Greater Boston Dental Center

All on 4 Reconstructions

An overdenture is any full arch prosthesis which is directly fixed to remaining tooth roots or implants. When all teeth in an arch have been lost, a common reconstruction is to place 4 well-spaced implants, which then support a full arch prosthesis. All on 4 is the common name for this restoration. Full function and esthetics are beautifully restored as the position of the prosthesis in relation to remaining bone and soft tissue is precisedly controlled, restoring a youthful smile. As the prosthesis is fully anchored to the underlying bone, full chewing ability is achieved. The results are nothing short of life changing as social confidence and self-esteem is improved significantly.

At Greater Boston Dental our team of specialists will provide the care needed for this complex restoration in one easy-to-navigate setting. All dental insurances are accepted, and in many cases medical insurance can absorb a significant percentage of the costs. Please call us anytime at (617) 924-7301 for a complimentary consultation and cost estimate. We love performing these cases and it would be our pleasure to help you!

Invisalign, implant, or other dental costs getting you down? “My insurance doesn’t cover that?” Here at Greater Boston Dental in Watertown, Massachusetts, 02472, we are proud of the fact that every insurance denial is reviewed by a doctor, with the majority of denials reversed and approved.

A little known and much underused tactic in dental practice is the insurance claim approval letter. It’s an extra step in dental office management, requiring a doctor’s time, but its a powerful tool for insurance company approval of any dental work.  Here is how it works:

Any dental insurance carrier gets hundreds of thousands of claims, none of which are initially reviewed by a human. The carrier’s software program checks for any condition in the patient’s entire lifetime dental history to deny the claim.  When it finds one  – and it does – the claim is rejected, with limited explanation, typically a vague 3 number denial code. The patient pays the full cost out of pocket.

Most claims have an excellent chance of insurance coverage, it only takes an office willing to wade through the mess of denial codes and insurance company idiosyncrasies and write letters with proper clinical terms and x-rays. These are amazingly effective. Rather than reply to the claim, the insurance company just pays it.

Dental care is expensive – we understand. Balancing high quality care with costs is part of our philosophy, which is why we also offer 0% financing for any insurance work over $1000. Please feel free to schedule a complimentary consultation and cost estimate for any work you are considering.

The quick answer: A stannous fluoride toothpaste, in addition to fighting cavities,  will have some effect versus the early stage of gum disease, and will delay the recurrence of gum disease after treatment by a dental professional. It has no effect versus advanced gum disease. The negative: Long term use of stannous fluoride is likely to stain your teeth irreversibly. Sodium fluoride will fight cavities only – it has no effect on gum disease bacteria – and will not stain your teeth.
Remember: All over-the-counter products are “band-aids” for tooth decay and gum disease. Just brushing with a certain toothpaste is not a substitute for regular care by a dentist. Neglect leads to a high probability of significant tooth loss in your lifetime.

 

The Long Answer:

First Stage of Gum Disease:  Mouth bacteria infects the gums only, especially the hard to clean areas between the teeth. Called gingivitis.  The antimicrobial effect of stannous fluoride  is effective at delaying the onset of gingivitis, but unfortunately it will happen eventually, typically by age 50-60, even if you have regular dental cleanings.  A stannous fluoride toothpaste is also effective at delaying the recurrence of gingivitis after treatment of gum disease by a dental professional.
Second Stage: Mouth bacteria spreads from the gums into the surrounding bone, causing the bone to resorb.  Called periodontitis. Think of periodontitis as mouth bacteria “eating away” the bone supporting your teeth.   Stannous fluoride, a two minute surface antimicrobial,  has no effect on periodontitis bacteria which are multiplying deep below the gum surface 24 hours a day.

Common national brands of stannous fluoride toothpaste are Parodontax, Colgate Total SF, and Crest Pro Health. To avoid confusion, just look at the active ingredients on the  back of the tube – there will only be one listed – and remember:
Stannous Fluoride: Will fight cavities and the first stage of gum disease, but may stain my teeth.
Sodium Fluoride, equivalent in action to sodium monofluorophosphate: Will fight cavities only, with no staining.

Regular dental cleanings are an absolute must, as they remove the tartar, or hard deposit, on the teeth, which is impossible for the patient to remove themselves. Without regular cleanings, tartar buildup will cause the majority of patients to develop gingivitis in 1-2 years and periodontitis in 3-4, even if their home care is excellent. Once periodontitis destroys 75-80% of supporting bone (typically 8-20 years), teeth loosen and fall out. This is why most of the world ends up in dentures by age 50-65. While modern dentistry can easily stop gum disease, virtually immediately, there is currently no way to restore lost bone. Once “eaten away” by disease, the bone is lost forever.

Contact us  at (617) 924-7301 or [email protected] with any questions on this article,  and see our website at GreaterBostonDentist.com. Greater Boston Dental is a group practice of four dentists and four hygienists in Watertown, MA,  designed to serve all your dental needs in one easy to navigate location. Please call us with any dental needs – we would love to give you reasonable, conservative, cost effective advice as your new trusted dental office.

 

 

Modern dentistry uses two materials for covering unsightly teeth:  White putty-like resin which is applied directly, (hence the name direct veneers)  and porcelain. Think of a direct veneer like fingernail polish, and a porcelain veneer like a false fingernail.

With the advent of modern 5^th generation white resin materials, direct veneers are indistinguishable from porcelain and overwhelmingly the best choice for great smile makeovers.  Direct veneers are like a thin coating of paint on the tooth surface. They involve no destruction of underlying tooth structure, no anesthesia,  and are easily removed at  at any future time*.  Porcelain veneers unfortunately are much thicker and require removal of one-third the  enamel surface of the tooth, irreversibly compromising it forever. (This requires standard anesthesia, “a shot of novocaine”)  There is no option to ever remove a porcelain veneer, as the tooth below was “shaved down”, and can never be left exposed. Another negative of porcelain is that it can “flake off”, sometimes repeatedly.

Direct veneers are also a third the cost of porcelain.  Please call us at Greater Boston Dental in Watertown, Massachusetts at (617) 924-7301 with questions, or to arrange a complimentary consultation and cost estimate.  Or email at [email protected].   We would love to help you with your cosmetic needs.

* Any veneer material will stain over 15-20 years.  Many patients who have direct veneers at age 25 decide to just remove them at 50.  With porcelain, the marriage is forever, forcing the patient into new veneers several times in their life.

Grand Rapids, Michigan was the first community in the United States to become fluoridated in 1945. Five years later, when the schoolchildren there exhibited significantly reduced tooth decay, the surrounding communities followed suit. However, fluoridating individual communities became a hotly contested political issue, and Massachusetts residents were wary – in 1967 only 8.2% of communities were fluoridated, almost last in the nation. Through political action and education by the dental and public health community, fluoridated water was slowly accepted in Massachusetts. By 2010, 61% of Massachusetts residents enjoyed fluoridated water – you can look up your community here:

fluoride-census Mass 2010

OK, but what does fluoridated water do, anyway? Fluoride in drinking water is highly effective if present while teeth are developing, from birth to age 8-10.  (Surprisingly, baby teeth are already developing at 6 weeks gestation, with calcified structure typically evident at 3-4 months. At birth, the enamel formation of most permanent teeth is already underway.)  Fluoride is incorporated into developing tooth enamel until age 10, and the resulting structure is highly decay resistant. 

Fluoride in toothpaste and drinking water is still effective after age 10 as a topical, i.e. surface contact agent, as its absorbed into tooth enamel to a small degree with consistent use. However, this only provides a fraction of the benefit of fluoridated water. 

Note that natural water only contains trace amounts of fluoride, and is not an effective systemic tooth decay preventative. Thus well water, often from artesian wells, and bottled water, which generally comes from natural springs, are not effective at tooth decay prevention. 

Evidence of the association of periodontal disease, sometimes called “gum disease”,  with general health issues is overwhelming. Studies at the NCBI (National Center for Biotechnology Information), a division of the NIH (National Institute of Health), clearly delineate the association of gum disease with cardiovascular issues, diabetes and pregnancy:

“Robust evidence shows the association of periodontal diseases with systemic diseases such as cardiovascular disease, diabetes, and adverse pregnancy outcomes. Periodontal disease is likely to cause 19% increase in the risk of cardiovascular disease, and this increase in relative risk reaches to 44% among individuals aged 65 years and over. Type 2 diabetic individuals with severe form of periodontal disease have 3.2 times greater mortality risk compared with individuals with no or mild periodontitis. Periodontal therapy has been shown to improve glycemic control in type 2 diabetic subjects. Periodontitis is related to maternal infection, preterm birth, low birth weight, and preeclampsia.”      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426403/ 

When reading any online medical information, law #1 is consider the source; are they selling anything?  The National Institute of Health, or NIH, is the “bible” of trustworthy online medical information, as they are a not-for-profit government institution. Public health is their sole mission.

Glossary:
Periodontal Disease: Affects nearly every human on earth at some point in life. Two stages: In the early stage, called gingivitis, bacteria are established in the soft tissue collars surrounding the teeth.  Once bacteria spread to the underlying bone, the disease is called periodontitis.  The bone is thus slowly resorbed, or “eaten away”, by the bacteria, and if neglected for 10-20 years will result in major tooth loss.  Modern dentistry can easily halt periodontal disease, but currently there is no method of restoring lost bone – it’s gone forever. Thus diagnosis at the gingivitis stage is critical. Please note gum disease can only be treated by a professional, there are no over the counter treatments. Antibiotics do little.

Sodium Fluoride vs. Stannous Fluoride: Which is best for me?

Sodium fluoride and stannous fluoride are the two major active ingredients in modern toothpastes, with sodium fluoride by far the most common.  Both prevent cavities. Stannous fluoride’s advantage is its  antimicrobial effect versus the bacteria which cause gum disease – but note that any toothpaste will remove gum disease bacteria mechanically through good brushing and flossing.  The negative of stannous fluoride is tooth staining, which can be difficult or impossible to remove.

For most patients, sodium fluoride is fine, as just brushing and flossing will remove gum disease causing plaque mechanically, and a rinse like Listerine can provide an antimicrobial effect – all with no risk of staining. Stannous fluoride can be appropriate for patients who don’t mind staining and desire to “throw everything in the closet” against gum disease, perhaps due to early onset, family history, dry mouth, or immunocompromise due to head and neck radiation. In the end, everyone’s oral chemistry varies, and stannous fluoride could well be an effective adjunct to brushing, flossing and regular dental cleanings in many patients. But its not absolutely necessary.

The type of fluoride in any toothpaste is clearly listed on the label. (Sodium monofluorophosphate is similar in efficacy to sodium fluoride and can be considered  equivalent).  Crest Pro Health, Colgate Total, and Parodontax are major stannous fluoride brands, and generally more expensive.

And the carefully worded ads which imply that just brushing with a stannous fluoride toothpaste cures gum disease? Don’t believe them. The good news: Modern dentistry easily treats gum disease, but early diagnosis is critical. Please see your dentist.

Contact us  at (617) 924-7301 or [email protected] with any questions on this article,  and see our website at GreaterBostonDentist.com. Greater Boston Dental is a group practice of four dentists and four hygienists in Watertown, MA,  designed to serve all your dental needs in one easy to navigate location. Please call us with any dental needs – we would love to give you reasonable, conservative, cost effective advice as your new trusted dental office.

Our golden rule for oral disease prevention and bad breath (halitosis) prevention: Brush and floss at bedtime, and no snacks afterwards.  The last thing that should touch your teeth at night is fluoride. The idea behind this is simple:  Bacteria are very hungry, let’s starve them.

Please consider:  Why does everyone have “morning mouth”, that is, bad breath,  after 8 hours of sleeping? Why not “afternoon mouth”, at 5 PM, after 8 hours of eating and drinking?

At bedtime,  your mouth, in a sense, goes to sleep as well, and the normal bacteria in your mouth grow undisturbed. A major factor is reduced saliva production, which normally “washes”  bacteria off oral surfaces; eating and drinking, to an extent, “scrub” as well. Note that reduced saliva at night is a normal part of the body’s daily rhythm (footnote 1), and can unfortunately be exacerbated by the side effects of many medications.

Thus, the bad breath of “morning mouth” is normal. However, it can be reduced significantly by good brushing and flossing.  Mouth bacteria happily double their numbers every 3 hours, so removing food debris,  their energy source,  can limit their growth considerably. This simple habit will markedly reduce your lifetime incidence of oral disease and make your partner happy as well.

 

1. “The biological significance of decreased saliva during sleep is unknown and it is unclear how the oral cavity compensates for this period of relative dryness. The amount of saliva produced is greatest during the waking hours of the day and diminishes dramatically during sleep and may represent another process in the human body that displays a circadian rhythmicity.” https://www.ncbi.nlm.nih.gov/pubmed/12531122

Excluding the common cold, tooth decay and gum disease are by far the most common diseases in mankind.  They are not completely preventable. Tooth decay and gum disease are virtually guaranteed in every individual – good oral hygiene and professional care can only limit the onset and degree of effect.  Thus, a few cavities by age 21 and gum disease onset by age 55 is inevitable. With no care, the picture changes drastically: A mouthful of cavities by 21 and gum disease onset at 30. Left untreated, over the course of 20 years gum disease “eats away” the bony support around the teeth, resulting in major tooth loss by 55.

Prevention begins essentially at birth, and is a constant lifetime battle. The golden rules are simple, the ones you’ve heard forever: Brush with a fluoride toothpaste  – fluoride is in almost every adult toothpaste preparation – and floss; of course see your dentist at least every 6 months. (Note: As your young child may swallow toothpaste, use a fluoride-free toothpaste designed for toddlers until age 2 or 3. Even brushing with plain water will have some mechanical plaque removal effect if you’re concerned about the additives in any toothpaste.)  Other than a toothbrush and floss, no other gadgets have ever been proven effective. Fluoride is the only ingredient which is proven effective in preventing tooth decay.

Fortunately, both diseases are easily treated with modern technology, virtually guaranteeing the retention of almost all teeth for a lifetime. Early diagnosis is a must, and this means seeing your dentist every 6 months! Once the majority of a tooth has decayed, it is forever weakened; and once gum disease eats away the bone surrounding a tooth, it can never be restored.

 

 

Contact us  at (617) 924-7301 or [email protected] with any questions on this article,  and see our website at GreaterBostonDentist.com. Greater Boston Dental is a group practice of four dentists and four hygienists in Watertown, MA,  designed to serve all your dental needs in one easy to navigate location. Please call us with any dental needs – we would love to give you reasonable, conservative, cost effective advice as your new trusted dental office.

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