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All Posts Tagged: Complex Cases

Dental Implants Explained

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Dr. Jeffrey Field, HBSC, DDS, Fellow ADSA and Diplomat NDBA

In this month’s Teeth Talk article, Senior Dentist Dr. Jeffrey Field explains all you need to know about dental implants, demystifying the terminology and various modern treatment options available to help you restore your smile.

Dental implants are titanium screws that replace missing teeth, or can be used to help anchor dentures more securely.

There are many options for missing teeth including dentures, porcelain bridges and implants.

Dentures are pieces of plastic or plastic and metal composites that look like teeth but that is where the approximation ends. They will never be as functional as your natural teeth, because, unlike your natural teeth dentures are not anchored to the bone.

Partial dentures have clasps on existing teeth to help hold the denture in place, but the dentures still can and do move with eating or speaking.

Full dentures are used when patients have no teeth. They rely suction between the denture and the empty gums to hold them in place. So as you can imagine, full dentures are not very secure during eating and talking.

A bridge is used to replace missing teeth where there are still teeth present on either side of the empty space. In this case the teeth on either side of the space are prepared for crowns, which means they are cut down in all dimensions. The crowns on the end teeth are attached to fake porcelain teeth in the middle, thus replacing the missing teeth. The problem is that crowns are meant to rebuild very damaged teeth. Often to provide a bridge we must cut down perfectly or relatively healthy teeth, thus permanently damaging them. Once a bridge is placed, over time you get recession of the gums or decay/cavities on the margins of the crowns, necessitating replacement of the bridge. As such the teeth your bridge are attached to get longer and less aesthetic over time. The gum recession and or cavities continue until you lose the  teeth that the bridge is attached to. So now you have lost 3 teeth minimum (the two end teeth plus the original missing tooth).

An implant is a free standing (does not rely on other teeth for support) and so if it fails you still have only lost one tooth unlike a failed bridge where you lose several teeth. Implants are titanium screws that are placed in the bone. Implants can be used to support crowns for single to multiple teeth or as bridge supports for longer spans of missing teeth. For patients missing all teeth in the upper, lower or both arches, implants can be used to help secure full dentures and make them more stable (move less).

If you would like to explore how dental implants could help your particular dental situation, please book a no obligation consult with Dr. Field or Dr. Antonoff to discuss your options.

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What You Need to Know About Wisdom Teeth

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Dr. Jeffrey Field, DDS HBSc

In this month’s Teeth Talk article, Senior Dentist Dr. Jeffrey Field explains what you need to know about wisdom teeth, including the risks and considerations regarding wisdom teeth removal.

Why should I get my wisdom teeth removed?

There are a number of valid reasons to remove wisdom teeth:

1) They are not functional. Studies have shown that most of chewing is done on the second bicuspid and first molar. That is we do not use our second molars let alone our wisdom teeth (third molars) to chew.

2) There is not enough room in the dental arch to allow them to completely erupt (fully emerge). As they remain partially submerged(partially impacted) they are very prone to recurrent infections. With each subsequent infection more and more jaw bone is destroyed, which in turn leads to a greater potential for re-infection and the cycle of infection after infection continues.

3) They are so far back in your mouth that you can’t properly clean them, leading to both dental decay(cavities) and periodontal diseases(gum infections)

4) They are growing close to nerves in the lower jaw and your sinus in the upper jaw. All teenagers should be assessed for wisdom teeth between the ages of 14-16 years old. Assessment at this age allows the dentist to see if wisdom teeth are present, their position, and likelihood of normal eruption. If any problems are noted, then this is the best time to remove them. The reason is, at this age the wisdom teeth will not have developed much of their roots and you can greatly decrease the chance of either nerve damage or damage to the sinus during their removal. If you wait till the person is 18 years old or older, the roots will be fully developed are therefore increase the risk of nerve or sinus damage.

What are the risks of having wisdom teeth removed?

For lower wisdom teeth there is a nerve that exits your brain in front of your ear and behind the jaw bone. This nerve provides feeling but no motor function to structures it innervates. The nerve splits into 2 pieces. One ends up supplying feeling to your lower lip and chin, but does not make your lower lip and chin move. So if this nerve is damaged your lip won’t droop in fact you will look no different, but you can have numbness to the lower lip and chin. This occurs in one patient out of every 5000 treated. The second branch of this nerves innervates the tongue supplying feeling and taste sensation to the side of the tongue. Numbness and loss of taste sensation can occur in one patient out of 15000 or 3 times less likely to occur than damage to the nerve to the lower lip and chin.

For upper wisdom teeth there are no nerves in the area, however upper wisdom teeth are close to the maxillary sinus (the air space under your eye that gets stuffed up when you have a cold. The risk is that extraction of upper wisdom can lead to an opening into the sinus. This is not a big issue and can be closed at the time of extraction. The only downside is that if this occurs you should not blow your nose for one month, just squeeze and wipe.

Where should I have my wisdom teeth removed?

Wisdom teeth can be removed either in a hospital operating room or in the dental office. In hospital you will have a general anesthetic and in the office you can either sedation plus local anesthetic (numbing) or just local anesthetic. However, except for the simplest of extractions we do recommend sedation for your comfort. Please see the information on general anesthesia versus sedation.

If you have questions about your wisdom teeth or that of your children, please book a no obligation consult with Dr. Field or Dr. Antonoff to discuss your options.

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Explore the Benefits of Intravenous Sedation

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Dr. Jeffrey Field, DDS HBSc

Is fear holding you back from getting the dental treatment you know you need? If so I can help. My name is Dr. Jeffrey Field and I have been providing dental sedation for 27 years.

Sedation will allow you have complicated and/or long dental treatments, as well as dental surgical procedures performed, while you drift in a dreamlike state. For most patients it will seem that no time has passed while your dental work has been completed.

Many patients ask how sedation differs from general anesthesia. Experientially for most patients there is little difference in that in both you have an intravenous line placed, through which medications are administered and you are sedated/become sleepy and the procedure is completed, often with you having no memory of the procedure.

The difference in fact is more technical.

With general anesthesia you are given larger doses of some of the same medications that are used in sedation as well as additional medications (general anesthetic gases and paralyzing agents) not used in sedation. You become deeply unconscious to a level that your breathing must be maintained by a machine. The additional medications used for in general anesthesia are the major causes of post-operative nausea and vomiting and have been associated with serious allergic reactions. Happily, none of the additional medications are used in sedation.

Finally, but less importantly patients having general anesthesia must arrive hours prior to their procedure and stay for usually several hours afterwards.

Sedation, in contrast has you drifting in a dreamlike state where you breathe on your own and your protective airway reflexes are intact. As such, you do not need to be intubated and breathe on your own. Sedation uses no general anesthetic gases or paralyzing agents and so post-operative nausea and vomiting are usually not an issue. As well, serious allergic reactions are far less common with sedation than with general anesthesia.

Sedation is a safer alternative for most dental procedures. This is not to imply that general anesthetics in trained hands are not safe, it is just they are not necessary for most dental procedures.

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With sedation you arrive 15 minutes prior to your procedure and go home about an hour afterwards.

If you feel intravenous sedation can be of benefit to you. Please call or send a website enquiry for a no obligation consultation with Dr. Jeff.

If you have any questions that you’d like to personally direct to Dr Jeff, please don’t hesitate to email: drjeff@lifestylesmiles.com.au

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