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11. CAN MY TEETH BE REPLACED BY DENTAL IMPLANTS AND WHAT ARE DENTAL IMPLANTS?

Occasionally, a patient's badly diseased teeth are better extracted and the bone around them prevented from rapid loss with dental implants (healthy dental implants preserve bone found around natural teeth). By placing dental implants at the time of extractions, more bone is available for dental implants. Dental implants are, most often, in the form of cylinders that replace the roots of a tooth. Dental implants do not appear like natural teeth.

After the bone has healed around the implants (four to six months), a structure is placed in the implant similar to a post or another cylinder with internal threads to attach bars to the implants. Dental implants can be used to support one single post and, later, a crown or they can be used in groups of two, four or six to support bolted-on frames or bridges that support a removable partial denture or single crowns.

Dental implants are usually more resistant to dental infections than natural teeth. Also, dental implants are usually much stronger than natural teeth, being longer, and because bone fuses to the implants. Further, dental implants are most often made from titanium metal and much stronger than the most vital of natural teeth. When Dr. LuBovich first started placing implants (in 1970), he used to inform patients: "Implants are second best to healthy natural teeth."

However, after 25 years- plus of performing dental implants, Dr. LuBovich now suggests: "Dental implants are far superior to natural teeth." Dr. LuBovich has found that dental implants are very successful (over 98 for both upper and lower jaws. Dr. LuBovich is so confident of a dental implant's potential for success, he offers a free replacement of any implant that fails within the bone healing period (four to six months), or he will apply the total cost of the implant to other prosthodontics services.

After initial healing is completed, implant health is usually successful for many years, or the life of the patient. Dental implants are wonderful replacements of teeth and our patients tell us, over and over, they would not take anything in the world in exchange for their dental implants.

Dental implants are wonderful bionic replacements for their natural teeth; ask other patients of Dr. LuBovich's about their dental implants. We are happy to refer you to many dental implant patients to review their treatments with you. This is helpful in your making a choice in your dental implant alternatives.

12. APPREHENSIVE DENTAL PATIENT?

Often, patients have past dental experiences that create terrorizing fears of anticipated dental treatment. We have been referred many of those patients, and patients are different in their dental experiences and pain thresholds, being higher or lower.

We recognize that God made 500 billion people, and no two are exactly alike. We will evaluate your history and apprehension of dental treatment and provide pre-medications in our office for your relief of anxiety. On those occasions, our patients usually forget they had any dental treatment, that day.

Also, your prompt recovery from extensive dental service, including implant placements, is our goal and we will prescribe pain medications that will enable you to recover with the least amount of post-care discomfort. You will be provided written instructions following many of our services and following those instructions well will greatly reduce your after-care discomfort and quick healing.

13. ABOUT NARCOTIC PRESCRIPTIONS

Narcotic abuse and control of pain-relieving medications is one of the major problems that health care providers must face on a daily basis, especially in patients who have had chronic pain. It is a well-known medical fact that narcotic medication taken longer than three months following surgery can be detrimental to one's health and may suggest or even lead to the possibility of drug addictions.

It is imperative that the patient understand that following surgery, adequate pain relief medication will be given until the six(6)week period has passed. Fortunately, for most patients this works very well. After the six(6)week period, we want everyone to be comfortable, without pain and without the harmful effects of narcotics; therefore, if necessary, we will refer you to a pain specialist to manage your medications and other forms of pain control.

We will reduce your pain medicine prescriptions as you progress and write instructions for pain medicine use that will be recorded in your chart. Prescriptions? instructions need to be followed with few exceptions. If you lose a prescription for pain medicine, it is likely there will be no refill for that pain medicine until the instructed amount of time has passed before we can (legally) provide you another prescription. If you have pain a few days or a week after a prescription is written, another appointment for an evaluation and examination will usually be performed before another prescription is written.

If a patient fails to follow a prescription order, another prescription may be refused. We are not in the business of helping patients feel good?we want to provide suitable pain relief for all patients; how- ever, we are controlled in our prescription writing by rules established by the State of Tennessee and the Bureau of Narcotics.

At this time, computer processing of your prescription allows the governing board to monitor how much pain medicine you take and how often. This is accomplished by monitoring through our DEA numbers, your name and your address, as well as Dr. LuBovich?s.

We care for your experiences in dental treatment and wish you to have a comfortable recovery; however, excess pain medicine taking will be considered a possibility if your needs are above normal. The governing agencies that control prescription writing have strict controls that need to be followed, and patient care has to follow a degree of normal variance in taking pain medicines.

14. COMPLETE DENTURES

Complete dentures are only considered to be 20as efficient as natural teeth in function and comfort. Further, complete dentures are not the end of a patient?s dental difficulties; they are the beginning of a whole new set of difficulties:

1) Bone under the dentures continues to shrink for a lifetime leaving less and less foundation for the dentures;

2) The upper denture settles up and back and the lower denture settles down and forward. This leaves a patient appearing as they did not have upper front teeth and pouches out the lower lip;

3) After five years of wearing a complete denture, there is usually so much bone loss the denture bearing areas need new bases;

4) After ten years, there is so much change the base will not fit even with a new base because the muscle attachments of the upper and lower jaws migrate toward the ridge and there is less vertical area for the denture base, also;

5) Denture teeth wear out and the entire dentures should be changed every ten years;

6) Seeds get under dentures during eating and more as the bone shrinks away; this cause pain with eating when the seeds are sandwiched between the base of the denture and the bone;

7)Dentures can come loose when patient sneeze, and more than one patient has sneezed their teeth out at an embarrassing experience.

Nonetheless, dentures provide benefit for many people; however, they should be known as being similar to artificial arms and legs--they are not as good as a healthy, full set of teeth or an implant- supported prosthetic system.

Often, patients develop changes in their faces with many years of wearing dentures; then, they wish a new younger look, and rearranging denture teeth for these patients often demands considerable time in setting and positioning teeth to the patients? satisfaction and desires for their smile.

Dentures are often the last resort or a result of patient?s choices. On those occasions, many patients are happy with dentures and find them better than their recollection of the difficulties they had with their natural teeth; however, they are most often known as lesser substitutes and many other patients are unhappy with the choices that lead to their having dentures.

We do not recommend dentures unless there is no alternative; and, when this situation is presented, we counsel our patients to what they may expect as a result of tooth loss and denture-making. See the section on what occurs with multiple tooth extractions and the placement of dentures.

15. REMOVABLE PARTIAL DENTURES

Removable partial dentures are considered to be better than complete dentures, and they receive their support from adjacent natural teeth . Partial dentures also obtain their retention from those same natural teeth. Partial dentures replace missing natural teeth and should be very stable to be functional for any length of time. They are not as good as implants and bridges and have certain limitations.

Removable partial dentures are best made with cast metal frames, acrylic bases with hard plastic teeth replacements. They can be made, usually, to be very stable. However, after a few years, as the areas beneath the bases shrink, the removable partial denture will start settling and the bases start moving.

This movement is usually so gradual the patient does not become aware of it occurring. In addition, since the movement is gradual, the partial denture will pull on the supporting anchor teeth and often loosen the anchor teeth in the process of the bases settling. After five years of removable partial denture use, they usually need new bases to correct for the settling and changes that occur. Furthermore, the chewing surfaces of the removable partial denture teeth will wear faster than natural teeth or crowns.

As a result, the benefit of replacing missing teeth is lost with the chewing surfaces wearing away and the bases settling with bone loss. When this occurs, it is important to replace the worn teeth; most often, the metal frame will continue to fit for five, ten or fifteen years, and the teeth and bases can be replaced at a lesser cost than replacing the entire removable partial denture with a new metal frame.

Partial dentures may be made with hidden attachments, and these are often called precision partial dentures; however, all partial dentures should be made to fit in a precision-like manner. Many times, because of the lesser cost, patients will choose removable partial dentures with wires clasping the anchor teeth(called clasps).

On some patients, the clasps are not visible; for other patients with high or low lip lines during smiling, the clasps are visible. If you need a partial denture and wish the attachment systems to not be visible, attachments built on crowns are available which will eliminate the clasp(wires) from showing. We will discuss your desires of design with you and partial dentures are very helpful for many patients. The design of the removable partial denture is very important; whenever possible, the replacement tooth sections should be supported with teeth or bar assemblies.

This prevents the leveraging of anchor teeth from loosening the anchor teeth. Think about a sawhorse with a board on the top and how it can go down in two directions; when a tooth replaces the fulcrum of the sawhorse, the bases can move in two directions, forward and backward. As a result, the anchor teeth(sawhorse) will be leveraged from two directions; when this occurs, the anchor teeth will be loosened and damaged if this leveraging occurs over a few months or few years.

The loosening of the anchor teeth for removable partial dentures will occur in varying lengths of time; this depends upon how much bone the anchor teeth have around them, how healthy the gums are maintained, and how long the roots are. When the teeth loosen, often they are not able to be kept any longer.

Partial dentures need to be made to fit very well; if they are made in a temporary manner, with all acrylic frames and wire claps, they usually damage teeth , gums and bone around natural teeth quickly.

16. ALLERGIES TO DENTAL MATERIALS

CONTENT FOR THIS QUESTION MISSING FROM OLD SITE

17. APPOINTMENTS IN OUR OFFICE

Our patient's time is just as important as ours; we recognize and consider each patient?s appointment timing as carefully as we can. Unfortunately, searching for excellence in prosthodontics often finds us doing more than we planned for a particular patient, or treating another patient who has an emergency.

We schedule some time for emergencies daily; however, we often run late on appointments. If you are a patient who just cannot wait or if you have "hurry sickness," please make your appointments at 8:00am only. This is the only way you can avoid waiting because of a delay in our schedule.

Please feel free to call our office several hours before your appointment to check and determine if we are on time for your scheduled appointment. We attempt to keep up with delays; however, a delay can immediately occur which costs us several hours with an unplanned emergency need of one or another of our patients.

Another appointment time that may keep you from waiting very long is 1:00pm; many times, we find ourselves running an hour or more late during morning appointments. If you need further consultations regarding your treatment plan or if you would like to have an opportunity to further discuss treatment alternatives, the very best time is around five or six o-clock in the evening.

If you are a patient who is carried to our office by others, early appointments are the best to be treated and be on your way quickly. If you have special needs in your appointments, when we can offer a ride home, we will be happy to do so. Please communicate your special needs in your appointments so we can do our very best to care for you.

18. OUR FINANCIAL POLICIES

Our general financial policy for dental implants is that fees for dental implants are due upon placement of the implants.

Our general policy for prosthodontic services is: One-half of the treatment costs are due upon starting treatment and the balance upon delivery of the prosthetic devices. Deposits on treatment services are applied to the cost of those services and not refundable unless no service has been performed.

Our services are custom-made for patients, and considerable effort goes into the making of our special prosthetic needs for our patients. We do not have finance plans for patients; however, we will be happy to assist and direct where you may go to obtain loans for dental services. Our banker/patients suggest we remain out of the banking business, that they are the professionals in that service. Regarding insurance, we are happy to provide the special services of applying for your insurance benefits.

Our insurance claims team will determine how to best file for your maximum benefits and discuss your benefits and how you would like to file your dental or medical insurance needs. We provide our patients many special custom letters in an attempt to make sure they obtain the maximum benefit from their insurance coverage.

Our business is in the business of providing our patients excellence implant and prosthodontic services and we look forward to being of benefit for you in your special needs.

19. PATIENT CLASSIFICATIONS

During the past twenty-five years of practicing the specialty of prosthodontic and implant dentistry, Dr LuBovich has been referred many patients whom other dentists care not to treat.

Those patients are generally referred here because of Dr. LuBovich's reputation in being able to satisfy patients. Special needs such as: better appearance, stronger restorations because of patients gritting or grinding their teeth so badly, complex implant needs, complex restorative needs.

During the course of these twenty-five years of treating patients other dentists choose not to, we have learned which patients have the best course of success in their implant-prosthodontic needs.

The type of patients who understand their dental difficulties and other things in their lives are, many times, their responsibility, and do not blame everybody in life for the course of their lives are the patients with the greatest potential of success in anything in their lives. Those patients who want to blame others for everything difficult in their lives on others have the least potential of success.

Patients who are benevolent, understanding of others and caring of others and themselves have a greater potential of success in their lives. Patients who are toxic, uncommunicative, and have a negative attitude toward life, also, have the least potential of success. Remember, if you fail to communicate, you ex-communicate. During our examination and history making, we will have the opportunity to know your dental history and needs very thoroughly.

We will provide you letters on your history, your examination, and your treatment plan alternatives. This booklet is yours for keeping and we will answer any questions you have in the course of your treatment, should you wish to receive care in our office. We look forward to making more friends in the course of our care in our office and we hope you wish the same.

20. THE UNUSUAL UNFORTUNATE EXPERIENCES THAT OCCASIONALLY OCCUR WITH DENTAL SERVICES

On some occasions, one could be hit by an airplane while crossing the street in front of your house. It is unfortunate, rare or seldom you would have to worry about falling airplanes; however, the chances exist. The same is true about some occasionally freaky things with any treatment of any health-care professional treatment.

For example, local anesthetics in dentistry are used for millions of patient care services each day. Most times, they are extremely well tolerated, and dental local anesthetics are very compatible; however, there can occur, in some rare patients, an allergy to one or another of the ingredients in the local anesthetic or more rare, an allergy to the local anesthetic, itself. An expression of an allergy to a local anesthetic is very similar to any other allergic response, and it is usually well treated with the emergency drugs dentists have in their offices.

Also, there is written, in the literature, of a reaction being potentially so severe, it may cause death to a person who has a compromised health history. Also, on occasion, the nerves about the face and jaw can be touched with an injection, and there can occur numbness for a varied length of time.

These experiences of numbness are infrequent; however, they can and will occur. Usually, these experiences of numbness are not great difficulties for patients; however on some rare occasions, numbness of a lip can create lip biting, soreness, burning or tooth pain on the associated side of the numbness.

This can occur more often with a tooth extraction, gum or bone surgery and with implant placement. Numbness or nerve injury can occur with greater frequency in some areas of dental treatment, and your dentist will inform you of what your chances of this occurring would be.

Occasionally, patients have extra nerves not found in regular places as suggested by anatomy textbooks; these secondary nerves can be damaged more easily because they are aberrant (extra or misplaced). Further, upper jaw teeth are close to upper jaw sinuses and the root portions of the teeth may even be half or more inserted in the sinuses. When one of these teeth is extracted, it is possible to experience a hole to develop from a nose to the mouth; again, this is rare; however, it can occur.

On some occasions, a nerve can be growing around a tooth root, and when this occurs, the pulling of that tooth may permanently damage a nerve causing numbness of that particular nerve. Nearly all dentists are very concerned about preventing dental services from creating any difficulty for patients, and much caution is exerted in preparing and preventing accidental injuries from occurring with patients; however on some occasions, a quick unexpected patient movement can cause a cut in a lip or tongue, and these things do happen more than being hit by airplanes.

A steady, calm patient, free from jumping and squirming, is a patient who can be usually assured of being unharmed with any dental procedure. I recall reading about a patient whose face swelled immediately with a dentist blowing air on a tooth being treated with a root canal; this swelling placed pressure on the nerve of touch innervating the lower left lip, and it was months before the nerve regained full feeling.

Dentistry is very similar to mechanics in many ways, and occasionally, a wrench will break and even with caution, injuries to patients may occur. We would like our patients to be aware that we plan to prevent and prepare and prevent, so we need not repair and repent; and we look forward to preventing airplane crashes in our care of patients.

God Bless and our very best in concern for you, our valued, much thought-about patients