About 10 years ago, I was having a lot of trouble with my teeth. My dentist said I had periodontal disease and recommended that I have my teeth removed so he could fit me with dentures. I wanted to stop hurting and going to the dentist all the time, so I got the dentures. That same dentist always worked with me until recently, when I took my daughter’s advice to see a new dentist. Now I find out I have lost a lot of bone and I want to know why my first dentist didn’t tell me about facial collapse, what it is, and if I can prevent further bone loss.
Judy, Tallahassee, Florida
It’s unfortunate that you are just now finding out about facial collapse. Hopefully they are fewer and fewer, but there are some dentists who not only aggressively sell their patients on dentures, but also fail to fully inform them about the problems with dentures and especially about the bone loss that leads to facial collapse. But further bone loss can be prevented with dental implants. And with bone grafting, the effects of the bone loss you have already suffered can, to a large extent, be reversed. Let’s take a look at what facial collapse is, and then we can explain your options for treatment at this point.
What is Facial Collapse?
We tend to think of our teeth as just the visible crowns that appear above the gum line, when, in fact, our tooth roots are integral to our dental and overall health. The roots not only attach the teeth to the jawbone, they also keep the jawbone in place. In fact, as soon as we lose a tooth, the body interprets the loss to mean that we no longer need the bone that used to support that tooth. So it begins to “resorb” the bone-building minerals from that part of the jaw, because there is always a need for those minerals elsewhere in the body.
When we lose most or all of our teeth, this process of resorption proceeds quickly at first and then slows down, and over the course of just ten to twenty years, we can begin to see the signs of facial collapse. The illustration to the right shows four jawbones. The first one still has a full set of lower teeth, and you can see that the jawbone is still present and healthy. In the second jawbone, there has been some vertical bone lost. And finally, in the last two, so much bone has been lost that it would be impossible to even support dentures.
The corresponding appearance that accompanies facial collapse is the kind of sunken-in appearance with strong vertical lines around the mouth that we associate with old age.
Because you have been without your teeth for about ten years, it is likely that your new dentist can take remedial measures to prevent the bone loss from progressing further, and there may even be a chance of reversing what you have already lost with bone grafting and dental implants.
Preventing and Treating Facial Collapse
Because dentures only replace the visible parts of our teeth, they can never prevent bone loss. But dental implants are actually tooth root forms onto which dental crowns are fixed, effectively replacing both the tooth root and the visible part of the tooth. These tooth root forms are placed into the jaw bone during a surgical procedure.
As you heal from the surgery, a process that is the reverse of resorption takes place. It is called osseointegration, and it means that the body brings more bone-building minerals to the site of the implanted root and surrounds it with new bone. By the time you are fully healed, your jawbone will have fully integrated the implant, so that it ultimately becomes part of the bone. The resulting structure is strong enough to receive a crown and to withstand the pressures of chewing.
And if you no longer have enough bone left to support an implant, bone grafting can be used to reverse the bone loss process. Bone grafting can sound like a difficult procedure, but it is actually a minimally invasive surgery during which safe and effective grafting materials are placed. Your body responds to the implanted material by regenerating tissue, and will actually replace the graft with your own bone-building minerals.
The Role of Implant-Supported Dentures
Finally, you do not need to replace every single tooth with a bone graft and dental implant to have a great outcome. Implant-supported dentures are held in place with six to eight dental implants, and they can not only solve many of the problems many people experience with removable dentures, they can also prevent further bone loss.
Your next step should be to talk over your treatment options with your dentist, and if you do not feel that he or she is really comfortable discussing dental implants, bone grafting, and implant-supported dentures, don’t hesitate to do more research. You will eventually find the right dentist to provide you with the kind of outcome you are looking for.
Good luck to you!
This Blog is brought to you by Dr. David Pumphrey of Pumphrey Periodontics in Atlanta, Georgia.