Dr. Mike Malone’s Blog

I was planning on attending a presentation being held at the local senior center about Clear Choice, but I heard they have had a lot of consumer complaints. I am retired, and on a very tight budget. I do not want to even waste my time going to the presentation if this company is not on the up and up. Can you give me any insight as to whether or not Clear Choice is ethical?

Thanks for your time.

Russel in Cripple Creek

Dear Russel,

We cannot empirically state that all Clear Choice dental implant centers are unethical, though many of what seem to be standard practices for them are highly questionable. Every center is obviously different, with different staff members, and different strengths and weaknesses. The stories that are emerging from people who have had evaluations or attended seminars seem to indicate that salesmanship and marketing are heavily emphasized within the entire Clear Choice organization, and those two priorities make the risk of poor dental health care choices very high. We are especially concerned with the consistent reports of treatment plans that recommend that ALL teeth be removed as part of the treatment. This is almost NEVER a good idea. If you do get a treatment plan from a Clear Choice facility, I would strongly recommend getting a second opinion.

Our best advice to you would be to find a dentist in your area who has experience, training, and credentials in dental implantdentistry. Look for a general dentist or prosthodontist that has several years of experience. A fellowship or membership in the International College of Oral Implantologists or the American Academy of Implant Dentistry is also a good sign. This Detroit cosmetic dentist has impeccable credentials - this will give you some idea of what to look for in a dentist in your area.

One of my molars has decayed below my gumline, and both my regular dentist and a specialist I saw said it has to be removed and replaced with a dental implant. I don’t have insurance and want to spread the cost of the two procedures out as much as I can. How long can I wait to get the dental implant after I have the molar removed?

Theodore in Grand Falls

Dear Theodore -

A few things will affect the timing of your dental implant after your molar is fully extracted. First, you must wait for the infection in the socket to heal. As soon as possible after the infection has cleared, you should have the root form placed. I know you wished to take more time, but I would advise you to keep the delay to a minimum. Here’s why.

After just a few weeks, the teeth surrounding the site of a lost tooth will begin to “tip” into the space, and the corresponding tooth in the opposite jaw (the opposing tooth) will begin trying to grow into the space. All of these are natural movements. Our teeth will naturally shift to touch their neighbors, and meet the teeth in the opposite jaw. If left too long, the shifting of teeth due to the missing tooth can cause headaches and TMJ pain, and can be very costly to repair.

The root form of the implant also needs several weeks to heal and to integrate into the bone of your jaw, so your dentist will need to fit you with a temporary tooth to help hold the space. A dental flipper, which is a simple resin tooth mounted on an acrylic plate, would be effective.

Your dentist may be able to work out financial arrangements with you to make your very necessary dental care more affordable. Good luck!

I am currently wearing full upper dentures, and I hate them. Nothing my dentist tries with them seems to work, and he has now suggested that I go to dental implants. I can not afford to do that on my own. Is there any kind of dental insurance plan out there that would help me cover some of the cost of dental implants? Thanks for your help with this.

Eliana from Miami

Dear Eliana,

You’re in a difficult position, and you’ve highlighted a little known issue that occurs when people have all their teeth removed. What many people don’t know is that when you lose a tooth, your body reabsorbs the bone at the site of the missing tooth. If you’ve lost ALL your teeth—whether through extraction or decay—your entire jawbone begins to shrink. After 20 years or so, you will be unable to wear any kind of denture at all. Restoring your oral health at that point becomes a lot more complicated, and will probably require bone grafts in addition to dental implants. Dental implants help halt the bone loss that makes your jaw bone shrink, and can serve as anchors for your dentures if you have no alternative but to have them extracted.

Sadly, no private dental insurance plan I am aware of will pay for dental implants.

To understand this, you have to think about it from the perspective of the dental insurance company. They wouldn’t stay in business long if they sold you a plan and then immediately paid out for coverage that dramatically exceeds the cost of that plan. They are a business, and businesses need to make money.

Dental insurance through an employer makes more sense to most people. Essentially, your employer is using pre-tax dollars to pay for the cost of employees’ dental care (along with a small profit for the insurance company) as a benefit of employment. Dental implants are almost never covered through an employer’s dental plan, either. They pay for the least expensive treatment, which is a denture rather than implants. If you require any kind of extensive dental work, the typical annual maximum of $500-$1,000 doesn’t usually go very far.

Talk to your dentist about financing your care. He may be willing to help you figure out a financial plan that will suit both of you to see you get the care you need. Good luck!

I recently lost one tooth due to decay underneath my crown. The entire tooth broke off at the gum. It had been root canaled so the post is there from the root canal. The tooth is on the top left and is the third molar from the back. My dentist says the tooth can’t be saved. I can’t decide whether to do an implant or a bridge. For a bridge, there is a filling in one tooth next to it and a inlay in the tooth on the other side. I’m worried about bone loss though. Will I get bone loss if it is just one tooth missing? Will I experience bone loss with a bridge? Please let me know what you think. I am 46 and in excellent health and no bone problems right now.
- Deborah from California

Deborah,
It doesn’t sound like there is enough left of your tooth to hold a crown, so it needs to come out.

Yes, even with one tooth missing, there will be bone loss in that space where the tooth used to be. Your body will resorb that bone to use the minerals elsewhere. But, since the space is a small space, the amount of bone loss isn’t very significant. Plus, it’s not in a place that will likely show when you smile.

However, if the adjacent teeth are sound and only have conservative fillings, a dental implant would be a good idea, just to avoid grinding down otherwise healthy teeth for crowns. A dental bridge requires you to have full coverage crowns on each adjacent tooth. A dental implant, on the other hand, just requires placing a root form, allowing it to heal, and then placing a crown on that root form.

I bit into a fork couple of months back. and hurt a lower tooth. I have just lost that one lower tooth(# 24). We are considering doing a bridge from canine to canine because the two on the two sides of the missing tooth are OK but kind of weak the dentist said. Options I have been given are 1) Maryland bridge or 2) fixed conventional bridge. I have tried to compare the two types from literature but I am not sure what would be my best option. I would really appreciate your opinion and advice.
- Avram from New York

Avram,
There may be more than those two options. I haven’t seen your case myself, so I can’t say for sure, but I’d maybe get a second opinion and see if there isn’t something else that can be done.

Neither of the two options sounds very attractive. A Maryland Bridge is conservative, but it is made out of metal, and it will darken the adjacent teeth. You may be interested to see a case of a Maryland Bridge that Dr. Malone removed to replace it with a more esthetic porcelain veneer bridge. The bridge from canine to canine sounds very aggressive for replacing just one missing tooth.

Was a dental implant considered as an option? I’d suggest finding a dentist who does a lot of dental implants and asking if this could be a case for an implant. There are also other conservative esthetic bridge options, such as a porcelain veneer bridge, an Encore bridge, or other choices that an expert cosmetic dentist could provide. You’re in New York. You can find an excellent cosmetic dentist by going to the mynewsmile.com cosmetic dentistry website.

Good luck.

Lafayette, Louisiana dentist

My 15-year-old daughter is missing her upper eyetooth. She had braces and after the braces came off, she had a retainer to wear during the day that had a fake tooth on it, along with a retainer to wear at night that did not have a fake tooth. She developed a reaction to the retainer, and when she would take the retainer out you could see the impression on the roof of her mouth and the roof was very red and inflamed.

We have three doctors trying to determine the best thing to do and I would like your opinion if you have time:
1. The periodontist wants to put in a temporary implant, (he will not put in a permanent implant because she is not 18) but the orthodontist says he has seen the patients that have had this done and it does not look good at all.
2. The orthodontist wants her to have a Maryland bridge done but her dentist has said the teeth will look grayish.
3. The dentist wants the orthodontist to make a different retainer that she will not have a reaction to.
- Stephanie from Georgia

Stephanie,
When I read comments like yours where you have opinions from different dentists and you’re concerned about the appearance, I look for how sensitive the different dentists are to appearance issues. In my opinion, that’s the key point you can take away from this. The vast majority of dentists are technician-minded and not that appearance conscious. Surprisingly, this is true of most orthodontists, too. People think of orthodontists as specializing in appearance-related issues, but most of them are dedicated to “straight teeth”, not to “beautiful smiles.” There’s a difference.

And with these comments, please realize that without seeing the case, this advice is partially guesswork.

Yes, a Maryland Bridge makes the teeth on either side a little grayish. Many dentists think that amount of gray isn’t significant, but to patients it is. The fact that your general dentist is sensitive to this issue is noteworthy.

A dental implant is the best permanent solution. So I’d plan on that in a few years.

For now, a removable retainer with the tooth on it, made out of a material that she isn’t sensitive to. There are a variety of materials to make these out of.

Bottom line - it appears to me that you should trust the general dentist here.

Related links:
Read more about your options if you have missing teeth.
One option is a dental bridge.
Click here to read more about fixing crooked teeth.
mynewsmile.com, the most popular cosmetic dentistry web site on the Internet, has a case of Dr. Malone’s posted with photos of a Maryland Bridge replacement. Dr. Malone did a porcelain veneer bridge.