When you miss or delay dental treatment, existing problems may progressively worsen. Infections get bigger. Cavities get deeper.

Gum disease spreads from tooth to tooth throughout the mouth. Bone loss can occur. Teeth and dental implants can get bone loss. Dental implants can move due to bone loss. The good news is that all of the aforementioned problems can be avoided.

Make it a top priority, in 2012 and beyond, to invest in strengthening your health.

It will benefit you to follow your dentist’s recommendations. If your bone, gums or teeth feel different than usual, then it makes really good sense to make an appointment to see your dentist. Over the long haul, it’ll save you significant time and money.

All the best to your success!

Dr. Joe Kravitz
Prosthodontist, Author and Speaker
Maryland, Washington DC, Virginia

A loose retaining screw for a dental implant abutment may yield a mechanical clicking sound. Your fingers can detect the metallic screw clicking inside the dental implant.

This is easily remedied. Visit with your dentist and request that he or she tighten the abutment screw. It’s really that easy :)

Don’t wait three months. Call the dentist immediately to fix the loose screw. Any delay in treatment may cause the thread of the dental implant abutment screw or the dental implants to distort and cause failure.

Remember that early detection helps to minimize more complicated dental treatments. Visit the dentist soon to keep your smile healthier!

All the best to your success,

Dr. Joe Kravitz, DDS, MS
Prosthodontist, Author and Speaker

The dental implant abutment is required to fasten your new tooth or teeth to the submerged dental implant.

The dental implant abutment comes either pre-made from the dental implant manufacturer or can also be custom made in a dental laboratory to fit your individual requirements.

Dental implant abutments are available in various materials:

1. Titanium metal (silver color)
2. Gold / palladium alloy metal (gold color)
3. Zirconium oxide ceramic (tooth or pink colored)
4. Aluminum oxide ceramic (tooth or pink colored)
5. Hybrid combination or metal and ceramics
6. Tooth colored ceramics (tooth colored)
7. Pink colored ceramics (gum tissues colored)

High quality dental implant abutments are custom shaped to mimic nature. The parabolic or curved shape follows your gum line. The shape of the dental implant abutment can also guide your existing gums that are flat due to a missing tooth, to regenerate to a curved shape. This can be accomplished without surgery. Because I document dental implant procedures with a digital camera, I have learned how to guide the gum tissues (gingiva) to re-grow where there was recession (gum shrinkage) present.

Be wary of lower fee dental implants and abutments, for inferior materials may be utilized to save money. Using incompatible materials such as non-precious metals may cause damage to your bone and dental implants.

Make the investment in higher quality materials for dental implant abutments to increase the probability of success. A successful smile can improve the quality of your life. Remember that if there ever is a clinical issue, immediately call the dentist to be seen. This dental visit can treat the minor issue before if becomes a bigger issue.

Here’s to your oral health and beautiful smile…

Be well,

Dr. Joe Kravitz, DDS, MS
Prosthodontist, Author and Speaker

An ugly gap appears. You start to make whistling sounds. Your teeth may shift causing your bite to become unstable.

Teeth may become temperature sensitive. Bone loss occurs. Gums shrink too. Food gets stuck between your teeth. It can be annoying.

When considering options to replace a missing tooth, I find that it’s best to think about it logically. Either way, it is an investment in time and money.

Fixed Bridge:

The fixed bridge is made by drilling down the tooth on either side of the missing tooth. It requires local anesthesia. It takes 2-4 appointments to complete the process depending on the aesthetic requirements and fit of the prosthesis (fixed bridge). The cost for the bridge may be in the range of $6,000 – $9,000. The complications of a fixed bridge may include the need for a root canal, repeated cavities due to leakage under the bridge.

Dental Implant:

The dental implant and new tooth can be installed in one appointment. You also leave with a custom-crafted resin tooth. You can smile again too! There is a follow-up post op exam to check the healing progress. There is a third visit to install the final ceramic tooth. The cost for the dental implant, abutment and crown may be in the range of $5,100 to $8,000 depending on the need for bone grafting and aesthetic requirements of the case.

The dental implant leaves the teeth adjacent to the missing tooth preserved. There is no need to drill on other teeth to have the one dental implant. If there is more than two teeth missing it is not necessary to have a dental implant for every single missing tooth. Dental implants can be placed spread out to support your new teeth (prosthesis).

The greater investment for the long term is the dental implant. The reason I say that is because the dental implant cannot get cavities.

The dental implant is very resistant to damage from acids as well. The fixed bridge option may yield cavities – that requires the fixed bridge to be replaced in 5-10 years…sometimes sooner! It is very important to understand how fixed bridges fail, so that you can have good strategies for success. Dirty Mouth may improve your understanding of this process.

Logically, the dental implant option may be more logical to replace one missing tooth.

The dental implant is most often the better choice, but not always. It’s best to consult with a dentist to examine:

• Your nutrition regimen
• Your home care regimen
• Your dental knowledge of prevention habits
• Your ability to follow directions
• Your ability to follow up
• Your medical history
• Your dental history and especially cavities (caries)

Please consider the logical process of fixed bridge versus a dental implant – when needing to replace one missing tooth.

Be well,

Dr. Joe Kravitz, DDS, MS
Prosthodontist, Author and Speaker

There are several different types of bone grafts available to increase support for dental implants. Let’s review them now…

1. Autograft

An autograft is graft material harvested from your own body. Areas of harvesting (also called the donor site) may include:
a. the upper or lower jaws (maxilla, mandible)
b. in your mouth
c. ribs
d. hips
e. leg bones like tibia and fibula
f. skull

Autografts require an additional surgical site. Sometimes you may have to use crutches to walk for the first two weeks. Ouch! A scalpel is used to cut open the gums and stitches are used to hold the gums closed. There is usually significant swelling, bruising and pain associated with this technique.

Many surgeons will use this technique; however, there is a high failure rate and bone loss because the transplanted bone may not survive leaving worse off that before the surgery. This has nothing to do with the worthiness of the dentist. It has more to do with the way bone heals, how blood vessels grow and the timing of separate cells healing. However, if I can avoid the extra surgery, I look for other alternatives to achieve bone regeneration success.

2. Allograft

An allograft is bone graft material taken from another human. This graft does not require an additional surgical site. The bone graft material comes from a tissue bank. Other people donate their bone. There are stringent standards for excellence; however, the bone tissue bank cannot insure that there is no risk of you getting disease such as HIV or AIDS. For this reason, I do not use this graft material, for I would not want the risk of disease transmission from a fellow human.

While I understand that this avoids the extra surgical area as with the autograft, the risk of disease trumps this for me. There are other alternatives as noted below.

3. Xenograft (pronounces “zeeno” – graft)

An xenograft is a bone graft material made from another species such as cow bone, also called bovine…or pig, also called porcine. There is no chance of disease transmission and it is very safe. The inorganic part of the bone is used as a scaffold. There is no need for an extra surgical site, so the chance of complications is minimized.

The xenograft material is used as a matrix to have your own bone throughout the graft material. Most xenografts are replaced by your own bone over several months to years. The bone regenerated from this material is very dense and strong. Xenografts can increase the support for dental implants.

4. Alloplast

An alloplast is a bone graft material that is man-made. This synthetic bone graft material can be made from surgical grade resins, hydroxyapatite, calcium phosphate, and other minerals that allow your own bone to regenerate into the alloplast material. This material is very safe and encourages your bone to grow throughout. Alloplast bone grafts can increase the support for dental implants and your smile.

5. Membrane

A barrier membrane is used to cover the bone graft for dental implants. The membrane helps to prevent the gum tissues from growing around the dental implant before the bone does. The membrane slows down the growth of the epithelium and connective tissues, so your bone can strengthen the supports for dental implants.

I hope you find this bone graft materials information useful. I wish you joy in your discovery and knowledge, to make a better decision to improve your smile – with dental implants.

Be well,

Dr. Joe Kravitz, DDS, MS
Prosthodontist, Author and Speaker

You cannot see the bone graft with your eyes. Bone grafting is accomplished with precision and knowledge of the basic sciences.

It takes a great understanding of how oral epithelium heals, connective tissues heal and bone heals. The dentist devotes many classroom hours towards this understanding so that mastery of the basics can occur.

The bone graft can be accomplished with or without the use of a scalpel and stitches (sutures). More extensive cases may require the gum tissues (epithelium and connective tissues) to be incised (cut open) to reflect the gum tissues to for seeing the area clearly. This process is called reflecting a full thickness periosteal flap.

What are the reasons for needing a bone graft for dental implants?

• Previously extracted teeth (or tooth)
• Missing teeth (or tooth)
• Periodontal disease
• Gum disease
• Extensive caries (cavities)
• Acid damage
• Poor fitting dentures cause bone loss
• Bone infections
• Bone defects
• Weaker bone density
• Cracked teeth (fractured teeth)
• Existing bone is too thin
• Existing bone is too short
• Medical conditions

When bone grafting occurs, researchers have shown that the bone density increases significantly. Some bone grafting materials heal at the expense of fat cells. When there are less fats cells there are more vital (alive) bone cells. When the bone density increases, the bone is of greater strength for the support of dental implants. The greater support for dental implants, the greater the support for your new teeth.

Bone grafting for dental implants is logical.

Bone grafting is for dental implants predictable.

Bone grafting is for dental implants healthy.

Bone grafting for dental implants has materials that come in a loose particle form, gel or putty form, a spongy form, or a block form. A future article will discuss the various types of bone grafts and materials.

If you or someone you know needs bone or was told they could not have dental implants, there is hope. There is frequently more than one way to achieve the primary goal – to have great looking teeth that function well and are durable.

Follow-up after dental implant bone grafting

Also, realize that consistent follow-up with the dentist who performed the surgical and prosthetic work, increases the chance of success. Neglect can lead to premature and unnecessary failure. When a patient misses follow-up visits, and refuses to follow the healthy recommendations for oral health, disease and failure can ensue. Inflammation in the mouth can damage and destroy healthy bone. So, let’s be focused on healthy, reasonable actions towards success so that your bone grafting procedures endure for as long as practical.

Bone grafting for success can lead to better dental implant outcomes. Bone grafting increases your bone density. Bone grafting can be accomplished in as little as one step, within minimal down time. Modern bone grafting techniques have provided us with the ability to help more people suffering with missing teeth, dental pain, poor fitting dentures, and failed fixed bridges. More people are smiling today because of improved procedures such as bone grafting for dental implants.

Be well,

Dr. Joe Kravitz, DDS, MS
Prosthodontist, Author and Speaker

Sub means below and antral means sinus.

This type of bone graft lengthens bone in the upper back jawbone (maxilla). The bone is lengthened below the maxillary sinus and above the bone. At no time does the subantral graft enter your sinus cavity, unless there is a torn sinus membrane that pre-exists.

We are born with a small pea-sized empty space in the upper back jaw – called the maxillary sinus. The maxillary sinus is bilateral, which means it exists on both sides of the upper back jaw. The maxillary sinus increases in size throughout childhood and teen years. Into adulthood, the maxillary sinus expands to the size of a small peach. This expansion destroys the bone of the maxilla around the upper teeth, especially if they are missing. This process of bone destruction is called pneumatization.

Missing teeth equals increased bone loss.

A subantral graft is indicated when the upper back jaw is too short. The subantral graft can provide increased bone length for dental implants and facial support. The subantral graft process is very successful and predictable.

Patient compliance is important with regards to smoking cessation. Smoking during subantral graft healing can make the subantral graft fail due to inadequate blood supply. It is important that you follow your dentist’s recommendations for healing and cleaning your mouth.

You may or may not leave the dental office with teeth. But we have a burning desire to help people leave the office with teeth. The sinus lift is better scientifically known as the subantral graft. The subantral graft can dramatically improve bone support for dental implants and your facial structures.

All the best-

Dr. Joe Kravitz, DDS, MS
Prosthodontist, Author and Speaker
Maryland, DC, Virginia

Emily had a new lower denture that caused pain every time she bit down on food. It felt like a shock wave (also called paresthesia) traveling up her jaw, into her neck and behind her head. Emily did not want to eat if it caused that much pain…

“It’s excruciating and unbearable. It feels like a lightning bolt is traveling through my jaw.”

Emily was losing weight, hungry and beginning to become malnourished. She desperately needed help!

Emily had a new lower denture. Other names for a lower denture include:

• mandibular complete denture
• lower plate
• lower removable teeth
• lower false teeth
• mandibular removable prosthesis
• lower prosthesis

Upon further examination, it was clear as to why the denture was a shock to travel through her jaw – the mandibular nerve was exiting through her bone onto the top of her lower jaw. This means the nerve, (which is normally inside the lower jaw) was laying outside of Emily’s bone.

Every time Emily chewed food, the lower denture would compress the mandibular nerve thereby creating a “shock” impulse of her nerve.

We adjusted the lower denture to make space for the nerve. The pain stopped when Emily wore her mandibular denture (lower denture). Emily inquired, “What else can be done to make the lower denture more stable?”

There were three treatment options available:
1. Use a zinc-free denture adhesive. Emily did not like this option so she pursued…
2. Place two dental implants to fix the lower denture. These dental implants would prevent the lower denture from sliding around and instability. Due to the finances available to Emily, she chose this option. Emily was very satisfied and was saving up for her ideal options which were…
3. Place 4-6 dental implants and fabricate a new lower set of fixed teeth (fixed bridge) retained in place by dental implants. These teeth are not removable and are fixed in place. Emily knew that this was the best option for her, when she could afford the fixed bridge option. This option places the least amount of pressure on her gum tissues.

We hope you find Emily’s story beneficial, in case you have a lower denture that is painful and shocking. Here’s to lower denture comfort and good eats!

Be well,

Dr. Joe Kravitz, DDS, MS
Prosthodontist, Author & Speaker

What is temperature sensitivity?

When your teeth detect changes in temperature, both cold and/or hot; it’s the discomfort you feel when you eat, drink and breathe. It can either be cold or hot sensitive.

Causes

There are many causes of temperature sensitivity which may include:
Bite pressures, Cavities, Gum disease, Cracks, Stress, Acid destruction, Food, drink, air, pool water, Old fillings leaking (microleakage), Other dental work leaking, Shrinking gums (recession), Sonic toothbrushes, Alcohol containing mouth washes, Toxic chemicals such as peroxide, bleaches, or Inflammation of the neurovascular bundle inside the tooth.

What can be done to treat temperature sensitivity?

1. Implement the home care instructions written by Dr. Kravitz in Dirty Mouth.
2. Receive detailed cleanings with a registered dental hygienist.
3. A proper diagnosis is key to determine the underlying cause.
4. Take appropriate actions to prevent the cause.
5. Follow through and treat as required.

Be well,

Dr. Joe Kravitz, DDS, MS
Prosthodontist, Author & Speaker

Origins of H. pylori

H. pylori originated from the mouth and specifically periodontal disease (gum disease). H. pylori can live underneath the gums tissues in the mouth. Barry Marshall and John Robin Warren first identified H. pylori in 1982 and went on to win the Nobel Prize in Physiology back in 2005.

Over 50% of people have H. pylori in their stomach and duodenum. The bacterium embeds and burrows into the lining of the stomach. H. pylori has been shown to cause gastritis, pain and stomach cancer.

What are the signs and symptoms of H. pylori infection?

• Difficulty swallowing
• Frequent burping
• Stomach pain
• Bloated feeling
• Weight loss
• Nausea
• Vomiting
• Bloody / black stools
• Bloody / black vomit

It is highly recommended that if you have stomach pain, that you have your physician conduct a breath test. Within 20 minutes you can find out if you have the H. pylori infection.

Treatment for H. pylori infection

Treatment includes an antibiotic regimen to kill off the harmful bacteria. A breath test can be repeated in one month to determine the effectiveness of treatment with antibiotics.

Dental implications of H. pylori

• Painful apthous ulcers in the mouth
• Periodontal disease
• Gastroesophageal Reflux Disease (GERD) may reintroduce H. pylori to the mouth
• Untreated H. pylori infections may lead to stomach cancer
• Endotoxins from bacteria released underneath the gum tissues (periodontal pockets) can lead to other systemic diseases such as heart attack, stroke, pancreatic cancer, diabetes, Alzheimer’s, and cancer

Take home message

See your hygienist / dentist to have your teeth cleaning, mouth evaluated and treatment for periodontal disease as necessary – all to prevent the spread of H. pylori from the mouth to the stomach. Also, don’t skip hygiene visits with your dental office, this may cause undue harm to your mouth, body and life. Hope this research helps and let us know if you have any questions.

Be well,

Dr. Joe Kravitz, DDS, MS
Prosthodontist, Author & Speaker