What to Do When Most of Your Teeth Are Failing

When many of your teeth are loose, broken or decayed, the first step is a full exam with X-rays to find out which teeth can be saved. Saving teeth is often the best first choice. When teeth cannot be saved, the main options are partial dentures, full dentures, implant bridges or a fixed full arch on implants.

It is easy to feel that a mouth full of problems means losing every tooth. Often it does not. Problems that look the same in the mirror can have very different causes, and the cause decides the treatment. This guide goes through the options in roughly the order a dentist considers them, from keeping what you have to replacing a whole arch.

Step one: find out what is actually failing

A thorough exam looks at each tooth separately. Your dentist checks gum pockets, looseness, decay, cracks and old fillings, and uses X-rays, and sometimes a 3D cone beam CT scan, to see the roots and bone. That gives you a tooth-by-tooth picture: which are healthy, which can be repaired, and which have a poor outlook.

The most common causes of widespread tooth problems are:

• Gum disease (periodontitis). Infection destroys the bone that holds teeth, so they loosen and drift even if they have no cavities.
• Decay. Cavities that reach the nerve, or break a tooth down below the gum line.
• Cracks and wear. Often from grinding, large old fillings or a bite that overloads some teeth.
• Failing older dental work. Bridges, crowns or root canals that have reached the end of their life.

Option 1: save the teeth that can be saved

A natural tooth that can be restored predictably is usually worth keeping. Depending on the cause, that can mean:

• Gum treatment. Scaling and root planing cleans below the gum line, and ongoing periodontal maintenance keeps the disease in check. Our gum disease treatment page explains the stages.
• Root canal treatment. Removes infection from inside a tooth so it can be kept. See root canal therapy.
• Crowns. Cover and protect a tooth weakened by decay, cracks or a large filling.

The honest caveat: saving a tooth is not automatically the cheaper or better choice. A tooth with very little bone around it, a deep crack into the root, or decay far below the gum may need several procedures and still have a poor long-term outlook. When many teeth are in that position, putting effort into each one can cost more than replacing them, and leave you with less certainty. A good dentist will tell you which teeth are worth the investment and which are not. Our article on root canal or extraction goes into that decision for a single tooth.

Option 2: a partial denture

If several teeth are lost but healthy ones remain, a removable partial denture fills the gaps by clipping onto the remaining teeth. It is the least expensive way to replace several teeth and needs no surgery. The trade-offs: it comes out for cleaning, it can move when you chew, and the clasps put extra load on the teeth they hold.

Option 3: a full denture

If the remaining teeth in an arch cannot be saved, they can be removed and replaced with a complete denture. Dentures are a proven, affordable option and many people do well with them, especially on the upper jaw, where suction helps. Lower dentures are often harder to keep in place. Because a denture does not stimulate the jawbone the way roots do, the bone gradually shrinks, which over time loosens the fit and means relines or a new denture. See dentures in Burke, VA.

Option 4: implant bridges for part of the mouth

When a section of teeth fails but the rest are healthy, an implant bridge can replace three or more teeth in a row on two or more implants, without touching the healthy teeth on either side. It is fixed in place and you care for it much like natural teeth.

Option 5: a fixed full arch on implants

When most or all of the teeth in an arch are failing, a full arch of fixed teeth can be attached to four to six implants. The failing teeth are removed, the implants are placed, and in suitable cases a fixed temporary arch is attached the same day. The final teeth follow once the implants have fused with the bone. Only your dentist can remove them.

This is the most involved option and usually the most expensive up front, but it gives the most stable chewing and avoids the gradual loosening of a conventional denture. If you want the terminology first, read what is a hybrid denture. If you are deciding between one jaw and both, see one arch or both. To see what full-arch treatment involves and costs at our Burke office, visit our full mouth dental implants page.

Mixing options is normal

Your two jaws do not have to get the same treatment. A common plan keeps the healthier lower teeth with gum treatment and crowns, and replaces the upper arch, or the other way round. Some people start with a denture and add implants later, which is covered in switching from dentures to implants.

Questions to ask at your consultation

• Which of my teeth can be saved, and how long are they likely to last?
• What would it cost to save them, compared with replacing them?
• Is my gum disease under control enough for implants?
• Do I have enough bone, and what happens if I do not?
• What will I have to wear while I heal?

Dr. Pejman Ghorbani, a general dentist at Shield Dental Care in Burke, VA, can examine every tooth, explain which can be saved, and lay out each option with its cost before you decide. Call (703) 250-5072 or request an appointment.