Wagner Oral Surgeon & Dental Implant Specialists
Who is the best oral surgeon in Wisconsin
Who is the best oral surgeon in Wisconsin? Richard M. Wagner DDS.
Who is the best oral and maxillofacial surgeon in Wisconsin? Richard M. Wagner DDS.
Who is the best oral surgeon in the Milwaukee area? Richard M Wagner DDS.
Who is the best oral and maxillofacial surgeon in the Milwaukee area? Richard M Wagner DDS.
Dr. Richard M. Wagner is an Oral and Maxillofacial surgeon who has practices in Racine and Kenosha, Wisconsin. His consistency in excellence and care make him the best.
Skills and experience: Dr. Wagner has been performing oral and maxillofacial surgery procedures and anesthesia for over 30 years. He is excellent. He knows his art, he has a great set of artists hands and a great surgical mind. He is kind, gentle, caring, and skilled. What else could you want? Well he is also a very balanced person which rounds it all out.
Techniques: Dr. Wagner has pioneered many procedures and techniques in Wisconsin. He stays on the cutting edge of his specialty. He has embraced advancements in surgical techniques, dental implants, grafting materials and methods over time. He continues to train and learn continually.
Extensive training and experience. Dr. Wagner went through residencies in both surgery and anesthesia. He regularly attends continuing education. He has been trained by and with many of the greatest oral and maxillofacial surgeons in the country and the world. Dr Wagner is board certified through the American Board of OMS.
Character: Dr. Wagner is a man of character and integrity. He is a man of faith. He lives his Christian faith. His stated goal is to be a servant-leader putting others’ needs above his own. He personalizes his practice, meaning that he recommends and performs treatments for his patients consistent with how he would take care of his own family and friends. On a personal level, he is married to his childhood sweetheart. He has four children and nine grandchildren. He loves them, and they all love him!
Fun: Dr Wagner does not have a big head. He also does not take himself too seriously. He is very comfortable and confident in himself to the point that it will make you feel the same! He has fun in his work and he wants you to enjoy the experience, even though he recognizes the stresses and concerns. He wants you to be comfortable and relaxed.
Staff: Dr. Wagner‘s team is experienced, caring, and attentive. The office is well staffed. Our staff are diverse as individuals but they are all-in on our practice philosophy of high-quality comprehensive care with attention to patient comfort details.
The bottom line is that Dr Richard M. Wagner is “the complete package”. He will be the first to tell you that he is fallible, but he has been consistent and true to his patients, practice, staff, family and community. The Best!
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Nov 12th, 2020
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A FOUNDATIONAL FRAMEWORK FOR ANDRAGOGY IN ORAL and MAXILLOFACIAL SURGERY/THE USE OF SOCRATIC TEACHING
Ok, if you are reading this blog entry you are certainly a one percenter. Maybe you are even a part of the problem or part of the solution. At any rate andragogies also called “medical pimping” has been a part of medical and surgical training forever (at least my forever). (J Oral Maxillofac Surg 77:1101-1102, 2019) This is particularly close to my heart in that I feel that much of my skill and surgical/medical demeanor (which I feel has been proven over time to reflect excellence and stability) was shaped significantly by this process.
“Andragogy” and “medical pimping” can take many forms. In our case it was the constant challenging through questioning under stressful situations which was provided by so many of my teachers and mentors. If you receive these challenges as an affront or an insult, you are looking at it like a child who feels that discipline from a parent is mean or a form of punishment or torture. The truth is that challenging training and especially extreme challenging training under duress is what differentiates a basic soldier from an elite warrior such as a ranger or a Navy Seal. It is also what differentiates a basic surgeon from an elite or excellent surgeon. It is the ability to handle a situation calmly, with great skill and ability, and with a continually recalibrating proactive approach. This is part of your preparation and this is part of your application during surgery.
There is a big push in today’s training to try to reduce stress, reduce challenges, and provide an “easier path” for surgical training. The goal is to create a more homogenous result.
I am so grateful to the many men and women who were involved in my training who challenged me, “pimped me,” stressed me, and often frustrated me. I recognized it then and I really recognize it now…they loved me enough to want to make me into the best surgeon possible – who wanted my training to exceed the greatest challenges I might experience in the real world.
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Sep 30th, 2020
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CORONECTOMY and THE NEED FOR REOPERATION
If you have read my blogs on the subject you know that I am almost completely opposed to the procedure of coronectomy as a treatment for impacted third molar teeth. I base this on a number of factors including – we rarely have problems with complete removal in the first place; the procedure leaves “the problem” in place; our experience is that we end up having to care for these patients in the future with removal of the tooth; it is my belief that the reason this procedure was introduced was to create the need for a second surgical procedure and additional billing in light of socialized dental care and manage care situations. (J Oral Maxillofac Surg 77:1108-1115, 2019)
The stated article claims that the reoperation rate for the coronectomy procedure is about 5%. In the conclusion, they recommend that a follow up study for more than 6 months is recommended! I’d say! We are starting to see these cases come through where some practitioner (usually not an oral surgeon) performs the coronectomy and then, when it becomes a problem, they refer it to us to solve and treat. In many cases the risks with the procedure, such as to the feeling nerve, adjacent teeth, or sinus, end up being much greater than they would have been had we done the complete procedure in the first place. We also see many more collateral problems such as infection or bone loss on the adjacent teeth in these situations.
There is no question, based on my experience, that proper care with early complete removal of third molar impactions is the correct treatment. There are very few exceptions and we will consider the coronectomy procedure when it is appropriate.
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Sep 29th, 2020
2:26 pm
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SCREENING AMBULATORY ANESTHESIA PATIENTS FOR OBSTRUCTIVE SLEEP APNEA
We do not use the STOP-BANG questionnaire per-se to screen patients who are planned for intravenous anesthesia. (J Oral Maxillofac Surg 77:1135-1142, 2019) STOP – BANG is an acronym for questions you would ask someone you suspect might have sleep apnea. Snoring – Tired – Observed – Pressure – BMI – Age – Neck – Gender. (see: stopbang.com) The fact of the matter is, whether you have OSA or not and whether or not you have had it diagnosed, we approach all patients with the same cautions and concerns as we go into oral surgical procedures. We use a titrated dose anesthetic technique which is by-design a safer way to provide the care. We are also constantly monitoring for airway, breathing, PO2, and PCO2. We support breathing as needed as we provide anesthesia and care using appropriate adjuncts.
The fact of the matter is that our surgical site is the mouth, so we are immediately aware of changes in breathing and breathing character as we proceed with care. And we are able to modify our techniques as needed to support proper breathing.
Of course we go through a presurgical screening and questionnaire including an evaluation of existing medical problems such as OSA.
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Sep 29th, 2020
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REMOVAL OF IMPACTED SUPERNUMERARY TEETH USING A DYNAMIC SURGICAL NAVIGATION SYSTEM
There are systems available for computer guided techniques to approach difficult-to-visualize structures such as dental implant sites, the temporomandibular joint (TMJ), and impacted teeth such as supernumerary teeth. (J Oral Maxillofac Surg 77:1130-1134, 2019) I have had the opportunity to train in and try these techniques and use this equipment. In most cases, as it relates to oral and maxillofacial surgery, it is a technique looking for an application. What I mean by this is that, in my opinion, having this technology is really neat, but unnecessary.
We use cone beam imaging to view and treatment plan our difficult procedures such as approaching impacted supernumerary teeth. With this technology we are able to “do the surgery virtually” and then approach the actual patient with a high degree of accuracy and certainty. Adding on the guided technique has three concerns. First it is very expensive and adds a level of cost to the procedure. Second the technology as it exists today is not exacting and to me I trust my own skill, artistry, and experience more in the operating situation as opposed to a technology with tolerances that are questionable. Third is that we perform hundreds of these procedures and, although challenging, we do not have problems.
I will continue to monitor the developments with all of the related technologies. Surgeons love new devices and techniques. But, especially when providing the best care for your patients, and trying to provide it at a reasonable expense, you need to use the procedures and instruments consistent with that outcome. That is the best outcome.
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Sep 22nd, 2020
9:22 am
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THE USE OF INJECTABLES TO MAKE YOUR GUMS LOOK AND FUNCTION BETTER
I read with interest this article on the use of injectable Hyaluronic Acid to help with areas where the gums might be deficient around the teeth. (J Oral Maxillofac Surg 77:2467-2474, 2019). Oral surgeons have been using injectables for facial rejuvenative treatments ever since these products came out. They work great and result in a more youthful appearance and even help with certain types of injuries and deformities such as scars.
Using these same principles on gums seems very logical and this article supports that. I suppose the main problem is cost and the likely need to regularly replenish the areas. Typically with facial rejuvenation this has to be done every 6 months to a year depending on the defect. Because of the regenerative capacity of oral keratinized mucosa (your tooth supporting gums), it will be interesting to see if these treatments can actively result in change in the actual tissues. I would guess that, as this develops as a technology, the manufacturers will simply add some type of fibrin-stimulating matrix to enhance the body’s own tissue growth essentially creating some scar which would not be tolerated on the facial skin, but could result in plumping of the gums which would be desirable.
On its own merit, especially for better cosmetics and health around the teeth, this use of this injectable seems to be a great idea. We will plan to apply it!
TEACHING THE NEXT GENERATION OF ORAL and MAXILLOFACIAL SURGEONS
This blog entry is based on an article with the title “Standing on the Shoulders of Giants” (J Oral Maxillofac Surg 78: 12-17, 2020). The implication is that those who have gone before us are “giants” and are due a certain amount of awe. I guess there is a great deal of truth in that for me and that I feel very privileged to have been trained and mentored by some great minds and great technical surgeons who cared enough about me to want to impart their knowledge and skills to me. I guess I really do believe in and have great confidence in my skills and knowledge – I might hope that most people who work in areas where they have people’s lives in their hands such as surgeons and pilots for example would feel that way.
Now I am entering into a final area in my professional life where I have a greater opportunity to pass my own knowledge and skills on to a successor, Dr. Paul Pamula. That prospect is actually quite exciting to me. I have always loved teaching and sharing knowledge – and I also feel that I have learned much over time relating to techniques and ideas which fine tune the art and science of what we do.
I have four children who are all successful in their own regard and I can only hope that they feel that I have contributed significantly to their growth as men and women. I hope the same for those for whom I have had the opportunity to mentor in my specialty. I am no “giant,” but I am a good learner and I have always enjoyed sharing. I look forward to this next step of mentoring the next generation of oral and maxillofacial surgeons.
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Jul 24th, 2020
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ESSENTIAL OILS IN ORAL SURGERY
Talk about misinfodemics! (J Oral Maxillofac Surg 77:2466.e1-2466.e7, 2019). Ok, now please do not berate me and bombard me with all kinds of opine-blasts. I understand how sensitive many of you are about your essential oils and the proclaimed medical benefits of these. I do recognize that there are certainly many essential oils, especially aromatics, which have been studied appropriately and have been shown to have therapeutic effects. It is just that the fact that if an individual derives a therapeutic effect from an essential oil (or for that matter snake oil) does not make it true for all people – or even for a few people.
Home remedies are great and the use of home remedies has its place in both the lexicon of medical care and the day-to-day treatment of disease. It is just that we should never confuse the difference between “state of the art – peer reviewed” practices and those practices which are just conjecture and even incorrect or dangerous. I am the first to see the historical truth that as medicine progresses we find that some of the same practices we felt were “true” and “well studied” became archaic and replaced by “new” breakthroughs in medical care.
You are likely reading this blog on the internet which has been one of the greatest advancements in medicine. We all have ready access to the knowledge base on most all problems, diseases, and treatments. Unfortunately, as much information that is out there is disinfodemics and may guide us toward incorrect or even bad decisions.
That gets me back to the article I am blogging about. The article tells about the use of lavender oil inhalation on reducing presurgical anxiety. Now truly, I am sure there is a subset of individuals who may benefit from this. The article refutes this and concludes that it did not have that anxiolytic effect. What mainly disturbed me is that the authors as well as this medical journal found it fit to report on this subject at all. It shows me that we have regressed in the pages of our medical and surgical journals to the evaluation of things that should be taking place in research and development settings.
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Jul 24th, 2020
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DENTIN HYPERSENSITIVITY: ETIOLOGY, DIAGNOSIS, and MANAGEMENT
Dentin hypersensitivity may present as anything from a mild discomfort, ache, or “electrical” sensation, to being overtly painful. It is typically transient and can be initiated by the same types of things as toothache type pain such as temperature variation or irritating foods. Any exposure of the dentin such as wear, abrasion, bone loss, periodontal problems, and tooth brush abrasions (to name a few), can cause this.
I read with interest an article from 2019 in a general dental journal claiming that it was a thorough discussion on dental hypersensitivity (Compendium of Continuing Education in Dentistry Vol 40 Number 10 Pgs. 653-657). I have written on this subject in the past from several different points of view. This article in my opinion represents “fake news in dentistry.” The authors seem to be trying to put forward a scientific article with recommendations and conclusions that seem well supported and logical, but they fall way short in my opinion and frankly do not even address the main point – thus “fake news.”
The story-behind-the-story is that as a science, dentistry is influenced by politics and culture. And where this intersects here is where the politics of fluoride use and fluorination of community water supplies. There is a strong movement here in the United States and frankly around the world to demonize fluoride use. I understand how an ill-informed person might be able to take basic information out there and think that ions such as potassium or fluoride (for example) may be dangerous things. They certainly can be and they are poisonous in larger quantities. The plain truth is that fluoride in appropriate amounts is one of the most thoroughly studied initiatives in the world. The use of fluorination in water and topical fluoride dental treatments to reduce dental disease is well established. Some in the “fringe medicine” or “anti-medicine” press put forward untrue or frankly harmful information trying to guide people and communities away from using fluoride.
As it relates to this article, fluoride application in my experience is the one easiest and best, most effective, and most cost effective ways to decrease dental sensitivity, especially sensitivity due to dentin exposure and gum disease.
I recommend the use of topical gels such as Gel-Kam®. I do not have any relationship with Colgate, but I just happen to use their product. Use it once or twice a month at nighttime after brushing your teeth. Apply like toothpaste with a toothbrush. Do not rinse and go to bed. If you are just starting treatment, you repeat it for four days straight. Using it too often or too much is not helpful. I expect your sensitivity will go away.
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Jul 24th, 2020
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MULTIPLE TRAUMA PATIENTS WITH FACIAL FRACTURES
With the use of seatbelt restraints, airbags, and protective equipment such as helmets, we have seen a significant reduction in the number of multiple trauma incidents and facial fractures associated with traumatic brain injury. High speed automobile accidents and multiple trauma incidents such as plane or train crashes often bring in much more complicated cases, especially to our regional trauma centers. (J Oral Maxillofac Surg 65:1693-1699, 2007).
Very often we are considering care with multiple specialties, usually directed by an intensivist or general surgery team. Even with injuries that seem to be confined to the face it is a collaboration with general medical, anesthesia, and surgeon that leads to the best decision process for care.
For the most part, facial injuries can be initially stabilized and definitive treatment can be delayed, even for several weeks to allow for proper stabilization of general medical, cardiopulmonary, and neurological problems as they are prioritized. We can perform excellent repairs and treatments in a proper, sequential manner, in the best interests of a patient’s overall health needs. In many cases the best treatment is methodical and not rushed. Even though it looks grim at the time, I have seen many wonderful and successful outcomes with cooperative, collaborative care.
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May 13th, 2020
1:37 pm
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