a new denture and despite paying an arm and a leg for a new denture that my regular dentist assured me would be done to my specifications and satisfaction, my mouth is extremely uncomfortable and I am unhappy. The appearance is much less attractive and even though I kept insisting on “more tooth” I feel like I have old person dentures. I have considered implants but the cost is more than I can absorb. In my search, I ran across your website and blog. How I wish you were practicing in the area again because I know I would be happy with the end result.

Can you tell me what you think about the all on 4 one hour implants? They are very costly but are they a good option? Can you recommend an implant or cosmetic dentist in the Chicago area? I’d love to hear from you and get your advice and opinion.

Thanks.
- Mira from Chicago

Dear Mira,
Yes, I remember you. I hope everything is going well for you otherwise.

When I was in Iowa, I used to drive to Chicago for my own dental work and see Dr. William Cohen, who practices in the northern suburb of Glenview. He is very nice, a terrific cosmetic dentist, and can work with you for dental implants. His fees are reasonable, and he does a lot of work with dentures and dental implants.

I wouldn’t recommend the all-on-four technique. It’s kind of risky. I would check with Dr. Cohen. He would be straight with you and would be willing to discuss all of the available options to help make this affordable.

- Dr. Hall

I would like to get an estimate for this if it can be done and it could be considered a medical condition so that my medical insurance would help pay for it.

Thank you for your time.
- Bev in Utah

Bev,
That’s a point that we don’t mention maybe as often as we should. One distinct advantage of dental implants over say a removable partial denture or a complete denture is that there is no extra hardware in your mouth, and people who are prone to gagging can sometimes have great difficulty with a plate, say, that goes across your entire palate as many dentures need to have.

As far as your insurance, your medical insurance won’t likely cover anything, so you will need to go to your dental insurance for any help. We get variations of this question a lot – “My teeth are affecting my general health, so can’t I expect my medical insurance to help pay for it?” But almost all medical insurance contracts have an exclusion clause that specifically denies coverage for any dental problems. Otherwise, even a simple cavity could be called an infection and it does affect your general health. The only exception is that medical insurance will generally cover dental damage from an accident. So if you break your front tooth diving into a shallow pool, medical insurance will generally help you pay for it. Otherwise, anything done to your teeth will be excluded from being covered by medical insurance.

We can’t give estimates for specific dental work. For that you need to consult a local dentist. We do have a page on dental implants cost to give you some general guidelines.

Lucille,
You are in a very tough spot. What happens is that when your teeth are gone, your body thinks it doesn’t need that bone any more and begins to resorb it and use those minerals elsewhere in the body. It’s called facial collapse. Eventually, it does get to the point where you can’t even wear a denture.

At that point, what you need is bone grafting to build the bone back up. And you may need to hunt around to find a dentist who can do this. This type of surgery is complicated and difficult, and there are oral surgeons who won’t attempt it.

Beyond that, there are a number of options for getting replacement teeth, depending on how important this is to you and how much money you want to spend and how much treatment you want. The simplest thing would be to just have the same kind of removable dentures placed over the newly built up jawbone. The problem with that is that you will go back through the cycle of bone resorption again.

The placing of dental implants will prevent bone resorption around those implants. The more implants you have, the more bone you will retain. You could have just two dental implants in each jaw and have what are called overdentures or snap-on dentures over those. That works reasonably well. Or you could have dental implant hybrid restorations where the dentures are securely fastened to the implants.

And what I would hope is that others would learn a good lesson from your story. It would have helped if, when you were twenty-five years old and possibly were tempted to think that getting false teeth would be the end of your dental problems, if someone had explained to you the long-term consequences of getting all your teeth extracted. So let your children and all your friends know of your difficulty, if you can feel comfortable doing that. For those who have lost all their teeth but don’t yet have the bone resorption to the degree you have, placing dental implants can prevent these other problems down the road.

Dr. Hall

Eileen,
When I refer to ”soft dentures” I am meaning dentures with a soft lining. Many dentists are offering that in cases where patients have bony “bumps” along the bony ridges of their jaw that would easily become sore if the denture fit closely to those places. They are more comfortable, but they’re more expensive, don’t last as long, and are a little more trouble to keep clean.

But I’m not aware of anyone that is making a pliable complete denture that doesn’t have a hard surface over the roof of your mouth. A complete denture needs some firmness to its framework in order to fit right and to give a solid feel when you chew.

Your solution would be to go to dental implants. A hybrid implant restoration completely eliminates the part that goes over the roof of your mouth, because the teeth are completely supported by dental implants. It costs more money, but it completely restores your chewing efficiency, it feels like your own natural teeth again, and it prevents the facial collapse that is inevitable with complete dentures.

- Dr. Hall

Dear Rebecca,
I am not in favor of this treatment plan. It’s easy for the dentist and a lifetime of difficulty for your son. Twenty-two is way too young to be getting all his teeth extracted.

Once the teeth are extracted, your son’s jawbone will start to shrink, and will continue to do so for the rest of his life. By the time he is 40 he will be a dental cripple, unable to comfortably retain any kind of a removable denture. His face will shrivel up and he will look much older than his years. He will be wanting expensive and complicated bone grafts to his jaw to try to get to some level of function where he can eat normal foods. By the time he is 60 it will be much worse.

Surely, out of those 27 teeth, there are some that can be saved. Any that are saved will help preserve that jawbone. Yes, it is more bother for the dentist and it will be more work for your son to maintain those teeth. But it is well worth it.

And, if there are none that can be saved, placing some dental implants will do the same thing as far as helping prevent the shrinkage of the jawbone. Even two implants per arch will help preserve his bone, though more would be better.

It’s easy to look down on your son and say, “Drug addict – not worth the trouble.” And he may well have similar feelings about himself. But I would hope for better things for him.

As far as the number of extractions, that is a little much for one sitting, in my opinion. The amount of novocain required to extract all the upper teeth in one sitting is pretty large, and that can be a significant risk factor, in addition to the amount of trauma from all those extractions. The lower jaw can be completely numbed with two main injections, but the upper jaw requires multiple injections.

If I were in your shoes, I’d go dentist shopping. Dentists have to pass minimum competency examinations, but there is no examination for caring. Find a dentist who gives you a feeling that he or she truly cares about your son and his long-term future, and that will greatly improve your chances of getting good care for him.
- Dr. Hall

Reply from Rebecca:

Dear Dr. Hall,
Thank you so much for your reply – I really appreciate it.

My son is the most important person in the world to me and if I was financially able I would have his teeth replaced with implants. I will accept your advice and get some other opinions. I am not an expert but I too thought this was an extreme treatment plan.

Again, thank you and have a great day!

Related links:
Immediate dentures are placed the same day as teeth are extracted. They require relining a few months after being placed.
Dentures that are made with special attention to their appearance are sometimes called cosmetic dentures.
Soft dentures are made with soft linings for a more comfortable fit and sometimes a more snug fit.

Now that I am older most of my teeth are broken or missing. I need to get dentures – my question is how do I know if I need a dentist or an oral surgeon to remove what teeth I have left? This is rather embarassing for me and it keeps me from a lot of activities involving my daughter because of the embarrassment.

Can you tell me which I should look for so I can have my teeth fixed and once again be able to smile in public?

Thanks in advance – I would appreciate the help.
Robert from Ohio

Robert,
I would go to a dentist who can do the tooth extractions – the surgery AND do the dentures. Doing pre-denture surgery isn’t complicated, and there are many general dentists who do it. Just call the dentist’s office and ask what the dentist USUALLY does. Don’t give any hint as to your preference before you ask the question. You just want to find out how the dentist usually handles cases like that. A dentist who usually does the surgery, too, will have plenty of experience at that.

And since you have this dental fear you talk about, you’ll also want a dentist who offers sleep dentistry. In Ohio that shouldn’t be a problem, as there are a number of dentists there who do sleep dentistry.

The reason is that there is a certain amount of coordination that is needed between the surgery and the denture. You may, for example, choose to have the denture placed the same day as the teeth are coming out. This is called an immediate denture. This eliminates the embarrassment of going for six weeks or more without any teeth. Even if you don’t do that, there are certain things the dentist can do during the surgery to help the dentures fit better and be more comfortable, and general dentists are more familiar with those things than oral surgeons.

But even if you did have an oral surgeon take out the teeth, you’d still want to go to the general dentist first, because the general dentist will coordinate the procedures.

Good luck,
Dr. Hall