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Newswise — A generation ago, many people who lost teeth due to age-related complications typically wore dentures. Now, dental implants are a common alternative. In this process, a provider places a screw into the jaw, later fitted with a crown, to create a permanent replacement tooth. In the U.S., roughly 2.5 million people implants each year.

However, dental implants aren’t risk-free. Periodontitis—plaque accumulation, which causes gum inflammation and destruction of tissues and bone around the teeth—affects 743 million people worldwide. When this occurs alongside dental implants, it could cause the implant to loosen or fall out.

, chair of periodontology at , explains what prospective patients need to know about how to prepare for, and care for, implants.

What are dental implants?

Dental implants replace lost teeth. There are different elements, involving minor surgery: The implant itself is essentially a titanium or zirconia screw placed into your jawbone. It acts as a replacement root for the missing tooth. Then, a special attachment called the abutment is fitted to the top of the implant. Finally, your dentist can actually make a crown on the implant, just like making a crown for teeth. The crown replaces the white part of the tooth, protruding from the gum.

Who’s a candidate for implants?

Pretty much everybody who’s missing a tooth or teeth are candidates for dental implants. Having said that, active periodontal disease is a risk factor for complications. People with uncontrolled diabetes, going through radiation to their head and neck, receiving active chemotherapy, or who are heavy smokers aren’t candidates. People with periodontal disease tend to have dental-implant-related complications such as peri-implant diseases. People receiving radiation therapy to their head and neck can have bone density changes, which will cause dental implant failure. Heavy cigarette smoking can also affect healing.

What do people need to know about peri-implantitis?

People develop gum disease around the natural teeth, whether gingivitis or periodontitis, which is a more aggressive form of gum disease. In the same way, implants can develop conditions called peri-implant diseases. Peri-implant mucositis, or inflammation around soft tissue of the implant, is the first stage. If left untreated, mucositis can progress to a more dangerous condition called peri-implantitis. There’s greater inflammation, and we also see bone loss. Eventually, the implant could become mobile--loose and moveable--and we might lose it without treatment.

What are the signs and symptoms? 

They can be very subtle, but peri-mucositis or peri-implantitis are very similar to symptoms of gum disease: red or tender gums around implants or bleeding when you’re brushing. If the area becomes infected, you’ll notice swelling, pus, or sometimes a bad taste in your mouth. Just think of it as gum disease around the implant.

Unfortunately, these diseases progress fast compared with gum disease around the natural teeth. We might have to remove the implant or, in severe cases, the implant will just fall out of your mouth. Typically, before the implant becomes really loose, you’ll notice tenderness and swelling.

What does upkeep involve?

Dental implants are wonderful in that they’re just like natural teeth. But, like natural teeth, dental implants require maintenance. Oral hygiene is the most important thing, just as you would clean your own teeth. Brushing and flossing are implant cleaning 101. Some people might have to utilize additional cleaning aids, such as a floss threader or floss with a stiff end. Those are tools that your dental providers should teach you how to use.

But, if you’re just missing one tooth that has a dental implant and a crown on top of it, brushing and flossing are sufficient.

Describe the implant process.

It typically involves more than one stage over a few months. Typically, an implant is placed by a dentist. A crown can be fabricated on top of the implant after several weeks or months. And the most important person in the initial consultation is you, the patient. I can’t emphasize enough how important a patient’s role is in this process. The most important phase is the initial consultation and treatment planning. Your team will evaluate your oral health and bone quality, as well as your medical history. If needed, your dentist may order additional scans on top of your regular dental X-ray, such as a CT scan to see a three-dimensional picture of your jaw bone, to make sure you have adequate bone quality and quantity. If the dentist feels you don’t have enough bone quantity, you may need a bone graft before the procedure.

Implant placement surgery typically takes about an hour. If it’s just a single implant, your periodontist, oral surgeon, or dentist will place an implant by making a small incision into the gum to expose the bone. A titanium implant post will be inserted into this tiny hole, and then your gum will be stitched together. Then, we’ll leave the implant to heal and integrate with your own jaw bone for about three months.

Then, your dentist will make a dental crown on top of the implant. At that point, it’s very similar to conventional dentistry.

Are implants typically covered by insurance?

Nowadays, most private insurance companies will cover dental implants, although they all have specific requirements, depending on your insurance plan. Most insurance companies will at least consider dental coverage of the procedure.

This all sounds painful. What can people do for pain management?

Believe it or not, this is a very small incision. Implant surgery is minimally invasive. Once the anesthesia wears off, you can definitely eat. You may want to be careful not to eat anything that’s too scratchy or hard because you’ll have some stitches in your mouth, but it’s not like you need to be on a fluid diet. Most people will do well with over-the-counter pain medication after a single tooth replacement. If we’re doing a full-mouth replacement—lots of missing teeth, with extensive surgery—we may prescribe some pain medication. The most important thing is to do your job as a patient: Brush twice a day and floss every day, and also make sure that you don’t have underlying periodontal disease or uncontrolled diabetes before you proceed.