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Dr. Thomas

Should I Switch Dentists During My Dental Implant Procedure?

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I had two teeth extracted for dental implants– number 5 and number 7. I’ve already had the extractions and had the implants placed. The dentist placed Maryland Bridges as a temporary replacement, while the implants sites heal. My problem is two-fold. First, since he’s placed them less than two weeks ago, they have fallen out four times. This has given me considerable doubts about his ability to complete this case well if he can’t even get the temporaries to stay on. It may be necessary for me to switch dentists. Second, I’m not even sure if you can switch dentists in the middle of a procedure. If I am, is it possible to get some of my money back? I’ve paid over $10,000 in full for all of this work so I’m not sure if I’d even be able to afford to switch dentists if I need to shell out even more money.

Carol

Dear Carol,

dental implants

I agree with you that your current dentist seems in over his head. There are a couple of reasons for this. First, is his choice of a “temporary” replacement.  Second, is his lack of understanding of how to place it.

Let’s start with the temporary replacement. A Maryland Bridge attaches the crown to the adjacent teeth with either metal or ceramic wings. This requires structural changes to the adjacent teeth in order to get the bridge to stay. In my mind, anything that permanently changes tooth structure is not a good temporary replacement.

A better option would be a dental flipper. Not only does it NOT affect any of your teeth, but it is also a lot less expensive than your current replacement option.

Maryland Bridge tooth preparationIn order for a Maryland Bridge to stay in place. the wings are etched and the backs of the adjacent teeth are etched. From there a composite bonding material is placed to keep them together. Almost always a small notch has to be made in the tooth to help with retention.

If the bridge falls off, it means there is either a flaw in the design, the technique, or both. Whichever it is needs to be repaired and the metal re-etched by the lab. It doesn’t sound like your dentist knows what the problem with retention is let alone how to resolve it. So, yes, you need a new dentist to finish off your dental implant procedure.

Switching Dentists Mid-Procedure

First, you should know that your dentist is ethically obligated to cooperate with you when you decide to switch dentists. This means he should provide the new dentist all the information, including the diagnostics done in preparation for the procedure.

As for your payment. He will owe you a refund on your bridge as well as the implant crowns. Those haven’t been provided yet. So, this will enable you to afford the remainder of the procedure with the new dentist.

Placing dental implants is a rather advanced procedure and I don’t have much confidence in your current dentist. It may be a good idea for you to have some more diagnostics done for your new dentist to look at the implant placement before the crowns are placed. The dental flipper can be provided immediately.

Aesthetic Considerations

I don’t know if your dentist mentioned that whatever color your implant crowns are made with is permanent. Because of that, I always recommend patients who are considering teeth whitening get that done before placing the crowns. This way you can match the crowns to the whiter color.

If you wait until after the crowns are made, your teeth will whiten but not the crowns. This will mean you’ll have to replace them to get them to match the rest of your smile. You’ll save money doing any whitening ahead of time.

This blog is brought to you by Sugar Land Dentist Dr. Siny Thomas.

 

Can I Just Take Antibiotics Until I can Extract the Tooth?

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I have a tooth that I am sure is infected. I don’t have time to deal with it right now as we are about to leave for a family vacation. I do have some leftover antibiotics and am sure I can get my doctor to call in another prescription. Then, when we get back, I’ll have the tooth extracted.  Is there a preferred antibiotic for this?

Douglas W.

Dear Douglas,

Man grabbing his tooth in pain.

I want to make sure you understand that antibiotics will not “heal” an infected tooth. The infected tissue has to be physically removed. I think you’re planning on doing that with an extraction. You should know you do have an option that will save your tooth, called a root canal treatment. This is a procedure where the dentist goes into the tooth canals with a tiny instrument to take out the infected pulp. It is always better to save a tooth whenever possible. This is because of the danger of root resorption.

What an antibiotic can do is sort of hold off an infection until then. How long they hold it off varies on the infection. Bear in mind, tooth infections are considered a dental emergency for a reason. If the infection grows too rapidly, it can become life-threatening. Think about how close your jaw is to your heart, lungs, and brain, you can see that you don’t want to let the infection spread.

There is a danger that you take your antibiotic and in the middle of your family vacation the infection blows up and you end up in the office of a strange dentist you don’t know while your family flounders on without you.

The better plan is to go ahead and get a root canal treatment before you go. This is a much easier procedure than a tooth extraction.

If It Comes to an Extraction

if it does turn out that the tooth can’t be saved, there are other considerations. First and foremost is the tooth must be replaced. If you don’t, the nearby teeth will begin to shift or tip into the spot. This will throw off your bite. When this happens, you’ll begin to experience jaw pain and it can even lead to migraines and TMJ Disorder.

There are quite a few tooth replacement options. The best replacement is a dental implant. This has a prosthetic tooth root that is topped by a dental crown. Having a dental implant is the closest thing to having a healthy, natural tooth in your mouth again.

Another option is a dental bridge. This suspends a false tooth between dental crowns. The downside of this is it requires two healthy teeth to be crowned. You may not want to do that.

Finally, there is a removable partial denture or a dental flipper. Both are removable. The latter is generally used as a temporary replacement option while you’ are waiting on something better like a dental implant.

This blog is brought to you by Sugarland Dentist Dr. Siny Thomas.