Q Two of my son's teeth got completely knocked out during a hockey match. This left a gap in the bottom row of teeth, near the back. Being a teenager, he feels self-conscious about his missing teeth even though it isn't that noticeable. My dentist has suggested dental implants to replace the teeth, saying that they're better than dentures because they act like natural teeth, are less of a hassle and don't need to be cleaned separately like dentures do. According to him, dentures usually don't work well, especially those for the lower jaw. They use the gums for support and, over time, can cause the bone to erode away.
My son is very keen to have these implants. However, I see the surgery as extremely invasive and I don't like the idea of my son having metal implants screwed straight into his jawbone, having heard about the dangers of mercury fillings. I also can't help feeling that the dentist is just trying to push a more expensive option just to fatten his own wallet. - C. Etches, Solihull
A Your worries are not unfounded. Dental implants are metal screws, typically of titanium, that are surgically inserted into the jaw to act as an anchor for a replacement tooth (the crown). While titanium is often described as a metal that doesn't react with tissues, there is evidence to suggest otherwise. The Bristol Wear Debris Team found that debris from joint replacements made from metals such as titanium, nickel, chrome and cobalt had worked their way into the liver, spleen, lymph nodes and bone marrow (J Bone Joint Surg, 1994; 76B: 701-12).
To ensure that your son doesn't have an allergy to particular metals, Huddersfield-based holistic dentist Dr John Roberts (www.holistic-dentistry.com) advises that you have him undergo a MELISA (memory lymphocyte immunostimulation assay; see WDDTY vol 15 no 8). This test detects the white blood cells that react to toxic metals, providing a diagnosis of metal sensitivity. "Don't just check for reaction to the metals in the implant itself," warns Dr Roberts. "The crown can also be made from different metals to the implant and this would create a galvanic action [between the implant and crown], leading to possible corrosion of metals in the mouth."
He recommends a crown made from an all-porcelain material. In fact, a new generation of implants, made entirely of ceramic, has just been approved for distribution in Europe. While these 'metal-free' implants have not yet arrived in the UK, Dr Roberts predicts that they will be in a couple of years' time.
Nevertheless, he hastens to add that ceramic is not, strictly speaking, metal-free as it contains aluminium, but "this is inert and does not react with tissues".
But before your son takes the plunge, it may be worth considering that each tooth is connected to an energy meridian in the body and that any interference to these lines may result in future adverse effects to his health.
As you said, dental implant surgery is very intrusive and, while surgical techniques for the procedure have improved the success rate, complications can arise. These include peri-implantitis, a bacterial inflammation that can lead to jawbone loss; nerve damage; haematoma (blood clot) in the floor of the mouth, causing possible airways obstruction; and sinusitis (Med Oral Patol Oral Cir Bucal, 2004; 9 [suppl]: 63-9; 69-74; Int J Oral Maxillofac Implants, 2004; 19: 731-4; Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2001; 92: 597-600; J Oral Maxillofac Surg, 1992; 50: 285-7).
"There are some nice bridge alternatives to dental implants," says Dr Roberts. Valplast dentures, which are widespread in the US, but still very new in this country, are a good option to consider. "They are made of nylon, are non-destructive to the oral tissues, and can be made very small and discreet. They are also more cost-effective than dental implants," he says.
Because your son is still in his teens, his jaw may still be growing. Dr Roberts suggests waiting until his 20s before getting implants, or at least waiting until he's stopped playing contact sports to avoid the problem happening again.