Wagner Oral Surgeon & Dental Implant Specialists

Advances in medical and surgical care over the years have resulted in a continual increase in life expectancy and individuals surviving who have more significant healthcare concerns. It is very common to see patients with various disease states requiring blood thinners (anticoagulants). Many of these patients are significantly anticoagulated (INR > 2.5). As an oral surgery team, we have to be aware that such individuals are at an increased risk of uncontrolled bleeding in the event of an injury or secondary to a surgical procedure such as extraction of a tooth.

How Anticoagulant Drugs Affect Oral Surgery

There are advanced techniques that can be used to aid in this care such as PRGF, advanced flap and suturing techniques, and surgical site medicaments. We use all of these in our practice where indicated or desired. In many cases, we inherit the patient after care has already been provided somewhere else and bleeding becomes a concern. This obviously places us at a disadvantage, but we have the knowledge and experience to help.

The take-home message is that, as we deal with improved quality of life and prolonged life through advancements in surgery and medicine, we also have to be very aware of the risks and potential side effects of such therapies. Proper technique and preventative treatments can go a long way toward improving the safety of your dental and oral surgical care.

Gentle Oral Surgery Team in Milwaukee

Our patients benefit from being treated by an oral surgery team with their best interests in mind. For a consultation with our gentle, positive oral surgery team, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 today! Our professional, experienced oral surgeon will take excellent care of you.

Ref: J Oral Maxillofac Surg 72:858-867, 2014

Grinding and clenching of teeth have been studied extensively and clearly have multiple causes. In most cases, there are multiple overlapping and layered causes. In some cases, it is a normal physiologic activity (such as a child naturally responding to a changing bite during development). In many cases, it is a natural response to a pathologic (abnormal) bite, bite relationship, jaw structure, and/or support structure. In many cases, it is the body’s own response to a disorder or disease of the jaws or supporting structures.

Jaw Surgery: Grinding and Clenching

The article referenced here talks about stresses on the parts of the jaw joint and relates them to clenching and grinding activities. What we know as jaw surgeons is that the main issue is the relationship of the bite to the jaw position. These are typically growth abnormalities that occur during development of the facial skeleton. Physiologic and psychological conditions (abnormal muscle balance, stress, etc) all contribute to the problems.

My practice experience as a jaw surgeon has shown me that the best approach is to control the basic factors that we can, such as correcting jaw and bite relationships with proper surgical, orthodontic, and dental reconstructive care. Once that is done, then we would address internal joint concerns. In most cases, the internal joint problems are relieved by correcting the support structure issues.

Results-Driven Jaw Surgery Team in Milwaukee

You deserve to receive oral heath care from a jaw surgeon who keeps abreast of the latest research and strives to provide a positive environment. For a consultation with a gentle, highly skilled jaw surgery team, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 today! Our professional, experienced jaw surgeon will take excellent care of you.

(TMJ, TMD, tempromandibular joint, orthognathic surgery)

Ref: J Oral Maxillofac Surg 72:1070-1077, 2014-07-01

A big part of the dental surgery practice is removal of teeth that are decayed and broken down past the point where they can be saved. In many cases, this involves decay that has occurred underneath a filling or crown and in many cases could be avoidable.

The Revolutionary Power of Fluoride

Fluoride use and fluoridation of the water supply is the most studied national health standard of all time. This has consistently shown that fluoridation significantly reduces caries (decay) safely and effectively. In spite of this, there are still loud voices making unsupported, unscientific claims that fluoridation is dangerous and should be stopped.

Fluoride is an ion, like potassium, that is needed and helpful to augment in our daily dietary intake. Like potassium, fluoride in larger concentrations is poisonous. This is the primary basis for the opposition. There are many such elements, ions, and molecules that if ingested in large quantities can be harmful or even fatal; but at appropriate quantities are good for you and even helpful.

The Dental Dangers of Omitting Fluoride

As a dental surgeon, I see the results of a lack of dietary fluoride in my practice on a regular basis. Patients who do not have fluoridated water, who filter their water, who do not get fluoride supplements (toothpaste, dental treatments, etc.), and other reasons, show a distinct pattern of increased dental decay. This is especially true for individuals with multiple restorations on their teeth and/or deep anatomy, where there are crevasses which hold bacteria and the acids they produce. Decalcification of tooth structure from acids and bacterial action on the soft, vulnerable tooth structure leads to decay and breakdown. Fluoride fights this and can even help to reverse the process.

A recent study in the Journal of the American Dental Association followed a population of patients at a VA hospital and showed a significant reduction in caries/decay in the patients receiving fluoride therapy. As a dental surgeon, I encourage patients to use topically applied fluoride, especially if they do not get it in their regular water supply.

Skilled Dental Surgery Team in Milwaukee

For a consultation with our gentle dental surgery team, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 today! Our professional, experienced dental surgeon will take excellent care of you.

Ref: JADA 2014;145(5):443-451

There is no question, that there can be anxiety when we go in to see a doctor and they have us sign a consent form prior to a procedure. The way this is presented can have a dramatic effect on how we perceive the process. I never want to “candy-coat” the fact that risks are real, but I also want my patients to be assured that I am doing my best to minimize the risks and give them an excellent experience.

We Provide Caring Oral Surgery Services

We serve patients by providing oral surgery procedures with honesty and your comfort in mind. Dr. Wagner and the entire staff, working out of our conveniently located office, are proud to serve patients from Racine, Milwaukee, and the entire Milwaukee metro area.

If you are ready to experience our quality oral surgery services firsthand, call our Racine, WI, office at (262) 634-4646.

Proudly serving Racine, WI and the surrounding Milwaukee-metro area.

Epinephrine (or adrenaline) is used along with local anesthetics because it increases the duration of effectiveness, decreases blood loss, and reduces the systemic toxicity of anesthetic drugs by localizing them. Epinephrine can cause systemic problems for some individuals.

Results-Driven Oral Surgeon in Racine

If you have ever had a reaction to local anesthetics, it was probably due to an inadvertent injection of the drug into your bloodstream. This often causes a significant physical and psychological response that is unpleasant and may even be life threatening. Although rare, the epinephrine can bring on adverse vascular and heart problems.

A recent study showed the use of clonidine as a substitute vasoconstrictor used along with local anesthetic drugs. It apparently provides the same benefits, has a better safety profile, and therefore would be better overall.

We Provide Quality Oral Surgery Services

I look forward to seeing this and other new drugs coming on the market which help us to take better care of our patients. We serve patients by keeping ahead of the latest trends in oral surgery and anesthesia. Dr. Wagner and the entire staff, working out of our conveniently located office, are proud to serve patients from Racine, Milwaukee, and the entire Milwaukee metro area.

If you are ready to experience our quality oral surgery services firsthand, call our Racine, WI, office at (262) 634-4646.

Proudly serving Racine, WI and the surrounding Milwaukee-metro area.

J Oral Maxillofac Surg 70:257-262, 2012

Pain control is a key part of the training of an oral and maxillofacial surgeon. The list below is medical terms we use to describe or qualify discomfort. I thought they might be interesting and give a couple of “words with friends” additions.

Pain Descriptors in Oral Surgery

We Provide Comfortable Oral Surgery Services

Your comfort is a top priority for our caring oral surgery team. We serve patients by providing oral surgery procedures with skill and care. Dr. Wagner and the entire staff, working out of our conveniently located office, are proud to serve patients from Racine, Milwaukee, and the entire Milwaukee metro area.

If you are ready to experience our quality oral surgery services firsthand, call our Racine, WI, office at (262) 634-4646.

Proudly serving Racine, WI and the surrounding Milwaukee-metro area.

Topical fluoride gel is available over-the-counter without a prescription at your pharmacy. We often use it with kids that are in orthodontic care to try to give some extra strengthening to the tooth structure and to rebuild tooth structure that might be adversely affected by debris on the teeth.

How Teeth Benefit From Fluoride

Fluoride is an essential nutrient for healthy teeth. It becomes incorporated in the apatite crystal of tooth structure to give it a stronger form. This increases the density and strength of tooth structure and therefore the resistance to decalcification and decay. It helps in shrinking the pore size on root surfaces and also tends to deaden the surface nerve endings on the tooth roots and therefore decreases root sensitivity on teeth.

How Fluoride in Water Fights Decay

In our area, there are many people on well water and I see a definite increase in decay under restorations on these individuals who do not have administered fluoride in their water. We also see this on individuals who do not use city water. We also tend to see an increased incidence in decay underneath restorations such as the edges of crowns or the edges of fillings in older patients, whose immune systems may be  diminishing. We certainly see this in patients with immune illnesses, such as patients who are undergoing chemotherapy.

The pearl is that topical fluoride can be used as a home application. Again, it is available over-the-counter at your pharmacy. I would typically recommend brushing it on after nighttime tooth brushing. Put a small amount on your tooth brush and just brush it on you teeth and leave it set. This gives it a chance to affect the teeth topically. This will help to reduce sensitivity on the teeth and can reduce the tendency toward getting decay under the teeth. If you are having an active problem with sensitivity or decay, I would recommend doing this for about one week and then after that, do it a few days a month.

Results-Driven Oral Surgery in Racine

Fluoride is an important part of your oral health routine, but care from an experienced oral surgery team. For a consultation, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 today! Our professional, positive oral surgery experts will take excellent care of you.

Excellence in an Oral Surgery Comes from Experience

Oral and maxillofacial surgeons have always been the experts in providing surgical care for the oral and facial region. New technologies, such as cone beam scanning, are instruments that help us all to provide better care. So many individuals use these technologies, such as advanced instruments, medications, materials such as bone graft, dental and facial implants, and techniques such as anesthesia. We see many glitzy advertisements on television promising great results. Do not be misguided by these. There is no shortcut to excellence and excellence does cost something. A hammer is just a hammer; if you put it in the hand of an expert carpenter or sculptor it can perform wonderful feats and produce great results.

Remember, oral and maxillofacial surgeons are the highest trained and are expert in the proper surgical care of the oral and facial region. We are trained in proper surgical care and can apply advanced surgical technique and instrumentation appropriately and effectively. Having the technology does not make a person an expert.

Oral Surgery with a Passion for Continued Education

Trust your smile to an oral surgery expert who knows that the latest technology is only effective when combined with high levels of experience and education. For a consultation, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 today! Our professional, positive oral surgery team will take excellent care of you.

Ref: J Oral Maxillofac Surg 71: 1819-1824. 2013

Innovations in Oral Anesthetics

I saw a recent article about the use of amitriptylene as a topical anesthetic for dentistry. (J Oral Maxillofac Surg 71:23-28, 2013). This is interesting. There are many medications which block nerve transmission orally. For patients who are sensitive to other local anesthetics, I like Diphenhydramine (Benedryl). It is widely available and is a simple histamine blocker. It numbs the tissue quite effectively and also reduces the inflammation response. The injectable form can be used just like local anesthetic. The gel tabs are bitter, but their liquid contents work nicely for topical anesthesia.

Partner with a Skilled Oral Surgeon for Optimal Health

Your oral health and your comfort are top priorities for our team. For a consultation with an oral surgeon, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 today! Our professional, experienced oral surgeon will take excellent care of you.

Clostridium difficile is an uncommon disease that has been on the increase and is felt to be mainly a side effect of antibiotic use. Clindamycin is a commonly used and appropriate antibiotic for oral infections. It is, however, a second or third line drug for me as an oral surgeon because of the risk of C difficile colitis. Clindamycin is actually not as good an antibiotic as Augmentin for oral/facial infections where anaerobic bacteria are suspected. Penicillin is still our first line drug followed by Amoxicillin and certain cephalosporins such as cephalexin. For the typical mild oral infection, the next line would be Augmentin. For penicillin allergic patients, my first line is erythromycin or azithromycin. As we get into the more serious infections, I modify my regimen on a case-by-case basis. Clindamycin is a commonly used and appropriate antibiotic for oral infections. It is popular and used by many dentists and oral surgeons. Again, I would typically use it as a second line drug behind erythromycin or Azithromycin for the penicillin allergic patient.

SOME NOTES ON CLOSTRIDIUM DIFFICILE

Clostridium difficile is an opportunistic pathogen, typically colonizing the intestinal tract after alteration of the normal flora by antimicrobial therapy (antibiotics). Inoculation is along the fecal-to-oral route. The prevalence of antibiotic-associated colitis has increased alongside the expansion of antibiotic use. The organism was first identified in stool samples of healthy neonates and named Bacillus difficilis owing to the difficulty of attempts to isolate and culture it. However, C difficile was not identified as the causative agent in antibiotic-associated colitis until 1978. Its main virulence factor is the ability to elaborate exotoxins, designated toxin A and toxin B, that bind to receptors on intestinal epithelial cells, creating the clinical manifestations of C difficile-associated colitis.

Some risk factors for C difficile infection (CDI) have been identified. Most, but not all, cases have been associated with antibiotic use. Hospitalization or assisted living facility admission are strongly associated risk factors, as are an age older than 65 years and debilitating illness. Although the associations are less clear, enteral feeding, use of proton pump inhibitors, abdominal surgery, cancer chemotherapy, and stem cell transplantation have gained attention as potential risk factors. In addition to therapeutic antibiotic use, perioperative antibiotic prophylaxis has been shown to confer risk for CDI. Of significance, CDI can occur in the absence of identifiable risk factors.  

Get Advice From an Experienced Oral Surgeon

As an oral surgeon, it is important to me to keep abreast of the latest developments in medications and techniques. For a consultation, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 today! Our professional, experienced oral surgeon will take excellent care of you.