HEALTH II - THAILAND

Putting a smile back on their faces

While it is far from cheap, a dental implant is not only beneficial for oral health but can also do wonders for a patient's self-esteem

She wasn't just worried; Nonglaksna Kitcharoenkankul was petrified. She'd had to have one of her teeth extracted and because of its prominent position her dentist had recommended she undergo a lengthy and expensive procedure she'd never heard of before.

"When I looked up 'dental implant' on the internet, I found lots of information, but what was most worrying were all the comments from people saying that it was extremely painful," recalled Nonglaksna, 52, a Bangkok native who works at an office in the city.

The problem was caused by a combination of poor oral hygiene and a habit she'd had since childhood of grinding her teeth in her sleep. The tooth got infected and started to hurt. Her dentist tried to fix things with a root-canal treatment. But this failed and then the only remaining option was to pull the offending tooth.

As a result of all that research she'd done online, Nonglaksna knew that dental implants were the most hi-tech solution available for replacing lost teeth. But she was reluctant to give her dentist the go-ahead, so afraid was she of the terrible pain.

Then, through a lucky coincidence, she got talking to a friend of hers who'd actually had the same procedure and was very happy with the results.

"My friend told me that there'd been no pain whatsoever. So I decided to give it a go. But when it comes to dental implants, I think it's especially important that you go to a competent and properly qualified dentist," Nonglaksna remarked.

While dental implants have been around for almost half a century, the procedure is still relatively rare in Thailand. This is partly because this imported technology has not been widely promoted here and partly because the cost is still prohibitive for the average wage-earner.

The bill for a single implant can range from 20,000 to almost 100,000 baht, depending on the particular brand used along with the level of professional and other fees.

But according to local dentist Chatchai Kunavisarut, dental implants are actually an ideal treatment for people who have lost one or more teeth.

Not only is the procedure beneficial for oral health, he said, but it also restores a patient's self-esteem.

"People these days are living longer. And a huge number of people lose some or all of their teeth as they grow older. Dental implants can be a real saviour. Patients get one or more new teeth, which not only enables them to chew food properly again, but also to smile," Dr Chatchai said with a smile of his own.

Dental implants were invented to address the flaws and inconvenience of conventional dental prostheses (false teeth), he went on, explaining that there are two types of dentures, removable and non-removable, and that both have drawbacks and cause different degrees of discomfort.

A removable dental prosthesis, be it a partial or a full denture, has three main disadvantages _ it rarely fits snugly in the mouth; it has to be taken out every night before the wearer goes to sleep; and it can cause further oral health problems because food particles and plaque tend to lodge in its crevices, increasing chances of infection.

"Wearing a removable denture is like putting on flip-flops," Dr Chatchai said, drawing a startlingly apt analogy. "You can walk in a pair of flip-flops, but you can't run very well because they don't fit your feet perfectly.

"It's the same with removable dentures; you can chew with them, but only because your cheeks and tongue adjust to accommodate the shape of the artificial teeth. But many users complain that their dentures don't actually fit in their mouths properly."

On the face of it, non-removable dentures would appear to be a better option. But these are only suitable for patients whose adjacent teeth are strong enough to support a prosthesis.

In order for a dentist to insert what is called a "bridge" _ a fixed partial denture _ the teeth on either side of the gap must be pared down.

"In order to create a bridge, the teeth right next to the missing one need to be ground down and made smaller so as to act as a foundation for the new artificial tooth. Paring teeth reduces their strength. Also, especially in young patients, the bridge needs to be replaced every 10 years. And every time a new bridge is created, the neighbouring teeth have to be pared down and this gradually makes them thinner and weaker," Dr Chatchai explained.

Dental implants were conceived to get around this problem. The treatment involves inserting a small piece of titanium into the hole once occupied by the root of the extracted tooth.

This metal "root" then functions as an anchor to which an artificial tooth, usually made of ceramic, is later permanently attached using screws.

"In the early days, the artificial root was made from stainless steel, but it was found that the human body tended to reject this material. After being implanted for a while, the stainless-steel root would work itself loose and eventually fall out and the underlying bone would also dissolve.

"Finally, scientists discovered that titanium was very well tolerated by the body. This was a huge stepping stone for the development of better quality artificial root devices," Dr Chatchai said, noting that 99% of artificial dental roots on the market today are made from this light but strong and corrosion-resistant metal.

Patients opting for a dental implant have to have a preliminary physical examination to check whether they are suitable candidates. The procedure is not recommended for those with severe heart disease or diabetes or very high blood pressure as these illnesses can lead to complications.

"And patients must be over 20 because that is the age at which the body stops growing," Dr Chatchai said.

"In patients below the age of 20, the jaw bone is still moving. And if that happens after we've put in an implant, it is hard to adjust. People who are on osteoporosis medication should not have dental implants either because taking such drugs is likely to restrict the ability of the wound to heal."

If they pass the health check, patients are then sent to have a dental X-ray and a mould is then created of both upper and lower sets of teeth.

This is necessary to determine the exact size and configuration of the cavity and to see how the missing tooth used to mesh with those around it.

If the tooth has been extracted only very recently, the wound is given time to heal before the titanium implant is inserted. This is a quick procedure and is carried out under local anaesthetic. Once the anaesthetic wears off, there may be some minor aching for a day or two afterwards, but this responds well to over-the-counter headache tablets.

The implant is barely noticeable; if one looks very closely at the site, one can just make out the tip jutting out of the gums.

Then it's just a matter of waiting. If the extracted tooth is in a very visible area, the dentist may offer to make a temporary denture to cover the gap.

"We have to wait for the bone [underneath the extracted tooth] to grow and fuse with the implant. This process can take from two to four months, depending on the quality of the bone. During this period, the patient can continue to wear a removable denture.

"After the root device has stabilised and becomes properly attached to the jaw bone, it is time to install the new tooth or teeth, which are usually made of ceramic. And they always look completely natural," said the dentist, noting that no significant side-effects have been reported to date.

In this procedure, as with any other type of surgery, if the operation has been carried out in sanitary conditions, the risk of the patient developing an infection is very low. Dental implants have had a success rate in excess of 90% to date, Dr Chatchai said, adding that the success rate for smokers is slightly lower (about 85%) for reasons as yet unknown.

Nonglaksna, the office worker, has certainly had no cause for regrets.

"It feels so natural using this new tooth," she enthused, "that sometimes I almost forget that I have a dental implant. I can eat normally and it feels so comfortable. It doesn't need any special care. All I need to do is to pay proper attention to dental hygiene."

And Nonglaksna has got it absolutely right there. Dental implants are no substitute for taking care of oral health.

"Regular dental check-ups, choosing the correct toothbrush and using it properly, as well as regular use of dental floss. These are all necessary to maintain good, strong teeth," Dr Chatchai said.