Do I need a separate dental implant specialist to have my implants done? This is a question that is asked to me periodically. The most recent occurrence of this question happened 2 weeks ago. Let me add, parenthetically, that the question is usually asked to me by a new patient. Once a patient becomes part of the practice, he or she is usually comfortable with the wide array of services that our office can provide.
Let me get back to our question and relate to you what happened. I was outlining a treatment for a new patient. The treatment included dental implants, removal of teeth, crowns, a full denture and a partial denture. We had discussed various options for a number of appointments. As always, I make the patient a partner with me in the ultimate plan. I inform and educate. Together we create a plan that works for that patient in that circumstance. After a number of discussions, he asks me the specialist question.
How specialties operate in dentistry
Before I answered him, I needed to explain how specialties operate in dentistry. To be called a specialist, you must practice one of the dentistry’s recognized specialties. Periodontics which involves treating the gums, endodontics which treats root canals, oral surgery which involves tooth extractions and more. Lastly, orthodontics, the discipline that helps to straighten teeth is another specialty. These are all recognized specialties by the governing bodies of dentistry. Governing bodies are state boards and national societies. You can’t just take any procedure and call yourself a specialist. You will be taken to task by state dental boards. Most dental specialists limit their practice to their specialty. This is why if you see a root canal specialist for a root canal procedure, you will need to go back to the general dentist to place a filling or crown over the hole that was made to do the root canal.
Technically, there is no such thing as a ‘dental implant specialist’
So now let’s go back to our question from my patient. The answer is simply that implant dentistry is not a recognized specialty in the United States. The American Dental Association (ADA) has not established implant dentistry as a specialty. Some professional dental organizations offer “credentials” in implant dentistry for their members, who often promote their expertise using these credentials. However, none of these credentials are recognized by the ADA. As such, no dentist is a “dental implant specialist” per se.
Now there are specialists such as oral surgeons or periodontists that place implants, but they are not “dental implant specialists”. In fact, if either of these types of doctors places an implant you have to go to another office to finish and put a crown on the implant. This is what I hear from so many patients who don’t like bouncing from office to office. Dentists who do the entire implant case for a patient from start to finish have been referred to as an ‘Implantologist’. Going by that unofficial and casual definition, my credentials and work fit into that category.
Planning and executing your implant procedure from start to finish
As a patient would you like to go from office to office to get your implant procedure completed? Starting it by one specialist and following up at another? Of course not! I find it very stimulating for me to plan and execute a case from start to finish. When I place an implant, I know what it will be used for and can control the placement to accommodate the final result. In cases where issues may arise, I can apprise the patient when it happens and then deal accordingly so the final result is not changed or if need be, altered in the least way possible. My patients always appreciate me staying on top of their treatment. You also benefit from getting the entire procedure done by one doctor – me.
If a picture is worth a thousand words, then these demonstrations must be worth over a million words for these doctors. This is so rewarding for me as I can share my many decades of knowledge with many of my colleagues. This allows more patients in our local area to benefit from one of the most exciting advancements in dentistry in many years.
If you are contemplating dental implants and would like to find out more about this exciting aspect of dentistry, please feel free to call me at 440-951-7856and allow me to share in creating a healthy mouth for you to enjoy for years to come. I look forward to hearing from you.
Help! I just started to get food caught between my teeth!
This is an issue that comes up many times during the week. I hear it from patients and I hear reports from our talented hygienists when they give me a report on the status of a patient. In fact, I just heard it this morning as I met a patient on the street and he complained of this also. Food impaction in the mouth is a result of spaces between our teeth. So before we talk about whether or not catching food is a concern, let’s discuss spacing in between teeth.
Our teeth work best when they are all neatly in a row.
In an ideal world, every tooth in your mouth would be lined up like little soldiers in a row. Each one next to its neighbor with no overlapping or crowding. They should touch each other in a firm way. Not too much pressure and not too little pressure. The reason that this arrangement is ideal as a self-protection mechanism. Let me explain.
The main purpose of our teeth, aside from flashing a dazzling smile, is to chew and properly break up food for digestion. The digestive process begins in the mouth with tearing, grinding and chemical breakdown via our saliva. Not all foods are cooperative and simply go down our esophagus. When the teeth are all aligned and touching each other they create a path for the food to actually slide off into our cheeks and not stay on our teeth. This helps to break down the food further as it can be brought back around and chewed a second or third time. All of this makes the food easier to swallow and reduces the work that your stomach has to do. Teeth are protecting themselves when they touch, as food does not get stuck on them. Proper alignment of your teeth is really a self-preservation tool for them.
Different types of spaces require different types of solutions.
Now, let’s return to the issues caused by spaces. In our not so perfect world, people can develop spaces between our teeth. Sometimes we lose a tooth and have a big space. Other times we have a cavity and develop a small space. Last, but not least, our teeth may drift or move a little creating a tiny space.
Okay, so what does all that mean. If we lose a tooth and have a large space, we all know that we have to fill the space and replace the tooth. If not, nasty things can happen to the teeth around the space and even in other areas of the mouth. Our second “space” example is when we develop decay in between teeth. These spaces will become painful as the cavity progresses and can really destroy a tooth. This pain will drive us to get the cavity remedied before it goes too far. Typically a filling will take care of this issue.
The most dangerous spaces are those that occur as teeth shift and drift. These tiny spaces become a place for food impaction. Food gets stuck in between these little spaces and sits against the tooth and gum for long periods of time. The food attracts bacteria. These bacteria then feed on the food and produce acid. This acid is what causes a tooth to decay. Many times this decay, or cavity as it is often referred to, will progress unbeknown to anyone. It shows up under the gum and moves into the tooth. All of sudden we have a toothache and are looking at a root canal or complete tooth removal. Not only do spaces prevent our mouth from working at optimum efficiency in the digestive department, but the spaces are a cause for a lot of dental work and pain – hence the patient complaints.
When it comes to spaces between our teeth, even regular brushing and flossing are not enough.
Some patients believe that they can keep these tiny spaces clean. This is very difficult to do and a challenge, even for the most meticulous of patients who brush properly and floss thoroughly as recommended. We usually can not see the food particles that are caught between our teeth as they are wedged very low on the tooth near the gum. To see this in one’s own mouth is nearly impossible. This is why a dentist is needed to close these spaces between our teeth properly. There are a variety of ways to do this and each situation is different.
So the next time you become aware of these spaces or the dentist asks you if you ever notice food packing in a certain place, your radar should go off and inquire as to how the issue can be remedied. If you notice one of these areas that were not a problem before, give me a call and I will do my best to suggest a treatment for you. Patients can reach me at 440-951-7856 and I look forward to talking to you about this or any other dental concerns you may have.
The Crown Holding My Partial Fell Out. Can You Please Make A New One?
Crown replacement is another common request that I hear in my office. It can be necessary when one of the anchor teeth that helps hold a partial or removable bridge (as it is often called) falls out. Either a tooth cracks or a crown that has been there for years has come off and no longer fits. This tooth or crown allows the partial to fit over it with a complex array of metal or non-metal arms. These arms, which we call ‘clasps’, allow the removable teeth to be stable in the mouth. It and a few of its friends that look similar create a steady base that allows functional movements and speech. These functional movements we shall call chewing. Without the tooth or crown, and the clasps on top and around it, the removable bridge would flop all over the mouth.
Once Upon A Time, Reverse Engineering Teeth to Fit Inside Crowns Was Nearly Impossible.
Unfortunately, crown replacement is not always that simple. I would like to illustrate it with a story from my years in dental school. When in school everything moves along at a snail’s pace. That’s okay, as the students are learning new skills and practicing to create a perfect result. Let me tell you about what happened in my second year, to one of my classmates. We were in our dental lab working on plastic teeth in a model of the mouth. We were making crowns and bridges as a full term project. We worked on this for weeks and months. Long hours both during and after school were invested by all of us. After all, this single project accounted for 70% of our grade. The night before the project was due, many of us were working in the lab and putting the final touches on our work. I noticed one fellow in particular who was not very happy. He was in his work area, laboring diligently with a notable frown on his face. I went over to him to find out what was wrong. He promptly showed me his finished work. It looked great. I congratulated him and asked him as to why he appeared to be upset. He proceeded to tell me that he although he has his project, he could not find the plastic model of the teeth upon which he made the project. It was lost! He has to work backward! He was attempting to shape the teeth to fit inside the crowns. The key to our grading was the fit of the project on the plastic teeth.
Modern Dental Technology & Techniques to the Rescue
Under normal circumstances, we take an impression of a natural tooth or a crown and then make the partial denture over the tooth. When the patient walks in the door with a partial and the supporting tooth underneath is compromised through breaking or falling off, we, just like my dental student friend, have to work backward. This is beyond difficult as we need to make the underneath tooth fit inside the partial denture. In truth, in the past, there were a variety of techniques to accomplish this but they were really hit or miss. Finally, after years of struggling, computers, scanners and advancements in dental technologies have come to the rescue. I can now take an impression of the original tooth and use this to create a scan which can be superimposed to create an exact copy of what was there. This exact duplication of the way the tooth was allows me to make a replacement crown that will fit into and under the partial that is already there. I can not tell you what a cost and time saver this is for everyone involved. The patient does need to have their removable bridge replaced and can return to normal life in just a couple of appointments.
This is just another way where modern dental techniques have turned a nightmare of the past into a very predictable and affordable procedure in the present. Do you have an issue with a tooth or teeth, which you think that there is no solution? Please call me and run the predicament by me. You never know what simple solution that I may have to suggest. I can be reached at 440-951-7856 and I look forward to hearing from you.
Since I deal with dental infections on a daily basis, I need various tools to help deal with these potentially life threatening issues. That’s right, life threatening. Before there were antibiotics, which was not that long ago, people died from oral infections and abscessed teeth. The infection got into their bloodstream and spread throughout their body. If it reached the heart or the lungs, it could trigger events which were fatal. Even not hitting those organs could create a condition of sepsis in the body that led to the patient’s demise. With modern medicine, there are very few infections which will not respond to antibiotics. This is very helpful in dentistry as we can alleviate pain and swelling with the use of a pill. Because teeth are so unique, we often times require some other intervention as the antibiotic alone will not do the job.
All of that being said, our most common antibiotic will be penicillin and it’s cousins, such as Amoxicillin and Augmentin. These work best on those bacteria that cause dental infections. Many of my patients say that they are allergic to penicillin and I need to go another route and avoid the penicillin. Many times, when I question the patient, it appears that they do not have a real allergic reaction, which in itself can be very serious.
The percentage of people who report allergies is thought to be far, far higher than the percentage who actually have allergies. There are many authentic signs to watch for, however, including…
Swollen lips, tongue or face
Some people wrongly believe they are allergic because they attributed their symptoms to the wrong source. Many conditions can produce the symptoms listed above, but that doesn’t mean that an allergy is present. Side effects of medicines can also be remarkably similar to allergy symptoms.
Even in cases where you are truly allergic, for the vast majority of people this will go away as the years go by. I am now advising all of my patients who state that they are allergic to penicillin to see an allergist and get skin tested. It is easy and simple to do. Most of my patients come back extremely grateful to find out that they are negative to the allergy test. This is really crucial in oral infections. You are now able to get the most appropriate and efficient drug for your problem.
End of the year cleanings and exams are filling up fast. When you come in for your cleaning and checkup, let’s review your current medications and make sure that it is accurate. Being precise in these areas can make a huge impact when we prescribe a course of treatment for you. Lastly, we just finished Veteran’s day. From now till the end of November, we are offering free exams and x-rays to all of those who fought for our country and helped preserve our freedom. We are also offering special reductions on teeth cleaning. Call me at 440.951.7856 to schedule your visit.
In the real estate world, there is a saying to guide those who wish to be successful. When asked what are the three most important things in selling or purchasing real estate, the answer given is, “Location, Location, and Location”. A similar thought appears in the health field. If you want find the three top secrets to good health, the answer is “Lifestyle, Lifestyle and Lifestyle. Choose the proper lifestyle and you will not fall prey to many of the diseases that plague us in our time. Those of you who follow me regularly and/or are patients of mine know how much emphasis that I place on life style. A new study just appeared which showed that brushing teeth thoroughly to remove plaque could help prevent heart attacks and strokes by reducing inflammation in the body to levels close to what can be achieved by statins.
I have written a number of times how the studies have shown that people with diseased gums are also more likely to suffer heart disease but it had never been shown that good dental health could lower the risk. This new study used a special toothpaste to remove plaque, the sticky bacterial buildup from teeth. Researchers found that people using the special toothpaste were able to remove twice as much plaque than those using a normal toothpaste and their levels of inflammation also fell by 29 per cent. Statins lower inflammation by around 37 per cent. The lead author of the study is the same one, Professor Hennekens, who discovered the benefit of aspirin in the 1990’s.
He commented, “I think this could have policy implications for tens of millions of people alongside statins, aspirin, and beta blockers and other agents that help lower cardiovascular disease.” That is a huge statement. Benefits are unlimited and side effects are almost non-existent.
“We want to try this out on bigger numbers of people with heart disease so we can see if it is actually able to prevent heart attacks and strokes. So this is a jumping off point, but it’s an important result,” said Professor Hennekens Leaving plaque on teeth creates a state of inflammation. Studies have shown that chronic inflammation may fan the fires of heart disease. Now we have our first evidence that removing the source of inflammation is beneficial not only for the mouth, but for our cardiovascular system as well.
But even with the best brushing techniques, there are a number of areas that are very hard to keep clean. Old fillings that are rough, broken or chipped teeth, and spaces that may develop between your teeth are sources of chronic inflammation. These areas should be smoothed, fixed or replaced to create an environment that is less conducive to bacterial and plaque accumulation. Modern bonding techniques and newer tooth replacement techniques all have this goal in mind.
Of course, the step before brushing is to eat those foods that leave behind the least amount of residue. Staying away from those types of foods, make our brushing easier. With Halloween approaching let’s keep this in mind. If you are going to indulge yourself, I recommend doing it all at one time rather than grazing the entire day on junk food. We come full circle to lifestyle. Good nutrition and proper hygiene will go along way for you. Are you overdue for your cleaning? Give us a call and reboot your mouth back to a state of cleanliness and renewed health. I can be reached at 440.951.7856
This statement was made to me this week. The situation was the following: social event in a couple of weeks; black spot on a crowded and turned front tooth. Part of the patient was saying, “I want to look good at this affair. Part of the patient was asking, “Will I look worse? Will the fix fall off?
Before we deal with those issues, let’s discuss why we do anything that is temporary. After all, the patient is sitting in the office. Let’s just fix the problem permanently and be done with it. As a rule, anything that it involves lab work usually can not be done in one visit. The reason is simple. The technology and the process to make something for you can not be performed in your mouth. Whether the technology is old or new, the making or “manufacturing”, if you will, of a replacement part needs fast moving components or high heat which precludes the process from happening inside your mouth. What we do is make a copy of your tooth after we have shaped or adjusted it and send this copy to a lab. They then have a duplicate of your tooth or mouth and can make something that is designed to fit your mouth and situation.
This two appointment process will leave your tooth in limbo. It has been shaped and modified and you may not like the way it looks or feels in this intermediary stage. This is where temporization comes into play. We make something right in the office to cover, protect and make the tooth or teeth look natural. There are many ways to do this and many material to do perform this step. Recently, we have moved to a new material which not only looks great but fits very well. I can make it for you very quickly and oftentimes you will leave the office looking better than when you entered. This is true depsite the fact that you do not have the permanent fix as of yet.
The patient who asked this question, needed a crown (cap) and was concerned about the interim crown falling off. Our newest technique has demonstrated great retention by the tooth. The need to re-cement an interim crown has decreased by a great deal. They fit very well and the only reason that they become loose is the fact that I use a light glue so that I can remove it easily for the final tooth. So falling off is typically not an issue.
In terms of cosmetics, I can alter the position and size of your tooth to create a much more pleasing appearance. Dark stain, spots or other discolorations are gone. If the tooth had a silver filling, your temporary will eliminate all of that. So, except for hardness and durability, the temporary has solved all of your immediate needs.
In our patient, who expressed concern, not only did I get rid of a cavity and black spot on the front tooth, but I also turned the tooth and created instant orthodontics for her. She was so happy and confidnent that her affair would go off without a hitch. Her tooth looked good, free of spots, and turned to create a pleasing cosmetic result.
The lesson to learn from this is to never assume that something can’t be done in an efficient and expeditious manner. You don’t have to walk around with broken, discolored, or unsightly teeth. They can be fixed faster than you may expect. Do you have a tooth that concerns you? Call me at 440.951.7856 and we can discuss it.
Well that’s really not a question. It’s more of a statement of a finding. The hidden implication is that something is not right. Those of you who know me can anticipate my response. Your fingers should not be in your mouth. It’s okay for me to put my fingers in your mouth, but not for you. Except for brushing and flossing, fingers in the mouth invariably lead to trouble. However, now that the subject is brought up, let’s spend a little bit of time discussing it.
Those areas on the outside of your teeth which develop craters or fingernail catches develop in a couple of ways. Cavities or decay is usually not one of them. Areas of decay are composed of slowly breaking down tooth structure that is being destroyed by the acid from bacteria in plaque. This plaque sticks to your teeth and causes decay or rotting of the tooth.. The decay doesn’t usually turn into hard and sharp catches for your fingernail. So a cavity is usually not the cause.
The areas that this patient referred to are usually caused by overzealous brushing or excessive tooth wear. Let’s spend some time with both of these. In sports certain injuries are called “overuse injuries”. It usually refers to too much of one motion or movement that wears out a certain body part. Baseball pitchers can wear out their shoulders if pitching too long or too often without proper rest. The same thing can happen in your mouth with either the wrong type of tooth brush or too much pressure. The outer surface of the tooth in the area near the gum is very thin. It is very easy to wear this away and then get into the inner layer of the tooth. This is much softer and these concave area or craters develop. As long as you continue to abuse the area, the greater will be the destruction. I had one patient who was so aggressive that he destroyed his tooth all the way down to the nerve. This caused him tremendous pain just by breathing in air and he required a root canal treatment to alleviate his pain
The other cause for these “catches” on the outer surface of the tooth is grinding. The force of grinding causes the outer surface to fracture. I just saw a patient yesterday, who grinds ice in his mouth. We commonly call this, “chewing on ice”. Even though one could thing of this as harmless eating as there is no sugar or chemicals in the ice. However the cold and pressure of purposeless ice chewing ends up with fractures along the gum line. He had 13 such fractures along his gum line.
The fix for both of these causes is rather easy. In the past, we had to drill large holes to fill this defect and prevent you from further destroying tooth structure resulting in fracture or root canal treatment was we pointed out above. With newer techniques we no longer have to drill large holes and even get you numb. We can use bonding to adhere the material. We can do 3-4 teeth, if needed, at once without even using local anesthetic. The result is quick and you can get back to your life without a numb mouth. Bonding is one of my favorite techniques as it is usually simple and non-invasive. I routinely do in office veneers as or cosmetic corrections as well, as fix damaged teeth in them form our “overuse injury”. This exciting technology allows us to solve many problems that were so difficult to treat in the pre-bonding era. If you see some area of your mouth that has changed and are curious as to what it if, please call me at 440.951.7856 and we can discuss it. Many times the fix is really easy, simple and pain free.
I recently read a book called The Blue Zones. It describes those habits, eating and lifestyle, that allow us to live the longest lives with the best quality. Check out their website her https://www.bluezones.com/ and purchase or pick up their book. It is really and eye-opener.
Nutrition is so important to our general health and this extends to our dental health as well. I have written quite a bit about the oral and full body relationship. I have found a great website with a tremendous amount of good nutrition information. Best of all, the doctor who is responsible for its content is a local doctor, Dr. David Gutman. Click here to visit the site and improve your total body health
I heard this complaint a couple of weeks ago. I also heard yesterday “ I have a tooth ache on both the bottom and top. I can’t pick which tooth is hurting me.” And last and not least, “whenever I chew I get a pain up to my ear”. Believe it or not all of these statements are really related and are rooted in the same source. When I examined all of these patients, there was nothing that was obviously wrong either visibly or on an x-ray. Yes, all of these problems and issues stem from a biting problem or a misalignment of the teeth. Those who follow me regularly know my mantra when it comes to teeth and biting. You need to keep you teeth apart and your lips together when you are not eating. Teeth only are meant to come together when we eat, not at any other time. This is one reason why gum chewing is so bad for you. Your teeth clash in a meaningless action. Chewing food is meaningful, gum chewing is meaningless. In addition to gum chewing, grinding or clenching does not have any purpose. Your teeth meet and press on each other. These actions of clenching or grinding have far reaching consequences.
First of all those actions or habits, put continual pressure on your teeth. According to Dental Health Directory Library, the human jaw is capable of applying approximately about 68 lbs/sq inch of pressure on the back teeth. If you intentionally clench your teeth you may increase that force to about 150 lbs/sq inch. However, an individual who clenches and grinds their teeth subconsciously at night can place up 1200 lbs/sq inch of force. Teeth were never meant to have continual pressure. The act of chewing applies forces, then lets up, and then re-applies these pressure. These forces far exceed what a tooth is capable of withstanding. The result can be a fractured tooth, a loose tooth, or a tooth that requires a root canal as the nerves and blood vessels inside the tooth are irreversibly damaged. Many of the crowns that I make for teeth are done on fractured teeth. These teeth fracture due to excessive forces. Oftentimes these harmful habits are the culprit.
In addition to the tremendous forces that are exerted on the teeth, there are forces that apply to the teeth, the jaw bone also is a recipient of these forces. The lower jaw transmits its trauma resulting from excessive forces to the muscles and ligaments that attach the lower jaw to the head. These delicate structures all come together right in front of the ear. This intersection of jaws and soft tissue is called the temperomandibular joint. We call it TMJ for short. Those three letters are mentioned a lot when people have non-descript jaw pain. It is not sinus, it is not tooth related, it is joint inflammation caused by inappropriate biting forces applied.
So what is the cause of these forces that wreak havoc in our mouths? Sometimes it is stress in our lives. This can be family or job related. Some people get ulcers, other people pull their nails, and others clench or grind. Let me take a moment to say that it doesn’t matter if you are a clencher or grinder or both. These actions are all bad for you. So one solution is too eliminate the stress in one’s life and the clenching, etc gets better. Many times that is easier said than done. Some of these oral actions become ingrained habits that are hard or difficult to break. This is where, the dentist steps in and makes a custom fitted mouth appliance to either help you break the habit or protect your teeth from the damage that will happen. There are many styles and shapes of these devices. A professional needs to assess you, make recommendations and fit you properly. As a patient told me last week, “ I was so skeptical of you grinding hypothesis. Now that I am wearing a device, I feel great and everything is comfortable. You have made a true believer out of me”. Our initial patient with the wrong root canal complaint, was actually grinding with a denture on her natural teeth. We see from this that although dentures can not create the same amount of forces as natural teeth, in the right situation, they can wreak havoc. So if you find that you have teeth breaking, fillings are always falling out, crowns are popping loose too frequently, or a toothache that you can’t pinpoint the tooth, give me a call at 440.951.7856. Together we can play detective and work on figuring out the problem. You only have one set of teeth, let’s do all that we can to take care of them.