From Wood to Titanium: Dental Professionals’ Opinions on Tooth Replacement

As in a previous post, this week I decided to venture into the Blogosphere to see what the professionals in the dental world were discussing. A lack of “hot topics” made my search quite uneventful however I was able to find some very interesting information concerning tooth replacement. While the majority of the population will eventually lose a permanent tooth, modern dentists have come up with numerous, effective ways to replace dentition. That being said, professionals must decide what method to perform in order to restore functionality in the mouth. Common knowledge dictates that when enough teeth are missing, typically in elderly citizens, dentures (image to the right) will be used to help chew and speak. But, this begs the question as to what dentists do when the patient needing to restore their teeth is not aged, and perhaps does not need the majority of their teeth substituted. As covered previously, a common alternative is a dental implant. Conversely in the instance that a tooth is knocked out (bottom left image shows dramatization of this), and the individual was able to recover it, most experts suggest reimplantation. My interest in both dentures and reimplantation spurred a blog search for the topics, and I was able to find two current posts discussing each of the issues. The first post was entitled “Removable Partial Dentures and Complete Dentures” featured on the blog DMDstudent.com. The author is a dental student at Temple University in Arizona. The post discusses a project he is making for dental school as well as some tips on making dentures. His knowledge on the subject will give me great insight with any questions I have. The second post I discovered is called, “Intentional Reimplantation” written by Doctor Jason Hales. He discusses a real-life experience with a patient losing a tooth, and the reasoning, and success from reimplanting it. I posted insightful comments on both blogs, and have included them below for convenience.

“Removable Partial Dentures and Complete Dentures”
Comment:

First off, let me congratulate you on a wonderful blog and post. I find the information I read on your page to be incredibly helpful and valuable. As a future dental student, I am learning a lot about what it truly takes to succeed in dental school, as well as what is expected of you. In this post when you talk about how much the project you are working on will affect your grade, it gives me more insight concerning the importance of lab assignments, and what a good finished product looks like. In summary, personal articles such as this are what make me visit your blog frequently. I chose to comment on this specific post however because it brought up numerous questions which I believe you could answer. You mention when creating dentures for a patient who has several missing teeth, the keys are retention, stability, and support. Obviously, partials that meet these requirements will be successful and will help a patient thrive. I wonder though, if dentures are always the most viable option. As there is so much advancement in implant technology, will dentists make a movement towards more implants and away from dentures, or is it not worth the expense, especially for older people to substitute missing teeth with implants? If so, what are the keys to successful implants and are they similar to those of dentures? Although I do have a fair amount of dental knowledge, I still consider myself a layman in terms of this subject, and the practicality of implants over dentures. While I know that income is something that greatly effects a patient’s decision on what type of procedure they would like (for instance amalgam versus composite fillings), I am curious as to what you believe are key factors when deciding what technique to use. I find the choices that dentists and patients have to make together a very interesting subject, and was curious as to whether there is a debate on what ways teeth should be replaced. While it depends largely on age and income, what other factors can influence the decision?

“Intentional Reimplantation”
Comment:

Thank you for writing this post on a most interesting and engaging topic. While I am in no way an endodontist or even a dentist, I am hoping to become one, and this blog as well as posts similar to this one inspire me even more to succeed at my goal. As a very athletic person and a college student, I have seen young people lose or chip teeth all too often. As many of my friends know I am interested in dentistry, in turn I am constantly barraged with questions about why teeth cannot simply be “shoved back in” when they fall out. After reading the article, I can explain that factors such as the amount of time the tooth is out of the mouth, damage to the periodontal ligament, and contamination by bacteria can all affect the ability of a dentist to reimplant a tooth. As a layman I was curious about what traditional endodontic surgeries and conditions must be avoided or present in order for a professional to support intentional reimplantation. The specific incident that you address covered this in addition to being very exciting to read. It showed me that dentists are truly required to think on their feet, and that when the unexpected happens one must act quickly and calmly. The idea of being quick on your feet makes me wonder how modern the idea of intentional reimplantation is. While it seems that the process could be very old-fashioned, even back to the times where doctors worked in unclean environments, it also seems very progressive and new. This then creates a new question, whether or not the method is a viable alternative to tooth replacement by implant or bridge. Obviously, as previously mentioned, there are certain criteria for the process to take place, but are these criteria easily met? And if so, are they less specific or more specific than choosing to get an implant? Moreover, are there other factors that can affect the situation such as income and age? I seem to find that the world of dentistry has numerous ways to accomplish the same task, and I am curious in this instance which is generally superior.

Maintaining a Healthy Heart: It Starts With a Healthy Smile

Throughout this decade, medical researchers have run numerous studies and attempted to form conclusions about the relationship between unhealthy gums and an increased risk of heart problems. A recently published and very convincing inquiry shows that in men less than sixty years of age, periodontal disease, or periodontitis (pictured right), is clearly associated with a rise in coronary heart disease. While this is not the first study of its kind, it is unique in that it accounts for the differences in weight, income, and overall health of subjects, and still augments the ever increasing data supporting more extensive dental care for a decrease in possible cardio troubles. Although it is not completely common for those who do not tend to their gums and teeth to have heart problems, maintaining a healthy mouth is important for avoiding cardio related ailments because of the susceptibility to sicknesses that periodontal disease can cause, and because of the proven research that depicts people are more likely to get heart problems with an unhealthy mouth.

According to a report by the National Institute of Health and the Centers for Disease Control and Prevention, over one-hundred and sixty million people suffer from high blood pressure, cerebrovascular disease (leading to stroke), cholesterol levels requiring medical attention and coronary heart disease in the United States alone. All of these epidemics in the population affect the pulmonary system as well as cardio health. It is important to recognize the plethora of factors that can lead to heart aliments to illustrate that poor dental health is not the only cause. The public must understand that because poor oral conditions can result in other harms to the body, it is not necessarily the cause. Realize that an older person with coronary heart disease and overall poor bodily health, will be more prone to lose their teeth than an in shape individual of the same age. Therefore, a bias can be seen from the dental community’s standpoint because if patients are more fearful of other health issues due to inadequate dental maintenance, they would almost certainly increase their visits to the dentist. This would be favorable to dental professionals because more patient appointments means more capital. While this is a motivating factor for dentists to support the theory of periodontitis affecting heart wellbeing, the actual science behind the disease confidently supports the idea of more extensive oral care.

In order to understand the effects of periodontal disease, one must first understand what anatomical changes occur. In short summary, the main effect of the disease is the recession of the gum line around the teeth. Essentially bacteria cause an infection that destroys the bone and fibers which secure teeth to the jaw. The result is the separation of gums from around the enamel of the tooth, and the formation of deep dental pockets. In turn, these pockets are then vulnerable to fill with plaque and food particles, creating additional bacterial infections. More gingival tissue is destroyed and teeth become loose. Inflammation occurs due to byproducts of the infection entering the bloodstream and being eradicated by the body’s immune system and gums then turn red and become puffy. A significant problem with this mechanism is that some of the disease fighting agents the body produces, such as C reactive protein (graphic to the left), also inflame arteries that can stiffen and promote blood clots and arteriosclerosis. Studies have shown that the antibodies used to combat the bacteria of periodontitis are only produced for that reason, and typically are not found in the mouth. With all the possibilities for detrimental effects on cardio health from oral problems, it is simple to see why dentists are stressing dental wellbeing.

As much research has shown, maintaining high oral standards is not only beneficial to the mouth, but to the body as a whole. Merely by brushing and flossing the recommended amount of times per day, a person can avoid serious conditions such as stroke, myocardial infarction, and high blood pressure. By preventing the gum line from receding, and preserving adult teeth the risk of dangerous bacteria infiltrating the blood stream via the mouth is severely reduced. As doctor Kenneth Bueltmann (former president of the American Academy of Periodontology) said after reading an early research report about the relatedness of periodontal health to cardiovascular diseases, "This data clearly stresses the importance of regular dental checkups to ensure a healthy, diseased-free mouth." Although more research should be conducted so that the specifics of the relationship can be found, the current steps being taken are necessary and will lead to more breakthroughs on the topic.

If more effort is put into finding the exact correlation between good oral health and good overall health, future medical professionals will have an extraordinary understanding of the interconnections of the body. Current research provides a good deal of evidence to support further research in medical treatments that target multiple parts of the body at once. Not only will these new treatments be more efficient at curing health problems, but they will also teach people about the phenomenal power of their own bodies. The more we learn about ourselves, the better equipped we will be in the fight against deadly diseases and syndromes in the future. Perhaps a time will come when a simple investment in brushing one’s teeth could be the deciding factor in whether or not they will survive a deadly virus.