Beyond Just Smiles Dental Blog

Commandment #5–The “Apartment Building Theory”

Choose Wisely meme of man wearing armor

Everyone knows you can choose your friends, but you can’t choose your neighbors. In dentistry, I apply that adage to the selection of ways that I can replace a missing tooth. Any of my patients that have had to do so know my “Apartment Building Theory.”

It goes like this:

If you live in  a single family home and your neighbor has a fire in his house, you can help him out with food, shelter, and clothes–but you don’t have to do so. It’s done out of the goodness of your heart.

If you live in an apartment building and your downstairs neighbor burns his house to the ground, yours goes with it since you’re attached. You don’t have a choice.

In dentistry, if one or more teeth are involved in a given restoration, then a cavity or problem in one of the supporting teeth affects every other tooth. The more individual teeth you have, the better your prognosis for the long term.

If a patient comes to me with a complaint of a missing tooth, I can offer one of four dental options for care:

  1. Do Nothing.
    • Pros:
      • Short-term, the cheapest option.
      • Single visit. No further treatment needed for that tooth.
    • Cons:
      • Of course, that means the lost tooth is not replaced.
      • Aside from the obvious decrease in the ability to chew, the surrounding and opposing teeth will collapse like dominoes.
      • The bone that used to be there to hold teeth will deteriorate.
      • A single lost tooth can cause the collapse of 4 or more other teeth.  (Rule #1)
  2. Removable denture(s).
    • Pros:
      • Relatively inexpensive in the short -term.
      • Can be fabricated relatively quickly.
      • Useful life about 8-10 years on average.
    • Cons:
      • These sound like the greatest thing since sliced bread on paper. They are quick to prepare and cheap–until you have to live with them.
      • It can be challenging to make them look natural.
      • Speech, eating, chewing, digestion, taste and appearance are ALL affected. And, since they have to be removed while sleeping, appearance is definitely a problem for some.
      • Many patients complain about having to remove bits of food from underneath after every meal.
      • A single lost tooth requires the support of at least 3 to 4 other teeth.
  3. Fixed Bridgework.
    • Pros:
      • Looks great (usually), feels natural (most of the time).
      • Does not need to be removed at night.
      • Short-term: about 25% less than an implant-supported crown.
      • No Surgical treatment needed.
      • Useful life about 12-15 years on average.
    • Cons:
      • Long-term: most expensive option.
      • Usually two neighboring teeth are crowned and a false tooth/teeth is soldered in between.
      • Dental work is subject to the pitfalls of Rule #2
      • Root canal treatment need is a risk (Rule #4)
      • Can be difficult to keep clean.
      • Nearly impossible to remove/repair.
      • Fails by decay under one of the abutment (“support”) crowns.
      • Usually involves a minimum of 2 or more adjacent teeth.
  4. Implants.
    • Pros:
      • Can be highly cosmetic.
      • Does not involve or depend on any other tooth/teeth
      • Long-term: may be less expensive because of independence.
      • Can be screw-retained for easy maintenance, removal or replacement (if porcelain is chipped or broken).
    • Cons:
      • Short-term: most expensive option.
      • Surgical procedures required for placement.
      • Requires precise attention to the fitting of the crown into your bite pattern.

My preferred method of treatment is the one that best fits my patients’ needs, goals and desires for their lifestyle.

The bottom line is that if you want to replace a missing tooth, you have to do something. And, the more teeth that need to be replaced, the more restricted, complicated and/or expensive the treatment options become. My only caveat is that if an option allows it to be independent of other teeth, the replacement is not dependent upon the future of every supporting tooth.

large orange apartment building surrounded by trees and cars
The more people/teeth/parts involved, the greater the potential for problems.

Single-family home vs Apartment complex. It’s a choice.

You need only ask your dentist what option is best for you, consider the pros and cons of each option and then Choose Wisely.

Thanks for taking the time to consider my recommendations for your own needs or those of a loved one.  You can read all of my “Rules” at Dr. B’s Five Commandments of Modern Dentistry. If you have questions about these choices, or any other issues concerning your dental health, feel free to call. We are always willing to help!

Until next time–Keep Smiling! Please check in again.

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