You Can Keep Your Natural Teeth for a Lifetime

Posted by Dr. Edward Magida | Filed under , ,

Modern dental treatment allows a person to keep their natural teeth for a lifetime. This statement shouldn't surprise anyone anymore. It is common knowledge. Isn't it?

It used to be that when you had a toothache or a loose tooth, you went to your local dentist and had it pulled. After all, your father had his teeth pulled when he had a bad one, as did his father, so why shouldn't the tradition continue?

If the tooth didn't need pulling then maybe it could be patched up. A humongous filling could be placed in it and on the way out the dentist would pat you on the back and say, "we'll keep an eye on it".

Nowadays this is called supervised neglect. More on that later, though.

How many times have you had someone tell you they are going to the dentist to have a tooth extracted because they didn't want to go through the time and expense of treating it? Maybe they are already wearing a partial denture and having it removed and a tooth added to the denture seemed "no big deal." Perhaps you have been introduced to someone and upon greeting you they smile and you notice the black hole. I know that I immediately wonder how someone can go through life like this, of course, I am biased with regards to these things.

I repeat my opening statement. Modern dental treatment allows a person to keep their natural teeth for a lifetime.

Most of the time a tooth gets in trouble because the person has not kept up with their dental examinations on a timely basis and/or a problem develops but the person decides to ignore it, thinking that somehow it will go away.

It doesn't happen very often, but every now and then a person comes in with a problem and before I even get to look or give any treatment, the person says, "C'mon, just rip it out, Doc." It's said very matter of fact, seemingly without thought. This is especially true if the offending tooth is in the back of the person's mouth. After all, out of sight, out of mind.

Most people probably think they have enough teeth and having one removed should have little consequence to their oral health. I can't emphasize enough how erroneous this is.

When a tooth is removed the other teeth in the area are affected. The adjacent teeth have a tendency to move or tip into the newly created space. This can create food traps around teeth that had no problem previously, If food can easily get stuck between teeth, the chances of new decay starting somewhere increase. Gum pockets can form around teeth that have tipped over and if these periodontal problems are not addressed, other teeth can be lost. If a lower molar is removed, there is a good chance the upper tooth on top of the new hole will start to elongate and drift down into the space.

What I am trying to have you understand in the fact that many detrimental things can happen if you lose a tooth. It is extremely important to consult with your dentist to determine the best course of treatment to prevent problems if you are told that a tooth that is non-restorable must be extracted. However, if after a careful examination, you are told that it is wise to keep and restore the tooth, do not let your dentist subscribe to the supervised neglect plan I mentioned before.

If a tooth needs a crown or an on-lay to properly bring it back to normal function, do not let the dentist put a boulder-sized filling in the tooth and say, "we'll see how this works out."

Large fillings do not support themselves, let alone support a whole tooth. I can't tell you how many times I see teeth that are almost 100 percent filling, with cracks either in the filling and or the tooth. Also, 99 out of every 100 teeth filled like this get new decay around or under the filling. Have it restored the way the dentist would like his or her tooth restored. If you think like this, your teeth will last a long, long time.

Sports mouthguard is an absolute necessity

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

I can't stress enough the importance of wearing a properly fitting mouthguard because I have seen the damage that can be done to a person's mouth during a sporting event.

Not too long ago I had to treat a young man who was on his high school lacrosse team. Due to the nature of the game, the players wear helmets to protect themselves from getting hit by the ball and the sticks. My patient was hit in the front of his mouth with a lacrosse stick while he was on the sideline, not actually in the game at that moment. It was an accident and the friend who hit him unintentionally had no idea how this small mistake would change this young man's life.

My patient came to the office with a severely fractured front tooth. It was an upper central incisor, the first one you look at when a person smiles. Its prognosis was hopeless. There are lots of things dentists can do to restore mutilated teeth, but sometimes things are not possible. This was one of those times. The tooth was absolutely beyond hope.

The young man was sent to see a local periodontist who placed an implant in the area where the fractured tooth used to be. For six months my patient had to wear a "flipper" which is a one tooth partial denture used to temporarily fill in the space left when the broken tooth was removed. For a front tooth, which is missing, six months can seem like a long time. After the required waiting time had passed and the implant had healed in the bone, I made a porcelain crown to fit the implant and make the patient's smile look normal again.

The simplest way to protect your teeth, jaws and TM joint is to wear a properly constructed mouthguard appropriately made for the type of sport you play.
The young man who lost his front tooth showed me his "guard," and I use that term loosely. It was not form fitted to his teeth. Actually it was just a thin piece of plastic he was supposed to bite on that wasn't fitted to anything.

When I recently went to a local sporting goods store to see what is available, I was appalled. Most of the ones being sold are either thin pieces of plastic that are absolutely worthless and can't protect teeth, or they are the so called "boil and bite" type, where you heat the plastic up with hot water and bite into it to make a lasting imprint of your teeth. The problem with these types of guards is that it is difficult to determine if the person had bit down hard enough to get a nice even mold of the teeth. Also, even if the teeth are securely covered by the plastic, the person might have bit down a little crooked in the soft plastic so now the bite is off and this can actually decrease playing ability.

The type of plastic used is critical. A properly made sportsguard fabricated from dental impressions should be made from laminated, very tough material.
The saying "you get what you pay for" is absolutely true when it comes to proper protection for your mouth.

Anyone who plays a sport that has the slightest possibility of causing damage to his or her mouth should have a dentist fabricate a well-fitting guard.

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.

"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 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.

Dentistry... ENJOY!!

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

Over the years, I have found there to be a sort of universal saying that goes along with anything pertaining to food or eating. It used to be that I noticed it when I frequented Chinese restaurants. I would place my family's order, usually ordering way more than we needed for that meal so we could take home the rest for the next day, and then I would dig into the noodles on the table. Upon the waitpersons' arrival and serving our feast, he or she would always, and I mean always, upon placing the last dish, say "enjoy". Enjoy... as if the kitchen staff had gone out of their way to make all this food only for my family that night. Enjoy.... just hearing it being said after our meal was served made me feel great, like royalty.

Nowadays, it seems like I hear it being said all the time. Whenever we eat out, the server emphatically states "enjoy", before departing our table. I would like to think that the establishment is proud of the food they serve and are grateful that we want to spend our hard earned money there. I feel like my presence is recognized by this saying..."enjoy". Recently, while buying groceries at a local supermarket I had the same type of encounter. After loading all the goodies into my cart, the cashier looked up and stated a sincere "enjoy". The interesting thing is that now some of the individual food manufacturers are placing this on their foodstuffs. I was opening a can of peaches for a snack when I noticed that it said on the top of the can "Enjoy by 7/9/04". By this point I'm sure all of you are wondering why a dentist is writing all this stuff. Well, there is a reason for my madness, so to speak.

I stated before that the saying "enjoy" goes with things associated with food and eating. While it is possible to eat some foods without teeth, having them surely improves the process. I would like to group all kinds of things dentists see and do on a daily basis into one sentence, and then follow things with my new favorite word. For the person who finally gets the willpower to have all his hurting teeth taken care of... for the person who finally finds out that replacing your missing teeth makes your life better... for the person who has lost her self esteem because of an accident that knocked her front teeth out, and has finally decided to get some implants and crowns to get her beautiful smile back... to the elderly person in a nursing home whose denture keeps dropping out and has finally decided to have a new one made...to the people that have all their life not smiled a lot because they had teeth that were too dark or crooked or chipped or any combination of these, and have finally had a beautiful set of porcelain veneers or crowns placed... ENJOY!!!

Dental Insurance 101 ---A patient primer

Posted by Dr. Edward Magida | Filed under , ,

I am writing this article as a last ditched effort for people to try and understand just what it means to have and use dental insurance benefits. Please be aware that dental benefits have not changed much for decades, meaning that the amount an insurance company will pay is still the same it was 25 years ago, even though the cost of dental treatment has gone up like everything else.

I am going to list a bunch of things people have done or tried to do with their insurance as told to me by people in the dental profession. Sometimes things were done out of being ignorant of things. Other times things were done out of frustration. Hopefully, by reading about this topic you can get a handle on just what dental benefits you do have….or don’t have!

Here are things patients have done, or tried to do

  1. Not paid their co-pay for a procedure.- Very few procedures are paid in full by the insurance company.
  2. Not paid their deductible.- This is a once a year payment that is due to the dental office.
  3. Not paid because their insurance “maxed out”.- If you need a lot of treatment, and you use up your benefits, you still are obligated to pay your balance for the treatment you needed and authorized your dentist to do.
  4. Not pay for a procedure if the insurance company “downcodes” a procedure, and therefore pays at a lesser amount.-Insurance companies are not known for always paying for better quality materials used in many dental offices today. They will pay for what they consider “adequate materials”. Do you want your mouth to be “just adequate”?
  5. Play ignorant about their policy benefits.- If you do not understand just what is covered, call the company and ask them. It’s your plan.
  6. Play ignorant about their yearly maximum benefits.-At some point, if you have much treatment, your policy will max out and you will owe the entire treatment bill yourself.
  7. Get upset because “their dental office doesn’t keep track of all aspects of their policy”.- There are hundreds of policies out there. It is not possible to expect your dental office to know everything about all the policies.
  8. Get upset with their dental office because insurance is messed up, when in reality, the patient gave the wrong policy information to the office.-Make sure we have your correct birthday, social security number, insurance company address.
  9. As the office to falsify dates of service in order to collect benefits.-I’m not losing my license for anybody!
  10. Get upset when their dental office doesn’t keep absolute track of a person’s remaining benefits.-It’s much easier for you to keep track of your remaining benefits, than for your dental office to keep track of the benefits for several thousand patients.
  11. Get upset when their dental office does not know to the absolute penny, how much of a benefit is to be expected.-Many times we do not know exactly how much will be paid until the check arrives.

C’mon folks. Get real. Whose benefits are these anyway? They are not the dentist’s. The dentist is just trying to do what’s best for the patient. You the patient absolutely need to understand your own benefits. You need to know what procedures get reimbursed at what percentages. You need to know that certain procedures, although deemed necessary by your dentist, might not be covered. It is not the dental office’s fault if your coverage is lacking!

Dental insurance should be looked at as a possible bonus towards treatment you need. It should not be looked at as the reason to get or not get treatment.

If you have dental benefits, that’s great. It will definitely help with paying for your dental treatment. All I’m asking is for you to be part of the picture. It’s your plan and you should know what it does or does not do for you.