Makeovers - Maybe It's Time to Smile

Posted by Dr. Edward Magida | Filed under , , , ,

The other night my wife was watching a reality TV show called "Extreme Makeovers". Don’t tell anyone but I was watching it also. This is a show where people start out as ugly ducklings and then are incredibly transformed into swans by the end of the show. This magic is done with the help of plastic surgery, fitness experts and cosmetic dentistry. This particular episode had a shy young woman named Amy who looked to be in her twenties. You could really tell that this woman had suffered in her youth from the teasing brought on by the way she looked. That problem about herself that bothered her the most was her teeth. She spent most of her life with oddly spaced, discolored ugly teeth. This problem affected her self confidence so much, that she rarely smiled or even spoke to anyone. Her cosmetic dentistry makeover consisted of porcelain veneers and teeth whitening. The porcelain veneers are thin shells of porcelain which are bonded to her existing teeth. The beauty of this procedure is that in one feel swoop, a dentist can correct color imperfections, size problems and also spacing issues. The veneers, being made of porcelain, appear perfectly lifelike and natural. They can lighten dark teeth, lengthen teeth shortened by the ravages of time, and straighten teeth for those people who might not have had the ability to get braces when they were younger.

This process was painless and the results were quickly seen. For her teeth that did not receive veneers, a bleaching process lightened them to match the veneers.
When Amy saw her teeth for the first time, she started sobbing. She just couldn’t believe the difference her teeth made in her overall appearance. Amy felt that just the improvement in her teeth alone would make a big change in her life. It gave her the boost in confidence she needed to get out and join the rest of the world. This young woman’s happiness was so evident and extreme, that my wife sat there with tears streaming down her face. My wife was amazed at the effect cosmetic dentistry had on this woman. I wasn’t surprised because I see it all the time. The advances in cosmetic dentistry have made it easier and more predictable than ever.

If you, or a family member or friend have been thinking about changing your appearance, consider improving your smile. Most people notice a nice smile on someone’s face above everything else. A nice smile will definitely improve a person’s self confidence. Who knows, this might also lead to a better job and a higher quality of life. Ask your dentist for an opinion about what can be done for you. You will be glad you did.

Do you have that "Long in the tooth look?"

Posted by Dr. Edward Magida | Filed under , , ,

Have you ever seen someone smile and it seems that their teeth are really long? You know what I mean. The teeth look like the teeth of a snarling dog, at least 50% longer than what they should be. Well, before you sign them up with Barnum and Bailey, you should realize that the teeth really haven't grown longer. Rather the gums have shortened. This can happen for many reasons. Because the gums no longer cover the roots of the persons' teeth, like they did years ago, the teeth appear longer. Many people have this condition called "gum recession". When it occurs in the front of the mouth, it can really make a persons smile seem older. When it occurs on the back teeth, it does not have that aging effect, but there are still problems that can develop. When the gums recede and the roots of the teeth are now exposed, the teeth can become more prone to tooth decay, due to the root surface not having any enamel on it. The exposed roots can also become more sensitive to hot and/or cold temperatures more easily.

How do your gums recede?. Healthy gum tissue attaches to the teeth near the bottom of the enamel part of the tooth. The gum tissue completely covers the necks of the teeth. There are certain instances when the gums pull away from the necks of the teeth. This condition is called recession, and it can happen in the following ways:

The most common way is for the gums to actually be worn away, because the person brushes their teeth incorrectly and/or too hard. You should only use a soft toothbrush to clean your teeth. Leave your medium and hard toothbrushes out of your bathroom. Perhaps your tool box is the correct place for them, to help clean your tools. Never use a front to back sawing motion to brush as it could harm the delicate gum tissues.

Gum, or periodontal disease, can also be a cause of gum recession. This disease causes the bone to shrink around the teeth. The gums can also shrink and pull away from the teeth.

Smokers tend to have more gum disease since the smoke causes the gums to not maintain their strength and attachment to the teeth.

Oral jewelry, such as a tongue bar, can rub away the gums from the necks of the teeth.

If you find yourself in the same boat as millions of others, that is with recession, what should be done? Well, many times nothing needs to be done. If the recession is not too bad, you just want to not cause any more recession.. Many times all this means is a change in the way you brush your teeth. Obviously cutting down or eliminating smoking will also help. While you're at it, keep the hardware, meaning your tongue piercings, on the shelf. Metal does not belong in a persons' mouth, period. If you have receding gums and do not have sensitivity to hot, cold or sweet things, that's great. As long as the recession stays in check you do not have to do anything.

However, if temperature and /or sweet things cause pain to your teeth, or if your dentist tells you that you are now starting to get cavities around the necks of the teeth (which used to be covered by the gums), then you might want to do some things.

Using a prescription strength fluoride toothpaste or mouthrinse is one way to combat the pain that develops in the teeth. The fluoride helps to stop the pain caused by temperature. It will also help prevent the occurrence of root cavities, which can happen because the now uncovered roots do not have any enamel protection like the rest of the tooth.

You can also use one of the "desensitizing type" toothpastes that have been formulated to stop the pain and sensitivity from developing.

Lastly, if your recession is rather severe and your teeth look funny because a lot of gum is missing, your dentist might suggest getting a "gum graft". This is a procedure where gum tissue from another part of your mouth is put in the areas where it is missing. Since it is your own tissue it should attach itself in the new area and replace the gum tissue you lost. After a few weeks the gum tissue in the new area blends in with the old gum and your smile looks younger because you are not " so long in the tooth" anymore.

Dental Treatment for Patients with Artificial Joints

Posted by Dr. Edward Magida | Filed under , , , , ,

Today's dentists are presented with a myriad of patients who have prosthetic joints, pins, screws and/or plates of some type. These patients need to have special consideration as far as how to keep these devices infection free. For many years there were conflicting ideas about the need to premedicate these people. The prevailing thoughts ranged from condemning the use of all prophylactic antibiotics for all dental procedures, to the complete opposite, which was to use antibiotics for all types of treatment on all patients, all the time for life.

In 1997, The American Dental Association, in conjunction with the American Academy of Orthopaedic Surgeons issued an advisory regarding antibiotic prophylaxis guidelines. This advisory stated that antibiotic premedication is not needed for patients who have pins, screws or plates, and it is also not indicated for the majority of dental patients who have total joint replacements. The advisory stated that only for those patients who would be at increased risk for blood borne total joint infection, should antibiotics be considered.

The following conditions or diseases would place a patient with a prosthetic joint at risk of infection following dental treatment:

  • Immunocompromised patients- either because of disease, drug or radiation induced suppression
  • Patients who have rheumatoid arthritis or systemic lupus erythematosus
  • Insulin dependent diabetics
  • Hemophiliacs
  • Malnourished patients
  • Joint replacement patients-up until the first 2 years after joint surgery
  • Joint replacement patients-if there has been a previous prosthetic joint infection

The advisory also stratified the incidence of bacterial infections developing based upon the severity of the dental treatment. The following are the types of treatments that would require antibiotic premedication. Extractions, periodontal treatments, implant placement, certain types of root canal procedures, initial placement of orthodontic bands, and a dental cleaning in a patient where much bleeding is expected to occur. Treatment that would not indicate antibiotics would include simple restorative or prosthetic dentistry, local injections, conventional root canal procedures, suture removal, orthodontic appliance removal, impressions and x-rays.

As stated before, some physicians and dentists advocate the use of antibiotic premedication for all procedures on patients with prosthetic joints. This can present a potential problem though, for the unrestrained use of antibiotics has been shown to have certain hazards. These include overgrowth of pathogenic organisms (disease causing bacteria ), secondary infections, bacterial resistance in the patient, bacterial resistance to the drug being used and allergic reactions, including potentially fatal anaphylactic reactions.

All patients preparing to undergo joint replacement should receive a complete dental examination including the taking of new x-rays to look for any infections present in the oral cavity. Even if the patient is not complaining of any problems or discomfort, a full mouth x-ray series is definitely needed, since many dormant or non-painful abscesses are found this way. The treating of any oral infection before the joint surgery is absolutely imperative to help prevent problems in the future with the prosthesis.

Every case is different, and if the treating dentist or physician has reason to think premedication is needed for a dental procedure, than after careful consideration of the guidelines, the patients health is of paramount importance.

JAW DEATH---something you don’t want to get

Posted by Dr. Edward Magida | Filed under , , , , ,

Many women, as they age, develop post menopausal osteoporosis. This is a condition characterized by a decrease in bone mass and density. As a result of this condition, their bones become fragile and break more easily. In order to prevent this chain of events from happening, doctors prescribe a class of drug known as biphosphonates, and the most popular oral version is called Fosamax. It is actually the 13th most prescribed drug in the U.S. The way the drug works is by altering the way the bone cells make new bone. While the drug helps prevent fractures in the spine or the hip, which could be devastating, it apparently causes problems in the jawbones.  There is the possibility of inhibiting new blood vessel formation, which can interfere with healing after the extraction of a tooth. Some patients, after an extraction, do not heal. Exposed bone is the result of the extraction and this can become infected and very painful and there is no way to treat the problem. The technical term for the problem is called osteonecrosis.

The popular name given to the problem is called jaw death. Most cases of jaw death have occurred in cancer patients who have taken intravenous bisphosphonates, which is one of the drugs given to cancer patients to reduce the incidence of cancer induced bone fractures. There needs to be more research done about whether the oral versions of the drug have the same incidence of problems. What this means is that any person who will be going on the drug needs to have a thorough clinical and radiological (xray) examination done of their teeth and mouth before they are started on the drug. If any dental treatment such as extractions or dental implants are needed, these should be accomplished before the drug regimen is begun. Routine cleanings, fillings root canals and crowns do not cause the associated problems. As to why the jawbone responds negatively to this drug, no one is really sure. So if you are taking this type of drug, please be sure to tell your dentist before treatment is started.

Invisible braces - Only your dentist knows for sure

Posted by Dr. Edward Magida | Filed under , ,

The Invisalign system is a series of totally clear, very thin mouthguard-like devices that are custom made for every patient. They fit over your teeth. "Does she or doesn't she... only your hairdresser knows for sure." That was a line in a popular commercial for hair coloring.

Now, it could be a line a dentist uses to promote a new system of invisible braces. That's because nobody can tell you are wearing them.

The Invisalign system is a series of totally clear, very thin mouthguard-like devices that are custom made for every patient. They fit over your teeth.

Used instead of metal braces, they are an alternate way to straighten teeth. To be considered for this type of treatment, you must have only mild to moderate crowding or overlapping.

Since the mouthguards are so clear, you can go through the day and no one will know you are straightening your teeth

Oral hygiene is much improved over conventional braces, which trap food, because you take the appliances out whenever you eat. You also take them out to brush and floss. Another plus is that you do not have to alter your diet the way you have to with metal braces.

One drawback is the cost.

Invisalign costs about 30 to 40 percent more than metal braces, and if you forget to wear the appliances, your results will get delayed.

To get started, you must schedule a consultation with a dentist who does this procedure. If you are a good candidate, impressions are taken and a very sophisticated lad uses a special computer program to fabricate your appliances, which are called "aligners."

Each appliance is worn for two weeks. During that time, the teeth out of alignment are moved ever so slightly. Depending upon the situation, upwards of 40 or more appliances are made for each patient. A new one is used every two weeks to continue the gradual process of moving the teeth into their proper spaces. Occasionally, the dentist might need to slightly recontour some of the teeth to keep the alignment process going smoothly.

In this day and age, with people getting all kinds of cosmetic procedures done so they will look and feel better about themselves, add this to the list of possibilities. If you do decide to have this done, don't worry, I'll never tell. Even if I did, no one would believe me.

"My Insurance Will Take Care of It..." -think so?

Posted by Dr. Edward Magida | Filed under , , ,

Many people have dental insurance through their employer. Many people do not take the time to read their benefits book to see just what their insurance will pay for. I can't tell you how many times a person has broken a tooth and needed a crown to restore it, only to find out that their dental insurance offered to them by their employer is the "bare bones" type that pays for cleanings and not much else. Don't get me wrong, I'll take something over nothing, but insurance is not insurance is not insurance. There are many differences amongst all the plans out there. Even if one employer uses this same dental insurance company as a different employer, the plans, and the benefits they have, are many times different. How is a person to know what insurance he or she has, and just what it will pay for?

Trojan. I'm not talking about the horse. I'm certainly not talking about, well, you know. I'm talking about the name of a computer program certain dental practices have installed that will tell you exactly just what a specific persons' insurance will cover. It will list exclusions to coverage. It will tell how often a tooth can get a new crown. Is orthodontics in your family's future? It will tell the maximum it will pay per person. Knowing a patients yearly maximum for insurance, which it tells us, is helpful in planning treatment to maximize coverage. It is a really great tool we use in my office to be able to tell patients exactly how much they will owe for every procedure done.

Every month the database gets updated with either new employers and/or new plans. If an employer is not listed, all we do is make a phone call and very quickly we are faxed the information. That information is then placed in next months computer update so it is in our system.

Since we have installed the program, we have been much more accurate in telling people what they will owe at the end of treatment.

One thing I like about the capabilities we know have with this program. People who are not patients of our practice, have heard that we have the program and have called to ask us if we would find out and explain to them the type of coverage they have. In the interest of promoting better dental healthcare for everyone, we have gladly helped out all those folks that called, and will continue to do so.

If you recently got new dental insurance or you just never really looked into just what your plan pays for, ask your dental office staff if they can "trojanize" you and find out all you need (or wanted) to know about your insurance.

Dental Insurance: It's only part of the answer

Posted by Dr. Edward Magida | Filed under , , ,

Congratulations! You just landed that dream job you've been after for the past year. You get a car allowance, secretary, fancy office, cell phone and corporate credit card. Of course you'll also get medical and dental insurance. Medical insurance you've always had, but dental coverage is something new to you.
Let me give you a short course in dental insurance.

First of all, dental insurance started in the late 1950's. Back then the average maximum benefit was $1,000. Of course, the premium wasn't very high. And, a person could get a lot of dental treatment done for $1,000, 40 years ago.

The problem is that now, in the year 2000, most benefit maximums on average are still $1,000. If you need a couple of fillings and maybe a crown, your total fee could easily surpass that.

And, while this dinosaur of a figure, $1,000, has not changed, insurance premiums and dental fees are much higher than years before.

What's this all mean? It means that dental insurance should be looked at as a supplement. It is not all encompassing, but can be used to help pay for regular dental exams and hygiene visits. It's there to help pay for part of dental treatment fees.

I can't tell you how many people say they are not going to have a necessary procedure done because they are out of benefits. Or worse, a person finds out that crowns or bridges are not covered, and since they've been told their dental insurance is "the best" available, decide that because the procedure in not covered by their insurance company, it is not needed. (Ironically what the insurance company will pay for is the extraction of that tooth when it rots away.)

Do not let your insurance dictate what treatment you get. If something is not covered, that does not mean it is not needed. It just means that the policy you have does not have that kind of coverage. Look for better insurance and/or accept the fact that you are responsible for the most part, for the condition of your mouth.

Ask questions about the coverage available. If there is only one plan available at your place of employment ask why.

Dental insurance is not like medical insurance. Medical procedures can become very complex and extremely costly and potentially run into six figures for long standing illnesses or accidents. There is nothing in dentistry that even comes close to that potential. That's the reason for a lower benefit limit, and anyone with the need for any treatment that's more than just the basic, is going to incur out of pocket expenses.

With all the latest advances in cosmetic dental procedures, many people are upset to learn that insurance policies pay for very few of them. Insurance companies could care less that the poor appearance of a person's teeth keeps them from smiling.

Fortunately, many dental offices have established payment plans for people who need or want major dental work done. Many people are investing in their smiles because they know the payback will be phenomenal. To see the look on someone's face once they feel comfortable smiling again is priceless. It makes going to work a lot of fun.

Dental Implants: An amazing alternative to dentures

Posted by Dr. Edward Magida | Filed under , , , , , ,

Mention the word implants and you may notice some eyebrows rise. Mention the words dental implants and you will notice some cringing.

I must say that as a practicing dentist with almost 20 years experience, that dental implants, where appropriate, are truly phenomenal. Whether it is a single tooth implant used to fill the space occupied a long time ago by another tooth, or a full set of teeth supported by implants, this type of treatment is becoming more and more common every day.

An implant is a metal cylinder made out of surgical grade titanium, called a fixture. The implant takes the place of your own natural tooth root. On to this implant, or a number of implants, the dentist attaches prosthetic teeth, which look and feel like your own.

The dentist, usually a periodontist or an oral surgeon, places the implant in a hole carefully drilled into the jawbone. This procedure is done with the patient fully anesthetized, but after the numbness goes away the patient may need pain medication for the next day or so.

After the implant is placed, the gum is replaced over the hole and the implant is allowed to heal and adhere to the bone. The process is called osseointegration. During this period the bone cells actually grow into little pores made in the implant. As the new bone matures and hardens, it locks the implant in place, making it rock solid. It is because this osseointegration process takes place that the use of implants is so predictable and such a successful treatment alternative.

Before a person is selected as a candidate for implants, the dental surgeon must do some measuring. Bone height and width are measured to see if enough is present to support the implant. If not enough bone is present, sometimes the bone can be increased to provide proper anchorage for the implant. This careful examination is done on a case by case basis. Just because your Aunt Becky had implants does not mean you can too. Sometimes implants cannot be placed because the density of the bone is not good. Another reason implants are not possible is because the person needs them in the upper jaw, but the person's sinus is in the way. In general however, most people can have implants placed. In some cases they can truly change a person's life for the better.

If you are tired of wearing dentures, have a missing tooth or teeth that you want replaced, or are facing the prospect of losing a tooth in the near future, you owe it to yourself to investigate this amazing treatment.

Get a grip on your dental health

Posted by Dr. Edward Magida | Filed under , ,

With all we know about dental disease - its causes and its treatment - there is no good reason that anyone should end up losing most or all of their teeth.

Teeth can last a lifetime, and all it takes is the commitment to take care of them.

However, I must still prescribe dentures and partial dentures to my patients when they need them. I do it, but deep down I always get an uneasy feeling, worrying that the patient will eventually have problems with them.

Over the past 12 years, I have treated hundreds of patients with dentures who are either homebound, or reside in nursing homes.

Many of these people had their teeth removed years ago, and now their jawbones have shrunk tremendously. It's harder to make a denture stable when the jawbone is hardly there.

I wish that these people were never talked into having their teeth removed. If the teeth remained, the bone would not have shrunk.

I can be of limited help to them. If the denture is still intact but loose, I will reline the denture, which will make it fit the new, shrunken shape of the gums. If, however, the person has lost too much bone over the years, then even this procedure cannot create miracles. Or bone, for that matter. If the bone is gone, the foundation for the denture, even the most perfect denture, is compromised.

So, what's a person to do?

Think suction cups.

Have you ever seen an octopus? Their arms are lined with suction cup like suckers that create great holding power for the octopus, which puts the creature at a great advantage.

Now those suction cups have been recreated on dentures.

People who have poorly fitting dentures can improve their quality of life with suction cup dentures because chewing is made easier. And that's important. The simple fact is that if dentures don't fit well a person cannot properly chew food, and instead of eating a variety of nutritious foods, the person ends up eating only soft foods.

However, when the underside of the denture is made with all these little suction cups, the retention of the denture improves.

Here's how they work: As the person places the denture, the suction cups engage the gum tissue and grab on, much like a plunger would if you pressed it against the floor. The net result of all these little suckers is a denture that has dramatically more hold. You really have to see these dentures to realize how superior they are compared to the normal type.

If you or anyone you know is having a problem with dentures that don't fit properly, you owe it to yourself to find out about the "dentures from the deep," suction cup dentures. They are truly phenomenal.

Geriatric Dental Patients

Posted by Dr. Edward Magida | Filed under , , , ,

Since 1988 I have been the staff dentist at numerous nursing, convalescent and adult care facilities. While at times, most people would find it a difficult, if not eye opening experience, I personally find it very rewarding to be able to help these patients with their dental needs and help with their problems. While most patients do not pose too much of a problem, there are some, due to their mental and/or physical ailments, that can be a true challenge to treat.

Dentists, at least most of us, are perfectionists. While in my office I strive for this all the time, I have had to learn that for some elderly patients, due to the limitations they present to dental treatment, this is not always possible. Sometimes I can only offer the best I can do given the circumstances. I know that there is no one else many times who would even attempt to help so I feel that at least I am trying my best.

Nursing home patients' needs are somewhat different than the rest of us. Many of them wear full or partial dentures. These are many times in need of repair or replacement. Teeth that have been removed should be added to the person's dentures to maintain a full compliment of teeth. I can't tell you how many people are wearing partial dentures that were made for them years ago. In the interim, someone took out one or more teeth but never bothered to replace the now missing teeth on the person’s denture. I don’t know how some people eat. Not being able to eat properly and nourish yourself, is a major downfall of patients in these types of settings. You wouldn’t think of buying one set of tires for your car and expecting to have them last your lifetime. You shouldn’t expect Uncle Bob’s denture to be a perfect fit forever either. The denture teeth wear down over the years and this makes it hard to chew, as well as causing the person’s face to "sink in" so to speak. Properly sized teeth give a person a more youthful look as well as increased chewing ability.

Sometimes the denture is fine but the patient has lost a lot of weight so the denture now "kind of swims" in the person’s mouth. In this case a reline of the teeth will allow it to fit properly to the shrunken gums. The biggest complaint I come across is the pain related to sore spots caused by pressure of the dentures on the gums. Sometimes all that is needed is some minor adjustment to the denture to make it a winner. Sometimes the reline procedure is needed to make a more intimate fit with the gums.

The biggest problem I see is the lack of basic oral hygiene. Either the person does not brush their teeth, or has it done for them on a daily basis, or it is done but is not very effective. This can easily lead to major cavity formation as well as periodontal disease. Both of these will ultimately lead to tooth loss. Many medications the elderly take will tend to adversely affect the teeth and gums. Many meds will dry out the person’s mouth which makes it easy for cavities to form. Someone with a dry mouth needs to pay extra attention to their oral hygiene.

If you know of someone in a nursing or convalescent type facility, please insist that the staff pay good attention to the oral hygiene of the person. This advice even goes to someone homebound or bedridden at home. I have on many occasions attended to people in these situations. The relative or personal aid must make sure the patient keeps his or her teeth as clean as possible. I know it sounds like common sense, but many times it just doesn't happen.

Getting back to why I do this. It is a great thrill to have the ability to help someone in need, and to help them in a way that no one else can or will. Just seeing a person’s new smile when all is said and done, goes a long way.