Dentures vs Implants
January 19, 2011 6:50 PM   Subscribe

After a series of disasters with a very bad dentist, I have been left with many teeth that cannot be saved.

(Sorry for the length of the post, just trying to get all the details in.) My general dentist is recommending dentures/bridges at the cost of about 5k (including extractions, etc.). I also paid for a $250 consultation with a prosthodontist in one of the larger cities nearby. She said that dentures would make me miserable, and instead I should have surgery to do a bone graft from my hip, and have implants. Because I clench my jaw a lot (apparently), I would have to have metal teeth. Total cost, around $80,000.00. (No dental insurance, btw...and dental insurance doesn't cover this sort of thing, I'm told.)

I mentioned that I have arthritis...and as such I'm not sure messing with my hips is a good idea, and have been hospitalized for blood clots from previous surgeries, so I had some concerns about the multiple procedure concept, but she said those were no big deal, and that the procedures are almost completely without risk or failure. (A statement I thought odd from a medical professional.) As well, I've done two posts before, and they were both failures.

Are dentures so bad that the only apparent alternative involves taking out a 10 year loan? Is the sort of surgery the prosthodontist recommends really failproof? Do prosthodontists know more than internists? (My internist has said that he does not recommend any surgery in my case because I've got DVT issues.)

So many of the returns from search engines are obviously SEO spammers, that I'm having trouble finding data on how dangerous the surgery is, or if there are known contraindications like clotting issues, or what chance of damage there is to your joints.

Does anyone mind sharing their knowledge or experience, or can clue me to the correct search engine keywords I should be using?
posted by anonymous to Health & Fitness (19 answers total) 5 users marked this as a favorite
I don't know why they have to use bone from your hip for grafts. When I got implants, they used some sort of magic powdered cow bone. Can you get another opinion?
posted by leesh at 7:01 PM on January 19, 2011

This is one of those second and even third opinion type deals. Where you want to find the best practitioner in the state or region of the country where you live, and pay for a consultation.

80k surgery and your medical history mean you need to talk to several medical professionals about this
posted by iamabot at 7:04 PM on January 19, 2011 [1 favorite]

I would get another opinion if you can afford it. I had bone loss in my jaw from a severe infection and they were able to inject some stuff in the "hole" during the extraction that caused the bone to grow back. I don't know if that's an option for your situation, but it would be worth finding out if you have options that don't involve such a serious procedure/taking bone from your hip-- some kind of middle-ground between dentures and $80k in surgical procedures and dental work.
posted by elpea at 7:04 PM on January 19, 2011

Also, try to find someone who is up on the latest technology as these tend to be less invasive/risky.
posted by elpea at 7:05 PM on January 19, 2011

After you get that second and third opinion, you also need to sit down and think through which would truly make you more miserable: dealing with dentures or paying off a 10-year loan. I'm sure dentures aren't a joy, but having properly-fitted dentures may be more helpful than the stress and strain of paying off such a huge amount at your age. (Not that I know what your age is, but because of the arthritis I'm guessing older.)
posted by BlahLaLa at 7:09 PM on January 19, 2011

You might look to see if there's a dental school in your area, and apply to their clinic You'll get an honest opinion, and if they do the work, it will cost substantially less.
posted by MexicanYenta at 7:24 PM on January 19, 2011 [1 favorite]

Yeah, I wouldn't trust any doctor that said "you'll hate it" to convince you to give her $80,000.

Definitely good advice with the dental school. You'll probably get great care, and you'll help some kids become better dentists. Who hopefully won't try to sell people $80,000 teeth.
posted by gjc at 7:37 PM on January 19, 2011

If your dentist really sounds as cavalier as you make her sound I would be running in the other direction. Good doctors don't make a promise that you will have a good outcome because that is impossible to know even with a young, healthy person. Besides the super expensive cost of implants, depending on your medical history, implants may not even be an option (ie: people with diabetis are not recommended to have implants due to the difficulty of healing around the posts). Millions of people have dentures in the world and get along just fine. Hubby has complete dentures and eats everything with them--steak, corn of the cob, etc. In my (uneducated...Im not a dentist but my sister is) opinion I would say if you have to choose between full dentures and full implants, go with the dentures. They are much less expensive, and much quicker to have done (these days they pull your teeth and put your dentures in the same day!) You'll still have some pain and "wear" spots on your gums but this problem usually is quick to fix. Implants will be $80,000 expensive and involve a whole lot of surgery, healing time, etc.
p.s. If you have no money and no insurance, the cost of having dentures done in Mexico, Philippines, India, etc is considerably less.
posted by MsKim at 8:14 PM on January 19, 2011 [1 favorite]

Very strongly consider getting a consultation at a dental school if at all possible. I use to go to a dental school for all my dental care and I always felt like those dentists had my best interests at heart, independent of a profit motive, in a way that I've never felt about any other dentist I've ever seen. Plus they should be up on the latest technologies.
posted by mskyle at 8:24 PM on January 19, 2011

Please get several opinions, and involve your GP and/or your arthritis doc. Implant surgery takes a long time to fully heal. Find out what they say about how you'd be eating during the healing process.

My mother had this done twice back years ago. It was a different kind of implant then, but basically they removed all her teeth, put in anchor screws, and used the anchors to attach bridges/dentures to make them stronger and more durable.

Except after all the surgery, multiple procedures, and pain, they ultimately failed. Worked their way out of the jawbone and couldn't be put back. It could be that because my mom is arthritic and has kind of porous bones it wouldn't have worked anyway, and there was no way to anticipate that. It could be that the technology then wasn't as good as they have now. But I'm pretty sure that if I asked her tonight if she could go back in time and have the implant work done again she'd say hell no. Because she's now 71, and spends most of her time with no teeth because her upper palate's gums and bones have receded to the point that her dentures now slip all the time, and there's nothing they can offer her. She can't eat anything interesting anymore. At 71!

There's no saying that one would have been better than the other in her case. But it's easy to point to the cost (it wasn't even close to $80K, but it was a lot), and that there's a lot of pain involved, also, with the implants. And then to have them fail utterly? Months of healing where you have very little you can eat. Not fun.

I'd give you a recommendation if we had one. BE VERY CAUTIOUS. I like the idea of the dental school, but make sure it's a GOOD dental school with state-of-the-art tech.
posted by clone boulevard at 8:34 PM on January 19, 2011 [1 favorite]

After you get a second and third opinion, this SCREAMS "medical tourism." My dentist in Bangkok is da bomb, and the cost is less than 1/3 of what it is in the States. Even if you made a couple of trips, you do the math. I also hear good things about Costa Rica. Good luck.
posted by cyndigo at 8:35 PM on January 19, 2011

I hate my denture (upper). I'm hanging on to the teeth in my mandible for dear life (I hear the lowers are so hard to wear). I never looked into implants or other treatments because of my financial situation; I have perio disease, and bone loss is part of that, as well as tons of pain/infection that just gets worse over time, no matter how hard you try to stop it. No one ever suggested a bone graft from anywhere but maybe because I've had to plead poor? I do like its appearance better than I liked my own, but I am uncomfortable almost all the time while wearing, which is most of the time.
Before I had the extractions/denture placed I was advised by any denture wearers I knew that I'd be much happier after. I have found that not to be true in my case. I have the same amount of misery as before, it is just different. On the best days it's on my mind ... I feel like I'm wearing a prosthetic, which I am.
$80,000 is a lot of money, but if it was even a possibility knowing what I know now I'd at least consider it. So yes, see the dental school.
posted by bebrave! at 8:37 PM on January 19, 2011

Yes, absolutely see another dentist. I had a similar situation: dentist error resulted in a bad root canal, a second dentist messed it up further and actually abandoned my procedure halfway through, packed my mouth with gauze and sent me to an implant specialist in the same building. I was told 12k, and given a choice between chin graft, pig bone, or cadaver bone, which they would not guarantee to be HIV-free. Or a bridge, which I also didn't want. I was hysterical.

I felt I had been burned by three different dentists (all of whom had been recommended to me by people I trusted), so I found a local general dentist unconnected to any of the three I'd already seen. I would absolutely have gone to a dental school if that had been an option for me. Anyway, my problem was eventually sorted out (by a rockstar endodontist and superhero prosthodontist) with a new root canal and crown for $4k.

in my experience there is a very wide range of treatments, prices and outcomes in dentistry; it's worth looking around to find someone who will try to treat you conservatively. Tell the dentists that you are very keen to keep your own teeth.
posted by apparently at 8:41 PM on January 19, 2011

I've gotten a lot of work done at dental schools, and almost without fail it's been subpar or too drastic for the given situation. I often hear dental schools recommended on here and elsewhere for poor/uninsured people facing large dental decisions, and as one of those people myself, I'd really really caution against it. (If by chance you're in the Bay Area, memail me and I can recommend a really amazing, honest, money-conscious, empathetic dentist!)
posted by soviet sleepover at 9:18 PM on January 19, 2011 [2 favorites]

I had major reconstructive dental surgery, involving damage to teeth as well as bone. IANYD.

I got offered a choice of synthetic, cadaver or harvested bone. First procedure, I picked cadaver bone. Didn't take, tho the success rate is very high (probably issues with my immune system). So the next step was bone harvested from me; it came from my jaw, not my hip, and hip was never mentioned. It worked perfectly.

So...I suspect you have a doc who, at best, isn't up on the latest technique. Get a second opinion. If you're close to Atlanta, GA, USA, I've got an oral; surgeon I can recommend.
posted by kjs3 at 11:56 PM on January 19, 2011

Here are the issues that you need to consider.
1. Is there enough bone upper and or lower to grip a conventional denture? Lowers are much more difficult to get used to because your tongue and cheeks dislodge the appliance and there is no smooth arched suctiony palate to grip on to. if there is enough bone, a conventional denture can be tried at lower cost. if you tolerate it well then you are fine.
2. Have your dentist or prosthodontist confer with your internist to discuss any contrandications to the graft. Large grafts work best when the host is the donor and hip bones offer a lot of bone mass for this. using the hip bone does not mean affecting the hip joint, is fairly straightforward and offers no real longterm downside if you heal well.
3. a second or third opinion is not out of line for this. there are almost always options in dental reconstruction. some are best because they are expedient and low cost, some are best because they offer long term stability and can deal with extra ordinary conditions unique to any patient.
Memail me if you want more specific answers, i am happy to offer some advice.
posted by OHenryPacey at 9:34 AM on January 20, 2011

Can you get to a big city with a good dental school? They might have dentists on the faculty who practice nearby, and who are just better dentists. Those people also know who the good ones are to use for referrals.

I used to live outside Boston, and found a dentist in Wellesley (*gulp*) who taught at Tufts Dental School downtown (*gulp* again), who was himself originally from India and who brought in (as assistants!) other fully-licensed, international dentists who were at TDS and looking for some practice. Not cheap, mind you, but he once scheduled big work for December and split the billing so I could get it to go against two years. (And he remembered my kids and sent us a Christmas card. I loved that guy!)

I'd been away from dentists for a decade, but he was originally a pediatric dentist so he knew lots of tricks to set me at ease. My first visit I was sweating and rigid as a board, but very soon I learned to trust him and I could lie perfectly still and even doze off while waiting.

He referred me to a great practice in Kenmore Square who only did root canals. They did two or three on me that were quick and painless. Wheen I let a guy from Providence do mine next one, it was slow and painful, accompanied by hysterical screams from the next cubicle where a woman was crying about the pain, the pain. (X-rays now show it to be inflamed and really not actually done at all right. Thanks, man.)

Eventually it was an hour's drive to Dr. Padamsee's office so I switched, but I've never found as good a dentist. (Hearing him rail loudly about the perfidies of the insurance industry in his still-heavy accent -- "The insurance companies are allllways trying to scrrrew you!" -- made me laugh. He was the best. *sigh*)

Anyway, see if you can find someone who teaches and get your consultation from them, or from someone they recommend.
posted by wenestvedt at 10:11 AM on January 20, 2011

The dental school at the University of Texas in Houston is excellent. Even if you're not in the area, adding in the cost of flights would still probably come out far, far less than $80K.

And I've also heard good things about Costa Rica. Go to the website and do a search for "dental implants." There's even information about where to stay for aftercare.
posted by MexicanYenta at 12:23 PM on January 20, 2011

I too need all my teeth replaced and, I won't go into why but, I cannot wear dentures. So I went to several dentists who told me that I would need a sinus lift and a bone graft (taken from my hip) before I could have dental implants. This sounded awfully painful and time-consuming, so I kept looking.

I found a place that specializes in what's called the all on four dental implants procedure. Basically, an entire bridge of teeth are permanently attached to four implants on each jaw. AND I was told that with this procedure I would not need a sinus lift or bone graft. So this is what I will be getting.

It's not cheap. I was quoted $50,000. But for me, it's worth it. I don't have the option of wearing dentures, and the traditional implants requiring the bone graft and sinus lift were quoted at $100,000.

This experience showed me that dentists are NOT created equal. So shop around until you find what makes sense for you. Good luck.
posted by iNurtureTheOdd at 3:33 PM on March 11, 2011

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