February 3rd, 2010
One of the goals in dentistry is to make the teeth look nice and natural, maybe even better than natural. So the search for white stuff to restore or replace teeth marches on. In all of recorded history, ivory has been used in various ways, but just like the industrial revolution, all of a sudden there has been an explosion of new products that technology has fostered.
We’re not talking gold, which has been around forever, just the tooth-colored materials and the latest developments, which we think are all that, but in ten years, who knows what we’ll have, unless the government tries to control dentistry, which would discourage any more innovation. Whew, check out that last sentence! I think my grammar teacher would have fainted.
Back in the 1930’s, they figured out how to bond porcelain over the gold and use silicate, or glass cement, to fill the front teeth. Those uses were very limited until after World War II, when they became much more prevalent. Incidentally, the use of plastics for fillings started after the war, and went into another direction. Many generations of improvements have produced the wonderful ceramic filling materials that we enjoy today. But let’s follow the evolution of the more aesthetic porcelain restorations that have attempted to recapture the natural beauty of our teeth.
The early porcelain-fused-to-gold (PFG) crowns were actually pretty nice, but they had two main problems. The porcelain fractured away from the gold frame, and they were super abrasive to the natural teeth. It was like chewing on sandpaper. In no time at all, the natural teeth opposite PFG crowns were worn down to the nerve. The only good solutions were to put PFG crowns on the opposing teeth, or make the biting surface out of gold, which defeated the purpose of using the porcelain.
Then came the porcelain-fused-to-non-precious metal (PFM) crowns. They are less expensive and because of the rigidity of the metal, there are fewer fractures in the porcelain, but they are just as abrasive, they look less natural, and many people are allergic to the metal, which is 62% nickel.
Until 1975, the idea of using porcelain without a metal substrate was unthinkable, because it would break immediately. It gets its strength from being bonded to something. But the advent of tooth bonding and laminated porcelain made it finally possible to make all-porcelain crowns. They were by no means a panacea, because there was still a lot of breakage and they were still too abrasive.
A series of refinements has produced more modern porcelain by using additives that make the traditional feldspar stronger and less abrasive. Ingredients such as Lucite and lithium disilicate have much smaller particle size, giving porcelains those superior qualities as well as a more translucent and natural appearance. These newer blends are categorized as “low fusing”, because they melt at a lower temperature. The old fashioned porcelain is still out there, so whether you get a porcelain-fused-to-metal or an all-porcelain crown or veneer, be sure to insist on a low fusing kind.
Is that all we’ve got? I thought you’d never ask. I saved the best one for last. The hottest thing out now is zirconia. It’s totally nonabrasive and unbreakable! Don’t make the mistake of using the brands that fuse porcelain over the zirconia, because the porcelain still breaks, but the homogenous porcelain-zirconia mixture is better, and pure zirconia is the absolute best. As I was placing one of those in a patient’s mouth, he asked me how durable it would be. I told him in all honesty that if a nuclear bomb went off across the street, all that would be left of him would be that crown.
Esthetically, zirconia is not very translucent, but on the back teeth, where you need the most strength, it looks perfectly natural. On the front teeth, which are not subject to as much stress, we like to use the more translucent types, which are more like your natural enamel, especially if you want to go for that extra bright white that’s so popular now.
Dr. Moulton’s article was published in the Desert Valley Times on
February 2, 2010.
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February 3rd, 2010
A little over a year ago, in an article about the use of bisphosphonates, I warned that we were just seeing the tip of the iceberg in the related incidence of osteonecrosis in the jaw (ONJ), and now, after more prolonged and widespread use, it seems that prediction is coming true. Bisphosphonates are a class of drug used to treat osteoporosis, mainly in women.
Initially, we were told by Merck and Company, a leading manufacturer of bisphosphonate drugs, that there was less than a one thousandth of a percent chance of developing ONJ with the oral version, such as Boniva, Fosamax, and Actonel, and why shouldn’t we believe them? However, a recent study at the University of Southern California School of Dentistry has shown that if an extraction is done on a bisphosphonate user, the incidence of ONJ jumped up to about 4.5 percent, 4500 times greater. According to Dr. Parish Sedghizadeh, director of the USC research center, “we’re getting two or three new patients a week that have bisphosphonate-related ONJ and I know we’re not the only ones seeing it.”
In that previous article, I explained the mechanism by which bisphosphonates make you very susceptible to bone disease and cancer, but to put it simply, they kill your bones. This makes them harder and more resistant to fracture temporarily, but the slightest infection can turn them to mush (osteonecrosis). The jaws are particularly susceptible to this problem because of the teeth. If you are considering taking medication for osteoporosis, be sure your dental condition is excellent first, and well maintained, and if while you are on bisphosphonates, you need an extraction or root canal, or have a gum infection or denture sore, quit taking it immediately. They say the bone damage might be reversible, but I’ve seen very little evidence of that, and I’m afraid after a certain point it won’t be.
Also, oral bisphosphonates have been linked to esophageal cancer. Dr. Diane K. Wysowski of the FDA division of drug risk management has received 43 reports of this cancer being caused from the medication, 35% of which have been fatal. They have long been known to cause esophageal inflammation. That’s why you are told to remain upright for a half hour after taking them.
These are just studies concerning oral bisphosphonates. For intravenous ones, such as Reclast, just multiply these statistics by ten. My recommendation is to find a more natural way to treat osteoporosis. Try prevention.com for good ideas, and ADA information on the subject can be found on their website at www.ada.org.
Dr. Moulton’s article was published in the Desert Valley Times, February 2009
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January 30th, 2010
Now that we have the most liberal Federal Government in the history of our country, they’re just salivating over all the different ways they can spend our money. And the biggest fiasco of all will be National health care. We already have the best health care system in the world. People come from everywhere to take advantage of the superior and accessible treatments that have been developed in the United States through free enterprise. However, in an effort to gain votes, politicians have used fear and enticement to sell people on “fixing” our system.
Unfortunately, that’s one campaign promise I’m afraid they will try to keep. So before we take our medicine, let’s consider what we could expect, by examining what the existing medical and dental insurance and government programs have done to those professions, and to the costs and quality of care borne by the participants.
Dental insurance became a significant factor in patient finances around 1970 in larger cities. At first, it was a considerable benefit, paying 80% of all charges up to about $2500 per year. If you take into account that costs are about ten times what they were in 1970, today that would be like having $25,000 in benefits every year. You couldn’t use it all if you tried! But even at that, there were complaints that dental insurance companies were making too much profit. They were collecting about twice as much in premiums as they were paying out in benefits. Consequently, the Insurance Commission made a rule that insurance companies could only keep 25% of the premiums for administrative costs. However, the CEO of the now defunct Pacific Union Dental Insurance Group confided in me that there were so many ways around that one, it wasn’t even funny.
So why can they collect many times more in premiums nowadays and be hard pressed to pay a meager average maximum benefit of about $1000 a year? To find the answer, just count the number of fingers in the pie.
The average dental office consists of a dentist, two assistants, and a receptionist. If a patient pays one hundred dollars, eighty of it goes to pay rent, equipment, supplies, labs, taxes, insurance, and payroll, and about twenty to the dentist. If a small insurance company is added into the mix, then part of that hundred dollars is used to pay premiums. The owner and employees of that insurance company are paid out of those premiums, with the remainder going toward actual dental benefits. The premiums from other insured members that don’t utilize their insurance that year can make up the deficit in benefits.
On a small scale, it works nicely, but as the insurance company grows and goes national, those premiums are quickly eaten up by more employees, big buildings, CEOs, VPs, executives, investor dividends, lawyers, consultants, advisors, company cars, company psychiatrists, data base management systems, stationary, postage, vacation pay, retirement pay, day care, office parties, waste, graft, fraud, lobbyists, taxes, and another list twice as long. There’s not enough left to pay decent benefits so they substitute double talk for benefits, and coerce hungry dentists into accepting less, causing service and quality to suffer, and one of the assistants to get fired!
So far we’ve been talking about administration woes associated with the implementation of large plans, but when you move from private dental and health care plans into government programs, there are other factors that make national health care an entirely different animal. With dental and medical insurance, do the employers pay your premiums out of the generosity of their hearts? Of course not. It comes out of your salary, which seems fair. You might think it would be the same with the government, but there’s one fatal flaw. A huge portion of the population isn’t paying their premiums. The working stiffs are footing the bill and the liberals are taking the credit, while villainizing those “rich” people in order to quell any pangs of conscience anyone may have about getting something for nothing. Well, the real joke on everyone is that that ‘something’ IS nothing!
Let’s use the example of the “charity” funds to illustrate. Those organizations solicit money from well-meaning people for this-and-that cause, but the recipients only end up with from 20% all the way down to 3%, depending on the size of the fund; the bigger ones keeping a higher percentage. Even though the government is vastly larger and more inefficient than any private enterprise would ever be, we will give those people who brought us the $4000 hammer and the $6000 toilet seat, the benefit of the doubt and say that 3% of the cost might trickle down to the facilities and personnel that are actually giving the medical care.
At that rate, for every million dollars used, about thirty thousand will actually go towards any kind of treatment; about the cost of a gall bladder and double hernia operation. In order to support even the worst of medical systems, (which is what it will be), economists have estimated a cost to taxpayers of about two trillion dollars a year; about one seventh of the gross national product, which is about 30 times what we currently spend on healthcare! To put that in perspective, in only five years it will have cost as much as every war in the history of this country! It will make every bailout and stimulus package we have ever done seem like a tip for your waitress. It’s like taking out a bigger credit card to pay for your last one, and you know where that leads.
That’s just the tab though. The real cost will be the downfall of our ability to access quality medical care. There will be no money left to provide it, no rapport between patient and doctor, no accountability by the providers, and no ability to find your own private practitioner. If you can get through all the red tape and beaurocracy of a system so complex it will make a dinosaur like Medicare look like a gazelle, and if you live long enough before you’re able to get an appointment, the person you will be assigned to will be some sort of tech rather than a doctor. The few doctors that are left will probably be reserved for the politicians when they realize what an abject failure this system will be, just like social security and the misappropriation charges right on the heels of the latest bailout. Instead of people coming to America for decent medical care, we will have to go somewhere else.
If you think this sounds a little extreme, I assure you I’ve been breaking it to you gently. At this point, we are pretty much at the mercy of this administration. All we can do is just not go quietly into that night.
Dr. Moulton’s article was published in the Desert Valley Times, January 2009
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December 18th, 2009
Most people consider braces a cosmetic endeavor, but that’s actually about third on the list. Function and hygiene are actually the most important reasons to use orthodontic correction. If the bite is incorrect, it can have far reaching consequences in the ability to chew, the muscles in the face and neck, the temporomandibular joint (TMJ) that hinges your jaw, and even in the spine. If the teeth overlap incorrectly, that can also cause entrapment of debris and tartar between the teeth, making it much harder to clean and causing an increase in decay and gum disease.
Only after those other considerations can we dwell on the cosmetics. However, it just so happens that the correct functional and hygienic alignment of the teeth is also aesthetically pleasing, so the cosmetic result just becomes a byproduct of the other corrections.
Once we have our priorities in order, we can decide on the methods. Traditionally, the thought of braces brings to mind a mouth overflowing with wires, brackets, and bands. When I was a teenager, it was kind of embarrassing to be a metal mouth with a tin grin, but today, some kids think it is a bit of a status symbol; just like in some countries it’s a sign of affluence to have a big gold tooth in the front of your mouth.
However, there are some serious drawbacks to all that hardware. It causes a tremendous hygiene challenge, can injure the gums and roots, cause decay and staining of the teeth, and although some kids think it is cool, others, and especially the adults, would rather not go through all of that. In some cases the brackets are necessary, but most of the time invisible braces are the best choice.
Invisalign has developed a system that effectively produces orthodontic corrections with minimum time, expense, and discomfort. It consists of a series of clear trays, or aligners, that fit over your teeth and gradually move them into the correct positions. They look great, they’re more comfortable, and they’re removable so you can eat, brush, and floss much more effectively. These are benefits that kids and adults alike can appreciate. One concern is that braces can throw your bite off, but the Invisalign trays are computer generated, so the finished bite is correct to within one hundredth of a millimeter.
Behind the scenes, the dentist must be trained and certified with Invisalign, and we work with one of their orthodontic specialists to collaborate on the best course of treatment. So if you’re thinking braces, your choice may be clear!
Dr. Moulton’s article was published in the Desert Valley Times, January 2009
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December 11th, 2009
In today’s financial climate, everyone is boarding up their windows for the storm. Budgets are tightened and spending is restricted to the essentials. At the store, we stick more to the necessities and look for bargains. We are cutting back on travel and entertainment and other things we can get by without. Rent, utilities and taxes are unavoidable, but what about healthcare?
Personally, I rate healthcare very high in the list. You might suspect that I am a little prejudiced on the subject, but few things are as important to me as the health of my family. Dental care is definitely as important as ever. However, here are some tips that may help you budget this necessity.
Number one in anyone’s book would be prevention. Dental insurance is generally pretty worthless, but why do you think they usually pay 100% on exams and cleanings? It’s because they are trying to save money! Statistics show that dental treatment is much less complicated and expensive if you discover the problem early, and the cleaner and healthier your gums are, the fewer problems will arise. So for you, the way to save money is to get in for your regular exams and cleanings. Healthy gums have even been shown to save on your medical needs, and any dental problems that occur within a year are usually minor. A typical example is a small cavity that might cost $150 to fix, but if you wait long enough, it may need a root canal and crown for $1500, ten times as much.
Don’t forget that home care is also a preventive activity. Diligent brushing and especially flossing make a bigger difference than anything else, but they can’t compensate for smoking. One more note on prevention: Start your children out early. In addition to discovering problems early, the child becomes more comfortable with seeing the dentist and may not need to see a specialist down the road. To help out, we provide all treatment at no charge to any children three years and younger.
For those that need a lot of dental work, take some tips from the consumer’s guide: 1. Shop around. I encourage my patients to get other opinions. It’s in their best interest to find out as much as they can about their condition, and methods and fees could vary quite a bit. 2. Get financing options. We have several programs that allow patients to finance up to 24 months with no interest, or longer with interest. Health savings accounts can also be used for dental expenses. Another suggestion is to be conservative. Find out if there are any simpler options, and take time to consider them or discuss them with your spouse. For instance, a tooth with a chip or crack is often scheduled for a crown. Ask if it is possible to get by with a white filling for a while. The ceramic filling materials available now are much more durable than they used to be, and they are bonded to the teeth, leaving a stronger finished product. Plastic veneers cost about a third as much as the porcelain. A removable partial denture might be used instead of fixed bridges or implants. Although these solutions may not be ideal, they are much less expensive, and they don’t interfere with your ability to upgrade later. Finally, don’t panic! Every economist will tell you that prosperity is a state of mind. If people are afraid, they sell their stocks and pull their money out of circulation. That creates a self-fulfilling result. The decline of the stock market is simply the result of everyone selling out, and it’s being fueled by all the politicians trying to scare people into socialism. I suspect it will settle down as soon as we do another type of cleaning: a political house cleaning!
Dr. Moulton’s article was published in the Desert Valley Times, October 2008
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December 11th, 2009
The waiting game is a dangerous game when it comes to oral cancer. It’s the reason why oral cancer is the only type of cancer that has not seen a decrease in death rates for decades. 34,000 Americans are diagnosed with oral cancer each year and over half of those die before 5 years. For those not familiar with calculus, that’s more than 8,000 deaths per year. That is a higher percentage than many other cancers combined.
If you wait until the signs and symptoms become obvious, it may be too late, so early detection is the critical key to survival. Most people assume that this is a smoker’s problem, but the middle-aged non-smokers have the fastest growing oral cancer rate of all.
About one out of every 25 Americans have a dysplasia, or precancerous lesion at any given point in time. It could be a small red or white spot anywhere in the mouth, the cheeks, lips, gums, tongue, or palate. They’re like small cancer seeds. They usually slough off, but if they take root by gaining a blood supply, then they become dangerous. If they develop under the skin, they can be even harder to detect.
You can observe signs yourself, if you look carefully. The most common start is a small red or white spot or sore. It may bleed easily or never seem to heal. Other signs include:
A color change of the oral tissues
A lump, thickening, rough spot, crust or small eroded area
Pain, tenderness, or numbness anywhere in the mouth or on the lips
Difficulty chewing, swallowing, speaking, or moving the jaw or tongue
A change in the way the teeth fit together
However, these signs may be difficult for you to find or discern. That is why it is so important to have your dentist check for you regularly. We include a complete cancer screening as part of our yearly dental exams, using a special fluorescent light to help detect any lesions. Then we do a simple brush test to send any suspicious findings in for a lab analysis.
This is the most effective way to combat oral cancer, because if you catch it early, the treatment is usually easy and successful, so the time to start is now!
Dr. Moulton’s article was published in the Desert Valley Times,
September 2008
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December 2nd, 2009
In this age of disposable everything from diapers to cell phones, baby teeth, also called primary or deciduous, are even considered disposable by some people. There is a growing attitude that since they are destined to be eventually lost, it doesn’t matter what happens to them along the way. However, nothing could be further from the truth.
There are 20 baby teeth in all that start to appear from 0 to 2 years old and systematically disappear from age 6 to about 13. Each one has a corresponding permanent tooth that develops underneath it, dissolving the baby root. During that time the permanent molars come in further back as the jaw grows larger to accommodate more and bigger teeth. That’s in an ideal world, but as you know, life never works out as planned. Besides accidents and decay, other problems, such as misalignment and developmental abnormalities can arise. I like to take every opportunity to remind parents about a common condition called baby bottle decay that occurs in children under 4 years old. If your baby uses a bottle or a sipper cup between meals, make sure it contains only water. Other types of drinks, even juice and milk, will cause decay to run out of control as the teeth are constantly bathed in nutrients that feed the bacteria. Because of this and other developmental problems that are so critical at that early age, we offer to provide all treatment of any child under 4 years old, at no charge as an incentive to give them a good start in life.
During the life of the baby teeth, the most frequent question we get about their care is whether it’s really necessary to treat them if they get cavities. I try to only treat them if they pose a potential hazard. It’s kind of a race between whether the tooth will be lost first, or the cavity will be a problem. Basically, if the child is 6 and has a cavity on a baby molar, then we need to fill it, but if the child is 11 or 12 and the cavity is small we usually let it slide. There are other mitigating circumstances of course, such as infection, the potential for the decay to spread to other teeth, and the need for space maintenance, but a more conservative approach is more in keeping with my mission statement: “If it ain’t broke, don’t fix it!”
Dr. Moulton’s article was published in the Desert Valley Times, August 2008
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November 25th, 2009
This condition is on the rise in our country with almost a third of all people suffering from it in one form or another. Most don’t even realize that it is usually treatable, so they suffer through it, eating on the other side or drinking through a straw. Although it’s generally considered benign, it can have far-reaching effects on the individual, not the least of which is a decrease in the quality of life.
There are many possible causes for tooth sensitivity, and very often an individual will have a combination of these. Let’s start with what happens in every case: the nerves of the tooth or teeth are being irritated, making them inflamed and hypersensitive to stimuli such as temperature, touch, or pressure. This is usually done through exposure of the inner core of the tooth, the dentin, which covers and protects the nerve. It’s a hard, calcified substance which contains nerve endings and is covered by another layer called enamel, an even harder calcium crystal.
If the enamel layer is lost through wear, erosion by acid, abrasion, fracture, or decay, then the underlying dentin can be exposed or injured. Also, the enamel only goes down to the gumline, so if the gums recede, that can expose the unprotected dentin in the root area. If wear is the cause, you can correct the bite, resurface the teeth and patch up the gumline grooves. Decay, abrasion and fracture have their remedies, but the most complicated solutions arise when dealing with erosion and gum recession.
Acid erosion is one of the main causes for the increase in tooth sensitivity. Acid reflux is definitely a cause for concern, but in general, take a look at what you drink. The diets in our country continue to contain more and more acidity due mainly to beverages. In order of increasing acidity, they are: fruit drinks, tea and coffee, sodas, sport drinks such as Gatorade, alcohol, and energy drinks being so off the scale they are a serious health hazard. You’ve seen those old movies where the villain throws the victim into a vat of boiling acid, and after the thrashing around, the camera pans in on a skeleton. Well if the villain had used Red Bull in his vat, there wouldn’t even have been a skeleton left. These constant acid baths gradually eat away your enamel, exposing and irritating the dentin. Treatments may include remineralizing the enamel and potassium nitrate toothpaste, but the best treatment is to just stick with water.
The other main cause for the increase in tooth sensitivity in the U.S. is gum recession, exposing the root surface. Here it is important to eliminate the underlying cause which is gum infection, and the use of sealants can be very effective in treating the exposure.
However, there are many other possible causes for tooth sensitivity, such as neuralgia, inflammation or infection of the nerve, cracks, leaking fillings, recent dental work, tooth whitening gels, abrasive toothpastes and even electrical currents created between teeth containing metal. That’s why it’s important to have the cause diagnosed and don’t give up hope that something can be done for that sensitivity.
Dr. Moulton’s article was published in the Desert Valley Times, August 2008
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November 18th, 2009
According to the American Dental Association, an updated clinical practice guideline on smoking cessation was recently released by the U.S. Public Health Service. The new guideline identifies new counseling and medication treatments that are effective in helping people to quit smoking.
A 24-member, private-sector panel of leading national tobacco treatment experts developed the new guideline. Their information was gathered from more than 8700 research articles that were published between 1975 and 2007. They have found that seven medications approved by the Food and Drug Administration have dramatically increased the success of quitting:
bupropion SR
nicotine gum
nicotine inhaler
nicotine lozenge
nicotine nasal spray
nicotine patch
varenicline
There was also evidence that counseling by itself or in conjunction with medication can increase the success rate. One of the most popular forms of counseling is through a quitline, such as 800-QUIT-NOW. It connects callers to programs within their state, and is easy for doctors and patients to access.
Dr. K. Vendrell Rankin, a professor at Baylor College of Dentistry, served as a reviewer for the guideline. “As a dentist, teacher and tobacco treatment specialist, I believe that one of the most significant additions are the principles of motivational interviewing—express empathy, develop discrepancy, roll with resistance and support self-efficacy,” said Dr. Rankin. “We know that patients don’t walk into the dental office ready to quit smoking or chewing tobacco, nor are they equipped to do so with only the aid of a prescription.” Dr. Rankin also expresses the importance of motivating, not lecturing, the patient who may want to quit smoking.
Other recommendations include:
Dentists and doctors should be asking their patients of they smoke and offering counseling and other treatments to help them quit.
If a patient is not ready to quit, clinicians should focus on motivational treatments that will promote future attempts to quit.
Counseling, whether it is individual, group, or over the telephone is effective, and should include practical counseling and social support.
Counseling treatments are now recommended for adolescent smokers as they have been shown to be effective.
The 2008 PHS guideline update and a consumer guide are available online at www.surgeongeneral.gov/tobacco/default.htm. You can also request a copy of the 2008 PHS guideline update by calling the Agency for Healthcare Research and Quality at 1-800-358-9295. To find out more about the latest resources for tobacco cessation, log on to www.ada.org/goto/quitsmoking.
Dr. Moulton’s article was published in the Desert Valley Times, August 2008.
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November 11th, 2009
Last week we talked about root canals, but what are your options if that’s not possible or desirable? Actually, the only alternative if the nerve has died or become infected, would be to remove the tooth. So the real choice is what to do with the space once the tooth is gone.
This is probably one of the most difficult dental choices people face. It’s difficult to lose the tooth in the first place, but then what do you do? There is the Zen choice of course, called the no choice. You wake up five years later and that space is still there.
Unfortunately, it is usually not that simple. The other teeth gradually collapse into that space from the sides and from the opposite arch, causing an increase in the tendency for decay and gum disease because of their unnatural relationships. There is a loss of function and comfort in the affected area, and a general malocclusion from the change in the way the teeth bite together. This in turn increases the muscular tension around the temporomandibular joints, causing premature arthritis, headaches, and cervical spine misalignment. It’s a cascading effect that seems very far reaching and maybe a little far fetched.
But these are very real consequences. The sneaky part is that it happens so gradually, like the old boiling frog adage. It’s like after three or four years you wonder why you hear a crunching noise when you open your jaw, or why you get those tension headaches.
There are some priorities, however, when considering whether to replace a tooth. A wisdom tooth of course is virtually disposable, and although it’s recommendable to replace any lost second molars, I must admit the loss in function and the shifting in the other teeth is minimal. But the first molars bear more stress than any other tooth, so replacing those or anything forward is an absolute must. And there is also the obvious cosmetic concern if the space is visible.
You usually have three basic ways to replace a missing tooth. The first is a removable partial denture. Although it’s the least expensive and it will maintain the correct relationship between the teeth, it’s not very functional or comfortable, or natural looking. It’s also a little overkill for one or two missing teeth, and is more useful when there are more spaces than teeth.
The second choice is a fixed bridge. This typically consists of two crowns that have the replacement tooth fused between them. The one piece ceramic construction can be computer generated for unparalleled accuracy. It is permanently cemented in place for a completely natural appearance and function.
The third choice is a dental implant. It is a titanium post coated with calcium that is very biocompatible. It functions like a root, and then a crown is attached at its surface. It is as close as you can come to a natural tooth.
The cost and appearance are similar for the bridge or the implant, but there are other pros and cons that may influence your choice. Although the success rate is better for the implant, it can take up to eight months after the extraction to finish, whereas the fixed bridge can be done much sooner. Whatever the choice though, it is much better for you in the long run to replace a missing tooth.
Dr. Moulton’s article was published in the Desert Valley Times on November 10th, 2009
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