Friday, August 23, 2013

Just Lost a Tooth? Now What?

When a tooth is lost, there are several options to replace it. You can have something that is permanent or something that is removable. There are four main options: 1. implant 2. bridge 3. partial denture and 4. nothing.


The best option is to replace it with an implant. Implants are very predictable and have a very high success rate. Once they are integrated into the bone, they can pretty much last forever. I joke around and tell my patients that it will still be in there 5,000 years from now. The disadvantage is that it is the most expensive option. Typically the implant and crown can range between $3500-4500.


The next best option is a bridge. However, I personally don't like this option for a couple reasons. First of all, if the teeth adjacent to the missing tooth are "virgin" teeth (perfectly sound teeth with no decay), then we would end up damaging them as well by cutting them down. The average lifespan of a crown or bridge is approximately eight years. That means that in eight years, we may likely have issues with the adjacent teeth. The reason this is the case is because decay can sometimes form at the junction between the tooth and the crown. Many people do not floss, so the surfaces that aren't cleaned regularly will have recurrent decay. Even if a person flosses, it is a challenge to floss under the bridge unless a floss threader is used. The cost of a bridge can range between $1000-1300 per unit. A bridge always has three or more units. The cost of a three unit bridge is comparable to an implant, so the implant to me is the only logical choice unless the adjacent teeth have significant decay and need to be restored anyway.

Partial Denture

The next best option after a bridge is a partial denture. A partial denture is the most economical choice ranging between $500-2000. It works......but I don't like this option either. As far as the patient is concerned, it is very inconvenient to always have to remove the appliance. For me, I don't like it because in many cases, the partial denture is retained by other teeth. Over time, the other teeth are damaged or compromised. It is an option though.

Do Nothing

By far this is the least expensive option. However, it is also the worst option. The remaining teeth shift and create problems. Teeth are like gears. They need to match up properly. For example, if the gears in a watch or engine don't match up, in a relatively short period of time the watch or engine will fail. In addition, the jaw bone will develop defects.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Wednesday, August 14, 2013

Minimally Invasive Dentistry

What exactly is minimally invasive dentistry? There is much written on this subject.

The device shown above is a cavity detector. It's a nice piece of technology that allows dentists to assess cavities more accurately. The technology is far more precise than visual or tactile inspection.

Even though we have and use many different tools and techniques, minimally invasive dentistry is not a collection of procedures, techniques or treatments. Minimally invasive dentistry is a concept. Basically, it can be summarized as doing the most conservative possible treatment to maintain optimal oral health.

There are three main advantages to this approach:
  1. We avoid unnecessary tooth destruction
  2. We minimize expense
  3. Results are more predictable
Let's look at a diagram on the right to demonstrate an example. Here we see that in the early stages of a carious lesion (a cavity), it is confined to the outer layer (enamel) of the tooth. As it advances, it penetrates into the inner layer (dentin) of the tooth. Once this happens, the progression of the carious lesion is accelerated. In other words, it gets bigger faster. If allowed to progress into the pulp of the tooth, now a root canal is required to salvage the tooth. If enough tooth structure is destroyed, then the tooth may not be salvageable.

How do we minimize expense and unnecessary tooth destruction? Easy, just treat at the earliest time possible. I often tell my patients that it's much better to change your oil than to change your engine; or change your car;  or simply stop driving. I know, crazy analogy but it makes sense. With the progression it gets more 20 fold or more. 

Let's look at some costs of possible treatments:
  • Treat early--cost of a filling: $100-200
  • Treat later--cost of crown or onlay/inlay: $1,000-1400
  • Treat much later--cost of root canal, build up and crown: $2,200-2800
  • Treat much much later-- cost of extraction $100-200 + bone graft $300-600 + implant $3,800. Alternatively a bridge $3,000 or partial $1,800 can be made to replace the missing tooth.
If we opt to wait, what are we waiting for? For things to get worse?

Unfortunately, most people will wait. Approximately, 80% of the population does not see a dentist on a regular basis. Most in this group will only address their issues when it is blatantly obvious or when they are in significant pain. The entire experience can however be much more pleasant while at the same time being easier on the pocketbook and psyche if a proactive approach is taken.

Here some examples of potential scenarios:

Small lesion treated very conservatively
Much more extensive decay. The restorability is questionable because it is impossible to determine
the extent of the vertical fractures.

In summary, addressing issues in the earliest stages possible will enable the conservation of tooth structure, will reduce costs, will increase predictability and decrease physical and/or emotional distress.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit