The NobleDentist Blog

This is an article by Lou Robson that appeared recently in The Courier Mail.

It started as a dull ache. A minor irritation in the lower jaw. A twinge which became, in 24 hours, all-consuming pain.

The bad tooth was crippling. An evil and unexpected ailment which reared its ugly head late on Christmas Eve. It robbed me of sleep and sent me reeling through the dark.

At 2am I Googled “dental emergency” and the numbers of several hospitals appeared. But, after a combined total of two hours on hold, all three sent me packing.

To receive emergency treatment I would have to a) earn less; or b) receive welfare – the necessary criteria to receive a healthcare card and late-night aid.

Even those eligible have to wait for public dental treatment. In southeast Queensland several regions, including Caloundra and Gympie, have six-year waiting lists. Queensland Health’s 270 dentists can accommodate only 1.48 million patients – a figure that leaves the remaining 2.62 million residents out in the cold.

Pay for a private visit and you’re still put on hold – in some cases for up to six months. To the uninitiated, the statistics are not important. But join the ranks of the suffering and the outrage surfaces like a bad tooth infection.

I self-medicated. Took three Nurofen Plus and lay in an empty bath. Flattened myself against the cool metal tub and performed breathing exercises in a vain bid to cope.

At 7am I started dialling. Called dentist after dentist. Appealing (and expensive) private practices with names like Sleepy Time Dental and Pain Free Dentistry. But no one answered. It was Christmas Day, and their cheery recorded messages jarred my jaw.

While others ate prawns and drank champagne, I endured the worst pain ever. I would have settled for a butcher. A fly-blown scene from an old Western complete with pliers and half-empty scotch bottle.

Then a dentist called. A kind-hearted soul who played his messages and heard the tone. Picked up on the desperation edged with anger and agreed to an appointment – in two weeks’ time.

Something has to be done. According to Dr Robert McCray, the Queensland President of the Australian Dental Association, about 650 children are waiting to have teeth removed in Logan, south of Brisbane, alone. Others are in agony in Mossman, near Port Douglas.

Waiting lists show the dentist drought extends from Cape York to Coolangatta – and it’s getting worse. The Australian Council of Social Services predicts a shortage of 1500 dentists by 2010.

It’s a well-paid profession. Public dentists earn between $65,000 and $85,000. Private practitioners up to $120,000. Good money for a life spent fishing about in the mouths of others.

But apparently the Federal Government is to blame for Queensland’s lack of oral operators. Too few university places have resulted in the state’s tooth catastrophe. These days all you can do is wait. Exceed the recommended daily dose of painkillers and lie in the bath.

But seven months and $3500 after my ordeal began, it’s finally over – a long-winded and multiple-visit affair involving a root canal and the removal of four wisdom teeth, all of which conspired to create an unforgettable Christmas.

A Yuletide that was not the season to be jolly.

This is a press release for a New Harvard Medical School Report.

For some people, the fear of visiting a dentist outweighs the pain of a toothache. But putting off that visit almost invariably leads to more advanced oral health problems and lengthier, more complex procedures. What many people don’t realize is that they can work with their dentists to learn about and implement anxiety – relieving strategies, according to Dental Health for Adults: A Guide to Protecting Your Teeth and Gums, a new report from Harvard Medical School.

The most direct approach is to be straightforward with your dentist and
explore various strategies for pain reduction together. Improvements in
techniques, medications, and equipment over the past 30 years mean much
more comfortable visits than those you might recall from childhood.

Dental Health for Adults describes in detail both standard and novel
treatments available for pain management, such as local and general
anesthesia, anti-anxiety medications, and conscious sedation. The report
also includes a lengthy discussion of alternative approaches to dealing
with dental anxiety. These are some of the tips in the report:
—Have your dentist agree on a “stop” signal so you can take a time-out
from the procedure.—Avoid caffeinated beverages before your visit, as they may make you
jittery.—Listen to music on a portable music player before and during treatment.—Practice relaxation exercises and guided imagery techniques.—Get regular dental checkups, which help you build a good rapport with
your dentist and enable your dentist to catch problems early.

Edited by Hans-Peter Weber, D.M.D., Head of the Department of
Restorative Dentistry at the Harvard School of Dental Medicine, the 48-page
Dental Health for Adults: A Guide to Protecting Your Teeth and Gums also
covers:
—dental basics—the relationship between oral health and general health—taking care of your teeth at home—dealing with emergencies—tooth replacements—braces for adults—cosmetic dentistry.

Dental Health for Adults: A Guide to Protecting Your Teeth and Gums is
available for $16 from Harvard Health Publications, the publishing division
of Harvard Medical School. Order it online at
http://www.health.harvard.edu/DHA or by calling 1-877-649-9457 (toll free).

This is an article by Maria Perotin that appeared recently in the Star-Telegram.

Tina Frost wept for days when she learned that she was about to lose every one of her upper teeth.

Then she steeled herself, got dentures, and tried for six years to ignore the discomfort and embarrassment that came with them.

Her dentist suggested replacing the fake teeth with dental implants, which would be fixed in her jawbone for a more natural feel. But the expensive treatment would have taken months, causing Frost to miss work for repeated appointments at the dentist’s office.

Frost passed on the idea until she learned last fall about a Fort Worth surgeon who is tapping computer-assisted technology to fit dental implants in just one visit.

Dubbed “teeth in an hour,” the procedure enabled Frost last month to abandon her dentures for good.

“I went home, and I had to make myself not eat hard food, because I felt like I had real teeth back,” she said. “It’s the best thing I’ve done in many, many years.”

Frost’s experience reflects a common dilemma for people who lose their teeth to decay or gum disease: While dentures are the cheapest, most common remedy, some users find them too loose or too painful to wear regularly.

For those patients, implants are becoming an increasingly popular—albeit costly—alternative. And some dentists expect the latest computer-guided approach to further boost their prevalence.

Dr. John Stella, the oral surgeon who treated Frost, said many people turn to implants after “their dentures end up in their kitchen top drawer.”

Stella, who has worked for years with traditional implants, said the computer-assisted technique devised by Swiss manufacturer Nobel Biocare could make the procedure attractive to “a whole new spectrum of patients.”

Although the widespread use of fluoride has improved Americans’ dental health, tooth loss remains a significant problem.

On average, U.S. adults are four teeth short of a mouthful. And about 8 percent of adults have lost their teeth altogether, according to the federal Centers for Disease Control and Prevention. One in 4 people older than 60 have lost all their natural teeth.

With so many Americans enduring tooth loss, implant sales topped $1.8 billion last year. And the market is expected to grow to $4.7 billion by 2012, according to a recent report from market research firm Kalorama Information.

Implants have become dentists’ preferred solution when patients lose a single tooth, said Dr. Kim Gowey, a Wisconsin dentist who is past president of the American Academy of Implant Dentistry.

The downside of replacing lots of teeth is the high price tag, he said, especially for the computer-assisted approach that can raise the cost as high as $30,000 for one jaw.

“I think the technology is great, and getting it done quickly is great,” Gowey said. “It costs more. But the advantage is, it’s boom, done in one visit.”

For Frost, 57, who spent upward of $13,000 for her choppers, implants have restored her confidence.

“It’s totally worth the money to me,” she said. “It’s really made a big change in my whole outlook.”

COMPUTER-GUIDED IMPLANTS

A dentist uses a computer-imaging technology to map the jawbone and determine where to place implants.

A drill guide allows the dentist to insert the posts without having to slice open the gums.

False teeth are prepared ahead of time, so they’re ready to be placed once the implants are in.

SINGLE-TOOTH IMPLANT

Is an alternative to a bridge denture anchored to adjacent teeth

Titanium implant is screwed into jawbone, heals in place after several months.

Titanium abutment is attached to implant.

Natural-looking crown is fitted onto abutment.

FULL DENTURE FOR ALL LOWER TEETH

Two types of full denture implants are available, relying on several implants to support an overdenture. Either may be more stable than a conventional denture resting on the person’s gums. One is fixed, and one can be removed by the wearer for cleaning.

TOOTH REPLACEMENT OPTIONS

Dentures

What are they: Artificial teeth that can replace an entire upper or lower jaw, typically made of plastic or porcelain. A dental adhesive is often used to keep them in place.

Advantages: Dentures allow users to eat and speak, and they support the facial muscles, preventing the sagging look that makes a toothless person look older. Prices vary widely but can be as low as $500 for one jaw.

Disadvantages: Some patients experience discomfort, such as a loose fit, irritation of the gums and difficulty chewing. That’s especially true with lower dentures.

Bridges

What are they: Also known as partial dentures, bridges replace one or more missing teeth with fake teeth. The device, which is attached to adjacent teeth for support, is usually made of metal, porcelain or a combination of materials.

Advantages: Bridges can be fixed or removable. They can restore your smile at less cost than alternatives.

Disadvantages: A dentist must grind down the adjacent teeth to sustain a bridge, so healthy teeth undergo damage that could otherwise be avoided.

Dental implants

What are they: Metal posts are inserted through the gums into the jaw, where bone fuses with the metal over time. A set of false teeth—either fixed or removable—can then be attached to the posts. At least two implants are needed to anchor a full jaw of teeth.

Advantages: Implants generally feel more natural and secure than dentures. When they’re used to replace a single missing tooth, implants don’t require the surrounding teeth to be damaged.

Disadvantages: A dentist has to cut a flap into the gums to expose the bone and place the implant, which can cause temporary swelling and pain. The procedure can take months to complete. Patients must have adequate bone to support the implant, so people with bone loss may need bone grafts beforehand. Implants are expensive, costing about $2,000 per implant in addition to the price of the artificial teeth.

Mini-implants

What are they: Smaller implants, typically used to stabilize a lower denture.

Advantages: They can improve the fit of conventional dentures. The procedure is much faster and less invasive than with full-size implants. They are also cheaper than traditional implants.

Disadvantages: Some dentists question the long-term effectiveness of the smaller implants.

Computer-guided implants

What are they: Like traditional implants, these posts are inserted into the jaw to anchor artificial teeth. A patient gets a CT scan that allows the dentist to visualize and plan the procedure. Computer technology is used to create a drill guide, which allows the dentist to position implants and false teeth in a single appointment.

Advantages: The drill guide allows a dentist to insert implants through small puncture holes, without cutting open the patient’s gum. As a result, the procedure is less painful, recovery time is shorter and a mouthful of teeth can be installed right away.

Disadvantages: The technology adds roughly $2,000 to the price tag. The procedure also calls for using several implants on each jaw, driving the cost higher than treatments that rely on fewer posts. Some patients pay as much as $30,000 for a single jaw.

Combination procedures

What are they: A variety of approaches combine dentures and implants. For example, a patient may wear traditional dentures on the upper arch and use implants to anchor the more troublesome dentures on the lower jaw.

Advantages: This strategy can be cheaper and require less surgery than relying entirely on implants.

Disadvantages: Recovery time varies depending on the specific treatment. The result may feel less sturdy than a complete set of fixed implants.