All Smiles with Improved Dental Care for Seniors
A dental technician at Exo Dental in Rogers paints a set of top dentures that were 3D printed. Digital dentistry is revolutionizing denture fabrication, giving seniors a reason to smile.
The earliest dentures were made more than 2,500 years ago with human and animal teeth strung together by gold wires, according to the University of Toronto’s Dentistry Library. Wooden dentures emerged 2,000 years later, in 16th-century Japan. In the 1700s, dentists tried using ivory and human teeth (what George Washington’s famous “wooden teeth” were actually made of).
The first modern dentures, made with porcelain mounted on gold plates, were fabricated in the early 1800s. The acrylic resin that today is the primary material used for denture bases first saw widespread use in 1938.
Seniors today aren’t the first to experience declining dental health as they age, nor will they be the last. Dentistry, however, has come a long way, particularly within the last 100 years, as advanced materials and new technologies have become available.
“You can get new teeth in a day,” says Dr. Jacob Smith, owner of Exo Dental in Rogers.
Root of the Problem
One in five seniors in Arkansas has had all of their teeth removed, according to America’s Health Rankings. A 2013 study by the Arkansas Department of Health found that 94% of seniors in Arkansas were missing at least five teeth, not including wisdom teeth.
“You’re going to lose your teeth either from decay – cavities, which are caused by sugar and acids, or there’s bone loss around your teeth,” Smith says, pointing to the root causes of gum disease and periodontal disease.
Even with good oral hygiene and regular dentist visits, a person’s teeth will deteriorate with age.
“There’s a lot of wear and tear that happens over life. Grinding your teeth, which is a very common side effect of life, between stress and anxiety - when you’re doing that over 70 years, some of my patients literally just have stubs, nothing there, because they ground them down so much over the years,” Smith says. “Nothing prevents further dental disease.”
Chronic conditions can also cause tooth decay and loss, along with bad habits, like smoking and poor diet.
“Systemic diseases affect your oral health… Lots of diseases can lead to poor oral health conditions,” Smith says. “And as you age, you typically will be on more medications, and the more meds you’re on, especially once you get to three or more, one of the side effects is dry mouth. Saliva is one of the best defense mechanisms for dental health, so if you can’t wash away all the sugars you’re eating with your saliva, you’re more likely to have dental disease.”
Dr. Jacob Smith
And deteriorating dental health isn’t just a cosmetic issue; tooth loss could lead to malnutrition or infection.
“Loss of teeth will impact what you eat. And most people reduce protein intake with poor dental health, so they become deficient in protein and that impairs their muscle health and immune system,” says Dr. Gohar Azhar, a Jackson T. Stephens distinguished professor of geriatric medicine and co-director of cardiovascular aging research at the University of Arkansas for Medical Sciences’ Reynolds Institute on Aging.
“A common bacteria in the mouth, porphyromonas gingivalis, that causes gum inflammation has been indicated in Alzheimer’s disease. So dental health is very important,” Azhar adds.
Digital Dentistry
Smith’s clinic specializes in tooth removal and replacement, utilizing some of the most advanced technology available in dentistry to keep his patients’ smiles bright.
“There’s probably only a handful of dentists in the state with the equipment we have,” Smith says. “The advancements in dentistry, in general, are going more digital.”
Digital scanning technology now allows a dentist to make a 3D map of the inside of a patients’ mouth. A dentist can use that 3D scan to design a crown, implant or set of dentures that perfectly fits the patient.
“There’s intraoral scans, with a camera that goes inside of your mouth and scans implants, teeth – anything in your mouth, soft and hard tissue. We can also do photogrammetry, where we’re getting the exact placement of the implants,” Smith says. “It’s a camera that takes 100 pictures per minute, then that gives us the 3D picture of the inside of your mouth. We put the photogrammetry with the intraoral scan and then we know exactly where the soft tissue and implants are and we can design the new teeth.”
Until recently, every set of dentures was handmade, milled in a specialized laboratory. That process is still common, Smith says, but new 3D printing technology has made same-day dentures possible.
“It’s not like digital dentistry has changed the way gums heal, that still takes time; but what has changed are the dental implants, the way we do those,” Smith says.
An Exo Dental patient reveals the change after receiving an “all-on-four” dental implant treatment.
The new “all-on-four” technique for dental implants and dentures is particularly suited for seniors. Patients get four implant screws and one bridge, which can support a full arch of false teeth (top or bottom row). The technique is more affordable and requires less bone density than piecemeal tooth replacements, and the dentures are more secure in a patient’s mouth.
“The cool thing about these are that you can do everything in literally one day. We can take the teeth out, place implants, digitally scan everything, design it on a computer and then 3D print the teeth in our office and screw them into the implants we just put in place,” Smith says. “We can do all of that because of digital dentistry.
“The advantages of the fixed implant dentures are that you can do it all in one day and you don’t have to put a denture on top of all the gum tissue you just did surgery on,” he adds.
And materials advancements are making dentures stronger by the day.
“There’s one brand called Ivotion that does the pink of the gums and the teeth color all in one. That’s the cool thing about milling dentures – you can mill out of anything,” Smith says. “When we do 3D-printed dentures, we’ll often print in one color and paint the gums, but cosmetically, it can be a little better to have the pink separately printed.”
The Price of a Perfect Bite
One remaining challenge in dentistry is the high price of care.
“Because dentistry isn’t integrated into regular medical health care, it’s all out of pocket. Finances play a huge role in the treatment we can do, unfortunately. A lot of times it’s not actually what’s best for the patient that we do in dentistry every day, it’s what they can afford, and that’s a reality that sucks, because as a doctor, I want to give my patients the best,” Smith says.
Many dental clinics offer third-party financing options that allow patients to pay out their care over time, and Smith says Medicare patients are generally able to cover full teeth replacements through their insurance; but implants typically aren’t covered.
Good dental hygiene and regular dentist visits can help. While tooth decay is inevitable, Smith says avoiding the dentist will make eventual care needs even more expensive.
“Not seeing a dentist regularly is what leads to teeth breaking, because a lot of times you can’t see the decay – it’s eating the tooth from the inside out – so now you need emergency dental care, and there’s no time to plan, you just have to get it done,” he says. “Cavities don’t go away on their own; once a cavity is there, it has to
be fixed.”
