Center for Facial & Oral Surgery. P.A. @facialoralsurgery - Tumblr Blog

Wisdom Teeth: The Tooth, the Whole Tooth, and Nothing But the Tooth?

The removal of wisdom teeth is now recognized as a necessity for the vast majority of the population. It is also widely known that their removal in the mid-teenage years enables the quickest patient recovery while minimizing the potential risks associated with wisdom tooth removal.

One of the risks of wisdom tooth removal is inadvertent bruising or damage to the nerve underling the lower wisdom teeth, the inferior alveolar nerve. Wisdom teeth tend to be the lower teeth that are located the closest to this nerve, which is a purely sensory nerve. It does not move any facial muscles, but it does provide feeling to both sides of the lower lip and chin, the lower gingival (gums) and teeth,

and there is a nearby nerve on each side that provides sensation and taste to each side of the tongue.

When Oral Surgeons remove wisdom teeth, this risk of this occurring is rare, especially if the patient is in their teenage years before roots have grown to their full length and extend closer to the nerve. Often, however, we find ourselves having to remove wisdom teeth on older adults, either due to dental decay or dental cysts and tumors that form around the clinical crown (top) of a tooth that has never erupted (is impacted). In these cases the roots are fully formed and may be in proximity to or engaged in the nerve. What is one to do in these cases to be able to treat the pathology without damaging the nerve?

In recent years, a good body of research has shown that in many instances, the problematic “top” of the tooth can be removed while leaving behind the portion of the roots that may be close to the nerve, thus minimizing any risk to the nerve. Will this cause problems? Surprisingly, patients report no more discomfort than if the entire tooth were removed. As for the roots left behind, more often than not, bone fills in over the top of them and the socket heals normally. On rare occasion a minor infection might occur at the site, which generally can easily be treated with antibiotics, but the incidence of infections at these sites is no greater than if the tooth were removed in its entirety. The only other occurrence that has been reported is that the roots left behind might begin migrating towards the surface over time. This is actually a benefit because as they migrate upwards, they move away from the nerve and can then be removed easily and safely.

Essentially, there are cases where the incomplete removal of a tooth is the preferred treatment and the removal of the whole tooth is actually not in a patient’s best interest.

The True Hidden Gems in Dallas/Fort Worth Outings

Having an adventure to uncover something new in your own city can open up avenues to learning and of great revelry; however, sometimes it feels like you can’t think of anywhere new to go.

Sure, the Stockyards are a classic, or the zoo always brings a smile to your face—but what about those little hole-the-the-wall treasures that leave you wanting to come right back for more? These places aren’t the latest and greatest, but they are unique and draw you in.

Follow along as we being to unpack these hidden gems in Fort Worth. And let us know what we missed!

Food

We live in a culinary kaleidoscope with cultures and cuisines mixing to create mouth-watering dishes. Not only are there the big-name restaurants, but one of the best aspects of the area around our Carrollton office are those small, family run establishments. For instance, Jesus BBQ is known for their diverse menu options including their infamous chicken-fried steaks. This family-owned restaurant was opened in 1970 and still features a juke box.

If you’re looking for good eats, but want to skip the wait, head north to Saginaw to eat authentic Mexican food from the Taqueria Albertos. While your mother might have told you to never take food from a strange truck, don’t let that dissuade you from trying these tacos! Parked in a gas station parking lot, customers line up at all hours of the day to eat breakfast tacos, quesadillas, and burritos. Everything is made to order, so bring your appetite!

Activities

Take your grocery shopping outdoors with a visit to Storm Farms in Dalworthington Gardens. Here you can pick your own strawberries in the spring, and pumpkins in the falls. Escaping to the farm is a good way to soak in the country air and leave the hustle and bustle behind.

If you’re looking for a slice of New York mixed with a secret venue filled with great Jazz, then the Scat Jazz Lounge is the perfect hidden gem for you. Featuring both local and nationally-renowned artists, this club is centrally located off Sundance Square in the basement of the Woolworth building. This adults-only club is great for a date out on the town.

Culture

We all love the big, famous art museums that host famous works from artists through history. However, if you’re looking for something more organic and local, check out the Race Street murals at the intersection of N. Retta and Race Street. These murals range from exotic to creative all the way to thought-provoking. Bring your camera, because this is a site you will not want to miss out on or forget about later.

Local artist J.C. Pace III is known for his original statues. Most recently, his art has taken then form of bronze avocados spread out around town. In addition to his years featuring these and other pieces, the Neiman Marcus in downtown Fort Worth has also commissioned several pieces. Disclaimer: viewing this art may cause you to crave some fresh guacamole!

We live in an adventurer’s playground here in North Texas. With so much to see, there’s always something new to discover. If you find a local hidden gem, leave us a comment so we can check it out, too!

A New Year…A Time to Reflect

As we leave another year behind, whatever trials may have been endured, we (Jeff and I) always feel grateful for the time that we have had to experience personal growth and to spend with our families. And as we enter a new year, we are always excited and at the same time a little apprehensive about what the coming months will bring. Each New Year brings its own challenges along with its own opportunities and rewards. Among the opportunities that we are anticipating this year is the chance to continue to provide the highest quality patient treatment that we are able and to continue to educate ourselves so as to be able to further improve that quality. I think it can become easy sometimes as we settle in to our day-to-day routines to fail to appreciate what a privilege it is to treat patients and to forget what a difference that we make in the quality of their lives. We are privileged to be able to manipulate tissue, whether that be enamel, gingiva, mucosa, skin, or bone with the consent of our patients, and to do so legally. As one of our surgical mentors pointed out some years ago, making and incision on another human being (or preparing a tooth) is a rare privilege and in any other setting would be considered an assault, but patients entrust their care to us and give us their consent to do just that.

Another opportunity that we anticipate is to be able to continue to work closely with those of you with whom we have developed not only superior professional relationships but also warm friendships, and the chance to work more closely this year with those of you with whom we have not worked as much in order to develop similar relationships and friendships. Certainly through the years, association with the many dental offices in this area has been one of the great blessings of our lives.

We hope each of you never underestimate or under appreciate what a blessing you are in people’s lives in providing the skilled care that you deliver. The dental community has truly been well served by each and every one of you. With that in mind, let us go forward together in rendering our services to the community at large, and may we all enjoy a Happy, Healthy, and Prosperous 2018.

A Heartfelt Message of Gratitude

As Dr. Dombrowski and I take stock of this past year, we each have to give thanks for feeling remarkably blessed. Certainly, the year has not been without its challenges; that comes part and parcel with this mortal experience, but the challenges have been met and either accommodated or overcome. Truly every day that we have the opportunity to draw breath is a blessing.

Among our greatest blessings are each of the dentists and doctors and their teams with whom we work and who have consistently entrusted us with the care of their patients, families and loved ones. Our relationships with you, some spanning over 20 years and some more recent, have provided us a tremendous amount of joy and satisfaction, and we thank you for your continued association and friendship.

And we of course would be grossly remiss if we failed to acknowledge how fortunate we have been to treat so many wonderful patients from this and surrounding communities. The patients we have seen have been varied and diverse and uniformly remarkable, and we truly love the opportunities that we have had to build relationships with them and their families through the years.

So as we close out 2017 and enter 2018, we simply want to say a heartfelt “Thank You” to all of you, our “extended family”, and to wish each and every one of you and your loved ones a joyous Holiday Season and a happy, healthy, and prosperous New Year!

Your Health and Your Teeth: More Closely Related Than You Might Think!

It is not uncommon—in fact it is the norm—that people see their primary care physician for their annual health checkups, and they see their dentist to get their teeth cleaned and to have any needed dental restorations performed. What most don’t realize is how much the health of their oral cavity can affect their overall health.

Did you know that roughly 25 years ago, researchers discovered that the bacteria that caused periodontal (gum) disease were able to enter the bloodstream and cause heart disease? Since that time, researchers have found that periodontal bacteria make the control of blood sugar in diabetics more difficult and can even be a factor in causing Type II diabetes. These bacteria have also been linked to premature and lower birth weight infants in women of child bearing age. Additionally, they have been shown to increase the risk of stroke and there has even been an association found between these bacteria and the development of pancreatic cancer.

One tooth in particular that is especially hard to keep clean if it erupts into the mouth is a patient’s wisdom tooth. Located in the far reaches of the back of the mouth, these are very difficult to access to brush and floss properly, leaving them especially predisposed to periodontal disease. In fact, landmark research by White, et al has shown that virtually all erupted wisdom teeth meet criteria for some degree of periodontal disease. Given these findings, dentists are now more conscientious about recommending removal of wisdom teeth for almost all patients, the safest and simplest time to do that being during their teenage years.

It is now becoming apparent that even small localized infections can negatively influence overall health, and one of the prime culprits in these “focal” infections is periodontal disease and periodontally diseased wisdom teeth. It appears that these bacteria enter the bloodstream and create inflammation in the walls of the blood vessels and the organs they serve. If a person is genetically or environmentally predisposed to many diseases, these bacteria appear to “light the fuse” to the process.

Best Road Trips to take in Texas This Fall

Is the hint of fall bringing out your inner wanderlust and calling you to adventure? The great thing about living in Texas is that vacation spots are as diverse as the landscapes. From feeding your inner-city slicker to letting the nature-lover in you run free, there are great vacation spots a short distance away, from anywhere in the state. Pull out your calendar, because these locations are begging to be visited this fall!

Hill Country Wineries

The scenery draws you in, but the wine entices you to stay. The Texas wine county, including local vineyards like the Spirit of Texas Winery in Early, TX, is a gem featuring winding rivers and towns laced with German heritage. While wine is popular, BBQ is still king in Texas. Check out local hotspot Cooper’s Old Time Pit Bar-B-Que for a truly mouthwatering experience. To work off the food, take a walk through the endless pastures and pop into watering holes to experience local music and Texas hospitality.

Perfect day to go out and Discover some Texas Wines! #GOTEXAN #Texaswine #TexasWineMonth #October #TXWine #DiscoverTexasWines #columbusday2017 #columbusday

A post shared by Spirit of Texas Winery (@sotwines) on Oct 9, 2017 at 9:28am PDT

Keep Austin Weird

Our neighbor-city to the south, Austin, is a great weekend getaway to feed your inner foodie, music-lover, and really anything else you might desire. Austin is full of adventure, with hikes through Zilker Park that will take you by the picturesque Lady Bird Lake. If you’re looking for an out-of-the-ordinary adventure, head to the Cathedral of Junk. Located in the Bouldin Creek neighborhood, a three-story structure made out of more than 60 tons of recycled materials has risen up. This is one spot that would only be found in Austin!

It’s Friday y’all get yourself some of this!!

Creamed corn with bacon & chipotle is back on the menu starting today. p: @sangydpham21

A post shared by KerlinBBQ (@kerlinbbq) on Oct 27, 2017 at 9:41am PDT

Go West, Young Man

The flat landscape of the metroplex may cause you to forget Texas is one of the best places to hike. Head west to hotspots such as Big Bend National Park or the Balcones Canyonlands National Refuge to soak up the landscapes. Big Bend National Park is commonly rated as a favorite spot for hikers. With trails for both the experienced hiker and the day-trip enthusiast, there will be something for everyone to enjoy.

Location, location, location! J. O. Langford bought the land surrounding the hot springs sight-unseen in 1909. With much help from Cleofas Natividad, the Mexican man who had been farming this land with his family, Langford built his home on this bluff overlooking the river. “It was high,” he describes, “with everything open to the south, so that we had a wonderful view of the Rio Grande canyon below, and would catch every breeze that came across the mountains in Mexico during the summer.” Follow the Hot Springs Historic Trail to take in the view Langford and his family woke up to every morning. #history #bigbend #hotsprings

A post shared by Big Bend National Park (@bigbendnps) on Sep 10, 2017 at 11:43am PDT

Cadillac Ranch

If adventure is calling you westward, make sure to check out Cadillac Ranch in Amarillo. This gigantic public art installation features dozens of old Cadillacs half-buried in the desert sand. The cars have been spray painted by visitors, and offer a truly unique backdrop in the Texas flatlands. Spray painting is encouraged, so make sure to bring supplies to leave you mark on these ever-changing pieces of art.

Back at the ranch. . . . . #cadillacranch #amarillo #texas #cadillac #route66

A post shared by Maxwell Senteney (@sadmaxsenteney) on Oct 26, 2017 at 3:33pm PDT

Waco

Thanks to Chip and Joanna Gains, Waco has put itself back on the map. Head down I-35 to experience the new Fixer Upper headquarters: the Silos. Filled with eclectic home furnishings and a hub for food trucks you can easily leave here with an empty wallet, but a happy heart. In addition, stop by local favorites such as Health Camp and Common Grounds to find some of the best milkshakes and coffee this side of the Brazos. If you happen to end up in Waco during a Baylor home football game, make sure to check out the brand new, state-of-the-art stadium. No tickets? No problem. See if you can join folks on their boat for sail-gating right outside the stadium.

What a great crowd at Brazos Nights! About to enjoy some Old 97’s! Gorgeous evening in downtown! #wacotx #brazosnights #explorewaco

A post shared by City of Waco, Texas (@cityofwaco) on Jun 10, 2016 at 6:09pm PDT

Fall is a great time in Texas marked by a reprieve from the excessive heat. Take this time to explore all that Texas has to offer!

CONUS vs. All-on-4®: What’s The Difference?

For patients who have lost all of their teeth or require the removal of the remainder of their teeth, a variety of full-mouth tooth replacement options exist. Among these options are the All-on-4® concept and the CONUS option. There are advantages and considerations for each that bear review and understanding before a choice is made on one over the other.

All-on-4® is a technique that involves the removal of all of the remaining teeth and the placement of 4 dental implants in each jaw. If the implants are able to be inserted tightly into the bone, the possibility of placing and securing a nice temporary set of teeth onto the implants exists. In these instances, the patient can leave the office having received “Teeth-In-A-Day”®. Approximately 3-4 months later, a final definitive set of teeth is made to replace the temporary set of teeth. While this can frequently be accomplished, often the implants cannot be placed tightly enough, or even at all, if bone is deficient or soft in one or more areas of the jaw. In this case, the patient receives conventional dentures to use until implants are ready for teeth to be added to them. The advantages of this technique also mirror its disadvantages. The teeth are fixed to the implants and cannot be removed by the patient. Typically, the patient sees their dentist 2-4 times per year and the dentist removes the prosthetic set of teeth and cleans them. As the teeth are secured in the mouth, it is difficult, if not impossible, for the patient to clean effectively under the prosthetic set of teeth and around the implants. As many of these patients lost their natural teeth due to bone loss (periodontal disease) and remain susceptible to it, the difficulty for them cleaning around the implants can lead to similar bone loss and implant failure.

By contrast, CONUS is a technique that involves the removal of all of the remaining teeth and the placement of the same number of implants per arch (4). In this technique, however, the implants are not “loaded” immediately (ie, no non-removable prosthetic teeth are placed at that time), but the patient does leave with their smile intact with a nice set of custom temporary dentures. 8-12 weeks later the doctor checks to see if the implants are ready for the final prosthetic teeth, and if so, the patient is referred to their dentist to fabricate them. The other difference from “All-on-4”® is that while these teeth fit tightly to the implants and are designed to be worn 24/7, they can be removed by the patient and cleaned periodically. Thus, patients have all the advantages of teeth that “stay in” as well as the advantages of being able to clean them frequently and more easily on their own between dental visits.

Both of these techniques have their places, and we provide both of them based on the needs and desires of that particular patient, but more and more, CONUS is being selected as the preferred option by our patients. If you have a need for replacement of your teeth, please feel free to contact either Dr. Nail or Dombrowski for an office visit to review your tooth replacement options.

“Teeth In A Day”®: Too Good To Be True?

Most of us have heard of dental implants and “teeth in a day”, but what does this phrase mean? What is the concept, and what is it not?

Well, firstly, “Teeth In A Day”® on dental implants most often refers to placing temporary teeth on either one or two dental implants, usually in the front of the mouth (the teeth that make up your smile) or the replacement of all missing teeth in either the upper, lower, or both jaws on a number of dental implants. Assuming that certain conditions are met, these teeth are attached to the implants that day, with the understanding that they are made of temporary materials and will have to be replaced with the final restorations 3-6 months later.

One of the common misconceptions is that teeth delivered in a day means that the patient can chew foods that day. In reality, these temporary teeth are placed “just for show”, and the patient must consume a very soft non-chew diet for 8-12 weeks minimum. Chewing too early on the temporary “immediate” teeth can cause the implants to become loose and fail.

Another misconception is that everyone is a candidate for “Teeth In A Day”®. In reality, a number of criteria must be met for this to be accomplished, including, but not limited to the following:

The implants placed must all be placed in bone that is solid enough that they can be inserted with a pre-determined amount of torque (tightness), or they cannot have immediate teeth placed onto them. This can only be determined at the time of surgery.

There must be enough intact healthy bone present in the desired locations to place the implants. Often, implants are placed at the time that diseased teeth are removed. In many of these situations, due to the disease associated with the bad teeth, the bone supporting them is found to be deficient or absent, and bone grafting must be accomplished and new bone formed before dental implants can be placed.

Generally, the patient cannot be someone who habitually grinds their teeth or who has a bite that would make it impossible for that patient to avoid biting on or hitting an immediately placed temporary tooth.

Other contraindications to consider can include patients who are heavy smokers or who are on medications that interfere with bone healing (for example, bone sparing agents, high dose steroids, etc).

Generally, in treatment planning for patients who might be able to receive their implant teeth that day, a “back up plan” is also prepared, in case the teeth cannot be attached to the implants that day. For single tooth implants, this is generally a temporary removable partial denture (basically a dental retainer that includes a tooth to replace the missing tooth), or in the case of complete removal of teeth, a conventional complete denture. These are worn for the requisite 8-12 weeks, and then the implants are cleared to be definitively restored.

When all criteria are met, however, placing temporary teeth on implants on the same day that the implants are placed can be a wonderful treatment option, allowing the patient to leave their treatment with their smile completely intact. If you are missing a tooth or teeth, or if you need teeth removed and desire to see if you would be a candidate for an instant smile, contact Dr. Nail or Dr. Dombrowski today for an office visit and an assessment. Working together with you, we want to give you the best smile and chewing function possible.

Preparing for Wisdom Tooth Removal

While the removal of teeth in general can be relatively simple, the removal of wisdom teeth requires a higher degree of skill. Due to a lack of space for these teeth in the jaw, they are often impacted (stuck) requiring that they be removed surgically. Even when these teeth are erupted into the mouth, lower wisdom tooth proximity to nerves and upper wisdom tooth proximity to sinuses can make their removal anything but routine. Additionally, these particular teeth are only about a half inch in front of your tonsils. As tooth removal goes, the removal of wisdom teeth is typically the most demanding and therefore requires a higher level of expertise, and they are generally most comfortably removed under a monitored intravenous sedation.

When you come to the Center for Facial and Oral Surgery, you will have the benefit of doctors who not only have dental degrees but are also state licensed physicians. Both Doctors Nail and Dombrowski are also Board Certified by the American Board of Oral and Maxillofacial Surgery, and between them they have over 40 years of experience in this field. While patients may be understandably anxious at having to discuss their wisdom teeth, a consultation with our doctors is sure to put you at ease, as they explain how they will comfortably take care of you on the day of your procedure. The doctors’ expertise in surgical and monitored intravenous sedative techniques are designed to give you the least stressful tooth removal experience, the best opportunity for healing without complications, and the quickest recovery possible.

Before the surgery

Especially in cases where wisdom teeth have only partially erupted, and/or are impacted, you might feel pain or swelling as they try to erupt into a jaw that is already full of teeth. While a majority of patients today do ultimately get wisdom teeth removed (as many as 85%), those with particularly bothersome pain during their eruption are the most likely to need their emergency removal.

A key resource leading up to your procedure will be your surgeon. The questions you might have will be addressed fully by our doctors (as well as questions that you might not have thought to ask). Typical questions include, “Why do I need my wisdom teeth removed?”, “What does the procedure involve?”, “What is the recovery like?”, and “When will I be able to eat normal foods?”

Your surgeon will also have specific instructions for pre-surgery behavior, particularly as it relates to when you should start fasting before receiving your intravenous sedation.

During the surgery

During the pre-surgical consult, your surgeon will have explained to you the procedure in detail, answering all of your questions, so that you are aware of what will take place during your procedure. Of course, as most patients are sedated for this, you will be blissfully unaware of what is going on during the actual procedure itself!

After the surgery

If you were sedated for the removal of your wisdom teeth, you can expect to awaken gradually, wondering when the procedure is going to start, and without pain due to the local anesthetic given to you while you were asleep. Long before this local anesthetic wears off, you will be instructed to take your pain medication at home, so that once the local anesthesia does wear off, you remain comfortable. The majority of patients report minimal pain or soreness after surgery, and most are often able to return to daily activities within just a few days.

You’ll be given specific instructions from your surgeon that are appropriate for your case. However, a common rule of thumb is to avoid rinsing your mouth vigorously for 24 hours after your procedure, so as not to disturb the healing or promote bleeding.

That having been said, be sure to continue to gently brush your teeth and maintain your best oral care. Anything you leave up to chance can impede your healing process. These and other instructions will all be part of your discussions with your surgeon before and/or after your wisdom tooth extraction surgery.

Once all is said and done, you’ll be one of the 85% of patients who ultimately have wisdom teeth removed. In the best surgical hands, and you can feel confident that you will receive care from our doctors that will provide you the best experience and fastest healing.

Dental Implants: 3 Things You Might Not Have Known

Dental implants are the longest-lasting, most popular and most written about tooth replacement option. Our office has published material on our website discussing the benefits and advantages to dental implants, and the technologies that allow us to give you the best options and greatest peace of mind.

Whether on our site or elsewhere, you’ve probably read about what implants are made of. You probably know at least a little about how they’re surgically placed. But, maybe you didn’t know the following facts about dental implants—read on to see what you might learn.

Equal to the populations of Iowa, New York, and California

The number of Americans with dental implants is growing every year, as well as the number of options a patient has when getting them surgically placed. According to the American Academy of Implant Dentistry (AAID), more than 3 million Americans have dental implants, a number that’s growing by 500,000 every year. Right now, the number is equal to the whole population of Iowa—and at that rate of growth, it could double by 2022.

If you’ve read anything about dental implants, you’ll now that there are other solutions people look at for replacing teeth, too. According to the AAID, a total of 15 million Americans have bridge and crown replacements for missing teeth. This is nearing the size of New York state, and growing fast.

The AAID also reports that more than 35 Americans are missing all their teeth on one or both of their jaws. This is nearing the size of the state of California.

Today’s implants are made of three parts, and can be placed in one or two surgeries

Dental implants are currently made of three parts—the implant itself is actually the metal post placed in the cavity of the natural tooth. This is then left to heal for at least eight weeks, if not three to four months. The healing process includes the implant naturally binding to your jawbone (see the next item for more on this point).

After healing is complete, the implant is surgically re-accessed to place an abutment over it, which gives the false tooth something to sit on. The crown is then glued onto the abutment, and your implant placement is complete.

Dental implants can now be placed with one surgery, too. You’ll still need to let the implant heal and fuse to the bone after placement, but Drs. Nail and Dombrowski also offer a state-of-the-art option where, for some patients, the second visit for the crown doesn’t need to be a second surgery. New technologies have made this possible, and eligibility is case-to-case. Talk to your surgeon to learn more.

Dental implants actually bind to your bone—and the discovery of this phenomenon was an accident

As the story goes, Swedish surgeon P. Branemark was studying bone healing and regeneration on rabbits in the 1950s, when he discovered that the titanium posts he had surgically placed in the rabbits had fused to their bone. He couldn’t remove them. It wasn’t long after this discovery that he saw the application for dental implants, and the trajectory to modern implants began.

Today’s implants are primarily made of titanium, as the metal has proven to be the best in “osseointegration,” or fusing to the bone around it. This is precisely the process that your jaw undergoes after the initial surgical placement of an implant post.

If you’re in need of an implant or might be soon, it’s likely you have other questions and curiosities about the surgery or the implants themselves. We’re here to answer your questions, so don’t hesitate to get in touch!

Impacted Canines

An impacted tooth simply means that it is “stuck” and cannot erupt into function. Patients frequently develop problems with impacted third molar (wisdom) teeth. These teeth get “stuck” in the back of the jaw and can develop painful infections among a host of other problems (see “Impacted Wisdom Teeth” under Procedures). Since there is rarely a functional need for wisdom teeth, they are usually extracted if they develop problems. The maxillary cuspid (upper eyetooth) is the second most common tooth to become impacted. The cuspid tooth is a critical tooth in the dental arch and plays an important role in your bite. The cuspid teeth are very strong biting teeth and have the longest roots of any human teeth. They are designed to be the first teeth that touch when your jaws close together so they guide the rest of the teeth into the proper bite.

Normally, the maxillary cuspid teeth are the last of the “front” teeth to erupt into place. They usually come into place around age 13 and cause any space left between the upper front teeth to close together. If a cuspid gets impacted, every effort is made to get it to erupt into its proper position in the dental arch. The techniques involved to aid eruption can be applied to any impacted tooth in the upper or lower jaw, but most commonly they are applied to the maxillary cuspid (upper eye) teeth. Sixty percent of these impacted eyeteeth are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted eye teeth are found in the middle of the supporting bone but stuck in an elevated position above the roots of the adjacent teeth or out to the facial side of the dental arch.

Early Recognition Of Impacted Eyeteeth Is The Key To Successful Treatment

The older the patient, the more likely an impacted eyetooth will not erupt by nature’s forces alone, even if the space is available for the tooth to fit in the dental arch. The American Association of Orthodontists recommends that a panorex screening x-ray, along with a dental examination, be performed on all dental patients at around the age of seven years to count the teeth and determine if there are problems with eruption of the adult teeth. It is important to determine whether all the adult teeth are present or are some adult teeth missing. Are there extra teeth present or unusual growths that are blocking the eruption of the eyetooth? Is there extreme crowding or too little space available causing an eruption problem with the eyetooth? This exam is usually performed by your general dentist or hygienist who will refer you to an orthodontist if a problem is identified.

Treating such a problem may involve an orthodontist placing braces to open spaces to allow for proper eruption of the adult teeth. Treatment may also require referral to an oral surgeon for extraction of retained baby teeth and/or selected adult teeth that are blocking the eruption of the all-important eyeteeth. The oral surgeon will also need to remove any extra teeth (supernumerary teeth) or growths that are blocking eruption of any of the adult teeth. If the eruption path is cleared and the space is opened up by age 11-12, there is a good chance the impacted eyetooth will erupt with nature’s help alone. If the eyetooth is allowed to develop much longer (age 13-14), the impacted eyetooth will not erupt by itself even with the space cleared for its eruption. If the patient is too old (over 30-40), there is a much higher chance the tooth will be fused in position. In these cases the tooth will not budge despite all the efforts of the orthodontist and oral surgeon to erupt it into place. Sadly, the only option at this point is to extract the impacted tooth and consider an alternate treatment to replace it in the dental arch (crown on a dental implant or a fixed bridge).

What Happens If The Eyetooth Will Not Erupt When Proper Space Is Available?

In cases where the eyeteeth will not erupt spontaneously, the orthodontist and oral surgeon work together to get these unerupted eyeteeth to erupt. Each case must be evaluated on an individual basis but treatment will usually involve a combined effort between the orthodontist and the oral surgeon. The most common scenario will call for the orthodontist to place braces on the teeth (at least the upper arch). A space will be opened to provide room for the impacted tooth to be moved into its proper position in the dental arch. If the baby eyetooth has not fallen out already, it is usually left in place until the space for the adult eyetooth is ready. Once the space is ready, the orthodontist will refer the patient to the oral surgeon to have the impacted eyetooth exposed and bracketed.

In a simple surgical procedure performed in the surgeon’s office called an “exposure and bonding”, the gum on top of the impacted tooth will be lifted up to expose the hidden tooth underneath. If there is a baby tooth present, it will be removed at the same time. Once the tooth is exposed, the oral surgeon will bond (glue) an orthodontic bracket to the exposed tooth. The bracket will have a miniature gold chain attached to it. The oral surgeon will guide the chain back to the orthodontic arch wire where it will be temporarily attached. Sometimes the surgeon will leave the exposed impacted tooth completely uncovered by suturing the gum up high above the tooth or making a window in the gum covering the tooth (on selected cases located on the roof of the mouth). Most of the time, the gum will be returned to its original location and sutured back with only the chain remaining visible as it exits a small hole in the gum.

Shortly after surgery (1-14 days) the patient will return to the orthodontist. A tiny elastic band will be attached to the chain to put a light eruptive pulling force on the impacted tooth. This will begin the process of moving the tooth into its proper place in the dental arch. This is a carefully controlled, slow process that may take up to a full year to complete. Remember, the goal is to erupt the impacted tooth and not to extract it! Once the tooth is moved into the arch in its final position, the gum around it will be evaluated to make sure it is sufficiently strong and healthy to last for a lifetime of chewing and tooth brushing. In some circumstances, especially those where the tooth had to be moved a long distance, there may be some minor “gum surgery” required to add bulk to the gum tissue over the relocated tooth so it remains healthy during normal function. Your dentist or orthodontist will explain this situation to you if it applies to your specific situation.

These basic principals can be adapted to apply to any impacted tooth in the mouth. It is not that uncommon for both of the maxillary cuspids to be impacted. In these cases, the space in the dental arch form will be prepared on both sides at once. When the orthodontist is ready, the surgeon will expose and bracket both teeth in the same visit so the patient only has to heal from surgery once. Because the anterior teeth (incisors and cuspids) and the bicuspid teeth are small and have single roots, they are easier to erupt if they get impacted than the posterior molar teeth. The molar teeth are much bigger teeth and have multiple roots making them more difficult to move. The orthodontic maneuvers needed to manipulate an impacted molar tooth can be more complicated because of their location in the back of the dental arch.

Recent studies have revealed that with early identification of impacted eyeteeth (or any other impacted tooth other than wisdom teeth), treatment should be initiated at a younger age. Once the general dentist or hygienist identifies a potential eruption problem, the patient should be referred to the orthodontist for early evaluation. In some cases the patient will be sent to the oral surgeon before braces are even applied to the teeth. As mentioned earlier, the surgeon will be asked to remove over-retained baby teeth and/or selected adult teeth. He will also remove any extra teeth or growths that are blocking eruption of the developing adult teeth. Finally, he may be asked to simply expose an impacted eyetooth without attaching a bracket and chain to it. In reality, this is an easier surgical procedure to perform than having to expose and bracket the impacted tooth. This will encourage some eruption to occur before the tooth becomes totally impacted (stuck). By the time the patient is at the proper age for the orthodontist to apply braces to the dental arch, the eyetooth will have erupted enough that the orthodontist can bond a bracket to it and move it into place without needing to force its eruption. In the long run, this saves time for the patient and means less time in braces (always a plus for any patient!).

What To Expect From Surgery To Expose & Bracket An Impacted Tooth?

The surgery to expose and bracket an impacted tooth is a very straightforward surgical procedure that is performed in the oral surgeon’s office. Due to the age of most patients it is performed with intravenous sedation, but in some it may be appropriate to use laughing gas and local anesthesia. You can also refer to Preoperative Instructions under Surgical Instructions on this website for a review of any details.

Bleeding, swelling, and discomfort are typically minimal after an exposure and bonding, with many patient resuming normal activities the day after surgery. Should any problems arise after surgery, you can simply call Dr. Nail at 972 395-7630.

This post was first seen at: http://www.facialoralsurgery.com/procedures/impacted-canines/

#impacted tooth #eyetooth #Impacted Eyeteeth #impacted canines

Facial Trauma

The dental specialist performs the proper treatment of facial injuries. These professionals must be well versed in emergency care, acute treatment and long-term reconstruction and rehabilitation – not just for physical reasons but emotional as well. Oral and maxillofacial surgeons are trained, skilled and uniquely qualified to manage and treat facial trauma. Injuries to the face, by their very nature, impart a high degree of emotional, as well as physical trauma to patients. The science and art of treating these injuries requires special training involving a “hands on” experience and an understanding of how the treatment provided will influence the patient’s long term function and appearance.

Dr. Nail meets and exceeds these modern standards. They are trained, skilled, and uniquely qualified to manage and treat facial trauma. They are on staff at local hospitals and deliver emergency room coverage for facial injuries, which include the following conditions:

Facial lacerations

Intra oral lacerations

Avulsed (knocked out) teeth

Fractured facial bones (cheek, nose or eye socket)

Fractured jaws (upper and lower jaw)

The Nature Of Maxillofacial Trauma

There are a number of possible causes of facial trauma such as motor vehicle accidents, falls, sports injuries, interpersonal violence, and work-related injuries. Types of facial injuries can range from injuries of teeth to extremely severe injuries of the skin and bones of the face. Typically, facial injuries are classified as either soft tissue injuries (skin and gums), bone injuries (fractures), or injuries to special regions (such as the eyes, facial nerves or the salivary glands).

Soft Tissue Injuries Of The Maxillofacial Region

When soft tissue injuries such as lacerations occur on the face, they are repaired by suturing. In addition to the obvious concern of providing a repair that yields the best cosmetic result possible, care is taken to inspect for and treat injuries to structures such as facial nerves, salivary glands, and salivary ducts (or outflow channels). Dr. Nail is a certified by the American Board of Oral and Maxillofacial Surgery, and as such is is proficient at diagnosing and treating all types of facial lacerations.

Bone Injuries Of The Maxillofacial Region

Fractures of the bones of the face are treated in a manner similar to the fractures in other parts of the body. The specific form of treatment is determined by various factors, which include the location of the fracture, the severity of the fracture, the age, and general health of the patient. When an arm or a leg is fractured, a cast is often applied to stabilize the bone to allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures.

One of these options involves wiring the jaws together for certain fractures of the upper and/or lower jaw. Certain other types of fractures of the jaw are best treated and stabilized by the surgical placement of small plates and screws at the involved site. This technique, called “rigid fixation” can often allow for healing while obviating the necessity of having the jaws wired together. The relatively recent development and use of rigid fixation has profoundly improved the recovery period for many patients, allowing them to return to normal function more quickly.

The treatment of facial fractures should be accomplished in a thorough and predictable manner. More importantly, the patient’s facial appearance should be minimally affected. An attempt at accessing the facial bones through the fewest incisions necessary is always made. At the same time, the incisions that become necessary are designed to be small and, whenever possible, are placed so that the resultant scar is hidden.

Injuries To The Teeth & Surrounding Dental Structures

Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral surgeons usually are involved in treating fractures in the supporting bone or in replanting teeth that have been displaced or knocked out. These types of injuries are treated by one of a number of forms of splinting (stabilizing by wiring or bonding teeth together). If a tooth is knocked out, it should be placed in salt water or milk. The sooner the tooth is re-inserted into the dental socket, the better chance it will survive. Therefore, the patient should see a dentist or oral surgeon as soon as possible. Never attempt to wipe the tooth off, since remnants of the ligament that hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. Other dental specialists may be called upon such as endodontists, who may be asked to perform root canal therapy, and/or restorative dentists who may need to repair or rebuild fractured teeth. In the event that injured teeth cannot be saved or repaired, dental implants are often now utilized as replacements for missing teeth.

The proper treatment of facial injuries is now the realm of Oral and Maxillofacial Surgeons who as specialists are well versed in emergency care, acute treatment, long-term reconstruction, and rehabilitation of the patient.

Source: http://www.facialoralsurgery.com/procedures/facial-trauma/

#oral surgeons #maxillofacial #dental specialist

Wisdom Teeth

By the age of 18, the average adult has 32 teeth; 16 teeth on the top and 16 teeth on the bottom. Each tooth in the mouth has a specific name and function. The teeth in the front of the mouth (incisors, canines, and bicuspid teeth) are ideal for grasping and biting food into smaller pieces. The back teeth (molar teeth) are used to grind food up into a consistency suitable for swallowing.

The average mouth is made to hold only 28 teeth. It can be painful when 32 teeth try to fit in a mouth that holds only 28 teeth. These four other teeth are your third molars, also known as “wisdom teeth.”

Why Should I Have My Wisdom Teeth Removed?

Wisdom teeth are the last teeth to erupt within the mouth. When they align properly and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this rarely happens. The vast majority of the time, wisdom teeth will either have insufficient space to erupt, will only erupt partially, or will erupt fully but will have insufficent space for proper hygiene. The medical term for things that become “stuck” in the body is “impacted”. Thus, when wisdom teeth fail to erupt fully, they are said to be “impacted”. The extraction of wisdom teeth is necessary when it is clear that they will have insufficient space in the mouth to erupt properly or insufficient space for proper maintenence if they do erupt. They may grow sideways, partially emerge from the gum, and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to successfully erupt.

These poorly positioned or impacted teeth can cause many problems. When they are partially or even fully erupted, the opening around the teeth allows bacteria to colllect beneath the gums that are covering the buried portion of the teeth that leads to infection with swelling, stiffness, pain, and illness. Chronic collection of these bacteria can lead to gum disease and cavities on the teeth in front of wisdom teeth. Additionally, the bacteria that collect under the gums around wisdom teeth have been shown to enter the bloodstream and cause heart disease, diabetes, an increased risk of stroke, and in women, premature and lower birth weight infants. The pressure from the erupting wisdom teeth may move other teeth and disrupt the orthodontic or natural alignment of teeth. Another serious problem occurs when tumors or cysts form around the impacted wisdom teeth, resulting in the destruction of the jawbone and adjacent healthy teeth. Removal of the offending impacted teeth usually resolves these problems. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.

Wisdom Teeth Presentation

To provide you with a better understanding of wisdom teeth, we have provided the following multimedia presentation. Many common questions pertaining to wisdom teeth are discussed.

Having trouble? Please make sure you have version 9 of the Flash browser plugin in order to correctly view this presentation. This software is available as a free download.

Oral Examination

With an oral examination and x-rays of the mouth, Dr. Nail can evaluate the position of the wisdom teeth and detect if they are are present or may cause future problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient. Patients are generally first evaluated in the mid-teenage years by their dentist, orthodontist or by an oral and maxillofacial surgeon.

All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. Dr. Nail has the training, licensing and experience to provide various types of anesthesia to optimize surgical outcome and patient comfort.

Removal

In most cases, the removal of wisdom teeth is performed under intravenous sedation or intravenous general anesthesia. These options, as well as the surgical risks (i.e., sensory nerve damage, sinus complications), will be discussed with you before the procedure is performed. Once the teeth are removed, the gum is sutured closed. To help control any oozing from the surgical sites, you will be instructed to bite down on the gauze placed in your mouth. You will rest under monitored supervision in the office until you are ready to be taken home. Upon discharge, your postoperative kit will include postoperative instructions, a prescription for pain medication, and a follow-up appointment in one-two weeks for a post-operative recheck (or sooner, if needed). If you have any questions, please do not hesitate to call us at 972 395-7630.

Wisdom Tooth Removal Overview

For a brief narrated overview of the wisdom tooth removal process, please click the image below. It will launch our flash educational MiniModule in a separate window that may answer some of your questions about wisdom teeth.

Having trouble? Please make sure you have version 7 of the Flash browser plugin in order to correctly view this presentation. This software is available as a free download.

Our services are provided in an environment of optimum safety that utilizes modern monitoring equipment and staff who are experienced in anesthesia techniques.

Source: http://www.facialoralsurgery.com/procedures/wisdom-teeth/

#wisdom tooth #wisdom teeth

Dental Implants

Dental implants are changing the way people live. They are designed to provide a foundation for replacement teeth that look, feel, and function like natural teeth. The person who has lost teeth regains the ability to eat virtually anything, knowing that teeth appear natural and that facial contours will be preserved. Patients with dental implants can smile with confidence.

What Are Dental Implants?

The implants themselves are small titanium posts that are inserted into the jawbone where teeth are missing. These metal anchors act as tooth root substitutes, and their placement is very generally very comfortable. The bone bonds with the titanium, creating a strong foundation for artificial teeth. Generally, anywhere between 8-12 weeks after implant placement, the healing caps at the top of each implant are exchanged for small posts called abutments, which act as stable anchors for the new teeth, and the new teeth are placed.

Implants also help preserve facial structure, preventing bone deterioration that occurs when teeth are missing.

The Surgical Procedure

For most patients, the placement of dental implants involves only one surgical procedure, and is among the most comfortable procedures performed by Doctors Nail and Dombrowski. First, implants are placed within your jawbone. Although this may sound painful, many patients resume normal activities that same day when they only have 1 or 2 implants placed. For the first two to three months following surgery, the implants are gradually bonding with the jawbone. You should be able to wear temporary dentures (if a large number of teeth are being replaced), and in some cases an immediate temporary tooth or teeth can be placed. During this time it is important to try not to chew directly on the new implant sites and to eat a soft diet. Also during this time, your dentist is treatment planning the new replacement teeth.

Once the implant(s) has/have bonded to the jawbone, the second phase begins. After having been cleared by our doctors, you will be released to your dentist who will remove the small cover caps from the implants and exchange them for small posts called “abutments” that will serve as anchors for the final teeth, and the final teeth will be placed. The entire process usually takes three to six months, and most patients experience minimal discomfort or disruption in their daily life during this time.

Dental Implant Presentation

To provide you with a better understanding of dental implants, we have provided the following multimedia presentation. Many common questions pertaining to dental implants are discussed.

Having trouble? Please make sure you have version 9 of the Flash browser plugin in order to correctly view this presentation. This software is available as a free download.

Surgical Advances

Using the most recent advances in dental implant technology, Doctors Nail and Dombrowski are usually able to place single stage implants. These implants do not require a second procedure to uncover them, but do require a minimum of eight weeks of healing time before artificial teeth are placed. There are many situations where the implants can be placed at the same time as a tooth extraction, and some instances when a temporary tooth can be placed on the implant that same day – further minimizing the number of procedures and office visits.

Dental Implant placement is ideally a team effort between an Oral and Maxillofacial Surgeon and a restorative dentist. While Doctors Nail or Dombrowski perform the initial tooth extractions, the actual implant procedure, and bone or gingival grafting if necessary, the restorative dentist (your dentist) fits and makes the permanent tooth or teeth. Your dentist will also make any temporary teeth needed during the implant process.

What Types Of Prosthesis Are Available?

A single prosthesis (crown) is used to replace one missing tooth – each prosthetic tooth attaches to its own implant. A partial prosthesis (fixed bridge) can replace two or more teeth and may require only two or three implants. A complete dental prosthesis (fixed bridge) replaces all the teeth in your upper or lower jaw. The number of implants varies depending upon which type of complete prosthesis (removable or fixed) is recommended. A removable prosthesis (over denture) attaches to either a bar, retentive anchor balls or a similar connection, or short titanium posts, whereas a fixed prosthesis is not removable by the patient and can only be removed by the dentist.

Doctors Nail and Dombrowski perform their in-office, outpatient implant procedures in the comforts of office procedure rooms, thus optimizing the level of comfort and sterility. Inpatient hospital implant procedures may be required for patients who have special medical or anesthetic needs.

Why Dental Implants?

Dental Implant Overview

For a brief narrated overview of the dental implant process, please click the image below. It will launch our flash educational MiniModule in a separate window that may answer some of your questions about dental implants.

Having trouble? Please make sure you have version 7 of the Flash browser plugin in order to correctly view this presentation. This software is available as a free download.

Once you learn about dental implants, you realize that if you are missing one or more teeth, or if you have been forced to live with failing teeth, there is a way to improve your life. When you lose several teeth – whether it’s a new situation or something you have lived with for years – chances are you have never become fully accustomed to losing such a vital part of yourself.

Dental implants can be your doorway to renewed self-confidence and peace of mind.

A Swedish scientist and orthopedic surgeon, Dr. Per-Ingvar Branemark, developed this concept for oral rehabilitation more than 50 years ago. With his pioneering research, Dr. Branemark opened the door to a lifetime of renewed comfort and self-confidence for millions of individuals facing the frustration and embarrassment of tooth loss.

Why Select Dental Implants Over More Traditional Types Of Restorations?

There are several reasons: Why sacrifice the structure of surrounding good teeth to bridge a space? In addition, removing a denture or a “partial” at night may be inconvenient, not to mention that dentures that slip can be uncomfortable and rather embarrassing.

Are You A Candidate For Implants?

If you are considering implants, your mouth must be examined thoroughly and your medical and dental history reviewed. If your mouth is not ideal for implants, ways of improving outcome, such as bone grafting, may be recommended.

What Type Of Anesthesia Is Used?

Most dental implant and associated grafting procedures can be performed in the office under local anesthesia, with or without general anesthesia.

Do Implants Need Special Care?

Once the implant teeth are in place, they can serve for as long as your well-cared-for natural teeth, perhaps for the rest of your life, if you take proper care of them and you keep your mouth healthy. This means taking the time for good oral hygiene (brushing and flossing daily) and keeping regular appointments on the schedule recommended by your dentist.

First seen at: http://www.facialoralsurgery.com/procedures/dental-implants/

#dental implants #tooth replacement #missing teeth

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