Question

Over the last 10 weeks, I have had to have a fair amount of treatment, including four extractions, as a result of irreparable, cracked teeth. When examining a panoral x-ray, my dentist also identified three fillings that needed replacing. Needless to to say, the combination of pain, infection, distress, local anaesthetic and the effort of many visits to the dental surgery, has had a detrimental effect on my ME. I would have classed myself as a moderate to bad sufferer before all this trouble but it’s definitely bad now. Hopefully, with careful pacing over time I will improve. That glass of mine is always half full.

My dilemma is what best to do regarding my missing teeth. As well as these four recent extractions, I had previously lost three others. I can still chew well enough on the right side of my mouth but my dentist has suggested implant replacements when my mouth has healed and I am, hopefully, a little stronger. I have to confess I am not keen, due to the potential risk of infection and the need for antibiotics, which I do not tolerate well. I was thinking more along the line of dentures, although I realise these can be troublesome. I would not feel confident at bridging the gaps either, given the fragile nature of my teeth in general. I will be 59 in September, just in case age is relevant.

Answer

It sounds as though you've had a difficult run of treatment on top of your ME problems.

Also, as I'm sure you're aware, it's difficult for me to be too prescriptive with regard to giving you my opinions, as I obviously don't have all of the clinical details as regards your medical and dental histories. But I am happy to give you some thoughts though for you to consider.

I do hope you are getting regular dental check ups. It's always better to get your dentistry on a regular basis, rather than when you have acute problems, like fractured teeth and infection. Like most patients in our generation, you will probably have heavily filled teeth. I like to recommend you have things “patched-up” as they occur rather than waiting for pain and infection to happen. I do of course understand that your ME might make this challenging from time-to-time, but do your best!

It's also a good idea to minimise problems by maintaining your oral hygiene at a good standard, both with home and professional care. We are learning that oral hygiene is important for your systemic health as well as your oral health. Poor oral hygiene is associated with increased risks with other conditions like heart disease, strokes and diabetes. Spend as much time as you can on brushing and cleaning in between your teeth with floss, interdental brushes and even flushing devices like waterpiks. Use a good quality fluoride toothpaste and maybe even mouthwashes at some time other than when you brush.

As far as your dilemma is concerned, I usually recommend that you go for simple solutions first, and if that doesn't do it for you, try the next simplest! In other words, you should aim for some stability! Let everything heal and settle following your extractions and see how you feel about your chewing ability and your smile in a month or two. That's what your teeth are for isn't it! You might be quite comfortable with the gaps that you have in your mouth. Then you could try dentures if you're not happy. These come in different designs and materials. The main disadvantage is the coverage of your soft tissues e.g. your palate, and they can move around. They are removable as well for cleaning and not everyone is able to tollerate them. Then there are bridges. These are restorations attached to the remaining teeth either by a fixed restoration e.g. a crown or inlay, or by bonding. Bonded bridges are very conservative, but not as reliable and can become detached on occasion. They are, however, quite useful in my experience for many situations.

Dental implants are the closest you will get to having your natural teeth back. They comprise a titanium screw usually into the jaw bone, with a ceramic crown or bridge attached. Sometimes they are used to stabilise a removable denture or a fixed screwed-in bar with teeth attached. The main issue is usually, is there sufficient bone, what critical anatomical structures are in the way and the fact that you will have to have a surgical stage to tolerate. Implants always involve multiple visits for planning and execution and are always going to be the most costly. The results however can be very good and long lasting – and they don't usually result in infection or the need for antibiotics, which you mentioned.

In conclusion, do your research and make sure you ask your dentist any questions you may have.