10. Dental Implants, Infections, Inflammation & Solutions

Here's something most people never get told before they sit in the implant chair: implants are not a set it and forget it fix. Nearly half of all implants currently in someone's mouth have some level of infection brewing around them right now, and most of those people have no idea.

In this episode, Tosha sits down with Lisa Charles to break down exactly what's happening underneath the surface of a dental implant, and what to do about it.

Why this episode matters

Implant placement is at an all time high, but the conversation almost never includes the infection risk that comes with it. The bone around an infected implant can dissolve away with very little warning, and the bar for what's considered a "successful" implant is lower than most patients would ever guess.

What you'll learn

Tosha walks through the real difference between peri-implant mucositis and peri-implantitis, why a water flosser belongs at the top of every implant home care routine, why flossing around implants is now considered a no, the early warning signs of infection most people miss, and the questions every patient should ask before they ever get one placed.

Key moments

The conversation moves through the daily care that protects an implant long term, the warning signs that mean it's time to call the dentist immediately, and the added complexity of implant supported dentures and full arch cases, where infection can hide completely out of sight underneath the appliance.

Tosha's perspective

If it's in the mouth, it's in the body. An infected implant doesn't stay contained, and the same bacteria that causes gum disease around natural teeth is just as capable of breaking down the foundation around an implant. The fix isn't fear, it's foundation first thinking, proactive home care, and asking the right questions before treatment ever begins.

Ready for healthier home care?
Grab the free 6-Minute Mouth Reset guide at mouthymatters.com

Connect with Tosha:
tosh.care | @toshardh | mouthymatters.com

Stay Awesome!
-Tosha, RDH

Disclaimer: This podcast is for educational purposes only.  Information discussed is not intended for diagnosis, curing, or prevention of any disease and is not intended to replace advice given by a licensed healthcare practitioner.  Opinions from guests are their own.  This podcast and its guests may have direct or indirect financial interests associated with products mentioned.

Transcript

Big Question: Are Implants Permanent

Tosha Kozlowski 0:00

Hello, and thank you for joining me for the Mouthy Matters Podcast. Today we're asking the big questions: dental implants, are they truly a permanent solution? I'm your host, Tasha Kozlowski. I've been a dental hygienist for 21 years, and I am now a practice coach, and I help teams elevate their hygiene department so that they can take better care of their patients. Today I'm here with my best friend, Lisa Charles, my partner in crime here. Hello, Lisa. Hello, good to see you again. All right. Well, let's get into all about implants. Today we're going to be answering the questions about how do you maintain your implants if you have them before you get an implant? What should you be asking your dental professional? And is it really just a set it and forget it? And what are the early warning signs if there might be an issue with your implant?

Lisa Charles 0:45

And this could not come at a better time because I have a family member who is about to get an implant. And so they've been going through this entire process. And now I can educate them and help them preserve their implant for as long as possible, which we're gonna find out with topic and question number one. People hear that, yeah. People hear that the dental implants are permanent. Does that mean they are maintenance free? Love this one.

Tosha Kozlowski 1:13

There has never been more dental implants placed throughout history, which is amazing because we know that for every tooth somebody is missing, it actually decreases all like it decreases the your life.

Lisa Charles 1:25

That is so shocking to me. When you told me that, blew my mind.

Tosha Kozlowski 1:29

Yeah. It's it's crazy. But on the contrast, when you restore the teeth, you gain back those years in your life. So, and there's a lot of different reasons why life expectancy and and age decreases without teeth. I mean, unfortunately, you know, if if you don't have teeth, you're not able to chew, you're not able to, well, there's so much of it. I mean, there's there's everything from the social pressures of the embarrassment, not wanting to go out to eat with friends because you maybe you can't chew something properly. Um and the overall nutrition, you can't get the same nutrition if you're not able to comfortably chew.

Why Implants Are Not Maintenance Free

Tosha Kozlowski 2:00

And so there's there's a lot, and and there's so much infection part of it. There's so many different facets to that. Um, but certainly when it comes to dental implants, they are not a set it and forget it. They are absolutely not maintenance-free. And there's a lot of triage that I wish more dental practices were doing before they placed dental implants because dental implants are very susceptible to infection. And it's something that we don't talk about enough in dentistry at all. Like we really get so excited to be able to help somebody restore their teeth and their smile with dental implants, and they, you know, they're they just look so beautiful and they really, really help our patients. But that doesn't mean that there's not a whole educational piece that shouldn't be going side by side.

Lisa Charles 2:46

Yeah. I love that. Okay, number two. What is periimplantitis? That's a hard word. It is. And how is it different from gum disease around natural teeth? Yeah.

Tosha Kozlowski 2:58

So when it comes to dental implants, periimplantitis means that the dental implant is infected to the bone. And there's also another term called periimplant mucositis, which means that the gum, that the implant is infected around the gum tissue. So I like to think of it as gingivitis or periodontal disease. So gingivitis is it's affecting the gums. There's infection inside the gums, gum disease, or peri uh periimplant implantitis, excuse me, is it's in the bone. So we know now that depending on which study you look at, nearly 50% of all implants right now walking around have perimucositis. That means that about it's about 47%, half of the implants that are have already been placed, people are just walking around with an infected implant and they don't know it typically. And that's super scary. So peri implantitis is the studies really vary a little bit more, but it's around 20%. So that means that there's that the bone is literally dissolving away around that implant. The way that implants are right now, when there's studies on them, like are they successful or not, the rate the success simply means that they are still in the patient's mouth, not in their hand. That's a low bar. Very low bar, very low bar. So when it comes to the amount of infection around implants, it's pretty huge. I mean, half having an infection. And once you have perimucositis, the infection in the gum, it's only a matter of time before it's in the bone. Let's not fool ourselves. I mean, unless you arrest it.

Lisa Charles 4:24

Unless you don't know it's happening.

Tosha Kozlowski 4:26

Yeah, exactly. Exactly.

Lisa Charles 4:28

Okay, so make sure you don't have an infection. Check. Number three, how should someone be cleaning around a dental implant implant every single day? I'm guessing this is different than how we should be cleaning all of our you know, ironically, it's it's almost exactly the same.

Tosha Kozlowski 4:45

So a water flosser is number one on the list. Use that pickpocket tip. My favorite tool in the world is the water pit. You're gonna use the same technique as you would around a natural tooth. Though the brushing technique, the same kind of thing. You may need to get some little pixer brushes, some little like proxy brushes, if there's some really large spaces in there, but you have to be so careful. Like, do not scratch your implant, is the big thing. So that's why when you go in to get your teeth clean, they may use some specialized instruments to clean around your implant to ensure that they're not scratching it. Because if you scratch an implant, if you scratch that titanium, that is a beautiful surface for bacteria. The same bacteria that causes gum disease affects dental implants. So we want to be water picking every single day, seriously non-negotiable. And not just your implant, like your entire mouth. Because if there's bacteria around your implant, there's bacteria around everything else. Your spit gets it everywhere. Plus, if there's bad bacteria in there, it wants to mature and grow and bring all of its friends to the party. So water picking every single day, foam mouth brushing, brush your tongue, all those things are super important. Here's the one thing that's been popping up a lot now is that there's a pretty good consensus that you do not floss your implants. Crazy. So the thing, the the new studies that are coming out are really that when we're flossing, depending on the type of floss that we're using, the fibers are shredding and getting left behind and they're getting stuck underneath the gum. The patient can't get it out. Sometimes the hygienist can't even see it. And so they're getting stuck there, and that's constantly attracting bacteria and biofilm and all that just gets stuck there. So it's this whole nice slimy surface, essentially, that's getting stuck there. And so the overall consensus is now that we don't flossom. Now, when I got out of school, it was C-shape all the way around there, and you shine that puppy up, you know, on both sides with the with the floss, but that's typically seen as a no-no now. So that is how you properly clean your dental implants. Also using like a really great toothpaste that's like, you know, free from SLS and some of those other products. I mean, when it comes to different ingredients and toothpaste, sometimes they can be really abrasive. They can be harmful to the good bacteria in your mouth. And

Peri-Implant Disease And The Scary Stats

Tosha Kozlowski 7:00

when we walk down, you know, Walgreens, Target, Walmart, whatever toothpaste aisle you're at, a lot of those toothpaste that are over the counter can be have a lot of irritants in them. And that is just not gonna be good for your good bacteria because we want to keep all the good guys in there. So when we're using toothpaste, we don't want one that has everything listed on there to deal with like all these fancy things, like truly less is more. And because people are gonna ask, like, Tasha, what products do you like? I love Dr. Jen Naturals, is one of my favorite brands. They're they're very clean, they don't have SLS in them. Supermouth has excellent toothpaste. Those are my two top favorites. So I'll just stop at that because those two are really, are really, really nice ones. And it's not a bad idea to have like a probiotic and a prebiotic. I mean, I compare it to like even if we have a really great diet, let's say, science has still shown that a solid multivitamin is really good. I mean, there was a study done, I think like they included like a centrum silver, like some of these really basic multivitamins, and they still showed health benefits. So when it comes to like oral probiotics and prebiotics and multivitamins, it's just a good buffer for our life, right? Like it's just gonna be helpful.

Lisa Charles 8:07

Even if you eat a well-rounded diet, unless you're growing it yourself, you know where it came from. We don't have the same nutrients as we once did, right? Okay, so this is we did just kind of talk about this, but I'm sure there's more detail that you can go into. Is a water flosser better than real floss for implants? 100%.

Tosha Kozlowski 8:26

100%. And even some periodonists, which are specialists in um in the in the gum tissue world and they place a ton of implants, there's several that even recommend using a water flosser in the dental office to help the patient clean. I mean, it's it's that that common. Even like some warm salt water, like if you are noticing some bleeding around your implant, that's a sign you have a problem. And so then you may want to add some medicament to your water pick to help get rid of some of those bad bacteria to just help your immune system. So um, we want to be really gentle with certain products, but with if you are noticing, like, gosh, when I touch around my implant, my gums just feel sore. That's a major issue. Go see your dental dentist right away. Like, you don't don't mess around with an implant. Like if it, if it's showing you a sign that there's a problem, go to your dentist because you really want to get that under control really fast because the anatomy of a dental implant is different than the anatomy of a tooth. So our natural teeth have certain types of fibers that hold them in, almost like we screw in a screw, but like the fibers hold that tooth down. So when the tooth, the natural tooth is removed, we then, you know, maybe do like a bone graft, let all that heal, but that's not the same as your natural tooth. And then we screw in a screw for the implant, a titanium, usually sometimes porcelain, and we screw that in. But the new fibers that attach to it attach, attach in a different direction because they're not a natural tooth. They're not what just like, you know, erupted into your mouth. And so those other fibers are not as strong. And there's some studies that show that they could be more inflammatory, meaning it doesn't take as much for those types of fibers and the gum tissue around an implant to get infected as a natural tooth. So they're they're just more at risk, is what it was what it's looking like. So because they're more at risk, if you have a dental implant or if you're considering getting one, just know that your home care piece now is even more important than it was before simply because the the anatomy is different. It's it's not what you were born with.

Lisa Charles 10:30

It's a foreign object. And sometimes that works and sometimes it fails, right? Yeah. Yeah. Well, you did speak a little bit to this as well, but what are the warning signs that something might be wrong with an implant?

Tosha Kozlowski 10:42

Yeah. So there's quite a few. So any type of bleeding, of course, like any type of bleeding around there, or even if it's bleeding in a different area in your mouth, know that it's contagious. So if you're noticing bleeding on the left side, but your implants on the right side, yikes, let's get on the water pick, like stat. But if your implant is bleeding, you need to see your dentist, like right away. So that because they can place medicine in there and they can do some other things that you're just not able to do at home. Pus, swelling, um, a bad taste, drainage, these are very common things. Like if you can't, you know, I'm pretending that I have I'm I'm touching my face right now for those of you listening. I'm touching my face, like you can see me. But if you're touching on your gum tissue or on your face where the implant is in your mouth and it feels tender, that is definitely a bad sign. Any type of mobility, or if your bite just feels different.

Daily Cleaning Tools That Actually Help

Tosha Kozlowski 11:30

If all of a sudden you're biting and now you are aware of where you're hitting on that implant, something's not right. Because what happens is when there's inflammation around the implant, it can kind of super erupt. So it comes up too high and you bite on it more quickly. And that's a sign that there's a lot of inflammation around there. So make sure that if you have implants, like you are going to the dentist a minimum of twice a year to get your teeth cleaned, whether you think you need it or not. Like, yeah, I did have some patients that were so dang healthy that I was like, you come in once a year. They did not have dental implants. I would I because I mean I you just have to be so proactive with those. Um, that's why I bring up that part of it. And I recommend the teams that I work with take a x-ray of the implant once a year, simply because dental x-rays, the radiation levels are so dang low. I mean, a full series of x-rays that's 18 films is like taking a one-hour flight. I mean, it's like being outside for four hours. Like it's it's very, very safe now. And so though, because dental implants, unfortunately, they can fail very easily without a lot of warning. I just like to be way more proactive than reactive on that. So those are like the biggest, uh, the biggest things of a sign that there's an infection. Yeah. Those are some doozies.

Lisa Charles 12:38

That's for sure. Okay. If someone has full mouth implants or an implant bridge, does the cleaning change for that? Hugely.

Tosha Kozlowski 12:48

Hugely. So we see our maybe not we, I'll speak for myself because I'm in the dental world. So my Instagram feed feed is full of dentistry. So I see a lot of before and after same-day implant cases where they're doing these implant-supported dentures and they look absolutely beautiful. We see these smiles that unfortunately that person, you know, some people have lost their teeth due, you know, due to cavities or due to gum infections and gum disease. And then they have those, their natural teeth or what's left of them removed, and they have dental implants placed the same day, and then they restore them with these fixed appliances. So some people call them all on X or all on fours. And it's just a, and there's two different ways to do it. So there's removable, so there's the implant supported where they'll place usually four implants on the top, rough, maybe four on the bottom, depending on the bone structure. And then you can either remove or not remove the dental, the the fixed appliance. So sometimes your dentist has to remove your dentures for you, or sometimes you can do it at home. So when it comes to implants getting placed, let's start there. So, like when we place implants, one of the most dangerous things that that we can do is not check the foundation to ensure that it's healthy. So we know through science that if we're placing implants in somebody's mouth that lost their teeth due to periodontal disease, they have a four times higher risk of losing their dental implants. They're they're literally seeding the implants in a foundation full of termites because though that infection has necrosed the bone. And they, and just because you remove the teeth doesn't mean you removed the infection. It's like if a diabetic loses a toe or a foot, you are amputating part of their body, but you're not amputating the diabetes. You're amputating a symptom of the problem. And the same is true in dentistry. So if somebody has lost their teeth due to gum disease, they just need to know that they're at extremely high risk. A smoker, a diabetic, people that have inflammatory conditions, they're at they're at much higher risk for implant failure. That doesn't mean that they can't get implants. It just means that they need to know their risk levels so that they can try to mediate some of those risk factors for them. So when we place implants, we want the foundation to be healthy first. Totally healthy. We want to do a lab test, we want to triage clearance. Like, is that foundation healthy? Is this person prepared for implants? Then once the implants are placed, we also need a maintenance phase to that. So if somebody has a single implant or a couple implants here and there, your maintenance is no different than going in for your regular teeth cleanings. They're just going to clean around your implant as usual. But if you have a fixed appliance that can only be removed by the dentist, it's a completely different scenario. We're talking very long dental appointments because you go to your dentist, the dentist has to come in there with a special screwdriver, take out a filling material that that's in the dentures that covers up the screw, a tiny little screw hole. So they take out that filling material, they unscrew it, they take out the top, they take out the bottom. That has to be done by a dentist. Then the hygienist has her job. So she then cleans both dentures, she cleans around the implants, hopefully cleans all the gum tissue because that gum tissue has just been covered with an with a denture for how long? Imagine what could potentially be underneath there. Right. So that would take some time. If he or she, the hygienist, finds inflammation, then they really need to do more of that medicated cleaning around those dental implants. And then, of course, the dentist comes, then after that, the dentist comes back in, puts it back on. This is five or six hundred dollar appointment that insurance typically does not go. This should be done pretty often. Now, the the recommendations by some of these implant companies are just take them off, Lisa, if you see inflammation. You cannot see underneath most of these appliances. So, how do you know? So that's really the tricky thing. Now, they do have some implant-supported dentures that don't go up so high into the gum. So you actually can see, but not everybody would want that. Because if I'm somebody that has a really high smile, for example, like if I smile and I show all my gums and I have a gummy smile, I don't want that. Like, I don't want somebody to see like the ledge. So you, you know, you wouldn't even want to place that that type. So that can be a tricky part of it. So I, for those reasons, feel more inclined to guide people into a removable situation. I know, I know people don't want to remove their teeth at night. I get that. But the maintenance is easier. The safety of it long term is is just gonna be better because they're you're taking there, the person is able to take them out every night, clean them, clean their mouth, and put them back in if you want when you're sleeping. Put them back in. But

Warning Signs And How Often To Check

Tosha Kozlowski 17:20

you can take them out and click and put them back in. Or if something, you know, got stuck underneath there, which can happen. And it's super hard when somebody gets something stuck underneath those dentures. If they can't remove them, they have to go to the dentist and get them removed. But if you have the removable kind that clip in, so they're still fixed that you can still eat steak and chicken and all these like harder to chew things. You can take them out, clean them, leave them out if you if you had a sore spot, you know, to like, you know, get let it, let it heal. So there's a lot of there's a lot of nuance to these things. And I don't know that enough practices are recommending a lot of recare for the people that have the implant supported fixed situation. They're just not getting taken out. And my fear for a lot of those people are that they're gonna lose that really expensive investment.

Lisa Charles 18:03

Yeah. And after all of that, to then it's like insult injury, you know?

Tosha Kozlowski 18:08

Yeah.

Lisa Charles 18:09

Yeah.

Tosha Kozlowski 18:10

So essentially, like, you know, for me, when somebody wants to have implants placed, the best thing that we can do is to ensure as a healthcare dental profession that their foundation is healthy first. Like, how do you know for sure that they're free from bacteria?

Lisa Charles 18:25

Take a lab test. I was gonna say that leads to the next question, which is what should patients be asking before getting or and after getting implants? Like they could get all of this information if they've got a great dentist before and after so that they know what they're what to expect.

Tosha Kozlowski 18:42

Yep. So if so I would I would ask the dentist before you do, so if somebody's wanting to get implant-supported dentures or a single implant placement, part of part of that triage questions would be is my foundation healthy right now? Are my gums healthy? Am I free from bleeding? So this goes to like that periodontal charting that I've talked about before, which is like measuring around the gum tissue. Are there any bleeding points? But also, does the hygienist get bleeding when he or she is cleaning your teeth? Because sometimes we sweep some of that under the rug in the professional practice in our you know dental practices. We're just like, oh, there wasn't bleeding points when I measured, but there's some bleeding on scaling. So just you know, brush and floss more, Lisa. But really, those are signs of infection, those are early signs of infection. And so I don't want my patient getting an implant yet if they have bleeding when I'm cleaning their teeth. Right. I don't want that. I we need to arrest that first. So we need to ask, like, if you're gonna get an implant, like, do my gums bleed at all during the cleaning, first and foremost. That is the best thing. If the answer is anything but no, that needs to be addressed first with that with a three-tier approach. What are they gonna do for the office? What are we gonna do at home and what about their immune system? The next step is looking at the x-rays. Like, ask them, do I have history of gum disease? Do I have bone loss? They're gonna know what that means. Like, is there bone loss around your teeth? Because if there is, that means that you're at a higher risk for losing that implant. And then how what is the maintenance expectate expectation? So this is either this could be single implant, fixed, or non-fixed. Like, how often do you think I'm gonna need to be coming in? That's not only just a prepare for time, but it's a financial question. Like, what is the investment in life in your time and in your pocketbook? Like, how often do I need to come in? Because that's gonna guide you on making the right choice for yourself. So those are kind of like my my very top ones. And then, and then also, I mean, for me, it's like home care is is is never anything but you know, water pick and and mouth and you know, brushing your teeth properly and tongue scraper, and then sometimes extra stuff if that's not enough. But that would be like my foundational piece for every single person because you can't be too proactive, right? And then from there, if you have fixed that your dentist has to remove, some of them may recommend just once a year taking them off. And so then you're just gonna need to be really hyper-vigilant with making sure that you're trying to get underneath there. I will say some of the water pick tips you can get underneath there, and sometimes you can't. So it's just gonna be depend on the device. So I would ask your dentist if there was a way to fabricate that non-removable denture so that you

Full Mouth Implants Risks Costs And Questions

Tosha Kozlowski 21:10

can get a water pick underneath there and just blast out any of the stuff. Because if you can't, there could there just could be like some growth underneath there, some biofilm that you're just never getting out.

Lisa Charles 21:21

So that's kind of the biggest ones. Okay. Well, uh, what is the biggest thing that you wish every implant patient understood? That it's not a natural tooth.

Tosha Kozlowski 21:31

And so you can't treat it as such. It's a wonderful, wonderful tool to to restore teeth and they can look beautiful and they can function beautiful, but it's not like a screw and a two by four. Like it can easily get infection, just like a natural tooth.

Lisa Charles 21:47

Right.

Tosha Kozlowski 21:47

And so you just have to be really um health conscious of your mouth and that, and it's a large it's an investment, right? Like implants are not cheap. It wasn't, I mean, plus, like I always think about when somebody has a has an implant, wh why did they end up having that implant? You know, so many of the times it's like, oh, I was a kid and I had a feeling, and then you know, be when I became an adult, that childhood feeling broke, so I had to get a new feeling and it was bigger, and then that feeling broke, and then I had to have a crown, and then that crown failed, and I needed a root canal and a buildup and a crown, and then that thing got reinfected, so now I now I had to remove it, and now I need an implant, and then I also need a sinus lift, and then I need a bone graft, and then I need the implant, and then there's the abutment, and then there's the crown.

Lisa Charles 22:27

Holy you just laid out first of all how expensive it is, because every single step is an astronomical fee, but that's what my my family member just did. It's insane. That was that was the the whole story. Yeah.

Tosha Kozlowski 22:44

So before you make before anyone makes the choice, which I am always for placing implants whenever possible. Whenever possible, place them. Do not go without a tooth. I mean, there there's many ramifications of not having a tooth, teeth, like in general. Like there, there's there, it's just from there's just too many to to list here. But if you know what you're getting yourself into, you're gonna be better mentally prepared. You're gonna have a realistic understanding. So if something doesn't go right, you're not like trying to like place the blame on like, well, what could I have done? They never told me. And like that can just feel really icky. And in the dental profession, like we I know for I know like for me, like every practice I've ever worked with, like we're really trying to educate our patients so that they know exactly what they need to do. But all of us are coming, like there's so much information being thrown at us every single day that it can be hard to remember all these details too, right? Like, I mean, let's be fair. Like, we're humans. I mean, we're there's only so much that we can absorb in a day. So, you know, for practices, I think it's really helpful to have a handout for the patient so that if they, you know, want to talk to their spouse about it or just like have it for future reference, like that's really helpful. I know when I go to any appointment, like I went to a dermatologist not too long ago and she was telling me all these things that I could do for my skin and all this kind of stuff. And I told her, I said, I hope you're writing this down because I don't think I'm ever gonna be able to remember all this. It was amazing information, but I think I'm a fairly smart person. But I was like, and she and her her assistant was in there. She goes, Oh no, I'm writing it all down for you, honey. And I was like, Oh, thank goodness, because that's amazing. I'm not gonna remember. So, you know, for dental professionals listening, like we need to have like a printout for our patients so that they know what they're getting themselves into because this is a partnership. Like the patient's also responsible for what they do at home, and we're responsible for what we do for them in the office and the education that we give them.

Lisa Charles 24:31

Yeah, I love that. It is a partnership.

Tosha Kozlowski 24:34

Yep. Partnership.

Lisa Charles 24:35

We all got to take control of our health. Yes. Well, thank you so much for all of this information. I can't wait until the uh podcast comes out so that I can send this on.

Tosha Kozlowski 24:44

I love it. I love it. Edu educate our friends, our families, and our loved ones.

Lisa Charles 24:48

Well, and maybe uh the dentist that we maybe the dentist that my friends saw too, or my family members saw.

Tosha Kozlowski 24:54

There you go. There you go. And be like, I need to do all these things. Yes. Well, this has been so much fun, Lisa. I hope that you all got a lot of gems out of this implant conversation. I love having conversations like this. If you guys have any questions about how to do better with your home care, you can go to mouthymatters.com and pick up my six minute guide to a healthier mouth. And we'll see you next time.