Why Dentists Use Mini Implants by Douglas Urban, DDS

By now most everyone is aware of dental implants and their place in dentistry. Titanium implants are used throughout the skeletal system to replace hips, knees, etc.  In dentistry large body titanium implants are now the number one alternative for replacing extracted teeth. However, large body implant dentistry is a significant financial investment and many people choose other alternatives like fixed bridges, removable bridges, or just leaving the gaping holes unrestored (what a shame) for financial reasons.

Another class of implants is the small diameter (about a tenth of an inch) or mini implant. How and why are mini implants used in dentistry? For years these implants have been used in narrow spaces too small for standard sized implants, other anatomic restrictions, to retain removable bridges and dentures, or for cost savings. I will focus on denture appliance retention and cost savings.

Mini implants are excellent for keeping dentures and partial dentures from flopping around in the mouth. They eliminate the need for adhesives while allowing the denture to literally snap onto the implant attachment. The denture appliance stays put until it is removed and cleaned. Sometimes mini implants are used as temporary stabilizing anchors during prolonged dental treatments or orthodontic correction. They can be removed with quick healing of the implant site.

Mini implants are about half the cost of the larger diameter implants and can be placed by most trained dentists in one visit. Often the denture can be immediately attached to the implants. How are they placed and what should I expect afterword’s?

Implants are placed after carefully planning the proposed implant sites. Although one is wide awake the area is locally anesthetized (like for fillings) and pilot holes placed. The receptor area usually has no feeling after the gums are numbed. The implants are directly threaded into place, placement angles confirmed, and the attachments placed on the implants. Since I do not peel away the gum tissue there is little soft tissue invasion sutures are not needed. The gums around the implants will be tender for a day or two until healing begins. Tylenol or Advil may be taken.

If the implants are secure enough your dentist will be able to convert your “removable denture” into a “retained denture” at the same time. This is a wonderful choice for people unable to afford fixed implant/bridgework, elderly or medically compromised individuals, and younger active denture wearers who like to scuba dive or surf.

ROOT DECAY by Dona Fujioka, RDH

Dona is one of our three hygienists. She has been here since 1996.

 

            Have you noticed any discoloration of your teeth along the gumline?  Have you felt any gumline sensitivity?  These are some of  the signs that may tell you that you have a cavity along the gumline.  Caries along the gumline are prevalent with people who have gumline recession.  Recession exposes the root surfaces, which is covered with cementum.  Cementum is more vulnerable to cavities because it has less mineral content and more soluble. Roots have no enamel covering, therefore, making it more susceptible to cavities.

            There are several risk factors for root decay.  One is xerostomia or dry mouth.  Dry mouth causes a higher risk for periodontal disease and cavities.  Normal saliva helps protect our oral health.  Without saliva, the mouth is lacking the natural enzymes that is necessary to help neutralize the pH in the mouth.  Some signs and symptoms of xerostomia are dry burning mouth and throat, difficulty swallowing, and dry, cracking lips.  Dry mouth is a common side effect of taking certain medications and there are over 500 medications with xerogenic side effect.  Another risk factor is root exposure due to loss of gingival tissue attachment from periodontal disease, abrasion due to hard brushing, and recession caused by aging.  The root becomes vulnerable to bacteria and demineralization once the surface of the root is exposed.  Physical limitations is also a risk factor.  Ineffective oral hygiene results in increase plaque accumulation and tartar build-up. 

            Root caries can be prevented through thorough examination and patient assessment.  Through implementation of chemotherapeutic aids, nutritional counseling, oral hygiene instructions and  patient education, risk for root decay can be reduced.  Prescription fluoride paste, in-office fluoride application and remineralizing products that contain calcium phosphate are some of the products recommended to prevent decay. Chewing gum with xylitol (as its main ingredient), saliva substitutes (such as gels or sprays) and sugarless candies are some strategies to help stimulate salivary flow for those experiencing xerostomia.  With all these preventive methods, progression of current root decay, or development of new lesions can be delayed.

           

The Empowered Dental Patient by Douglas Urban, DDS

In my career I have encountered all types of people who needed dental work. I think most dentists really enjoy the interaction with their patients when presenting treatments. I am referring to the type of person who asks questions and understands what service is being provided and why.

In dentistry as well as medicine there are always treatment options. They may range from doing nothing to complete reconstructions. All alternatives have consequences. It is up to you with the advice of your dentist to weed through the consequences to determine the best course of action.

First, let’s look at periodic cleanings. I am not sure exactly where the “see your dentist every 6 months” originated. It could have been from a toothpaste commercial. Regardless, every person presents with different dental problems that may require dental cleanings every 12 weeks or once a year. This should be discussed with your hygienist and dentist and consequences should be weighed when arriving at a treatment option.

Second, let’s review x-ray frequency. I recommend some of my “high cavities” patients have check-up x-rays every six months. Depending on risk of decay or examination of recently placed dental work I will advise check-up x-rays every year. Complete x-rays should be acquired every 3-5 years. Once a person has demonstrated a good maintenance record and stable dental health radiographs can be less frequent and more regular.

Third, I want to consider the missing tooth. Believe it or not back teeth are important too. A missing molar can lead to other teeth drifting into the unoccupied space resulting in an unstable set of teeth. With continued drifting the bite can collapse and place more pressure against the front teeth. These in turn will spread and start showing gaps where no gaps existed. For this reason I will recommend replacement of missing teeth. Replacement alternatives include doing nothing, placing a removable bridge, placement of a fixed bridge, and placing an implant. Each treatment option carries a different prognosis and cost and should be discussed with your dentist.

Last, we should not look only at treatment options, but also the length of treatment. I have completed extensive treatment in just a few appointments within a month’s time. Likewise, I have provided similar treatments over the course of many years. Tailoring treatment sequence and duration should be openly discussed when making financial arrangements.

All treatments have inherent life expectancies. As a kid I thought a filling would last forever. Although they last a long time fillings do eventually cease becoming a good restorative solution and should be replaced. In fact most dental work later in life is usually replacement of previous dental work.

Feel free to ask questions and get involved with your dentist. Expectations are easily met when we know exactly what to expect.

Teeth in a Day? by Douglas Urban, DDS

 Radio and TV advertisements claim that you can walk in the dental office in the morning with decayed, loose, and rotting teeth and walk out in the afternoon with new permanent teeth. What is this? How does it work?

First, let’s figure out who is a candidate for this treatment. Obviously, those with loose rotten teeth that have become stained and crooked over time would be the best candidates. However, suppose you have been wearing removable bridges hooked onto the front teeth. Now those front teeth are no longer able to take the brunt of holding bridges, withstand chewing food, and to provide an appealing smile. Is it worth expensive dental treatment to fix up what is left and have another set of removable bridges only to have the teeth fail completely in a few years? I cannot answer that question, but I can suggest an alternative.

Teeth in a day basically involves preplanning a restorative option that includes removing all the remaining teeth in the lower or upper jaw, placing 4-6 permanent implants, and securing a fixed full bridge over the implants at one sitting. This bridge does not come out, allows for strong chewing, and the teeth are brushed as usual. There is no denture adhesive needed, no altered taste, and teeth do not come out when brushing. Visits to restaurants are routine and those live active life styles like surfing and swimming are no longer fearful of losing their removable teeth.

Usually, the “teeth in a day” procedure involves coordination with your dentist, surgeon and laboratory. Your dentist will guide you through this process and make recommendations based on the amount of dental destruction that has gone on in the mouth. Then the dental team will get records (like photos, models, examination) and plan on a path of action. Once teeth are removed, implants placed, and bridge secured there is a rest period of 4-6 months for healing. Then your dental team will manufacture a stronger bridge for secure long lasting wear.

So teeth in a day can happen. It may take a few visits to have everything ready for the big day. It is a good idea to plan for a few follow-up visits to insure a good long term outcome.

Costs will vary so ask your dentist about the affordability of this process.

Is There a Correlation Between Rheumetoid Arthritis and Periodontal Disease?

Obstructive Sleep Apnea and Snoring

Does it seem like you go to bed early, get your eight hours of sleep and still feel tired? Perhaps you are not getting the sleep you think you are. Many of us suffer from obstructive sleep apnea or OSA.

Sleep apnea literally means sleep without breathing. Try holding your breath 10 to 60 seconds thirty or more times an hour. Without our awareness this can happen when we are asleep. Over time this can lead to hypertension, heart disease, weight gain, depression, diabetes, impotence, GERD, liver disease, memory dysfunction, strokes, and death. As a concerned health provider I decided to see if I had sleep apnea and, if so, what remedies existed to treat this silent killer.

I recently tested an “at-home device” for diagnostic screening of sleep apnea. This device slips onto your finger tip and measures pulse and oxygen levels while you sleep. It was discovered that during my sleep cycles my blood oxygen levels were dropping below acceptable levels and my heart rate climbed to the high eighties. I suspected I had a problem when I would awake several times a night without any reason. My dentist recommended a sleep study test at a sleep laboratory and I complied. The sleep lab is very similar to a nice hotel room except the technician affixes monitoring cables to your legs and head to measure such things as random limb movements and REM sleep cycles.

The results showed a mild sleep apnea condition existed so I returned to run another test that included the assistance of a breathing device called a CPAP machine that would exert positive air pressure when I inhaled. This made breathing a lot easier although the CPAP would occasionally dislodge if I rolled over on my side. Regardless, I saw positive results with REM sleep patterns and higher oxygen blood saturation levels. The only problem was finding a more comfortable alternative to the CPAP mask.

Not to be deterred an oral device was ordered for me to help keep my jaw from falling back into a slack position and blocking my airway. Although I have prescribed these devices for many years I have not had a reason to wear one. I have not yet had a third sleep study done to monitor the success of the device, however I have been told that I don’t snore much anymore. These dental devices can be effective in keeping the jaw in a more forward position to allow good breathing and good sleep. They are small and portable and do not make any noise that would keep others awake in your room. The fees range from $500 (for light to moderate snoring) to $2500 (for mild to moderate OSA).

As with any device made for OSA it is highly recommended that a follow up sleep study test be performed to gauge the effectiveness and make any adjustments that are required.

How Do I Get A Cavity? by Dona Fujioka, R.D.H.

Dental caries (cavities) stems from a dental disease that can be prevented. With the combination of biofilm (dental plaque) and fermentable carbohydrates, with an acidic (low pH) environment in the mouth, dental caries occur.

Tooth surface goes through a process of demineralization (mineral loss) and remineralization (mineral gain) several times a day. When dental plaque is present, its presence creates a condition of unsaturation and supersaturation. Unsaturation occurs during acidic conditions (low pH) in the biofilm when there is less minerals present. This is common in the presence of fermentable carbohydrates. Supersaturation happens when there is an increase in minerals (from saliva or calcium fluoride formulations) and an increase in pH due to reduced or lack of fermentable carbohydrates present or different buffering systems. The increase in the saturation level stops the mineral loss of the enamel and allows minerals to return to the partially demineralized enamel. This process is essential in the development of a cavity. A cavity develops when more minerals are lost than gained during the demineralization and remineralization process. The good news is that an early carious lesion (cavity) can be stopped as long as it is non-cavitated.

Non-cavitated carious lesion can be reversed in several ways; decreasing the amount of dental plaque, reducing the frequency of carbohydrate ingestion and increase in the amount and concentration of fluoride.

Understanding the disease process rather than just treating the condition is a better way of looking at dental caries. With a better understanding, it allows for a preventive approach, especially for those who are at high risk.