Do I Need to Tell an Implant Dentist About My Substance Use?

Posted on by .

I’ve had two consultations about dental implants. I disclosed my casual substance use to one of the doctors, and they dismissed my case. The doctor said she couldn’t do the surgery because of my substance use. I didn’t mention the drug use to the other doctor because I’m not comfortable with him. Do I need to mention it when I find a dentist for my implants? I’m afraid that no one will take my case now. Thanks. Josiah from NV

Josiah,

You need to inform your implant dentist what you use, as well as your dose and frequency. This helps the dentist determine how to handle your case and administer sedation accordingly.

Why You Need to Tell an Implant Dentist About Your Substance Use

Model of a dental implant with the crown, abutment, and root form labeled

Disclose all medications and substances you take before dental implant surgery

Telling your implant dentist about your substance use allows them to adjust sedation properly, based on the amount of the drug in your system and how it may affect your response to anesthesia. Providers who routinely manage sedation view this as standard information—not an automatic dismissal of your case.

How to Find an Implant Dentist

Begin with a general dentist. Implant treatment requires thoughtful planning before surgery, even when a specialist handles the surgical placement.

When reviewing credentials, prioritize a dentist’s post-graduate training and experience in implantology. Look for these credentials:

  • Advanced implant education or certification through the International Congress of Oral Implantologists
  • Board involvement or training from the American Board of Oral Implantology

Some general dentists place implants and manage sedation themselves; others coordinate care with surgeons. Either method works when the dentist has sufficient training and experience.

Dr. Steven Brooksher, a Baton Rouge accredited cosmetic dentist, sponsors this post. Read why so many patients view Dr. Brooksher as one of the best dentists in Baton Rouge.

 

Can I Get Dental Implants If I Take Actonel?

Posted on by .

Can I get dental implants if I’m on Actonel for osteoporosis? My upper left front tooth and incisor behind have been missing for 14 years. I had my first consultation with a dentist last week. She is not pressuring me to get dental implants but presented them as an option. I haven’t disclosed my medical history to the dentist yet. However, she said implants need healthy bone, which made me think of the medication. Would Actonel prevent me from getting dental implants? Thanks. Craig from NH

Craig,

Model of a dental implant with the crown, abutment, and root form labeled

Each patient’s case is unique, so you must find an experienced implant dentist or oral surgeon to determine whether you are a candidate for dental implants. However, we will provide general information on whether a person taking Actonel® or other bisphosphonates can get dental implants.

Can You Get Dental Implants While Taking Actonel or Other Bisphosphonates?

If you take Actonel or other bisphosphonates, you may still be a candidate for dental implants. Actonel is a bisphosphonate that treats osteoporosis by slowing down the cells that break down bone tissue. However, an implant dentist, oral surgeon, or periodontist (gum and bone specialist) will take a CT scan of your oral anatomy and review your medical and dental histories to determine if you are a candidate for dental implants.

How Do Bisphosphonates Affect Dental Implants?

Bisphosphonates increase the risk of developing jaw osteonecrosis, which can weaken bone tissue. However, if you are a candidate for dental implants, an implant dentist or specialist may recommend the following:

  • Stop taking bisphosphonates four to six months before dental implant surgery.
  • Avoid the medication while dental implants fuse with your jawbone.
  • Resume the medication when the risk of compromising your dental implants is low.

What Does Research Show for Bisphosphonates and Dental Implants?

The October 2023 issue of Cureus published an article on bisphosphonate-treated patients and dental implants. Researchers recommend careful consideration, management, and bone monitoring for dental implant patients taking bisphosphonates.

A September 2023 Materials (Basel, Switzerland) article cautions that patients taking bisphosphonates have higher dental implant failure risks than patients not taking the medication.

Schedule Dental Implants Consultations

Schedule consultations with implant dentists, periodontists (implant specialists), or oral surgeons if you want dental implants. Tell the doctor that you take Actonel for osteoporosis. Take notes and compare your treatment options from the consultations. However, avoid insisting on dental implants if they are not recommended. If you are not a candidate for dental implants, a skilled cosmetic dentist can give you natural-looking results with alternatives.

 

Dr. Steven Brooksher, a Baton Rouge-accredited cosmetic dentist and a fellow of the International Congress of Oral Implantologists, sponsors this post.

 

Is My Tooth Cracked Beneath a Dental Bridge?

Posted on by .

After my routine hygiene and dental exam last week, my dentist said I needed a new upper left bridge. She said an anchor tooth in the bridge was cracked. I don’t have problems with the bridge, nor have I felt any discomfort. Should I deny a new bridge if I don’t have symptoms? Thank you. Portia

 

Portia,

Your dentist’s diagnosis should accompany an X-ray showing your tooth is cracked. Generally, you would feel sharp pain when biting hard food if a tooth is cracked. Also, it is unusual for a crowned tooth to crack. A crown protects a weak tooth and prevents it from cracking.

We recommend getting a second opinion from an advanced cosmetic dentist without mentioning your dentist’s diagnosis. Ask for an exam and X-ray, but provide as little information as possible. Avoid telling the dentist that you or your dentist think your tooth beneath the bridge is cracked. You might ask if the dentist seeks anything questionable about your upper left teeth.

A dental bridge hovering above dental implants and abutments

Dental implants can anchor a bridge and replace multiple missing teeth in a row

Your situation underscores the advantage of replacing a tooth with a dental implant. If anything goes wrong with a tooth that is a part of a dental bridge, a dentist usually replaces the entire bridge. However, a dental implant stands alone and is not affected if you need dental work on an adjacent tooth.

If your tooth beneath the bridge cracks, a dentist must remove the tooth and extend the bridge to cover the space left after the extraction. Consider getting a dental implant or an implant bridge as an alternative to traditional bridgework to replace missing teeth.

 

Dr. Steven Brooksher, a Baton Rouge accredited cosmetic dentist, sponsors this post.

Dentist Won’t Place Implants Until I Get Wisdom Teeth Removed

Posted on by .

My upper right first and second bicuspid teeth have been missing since I was 16 years old. Two years ago, I started saving for dental implants. I saw an implant dentist two months ago, and she did a 3D scan of my teeth and noticed my impacted wisdom teeth. She asked if I had any complications, and I told her that my wisdom teeth hurt regularly and had felt worse within the past five months.

The dentist recommended getting my wisdom teeth out before I get dental implants because if the wisdom teeth flare up during dental implant recovery, I could have a rough time. She referred me to an oral surgeon. I am 42 years old and terrified of wisdom teeth removal because of my age. All my wisdom teeth are impacted, and two are angled near a nerve. I am afraid of nerve damage from the surgery. I read about a procedure that can take off the tops of the teeth. Would I qualify for that? Do I really need to get my wisdom teeth out before getting dental implants? Thanks. Micah from Lexington, KY

Micah,

Thank you for your question. We understand your disappointment about delaying a dental implant procedure to get your wisdom teeth removed. But your dentist is correct. If your wisdom teeth flare up during your four months of recovery after dental implant surgery, you can experience much discomfort.

What Happens If Your Wisdom Tooth Is Near a Nerve?

If your wisdom tooth is near a nerve, your oral surgeon will use a 3-D CT scan to navigate around the nerve while removing the tooth. Wisdom teeth are near two nerves, the lingual nerve, and the alveolar nerve.

  • Lingual nerve – Supplies sensation to the floor of your mouth and the front two-thirds of the tongue
  • Alveolar nerve – Supplies sensation to your lower lip and skin over your chin

If a wisdom tooth has long roots entangled in nerves, some oral surgeons perform a procedure called a coronectomy.

What Is a Coronectomy?

A coronectomy is a surgical procedure that removes the crown of a wisdom tooth and leaves the roots intact. A surgeon may use this method to prevent touching nerves. The procedure is controversial because using tooth roots behind can create new risks, and your oral surgeon may not use it.

What Happens If Wisdom Teeth Removal Bruises a Nerve?

Model of a dental implant with the crown, abutment, and root form labeled

Dental implants need to be undistrubed in a healthy environment

If wisdom teeth removal bruises a nerve, the effects are usually temporary but can last up to 18 months. As the nerve heals, you may experience numbness or tingling in these areas:

  • Tongue
  • Lower lip
  • Skin over your chin

We encourage you to schedule a consultation with a board-certified oral surgeon to discuss your concerns and the state of your wisdom teeth. The surgeon will explain your options for sedation to relieve your anxiety during the procedure.

After dental implant surgery, avoiding disturbing the implants and preventing them from fusing with your jawbone is essential. Delaying wisdom teeth removal and needing emergency surgery could interrupt dental implant healing and recovery.

Baton Rouge dentist Dr. Steven Brooksher sponsors this post. Dr. Brooksher is a Fellow of the International Congress of Oral Implantologists.

Can Teeth Grinding Loosen Dental Implants?

Posted on by .

My dentist placed three dental implants last August. One implant is loose. When I got the implants, my dentist made a custom night guard to wear because I grind my teeth. I don’t wear it because I hate the thing. It’s so hard to get used to it, and it is very difficult to sleep when I wear it. Could my not wearing the night guard be the reason why the implant is loose? Is this going to happen with the other 2 implants? I am embarrassed. I will have a hard time facing my dentist and telling him that I have not been wearing the night guard. I want to know before seeing him if this could really be my fault. Thank you for your time. TJ

TJ – Thank you for contacting Dr. Brooksher’s office. The only way to be sure about the cause of your loose implant is to have it examined.

Can Teeth Grinding Loosen Dental Implants?

Dental implant model with the fixture in the bone

Pressure from teeth grinding can weaken a dental implant

Teeth grinding (bruxism) at night puts extra pressure on dental implants and can loosen them. If you grind your teeth while you sleep, it is vital to wear a night guard to avoid damaging your implants. You should wear the night guard while implants heal and afterward.

It is best to find out now why your implant has loosened. You have two other implants that your dentist must observe. If the preventive measure is as simple as wearing a night guard, you should know that now and ensure the success of your implants.

What Happens If an Implant Is Loose?

If your dentist will examine your implant and the area around it to determine if he can stabilize it. If not, your dentist must remove the implant. Depending on the condition of the implant and the area around it, you may need bone grafting before your dentist places another implant. Although you might be embarrassed, scheduling an appointment with your dentist is important. Also, if your mouth guard is excessively uncomfortable, your dentist may need to check it for fit.

 

Baton Rouge dentist Dr. Steven Brooksher sponsors this post. Dr. Brooksher is a Fellow of the International Congress of Oral Implantologists.

What Are My Options for Teeth Broken Near Edge of My Gums?

Posted on by .

I am wondering if dental implants are my only option. I have three teeth that are about two-thirds broken off. The break almost hit my gumline. I was biking on an unfamiliar trail that wasn’t in good condition. It’s a scenic trail, but I didn’t get enough information about its condition. I hit a huge hole that sent me flying off the bike. There was more damage to my lips and teeth than to the bike. I always wear a helmet and am fortunate not to have a concussion. I do not know any biker who wears a mouthguard, but I am seriously considering it now that my left front and center teeth and the two next to them broke. Amazingly, the teeth do not hurt unless I mistakenly chew on them. I have a dentist, but he is only two years out of dental school, so before I let him do anything to my mouth or refer me to a specialist, I wonder if there are options other than dental implants. – Thank you. Raymond from Tampa, FL

Raymond,

Thank you for your question.

You did not mention when you had the accident, but it is best not to delay getting treatment. Although you do not feel any pain, the trauma to your teeth and their continued exposure increases the risk of infection.

What Are Your Options for Teeth Broken Near the Gumline?

Dental implant with markers for crown, abutment, and root formIf your teeth break near the gumline, your dentist needs to examine and x-ray them to determine the extent of the damage. Tooth replacement options may include a dental implant or a dental bridge.

Dental implants

Dental implants are the best form of tooth replacement for several reasons:

  • They minimize the bone loss that occurs when teeth are missing
  • They will look and function like your natural teeth.
  • The results can last a lifetime.

The implant process takes longer than other tooth replacement options because it involves surgery and time for your jawbone to fuse with the implants before getting your final dental crowns. Still, the results outlast other tooth replacement options.

Dental bridge

A dental bridge can restore multiple missing teeth in a row. It consists of dental crowns joined at their sides. The teeth on either side of the missing ones will anchor the bridge. A dentist must reduce the size of the anchor teeth to ensure the crowns on the ends of the bridge fit over them.

If possible, look for a dentist with advanced implant and cosmetic dentistry training and accreditation. After your exam and x-rays, the dentist will explain your options and their pros and cons.

Dr. Steven Brooksher, a Baton Rouge accredited cosmetic dentist and Fellow of implantology, sponsors this post. Read about what Dr. Brooksher does to provide patients some of the best dental care in Baton Rouge.

I Had a Panic Attack at the Dentist and Walked Out

Posted on by .

I am always nervous about the dentist, but last Wednesday was worse than ever. When I pulled into the parking lot, I started feeling nauseous. I thought about calling the office and telling them that I was in the parking lot but sick. For some reason, I decided to go in anyway. I felt woozy and sat down quickly. When the dental assistant called my name, I jumped up and walked out of the office.

I was supposed to talk to my dentist about implants for two missing upper molar teeth. But I had a panic attack in the waiting area and had to leave without seeing her. I called to apologize but did not reschedule. I don’t know what to do next. I am terrified that this is something that I won’t be able to cope with enough to get dental implants. I am embarrassed but do not want to start over with another dentist. Thanks. Malachi from TX

Malachi – Thank you for contacting Dr. Brooksher’s office. Millions of people have dental anxiety and skip appointments because of it.

You may need to start by addressing the reason for your anxiety. Past dental experiences that were emotionally or physically painful can cause anxiety. Also, consider whether your current dentist understands and sympathizes with your anxiety.

Dentists who welcome anxious patients will listen to your concerns and fears and address them. Frequent, clear communication may be enough to calm your fears. Some patients require sedation for dental appointments, and you may be one of them.

A beach hammock between palm trees portraying the relaxation of sedation dentistry

Sedation dentistry relaxes you during denal visits


We suggest that you start by speaking with your current dentist. If she does not understand your anxiety, look for another implant dentist. Schedule a consultation, explain your concerns, and ask what the dentist can do to help you relax. Ask friends for recommendations for dentists or search online for dentists who cater to anxious patients. We are confident that you will find a dentist to meet your needs.

Dr. Steven Brooker, a Baton Rouge Fellow of implant dentistry, sponsors this post. Dr. Brooksher is accredited by the International Congress of Oral Implantologists.

What Happens If I Don’t Replace Missing Teeth?

Posted on by .

I have opted for my dentist to pull teeth for the last ten years instead of doing root canals and caps. Now I am missing four upper back teeth. All my wisdom teeth are gone, so the two teeth in front of them on both sides of my upper jaw are missing. You cannot tell the teeth are missing unless I hold my head back and laugh. Now that I moved to Massachusetts, I have a new dentist suggesting that I replace my teeth with dental implants. She says I will regret it as I get older if I do not get the implants when my teeth start shifting around. She can already tell from my x-rays that my teeth are moving, and she showed me the x-ray comparison. I’ve had this dentist for three years, and I trust her. But a second opinion is always good. I am not considering dental implants yet. Why not get a dental bridge? What will happen if I don’t replace my missing teeth? Thank you. William from Springfield, MA

William,

Thank you for your question. Your dentist may be persistent, but she seems to be genuinely concerned about your long-term oral health if you do not replace your missing second and third molars.

What Happens If You Don’t Replace Missing Teeth?

If you do not replace missing teeth, it can affect your long-term oral health in these ways:

  • Tooth misalignment – Teeth are placeholders for proper alignment. Gaps in your smile cause teeth to lean against each other and crowd your smile. When teeth are missing, other teeth will begin to drift toward the spaces.
  • Jawbone shrinkage – In areas of missing teeth, the jawbone shrinks 25 percent within the first three months and up to 50 percent within six months. Multiple missing teeth can accelerate facial wrinkles and sagging.
  • Challenge with oral hygiene – It is challenging to brush and floss between teeth that lean on each other. Crowded teeth increase the risk of plaque and tartar buildup, tooth decay, and gum disease.

Why Get Dental Implants?

Dental implant model with the fixture in the bone

A complete dental implants replace a tooth’s roots and crown

A complete dental implant replaces a tooth’s root and crown. The artificial tooth roots fuse with your jawbone and look and feel natural. A dental bridge requires shaving down the tooth on either side of the missing one. But you are missing second and third molar teeth with no teeth behind them to support a bridge. Although a dentist may offer alternative bridge treatment, other teeth will need to support it. The option will be less healthy than individual implants.

We suggest that you discuss your concerns with your dentist and ask for more information on dental implants and what you can expect with or without them in the long term.

Dr. Steven Brooksher, Baton Rouge accredited cosmetic dentist and Fellow, International Congress of Oral Implantologists, sponsors this post.

Why Is My Palateless Denture Loose?

Posted on by .

Last August, I found a dentist who does palateless dentures. He took some x-rays, reviewed my medical records, and said I could get the denture. I was excited because I have worn dentures for 20 years. I was very nervous because I had never had any oral surgery before last September when the dentist did four implants. I was under IV sedation, so the surgery went better than expected. Everything seemed to go okay until mid-January, when I felt something shift in my mouth. I returned to the dentist before my next scheduled appointment. He said that the denture might be loose, and he will check the implants next week. I am terrified of what the dentist might find and that I might lose all the implants. I don’t know if my anxiety will let me start all over again. Now, my trust level is down. What are some reasons that my palateless denture might be loose? – Thanks so much. Giada from Florida

Giada,

Thank you for your question. Dr. Brooksher would need to examine your denture and take a 3-D cone beam CT scan to identify the problem. But will explain some possible causes of your loose palateless dentures. But first, we will explain how a palateless denture works for any of our readers who are not familiar with it.

What Is a Palateless Denture?

Palateless upper denture prepared for dental implantsA palateless is shaped like an arch and has no upper plate that touches the roof of your mouth. A palateless implant denture snaps or screws onto dental implants. Dental implants are tiny screws that an implant dentist places in your jawbone. Two to six implants can keep your denture in place. After about four months of healing, your dentist will attach the final denture to the implants.

Palateless implant denture vs. traditional implant denture

  • Traditional denture – A traditional denture has a palate that touches the roof of your mouth. Suction from the top of your mouth keeps the denture in place. Many denture wearers find it uncomfortable. Some also say that it distorts the taste of food.
  • Palateless implant denture – Dental implants embedded in your jawbone can support a palateless denture. You will have a more comfortable experience wearing dentures that do not cup the roof of your mouth.

Why Is Your Palateless Denture Loose?

If your palateless implant denture is loose, perhaps the denture is not secured to the implants. Or, your implants and jawbone may not have fused. An examination and 3-D CT scan will provide the answer.

  • Denture not secured to the implants – If your palateless denture is loose, your dentist must determine the cause. Perhaps the denture base is misaligned with the implants. Or, maybe the connection between your denture and implants is unstable.
  • Jawbone and dental implant did not fuse – When your jawbone and implant do not fuse, the cause could be the location of the implants, inflammation around the implants, poor-quality implants, or other factors.

Get a Second Opinion Right Away

We recommend getting a second opinion right away. The American Society of Implant and Reconstructive dentistry cautions that if the implant connection is loose, it can have these effects:

  • Alter your bite (the way your upper and lower teeth meet when you close your mouth)
  • Damage the implants
  • Cause bone loss

You mentioned that your dentist took some x-rays, but you did not say a 3-D cone beam CT scan. Did your implant dentist complete that scan? Search for an implant dentist with credentials (not membership only) from the International Congress of Oral Implantologists or the American Dental Implant Association. Schedule an appointment for a second opinion. You will need a comprehensive exam and a 3-D CT scan at some point.

Your anxiety is understandable, but an implant dentist will recommend sedation options to keep you relaxed while getting the care you need. We wish you a healthy resolution for your loose palateless denture.

 

Dr. Steven Brooksher of Baton Rouge, Louisiana, sponsors this post. Dr. Brooker is a Fellow of the International Congress of Oral Implantologists.

I want this stainless-steel post out of my tooth

Posted on by .

I knew my dentist was going to insert a post into my root canal tooth (lower molar), but I didn’t think to ask what the post was made of. I found out today that the post is stainless steel. I am wearing a temporary crown and will get the final crown in about two weeks. My dentist explained that the stainless-steel post will be encased, but can it be removed and replaced with a non-metal post? If there is no other way to save the tooth, I would rather have an extraction. I’m really concerned about getting this post out of my mouth. I think I am having a reaction to it, and it is making my ears ring. – Thank you. Alex from S. Carolina

Alex,

Thank you for submitting your question to our office.

Although a dentist can remove a stainless-steel post from your tooth, there are risks.

Purpose of a post in a tooth

A dentist might insert a post in a root canal to strengthen the tooth or support a crown. The post can be useful in these situations:

  • Front teeth – A post strengthens the tooth against horizontal fracture.
  • Molar and other teeth – The post can serve as the foundation for building up the tooth and retaining the crown.

History of tooth posts

In the 1970s and earlier, prefabricated dental posts were made of stainless steel. In the 1980s, studies confirmed that metal ions can seep out of the tooth and into the bloodstream—even though the post is cemented inside the tooth. The nickel in stainless steel often causes a reaction in people with metal allergies or sensitivities.

Alternative materials for dental posts

Alternative materials for dental posts include titanium, zirconia, carbon fiber, and fiberglass. Titanium is a strong, biocompatible metal that many dental practices used. And in the 1990s, other materials, including carbon fiber and fiberglass were used to make dental posts. Now, the ceramic zirconia is an alternative for a biocompatible, flexible high-strength post.

If you have metal allergies or sensitivities, a dentist can remove your post. But it seems that your dentist is not the one to do it. The complexity of removing the post depends on how deeply your dentist embedded it and how firmly it is cemented. A skilled dentist might use an ultrasonic tip to dislodge it.

Get a second opinion

Diagram of the phases of a dental implant for a comparison to a partial denture.

Get a second opinion to preserve your tooth instead of needing an extraction and implant

You can ask your dentist to postpone your dental crown until the post is removed. If a crown is cemented over the post, it will become more difficult to remove it. Although Dr. Brooksher would need to examine your tooth, your description does not suggest that you might require an extraction and dental implant. We recommend that you schedule an appointment with a skilled dentist for a second opinion. After examining your tooth, the dentist will explain your treatment option.

Best wishes for a prompt resolution.

 

Steven Brooksher, DDS, of Baton Rouge, sponsors this post.