Niagara Dental Implant & Oral Surgery

Wisdom tooth pain and treatment

Where does wisdom tooth pain come from?
Wisdom tooth pain can be caused by many factors. Most adolescents don’t even know that they have wisdom teeth until movement of the tooth begins and some of the tooth breaks through the gum overlying the wisdom tooth. This can cause a teething like pain that can be intermittently troublesome to many patients experiencing this. Other patients may experience a dull ache or pressure like feeling in their jaw or near their ear and still others may have vague facial pain or headaches that come and go. Although these other vague symptoms may have other causes, impacted wisdom teeth, especially in the adolescent, can be a major source of face/jaw pain and discomfort.
Who should I see first in the event that I have wisdom tooth pain? Many patients see their general dentist first because that is to whom they have easiest access. Also, your dentist would be the best person to determine if your pain could be coming from another source, such as an adjacent tooth or your jaw or facial muscles. However, if you cannot get in to see your dentist in a timely fashion or you have already been told by a dental professional that your wisdom teeth could be the source of your pain you may call an oral surgeon’s office directly to schedule an appointment for a consultation.
Who is the best person to remove my wisdom teeth? Although any licensed dentist is trained to remove wisdom teeth only oral and maxillofacial surgeons have been specifically trained to manage the most difficult of situations. Also, they are able to provide adequate anesthesia for you in an office based setting because oral and maxillofacial surgeons are uniquely trained in the administration and delivery of general anesthesia. Many oral and maxillofacial surgeons focus their practice largely on the management of impacted teeth.
When is the best time in my life to remove wisdom teeth? The best time to remove wisdom teeth is between the ages of 14 and 25. The reason is simple. It is the time in a person’s life where this procedure has the least risk associated with the procedure. The risks that we discuss with all patients are the risks to a nerve that courses below the lower wisdom teeth and supply sensation to the lip, chin, gums and cheek on the same side as the wisdom tooth. If injured during the procedure, this can lead to a temporary numbness in these areas which in rare circumstances can be permanent. Other less serious complications are exposure of the sinus cavity that sits above the upper wisdom teeth and healing times which are typically prolonged in older individuals.
Should I be worried about losing movement in my face after the surgery if a nerve injury is encountered? No. The nerve that lies below the lower wisdom teeth only supplies sensation (feeling) and does not move any part of your face.
Should I remove my wisdom teeth even if there is no pain? Well that depends. If you are under the age of 25-30 then the answer is usually yes.  The reason, it is a less complicated procedure that will have effects on your oral and dental health. Also if your wisdom teeth give you problems later in life it will likely become a more complex procedure. If you are over the age of 30 then the reasons for your having the procedure become more important. If it is simply because you didn’t have time in your life until now then this is probably not the best procedure for you. However, if there is a problem with you wisdom teeth such as pain, or an asymptomatic infection or decay in the teeth then you could be a candidate for this procedure.

What can I expect after the procedure? Most post operative courses are approximately 5-7 days in duration.  You can expect to resume your usual daily activities and go back to work or school in this period of time.  Because everyone heals differently this is just an estimation.  Some may take a few days more and some can even take a few days less.  Typically, the older you are the longer it will take to heal.

When should I schedule for the procedure to be done?   The beauty of this procedure is that, unless you are experiencing severe symptoms, it can be scheduled at your leisure.  Most people tend to schedule the procedure around holidays, long weekends or school vacation.  This gives ample time for healing and your loved ones can be sure to be available to help you.

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Minimally invasive oral surgery

What is a minimally invasive surgery?
Minimally invasive surgery is surgery that reduces trauma to the body.

What are the advantages of minimally invasive surgery?
Smaller incision which are used will lead to faster recovery times, less pain, swelling and scarring and in many cases less post operative complications.

How does minimally invasive surgery in the mouth work?
Similar to other types of minimally invasive surgery, minimally invasive oral surgery uses smaller incisions and leads to less tissue trauma which in turn leads to shorter healing times and less post operative pain and swelling.

Can anyone perform minimally invasive surgery?
Yes anyone can, but not everyone does. The reason is that only surgeons that are intimately familiar with tissue handling (i.e. the texture, feel, resiliency, elasticity) would be most successful in performing minimally invasive surgery. In order for minimally invasive surgery to be successful the surgeon must have a higher degree of mastery of the surgical anatomy and surgical procedure. This level of mastery comes with time and experience.

How do I know if my dentist/surgeon has achieved the level of mastery to perform procedures in a minimally invasive manner?
Well, for starters you can simply ask. Also, certain surgical specialties have a better understanding of face and jaw anatomy.

Which surgical specialties have a this type of knowledge and experience? As you may have guessed Oral and Maxillofacial surgeons have the greatest understanding and experience of jaw and face anatomy.

Are oral surgeons the only specialty with this type of experience and understanding?
While oral surgeons by far have the most experience they are not the only dentists that might be able to perform minimally invasive surgery. Other dentists or dental specialists are periodontists, some prosthodontists and some well trained general dentists that have focused their practice to the art and science of oral surgery.

What kind of procedures qualify for minimally invasive surgery?
Procedures that lend themselves to a minimally invasive approach are routine surgical extractions, extraction of wisdom teeth, placement of dental implants, bone grafting/ tissue regenerative procedures (i.e. sinus lift procedures, ridge augmentation, and gum grafts).

Is every patient a candidate for minimally invasive surgery?
No, not every patient or every site can be treated in a minimally invasive manner. Although any good surgeon will do what he or she can to minimize trauma to the tissue, not every procedure for every patient would qualify for a minimally invasive approach.

What factors determine if a patient or procedure is amenable to a minimally invasive approach?
There are at least a couple of determinants for this. Anatomical variations would rank high as would the anatomical site and anticipated result.

What do you mean by this?
For instance, some patients simply lack too much bone and would need extensive grafting of bone. This would necessitate making larger incisions where tissue trauma becomes a secondary consideration and obtaining sufficient bone for implant placement becomes the primary consideration. Also, a wisdom tooth may be severely impacted with close association to a nerve or other anatomical structure which would then make the minimally invasive approach take a back seat to successful completion of the surgery.

Would my surgeon be able to tell me in advance if a minimally invasive approach would be appropriate for me?
Yes, in most cases once your surgeon has evaluated all of the diagnostic data (physical exam, radiographic imaging [x-rays, ct scans]) he or she should be able to give you an idea if a minimally invasive approach would be right for you.

Is there a chance that this could change during the procedure?
Yes, there is a chance that this could change if some unforeseen situation occurs. Ultimately, your surgeon should have your best interest at heart and will do what is necessary to get you the best result possible.

Standard Dental implants vs Mini Dental Implants

If you live in the Buffalo area you’ve probably heard of mini dental implants. Many patients come to our office and have many questions such as what is a mini dental implant and how is that different than a standard dental implant. I will surely answer this and any other questions that you may have around this.
What is a mini dental implant (AKA MDI)?
A mini dental implant is an extra narrow titanium screw that is meant to integrate to bone provide support for a prosthetic. Usual diameters are less than 2.9 mm.
What is a standard or conventional dental implant? A conventional or standard dental implant is a root form titanium screw that is meant to integrate to bone to provide support for a prosthetic. Usual diameters are anywhere from 2.9 mm to 5.8 mm.

What are the differences between an MDI and a conventional implant?
Other than the obvious differences of diameter and the mechanical problems that can be associated with withstanding stresses, MDIs and standard dental implants have different connections between the implant and the restoration. The weakest link in the chain of implant and restoration is connection between the implant and restorative part. In a conventional implant there is an intermediate part called an abutment. The abutment connects directly to the implant via an internal hexagonal shaped connection that resists rotation. Additionally it connects to the implant with a screw that is torqued to manufacture specification, which is usually about 30 Ncm^2.. Finger tightness is nowhere near this torque pressure. This secure connection then serves as the base on which the crown is cemented. Sometimes the crown and abutment are fabricated in 1 piece. However in this case the 1 piece is screwed in to the implant through the internal hex connection.
MDI’s on the other hand have no such internal connection. Because of their narrow connection they can only accommodate a connection on the outside of the implant. Usually the implant has a small ball on the top with which it attaches the crown.

Is one type of implant superior to the other in the case of single tooth restoration ?
Yes, the standard implant is superior because of the superior connection of the restoration to the crown. The external (or ball to crown) attachment of the MDI is inferior and can lead to failure by way of fracture, micro-movement (torsion/or twisting of the crown on the implant) or loss of the restoration due to inadequate retention.

Why do they make MDIs? MDIs have long had a role in retaining removable dentures in cases where inadequate bone is present or cost is a factor. The ball design of these implants make them a good candidate for retaining removable dentures while there narrow design make them good candidates for placement in narrow jaws without the need for bone grafting.

Do you place MDIs? No, we here at Niagara Dental Implant & Oral Surgery do not place MDIs.  In cases were MDIs would work we are able to either place a narrow 2.9 mm or 3.0 mm standard implant or grow bone by way of grafting to accommodate a standard implant.

Why don’t you place MDIs in cases where they might work?  Because of their inferior mechanical qualities we do not feel that these implants would be the best implants to place.  Also, sometimes patients may want to change the type of restoration  that is supported by the implant.  In the case of MDIs that would be very difficult.  In fact, it would require removal of all of the mini dental implants and replacing them with standard or conventional dental implants.

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How to limit your risk of tooth decay

Most people don’t realize it but tooth decay is a disease of modern times. That’s right! thousands of years ago humans did not suffer from dental caries or more commonly known as “tooth decay”. Bacteria in your mouth that are normal inhabitants are what cause tooth decay and when conditions are right they attack the enamel of your tooth literally dissolving the enamel and create a home for themselves in your tooth. Soon the numbers of those bacteria increase and they eat more and more of your tooth.
So ultimately you can’t really get rid of all the bad, decay causing, bacteria in your mouth because they naturally live there. But what you can do is control the conditions so that they [the decay causing bacteria] are present in low numbers. Things you can do to prevent control oral conditions to reduce your risk of tooth decay:
1. limiting your sugar intake
2 Reducing or eliminating consumption of sports drinks, soft drinks and energy drinks
3. limiting consumption of processed foods
4. Eating foods that not processed and qualify as probiotics
5. Daily oral hygiene i.e. brushing and flossing your teeth
6. Routine dental care at your general dentist (this means a minimum of 2 yearly check ups and cleanings)

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Congrats…

….to Nikki Manhardt DAANCE certified oral surgery and anesthesia assistant  for completing and passing her ACLS certification.

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