What can a lost tooth cost?

Dr RAJ KUMAR looks at some issues of concern to general dental practitioners

[ACCORDING TO EMINENT EXPERT in geriatric dentistry Poul Holm-Pedersen: “If a patient is free from periodontal disease and caries, then the teeth can be for life.”

However, unfortunately many patients suffer from periodontal disease and lose teeth prematurely. Periodontal disease is a silent disease, as many patients do not recognise anything is wrong until the teeth have lost their supporting bone and are mobile. It is usually then that the patient consults with a dentist and finds out that they have a progressive disease.

At each examination the dentist is required to carry out a basic periodontal examination. Many do; but, equally, the Faculty of General Dental Practitioners has found that many do not. Radiographs (X-rays) are taken every two to three years to assess for caries or bone levels around teeth. Patients may have attended for many years and not know they had bone loss associated with periodontitis.

If the disease goes unchecked by the dentist, then the patient has a right to make a claim for dental clinical negligence.

Caries is sometimes different, in that a patient may suffer pain or toothache and the symptoms force the patient to attend the clinic. In most cases the tooth can be saved. In a small percentage of cases,

teeth can be damaged or lost from trauma or road traffic accidents. Root resorption of teeth that have undergone fixed orthodontic treatment can also reduce their life expectancy, as William R Proffitt found. The loss of a tooth usually leads to bone loss as well as cosmetic and aesthetic challenges. If a patient wants a like-for-like replacement, then a fixed dental implant and crown are the ideal solution. Implants avoid the unnecessary trimming down of natural teeth for conventional crown and bridgework – which would reduce their life-expectancy. Implants are usually made of sterile titanium, which is placed into the bone in a sterile environment. Within three to four months the bone will have successfully integrated with the titanium surface and Internal root resorption after car accident the crown or bridge can be attached. The and fractured tooth average cost of an implant crown placed by a specialist or oral surgeon is £3,000. The medical history of the patient must be considered, as it is known that immunocompromised, diabetic and smoker patients have a reduced success rate with implants.

How long should an implant last?

Implants can suffer from infection of the supporting bone, known as peri-implantitis. Bone loss and implant failure leads to a larger defect of the supporting tissues. According to published papers, most studies cite implant success rates of up to 10-15 years. Some patients will suffer periimplantitis, but not lose the implant; others, however, will lose the implant completely.

Again, HolmPedersen quotes that an implant crown may need to be replaced every 20 years due to peri-implantitis.

The replacement of a failing implant would require added bone grafting to restore the supporting bone and soft tissue volume. Bone grafting is a complex procedure and is known to fail.

The average fee for bone grafting and a second implant crown Implant crowns to replace central incisors can be £4,000-£5,000. The replacement of a failed implant within 20 years would require a more complex procedure and added costs.

It is not uncommon in medico-legal reports to quote for two or three cycles of implant replacement during a patient’s lifetime. Orthodontic medical negligence cases may therefore run to £100,000-£300,000.

In summary, once a tooth is lost it becomes a very expensive and complex procedure to have a like-for-like replacement. q