Dr. Hall,
I’m supposed to be going in for dental implant surgery on the 16th of this month. I have not yet explained to Clear Choice who is my dental surgeon that I am on methadone. Do I need to tell them and I have a feeling if I do that they’re not going to continue through with my surgery. They got really freaked out when I mentioned that I used to be on Suboxone. So I can only guess that they’re going to be really freaked out when I tell them that I’m currently on methadone. Will you please get back to me and let me know the answer to this question because I’m really stressed out about it. I feel as if I don’t want to tell them but I’m afraid not to tell him because I don’t want to die during dental implant surgery you know.
Thank you,
Mike Redding from Nebraska
(See Dr. Hall’s answer below.)
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Mike,
You absolutely need to tell your surgeon that you are on methadone—what your dose is and what frequency. For the sake of your safety and if you want to be adequately sedated, they need to adjust the sedative medication they give you by taking into account, not only how much methadone will be in your system at the time of your surgery, but also the effect of chronic opioid use on your biochemistry.
Don’t worry about the possibility that they won’t want to see you if you tell them. It isn’t particularly difficult to adjust a sedation regimen to accommodate other drug use. I did a lot of that when I was practicing. If they don’t want to customize their regimen for you, take that as a red flag that you should go to a different surgeon.
I have fielded a lot of complaints from people who have gone to ClearChoice for dental implants. A couple of them have been harrowing experiences relating to their unwillingness to properly take care of the unique sedation needs of the patient.
I’ve also received complaints about the assembly-line type of care from ClearChoice and their financial policies. If they give you any trouble over this or seem to dismiss your situation as unimportant, either way, it isn’t too hard to find a dentist with expertise in dental implant surgery. And it will probably be less expensive for you. If I were in your shoes, I would seek out another dental practice just based on the initial reactions they gave you, because I would lack faith that they really cared about me as an individual.
Start with a general dentist and not an oral surgeon. Even if the surgery is done by an oral surgeon or a periodontist, implant cases need to be planned out by a general dentist. Check out their doctor bio and see if there is an indication of advanced training in dental implantology. Look for credentials from either the International Congress of Oral Implantologists or the American Board of Oral Implantology, or for other post-graduate coursework in implant dentistry.
Some of these general dentists will refer you to a surgeon who will actually place the implants, while the general dentist takes care of placing the replacement teeth. Other general dentists have learned the surgery and sedation skills needed and will do that themselves. Just look for the credentials that let you know that they have enough expertise. You’re in the Omaha area, so you should be able to find someone with the expertise you need.
– Dr. Hall
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
You are describing something that sounds a little like facial collapse, except that an implant-supported denture, if properly done, should treat or prevent facial collapse and not cause it. A well-done implant denture should restore normal facial height and should fill out your cheeks. So part of your problem could be in the construction of your denture. If the bases of the upper and lower were wider and your smile broader, they would support your cheeks. And if they were built up vertically, there would be less sagging in your face.