As dentists, we have always maintained that nothing can be as good as natural teeth. Traditionally the goal of every dentist has been to save as much of and as many natural teeth as possible. All preventive dentistry procedures are aimed to avoid or minimize the DMF score. DMF stands for Decayed, Missing and Filled surfaces. Each decayed or missing or filled tooth surface is given a value and the additions of these values constitute the DMF score of each individual. Obviously the goal of every dental implant procedure is to keep this number as low as possible. Dental implants are often used because of their natural appearance, minimal maintenance, and durability. They provide the look and feel of a natural tooth, lowering the overall DMF score and provide a chewing surface that is both resilient and beautiful. The 20th and early 21st century have improved our health dramatically and have extended our lifespans well into our 80s, 90s, and even centennial years. Due to our long lives, the following statements have become true for many people:
- Through our better understanding of our diet and discoveries of healthier life styles, we are able to control or avoid many of the diseases like Diabetes and Cardiovascular conditions leading to premature deaths.
- Technological advances have controlled many diseases and are helping millions to live many years beyond “natural life expectancy” for human beings. Without the benefit of dialysis, if left to nature, people with kidney failures would die. Without the benefit of pacemakers, people with cardiac arrhythmias would have very short lives.
- Advances in pharmaceuticals are responsible for adding many years of meaningful life to humans. Through continuing pharmacotherapy, many of the bodily functions that naturally deteriorate or go array are kept in check and continue to function satisfactorily. Anti-depressants and other psychotherapeutic agents restore chemical imbalances in brain. Antihypertensive medications, keep blood pressures in acceptable levels.
The obvious beneficial result of all these medical advances is longer healthier lives for humans. Of course the research and advances made in medicine have been concentrated on vital organs and systems like brain and cardiovascular system. While the technology and pharmaceuticals prolong the vital functions of the body, some less significant parts like salivary glands follow their original timetable of deterioration, degeneration and loss of function. Additionally and perhaps more significantly, many of the same drugs that prolong our lives by regulating vital bodily functions adversely affect the salivary gland secretions. The combined effects of natural deterioration of salivary glands and decreased flow of saliva as side (adverse) effects of routine life saving medications result in dryer mouths in the elderly.
There are number of ways to alleviate the physical discomfort of dry mouth through use of special mouth washes, gums and artificial saliva. However, what remains missing from these mouths are the enzymes and chemicals that prevent and/or slow down the caries process, the decay of teeth. What this means, is that despite our advances in medical technology, our teeth are often unable to keep up with the demands of our longer lives.
As a result, decay and tooth loss has become an accepted fact of life. Fortunately, the last few years have begun to reverse this trend and soon (within the next decade or so), we may be able to completely reverse tooth decay. Until then, however, we will have to endure DMF profiles and tooth replacement. The bacteriology of tooth decay that is commonly seen in the senior population is different from what is seen in younger people with normal salivary flow. These cavities attach the root surfaces of the teeth that over the years are exposed through gum recession and/or gum disease. The mere locations of these cavities always present a challenge for the restorative dentist, often involving expensive surgical procedures to expose the healthy tooth next to the cavity.
Saliva carries important enzymes that neutralize the bacterial acids that lead to tooth decay and carry potassium, calcium, and magnesium, which are essential to the remineralization of teeth and the fundamental repair of our teeth from basic decay that has not yet developed into a full blown cavity. While pit and fissure caries are common in younger people due to the increase of sugar in our food supply, root and cervical caries have been an issue facing older adults since the beginning of time and they have always proven to be frustrating. Also, many elderly people, though they are increasingly rare as they pass on, have not benefited from the fluoridation of water throughout their lives. This has also resulted in their teeth being slightly more vulnerable than their successors, which also contributes to carious lesions.
The most frustrating aspect of root caries is their never stopping recurrence. Unlike the other two types of cavities involving pits and fissures of the teeth or cavities in between the teeth, root caries are not limited to specific sites. In case of pit and fissure cavities, once the entire pits and fissures are filled and sealed, there cannot be any more caries activity until the filling breaks down 5 to 10 years later. It is not uncommon to see new caries activity right next to a new root filling that is completely intact within a year. The results in increasing the size of a filling, degradation continues, and the underlying structure of the tooth becomes weakened, resulting in breakage and loss. The longer we live, often with the help of medications, the more we are prone to this frustrating situation and the more difficult it would be for us to present ourselves to a dental office and go through lengthy and expensive procedures.
Given these facts, as a profession we must use our judgment and do a thorough evaluation of each patient in determining the best treatment plan for the patient who presents with root caries. In case of root caries in the presence of dry mouth, we must seriously consider the benefits and longevity of expensive lengthy procedures like root canal treatments, crown lengthenings, and new crowns versus replacing the affected tooth with titanium or zirconia implants that are immune to any kind of caries process. Often times, the implant is the most economical option, given the average root canal treatment runs between $1200-1500, including the crown. If this has to be done repeatedly, costs can add up. Implants generally cost between $1000-$1500, and are often one and done. Though dentists hate to remove a tooth, but sometimes it is more pragmatic to replace a dying tooth than to try to save it.
As citizens of one of the most advanced nations on Earth, we are far beyond reliance on nature for quality and length of our lives. That means our teeth are exposed to unprecedented lengths of use and wear. Especially as we age and our body functions are inhibited by natural deterioration or modern medicine.
Recognizing this factor and considering replacing the affected teeth in the vulnerable mouth, at a time that the patient is physically able to go through the dental procedure, avoids frustrating and repeated treatments that ultimately cost more and would result in the loss of the tooth at a time that patient may not be fit to go through implant treatment. Dental implants can also help preserve other teeth and improve health, given that tooth loss can have adverse effects on the health of the gums and jaw, which results in greater vulnerability late in life. When a senior citizen is young and healthy enough to accept implants, they are helping preserve their teeth and overall health.