Dental implants: Do yours have a dirty little secret?

Peri-implantitis has been described as a 'time bomb', with an alarmingly high number of patients with dental implants unaware of the devastating effects of neglecting their oral health. Here, dental hygienist and therapist, Amanda Gallie, offers some top tips in protecting your investment.

Few patients understand the consequences of a little-known disease that is emerging as a challenge for dental practices all over the UK. Peri-implantitis is a bacterial infection that can cause serious loss of bone, and people with dental implants who neglect their oral health care are at risk.

Dental implants are an increasingly mainstream part of dental care - their popularity growing rapidly in the UK in the last few years - and are now considered the treatment of choice for replacing missing teeth. According to the latest Adult Dental Health Survey, half a million adults have at least one dental implant.

But, implants require long-term care and regular dental check-ups as these are crucial in identifying disease.

Like natural teeth, poor oral hygiene can cause plaque and bacteria to build up on the gum around implants. Over time, the bacteria can irritate the gum tissue and cause a common and treatable inflammatory disease called peri-implant mucositis.

However, if left undetected or untreated, it can develop in some patients into a more serious disease called peri-implantitis, which is the deterioration of supporting bone around the implant. Eventually, if left untreated, the implant may become loose and may have to be removed.

Studies have suggested that one third of implant patients may be affected by peri-implantitis. But, with improved home care, with more time spent on your twice-daily oral health regime and with regular hygiene visits, you can preserve the stability of your dental implants.

Perfect smile

Here are a few tips on how best to protect your investment in that perfect smile. Don't make a costly mistake. You ignore them at your peril!

Amanda explains: 'Because the skin type that heals around the implant to become your new gum tissue is a type of scar tissue, the new gum is more prone to bacterial breakdown. The tissue can become inflamed and ulcerated - and this is called implant mucositis. The condition can progress to a disease called peri-implantitis which is similar to gum disease and, if untreated, can lead to bone loss and eventual loss of the implant. Symptoms may include soreness, redness, tenderness to touch, pus and bleeding, and there can be halitosis but, often, because bone loss is painless, many people fail to realise they have the condition. So excellent oral hygiene and regular hygiene appointments after an implant is fitted, are essential.'

Home care

However, if healthy, a patient who has implants need only visit their dentist once a year, but are advised to visit the hygienist or therapist every three months. It is important that you consult with a dental professional who has had implant experience. Patients now have direct access to hygienists and therapists without having to see their dentist first. So, you can see a hygienist at a different practice if, for example, your dentist doesn't employ one. Go with a personal recommendation or good CV on a website.'

Leap of faith

Amanda says: 'Hygienists and therapists want to help you get better. We will not judge you so, if you fear you've neglected your oral health care and are embarrassed, please don't be. All you need is the leap of faith to come to see us and let us help you get to where you want to be in terms of your oral health.'

But if you are suffering with the disease, dental teams may offer you supportive periodontal therapy (SPT).

Amanda explains: 'This is usually a treatment phase to detoxify a patient's gum and supporting tissues. Once this has been deemed successful, a patient goes into a maintenance phase of three-monthly appointments to keep the bacterial load at a minimum, so that the body can work in conjunction with good home care to keep the tissues healthy. The treatment is gentle and well tolerated but local anaesthetic can be used if needed or requested.'

Although peri-implantitis is not just an age-related disease - as Amanda explains, 'it's all about how your body reacts to the plaque bacteria' - the maintenance of dental implants can prove a challenge in older, less dexterous patients. In these cases, Amanda advises using an electric toothbrush to remove the plaque efficiently. She says: 'Hygienists and therapists can train family members and/or carers in how best to brush the teeth if that is agreed by the patient. More frequent professional cleaning may be advised, so every one to three months in some cases.'

So, if you have had dental implants fitted and are proud of your new smile, make sure you remember that in order to keep smiling it means a lifetime commitment to tip-top maintenance and regular hygiene visits. Your dental hygienist or therapist is only too happy to help!

Top tips

1. Allow 5-10 minutes for home care morning and night

2. Use a good mirror and have a good light so you can see

3. Disclose, so you can see the plaque

4. Use specialist implant brushes and interdental products twice a day. These are available from your hygienist

5. Make sure you attend for regular three-monthly professional cleaning.

Toolkit

Amanda recommends using:

  • An electric or implant brush
  • Interdental aids daily. Your hygienist will advise you on the correct type and size
  • Disclosing tablets once a week to help you keep an eye on areas where the plaque bacteria can accumulate.

Diet and lifestyle

To avoid the risk of peri-implantitis - and to help limit inflammation as a whole:

  • Drink lots of water
  • Eat plenty of green vegetables
  • Include olive oil and fish oil in your diet
  • Quit smoking
  • Keep to the recommended units of alcohol
  • Exercise regularly.

Amanda Gallie is passionate about teeth and gums … in fact everything related to the health of the mouth. She is a dental hygienist and therapist with more than 15 years of experience, during which time she has amassed a wide range of skills from hands-on clinical expertise to lecturing, teaching and writing.