A book written by clinicians for clinicians that presents a broad view of the clinical applications of opioids; it covers the pharmacology of opioids and its clinical application in a wide range of situations from acute to chronic cancer and non-cancer pain across ages from paediatric to geriatric populations.
It also covers the socio-historical, ethical, legal and criminal aspects related to the use of opioids, and includes the limitations of opioids as well as recommended precautionary measures when prescribing these drugs. For the busy clinician who has to manage pain either as a generalist or a specialist, this is a very handy text to keep within reach.
Did You Know?
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Dental implants can be used to support fixed or removable dental prostheses, such as crowns, bridges and dentures, which act as replacement for missing teeth.
Treatment with dental implants in older patients are not contraindicated and can be predictable, as long as systemic and local conditions are suitable.
A consultation with the dentist, and necessary diagnostic records for planning, will be needed to determine an individual’s suitability for dental implant treatment.
In this 'Ask the Specialist' Q&A forum, Dr Phang Zi Ying, Associate Consultant from the Prosthodontic Unit, Department of Restorative Dentistry at National Dental Centre Singapore (NDCS), answers your questions about dental implants for seniors. NDCS is a member of the SingHealth group.
This Q&A forum is open from 1 June to 27 June 2022.
To post your question, please log in as a member. If you are not a member, you can register for a FREE membership here.
If you have problems posting your questions, please email your questions to marcom@healthxchange.com.sg
Kindly note: Your question will only go live / appear on this page after the doctor answers it
How does one strengthen a slightly shaking molar?
Answered by Dr Phang Zi Ying, Associate Consultant, Prosthodontic Unit, Department of Restorative Dentistry, National Dental Centre Singapore (NDCS)
Dear Siew Choo, there are different reasons for a tooth to become shaky, for example, it can be due to trauma or gum disease. A consultation with the dentist will allow an accurate diagnosis of the cause of the shaky tooth, and a suitable treatment plan can be recommended.
I had my last Prolia jab in Apr 2019. Can I have dental implant?
Dear uhctanwb, Prolia, also known as denosumab, is a drug given to prevent excessive bone loss. It has been observed that some patients who have received or are receiving these medications develop osteonecrosis of the jaw in which the healing of the bone is affected and some parts of the bone may die off. This is usually related to an episode of dental surgery such as tooth extractions or implant surgery. While successful implant therapy is possible, every case must be assessed individually. It is recommended to consult with your dentist to determine a suitable treatment plan and better understand the risks involved.
Hi
I been a dental patient with NDC fir sometime now. I am a Senior and I have ask my therapist a couple of times wrt to dental implant but haven't got CLEAR answers. I am having biting issue at my right jaw and uses the left fir all chewing. Even that is giving some issues now. Pls advise the way forward. Thanks.
Hello, it is recommended to speak with your dentist to better understand your oral condition. After assessing your oral condition, your dentist will propose a treatment plan for you.
What are different types of implants and cost of these implants for a single implant? How much time does it take for the surgery and time for full recovery? Thanks.
Dear Daljit, depending on the complexity of the case, the estimated cost of a dental implant for single tooth replacement is $4500 - $5500, as listed in the Ministry of Health website. Dental implants can also be used to replace multiple teeth, such as in bridges or dentures. The time needed for surgery depends on the surgical complexity and may differ from person to person. Generally, dental implant surgeries are completed under local anaesthesia and may take 1 to 2 hours. Post-operative complications include pain, swelling and bleeding; these should resolve within the week. Dental implants may require a period of healing ranging from 2 to 6 months before they can be used to support crowns, bridges or dentures.
How traumatic is the implant process? My elderly has dementia and significant anxiety issues. Would the process be very scary for her?
Dear Aleithien, it takes several visits to plan for dental implants and subsequent surgery and restoration. Family members with neurocognitive disorders and anxiety, may find it difficult to cope and tolerate these procedures. Family members may consult their dentist to determine a suitable treatment plan.
Doctor, may i know please cost of dental implants?
As listed on the Ministry of Health website, the approximate cost of a dental implant for single tooth replacement will range from $4500 - $5500, depending on the complexity of the case. A cost estimate will be provided before treatment starts.
I'm currently on Prolia since end 2018 for osteoporosis. I'm wearing a bridge on my upper front teeth. Am I suitable for implant to replace my bridge?
If yes, what is the preparation process & how long?
Dear enys1960, Prolia, also known as denosumab, is a drug given to prevent excessive bone loss. It has been observed that some patients who have received or are receiving these medications develop osteonecrosis of the jaw in which the healing of the bone is affected and some parts of the bone may die off. This is usually related to an episode of dental surgery such as tooth extractions or implant surgery. While successful implant therapy is possible, every case must be assessed individually.
If a patient has been using a bridge to replace their upper front teeth for a long time, it may be possible that the edentulous ridge (area where the teeth are missing) may have resorbed with insufficient bone present for dental implant placement. It is recommended to consult your dentist to determine a suitable treatment plan and better understand the risks involved.
hi Doctor Phang
Is dental implant a permanent solution to removable dentures? Can we still floss it?
Dear tayd01, dental implants can be used to support either fixed crowns and bridges or removable dentures. Depending on the design of the prosthesis, flossing may or may not be possible. However, your dentist will ensure that one can adequately clean around the implants. Other cleaning aids, such as interdental brush, may be used instead.
Many seniors may not be suitable for dental implants due to bone loss, in which case, can they be considered for mini-implants instead?
Dear tee_kl, a consultation with the dentist is recommended to determine the goals and suitability for dental implant treatment. Further diagnostic records, such as radiographs or bone scans, will be necessary to determine the size and position of implants to support the prosthesis. Implants less than 2.5mm in diameter are unlikely to be recommended for routine treatment.
1. Will there be any side effect after the dental implant
2. If the dental implant is done on the upper jaw, does it cause sinus
Dear wc_wah, post-operative complications of dental implant surgery include pain, swelling and bleeding; these should resolve within the week. Dental implants may require a period of healing ranging from 2 to 6 months before they can be used to support crowns, bridges or dentures.
Sinus symptoms may also be associated with dental implant surgery. Patients may experience varying side effects depending on the site and complexity of the surgery. It is recommended to consult your dentist, who will be able to provide a more detailed discussion on possible side effects and complications.
3 years ago, I was referred by polyclinic dentists to National Dental Centre to clean my implant as they said they cannot use metal equipment to clean my implant. NDC referred me back to polyclinic asking them to use plastic implant curette. This year I went to polyclinic dentist and was told they don't have the equipment and wanted to refer me back to NDC. What is happening? Do dental implants need scaling and polishing just like normal teeth? How often should this be done?
Dear Eileen, like teeth, implants require maintenance care for long term success. The recall interval should be tailored to the individual’s needs, based on your dentist’s evaluation of your oral condition. This can range from 3 months to a year. As a specialist center, NDCS treats implant related complications, such as the management of bone loss around implants. However, we do not provide routine scheduled dental examinations nor regular reviews and scaling and polishing of otherwise healthy implants or teeth.
I am existing patient at NDCS. I am undergoing gum treatment for more than a year and told the conditions has stablised. There is a molar teeth that I was adviced to remove. I am looking into the possiblity of dental implant but not sure how to go about it and appreciate if someone can help to advise.
Dear Taymgm, it is recommended to speak with your dentist to better understand your oral condition. The amount of bone remaining and feasibility of dental implant in the region of tooth loss can typically only be determined after the tooth has been extracted.
Dear Doctor, I am 74 and now suffering from rheumatoid arthritis after having a prostate operation .
Question 1 : where should I go to find out suitable or not ? Any dentist or any Govt. institution you may suggest ?
Question 2 : will the dental implants have any side effect later to an old man like me having one after another disese ?
Thanks a lot.
Dear James, like teeth, implants require maintenance care for long term success. While rheumatoid arthritis is not a contraindication for dental implants, it may affect the joints of your hands and over time, making it more difficult for you to clean and maintain your dental implants. Certain medications used in the treatment of rheumatoid arthritis have also been associated with osteonecrosis of the jaw in which the healing of the bone is affected and some parts of the bone may die off. A detailed dental consultation to determine the necessary treatment and risks involved is recommended.
I am above 60yrs old. I understand that as we age, we will lose our bone mass. Will it affect our dental implant as our bone is not as strong as before?. Thank you.
Dear Vivien, in general, a dental implant is unlikely to lose surrounding bone unless it has severe gum inflammation. Like teeth, dental implants require maintenance care for long term success.
Hi Dr Phang
Under what conditions is implant not suitable for a senior like me ? About 10 years ago I was advised to go for dentures instead
Regards, Leonard
Dear Leonard, suitability for dental implants can depend on various local factors, such as the amount of bone present to support dental implants, the number of implants and position needed, condition of your remaining teeth, and complicated by medical conditions such as osteoporosis, uncontrolled diabetes etc. A detailed dental consultation to determine the necessary treatment and risks involved is recommended.
1) When a tooth needs crowding, can a dentist know then if there are enough bone mass for implant? What tests are needed to know it?
2) How long after a tooth is extracted before an implant can be done? How long is the implant process, ie from extraction to implant completion?
3) Can a diabetic patient have implant?
4) Is there a max age limit for implant?
5) What is the estimated cost today for an implant?
6) What are the implant options available and their costs?
7) Is an implant as strong as an original tooth?
8) Can a damaged implant be replaced or repaired?
9) Is there a lifetime for an implant?
10) How to protect an implant so that it can last longer?
11) Is implant tooth's surface strong than original tooth's in term of decay?
Thanks doctor,
Orson
Dear Orson, a detailed dental examination and consultation with your dentist is required to determine your goals and suitability for dental implant treatment. Generally speaking, according to Ministry of Health website, a dental implant replacing a single tooth will cost $4500 - $5500 depending on case complexity.
Further diagnostics radiographs or bone scans are required to determine the feasibility of dental implants, as well as the size and number of implants required to replace your missing teeth.
Dental implants will not decay. However, like teeth, they require maintenance care for long term success and may also experience complications such as gum inflammation or bone loss around implants, loosening of the implant crown, fracture of the implant fixture or the implant crown etc. Management will depend on the exact complication experienced.
Hi Dr Phang Zi Ying, I am a 55year old female who had just been diagnosed with osteoporosis. Polyclinic doctor ordered me to have my dental cleared by dentist before i can be started on any medication as taking Bisphosphonste will result in weakening of my dental bones. Dentist requested that i remove an impacted wisdom tooth, extract a molar and do an implant and extract 2 other molars and do root canal. I am intimidated and presurised by the assessment on my dental condition. I would appreciate it if you can advise if I would even be allowed to do a dental implant, taking into consideration my osteoporosis. This will help me in narrowing down my options at this point. Thank you very much.
Dear Cloud, bisphosphonates are a class of drugs given to prevent excessive bone loss. It has been observed that some patients who have received or are receiving these medications develop osteonecrosis of the jaw in which the healing of the bone is affected and some parts of the bone may die off. This is usually related to an episode of dental surgery such as tooth extractions or implant surgery. While successful implant therapy is possible, every case must be assessed individually. A detailed dental consultation to determine the necessary treatment and risks involved is recommended.
Question posted by tay seoh leng
Hi Dr,
I am taking osteoporosis medication, Alendronate, for the past 4 years. If I will to have a dental implant, will there be any issues/problems with my jaw bone?
Dear Seoh Leng, Alendronate is a drug given to prevent excessive bone loss. It has been observed that some patients who have received or are receiving these medications develop osteonecrosis of the jaw in which the healing of the bone is affected and some parts of the bone may die off. This is usually related to an episode of dental surgery such as tooth extractions or implant surgery. While successful implant therapy is possible, every case is assessed individually. It is recommended to consult your dentist to determine a suitable treatment plan and better understand the risks involved.
Question posted by Ms Yuen
Dear Dr,
For dental implants, is it better to consult the Polyclinic or Pte clinic cos I’m concerned about cost?
Dear Ms Yuen, during your consultation, your dentist will propose a treatment plan for you after assessing your oral condition. For an estimate of dental treatment charges, please visit the Ministry of Health website.
Question posted by Lee H L
I have been exploring this implant for quite some time, but have not made up my mind whether to proceed. My upper right tooth 3rd from the wisdom was pulled off for a long time and the immediate next tooth is not very firm, and so I am not sure whether should I wait till this tooth drop off then do both together so should I proceed to fill up this space? And also what is the cost? Thanks.
Dear Lee, as listed on the Ministry of Health website, the approximate cost of a dental implant for single tooth replacement will range from $4500 - $5500, depending on the complexity of the case. A cost estimate will be provided before treatment starts.
A consultation with the dentist is recommended to determine the cause and prognosis of your shaky tooth, and to determine the goals and suitability for dental implant treatment.
