Let's Talk About Dental Implants! By: Dr. Dennis Rothschild

Lately, the most common question I have been asked is about Implants! Are they right for me and how long do they last? So today I am going to answer some of those questions for you!

A dental implant is an artificial tooth root that is surgically anchored into your jaw to hold a replacement tooth or bridge in place. The benefit of using implants is that they don't rely on neighboring teeth for support and they are permanent and stable. Implants are a good solution for tooth loss because they look and feel like natural teeth.

The quest to replace lost teeth is not a modern one. There is evidence of tooth replacement that dates back to 400 BC in the accent city of Sidon. It was not until the 1800's that gold alloys were surgical placed into the bone but in 1937 the first modern Implant was placed to replace a lost root. There has been many different transformations in technique and alloys over the past 80 years to give us the predictability be have today in modern Implantology. 

Today implant material is made from different types of metallic materials that are compatible with body tissue. There are different types of dental implants: the first and most common type of dental Implant is placed directly into the jaw bone, like natural tooth roots; the second is used when the jaw structure is limited, therefore, a custom-made metal framework fits directly on the existing bone.

How do they work?

Strategically placed, implants can now be used to support permanently cemented or screw retained bridges, eliminating the need for a denture. The cost tends to be greater, but the implants and bridges more closely resemble real teeth.

Can anyone receive dental implants?

To be an implant candidate you must be in good health, have the proper bone structure and healthy gums for the implant to stay in place. People who are unable to wear dentures may also be good candidates. If you suffer from chronic problems, such as clenching or bruxism, or systemic diseases, such as diabetes, the success rate for implants decreases dramatically. Additionally, people who smoke or drink alcohol may not be good candidates.

What can I expect during this procedure?

If you have a tooth that has failed then it will need to be removed. The next step is based on your bone support.  When it comes to predictability with implants it is all about bone. Both quality and quantity are needed.  Traditionally the space (socket) where the tooth was removed is grafted with bone to allow the body to heal and grow a strong foundation. This process can take 3- 12 months. Then the surgery to anchor the implant "artificial root" into or on your jaw is completed. The procedure is done in the dental office with local anesthesia. The gum is then secured over the implant, which will remain covered until the implant fuses with the bone. The dentist then uncovers the implant and attaches an extension, or post, to the implant. Most patients today want to never go without a tooth so the push to meet this need is to shorten the healing times. There have been procedures designed to place the implant in the space (socket) the root left when it was removed. This is defined as an immediate implant but with any compromise you always give up some predictability.  With immediate implants there are many factors to consider and is not always your best option.

How long does the process take?

The process can take up to 12 months to complete. Each patient heals differently, so times will vary. After the implant and posts are placed surgically, the healing process can take up to six months and the fitting of replacement teeth no more than two months. Sometimes, if a patient has good bone quality, posts can be placed and replacement teeth fitted in one appointment.

What is the success rate of implants?

The success rate for implants depends on the tooth's purpose and location in the mouth, as well as a patient's overall health. Today, depending on which study you are reading, implants success rate are well above 90% at ten years which is significantly higher than any other dental procedures.

How do I care for implants?

Poor oral hygiene is a big reason why some implants fail. It is important to floss and brush around the fixtures at least twice a day. Your dentist will give you specific instructions on how to care for your new implants. Additional cleanings of up to four times per year may be necessary to ensure that you retain healthy gums.

What is the cost of implants?

Since implants involve surgery and are more involved, they cost more than traditional bridgework. However, some dental procedures and portions of the restoration may be covered by dental and medical insurance policies. We can help you with this process.

Do I Need Dental X-rays? By Dr. Dennis Rothschild

A frequently asked question at our office is, “How often should I have x-rays taken and why do I need them?” This is a great question!

Dental x rays are one of the most important parts of maintaining good oral health because they give the dentist a picture of what is going on beneath the surface of the teeth. They also allow me to see what is going on between your teeth. Having x-rays taken regularly can diagnose and prevent serious complications that would otherwise go undetected. 

As a general rule of thumb, you should get a set of bitewings taken once a year, and a full mouth series (FMX), which includes 10 to 18 intra oral X-rays and one extra oral (panoramic) X-Ray once every 3 - 5 years.  Of course, if you are experiencing pain or other problems/concerns/suspicions in between x rays, additional ones may need to diagnose. In today’s blog I will explore the risk of radiation from dental x-rays and the factors that determine how often you need x-rays taken.

HOW MUCH RADIATION IS IN A DENTAL X-RAY?

You are exposed to low dosage radiation all day, every day and your body is designed to deal that exposure.  Media information often lumps all x-rays into one category, which leads some to worry about the exposer risks dental X-rays will add. 

The fact is that X-rays save teeth and lives by allowing diagnosis for dental disease at its earliest detection.  If as dentist we relied on visual or patient description alone your health would be greatly comprised. That being said, yes, dental X-rays use radiation to image the teeth and bones.

Unlike x-rays machines when we were young, modern digital x-rays are extremely low in radiation.  Let’s break this down so you can see why we use the term extremely low. When you are measuring radiation the measurements are in milliseverts (mSv).  To illustrate someone's normal daily exposure the Mayo Clinc put together data to compare the radiation from dental x-rays to the radiation we are exposed to everyday. Their findings are below:

Eating a banana                                0.1 mSv          

Average Year of Watching TV     10 mSv          4- Bitewing X-rays             0.038 mSv

 5 Hour Airline Flight                      25 mSv           Full mouth dental X-rays0.150 mSv

1 yr. living in a brick home              70 mSv

Avg Yearly dosage from food      400 mSv

 (Source BBC and MayoClinic)

As you can see a dental x-ray has the equivalent radiation to eating bananas! This is why we say that in comparison to exposure you have throughout a normal day to radiation, dental x-rays are extremely low.    

FACTORS THAT DETERMINE HOW OFTEN YOU SHOULD HAVE DENTAL X-RAYS TAKEN:

Do you have exisitng restorations or previous decay?:

The number one factor for determining how often you need dental x-rays taken is the amount of fillings or restorations you already have in your mouth. If you have multiple fillings or other dental restorations, you need to have x-rays taken more often. It is important not only to monitor the state of the fillings and restorations you have, but also to keep an eye on the surrounding teeth because you are more prone to decay.

Your Age:

Certain ages are more prone to specific complications, and therefore need to have x-rays taken more frequently to check for decay or other possible complications. An example of this would be around age 17 wisdom teeth usually come in, and need to be looked at through x-rays to see if they are causing problems and need to be removed. Also, children’s teeth are more susceptible to cavities and need to be x-rayed more often.

Overall Oral Health:

Plain and simple: Some people are more prone to cavities and/or gum disease. People that have shown that they are at a higher risk of getting cavities or gum disease need to have dental x-rays taken more often, to catch signs of these at the earliest stages possible. On the contrary, patients that have shown that they are not cavity-prone can go longer in between x-rays.

Previous Operations and Procedures:

Patients that have had serious oral surgeries or restorations need to keep a closer eye on what is going on with their oral health than others. X-rays not only detect cavities but also can detect other complications like bone degeneration that could be from previous extractions or other things. For example, patients with dental implants need to have x rays taken regularly to monitor any irregularities or changes.

Medications:

Some medications can cause dry mouth, and make you more susceptible to decay. Other medications can cause other complications to oral health, such as weaker bone. People taking medications that affect their oral health need to have x rays taken more often.

Location:

Unfortunately (or maybe, fortunately), where you grew up may influence how often you need to have x-rays taken. Some cities have higher amounts of fluoride in the water source, which has shown to promote oral health in those areas. If you grew up somewhere that fluoride wasn’t a part of the drinking source, you should get x-rays more often to keep an eye on decay.

Undergoing Cancer Treatment:

Having undergone cancer treatments is an important factor in determining how often you should have dental x-rays taken. Some cancer treatments such as chemo and radiation therapy can have negative effects on teeth and surrounding bone and should be monitored. Always let your dentist know what type of cancer treatments you have undergone so that they can plan your x-ray treatment accordingly and safely.

Fluoride - Not Just For Kids By Dr. Dennis Rothschild

I recommend fluoride for most of my patients, no matter what their age. When we were young the main use of fluoride was to protect teeth during development and eruption, but now research has shown that fluoride also helps protect erupted adult teeth in the battle against tooth decay.  

Professional cleanings remove all the plaque and debris, and leave your teeth shiny and bright, but unprotected.  This is the best time to apply fluoride to your teeth.  When nothing is in the way!  The evidence is clear that professional strength topical fluoride applications provide numerous additional benefits (beyond fluoridated water and toothpaste) for all adult patients, not just those with a moderate to high cavity risk.

 I know some of my patients express concern or confusion about fluoride, but when administered correctly I have witnessed the power of fluoride and its benefits throughout the last 15 years in my own practice.  Although most clinicians preach about the use of fluoridated toothpaste and fluoride rinses at home, in-office fluoride treatments and even prescription strength applications or toothpastes are often overlooked, especially if patients are over the magical age of 16. 

Consider the following when deciding if fluoride will be a benefit you:

• Are you taking medications that cause a dry mouth? A decrease in saliva can increase the risk for decay. Fluoride treatments can help reduce the risk of decay in this population.

• Do you have exposed root surfaces? Root surfaces are extremely susceptible to decay and decay can travel quickly through the root. Fluoride treatments can help make roots stronger and resistant to decay.

• Have you needed a tooth worked on due to decay in the past few years? If so, you are at risk for decay and delivering a fluoride treatment will reduce this risk.  

• Do you have crowns and/or bridges? Fluoride can help protect the margins of these restorations and potentially eliminate decay around the margins, which is the leading cause of bridge failure.

• Are you in Braces, wearing bonded brackets or bands? High concentration of fluoride can help keep teeth cavity free during orthodontic treatment or around permeant retainers after orthodontics is finished. 

• Have you undergoing or going to be receiving head and neck radiation? Radiation damages salivary glands, which causes an extreme reduction in salivary flow. Saliva is an important component in the fight against tooth decay. Without it, the risk for decay is extreme. This patient will benefit from fluoride treatments, and with most we will also put together a program for you to follow at home.

• Are you experiencing tooth sensitivity? Fluoride can help reduce the pain and discomfort caused by exposed root surfaces. Regular fluoride applications can help eliminate this sensitivity.

• How well do you keep up your brushing and flossing? Plaque on the teeth increases the risk of decay. Fluoride helps fight the decay process caused by high levels of plaque.

Something to Smile About by Dr. Dennis Rothschild

These days, lots of dentists 'specialize' in cosmetic work. But claiming it and performing it professionally are often two different things. For one thing, it's a highly complicated area of expertise—requiring not only technical skill, but a keen artistic eye for color, shape, balance, and size. Furthermore, it requires excellent doctor-patient communication, since changes in your smile will affect you either positively or negatively for the rest of your life!
We take these concerns seriously. That's why we've invested the training time and technology needed to provide real help for people wishing to enhance their smiles. For example, we use a highly specific photographic analysis procedure to diagnose and plan the entire case up front, keeping you involved with each step. We talk with you about all kinds of things you probably never considered, but which will impact your final look: your facial shape, your gumline arches, the position, color, shape, size and relationships of your teeth, and the overall look and balance of your smile. Then we take professional quality photographs, assemble a diagnostic wax-up of your entire mouth, and create a working model to demonstrate precisely what you can expect. And in all of this, we evaluate the plan for both function and appearance. The result is a smile that you always dreamed of!