Got a tooth question? We have answers!

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toothHey, friends, I’m back.  This time with a slew of questions from all of YOU about your teeth.  Last Sunday on the radio broadcast we talked about dental topics  – something I don’t do very often.  I don’t talk about the teeth much because basically in medical school we learn exactly NOTHING about teeth.  Happily, HCMC (the health care system that employs me) has a terrific group of dentists and oral surgeons.

On the show, we intended to talk about dental implants and other oral surgeries. Eventually, we did do this.  But I, of course, had other insightful and probing questions for my guest (oral surgeon Louis Christensen) – questions like:

  • “Why are they called ‘wisdom teeth’?”
  • And maybe more to the point, “Did I get dumber when I had my wisdom teeth yanked out?”

I think the correct answer to the first questions is “nobody knows” and the answer to the second question is “Yes.

Dental implants are really cool if you are a hockey player.  Or even if not a hockey player.

Christensen studioFortunately, listeners to the show had questions that were much more en pointe, as they say.  We learned cool stuff from Dr. Louis Christensen (that’s him in the picture) who joined me early on a Sunday morning in the WCCO studios in downtown Minneapolis.  He’s an oral surgeon who does surgeries not only on wisdom teeth, but he does dental implants, jaw reconstruction, face reconstruction (oh my!) and lots of other work to keep our teeth and faces in top shape.

As is often the case, though, we didn’t get to cover all the questions people had, so in this post we’ll try to answer some.  If you missed the show, you may want to check out the podcast here.

So if you cornered an oral surgeon at a cocktail party, what would you ask?

Sending questions via text message is a popular way to ask questions during our live show – but we get dozens of text questions and we just don’t have time to get to them all!  So I asked Dr. Christensen to give really brief responses to some of the questions that were sent in via the text message line.  He did just that, and below are his responses to some dental questions.  Sort of like we cornered him at a cocktail party and started peppering him with questions!

Here are some a) questions from real listeners, b) Dr. Christensen’s answers and c) some of my (Dr. Hilden) comments.  Here we go  . . .

Q:   When you do a bone graft for dental implants, where does the bone come from?

Dr. Christensen:     “Bone can come from synthetic sources, cadavers, animals (obviously undergone sterilization) and one’s self.  The amount of bone need dictates the source.”

Gilbert Stuart [Public domain], via Wikimedia Commons

Gilbert Stuart [Public domain], via Wikimedia Commons

My comments:  We learned on the show that dental implants have come a looooong way since, say, George Washington.  (You know, wooden teeth and all?  Actually I learned that the 1st Prez never had wooden teeth – they were made of bone and ivory and such.  Another myth debunked).

But seriously, implants can replace a missing tooth anywhere in the mouth.  They are placed by putting a metal, usually titanium, pin into the bone and then the tooth is affixed to that pin.    Sort of like the footings on a fence post that are anchored into the ground.  These are my words as a total non-dentist, but it helps me to visualize it.  So the implant is anchored into the bone of your jaw or face.  It can be done really quickly.  In some cases – a new tooth can be implanted in a single day!  Hockey players, there is hope!

Q:   Does Fosamax use affect future use of implants?

Dr. Christensen:     “Yes, Fosamax can affect one’s ability to get implants.  Just like getting a tooth out, placing an implant poses a risk for the bone to not heal.”

My comments:  This is a subject we talked about on the radio broadcast – that being the risks of certain medications, called bisphosphanates, on the health of bones.  I don’t mean to pick on Fosamax (which is the brand name for alendronate).  It and the other bisphosphanates are really helpful medications for patients with conditions ranging from osteoporosis to cancer.  But there is a particular issue with the jaw bone, which can be damaged by these medications which in turn can make pulling teeth and getting dental implants rather dicey.  To hear more on this subject from Dr. Christensen, listen to the podcast of last week’s show.

Q:   Why are dental implants considered cosmetic and so often not covered by insurance?

Dr. Christensen:     “Insurance plans are individualized; some insurances are covering dental implants.  Patients would need to contact their insurance.”

My comments:  Insurance issues are a bit of a sore spot with me (and lots of doctors).  I am frequently baffled by insurance issues.  I know it is possible because I have awesome dental insurance but that may not be the case for everybody.  Teeth are so important to our well-being, and yet getting coverage for procedures which are potentially life-altering, such as implants, can be difficult.  I think it is a feature of our health care system in general; how we choose to pay for our medical (and dental) care in this country.  One listener to the show, after hearing us talk about the cost of dental procedures, sent a text message to me which essentially chastised me for making light of the subject.  I felt bad that I came across that way.  I actually long for the day when we all can get the health care we need and deserve without having to check our wallet first.

Q:   My dentist recommended a root canal, but I’m not having any pain.  Why get the root canal?

Dr. Christensen:     “Root canals are recommend for teeth as an effort to save them.  Usually teeth recommended for root canals have had a history of cavities and have hurt previously.  Always better to treat something before it becomes painful.”

My comments:  Most of us would rather gnaw our own arm off that get a root canal.  So I can relate to the person who asked this question.  Hey, my tooth isn’t hurting (yet) so why go through the root canal procedure?   But the purpose of a root canal is to save a tooth from future problems.   I never realized that the root canal may be your ticket to preventing having to have the tooth extracted (pulled) in the future.  This is the branch of dentistry called endodontics.  Also something I didn’t know.  I get the various dontics confused.  Orthodontics.  Periodontics.  Endodontics.  Lots of specialization in dentistry, eh?

As an aside, I think the endodontics – the root canal people – have an image problem since in looking into this subject I found out that they actually launched root canal awareness week some time ago.  It’s on their website.  I’m not kidding.  Hey, everybody, it’s root canal awareness week – let’s par-tay!

Root canals are so ripe for jokes I just can’t resist.  But hey, it could save your tooth!

Q:   I have lots of cavities over the years.  Is it possible that wisdom teeth that are still in place are spreading infection to my other teeth?

Dr. Christensen:     “Multiple cavities throughout the mouth are unlikely to be caused by wisdom teeth.  An evaluation by a general dentist is always beneficial.”

My comments:  So I gwisdom toothuess you can’t blame your wisdom teeth for the decay in the rest of your teeth.  I can almost hear Dr. Christensen saying – even though he didn’t actually say this – that we should all brush and floss a bit more faithfully.

See the wayward tooth in the lower left of this x-ray?  That’s a molar (wisdom tooth) coming in all kiddywampus.

Years ago I told a dentist friend of mine, back when I was youthful and reckless, that I didn’t regularly floss and that my dentist was none the wiser for it.  He replied that dentists can tell when the guy sitting in the dental chair is telling a fib – I guess the decaying gums are a dead giveaway in the non-flossing patient.  So do like your mom has been telling you for, like literally your whole life.  Brush and floss.  Every day.  Two or three times every day.  Just do it.

Q:   Why do my teeth hurt when I eat cold or hot?

Dr. Christensen:     “I would recommend an evaluation by a general dentist if your teeth hurt when eating/drinking hot or cold liquids or foods. There are multiple causes for temperature sensitivity.”

My comments:  I echo Dr. C’s advice on this one.  If eating hot or cold foods is actually hurting your teeth then you should go see your general dentist.  It could be anything from worn away enamel (maybe from grinding your teeth, for instance) to exposed nerve roots from gum disease, to caries (dental-speak for cavities), to loose teeth.  There are lots of possibilities.  This is a good reason to see your dentist.

So that’s our dental lesson for the day.  I really appreciate the advice of Dr. Louis Christensen and your time in checking with us on MyHealthyMatters.  And for putting up with my wise cracks.   Got a comment?  Enter it below.  And remember, subscribing by e-mail is simple – you can also do it below this post or up above.  I promise not to flood your in-basket with lots of junk.  Give it a try!

David

As always, whenever we give medical advice on Healthy Matters, either on the radio show or in this blog, please know that by necessity we can only give general advice.  None of what you hear or read should be taken as specific advice for your own situation.  For that, please see your own doctor, or in this case, dentist.

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13 Responses to Got a tooth question? We have answers!

  1. Mark says:

    Hey there,
    Very helpful post. Thanks.
    i’ll take my dad to the get dental implants as he is 75 now.Anything I should pay attention to?

  2. healthymatters says:

    Great idea for your dad! The only things to think about are his current medications – especially to know if he is on a class of medications called bisphosphanates. These are medications for osteoporosis and/or cancer and can lead to problems in the jaw bone around the time of implants. Other than that, I think it is a great idea! Thanks for checking in. David

  3. You do need more than just missing teeth in order to get dental implants. As said in the article, the implant is put into the bone of your jaw, so your jaw has to be able to hold the implant. Some diseases like periodontal actually eats away at the bone they put the implant into.

  4. healthymatters says:

    You are so right – great points! As a doctor, I know relatively little about dental health, so I’m learning a ton about teeth, implants, gum disease, and so forth through these recent conversations with my colleagues in dentistry and insights from people all over – like you. Thanks!
    David

  5. This is some really good information about dental implants. It seems like it would be a good idea to to ask about bone grafting if you are thinking about getting them. My grandmother has lost a few teeth, but she isn’t sure if she should get implants because her jaw is so weak. It seems like it would be smart of her to talk to her dentist about dental implants and if her bone is strong enough for it.

  6. healthymatters says:

    Really good points for your grandma. I didn’t know, before talking to my oral surgeon colleagues, about the need for strong jaw bones prior to implants. Bone grafting is a sorta big deal, though (at least I think it is!) and so would be great for her to talk to an expert. Thanks for posting! -David

  7. It is too bad to see that implants are not always covered by insurance. I can see how they are a cosmetic procedure though. They are there to improve and beautify your smile. Therefore, it is considered cosmetic. But, it is too bad that they are considered cosmetic! It would be wonderful to be able to fix your smile without paying so much money!

  8. healthymatters says:

    I’m with you. But I do think it is more than cosmetic to have good functioning teeth. Ah, the health care payment system, ain’t it grand? Thanks for posting, Kendall! David

  9. Luke Smith says:

    Great comparison between a dental implant and the footings of a fence post, it really helped me understand what exactly happens during a dental implant. My Mother is missing quite a few of her teeth at this point, but she’s very concerned about dental implants and how effective they are. Maybe I should use your joke about George Washington’s wooden teeth (I can’t believe that’s not a thing!) to help her come around. I imagine implants today are a lot more comfortable and easy to care for than we might think as well, I bet if it’s done correctly you wouldn’t be able to tell it from a regular tooth. It seems like choosing a good practioner to install it might be the key, so I’ll have to talk with her about that.

  10. healthymatters says:

    The fence post metaphor works for me! You should have her look into it. Things have come a long way since George Washington! Thanks for checking in! David

  11. S. Kadali says:

    I needed a bone graft for my dental implant which I had done a couple of years ago. It adds up the total treatment time and the cost, but I don’t think there’s a way to avoid it if you want a permanent solution. The reason I needed the graft was because I had a baby tooth that just never fell out (till eventually at 25 when it started getting loose), so the permanent tooth was growing outward for years. But it never hurt so I didn’t do anything about it.

    So my choice was to have the baby tooth remove and wear braces for probably 2 years to move the perm tooth down (no guarantees if it would stay there) OR have them both removed and put an implant in. I chose the implant, but of course removing the teeth didn’t leave enough bone so they had to put a graft in.

    Lesson for anyone reading: If you have dental abnormalities growing up, take care of it when you’re young or it’s going to cost you thousands of dollars PER TOOTH later in life!

  12. It’s interesting to hear what an actual dentist/oral surgeon has to say about dental implants and root canals. Like most people, the idea of a root canal is something that I would rather put off. I have also wondered why you would get one if your tooth feels fine. The fact that you are trying to save the tooth before any pain is felt makes a lot of sense. However, I’ve heard that they don’t always work. Would it be better just to get an implant?

  13. David Hilden, MD MPH says:

    Hmm, not sure, Kairi, but you bring up a good question. I’ll think I’ll ask my dental colleagues. I bet they would say try to save the natural tooth first (with a root canal – yikes) and then go to an implant. I’ve never had a root canal but it doesn’t sound fun.

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