Saturday, September 25, 2010

Impacted Wisdom Teeth

Q: Do all impacted wisdom teeth need to be removed?  R.R. in Burbank

A: Dentistry is a funny business, with most body parts, doctors would recommend that you should keep them as long as you can.  However, when it comes to impacted wisdom teeth, molars buried under the gum and bone, you may want to consider having them removed as they can cause problems with your teeth and jaw.

Impactions can result in infection, decay of adjacent teeth, gum disease/bone loss and the formation of a cyst or tumor. If you are considering any specialty dental work you may find that your doctor will want them removed. Many orthodontists will want them out before starting braces on the teeth to allow for room in the mouth to correct crowding.

The younger you are when you have them removed the better because of  “softer” surrounding bone in the young jaw. We simply heal faster when we're younger.

Monday, September 20, 2010

Bone quality key in procedure for implants

Q: My friend’s dentist placed a dental implant and attached a temporary crown in the same visit. I now need an implant, but my dentist says I have to wait 4 to 6 months after the implant is placed before he can attach a crown. Why the difference in treatment methods?... Marla in Glendale

A:  Excellent bone quality indicates the ability to load the implant immediately with a temporary crown. Poor bone quality requires time for “osseous integration” which allows your own bone to thoroughly bond to the surface of the titanium implant. Most patients are limited from receiving an immediate temporary at the time of surgical placement of the implant due to bite interferences, oral habits and non-compliance in hygiene.

Wednesday, September 15, 2010

New Crown after Root Canal Treatment

Q: Do I need a new crown after a root canal is done through my old one?
V.S. in Eagle Rock

A: Yes and no. (There. That narrows it down!) If the crown or bridge was recently made and upon examination and digital X-ray evaluation it appears sound, a permanent filling (called a core build-up) can be bonded into the hole.  However, if the crown or bridge is old and shows leakage, decay, fractures or excessive gum recession, it is better to make a new one.  Statistically, the number one cause of an abscess is   “coronal leakage”: the washing out of cement over time, allowing decay to form underneath the crown, infecting the nerve canals. As in medicine, there is no harm in seeking a second opinion to help you make the decision.

Thursday, September 9, 2010

Trismus Prevention

Q: After having what I thought was routine crown-work on my lower back teeth, the following day I could barely open my mouth to eat. What did the doctor do to me?!!.........Phil in Canoga Park

A: Chill, Phil. You’re scaring me with those two exclamation points. One I can take, but two sends me to the shrink. Often after mandibular block injections, required to anesthetize the back lower teeth, the common side effect “trismus” occurs. (In your case, it’s “trismus in July”.) Often multiple injections are needed to numb these posterior teeth due to a tricky network of nerves that must be reached.  Limited opening, muscle spasms, stiffness and pain. This is caused by inflammation of the muscle fibers, hemorrhage into the muscles of mastication or low grade infection. This will all go away.  In the mean time, your dentist might recommend warm compresses, 800mg of Ibuprofen, muscle relaxants (Flexeril, Diazepam), salt water rinses, antibiotics, and in severe cases, a steroid such as Methylprednisone. Complete recovery can take several weeks.