My Blog
By David J. Adams, DMD, MS, PA
March 04, 2021
Category: Oral Health
Tags: osteoporosis  
CertainDrugsforOsteoporosisCouldImpactYourDentalCare

Osteoporosis is a serious bone weakening disease in older adults that can turn a minor fall into a major bone fracture. But the condition could also impact dental treatment—triggered ironically by the drugs used to treat osteoporosis rather than the disease itself.

From the Latin for “porous bone,” osteoporosis causes bone to gradually lose mineral structure. Over time the naturally-occurring spaces between mineralized portions of the bone enlarge, leaving it weaker as a result.

Although there's no definitive cure for osteoporosis, a number of drugs developed over the last couple of decades can inhibit its progress. Most fall into two major categories, bisphosphonates and RANKL inhibitors.

These drugs work by inhibiting the normal growth cycle of bone. Living bone constantly changes as cells called osteoblasts produce new bone. A different type, osteoclasts, clear away older bone to make room for these newer cells. The drugs selectively destroy osteoclasts so that the older bone, which would have been removed by them, remains for a longer period of time.

Retaining older cells longer initially slows the disease process. But there is a downside: in time, this older bone kept in place continues to weaken and lose vitality. In rare instances it may eventually become detached from its blood supply and die, resulting in what is known as osteonecrosis.

Osteonecrosis mostly affects two particular bones in the body: the femur (the long bone in the upper leg) and the jawbone. In regard to the latter, even the stress of chewing could cause osteonecrosis in someone being treated for osteoporosis. It can also occur after tooth extractions or similar invasive procedures.

If you're taking a bisphosphonate or RANKL inhibitor, you'll want to inform your dentist so that the necessary precautions can be taken before undergoing dental work more invasive than routine cleanings or getting a filling or crown.  If you need major dental work, your dentist or you will also need to speak with your physician about stopping the drug for a few months before and after a dental procedure to minimize the risk of osteonecrosis.

Fortunately, the risk for dental problems while undergoing treatment for osteoporosis is fairly low. Still, you'll want to be as prepared as possible so that the management of your osteoporosis doesn't harm your dental health.

If you would like more information on osteoporosis and dental health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Osteoporosis Drugs & Dental Treatment.”

By David J. Adams, DMD, MS, PA
February 22, 2021
Category: Dental Procedures
WhetherVotingforaCandidateorWisdomTeethYouCanChooseWisely

During election season, you'll often hear celebrities encouraging you to vote. But this year, Kaia Gerber, an up-and-coming model following the career path of her mother Cindy Crawford, made a unique election appeal—while getting her wisdom teeth removed.

With ice packs secured to her jaw, Gerber posted a selfie to social media right after her surgery. The caption read, “We don't need wisdom teeth to vote wisely.”

That's great advice—electing our leaders is one of the most important choices we make as a society. But Gerber's post also highlights another decision that bears careful consideration, whether or not to have your wisdom teeth removed.

Found in the very back of the mouth, wisdom teeth (or “third molars”) are usually the last of the permanent teeth to erupt between ages 17 and 25. But although their name may be a salute to coming of age, in reality wisdom teeth can be a pain. Because they're usually last to the party, they're often erupting in a jaw already crowded with teeth. Such a situation can be a recipe for numerous dental problems.

Crowded wisdom teeth may not erupt properly and remain totally or partially hidden within the gums (impaction). As such, they can impinge on and damage the roots of neighboring teeth, and can make overall hygiene more difficult, increasing the risk of dental disease. They can also help pressure other teeth out of position, resulting in an abnormal bite.

Because of this potential for problems, it's been a common practice in dentistry to remove wisdom teeth preemptively before any problems arise. As a result, wisdom teeth extractions are the top oral surgical procedure performed, with around 10 million of them removed every year.

But that practice is beginning to wane, as many dentists are now adopting more of a “wait and see” approach. If the wisdom teeth show signs of problems—impaction, tooth decay, gum disease or bite influence—removal is usually recommended. If not, though, the wisdom teeth are closely monitored during adolescence and early adulthood. If no problems develop, they may be left intact.

This approach works best if you maintain regular dental cleanings and checkups. During these visits, we'll be able to consistently evaluate the overall health of your mouth, particularly in relation to your wisdom teeth.

Just as getting information on candidates helps you decide your vote, this approach of watchful waiting can help us recommend the best course for your wisdom teeth. Whether you vote your wisdom teeth “in” or “out,” you'll be able to do it wisely.

If you would like more information about what's best to do about wisdom teeth, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Wisdom Teeth.”

By David J. Adams, DMD, MS, PA
February 12, 2021
Category: Oral Health
Tags: dental care  
LocalAnesthesiaMakesforaMorePleasantandPain-FreeDentalExperience

You know you should see the dentist about that nagging tooth or gum problem, but you keep putting it off. Truth be told, you're a little nervous that your treatment visit might be unpleasant.

In one sense, your concern isn't unreasonable: The teeth and gums abound in nerves that are more than effective in signaling pain. Even minor dental procedures can trigger discomfort. In another sense, though, there's no need to worry, thanks to pain-numbing techniques using local anesthesia.

The term “local” is used because the applied anesthetic only affects the area and surrounding tissues needing treatment. The anesthetic drugs temporarily block nerve electrical impulses from transmitting pain signals to the brain. Unlike general anesthesia, which requires placing a patient in an unconscious state, a patient can be awake, yet feel no sensation around the anesthetized tissue.

Dentists typically use a two-step method to prevent patients from feeling any pain during a procedure. First, they apply a topical local anesthetic to the surface of the gums. Once these top layers have been numbed, they numb the underlying tissues by injecting the anesthetic with a needle. The goal of a topical application is to ensure the patient doesn't feel the prick of the needle used for deep tissue anesthesia.

Dentists follow strict protocols using anesthesia that have been developed over several decades. As a result, local anesthesia has revolutionized dental care and greatly reduced patient discomfort safely and effectively. Its effectiveness has in fact led to a common complaint that the numbness may linger long afterwards. But that also has been addressed with better combinations of anesthetic drugs to reduce the duration of the numbing effect.

And not only does local anesthesia make for a more relaxing and pleasant experience, it also benefits the dental provider. Dentists tend to work more efficiently when they know their patients aren't in discomfort, which can result in better treatment outcomes.

If you've been putting off a trip to the dentist because you think it might be painful or uncomfortable, put those concerns to rest. With the help of local anesthesia, dental treatment can be relaxing and pain-free.

If you would like more information on having a pain-free experience at the dentist, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Local Anesthesia for Pain-Free Dentistry.”

By David J. Adams, DMD, MS, PA
February 02, 2021
Category: Dental Procedures
Tags: dental implant  
3ReasonsWhyDentalImplantsAreaSoundSmileInvestment

In looking at options to replace your missing teeth, you might have heard others rave about dental implants. You're almost sold on this innovative restoration method—but you're a little skittish about the upfront cost.

Here are 3 reasons why getting dental implants to restore your missing teeth is a sound investment.

A solid long-term solution. Based on findings from over 3 million implant installations over the last forty years, more than 95% of implants continue to successfully function after ten years—and many are on track to last decades. That's something that can't be said for other forms of restoration. An implant's large upfront cost could in fact even out over the long-term and ultimately cost less than other restorations that may need to be replaced sooner.

A benefit to bone health. One of the more negative consequences of missing teeth is ongoing bone loss, a process that can continue to occur even when teeth are replaced by dentures or bridges. But bone cells readily grow and adhere to the titanium metal implant imbedded in the bone, slowing or even stopping continuing bone loss. If for no other reason, their positive impact on bone health is a top reason for choosing implants.

A range of choices. Replacing multiple missing teeth individually with dental implants can be quite expensive. But individual tooth replacement is only one of the ways implants could benefit you. It's possible to place just a handful of implants along the jaw to support other types of restorations like bridges and partial or full dentures. Not only is this cost-effective, but the implant-supported restoration may be more stable and secure. And these implants may also contribute to bone health.

But before you make your decision, visit us for a complete dental examination. We'll assess if your dental condition makes you a good candidate for implants, and then provide you more information on the process and costs.

If you would like more information on dental implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dental Implants 101.”

By David J. Adams, DMD, MS, PA
January 23, 2021
Category: Oral Health
Tags:   
YourGumsNeedExtraCareAfterPeriodontalDisease

We all benefit from regular dental care, regardless of our state of oral health. But if you've experienced periodontal (gum) disease, those regular dental visits are even more important in making sure your healed gums stay that way.

Gum disease is a bacterial infection caused by dental plaque, a thin film of bacteria and food particles accumulating on tooth surfaces. The infection triggers inflammation in the gums that quickly becomes chronic. That's why people with gum disease have reddened and swollen gums that bleed easily.

The infection can aggressively spread deeper below the gum line, eventually affecting the bone. The combination of weakened gum detachment from the teeth and bone loss may ultimately cause tooth loss. But we can stop the infection by thoroughly removing all plaque and tartar (hardened plaque) from the teeth and gums. As the plaque is removed, the gums respond and begin to heal.

It's possible then even with advanced gum disease to restore health to your teeth and gums. But although the infection has been arrested, it can occur again. In fact, once you've had gum disease, your susceptibility for another infection is much greater. To stay on top of this, you may need to visit the dentist more frequently.

These upgraded visits known as periodontal maintenance (PM) are actually a continuation of your treatment. Depending on the extensiveness of your gum disease, we may need to see you more than the standard twice-a-year visits: Some periodontal patients, for example, may need a visit every two to three months. Again, the state of your gum health will determine how often.

In addition to standard dental cleanings and checkups, PM visits will also include more thorough examination of the teeth and gums, particularly the health of the tooth roots. We'll also check how well you're doing with daily plaque removal and if there are any signs of gum infection. We may also prescribe medication, rinses or topical antibiotics to help control your mouth's levels of bacteria.

A patient's periodontal “maintenance schedule” will depend on their individual condition and needs. The key, though, is to closely monitor gum health for any indications that another infection has set in. By staying alert through dedicated PM, we can stop a new infection before it harms your dental health.

If you would like more information on gum disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Periodontal Cleanings.”





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