Which is more important: teeth that look great or teeth that work well and feel good?

To a prosthodontist, the answer is “all of the above.”

Not long ago, Dr. Robert F. Faulkner was beginning a lecture to a group of healthcare professionals. He asked how many of them knew what a prosthodontist is. Not a single hand was raised.

“It’s probably the least-known specialty around,” says Dr. Faulkner, one of a handful of prosthodontists in the Tristate area.

Simply put, prosthodontics (that’s pros-tho-dontics) is the dental practice of restoring and replacing teeth. One of nine specialties recognized by the American Dental Association, the certification requires three years of training in an ADA-approved residency program. The word combines prostheses, or artificial body parts, and the “dontics” of dentistry.

Prosthodontists specialize in making use of the latest-generation materials used to fix what genetics, lifestyle, disease, trauma and age can do to your mouth — materials including dental crowns, implants, bridges, dentures, veneers and inlays. These specialists are trained to take on more challenging cases, such as mouths, jaws or teeth that are damaged or deformed by a birth defect, injury or a disease like oral cancer.
“Typically, someone who sees a prosthodontist has more comprehensive needs,” Dr. Faulkner notes.
 

About 25 percent of Americans over age 60 are missing all their natural teeth, according to the U.S. Centers for Disease Control and Prevention. More startling: One out of every 20 adults in the boomer prime years (45-54) has no natural teeth left.

Prosthodontists often collaborate closely with general dentists, oral surgeons and periodontists (specialists in gum disease) on restorative procedures, including those titanium-screw implants that can anchor crowns, bridges or dentures.

Dr. Faulkner has been practicing dentistry since 1980, and lecturing internationally since he became a prosthodontist in 1993. There are dentists who are exceptional at restorative work, he notes. "However, at times the patient needs more extensive work that requires special treatment that can only be done by a prosthodontist."

His specialty emphasizes a difference between “cosmetics” and “esthetics” in dental restoration. In a classical sense, esthetics (or aesthetics) assesses or appreciates beauty below the surface. Think of it this way, Dr. Faulkner says: The value of form following function by combining science with art.

“I’m 55, and I’m not naive enough to say I don’t want to look good,” he admits. “But I’ve been around long enough to know that it can be OK to look good, but it had better work.”

To the boomer generation and beyond, people place more importance on the value of their investments, he continues. Veneers, applied to teeth to make them look white and bright, are satisfactory for some people, especially those whose teeth and gums are in good shape.

“Most of the time, to the casual observer, the teeth look better. Not everyone is told about the life expectancy of veneers, and that it's likely they’ll have to be replaced in the future.”

One analogy Dr. Faulkner offers is kitchen countertops. “If you’re in your 20s with a starter home and your second child on the way, you’ll replace them with something that looks good enough until it comes time to sell the house and move up,” he says.
“Now you’re 55, the kids are gone, you’re moving into a new home or remodeling what you have, and it likely will be your last home. You feel it’s your turn to have not only something nicer, but something that’s going to last. It doesn’t mean everyone’s going to get granite, but you don’t want the cheapest Formica, either.”
Prosthodontics originated in making dentures look and function more like natural teeth. "Today, however, the specialty encompasses all types of dental restorations — fixed and removable — that return form and function to make teeth look good and preserve a high level of oral health," Dr. Faulkner says.
Or, as one woman patient told him: “I want my mouth to be healthy and I want to make sure this is going to work.”
The artistry of dentistry meets the scientific aspects of prosthodontics in his office laboratory, staffed by two technicians. They use state-of-the-art lab techniques to create prostheses with millimeter-fine precision, while maintaining and enhancing the natural beauty of their creations.
One of the most popular advances is the use of dental implants to anchor full or partial dentures, single tooth crowns and fixed bridgework. Bone loss is a key reason. When a person loses a tooth, adjacent bone will recede. Dentures fail to stop that loss. That’s why a person’s cheeks might appear to cave in when dentures are removed.
“Implants absolutely help minimize bone loss,” Dr. Faulkner notes, a statement backed by scientific data. With a few implants as anchors, it’s possible to construct dentures that work dependably, last longer and, yes, look better.

“We should put back what nature gave you,” he remarks. “That’s where the art part comes in.”