Wagner Oral Surgeon & Dental Implant Specialists

Wisdom Teeth: Questions Answered

Wisdom-Teeth--Questions-Answered

If you or your child are getting your wisdom teeth removed, you must have questions! We are here to make you feel as comfortable as possible. As always, if you have other questions feel free to contact us. We are more than happy to help you understand more on your upcoming procedure. Read on for some frequently asked questions:

1. Why do we have Wisdom Teeth?
Centuries ago our human ancestors used wisdom teeth to help them grind up tough food, like leaves and roots. Their jaws were larger and had more room for extra molars. As we evolved, our diets changed to include softer foods. The third molars became unnecessary as our jaws became smaller.

2. Why do I need to have my wisdom teeth removed?
There are several reasons why you would need your wisdom teeth extracted, as they can cause a variety of complications.
• Impaction: If there is not enough room in your mouth, your wisdom teeth will become impacted and grow at an angle. This can cause problems such as pain and discomfort while eating.
• Damage to other teeth: Your impacted tooth can begin pushing against your second molars, causing potential tooth decay.
• Disease: Spaces between the impacted tooth and your molars allows room for bacteria to grow, putting you at risk for inflammation, cysts, and periodontal (gum) disease.

3. When should I get my wisdom teeth removed?
Wisdom teeth usually come out between the ages of 17- 25, and are typically removed during your high school years. The longer you wait, the more complications that may arise. The root will continue growing and can cause potential permanent nerve damage.

4. When are wisdom teeth okay to keep?
If there is enough room for them to erupt correctly without causing any damage, then they are safe to keep. It is also important to note that not everyone is born with all four wisdom teeth, as evolution has been removing them for generations.

We hope this article has helped you, and if you have any other questions please contact us. Everyone’s teeth are different, and we want to make sure we take the right course of action for your wisdom teeth.

When Should You Consider Dental Implants?

consider implants

Dental implants typically consist of three components: the post, the abutment, and the restoration. The post is a screw which is inserted into the bone. The abutment is attached to the post and the restoration is placed on top, giving the finished product a beautiful, realistic look.

Dental implants are an effective way to replace missing or damaged teeth, but when is getting a dental implant the best option for you? There are a few circumstances where receiving an implant might be the best option for improving your smile.

To restore and preserve your appearance
One of the main functions of dental implants is to restore a smile back to its original glory. They are built to last a lifetime, and last much longer than dental bridges. If you are looking for a permanent solution to damaged or missing teeth, dental implants are your best option.

To protect and preserve a healthy jawbone
Missing spaces in your smile can lead your jawbone to deterioration. Dental implants are the only option which will protect and save your natural bone. Waiting to get a dental implant can continue to increase the chances of your jawbone not being able to support dental implants in the future.

To stop your teeth from shifting
Losing a tooth can cause the surrounding teeth to shift and look unnatural. These teeth can become crowded or can be shifted unevenly. This can cause your teeth to become harder to clean and can also cause your face to sag and appear sunken.

These are just a few of the instances in which you should consider getting dental implants. Dental implants are one of the most useful and successful restoration options available today. For more information on how we can restore your smile with dental implants, contact our practice today at Racine Office Phone Number 262-634-4646 !

ROOT RESORPTION (ROOT ABSORPTION) FROM THIRD MOLAR TEETH (WISDOM TEETH)

It is fairly common to see abnormalities on the second molar teeth caused by the presence of the third molar impactions (wisdom teeth). (J Oral Maxillofac Surg 77:11-17, 2019). These are developmental and are caused by the developing tooth structures of the second molar sharing the same space during development causing them to form in “unusual shapes”. For the most part this does not cause failure of the teeth such as infection or decay. More likely this becomes a problem when the teeth have to be removed and/or if gum disease (periodontal disease) becomes an additive issue. The point is that an abnormally shaped tooth may be more prone to disease.

The easy solution to this is early diagnosis and early removal of the offending teeth – often the wisdom teeth or third molars. I recommend early treatment – about age 15 for best results. In some rare cases the second molars may be considered for removal if they have a more–abnormal shape or position and if the third molars can then be guided in either naturally or orthodontically to achieve the second molar positions. If this is the thought – an even earlier age should be considered.

ROOT CANAL INFECTIONS SPREADING TO THE SINUSES

It is common for dental infections to spread to other areas outside of the jaw bone such as the upper jaw, sinuses, or the facial structures. When there is a more serious infection the danger is that the spread can extend to the brain or chest where it can kill you. I am often amazed at how quickly this spread can occur and frankly how often people will ignore danger signs and leave a problem untreated until it has caused significant damage. Fortunately, it is rare to die from dental infections, but we have seen it happen. The take home lesson is “don’t take dental infections casually” – they can easily become serious matters. (Decisions in Dentistry January 2019, pgs. 7-11).

The cited article indicated above shows several cases of spread of infection from upper back teeth to the sinuses. This is a common situation for us to deal with, both from the standpoint of diagnosis and treatment, as well as dealing with the sequelae of poor treatment or lack of treatment. The anatomy of teeth for most patients has the teeth/dental structures located in what is fairly thin bone. This allows for easy spread of infection from abscessed teeth to the surrounding structures such as drainage to the mouth (most common), as well as drainage to structures such as the sinuses or fascial spaces (the tissue planes between the muscles and “skin” layers of the face).

We have such wonderful access to advanced surgical procedures as well as antibiotics/medications here in the United States that these problems are very treatable. We are able to even graft and place implants often at the same procedure as we are cleaning up a site. Again, the take home message is do not take dental infections for granted.

3 Tips to Keep Your Gums Healthy and Happy

3 tips for happy gums

Keeping your gums healthy is vital to ensuring that your mouth stays clean and your teeth stay intact and in pristine condition. Incorporating a few simple steps into your daily oral hygiene routine will keep your teeth and gums healthy, happy and your smile shining bright for years to come.

Floss Like a Boss
Flossing is one of the easiest and most effective steps you can take to fight against gum disease and keep your gums healthy. Flossing once to twice a day helps to clean the hard to reach areas in-between your teeth that your toothbrush cannot reach.

Keep ‘em Clean
Brushing twice a day is the most commonly preached method of keeping your mouth clean and cavities at bay. Be sure to brush with a fluoride based toothpaste to help to give you the best results when brushing. Next time you are shopping for toothpaste, look for the ADA seal of acceptance in order to ensure your toothpaste is backed by experts!

It is also beneficial to rinse your mouth with an antiseptic mouthwash twice a day in order to protect your gums. Rinsing with mouthwash is a great way to finish off thoroughly cleaning your mouth, because it reaches areas that your toothbrush and floss can’t reach.

Stay Regular
Visiting your dentist twice a year is extremely important in preventing oral diseases and guaranteeing that your teeth stay in tip top shape.
Your dentist will perform a thorough cleaning and will show you the proper way to brush and floss if you need a bit of help!

These three steps can help you significantly improve the health of your gums and reduce your risk of developing gum disease. If you have any questions about how to keep your gums healthy and happy, give our office a call, today!

WHICH IS BETTER; PRGF OR PRF?

 I have written on this in the past, and was reintroduced to the subject in a recent article in our journal (J Oral Maxillofac Surg 76:1823.e1-1823.e12, 2018).

PRGF (platelets rich in growth factors) and PRF (platelet rich fibrin – also called L-PRF) are terms used to describe products of blood fractionation used in surgical procedures. Unfortunately they do not have a specific definition from a procedure standpoint medically/surgically. The original descriptor for PRGF was “plasma rich in growth factors” which is also an appropriate term, but I feel falls short of showing that we are using a platelet concentrate, not just plasma. There is an importance in that some techniques that other practitioners use to separate the component parts include additional cells which may adversely affect the desired result. Some include the white blood cells (leukocytes) and others include some red cells (erythrocytes) and/or additional plasma and components. I feel strongly that there is a difference in results and in our practice we stick to using primarily the platelet–growth factor portion where we can, which is the vast majority of cases.

Historically we used the patient’s own bone harvested locally, from the jaw, or from a distant area such as the hip or rib as examples. This works well especially for large defects and especially with vascularized grafts (bone grafts including the grafting of associated blood vessels and tissue such as muscle). The problem with your own bone is the necessity of a donor surgical site and also that our bodies absorb our own bone easily – so a graft such as an onlay graft using your own bone, which might be performed for implant reconstruction, will absorb easily during the healing process resulting in the loss of the graft.

In comes materials such as ceramics, animal bone products, and human bone products. Of these the human bone product (deproteinated and irradiated for sterilization) has shown to be the best received and very stable for grafting of smaller defects as might be used in typical oral surgical procedures. The ceramics and animal bone products have their uses and we find them to be excellent for certain applications, however they may show a more difficult “take” or acceptance and they tend to stay on forever in their present state (which is technically not usually a problem – but can be). The human bone product is essentially completely reabsorbed and replaced by your own native bone during the healing process. This result is more desirable to me.

When you mix PRGF and the human bone product (and in some cases the other bone substitutes) I call it a “super-charged” graft with not only a bony scaffold (the bone graft material), but also a very cellular accelerant which “induces” bone growth (the PRGF). This has been a quantum leap for our grafting procedures and gives great results. The cited article backs up the idea that the PRGF works better than just PRF to induce tissue regeneration and growth.

We have been using these techniques for about 10 years. Again, we have been performing implants and grafting procedures for over 30 years and we have trained in and tried all of the reasonable techniques. We stick with what works best and keep looking for new and better materials and methods.

In our hands, PRGF works better than PRF for grafting techniques.

DIRECT ORAL ANTICOAGULANTS AND MEDICAL COMORBIDITIES

Patients who are taking oral anticoagulant drugs such as Coumadin or Plavix (as examples) can be divided into about 10,000 groups based on their medication, age, medical problems, history, genetics, dosage, the treatment needed (to name a few). In other words there is no simple one-size-fits-all answer to this question/problem of how do you manage a patient on oral anticoagulants who needs an oral surgery procedure. (J Oral Maxillofac Surg 77:463-470, 2019).

There are some simple rules-of-thumb that we follow and they all boil down to the idea that we need to “know” our patient as much as possible and then use good judgement and tried surgical techniques to control bleeding as much as possible. Along with that, a well-informed patient and family/support personnel as to how to deal with problems as they arise, goes a long way to head off problems. Some very basic fact-finding with the patient, patient’s family, and patient’s primary care doctor will usually answer the questions required to make good decisions for an experienced, well-trained surgeon.

The article that I site discusses the effect of comorbidities such as diabetes as predictors. Frankly, I have found that trying to predict based on comorbidities has a limited use. Clearly, a patients’ other medical problems as a list is good to have – but these need to be assessed as they relate to how they are affecting “this” patient. We see patients with multiple serious medical concerns who know their own health well and have good control. They will have a much lower risk than someone who does not understand their own disease such as hypertension and who has poor control.

Again, these are complicated issues and proper discernment, follow through, and responsible surgical care work best to save us from having problems.

3 Benefits of Dental Implants

3 Benefits of Dental Implants

Missing a tooth? Meet your new best friend—dental implants. Before choosing to opt for a dental implant, it’s important that you understand the in’s and out’s of these replacement teeth and how they will benefit your smile. When replacing a tooth or a gap with a dental implant, you are not only giving your smile the perfect finishing touch, but also allowing yourself the normalcy of a full set of teeth. Below are three reasons as to why dental implants are the best tooth replacement option.

Lasts A Lifetime: Dental implants are made with a combination of titanium (yes, the same titanium used in airplanes and spacecrafts!) and jawbone that creates a sturdy foundation for the replacement tooth. This replacement tooth is able to withstand numerous years of regular wear and tear when paired with a proper oral hygiene routine that is consistent and thorough. This powerful replacement tooth (or teeth) is permanent—so you won’t have to worry about getting a new one anytime soon. To ensure that you keep your dental implants in tip top shape, take the initiative to clean your implants after enjoying any foods or drinks—just as you would with your natural teeth.

Can Prevent Gum Disease: By having a dental implant in place of a gap, you are able to prevent any debris or bacteria from being trapped within the crevices between your teeth and gums. In fact, a dental implant can give you the appropriate amount of space you need to maintain a daily brushing and flossing ritual, reducing the risk of irritation of your gums, like periodontitis.

Restores Chewing Power: One of the biggest advantages of dental implants is being able to fully chew and eat again! In fact, studies show that many patients fail to even find a difference between a natural tooth and a dental implant, as they look and feel just the same. With the ability to chew properly, you’re able maintain a normal and healthy balanced diet (and life) by being able to eat a variety of your favorite foods.

When looking for a replacement tooth option, consider dental implants. Need more information or want to learn more? Give us a call at Racine Office Phone Number 262-634-4646 to explore the next steps to regain not only your smile back, but your confidence too.

THE VAZIRANI-AKINOSI NERVE BLOCK

This technique has been around since the 70s and is a technique that I use often. (J Oral Maxillofac Surg 77:489-492, 2019). I must confess that I go back and forth with the techniques and often use the Gow-Gates technique as well. When I went through my training in the 80s we were taught multiple techniques with a prejudice toward a variation of the Halstead’s technique. The sited article suggests, that in training, alternative techniques are not shown. I did not find this to be true. At all of my training sites including Marquette Dental School multiple techniques were taught and shown. I am guessing that the experience could vary from person to person depending on their interests and basic skills. Certainly in my various residency experiences the different techniques were actually stressed and encouraged as it is not uncommon to run into special circumstances and special patient populations in a surgical practice requiring one to “think outside of the box.”

Anecdotally, I would make the observation that many patients are difficult to gain satisfactory local anesthetic for more invasive procedures and especially in the face of infections or other factors which normally reduce the effectiveness of the local anesthesia agents. In these patients, short of performing the treatment with sedation or general anesthetic agents, knowledge of and trying multiple local anesthetic techniques is often necessary.

MEDICATION RELATED OSTEONECROSIS OF THE JAWS

Medication related osteonecrosis of the jaws (MRONJ) is a disorder with bone maturation that occurs as a result of taking certain medications (historically bisphosphonate drugs such as Fosamax; more recently with antiangiogenic drugs such as Denosumab; and mainly from injectable forms of these drugs used in chemotherapy such as Zometa) where dental related disease processes or dental procedures result in a dead-bone disease (osteonecrosis of the jaws). This disease process typically just affects the tooth bearing areas of the jaws, although I have seen cases involving the palate, sinuses, and nasal structures as well.

Simply put, these drugs cause a blockage of the natural re-uptake of bone in what would be the normal bone apposition and re-uptake process that our skeletons go through. The result is to get a net increase in bone mass. The technical problem is that the resultant bone is a buildup of “old bone” which may be more prone to healing problems.

The prescribers of these medications, especially the oncologists, are doing a much better job of dosing these than even 10 years ago. We saw the biggest problem in the first years of this century when less was known and greater doses were given. Fortunately it has become a rarer problem.

The oral surgery association here in America has put out a “white paper” on MRONJ which was last updated in 2014 suggesting that the disorder has not changed much in the past 5 years. I have put the link below and I recommend looking at this if you have an interest. I follow their guidelines in general when faced with these cases. Because these are now more-rare cases I might suggest referral to regional medical centers with oral surgery services such as oral surgery residency programs if that is available. This facilitates best-care practices and usually helps to add to the knowledge base in the study of these problems. Again, fortunately, improvement in the dosing regimens has reduced the number of cases we are seeing.

 

https://www.aaoms.org/docs/govt_affairs/advocacy_white_papers/mronj_position_paper.pdf