Do YOU Know What Is In Your Parents’ Mouths?
Submitted by Dr. Joy Poskozim DDS FSCD CDP
Founder of Joyful Dental Care – House Calls, Advocate, & Presenter
Geriatric House Call Dentist for over 15 years, Dr. Joy Poskozim speaks to Long-term Care Facility Administrators, Nursing Staff, Caregivers, and loved ones on the importance of oral health care as we age. Her goal is to share as much dental information as possible, thereby making it easier to communicate to traveling dentists on what oral health problems residents may have.
Having provided oral care for the geriatric community for over fifteen years, Joy understands medical conditions – and the subsequent issues revolving around them – supersede oral care.
How would explain to a dentist what fell out of your parent’s or client’s mouth? Get some pointers below.
Do YOU Know What Is In Your Parents’ Mouths?
Would you be able to explain to your dentist what may have fallen out of your mom’s mouth at breakfast?
Would you be able to explain to your community’s traveling dentist like myself what fell out of a resident’s mouth at breakfast (without a picture)?
This month I will be going over common dental terms with pictures to show what may or may not come out at some point, and then what to do if one of them does shake itself loose.
First Things First: Dental Fillings.
Dental fillings these days mean a lot of different things. The picture above shows the tooth-colored plastic fillings. Fillings like these are bonded to teeth and can break off in parts over time based on how our bites change – especially if the filled teeth are retaining or holding onto a partial denture. A lot of different forces are being applied to these particular teeth. Not only are they holding onto a static one removable piece – the partial denture – but they are also holding the filling in place.
Fillings can also be cemented into or onto teeth. These are called inlays or onlays and will come out in one piece if the cement gives way
due to trauma (biting into something hard just the right way to loosen it out) or to age.
As a geriatric house-call dentist, I can go into the home or nursing home and recement the inlays/onlays if there is no new tooth decay or cavity underneath or inside the tooth.
Odorless, Tasteless Liquid Filling That Has Fluoride
However, if there is decay, and the patient is home or bed-bound, I can apply an odorless, tasteless liquid filling that has fluoride in it: Silver Diamine Fluoride.
There are at least three different types on the market, but they all work the same way. The bacteria that cause a cavity are aerobic or breathe oxygen, and the silver basically suffocates the bacteria, preventing the bacteria from penetrating more into the tooth, thereby preventing an abscess. It is applied with those little micro brushes seen in the middle of the case in the picture above.
The second step is applying another odorless, tasteless liquid to help prevent the silver from tarnishing, therefore discoloring the tooth. The tooth is not “filled” per se, but it will prevent the cavity – dental infection – from spreading to other teeth or up the root and out of the mouth, like the nasal or maxillary sinus, for example, preventing a medical condition like a sinus infection.
Silver has already been used to help soothe and heal skin wounds and burns in the form of silver nitrate. This procedure is like that. It is applied with the brush three times, and, if it is a front tooth, the second step is applied to preserve the color of the enamel. Then, a fluoride varnish is applied to keep it all in place and help the tooth remineralize.
It usually only takes one appointment to do this, but sometimes the decay hasn’t all been covered, so a second application a few months later needs to be done. I also like to be able, for my office patients or those who can handle a longer dental process, to scoop out the softer decayed part of the tooth until I reach a harder tooth structure and then apply the SDF.
Modern Dental Technology Is Amazing
This has truly been an amazing part of modern dental technology that I am thrilled to have been able to provide for my patients to keep
the tooth pain and infection-free.
The upper right tooth has a dark line where it hits the gums. This is seen all the time with this type of crown, or cap. The metal underneath the porcelain tarnishes with age. Good news! NOT a cavity. But, not very esthetic. Most dentists do not make this type of crown anymore just for this reason. That being said, most crowns done in the 80s-early 2000’s will have this appearance to them. Now we are making monolithic, or one-layer crowns that are only one tooth-colored material. So important, though, to show this to help others know that this crown is still healthy.
If a crown does fall off, and there is good tooth structure underneath, I can once again recement back on. Other times I will use the SDF to suffocate the bacteria that may be underneath the crown, then recement on top of that. Safe and secure – for another 40 years!
Implant Crowns Have Been Incorrectly Called Posts
Posts are what support a natural tooth after it has been root-canaled. Pictures to follow.
These pictures are of dental implants – or tooth replacements – like knees or hips.
Also made of titanium, they are either bonded or cemented to their crowns/caps.
On the left is what the implant “abutment” looks like, and on the right is what is seen once the implant crown’s gums begin to recede, showing the implant abutment underneath the crown.
They can live like this for the patient’s lifetime, but it is good to recognize that these are not natural teeth. The biggest problem that can arise is the gums around these types of crowns to inflame, get red, and even in worst-case circumstances release pus.
Antibiotics Can Be A First Defense Against
That is when I need to be called! Antibiotics are the first defense against that type of situation, and they work about 80% of the time, but it is truly up to the caregiver to make sure these gums are brushed and rinsed thoroughly at least twice a day to prevent sepsis.
I get a lot of questions about the crowns on the left. This is a crown that needed to have a root canal after the crown was cemented on the tooth. The tooth is filled with a composite resin or tooth-colored
filling. But, more often than not, the plastic material is not as opaque as the porcelain crown, so it appears to be darker, thus suspected of being a cavity.
Good news! It is not! And, even more good news, the tooth is sealed off underneath, preventing future infection. This crown can be recemented back on if necessary.
The tooth on the right has remaining silver in it with a porcelain crown being cemented onto this type of root-canaled tooth. Also sealed off, this tooth has very little chance of becoming infected in the future.
What About Partials?
This person has two partial dentures – one upper and one lower. The natural teeth are in the front, and the upper and lower canines are the anchors or retainers for the removable back teeth. The metal things are clasps that allow the dentures to fit alongside the natural teeth.
Partial dentures can be made of a flexible acrylic, otherwise known as a “flexidenture.” The good news is that they are light and very easy to get accustomed to.
The bad news is that teeth cannot be added to this type of acrylic, so they must be removed every night and teeth brushed twice a day consistently to protect the teeth holding the dentures in place.
Another type of material is regular acrylic. The problem with these is that, just like complete dentures, the acrylic can fracture if not kept in water when not in use.
The acrylic can be re-added and teeth/clasps can be added as well if necessary.
A third type of partial denture is a chrome or metal denture. These are the strongest and most durable, but also the most expensive and least esthetic. Teeth and clasps can be added if necessary, but, because they are heavier, they also must be removed nightly to help protect the teeth supporting them.
All removable dental prostheses need to be removed at night to allow the gums underneath to breathe. They also need to be cleaned.
The most common problem I see with my memory care patients is the teeth being brushed with the dentures still in place. This can cause horrible problems to the teeth holding the partials in place. If any kind of decay penetrates into these teeth supporting the partials, they may break off, and now these types of partials no longer stay in place.
I can take impressions to have a lab add a tooth, and even another clasp, to the partial, but now this person will be without their dentures for a bit, which can cause problems eating and even remembering they have a partial when I try to put it back into their mouths.
Learning how to take your client/patient/loved one’s partials in and out to be able to help protect the teeth holding them in place is crucial to their well-being. 
Do You Know What Implant-Supported Dentures Are?
These are implant-supported dentures. The top picture shows complete dentures where the person has no teeth, but only implants, as seen in the bottom picture.
We will be seeing these types of dentures more and more as our boomers choose to wear oral prostheses that are more secure. 
Yes, these dentures have to come out every night as well. Gums still need to breathe regardless of what type of restoration is placed on top of them.
Once again, crucial to learn how to take these in and out to prevent infection around the implants.
I hope this helps in providing some insight into dental terms and what is the future of our clients/patients/residents/loved one’s mouths!
Questions/concerns/comments? Never hesitate to ask!
Submitted by Dr. Joy Poskozim DDS FSCD CDP
Founder of Joyful Dental Care – House Calls, Advocate, &Presenter
Geriatric House Call Dentist for over 15 years, Dr. Joy Poskozim speaks to Long-term Care Facility Administrators, Nursing Staff, Caregivers, and loved ones on the importance of oral health care as we age. Her goal is to share as much dental information as possible, thereby making it easier to communicate to traveling dentists on what oral health problems residents may have.
