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I have to have all my teeth extracted. How can I keep my face from collapsing?

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Dr. Hall,
I just turned 40 & have to have the rest of my teeth (16) pulled. I am a crying mess. I recently found I have a severe calcium deficiency which I am slowly but steadily turning around, but I need dentures & can’t afford a full set of implants. I have 1 implant already.
Would you say all-on-4 would keep my face from collapsing? Or do you have other ideas for me? I am a single mom of a 1- & 3-year-old and don’t want to look like their grandma. Please help.
– Stephanie from Minnesota

(See Dr. Hall’s answer below.)


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Stephanie,
My first question for you is, Why do you have to have all your teeth extracted? You’re not giving me any details about this treatment plan, so my first response is to question it. Dentists vary in their desires to save existing teeth. Some view it as much simpler to extract teeth and do a denture. Saving teeth can be much more complicated. I would suggest getting a second opinion. Find a dentist who has strong views about trying to save teeth and see what he or she recommends for you.

Second, I’m not sure I understand this severe calcium deficiency you say you have. Is this something your dentist told you? A calcium deficiency doesn’t have anything to do with the health of your teeth, not at this point in your life. It can lead to cramps, nerve problems, or osteoporosis. But the teeth are all fully formed and will not be affected in adults by any calcium deficiency. I have heard this used as an excuse to explain problems with tooth decay, but there is no connection. The greatest contribution to decay problems is frequent snacking. There are other contributing factors, but that is the one that most often leads to rampant decay.

If you indeed do have to have all your teeth extracted, and you have no teeth or dental implants left in your jaw, you will, over a period of ten or twenty years, end up with facial collapse as your body gradually resorbs your jawbone, which it perceives you no longer need. You’re correct that this will leave your face looking sunken-in and old. But worse, it will leave you a dental cripple, unable to adequately retain any kind of removable lower denture and also impairing your having a satisfactory upper denture. The presence of any dental implants will prevent any bone resorption around those implants. Even two implants will be a great help, and a snap-on denture would be a tremendous improvement over a removable denture. Better would be four implants.

With freshly extracted teeth, you probably wouldn’t need the all-on-4 denture. What the all-on-4 denture does is eliminate the need for bone grafting when you have had a lot of bone resorption already. But if the teeth have just been extracted, there isn’t time for bone resorption. Though it would be best if the surgeon would place some bone graft material in the extraction socket—a relatively simple procedure.

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

I think I can smell my husband’s dental implants

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Dear Dr. Hall,

My husband is in the process of receiving dental implants, “all on 4’s,” in the front, on top. He has had the temporary teeth placed in his mouth and we are waiting for the permanent teeth to be implanted. Here’s the problem: I suffer from chemical sensitivity and I am reacting to one of the substances in his mouth. Whenever I get close to him (especially at night), his mouth smells like rubber. I have to pull the covers over my face, the smell is so strong.
The posts are made from titanium, the teeth that he has in now are acrylic, and the permanent teeth will be porcelain. The posts are screwed very tight in his jaw, and my husband isn’t thrilled at the prospect of having them removed. I understand how he feels, but I will have to be living with this chemical exposure on a long term basis, which is not good for my health . . . or his!
The oral surgeon said that the titanium posts were the only ones that work for his particular situation. Of course, oral surgeons follow the “standard of care,” and don’t make it their business to be concerned about environmental health and educating themselves on alternative options.
What are your thoughts on replacing the posts with a less toxic material?

– Joan Marie

(See Dr. Hall’s answer below.)


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Dear Joan Marie,

I think there are several options to what you are smelling in your husband’s mouth, and it is very unlikely for that to be the titanium implant posts. The titanium posts are embedded in the bone and I can’t imagine that they are giving off any smell at all. Even with titanium exposed to the air, it’s very inert so I don’t believe it gives off any smell. You could test that by asking the dentist to let you smell one of the implant fixtures.

It’s possible you’re smelling the acrylic in the temporary teeth. Acrylic does give off a very slight smell. It is also possible that there is food debris collecting somewhere in his mouth, maybe under the temporary implant denture, and that’s what you’re smelling. If that’s the case, I’d check with the dentist to find a way to improve the oral hygiene of the case. Possibly a Waterpik would help clean out under the denture better. Rinsing with hydrogen peroxide can also help clean out old food debris, but you have to be careful not to use the peroxide for more than a couple of weeks or it will stimulate the growth of an oral yeast infection.

About replacing the titanium posts, that would be several involved surgical procedures. It’s not just that they are screwed into the bone. After they are placed, there is a process called osseointegration that occurs where the bone fuses to the titanium. So the posts would have to be surgically removed with some of the attached bone. That would mean that bone grafting would have to be placed to grow some of the bone back, which would take a few months. Then new holes would have to be made in the bone for zirconia posts, which is the alternative to titanium. And then it can’t be absolutely guaranteed that there will not be any sensitivity reaction to the zirconia. Titanium is a very bio-compatible material with very rare instances of sensitivity. The same is true of zirconia. Neither one has an undisputed record of no sensitivity. See my blog posts about titanium allergy and zirconia allergy.

Another point that occurs to me is that, while you are complaining about the smell, you haven’t said that you have had an actual sensitivity reaction. I don’t know if you could clarify that.

All things considered, I think it would be a risky proposition to try replacing the titanium posts when that is probably not the source of the smell and even if it were there is no guarantee that the zirconia would be any better.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

Bone grafting for my dental implant didn’t work

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Dear Dr. Hall,

I chose to use my regular dentist to do a dental implant as he has done hundreds of them over the years. When first attempting to place the implant, he informed me that I would need to have a bone graft first. He did the bone graft, then, after healing, I went back for the implant. He again attempted to place the implant but had to remove it as he said the bone was still too thin and he couldn’t do an implant after all. So now after three surgeries, I am left with no implant and the suggestion to get a bridge instead. Is it possible this could have also happened with a specialist?

Thank you,
Linda Cohn

Linda,
The short answer to your question is that no, I doubt this mishap would have happened with a dental implant specialist. Although dental implantology is not a recognized specialty in dentistry—there are just some dentists with more advanced training and oral surgeons and periodontists who specialize in surgery.

However, I don’t want to be too hard on your dentist. It sounds like he is really trying to do the right thing and may have a lot of experience with implants, but bone grafting is a tricky procedure, and I think he may be a little short on experience with that aspect of implant dentistry. He may be just starting to get into the grafting. Any dentist who tries to explore new skills is going to have things like that happen.

A dentist of lesser integrity would have just plowed ahead and placed the implant. It would probably have done just fine for a while and then failed at some point down the road. So I think he has done the right thing.

Let me share a story of the first set of porcelain veneers that I placed. As time went on, I became accredited in cosmetic dentistry and felt that I produced truly beautiful work. But, as with any dentist expanding their knowledge, I had a first case. The patient would come back for regular checkups, and as my skills improved, I became more and more dissatisfied with how her smile looked, since it was very mediocre. Finally, I think it was after three or four years, I shared my feelings with her and offered to re-do her case for free, and she accepted.

It sounds to me like your dentist is leveling with you, and feels like you will end up with a fine result. For a single tooth, a dental bridge or a dental implant are two acceptable ways to treat the case, each with their pros and cons. If you really want to go with the dental implant, you could ask your dentist to refer you to a periodontist or oral surgeon with extensive experience in dental implant surgery.

– Dr. Hall

Do you have a comment or a question or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

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.

After 30 years with dentures, can I get a pretty smile again?

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Dr. Hall,
I have had an upper denture for close to 30 years. Can I have implants now? I have never had a pretty smile, and I would love to have a pretty smile.
Melissa from Alabama
.

Melissa,
Yes, you absolutely can have a pretty smile now, with dental implants instead of the old upper denture you have, even if you have been without upper teeth for thirty years.

Let me explain your solution in two parts, because it sounds like there are two parts to your problem. First, you say that you have had an upper denture for 30 years. Over that amount of time you are going to have a serious loss of bone in your upper jaw, and it is probably difficult to hold any kind of a denture in without denture adhesive, and even that may not work too well any more. That part of your problem requires dental implants to solve. I’ll explain what’s involved in that in a moment.

Second, you say that you don’t have a pretty smile. That part of your problem doesn’t really require dental implants–it just requires having an attractive denture made out of quality materials that won’t discolor or wear down easily. When you have dental implants placed, they will likely be placed to retain a denture–you’ll be getting an implant-retained denture. It will be different from a removable denture in that it won’t cover your palate at all, but it will still be a denture. To illustrate, I am posting two photographs of patients with implant-supported dentures from one of our mynewsmile dentists. You can see that while Tom, on the left, decided he wanted a more subdued color to his teeth, and Brenda, on the right, wanted bright white teeth, that both have attractive, natural-looking smiles. Their smiles will continue to look attractive for many years because they are made of quality, durable materials.

beautiful smiles with dentures

About getting dental implants, after wearing removable dentures for 30 years, you are going to have a significant degree of facial collapse. With facial collapse, you probably don’t have enough bone remaining in your upper jaw to be able to place stable dental implants. This can be solved with bone grafting. That’s a separate procedure that will require time to heal before the implants can be placed, and you will need an oral surgeon or an experienced implant dentist to do that for you.

How should you proceed? With any dental implants case, you want to start by visiting the general dentist. Never start by seeing the oral surgeon, as we have seen some sad cases where, in their eagerness to make sure they are the ones to place the implants, they go ahead and place them before you see the general dentist and they place them in the wrong spots. In your case, since a beautiful smile is important to you, you want to see an expert cosmetic dentist. There are several excellent cosmetic dentists in Alabama, so you should have no problem there.

– Dr. Hall

Do you have a comment or a question or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

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.

A case of implant dentistry incompetence from the U.K.

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Dr. Hall,
I had implants fitted and the crown came loose. I went back to the dentist and he x-rayed my mouth and reassured me that the implants looked fine and that it was just a case of cementing the crown back in place. When he tried to remove the loose crown it would not come away and he had to use a special tool, when it came away the implant came with it ! is it possible that he pulled it out accidentally or would an implant not succumb to force?
– Ann Marie from the U.K.

Ann Marie,
Clearly your crown was not loose – it was the implant that was loose all the time. A loose crown is so easy to remove that it usually falls off of its own accord – it would never require any kind of special tool. And I’m sitting here trying to imagine the gross incompetence of the dentist not being able to figure out that the crown was not loose, when he was not able to remove it. Now I realize that standards of health care in the UK are not very high, but even with that, I’m having trouble reconciling this that happened to you with incompetence. It kind of seems like the dentist wanted to go through the motions of recementing the crown to cover up that the implant was loose. A loose dental implant is serious. A loose crown is easy to fix.

A loose dental implant can happen for several reasons. You didn’t tell me the time frame of when this came loose, but if it is right after the crown is placed on it could be an indication that the crown was placed prematurely – before osseointegration was complete. Or it could be that the stress on the crown was too much for the situation, that the implant was not substantial enough to take the stress, or that the quality or amount of bone support of the implant was inadequate.

It’s also possible that the implant became infected. However, that would probably have been associated with pain, so I’m going to put that further down on the list of possibilities.

Fixing this is not a simple matter. It’s more complicated than just replacing the implant. The bone will have to be filled in again – the bone that was removed before the implant was placed. It’s possible that more bone will have to be grafted in because what was there may not have been adequate in the first place, and with what has happened in the loss of the implant, there is likely to be some shrinkage. And then, of course, you need to find someone that will do this right. I wouldn’t go back to the original dentist – no way.

If you were in the United States, I would advise you to demand that this dentist pay whatever it costs you to fix this right. You would have excellent legal leverage. In the UK, however, you have different standards of care and a different system, so I don’t know what to advise you about that.

– 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.

Clear Choice pricing seems so arbitrary. Dr. Hall explains their pricing

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Dear Dr. Hall,
My story begins with being convinced to have my teeth removed by a different facility other than Clear Choice. I was fitted for dentures, and sent home. At age 42, and after thousands and thousands of dollars of previous care, I was at my wit’s end. I was told by the dentist that I could get the dentures stabilized down the road with implants and that would be that. But it wasn’t. I couldn’t wear the dentures, at all. Between pain and severe gagging, I ended up returning over and over for fitting. After a horribly frustrating and deeply depressing year, I went to Clear Choice for a consult. I purposely went there for info on the All-On-4 procedure. I wanted to do individual mini implants for each tooth, but decided financially and the amount of time involved in getting all of those procedures wasn’t the best fix for me. My consult with Clear Choice was fine. Beautiful, classy office, no wait, very professional staff.

They quoted me $67,000. After learning my husband was 64, they offered me a senior discount bringing the price to $52,000. This seems weirdly arbitrary to me. Is the procedure worth 67 or 52 thousand? Even at 52, it seemed very high. I can get individual implants done by a very good dentist locally for around $1,900 apiece, start to finish, should I reconsider this route? How do I go about finding other dental professionals that are qualified to do the All-on-4 procedure? I have tentatively called around, but most offices seem confused and assume I want to just do stabilizing implants for my polyresin dentures, which I cannot wear! At my age I really don’t want to make a 2nd mistake, the first was letting the first dentist remove all my! teeth w hen at least 10-12 were totally salvageable really haunts me. I have been so distraught and so depressed. I had a fantastic smile, and now I am forced to try to wear my top denture only when going out. Please give me any advice on this. Should I go back to Clear Choice and just ask them to work with me financially? I can afford the procedure if it’s spread over a year or so, but not up front. God willing, I will live for some time, and I don’t want to do it with pain, embarassment, or an inferior set of teeth.

Thanks for a great website,
Diana from Georgia

Dear Diana,
Clear Choice will not work with you financially. This you have to understand. They are a business operation. It’s a corporate dental implant clinic that exists to make money, not what you think of as a traditional dental office where you have a caring dentist who sort of becomes a personal friend. The initial quote of $67,000 which was trimmed to $52,000 is to make the real fee seem more reasonable. But in fact both fees are very high for what they are doing.

Be skeptical of the All-On-4 dental implants procedure. It’s a compromise to avoid the need for bone grafting. While it can work well, I would get a second opinion. The best way to treat your situation for long-term results would be with bone grafting. That is expensive and time-consuming. The reason Clear Choice is so expensive is because they’re pricing their service to compete with the bone grafting. And the reason their facility is so nice and their dentists make so much money is because they don’t actually have to do the bone grafting – they have a short cut around that, which greatly increases their profit margin.

My advice would be to check around and get other opinions. Check the website of the International Congress of Oral Implantologists. I believe they have a list of dentists who have credentials with their organization. Fellowship in the ICOI is a great credential. Diplomate status is even better. Find dentists who will let you have an intial visit to meet the dentist without any charge, visit a couple of them, and pick a dentist you think you would like to work with. Get past the receptionist and to the dentist with your questions, and you’ll get past this confusion that you are feeling. And don’t put too much faith in this All-On-4 procedure. Instead, ask yourself this question after you visit the dentist – Do I believe this dentist will care what condition my mouth is in in ten years?

Clear Choice dentists, as a rule, I believe, have dentists with great expertise. But I will tell you what I tell everyone else – I would strongly recommend a second opinion after you get a treatment plan from Clear Choice.
– Dr. Hall

Read more about dental implants.

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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.

A great experience at Clear Choice

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My experience with Clear Choice was great. I tried to get this procedure done in Michigan but it would have taken 1 1/2 yrs to complete and I might have to have bone grafts,and I would have to travel to all the different places to accomplish this task.

Went to 2 periodontists..which one of them had to tell me that he is “famous” and he is “very expensive” and his charge was $50,000.00 plus. The oral surgeon couldn’t give me an estimated charge for a year, and his charge was in the $35,000 mark! The other periodontist alot of bone loss on the top.

There was no pressure applied. The complete figure was much cheaper than having it done in my home state, Michigan. And to have it complete in 6 months!
– Gail from Michigan

Gail,
Glad you had a good experience.
– 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.

Recommend a dentist for implant dentures in Chicago

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Dr. Hall,

Several years 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 was quite flattered that you drove all the way from Chicago to see me. 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, an excellent 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.

The all-on-4 technique could be a good choice for you. Since you’ve been without teeth for a number of years, you’re unlikely to have much bone left to anchor implants, and the all-on-4 technique might help you to avoid needing bone grafting. 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. Or you could get a new well-fitting upper removable denture.

– 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.

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