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Advanced cosmetic and general dentistry

Eight years of missing teeth, and my face is starting to sink

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I have had three upper tooth missing for about 8 years and one lower tooth missing for about 9 years. I have noticed what feels like a decrease in volume in my jawbone on that side of my mouth. It is also difficult for me to chew on that side, so I chew on the left side of my mouth. When I look at myself in the mirror, I notice that the right side of my face looks a little sunken. Finally, I can get dental implants, but I wonder if this thing with my jawbone and face will get corrected with the implants. Oksana

 

Oksana – The situation you are describing with your cheek and jawbone is likely an indication that your jawbone is shrinking. When a tooth is missing, your body resorbs the jawbone from the space. A shrunken jawbone can cause the face to sag, as you described.

Can You Get Implants with Bone Shrinkage?

If you have jawbone shrinkage, to receive dental implants, bone grafting, an implant dentist or oral surgeon must build up your jawbone.

  • After the grafting procedure, when your jawbone heals, dental implants can be placed.
  • It takes about four months for bone grafts to heal.
  • Building up your jawbone and placing the implant will help to give your face its natural form again.

Beware of Bargain Implants

Dental implant diagram of component, implant fixture in bone, and crown placement

Dental implants can prevent bone shrinkage and facial sagging

People who need dental implants might be tempted to find the lowest cost possible. The danger in price shopping is that you may receive poor quality in implant fixtures and implant placement. We strongly recommend that you find a few experienced implant dentists with whom you can have consultations.

You will discuss your options with each dentist and decide who you want to complete your implant placement. Be sure to find an implant dentist who is also a cosmetic dentist. They will provide you with natural-looking crowns for your implants.

 

This post is sponsored by Michael Szarek, DMD of Lowell, MA.

Should My Dentist Replace a Cracked Porcelain Veneer for Free?

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In March 2021, my dentist placed ten veneers on my top front teeth. I agreed to ten veneers because I have a broad smile. My dentist did beautiful work, and I have recommended several friends to her. I wore a nightguard before I got the veneers because I grind my teeth. And I have never stopped wearing a nightguard. Two nights ago, I forgot to wear my night guard, and in just that one incident, my right lateral incisor veneer cracked. Should forgetting to wear my nightguard one night cause a veneer to crack? Can a dentist repair a cracked veneer? And should I ask my dentist to replace it for free? I was planning on getting a dental implant for a lower first molar, but this setback might delay my plans. Thank you. Lyzelle from ME

Lyzelle,

Thank you for your question.

Can a Dentist Repair a Cracked Porcelain Veneer?

If a porcelain veneer cracked into two pieces that fit together perfectly, a cosmetic dentist could bond the veneer onto the tooth. The crack will be virtually invisible.

Should Your Dentist Replace Your Cracked Veneer at No Cost?

If your porcelain veneer cracked because you failed to wear your nightguard, your dentist is not responsible for replacing the veneer at no cost. But your veneers are only three months old, so some dentists would replace the cracked one and charge you for the lab fee or another portion. But you can expect to pay the full cost if it happens again.

Dental implant diagram of component, implant fixture in bone, and crown placement

Dental implants are highly effective for tooth replacement

Another factor is whether your dentist gave you specific instructions about wearing your nightguard to avoid damaging your veneers. If your dentist explained the risk, she might not be inclined to replace your cracked veneer at no cost. And you mentioned wearing a nightguard even before your dentist placed the veneers, so unless there are factors that you have not mentioned to us, be prepared to pay the total cost of replacing the veneer.

We understand that you have been anticipating getting a dental implant. But if you have found an excellent dentist, be reasonable if she is willing to negotiate with you on the cost of replacing the veneer.

 

Michael Szarek, DMD, an accredited cosmetic dentist in Lowell, MA, sponsors this post.

Should I choose zirconia or titanium implants?

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I have four missing teeth and am gradually replacing them with dental implants. My first two implants are titanium. But I read online that zirconia implants might be better because titanium can cause an allergic reaction or neurological issues. I will receive my next two implants in the fall. Should I ask for zirconia implants this time? Thank you. Oliver from RI

Oliver,

Thank you for submitting your inquiry to our office.

Titanium is one of the most biocompatible materials used for prosthetics in the medical and dental fields. Although people with specific metal allergies or sensitivities might benefit from zirconia implants, titanium is widely used. The human body contains various elements that help it perform essential functions, including zinc, iron, and copper. If a specific metal causes a reaction, it must be determined on an individual basis.

Are Zirconia Dental Implants Better than Titanium?

A December 2016 article, Zirconia Vs. Titanium Implants – Deciding Factors, was published in the Journal of Dentistry, Oral Disorders & Therapy. The report makes the following points:

Zirconia implants

Although zirconia is an ultra-strong ceramic, many implant dentists recognize its limitations:

  • An implant dentist or oral surgeon cannot usually leave zirconia implants to heal beneath the gums
  • Zirconia lacks the flexural strength of titanium and may crack under pressure
  • Adjustments to zirconia can lead to micro-cracks that can spread and result in dental implant failure
  • The small diameter of zirconia implants increases fracture risk
  • The one-piece design of zirconia implants is not conducive to using for full-mouth reconstruction

What If You Have A Titanium Allergy?

Photo of five dental implant screws. On both the left and right side is a single titanium implant, and three zirconia implants are between them.

Titanium (metal) and zirconia (white) dental implants

Although most people are concerned about an allergic reaction to titanium, only 6% of patients have titanium allergies. And some metal reactivity tests are unreliable. But if you have a confirmed titanium allergy—or if you simply prefer zirconia—zirconia dental implants may be an option.

Schedule a Dental Implant Consultation

We recommend that you begin with a consultation with a skilled cosmetic dentist who restores dental implants. He or she will explain your options for crowns or dentures on zirconia vs. titanium implants and the result you can expect.

Dentists who do not have advanced implant surgery training work with a periodontist (implant specialist) or an oral surgeon to plan for and place your dental implants.

 

Michael Szarek, DMD, an accredited cosmetic dentist in Lowell, MA, sponsors this post.

New dental crowns for a gap make my jaw and neck hurt

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I received a dental implant on a left incisor and crowns on all front six teeth. I received the other crowns to close a large gap between my front teeth. Now my speech is slurred and lispy, and I have neck and jaw pain, dry mouth, and numbness in my lips. I regret closing my gap. Are the crowns causing this problem? If so, I want them removed, and I will keep my gap. – Dahlia from CT

Dahlia,

Closing your gap is not the issue, but the quality of your crown placement is the problem. Correctly sized and seated crowns do not create the symptoms you described.

When Dental Crowns Cause Symptoms

When dental crowns cause symptoms, including pain, numbness, or dry mouth, it could be that the crowns are too thick, too long, or both.

  • Oversized crowns – Oversized crowns can prevent your lips from closing naturally and effortlessly.
  • Lip incompetence – When your bite is correct and you put your teeth together, your lips should close naturally without thinking about it or trying to close them. Your lip numbness and dry mouth suggest you have lip incompetence—the ability to close your gaps naturally.
  • Thick crowns – Too-thick crowns can disrupt your bite (the way your upper and lower teeth fit together) and cause jaw and neck pain. Speech problems can result, too.

What to Do About Faulty Crowns

When dental crowns cause pain and dry mouth, you must find a cosmetic dentist to correct the issue. A dry mouth and lack of saliva breeds bacteria and promotes rapid tooth decay. Saliva contains antibodies to help fight decay, so don’t let the problems linger.

Diagram of three phases of dental implants, for information on implants and diabetes from the office of Lowell, MA dentist Dr. Michael Szarek.

Get a second opinion to check your implant crown and crowns on your natural teeth

We recommend that you find an advanced cosmetic dentist—preferably accredited—for a second opinion. It is challenging for a dentist to place multiple crowns simultaneously and balance your bite correctly. But a trained cosmetic dentist who understands occlusion and bite (how your teeth fit together and come in contact when you bite) can evaluate your case.

The cosmetic dentist will do the following:

 

Unfortunately, you may need new crowns. But your oral health is essential to your well-being.

Best wishes.

 

Michael Szarek, DMD, an accredited cosmetic dentist in Lowell, MA, sponsors this post.

Jaw swelling is worse after a tooth extraction

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My bottom right second molar was hurting on and off for a few months. My jaw started swelling, so I finally went to a dentist. And a little over a week ago, the dentist extracted my bottom right second molar. Before I left the dental office, my doctor gave me an amoxicillin prescription. I’ve been taking the medicine, but the infection and pain are worse. The swelling in my jaw is large and hard. Do I need to ask for a stronger dose of amoxicillin before Io lose the tooth? Thank you. Reuben

Reuben,

Although amoxicillin often works well for tooth infections, your infection is not improving. It’s getting worse. Many infections have a bacterial strain with amoxicillin resistance. That is likely the case with your infection.

Infections in the jaw can become severe, spread elsewhere in your body, and become life-threatening.

Signs and symptoms that the infection is spreading:

  • Diarrhea
  • Dizziness
  • Fatigue
  • Fever, including sweating or chills
  • Headache
  • Nausea
  • Rapid heart rate
  • Stomach pains
  • Swelling that makes it difficult to open your mouth, swallow, or breathe
  • Vomiting
Diagram of three phases of dental implants, for information on implants and diabetes from the office of Lowell, MA dentist Dr. Michael Szarek.

Treating a severe jaw infection is the priority. A dental implant can replace a lost tooth.

Call your dentist immediately and request a different antibiotic that will help your body fight the infection. Don’t delay getting the prescription filled and taking the new medicine right away. If your symptoms get worse, go to an emergency room.

The effects on your overall health are at risk. If you lose the tooth, you can visit an implant dentist to replace it. But for now, it is essential to get the infection under control.

Michael Szarek, DMD, of Lowell, MA, sponsors this post.