Study Shows Smoking Increases Chances Of Dental Implant Failures

Dr. Marc Salomone D.D.S

The introduction of dental implants to dentistry revolutionized the way people treated lost teeth. They are preferred by many and have replaced dentures as they are more comfortable and appeal aesthetically.  Dental implants are a blessing for many who are looking for a suitable replacement for their lost teeth.

Basically, the lost tooth is replaced by an implant which is made up of a material which closely resembles natural teeth.

A titanium screw is inserted in to the jaw bone to which it fuses (osseointegration). This titanium screw serves as an anchor point which supports the entire artificial tooth. The artificial tooth is coated with hydroxypatite which is also present in natural tooth.

Now, coming to the effects of smoking on dental implants.

BBC news reported the findings of a research done by dentists across Europe which studied the rejection of dental devices and procedures by patients. The study has found the smoking increases the probability of rejection of a dental implant by the human body. Although, rejection of a dental implant occurs in few cases, smoking increases this risk considerably. This finding is not completely new though. Many dentists have reported lower success rates of dental implants in smokers.

Let us now look at the reason for this failure. An ideal candidate for the implant procedure requires good healing and blood flow to make sure the gums heal properly. Smoking considerably affects the healing ability of the body and reduces the blood flow as well. Good blood flow is required for effective healing of the gum tissue. Due to this various factors, the likelihood for rejection of the implant increases.

It’s just not the implants that are affected by smoking. Other dental procedures such as tooth extraction and dental fillings (restorations were also effected). 
Smoking also makes antibiotics and creams less effective before and during dental treatments. Some stats by ADA that support this claim in another study are: “32% of smokers needed to have a filling replaced, 10.1% needed a tooth extraction and 22.5% needed a major dental cleaning because of periodontal disease”.

The good part is that kicking this habit reduces these effects. The healing ability and blood flow slowly begins to return to normal levels and few studies have showed that normal levels can be regained after several years of quitting.

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Wisdom Teeth: Preventive Removal Is Best

Dr. Robert L. Bass D.D.S.

Your wisdom teeth, or third molars, are the last teeth to emerge from your gums during your late teens, or "age of wisdom", which gives them their name. But wisdom teeth are not really so wise. They often become impacted or trapped in the jaw bone and gums and fail to erupt as straight and fully functioning teeth. Impacted wisdom teeth nearly always have to be removed. Example of impacted wisdom teeth can be seen in the following graphics

Why do we have wisdom teeth at all if they have to be removed so often? Human beings once had tougher diets. As our diets became softer and more refined, we no longer needed jaws for strenuous chewing. The jaws failed to develop, leaving little room for third molars. In addition, due to mixing of gene pools, some adults never develop wisdom teeth at all and some end up with more teeth than jaw. Perhaps in the distant future, we won't have to worry about them at all. Today, most people experience at least one impacted wisdom tooth.

Why Remove Wisdom Teeth? Wisdom teeth that are not painful seem harmless enough. But if they are not removed early, they often cause problems such as:

1. INFECTION (PERIOCORONTIS): The mouth is full of bacteria that normally do not get past the protective layer of gums. But when an impacted tooth breaks through the gum surface, bacteria can get in causing an infection in the gums around the crown of the tooth. This infection can cause severe pain, swelling, jaw stiffness, and even general illness.
2. DESTRUCTION OF THE NEXT TOOTH: An impacted tooth may still try to grow where it has no room, eroding the tooth next to it. This is called RESORBTION. Eventually, this could lead to the loss of both teeth.
3. PAIN: Infection in a decayed wisdom tooth or in the gum around an impacted tooth can cause pain. If a decayed wisdom tooth is not situated in a healthy position, or if it is not restorable, we may recommend its removal. An impacted tooth can also cause pain if it presses against a nerve or the next tooth.
4. CROWDING: An impacted tooth can crowd nearby molars out of alignment. If you are undergoing orthodontic care, we may recommend that your impacted wisdom teeth be removed.
5. CYSTS: When a tooth is impacted, the sac of tissue around the crown remains in the bone. Occasionally, the sac fills with fluid forming a cyst that can readily destroy or enlarge the bone and endanger surrounding structures.

Why Early Removal? Before you reach adulthood, the roots of your teeth are not totally formed and the surrounding bone is softer. Therefore, there is less chance of damaging nerves and other nearby structures during surgery. The operation itself may be more difficult as you get older. The risks are greater and the healing is slower. If you wait until your wisdom teeth cause you trouble, you may have to be treated for complications such as infection, before they can be removed. In short, early removal of your wisdom teeth is likely to prevent problems later on. In addition, we may recommend that opposing healthy wisdom teeth be removed at the same time if they are impending on the opposing jaw. A recently completed clinical study of more than 9,500 patients revels that the optimal time for extraction is between the ages of 12 and 24 years. In general, difficulties increase with age.

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New Research Reveals Elderly People Who Lose Their Teeth May Be At Increased Risk For Dementia

Dr. Marc Salomone D.D.S

The new study included more than 4,000 Japanese participants, 65 and older, who underwent a dental examination and a psychiatric assessment. Compared with participants who still had many of their natural teeth, those with fewer or no teeth were much more likely to have experienced some memory loss or have early-stage Alzheimer's disease. 

The findings were published online last month in Behavioral and Brain Functions. Participants with symptoms of memory loss tended to report that they had visited the dentist rarely, if at all.

Dr Nozomi Okamoto, the study's principal investigator, said that this may be one explanation for the study's findings but suggested that there may be other links between tooth loss and memory problems. She said: 'Infections in the gums that can lead to tooth loss may release inflammatory substances, which in turn will enhance the brain inflammation that cause neuronal death and hasten memory loss. ‘The loss of sensory receptors around the teeth is linked to some of the dying neurons.'

This may lead to a vicious cycle, Okamoto explained. The loss of these brain connections can cause more teeth to fall out, further contributing to cognitive decline. A few months back, researchers elsewhere discovered that gum disease can affect the brain in elderly patients. This, they concluded, can happen by causing inflammation throughout the body, a risk factor for loss of mental function.

The study, based on adults aged 60 and older, found those with the highest levels of the gum disease-causing pathogen Porphyromonas gingivalis were three times more likely to have trouble recalling a three-word sequence after a period of time. The research was led by Dr James Noble at Columbia College of Physicians and Surgeons in New York. It also found that adults with the highest levels of this pathogen were two times more likely to fail three-digit reverse subtraction tests.

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Temporomandibular Disorders

Dr. Marc Salomone D.D.S.

Temporomandibular Disorders (TMD) occur as a result of problems with the jaw, jaw joint, and surrounding facial muscles that control chewing and moving the jaw. These disorders are often incorrectly called TMJ, for temporomandibular joint.

What Is the Temporomandibular Joint?

The temporomandibular joint is the hinge joint that connects the lower jaw (mandible) to the temporal bone of the skull, which is immediately in front of the ear on each side of your head. The joints are flexible, allowing the jaw to move smoothly up and down and side to side and enabling you to talk, chew, and yawn. Muscles attached to and surrounding the jaw joint control the position and movement of the jaw.

What Causes TMD?

The cause of TMD is not clear, but dentists believe that symptoms arise from problems with the muscles of the jaw or with the parts of the joint itself.

Injury to the jaw, temporomandibular joint, or muscles of the head and neck - such as from a heavy blow or whiplash - can cause TMD. Other possible causes include:

• Grinding or clenching the teeth, which puts a lot of pressure on the TMJ
• Dislocation of the soft cushion or disc between the ball and socket
• Presence of  osteoarthritis or  rheumatoid arthritis in the TMJ
• Stress, which can cause a person to tighten facial and jaw muscles or clench the teeth

What Are the Symptoms of TMD?

People with TMD can experience severe pain and discomfort that can be temporary or last for many years. More women than men experience TMD and TMD is seen most commonly in people between the ages of 20 and 40.

Common symptoms of TMD include:

• Pain or tenderness in the face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak, or open your mouth wide
• Limited ability to open the mouth very wide
• Jaws that get "stuck" or "lock" in the open- or closed-mouth position
• Clicking, popping, or grating sounds in the jaw joint when opening or closing the mouth (which may or may not be accompanied by pain)
• A tired feeling in the face
• Difficulty chewing or a sudden uncomfortable bite - as if the upper and lower teeth are not fitting together properly
• Swelling on the side of the face

Other common symptoms of TMD include toothaches, headaches, neck aches, dizziness, earaches, and hearing problems.

How Is TMD Diagnosed?

Because many other conditions can cause similar symptoms - including a  toothache, sinus problems, arthritis, or  gum disease - your dentist will conduct a careful patient history and clinical examination to determine the cause of your TMD symptoms.

He or she will examine your temporomandibular joints for pain or tenderness; listen for clicking, popping or grating sounds during jaw movement; look for limited motion or locking of the jaw while opening or closing the mouth; and examine bite and facial muscle function. Sometimes panoramic X-rays will be taken. These full face X-rays allow your dentist to view the entire jaws, TMJ, and teeth to make sure other problems aren't causing the symptoms. Sometimes other imaging tests, such as magnetic resonance imaging (MRI) or a computer tomography (CT), are needed. The MRI views the soft tissue such as the TMJ disc to see if it is in the proper position as the jaw moves. A CT scan helps view the bony detail of the joint.

Your dentist may decide to send you to an oral surgeon (also called an oral and maxillofacial surgeon) for further care and treatment. This oral healthcare professional specializes in surgical procedures in and about the entire face, mouth, and jaw area.

What Treatments Are Available for TMD?

Treatments for TMD range from simple self-care practices and conservative treatments to injections and surgery. Most experts agree that treatment should begin with conservative, nonsurgical therapies first, with surgery left as the last resort. Many of the treatments listed below often work best when used in combination.

Basic Treatments for TMD

• Apply moist heat or cold packs. Apply an ice pack to the side of your face and temple area for about 10 minutes. Do a few simple stretching exercises for your jaw (as instructed by your dentist or physical therapist). After exercising, apply a warm towel or washcloth to the side of your face for about 5 minutes. Perform this routine a few times each day.
• Eat soft foods. Eat soft foods such as yogurt, mashed potatoes, cottage cheese, soup, scrambled eggs, fish, cooked fruits and vegetables, beans and grains. In addition, cut foods into small pieces to decrease the amount of chewing required. Avoid hard and crunchy foods (like hard rolls, pretzels, raw carrots), chewy foods (like caramels and taffy) and thick and large foods that require your mouth to open wide to fit.
• Take medications. To relieve muscle pain and swelling, try nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (Advil, Motrin, Aleve), which can be bought over-the-counter. Your dentist can prescribe higher doses of these or other NSAIDs or other drugs for pain such as narcotic pain relievers. Muscle relaxants, especially for people who grind or clench their teeth, can help relax tight jaw muscles. Anti-anxiety medications can help relieve stress that is sometimes thought to aggravate TMD. Antidepressants, when used in low doses, can also help reduce or control pain. Muscle relaxants, anti-anxiety drugs, and antidepressants are available by prescription only.
• Wear a splint or night guard. Splints and night guards are plastic mouthpieces that fit over the upper and lower teeth. They prevent the upper and lower teeth from coming together, lessening the effects of clenching or grinding the teeth. They also correct the bite by positioning the teeth in their most correct and least traumatic position. The main difference between splints and night guards is that night guards are only worn at night and splints are worn full time (24 hours a day for 7 days). Your dentist will discuss with you what type of mouth guard appliance you may need.
• Undergo corrective dental treatments. Replace missing teeth; use  crowns, bridges, or braces to balance the biting surfaces of your teeth or to correct a bite problem.
• Avoid extreme jaw movements. Keep yawning and chewing (especially gum or ice) to a minimum and avoid extreme jaw movements such as yelling or singing.
• Don't rest your chin on your hand or hold the telephone between your shoulder and ear. Practice good posture to reduce neck and facial pain.
• Keep your teeth slightly apart as often as you can to relieve pressure on the jaw. To control clenching or grinding during the day, place your tongue between your teeth.
• Learning relaxation techniques to help control muscle tension in the jaw. Ask your dentist about the need for physical therapy or massage. Consider stress reduction therapy, including biofeedback. www.desertoralsurgery.com

Do You Suffer From Sleep Apnea?

Dr. Robert L. Bass D.D.S

People with obstructive sleep apnea (OSA) have disrupted sleep and low blood oxygen levels. When obstructive sleep apnea occurs, the tongue is sucked against the back of the throat. This blocks the upper airway and air flow stops. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears and the flow of air starts again, usually with a loud gasp.

Repeated cycles of decreased oxygenation lead to very serious cardiovascular problems. Additionally, these individuals suffer from excessive daytime sleepiness, depression, and loss of concentration.

Some patients have obstructions that are less sever called Upper Airway Resistance Syndrome (UARS). In either case, the individuals suffer many of the same symptoms.

The first step in treatment resides in recognition of the symptoms and seeking appropriate consultation. Oral and Maxillofacial Surgeons offer consultation and treatment options.

In addition to a detailed history, the doctors will assess the anatomic relationships in the maxillofacial region. With cephalometic (skull x-ray) analysis, the doctors can ascertain the level of obstruction. Sometimes a naso-pharyngeal exam is done with a flexible fiber-optic camera. To confirm the amount of cardiovascular compromise and decreased oxygenation levels, a sleep study may be recommended to monitor individuals overnight.

There are several treatment options available. An initial treatment may consist of using a nasal CPAP machine that delivers pressurized oxygen through a nasal mask to limit obstruction at night. One of the surgical options is a uvulo-palato-pharyngo-plasty (UPPP), which is performed in the back of the soft palate and throat. A similar procedure is sometime done with the assistance of a laser and is called a Laser Assisted uvulo-palato-plasty (LAUP). In other cases, a radio-frequency probe is utilized to tighten the soft palate. These are procedure usually performed under light intravenous sedation in the office.

In more complex cases, the bones of the upper and lower jaw may be repositioned to increase the size of the airway (Jaw Surgery). This procedure is done in the hospital under general anesthesia and requires 1 to 2 days overnight stay in the hospital.

OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment. Dr. Bass specializes in treating Sleep Apnea in our practice. Please contact us if you would like a consultation regarding this condition.

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