Neal, Leonard, and Sorensen Implant, Facial, and Oral Surgery

Gauze 101

We get dozens of questions every week about how to use gauze after an extraction. How long do I leave it in? Can I eat with it in my mouth? How many days should I use it? What if I run out? Should I moisten it in with anything? I’ve heard of using tea bags, what’s that about?

Here’s the lowdown: the main reason we have patients use gauze is to apply direct pressure to the extraction/surgery site. Yes, it absorbs blood, too, but bleeding is usually well under control before we allow patients to leave our office. By folding the gauze (we use 3×3 size) into a small square, it creates enough thickness so that when the gauze is placed directly over the surgical site, it applies pressure to the wound when the patient bites his or her teeth together. Pressure is the magic word! Generally, you only need to leave the gauze in place as long as the site is actively oozing or bleeding. We recommend leaving the gauze in place, with direct biting pressure, for about one hour. After an hour, remove the gauze and evaluate the surgical site. In most cases, the surgical site will ooze slowly for several hours and taper off until you won’t need the gauze anymore. While the site continues to ooze, just change the gauze once per hour. You may think changing it more often will help, but actually, removing the gauze too often can dislodge a blood clot and start the bleeding up again. It’s normal for most patients to use gauze for several hours following surgery, but having to use gauze the following day, is not normal.

In addition to evaluating the surgical site when you remove gauze, look at the used gauze pack as well. If it’s wet with mostly pink fluid and some red, you will likely not need to use gauze for much longer. (maybe 1 or 2 more one hour cycles) Many people misinterpret wet, pink gauze for bleeding, when actually, just a little blood mixed with your saliva turns it pink. If the gauze is completely soaked and dark red all over, you probably have not been applying enough pressure. In that case, place a new gauze pack, lie down, and bite continuously, without talking or eating for an hour. If those actions do not decrease the bleeding, you may need to give your surgeon’s office a call. We always supply our surgical patients with ample gauze, but if you should run out, just call us and you can come and pick up some more. If that’s not convenient, you can pick up gauze at any drugstore, some grocery stores, or big retailers like Target, Fred Meyer, and Wal Mart.

When you’re ready to eat or drink something, remove the gauze, consume your milkshake, jamba juice, or jello (or whatever sounds tasty), and then place a fresh gauze pack. Eating or drinking with gauze in place is not a good idea.

We sometimes get questions about tea bags. Here’s the deal- black tea contains tannic acid, which can aid in clotting. If you’re having particular difficulty with keeping your bleeding under control, you can moisten a tea bag, wrap it in gauze and bite on it. In most cases, plain gauze works fine, but if you want to try the tea route, go for it.

As always, if you think something is not normal, or you’re having difficulties with bleeding, or anything else for that matter, just call us. We’re glad to help you over the phone, and we always have a surgical staff member on call, 24/7. Hopefully, this clears up some of those gauze mysteries.

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You and your dentist may have a bone to pick with Delta Dental

Dr. Neal, who is the current president of the Seattle-King County Dental Society, recently wrote an article for the Seattle Times. Below is a link to the page as well as the article.  Nice job Dr. Neal!!!

You and your dentist may have a bone to pick with Delta Dental
Originally published November 5, 2017 at 12:01 pm Updated November 3, 2017 at 3:07 pm

Doctor Craig

By Craig E. Neal
Special to The Times

Something important happened for oral health in Washington. Dentists across the state closed their offices for a day in September and met to vote on bylaw amendments to make Delta Dental of Washington, the state’s largest dental benefits carrier, more patient-focused, transparent and responsive to member dentists.

In this day of razor-thin margins and contested elections, the results weren’t even close: More than 91 percent of the votes cast supported the changes.

Despite this overwhelming majority, Delta has chosen to act as if it never happened. If Delta has its way, almost none of the member-voted changes will matter. Patients will continue to see premiums rise with few options to seek coverage elsewhere. Their dentists’ clinical decisions will continue to be overruled by insurance clerks, resulting in services delayed and claims denied.

That is because Delta’s board of directors recently vetoed virtually all the changes, effectively ignoring the clear direction provided by Delta members who voted to support the amendments.

These member dentists understand exactly how these changes will benefit their patients and how harmful the board’s veto is.

One vetoed amendment would have required Delta to establish an independent review board, administered by the Insurance Commissioner’s Office, to deal with disputed claims. That is the way medical insurance works: Disputed claims can be submitted to an independent panel that reviews the doctor’s recommendations and the insurer’s position and makes a final, binding determination. But Delta continues to oppose any resolution process that would take the final decision out of its hands. The insurance commissioner has virtually no authority to intervene on behalf of dental patients caught in the middle, thereby removing an important piece of public protection.

Another vetoed amendment would have required Delta to dedicate 94 percent of their premium revenues to paying dental claims from patients like you. If Delta did not meet this target, it would have been required to issue refunds to those purchasing coverage. This was the percentage Delta reported paying out in 2011, when trumpeting the efficiency of its operations, so it would seem a reasonable target today.

As the head of a nonprofit company, CEO Jim Dwyer, whose salary has more than doubled to $2.75 million over the last six years, claims Delta can no longer afford to dedicate that much to patient care. The board of directors, all now receiving more than $100,000 for part-time service on a nonprofit board, agrees.

Their position demonstrates how patient benefits increasingly are taking a back seat to advertising, salaries and other overhead. Delta’s bottom-line focus ignores what their members are saying is best for patients, a trend that sadly isn’t new.

In addition to their vetoes, the board canceled the organization’s annual meeting, depriving member dentists of another opportunity to advocate on behalf of their patients.

Instead, Delta suggests their Member Advisory Committee hold a forum to discuss the issues. But they’ve also vetoed a provision to require the board to publicly vote on recommendations from that very committee. They’ve even written the committee out of the organization’s bylaws — without a vote of the members.

In short, Delta’s response continues a well-established pattern of resisting any accountability to member dentists, the patients they serve, or state regulators. So, the battle for accountability is likely to shift to the courtroom. Dollars that should be going to patient care or promoting oral health instead will be spent on lawyers.

This isn’t just a spat between the state’s largest dental-benefits provider and its member dentists. As patients, the public has a significant stake in the outcome. If the dentists’ reforms are upheld, patients will get more money going to their care, more transparency about how their premium dollars are spent, and access to a legitimate, independent forum for resolving disputes with their insurance company.

Craig E. Neal

Should I Get a Dental Implant?


No one is ever excited to hear that they need a tooth extracted and while nothing is ever as good as our natural teeth, luckily we have some very good options to replace missing teeth. Every day we see patients who are looking for options to replace missing teeth and are often left asking themselves “Should I get an implant?”

More and more people are getting dental implants to replace missing teeth. In 2016 it was estimated that over 3 million people have dental implants and that number appears to be growing by about 500,000 each year. The likely reason is that dental implants are a long term solution to replacing teeth and unlike fixed bridges, implants do not affect neighboring healthy teeth.

A dental implant is a titanium post that is surgically placed into your jaw bone. This titanium metal is the same metal that is used in hip and knee replacements. It has been used in dentistry and medicine for years and has been proven very safe. The titanium metal and bone fuse together and integrate the implant into the bone. This process does take time though, successful integration can take up to several months. But once your surgeon has determined that the implant has successfully integrated, your dentist will attach a tooth to the implant and the process will be complete.

Dental implant surgery is, of course, surgery and is best done by a trained surgeon. An oral and maxillofacial surgeon has specialized education and training in the complexities of the bone, skin, muscles and nerves involved, to ensure you get the best possible results. A study performed in 2014 in the Journal of the American Dental Association suggests greater implant success rates when performed by a dental specialist.

After more than 20 years, the vast majority of dental implants first placed by oral surgeons in the US continue to function. More importantly, the patients that chose to receive those early implants are still satisfied they made the right choice. Dental implants continue today do be the gold standard for replacing missing teeth. If you need to have a tooth extracted or had teeth extracted years ago by visiting your oral surgeon, we can walk you through all the steps of replacing your teeth.

Do I Need My Wisdom Teeth Out?

With age comes wisdom…and wisdom teeth.

One of the most common questions we are asked is “Do I need to have my wisdom teeth out?” Usually the answer isn’t as straight forward as you might think. When going to the oral surgeon he/she will evaluate your teeth and then discuss the risks of removing the wisdom teeth and compare those to the risks of not removing your wisdom teeth.

While everyone is different, here are some common risks that we see in retaining wisdom teeth:

1)Wisdom teeth that aren’t in the right position can allow food to become trapped. That gives cavity-causing bacteria a place to grow, which can effect your wisdom teeth and the adjacent teeth.

2)Wisdom teeth that haven’t come in properly, which can make it difficult to floss between the wisdom teeth and the molars next to them.

3)Wisdom teeth that have partially come through can give bacteria a place to enter the gums and create a place for infection to occur. This may also lead to pain, swelling and stiffness in your jaw.

4)Wisdom teeth that don’t have room to come through are thought by some to crowd or damage neighboring teeth.

5)A wisdom tooth that is impacted can form a cyst on or near the impacted tooth. This could damage the roots of nearby teeth or destroy the bone that supports your teeth.

When you visit us and Neal, Leonard, Sorensen Implant, Facial, and Oral Surgery, we will evaluate your wisdom teeth and then discuss these risks and compare them to the risk of surgery. In most patients, the risk of surgery is usually very low.

The important thing to remember is to be evaluated by your surgeon before your wisdom teeth become a problem. Your surgeon will help guide you make the choice which is best for you,

My own relationship with candy is not totally healthy…..

Five years ago, her daughter, then 3, was invited to play at the home of a new friend. At snack time, having noted the presence of sugar (in the form of juice boxes and cookies) in the kitchen, Dr. Kawash, then a Rutgers professor, brought out a few jelly beans.

The mother froze. Her child had never tasted candy, she explained, but perhaps it would be all right just this once. Then the father weighed in from the other room, shouting that they might as well give the child crack cocaine.

“It was clear to me that there was an irrational equation of candy and danger in that house,” Dr. Kawash said in a recent interview. “And that was irresistible to me.”

From that train of thought, the Candy Professor blog was born. In her writing there, Dr. Kawash dives deep into the American relationship with candy, finding irrational and interesting ideas everywhere. The big idea behind Candy Professor is that candy carries so much moral and ethical baggage that people view it as fundamentally different — in a bad way — from other kinds of food.

“At least candy is honest about what it is,” she said. “It has always been a processed food, eaten for pleasure, with no particular nutritional benefit.” Today, she said, every aisle in the supermarket contains highly manipulated products that have those qualities.

And, she points out, many people who avoid candy will cheerfully eat sugar-packed chocolate-chip energy bars and drink Gatorade for health reasons, although a serving of Gatorade contains about the same amount of sugar as a dozen pieces of candy corn. Dr. Kawash’s expertise is in American culture and gender studies, but some nutritionists share her views on the pariah status of candy.

“I don’t think candy is bad for you,” said Rachel Johnson, a nutrition professor at the University of Vermont who was the lead author of the American Heart Association’s comprehensive 2009 review of the scientific literature on sugar and cardiovascular health.

Dr. Johnson said that candy is considered bad because it lacks the “health halo” that hovers over sweet food like granola bars and fruit juice. “Nutritionally there is little difference between a gummy bear and a bite of fruit leather,” she said.

Dr. Johnson also noted that candy provides only 6 percent of the added sugar in the American diet, while sweet drinks and juice supply 46 percent. “There’s reason to believe that sugar in liquid form is actually worse than candy, because it fills you up and displaces healthier food choices,” she said.

Dr. Kawash, who studied architectural theory, narratives of women and medicine, and the imagery of terrorism before she began to write Candy Professor, has complicated feelings about her current specialty. She describes her childhood in Sunnyvale, Calif., in the 1970s as an “endless, and mostly frustrating quest for candy,” restricted to a small weekly indulgence after church on Sundays. Later, she said, binges on gummy bears and spice drops fueled her undergraduate research at Stanford; more recently, she found herself flushing handfuls of candy corn down the toilet to prevent herself from eating “just a few more.”

Fortunately, some of that passion has now been channeled into research. There are many blogs devoted to tasting, photographing and tracking down obscure types of candy, such as Candy Addict and Candy Blog, but Dr. Kawash’s work is rarely about taste or nostalgia. She is much more interested in untangling the threads of control, danger and temptation that candy has carried since it became widely available in the 1880s.

Until then, most candies — like fudge, brittle and taffy — were homemade, and store-bought hard candies like horehound sticks and peppermints were relatively expensive. But advances in technology enabled sugar to be spun, aerated, softened and flavored in new ways, and sold cheaply. Just like that, candy entered popular culture.

Dr. Kawash notes that candy, like cigarettes, was long advertised as having health benefits. “Eat Tootsie Rolls — The Luscious Candy That Helps Beat Fatigue,” reads one of the many ads she has exhaustively analyzed on her blog. One post is dedicated to the “slippage” between candy and medicine that she has found in a close reading of the history of cough drops — hard candy in a socially acceptable form.

But there have always been what she calls “candy alarmists,” who warned that candy was too stimulating, too soporific, poisoned, or otherwise hazardous. Dangerous candy appears in many fairy tales, a theme continued with the modern public-safety message, “Don’t take candy from strangers,” and in public scares over tampering and contamination. (Dr. Kawash recently detailed how all of this led to the candy wrappers we know today in The Journal of American Culture.)

In the early 20th century, she said — in the absence of any medical evidence — doctors blamed candy for the spread of polio. In the 1970s, refined sugar approached the top of the food counterculture’s list of enemies, spurred by international best sellers like “Sugar Blues” and “Sweet and Dangerous.” Tooth decay was the longtime threat; more recently, the global spread of obesity has prompted fears of the “empty calories” in candy.

Now a tentative cook and a buyer of organic eggs, Dr. Kawash is convinced that candy is often the scapegoat when Americans sense that something is wrong in the food supply. The social critic in her says that corn syrup and the cheap candy produced with it have unhinged our notions of how much candy is too much. At the same time, the historian in her can’t help pointing out that “corn syrup was a wonderful thing for candy.” Its invention in the late 19th century made the commercial production of soft confections like fudge and candy corn possible.

The disruption of traditional agricultural systems — including the presence of corn in so many processed foods — has also dislodged candy from its established place as an occasional treat.

“Candy should not be sold in huge bags at the drugstore,” said Jennifer King, a founder of Liddabit Sweets, a small candy company in Brooklyn that proudly sells candy bars — such as a recreated Snickers — for as much as $6.50. Liddabit products are indulgent but also virtuous: Ms. King and her partner, Liz Gutman, make treats like apple-maple lollipops and spiced caramel chews by hand, from prestigious and often local ingredients. (The honey in the honeycomb candy is gathered from hives in New York City.)

Dr. Kawash says that the fetishization of candy ingredients and the aestheticization of candy — like the color-coordinated candy landscapes now popular at weddings — are relatively new.

“When the moneyed classes indulge in sugar, it’s part of an acceptable leisure activity,” she said, chewing over the significance of high-end candy destinations like Dylan’s Candy Bar.

“But when poor people do the same thing, it’s considered pathological,” she added, citing the current debate over using food stamps to buy soda, candy and other “bad” foods.

Dr. Kawash, 46, retired from teaching in 2009. She said that her increasing interest in candy was making it difficult to fulfill her administrative, teaching and parental responsibilities, and knew that studying the evolution of the shape of the Hershey’s Kiss would never win her respect within the academy.

The blog is not so much a public forum, she said, as a “research trail,” a way of chronicling the hours she now spends reading old issues of Confectioners’ Journal, scanning patent applications, and combing archived phone books to count the number of candy shops in Brooklyn in 1908 (564).

Dr. Kawash says her research is partly fueled by anger toward candy manufacturers who publish inaccurate, often sugarcoated histories of their products. In fact, she says, the home-kitchen inventions of candy-shop owners were often simply copied, stolen or swallowed up by large companies.

“The history of candy, like the history of wars, is always written by the winners,” she said. “We can’t just let that go unchallenged.”

Relieve Stress

A Different Perspective on Stress Relief and Management

Stress seems to be an inescapable part of life, doesn’t it? I remember one of my lectures on stress – I always thought stress just came from a high workload, but woah, I was wrong. It all differs depending on the person – stress can be financial, social, mental, or emotional. It can come from pressure and conflict. It can come from natural disasters, noise, and pollution. It can come from low self-esteem, an impatient and perfectionist personality, all sorts of stuff.

What is it for you? If stress is a problem for you, think of something that really gets you, and then read on with it in mind – perhaps there are different ways of handling your stress, not the usual massage or walk in nature. Perhaps we can prevent stress from arising in the first place.

Relaxed at work? Really?
A Quick Overview
There is an increasing awareness of stress in society, from its harmful effects to its sources and ways to manage it. Here’s a quick, and very simplified, overview.

■A stressor happens – for example, a dog jumps up and starts chasing you angrily.
■The body responds. It’s a survival mechanism; your heart rate and blood pressure increases, more blood flows to the muscles. This allows the classic “fight or flight” response.
■This is great for the short term, we have more resources available to handle whatever happened. The problem arises, however, when the stressor occurs over a long period of time.
■The body needs to return to balance and recuperate after such events. If it doesn’t get a chance to, the body will then wear itself out very quickly.
■For example, if your stressor isn’t a dog, but a job that requires 12 hours a day, dealing with loud and angry customers.
■Your body remains in this “alarm” stage the whole time, and very often we can’t “switch off” even when we get home.
■The increased blood pressure and heart rate then becomes damaging, over long periods of time, it can damage blood vessels, increase risk of cardiovascular disease, and a whole lot of other stuff.
Things are made worse, as our stress system was made for physical stressors, and not so much the social, mental, or emotional stressors that we increasingly deal with nowadays.

I’ve found the standard strategies to be very helpful in this regard. Get some regular exercise, book in a relaxing massage, take a walk in nature, or learn some time management skills – even assertiveness skills, such as learning to say “no” to an extra demand on your time.

A Different Perspective
But one thing you’ll notice about these strategies: they reduce stress after it has already occurred. Is it possible for stress not to arise in the first place? In my experience, yes, but these are just my experiences and thoughts – please ignore me if you disagree with them.

We seem to think that stress comes from the outside world, right? It comes from the workload in the office, the screaming and shouting at home, and the howling dog next door. But what if it comes from our internal resistance to these things?

Maybe an example might make it easier to see. One man’s music is another’s loud noise. One might love rock music and blast it at full volume, but this causes his brother to wince. But if it is the same song, why is there such a difference in reactions? Perhaps, the music itself is neutral. Our responses – whether we are stressed by it or we fall asleep listening to it – depend purely on us.

Do you agree with me so far? What if we applied the same idea to your stressor? In my last examination period in June, I was going nearly insane from stress and fell sick. I was studying and working from the moment I woke up to the moment I fell asleep, with little breaks for food. But what if the workload itself was neutral; what if my stress came from my inner resistance to it? Would doing some inner work around this area change this stress? In my experience, very much so!

By comparison, I just finished the recent October examination period, where the workload was even higher than the June period. But this time, the stress wasn’t there. Now, I’m not talking about some magical state. I still needed to go for walks to stretch out my legs, I still needed some coffee to keep me awake, and I was still physically tired (by analogy, even if I love rock music, playing it at maximum volume will still hurt my ears). But I was not emotionally stressed. I didn’t mind working and studying 14 hours a day, in fact I felt quite fulfilled by it. So it is possible for stressors to happen and still be at peace.

What Can We Do?
There are two ways I’ve found to handle this. For new readers, they tie back to my old favourites – the two Core Practices of emotional or cognitive work.

1.If you are the type of person who prefers working with emotions, please read Welcoming and Releasing Emotions.
2.If you prefer working with your thoughts or beliefs, you can try the psychological Cognitive Distortion techniques, or undo your thoughts with The Work.
The Resistance
The first way involves dealing with this resistance straight on, using the technique that works for you the best. As an example, I might look at my calendar and see that I still have THAT MUCH to do, and feel frustration, or despair. I’ll dive straight into those feelings and in doing so, let them go. Or, the thoughts around this workload might be – It’s not fair, I can’t take it anymore, I should be out at the beach, or how come I’m not Donald Trump’s son?

Spend a few minutes a day, maybe half an hour, letting go of these feelings, or undoing these thoughts, and see if things don’t change.

The Failure
The second way, and my favourite, was taught to me by Tom Stine. In essence, we explore what might happen in the other direction. What if I didn’t do all these things? What if I didn’t work hard? What if I didn’t have a job, what if I didn’t run if a mad dog was chasing me? (Of course, this is not to recommend that you do or don’t do those things – it’s purely an inner exploration.)

Explore it; go into it, all the fears and emotions and whatever it is that arises. For example, if someone was working every weekend in the hopes of getting a promotion, then what will happen if she didn’t get that promotion? And just follow it, and make it as bad as possible. There’s an explorative technique for getting to the roots of our fears, called the “And then what?” We can adapt this technique to whatever is underneath our stress, even if it wasn’t fear.

What if I didn’t get that promotion? Then I won’t have enough money. And then what? Then I’ll lose my house. And then what? Then I’ll have to move back home. And then what? Then I’ll be the laughing stock of all my friends. And so on, until we get to the root.

And we can work with these results in the same way. In my own work, I chose to delve into my emotions, as if all my worst-case scenarios had come true, and feeling the pains I would have if they did. Or we can work with the thoughts in the same way: Is it true that I will be the laughing stock if I have to move back home? (Some of the thoughts might not make sense or be easy to undo, though, which is why I chose the emotional techniques).

What Will Happen
In feeling and dropping the underlying emotions, by and by we find that they no longer drive our actions. It might not happen overnight, but slowly we begin to see that that it isn’t that bad, even if we fail. We might see that we will basically be OK if we can roll with the punches. If we don’t get this job, we’ll get another one. If our flight is delayed for hours, we’ll catch up on some reading.

What happens when we have this inner freedom? Our attention and our energy become dedicated to the action itself. No longer is it a stressor, something that has to be done with gritted teeth; now, it becomes a joy, a fulfilment of potential.

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What Exactly Does the Dental Implant Procedure Involve?

First, you will need to discuss your options with your dentist. Together, it will be decided if you are a good candidate for dental implants. The dentist will take a complete dental history, x-rays, and complete a thorough oral examination. If you are a candidate for implant surgery, the procedure is as follows:

1. Surgical placement of the implant(s) into the bone. This is usually done right in the dentist’s office, with a local anesthetic. After surgery, there is a healing period of approximately four months. During this time, the implants fuse to the bone by a process known as ‘osseointegration’.

2. Next, there is a minor surgical exposure of the top of the implant, whereby the dentist will attach the post to the implant. The function of the post is to become the support for either one tooth or a set of teeth. This is a short procedure that usually requires only local anesthesia.

3. The last phase is the restorative phase. The dentist will take impressions and then make a prosthesis that will attach to the implants. This will require several visits. Once completed, your mouth will be restored to natural looking, strong teeth.

What Exactly Does the Dental Implant Procedure Involve?
First, you will need to discuss your options with your dentist. Together, it will be decided if you are a good candidate for dental implants. The dentist will take a complete dental history, x-rays, and complete a thorough oral examination. If you are a candidate for implant surgery, the procedure is as follows:
1. Surgical placement of the implant(s) into the bone. This is usually done right in the dentist’s office, with a local anesthetic. After surgery, there is a healing period of approximately four months. During this time, the implants fuse to the bone by a process known as ‘osseointegration’.

2. Next, there is a minor surgical exposure of the top of the implant, whereby the dentist will attach the post to the implant. The function of the post is to become the support for either one tooth or a set of teeth. This is a short procedure that usually requires only local anesthesia.

3. The last phase is the restorative phase. The dentist will take impressions and then make a prosthesis that will attach to the implants. This will require several visits. Once completed, your mouth will be restored to natural looking, strong teeth.

Is the concept of dental implants a new one?
Interestingly, dental implants have been performed for thousands of years. Egyptian mummies have been found with gold wire implants in the jawbones. Pre-Columbian skeletal remains exhibit dental implants made of semi-precious stones. Recently, a Roman soldier was unearthed in Europe with an iron dental implant in his jawbone. In the Middle East, implants made of ivory have been discovered in skeletons from the Middle Ages.
Modern implantology began in the United States at the beginning of the 20th century. However, popularity really grew in the 1980’s with the increased success of the titanium cylinder. Since then, many brand name implants with minor variations have been approved.

What factors contribute to long-term success of Dental Implants?
Long-term success depends on multiple factors. First off, success will depend on the quality and quantity of bone. The better the bone and the more available, the greater the chance of long-term success. Secondly, the experience and ability of the dental surgeon will be a factor. As with any surgical procedure, there is no substitute for the experience and individual talent of the dentist. And finally, the quality of the restoration placed on top of the implant will play a big role in long-term success. If the design of the implant crowns or overdentures are poorly constructed, and biting forces are not balanced, even the best-placed dental implant will have a compromised survival rate.
Who can place a dental implant in my mouth?
A periodontist, an oral surgeon, or an implantologist places dental implants. The periodontist and oral surgeon are teamed with a restorative dentist. They will place the implants and then the patient will be seen by a restorative dentist for completion of the crowns or overlying appliance. There will be two dentists during the course of treatment. An implantologist is trained in both dental implant surgery and restoration of the dental prosthesis. An implantologist will do both the surgery and the restoration, and there will be only one dentist during the course of treatment.
Who can restore the teeth on the top of dental implants?
A general dentist trained to restore implants, an oral implantologist, or a prosthodontist can restore teeth. It is the choice of the patient to use a “one doctor approach,” whereby the oral implantologist does both the surgery and the restoration, or the “two doctor approach,” whereby the surgery and restoration are performed by two different clinicians.
Are there any age limitations for dental implants?
No. Any person at any age can have dental implants as long as there is enough bone available in which to place the implants.
What might be some of the factors that would prevent me from being an implant candidate?
There are some medical factors that might prevent a person from being a good candidate for dental implants. Some of these may be uncontrolled diabetes, chemotherapy or radiation therapy, parathyroid disorders, blood disorders, rare bone disorders or bone marrow cancer. Some physical factors may include insufficient or poor quality bone, low sinuses or nerve bundles.
How often will I need to have my dental implants checked?
The success of your implants will depend greatly on how well you maintain them. They will need to be professionally cleaned by a hygienist and examined by your implant dentist every three to four months. This hygienist should be trained in the specific procedure of maintaining dental implants. Also, brushing and flossing daily is absolutely necessary for long-term success.
Is dental implant surgery painful?
No. An effective local anesthetic is used during the surgery so that you do not have any discomfort during the placement of the implants. The mild discomfort you might experience after surgery can be controlled with medications.
When can I return to work after implant surgery?
You can go to work the next day, unless some particular surgical circumstance arises. Your implant dentist will discuss all postoperative instructions with you.

The Whole Tooth – Reasons to see a Dentist at Any Stage of Life

We know we should. We mean to. But many times, we put off visiting the dentist until there’s a problem – like intense pain.
This approach is a big mistake.
“Dentistry’s strength is in it’s model of prevention.” said Mary J. Hayes, DDS, spokeswoman for the American Dental Association. She likens oral care to car care: regular maintenance can prvent needless disasters.
“And we should care for our teeth at least as well as we do our cars.” She says.
Forget what you’ve heard: the ADA – along with the American Academy of Pediatries and other experts – now reccomends that a child see a dentist around his or her first birhtday. “A lot of decay starts in very young children and can be very hard to treat.” Hayes says.
Between regular checkups, Hayes reccomends, children should visit a dentist if anything seems “off”. You probably wouldn’t know if your your child had a cavity: If you see anything, that means it’s pretty big.” It’s also a good idea to have a dentist check your childs mouth if he or she had a fall with a chin impact. Teeth can chip with out the parent or child realizing it.
One hazard: increased soda consumption. “Both regular and diet sodas harm teeth.” says Hayes, “because the phosphates they contain interfere with calcium deposition.”
Most adults should visit a dentist every six months to a year. Some people, however, accumlate a lot of calculus, or tartar, because thier body chemistry. If you find you’re one of them, consider having a cleaning three to four times a year. Still tempted to put off that checkup? “Dentists can screen for oral cancer, which can be devastating if not caught early.” Hayes says.
“Older people need to keep up with dental care and keep those natural teeth intact for as long as possible,” Hayes says. “As we age, we have enough problems without our nutrition being compromised because of trouble eating. And you wouldn’t want to add a dental problem on top of other health issues.”
-By Caolyn Sperry
GateHouse News Service

What to do if your tooth gets knocked out

Teeth: Milk not necessary

If a tooth falls out, it’s important to keep the ligament trailing off the end of the tooth moist. But the old wives’ tale about putting the tooth in a glass of milk is wrong, says Dr. Kimberly Harms, a spokeswoman for the American Dental Association who practices in Farmington, Minnesota.

Rinsing the tooth with milk (or water) is a good idea, she says. Milk is useful not because of its calcium content, as many believe, but because it has a neutral pH, she says.

If you lose a tooth, say, at a ball game, and neither milk nor water is immediately available, “suck off the dirt,” she advises.

After rinsing, immediately put the tooth back in its socket. To make sure you’ve put it in correctly, bite down, and it should feel normal. “I’ve had patients put it in backward,” Harms says.

If for some reason, you can’t keep the tooth in its place, the second best option is to keep the tooth in between the gum and the cheek, she adds.

Then get to the dentist or the emergency room as quickly as possible. “The critical period is an hour,” she says. “The longer the tooth is out, the less chance of having a successful implantation.”

If your child loses a baby tooth, chances are the dentist won’t reattach it, but visit the dentist anyway to make sure the root of the tooth isn’t broken, Harms advises.

Here’s some advice about teeth that have suffered trauma from the National Library of Medicine. Parenting magazine has information about knocked-out baby teeth.

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Early Visualization Of Mucosal Diseases

VELscope® is a revolutionary hand-held device that provides dentists and hygienists with an easy-to-use adjunctive mucosal examination system for the early detection of abnormal tissue. The patented VELscope technology platform was developed in collaboration with the British Columbia Cancer Agency and MD Anderson Cancer Center, with funding provided in part by the NIH. It is based on the direct visualization of tissue fluorescence and the changes in fluorescence that occur when abnormalities are present.

How the VELscope Works
The VELscope handpiece emits a safe blue light into the oral cavity, which excites the tissue from the surface of the epithelium through to the basement membrane (where premalignant changes typically begin) and into the stroma beneath, causing it to fluoresce. Typically, healthy tissue appears as a bright apple-green glow, while suspicious regions are identified by a loss of fluorescence, which thus appear dark.
The clinician is then able to view the different fluorescence responses to help differentiate between normal and abnormal tissue. In fact, VELscope is the only non-invasive adjunctive device clinically proven to help discover occult oral disease.

Benefits Patients, Clinicians and Practice
When used as an adjunctive aid in combination with traditional oral cancer examination procedures, VELscope facilitates the early discovery and visualization of mucosal abnormalities, including oral cancer. In one or two minutes, with no rinses or stains required, a VELscope system examination helps healthcare professionals assess their patients’ oral health. Through the CDT code D0431, an increasing number of insurance companies are recognizing VELscope as an adjunctive screening device. VELscope combines minimal per-patient costs with more effective screening.



Rates of occurrence in the United States
Close to 36,000 Americans will be diagnosed with oral or pharyngeal cancer this year. It will cause over 8,000 deaths, killing roughly 1 person per hour, 24 hours per day. Of those 36,000 newly diagnosed individuals, only slightly more than half will be alive in 5 years. This is a number which has not significantly improved in decades.

Oral Cancer Death Rate
The death rate for oral cancer is higher than that of cervical cancer, Hodgkin’s lymphoma, laryngeal cancer, cancer of the testes, and endocrine system cancers such as thyroid, or skin cancer (malignant melanoma). If you expand the definition of oral cancers to include cancer of the larynx, for which the risk factors are the same, the numbers of diagnosed cases grow to approximately 50,000 individuals, and 13,500 deaths per year in the US alone. Worldwide the problem is much greater, with over 640,000 new cases being found each year.

The death rate associated with this cancer is particularly high not because it is hard to discover or diagnose, but due to the cancer being routinely discovered late in its development. Often it is only discovered when the cancer has metastasized to another location, most likely the lymph nodes of the neck. Prognosis at this stage of discovery is significantly worse than when it is caught in a localized intra oral area. Besides the metastasis, at these later stages, the primary tumor has had time to invade deep into local structures.

A Treacherous Disease
Oral cancer is particularly dangerous because in its early stages it may not be noticed by the patient, as it can frequently prosper without producing pain or symptoms they might readily recognize, and because it has a high risk of producing second, primary tumors. This means that patients who survive a first encounter with the disease, have up to a 20 times higher risk of developing a second cancer. This heightened risk factor can last for 5 to 10 years after the first occurrence.

The Cost of Oral Cancer
It is estimated that approximately $3.2 billion is spent in the United States each year on treatment of head and neck cancers

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