Takeaways from Health Live webinar with Dr Rajeev M Narvekar on Implants & Dental Care for Seniors

As part of the Health Live @ Seniors Today series, leading Prosthodontist and Dental Surgeon Dr Rajeev M Narvekar answered questions on implants and dental care for senior citizens, reports Dr Noor Gill

On November 28, 2020, Seniors Today held its weekly Health Live webinar where it hosted Dr Rajeev M Narvekar to discuss dental implants and throw some light on why senior citizens should visit the dentist at least once in six months.

Dr Narvekar is a Leading Prosthodontist and Dental Surgeon, with a basic dental degree in India and specialty training in Philadelphia, USA. He is Head of the Centre for Advanced Dentistry, Breach Candy Hospital. His private practice is limited to rehabilitation of Oral and Maxillofacial defects. Intra-oral treatment includes replacement of a single tooth to full mouth reconstructions conventionally and with implants.

Before we dive into the webinar, Dr Narvekar told us how it is to have dental practice in the current times of an ongoing pandemic. He told us that his clinic has been up and running since June 2020. Initially everybody was groping in the dark, trying to figure out what needs to be done to protect the practitioner and the patient. But now they have some set protocols in place and he thinks that they have the situation sorted out and under control. Besides the regular code of conduct and precautions that they have in place at their practice, they also have a large extra-oral suction- which sucks out all the aerosols, besides the actual suction which suctions in your mouth. They also have HEPA filters which take care of the remaining filters. And now something new which is called the “corona guard” has been installed, which sends out electrons, and these electrons destroy the S-protein and prevents the viral host from attaching to the human cells, thereby preventing Covid-19 to a large extent. And of course he says that they give emergency treatments precedence over elective treatments.

For the safety of the patient, they have a triage system in place, which is like tele-dentistry, they try and treat the patient, the best they can with oral medication, painkillers and antibiotics and if that doesn’t work, they call the patient to come and visit them when left with no other alternative. 

• Dental implants are not covered by the insurance companies. It is an elective treatment and at this point, the insurance companies consider them as aesthetic procedures rather than functional/necessary ones, which in Dr Narvekar’s opinion is not true. 
• Aerosols are generated by ultrasonic instruments and air motors. The instruments that are used for dental implants are electric motors and the aerosol generation is 1/10th of what it is with air motors. Hence, making it relatively safer.
• In the current times, there are a couple of ways of regenerating bone. There are sinus grafts, which can also be used as a substitute, if you don’t have enough bone. Basal implants can also be used when there is amount of bone is not sufficient
• Failure of Implants: With anything, there is always a slim chance of failure. Sometimes it can be because of bone infection, concomitant infection, and poor bone quality. Sometimes even if all these factors are taken into count and taken care of, there can still be failure of the implants. An infection can occur at any time- pre, intra or post operatively; for a variety of reasons. But the risk of that happening is 2-3%.  
• Dental Implant v/s Bridge: If you have a single tooth that is missing, to put a bridge what you have to do is shape and prepare 1 or 2 of the adjacent teeth and then put the bridge in place and cement it into place. Whereas with implants you don’t have the touch the adjacent teeth. If you have sufficient space and bone available for the procedure, you can secure your implant without touching the adjacent teeth and have a single tooth replacement for what’s missing. This also applies for a couple of missing teeth. 
• When it comes to tooth extractions and implantations, you need to know why the tooth had to be extracted in the first place, if it was because the tooth was infected, then you need to wait for about 3-4 months for the bone to heal before you can go in for an implant.
• Implant Care: Regular and simple maintenance of the prosthesis and heading back to your dentist every 6-8 months for a follow up visit should be suffice to maintain the implant/prosthesis. Apart from that, the protocol is the same as that of brushing your teeth. 
• Sensitive Teeth: It is more mental than dental. Under stressful conditions and sitting at home, being one of them, patients tend to clench their jaws, which leads to broken teeth, chipped tooth, an old dental bridge which has broken, etc. 
• Implants and blood sugar levels: Insulin is a great healer. If you are diabetic and plan on undergoing a dental implant surgery, you need to get your blood sugar levels under control, since diabetes delays the process of healing. So if you get the implant and your blood glucose levels aren’t well controlled, there is a high chance that the bone won’t heal properly. 
• Dental care for smokers and drinkers:

1. 1. Keep the amount of drinks and cigarettes in check. 
   2. Visit a dentist every 6 months, to make sure that your oro-dental hygiene is maintained well. 
   3. Keep your gums in good health.

• Dentures: Denture sets sit on your gums, and over a period of a number of years, you always have bone resorption, which means that you basically have bone loss. It also depends on the kind of food you can and want to eat. If you have 6-8 implants or a bridge in between, you can eat a lot more than what you can with a denture. 
• Basic tooth and gum care is recommended to help maintain healthy teeth and gum:

1. 1. Get regular dental check ups
   2. Visit your dentist every 6 months
   3. As your age advances, various gum and cavity issues arise. Some patients who are on certain medications for other complaints can cause xerostomia- which is dry mouth. The saliva in your mouth acts as a lubricant and keeps your teeth, gums and mouth clean. But when you have a dry mouth, you tend to get caries. 
   4. Use fluoride toothpaste. Or a fluoride guard. 
   5. If you have a dry mouth, drink water instead of taking drinks that have a high content of fizz or acidity or sugar. 
   6. Be careful of what you’re eating or consuming. 

Dr Rajeev M Narvekar can be reached for a consult at narvekar.rajeev [at] gmail.com