Several opinions-collapsed arch, jaw, bite. Osteoporosis Implants

@tmtm4 I don't have periodontal disease, but because of gun recession, my gums have thinned and the roots of my teeth are exposed a bit. Stress affects this a lot. This is likely from tension in my neck and jaw and it has been going on for years. It started when I was younger and dentists would ask if I was brushing too hard or using a hard toothbrush. Well, maybe I did. I was quite upset as a child getting cavities and didn't want it to happen again. The gums have to seal around the teeth roots, and if you have tension pulling on the gums through the jaw (as can happen with grinding teeth and stress), it can affect it. Even grinding teeth, or having a tooth that is "taller" than the others puts stress on that tooth and can start blunting the roots of the tooth from pressure and can loosen that tooth leading to possible loss. My dentist showed me an x-ray demonstrating this, and had me have my bite adjusted by filing down (very slightly), the teeth that were "too tall", so that it evened out the pressure of biting over the whole mouth.

For grinding at night, having a bite guard made and wearing it helps with the pressure. I had one for awhile, but after my implants and new bridge and bite adjustment, it no longer fits, and they say I don't need it now.

My mom has similar issues with her feet and deformity due to arthritis along with severe osteoporosis. It is good that you are treating the thin bones. My mom had a spontaneous compression fracture in her spine because of the severe osteoporosis because she had a problem with a parathyroid gland that was malfunctioning and causing calcium to be pulled out of her bones. If that is the situation, it's best to be seen by an endocrinologist because some medications for osteoporosis don't help enough in that situation. My mom was on Fosamax for 10 years before the spine fracture happened, and now is receiving injections of Evenity instead.

What brings you joy? You may wonder why I asked this, but you can find ways to distract yourself from the stress and health problems that you live with. Fear increases pain a lot, and finding something creative to do can take your mind away from it all. This is a lesson I had to learn myself because I was very fearful of pain and surgeries, and when I needed to choose between surgery for cervical stenosis and loosing the coordination of my arms, I decided to face my fear and embrace the surgery that changed my life. I had the voice of a small powerless child inside influencing me who had not resolved the past fearful issues. I worked through all of that, and left that fear behind. I realize your experience is different, but you can control the voice in your head and how it talks to you about your life. You can choose to occupy your mind with something that brings you joy. I say these words with kindness, not criticism. Mayo Clinic does have a pain management program that teaches people how to re-frame their thinking about pain, and all the artwork everywhere at Mayo speaks to this need to be inspired by beauty as part of healing. There is also a great discussion on Art and healing here on Connect.
https://connect.mayoclinic.org/discussion/art-for-healing/

I went to a surgeon in KC that said he can do an all on 4 for $15,500 for everything. The dentist will take care of me afterward until I get the final bridge. They took a 3-d x-ray but he didn't examine my mouth. the dentist sent him what he had. Tghe dentist would get $10,500 for his part.
My front two teeth are almost gone from periodontal disease and I take Oriencia infusions once a month for RA. I'm scared they will be gone by the time I have surgery so I am wondering if I should do the crowns first on the bottom. I can't get into the dental school for a month.
I brush my teeth 2/3 times a day and use mouthwash. I don't understand why this is happening. I am retired and this will take everything I have. This is so hard.

Could you clarify for me about the two front teeth that require crowns?
Are they teeth with severe periodontal disease? If so, that’s a big no! There’s no point in putting money into teeth that you’re concerned will be lost due to bone loss caused by periodontal disease.
Are these the teeth that have been worn down from grinding them? If that’s the case, i undertand the need for crowns. But again, they better be stable, healthy teeth and not teeth that will be lost.

I really can’t answer why this is continually happening. Generally periodontal disease, if caught easily, can be stopped. Once it progresses too far, then it can cause bone loss, which causes tooth loss and then it’s like dominos falling.

It’s difficult for me not being able to see what’s going on in your mouth and I don’t know your complete oral history.
I’m so sorry this is happening and I know it’s hellaciously expensive. If your goal is to have solid, working teeth again, the I’m afraid what your dentist is advising is the best route with the implants.
Brushing several times a day is good but I’m hoping there is also daily flossing. That gets into the areas between the teeth down into the gums to remove plaque, (tarter), food debris that collects in the deeper pockets of gum tissue that are the root cause of periodontal disease.

Before you jump into having crowns done, I’d wait the month until you can get to the dental school for their opinion. Just be mindful of watching what you eat. Avoid really hard or chewy foods right now. No corn on the cob, no foods that you bite hard or tear into. Cut food into small pieces which I’m sure you’re already having to do because of so many lost teeth.
I want nothing more than for you to have your smile return instead of these tears! Take a deep breath. Nothing major should be happening in this next month so don’t rush into this. If you can get into the dental school they may have a lessor fee schedule for you so that might help offset the cost.
Most dental practices take a down payment and then monthly payments instead of having you pay all at once.

You mentioned it’s a month waiting, but did you make an appointment at the dental school?

I did make an appointment, and they got me in the doctoral student screening on July 19th, but they want all my records, and I don't want to make the dentist & surgeon I have now angry. I have spoken with the surgery coordinators at length and do not want them to think I wasted their time.
It is the bottom two teeth that are bad. I think the top ones are falling out because of periodontal disease, but my former doctor said everything can wait until after I got my back, foot 2/3 times, and shoulder first. I had just retired and needed every surgery for obvious reasons. He said that would be fine although now he says it is because of my inaction." He said I could wait! Nevertheless, I wish no ill will on him. I don't think he saw this coming. He is a good man. The problem now I'm scared and overwhelmed. I can't get in before the 19th so I get to worry for a little over two wks.
One dentist told me my teeth are falling out because of osteoporosis, but I know I have bad periodontal disease.

I did make an appointment, and they got me in the doctoral student screening on July 19th, but they want all my records, and I don't want to make the dentist & surgeon I have now angry. I have spoken with the surgery coordinators at length and do not want them to think I wasted their time.
It is the bottom two teeth that are bad. I think the top ones are falling out because of periodontal disease, but my former doctor said everything can wait until after I got my back, foot 2/3 times, and shoulder first. I had just retired and needed every surgery for obvious reasons. He said that would be fine although now he says it is because of my inaction." He said I could wait! Nevertheless, I wish no ill will on him. I don't think he saw this coming. He is a good man. The problem now I'm scared and overwhelmed. I can't get in before the 19th so I get to worry for a little over two wks.
One dentist told me my teeth are falling out because of osteoporosis, but I know I have bad periodontal disease.

Thank you for giving me a clearer picture of what’s going on. Oh golly, this is a lot to take in, isn’t it.
I’m going to combine several of your replies today. Sorry for the delay, I was on the road and not able to get back to you.

To answer your question. I am not an dentist but I do have dental education background, specialty training in several different areas of dentistry and 30+ years experience as a certified dental assistant. So while I am familiar with situations like yours, I am not in any way diagnosing or telling you what to do. I’m just using my experience to help YOU make some informed decisions.

Let’s tackle the All on 4 first. You’ve had several dentists look at this option for you and all but one said, “No”. That’s very telling and I’d go with the popular opinion.
Since your original post mentioned you had a collapsed arch, that would be the reason it isn’t advisable to have 4 posts (implants) holding a full upper arch of 14 replacement teeth. That could potentially end up shifting as there is no support for the arch…too much pressure without palate stability.
The other option presented to you was having implants on the upper to hold the denture. The upper implanted posts would not have teeth on them, but rather, they are posts at the gum line that allow a removable denture to be affixed to them. That stabilizes the maxillary (upper) arch and still gives you a full smile with the ability to eat without having the adhesive on the upper plate. Also easier to keep clean.

Lower dentures are done the same way if needed. However, since it sounds as though your lower teeth are ok? Maybe a partial denture would work on the bottom. You could have your two front teeth crowned to preserve them. Then have partial denture for the bottom to fill in with the missing 4 molars.

I’d make sure those 2 teeth on the bottom are really stable before I’d put crowns on those. If your other remaining lower teeth are not affected by bone loss, you could have the two front teeth extracted and have replacement teeth for those 2, along with the 4 molars added to the partial denture. The partial would affix with clasps to the remaining bicuspids. I posted a photo below. Only for a rough idea. It is not exactly what yours would look like.

Personally, I think you should be honest with your dentist and tell him you appreciate all he’s done and would really like to do this work. But that you simply can’t afford it. Ask if he has any less expensive options he could offer.
And, that you would like an exam at the dental college to see if they may take you on as a patient where it can be accomplished for a lower cost. You have every right to do what’s best for you!
You can request your records. It won’t anger the dentist!

From experience we made every effort for our patients to accommodate their needs. But I do remember a couple of patients we referred to the dental college because they were great candidates for the new dentists and were able to get their work done for less. You can assure your dentist that you want to continue with his office in the future for cleanings and exams. What’s the point of having these marvelous new teeth if you can’t afford to buy food to eat when they’re done?

That leads me to my next question. Are you on a 4 month recall program for teeth cleaning? Did the hygienist do a root planing procedure to help correct your periodontal disease to get your bone and tissue healthy? What is your routine with your dental office?

Thank you so much for helping me to see a clearer picture. I never had periodontal work. They wanted to send me to a specialist and I couldn't afford it. I was a single parent with two girls and two grandkids. Obviously hindsight is 20/20. I never missed a cleaning and checkup though.
This is a bizarre thought, but I went through the habit of eating two large cupfuls of dry cheerios for months. That's when I noticed my teeth looked different so I stopped.

I don't know what a 4-month recall is and my hygienist didn't do a root planning procedure. In fact, when my doc said it was from my inaction, I got angry and switched dentists because he was the one who said I could wait to get dentures. Two/three yrs. ago, I had eight teeth on my upper arch. On a positive note, my new hygienist cleaned my teeth better than they had ever been cleaned.

Bless you for helping to get a clearer picture. I think I am going to get implant-supported dentures with a palate. It will cost me a fortune and that alone scares me to death. I hear awful rumors about the dental school so that is on my mind as well. Thank you again. I know I am all over the place. I fear for my future.

You’re welcome. I wish I could help you out more.
Having a professional dental cleaning regularly is incredibly important if you have periodontal disease. I’m glad you switched dentists and had a better hygienist!
In our practice, if we had patients with severe periodontal disease, they were seen for a cleaning every 4 months, for at least the first year to make sure the disease was being kept under control and bone support was increasing.

You just mentioned something that made my eyebrows raise…the comment regarding awful rumors from the dental school! Yikes. Do you know if they were actually proven to be inferior or questionable? Since I’m not from your state, I have no knowledge of what the negativity is.

But, if that is the case and this is not a reputable dental college, perhaps it’s better to stick with your current dentist who can do the implant secured denture for you. You can work out a payment schedule fee with him. Our office always worked with our patients reach a level of payment where they were comfortable.

Check with your dentist to see if there are any other options.
Losing your teeth and having replacements is a big deal. We take our teeth for granted and having them restored when they’re gone is expensive.
https://money.usnews.com/money/personal-finance/family-finance/articles/2018-07-26/7-options-for-affordable-dental-care
I don’t want you to fear for your future. If you’re on Medicare there are some supplemental policies that have dental insurance. Have you considered that option?

I qualify for Medicare Nov 1st. I have Metlife and Delta Dental now. I remember always using my teeth to open drinks because my hands don't work so well.
I clear $2500/month from my teacher benefit and SS retirement. Health and dental insurance is over $900/month and rent is $$750. That leaves me with $850 for utilities, food and gas.
Even though I qualify in five areas for SS Disability I don't have enough work credits. Teachers in MO had to pay into PSRS instead but they do not have Disability after you are eligible to retire. In other words, I get no help.
With my health history, I am scared Medicare and supplements will add up. IDK.

I have an idea. It’s very unorthodox but I remember in the dental practice where I worked, we occasionally had patients who absolutely could not afford a full porcelain crown, but we needed to preserve their teeth.
So as a stop-gap measure, we’d make a temporary crown to help save a deteriorated tooth. We removed all the decay from from the tooth and basically prep it as though it was getting ready for a crown. But, we’d place a temporary plastic crown or construct a resin crown to go over the prepared tooth and used permanent adhesive. That was for front teeth. Molars, we used stainless steel crowns. Again, this was a temporary fix to buy time… As long as the patients didn’t open bottles, eat corn on the cob or chew taffy it lasted a really long time. Then when the money was available, we constructed the new, permanent crown.

So, I’m wondering if your dentist would consider this option for you! It’s not unreasonable to request this.
You need to save those two front teeth on the bottom but can’t afford to right now. See if he’d clean out the decay and place a more ‘permanent’ type of temporary cap on for you now. That way those teeth wouldn’t deteriorate any further. Then, keep up with regular cleanings so the rest of your teeth remain strong and stable
Hold out for your Medicare in November. Your health insurance rate should drop and often a dental supplemental policy can be added. Or with the difference in premium cost you may have more discretionary money available. It’s worth a try. Then you may be able to afford the new permanent crowns.
Since you’ll be eligible in November, I’d suggest calling or going to see a Medicare insurance agent in your area soon. Where I live, there are several of these insurance companies who help retirees get their Medicare set up. My husband and I used this service. The guy knew his stuff and there was absolutely NO charge for this service. That way you can find out what your benefits will be in the future and this can help give you a plan going forward. I don’t want to see you frightened for the future.
What do you think?