Expert: Rafael Mosery,D.D.S. - 6/28/2006

Question
My mother is 73, and has always had problems with her teeth and gums.  She takes excellent care of her teeth, visits the periodontist every three months, etc, but due to her age, she is having many more problems lately.  She has also recently started going to a new dentist and periodontist who share a practice near our home.  In the last 2 months with them she has spent over $7,000 on her teeth, with more work coming.  She has no dental insurance, so we are paying for all of this out of pocket, which gets expensive.  
I have asked her about getting dentures, since her teeth are literaly falling apart, but she says that the dentist told her that she cannot have dentures, due to the shape of her upper palate. She has also told me that she cannot have implants done in the upper portion of her mouth, since her upper palate is too thin, and the implant would go up into her sinus cavity.  That just doesn't sound possible to me.  
I am planning to call her dentist myself to discuss things, as she gets confused easily, and may be mistaken, but I wanted to ask first, are there people who cannot have dentures at all, and does the implant thing sound reasonable to you?  I am of the opinion at this point that quite possibly she is being taken advantage of by her dentist.  I mean, every time she goes in for one procedure, she comes home crying that they have found another problem, which will cost (usually) another $1000 or more to fix.  And these procedures are only a few weeks apart!
I'm not asking for an indictment of the dentist, just some basic info, so that I can discuss this semi-intelligently.


Thanks,
Stephanie

Answer
I'm sure this must be very disconcerting for you. Unfortunately it is very common to see patients of your mother's age(sometimes younger, sometimes older) with what appears to be an overwhelming dental situation that just seems to cascade. Very often, the geriatric patient has a situation where root decay, periodontal disease etc just catch up with the patient. Sometimes it could be related to medication the pt is taking for any number of ailments that decreases their salivary flow, this would result in the scenario described as well. In regards to being a suitable candidate for a full denture it is possible that anatomically there just isn't any support left,that is ,bone support to satisfy the basic retentive requirements of a comfortable denture. Sure you could have one fabricated but after all the teeth are out and the denture is not serviceable then what?
In regards to dental implant placement, the same holds true. We need a minimum height of 12mm of bone and 5-8 mm in width to consider placing implants. it's very common that these patients that have no bone for the denture are similarly not good candidates for implants. So far everything you've mentioned sounds reasonable.
Ofcourse I'm going by what you're dscribing .
Saving her natural teeth for as long as possible would probably be the best route and also the least taxing on your mother, physically.
If all else fails there is the option of MAKING her a candidate for dental implants.
If it came to it, she might be a candidate for bone grafting procedures that could develop potentially favorable sites for implant placement. These procedures are time consuming(8mo. + 6mo for implant healing atleast) and quite costly.
For now your goal should be to try and preserve what you can before proceeding with implants or a denture.
Good Luck and G-d bless you for taking good care of your mother.
Dr.Rafael Mosery