Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

June 20, 2012

This complex appearance-related question won’t be solved by an unmotivated dentist

Dr. Hall,
I am a 67 year old woman who has had surgery for gum disease within the last six months. Also, because of the gum disease I have 6 missing upper teeth (3 on either side). I do have the front six and a back molar on each side. I suppose due to bone loss from the gum disease my front two upper teeth have a major gap between them. At the moment I contemplating either implants but due to the cost that may not happen. I have talked to my dentist about “partials”…currently I have a flipper. I have also been to an orthodontist to discuss braces to close the gap between the top 6 teeth, particularly the middle two. The problem with braces is that the flipper won’t fit and due to the amount of movement needed a partial would have to be remade multiple times. I am not sure if I just live with the gap and get the partial for the uppers and be done with it (even though I am 67, I still work, very active and I HATE that gap). My oral surgeon does do implants but he is talking well over $20,000 and that is a great deal of money. Any suggestions would be appreciated.
Janie in Texas

If you’re going to get this aesthetic problem solved, you’re going to have to get out of this group of conventional-thinking dentists and find a dentist who is passionate about doing appearance-related dentistry.

I can think of a couple of possible solutions to your problem that might work, but each one would depend a lot on assumptions about your condition that I really shouldn’t make via e-mail. A specific solution would require a complete examination to let me know the bone levels on the existing teeth, the sizes of your front teeth, the size of the gap, the prognosis of the remaining teeth, and how everything fits together.

Now maybe there are no good solutions other than what your oral surgeon is suggesting, given everything the way it is in your mouth, but I can tell you that the prevailing thinking in established dentistry would be that this isn’t that big of a problem and it’s not worth trying very hard and certainly not worth taking any risks. The way we were taught in dental school is that patient concerns like you are expressing over this gap are relatively trivial, and to give them too much weight is pandering and unprofessional. They would not want to APPEAR to be thinking that, but in their professional circles as they talk behind the scenes among themselves, this is the thought pattern that we see all too often.

I would suggest getting a dentist who truly believes that appearance is important. Go to our list. There are actually several of our recommended dentist within 30-50 miles of you. They are all screened carefully by me personally to be highly sympathetic to appearance-related concerns like yours and to have excellent skills.

Dr. Hall

About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

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