Losing all your teeth can be difficult. Recovering from the surgery, waiting for the denture to be fabricated, hoping that the results meet expectations and resolve all problems for the patient. Once teeth are removed and denture seated, the patient has to get used to wearing it. Returning for subsequent appointments for denture adjustments are necessary for patient comfort and motivates him/her to consistently wear the prosthesis. Overtime, the denture will become loose due to bone remodeling after the teeth are extracted, and a reline is needed. The denture is sent to a dental lab, and excess space between the denture and the gums is filled in with added material to the denture. The goal is to have a prosthesis that is esthetically pleasing and functional for the patient. Good communication between patient and dentist is paramount to producing a stable denture.
Spring Lake Dental Group
Goodbye 2020! This year has been hard. As we continue towards the end of 2020, waving farewell in our rearview mirror, it gives some comfort to reflect on the moments of kindness of the human spirit. Let our hearts find comfort in the compassionate and back-breaking work of physicians, nurses, first responders, the tenacity and ingenuity of our educators, the patience of our grocery store workers and countless others. 2020 has highlighted the invaluability of every job, career, position; there are no small parts. Seconds before January 1, 2021 arrives, I wish I could click the heels of my ruby red slippers and say, “There’s no place like home” and things would return to normal, but that won’t be the case. We will still be fighting a pandemic, dealing with social and political conflicts, and a questionable economy. But let us continue to fight the good fight. Let us renew ourselves, let us hold our loved ones close, let us stay in the arena.
Author: Dr. Alison Vitelli, DMD
This pandemic has certainly challenged us. But I am comforted to find that almost all of our patients at Spring Lake Dental Group are happy, healthy and following the guidelines put forth by the CDC. The end is not yet in sight, but I am hoping that wearing masks and social distancing will keep the virus infection numbers down as we progress through the winter months. I have received my influenza vaccine and yet, I respect this as an individual decision. The year 2020 will forever be remembered for our efforts together in fighting this pandemic and I encourage each and every one of you to stay optimistic as we support each other mentally, spiritually and physically.
This year has brought many staff changes within our practice. I hope that you have noticed that staff turnover through the years at Spring Lake Dental Group has been minimal. This has always been a challenge, but when you are located next to a major military installation like Fort Bragg, we do lose many outstanding personnel through military orders. The pandemic has also ravaged our staff. The challenges presented by this pandemic are far reaching. Parents have been especially challenged. We have been given tough decisions concerning our health, our education and the care of our loved ones that might have mitigating health risks. As our staff has adapted to these challenges, we constantly strive to keep the level of training, supervision and motivation at a level where the safety of our patients is foremost in our thoughts.
We have been very fortunate in attracting a new hygienist into our family here at Spring Lake Dental Group. I have always felt that experience and knowledge are at a high premium when treating gum disease. Having the wherewithal to attract somebody like Jenny Lowder has been a Godsend.
Ms. Lowder is a Certified Dental Hygienist that has been practicing for sixteen years. She earned her baccalaureate from East Carolina University in 1997 and her Associates Degree in 2004 from Fayetteville Technical Community College. She worked for many years in Dr. Dowd’s practice until he retired and has experience in working for corporate dentistry for a short time. But we are thrilled to have somebody with her experience and knowledge join our practice. I knew Jenny personally prior to her joining SLDG and think that you will find her outgoing personality and professional demeanor to be a huge asset in receiving high level care and education. She loves her profession and is especially energetic in assessing each new patient and working with them to understand their particular oral health situation.
I hope you will join me in welcoming Ms. Lowder to our practice. She is accepting new patients and looks forward to long and productive with Spring Lake Dental Group. As she is an avid dog lover, you might initiate your conversation with her asking about her miniature schnauzers!
There are many relationships in a dental office. There is the relationship between the dentist and her/his assistants, hygienists and their patients, office manager and business staff, etc. One relationship that has a great affect upon the patient and the dental office is insurance. Dental insurance provides a means where treatment can be completed at a reduced cost for the patient because of the agreement between the patient and their insurance. The insurance company and the patient are in a relationship based upon a fee that the patient pays, and the insurance company agrees to pay a percentage of dental treatment with the remaining cost being the responsibility of the patient. When a dental office is in network with an insurance company, they agree to accept the insurance and have privy to their patient base at the cost the insurance will pay for each dental treatment, this cost is usually much different/less than the office fees. The dental office accepts the fees and the time limits that covered treatment can be performed; we accept but do not let that dictate the treatment that is recommended, all options must be presented to the patient. When a patient questions a non-covered treatment, have to wait for care due to the time limits set by their insurance, disagree with the amount that the insurance will cover, it is the patient’s right to contact their insurance company and let their concerns be known. We contact insurance companies on behalf of our patients often, we are patient advocates. The patient/insurance company relationship is one in which the patient is actively involved and to be heard and their issues considered is a minimum.
Author: Dr. Alison Vitelli, DMD
Plenty of times we are asked about tooth replacement options such as implants, dentures or bridges. Of course, these options are given after a detailed evaluation of the area that needs to be replaced, as well as, medical history and habits of the patient. Implants are a versatile option to replace single or multiple teeth. For example, an ideal and pretty predictable scenario for an implant would be a healthy patient that lost a a single tooth, and the teeth adjacent to that site do not need any treatment. In this case, the implant is favored because it would be replacing a single tooth without affecting any other areas. Implants would also be indicated when multiple sites need to be replaced, as well as, for denture wearing patients. In the later stages, stability and retention of the complete or partial denture will be improved.
Fixed bridge are another great tooth replacement option. This is favored when contraindications for implant placement are present. Or when the teeth adjacent to the missing tooth site needs extensive fillings or crowns. Some contraindications for implant placement include systemic bone conditions, past history of using medications for bone density treatment, and smoking, among others. Every patient and every site is unique, so please do not hesitate to ask our professional opinion in what your best option will be!
There are two issues I would like to discuss today. The first being about pain relieving efforts following dental surgery and the second about lowering the risk of virus transmission within the dental office.
We have been inundated with debate about the pros and cons of “following science and listening to our scientists”. I have always been an advocate for evidence-based dentistry and during this pandemic I have watched and participated in more webinars than I care to think about. But staying up with the literature and being a lifelong student have always been a challenge within this profession. The opiate epidemic within our country has caused me to re-examine how I prescribe medication for dental surgery pain. Not that I don’t use opiates (a narcotic analgesic) anymore, but the literature has given me alternatives to consider as I evaluate each particular situation. A centrally acting narcotic has addictive liability that has to be weighed against the amount of pain relief that you are achieving with its use. And can you, with appropriate patient compliance, receive the same amount of pain relief with other options?
The American Dental Association (ADA) recommends considering non-steroidal anti-inflammatory drugs (NSAIDS) as first-line therapy for the management of acute pain. The following studies specifically show that naproxen sodium mono-therapy and ibuprofen/acetaminophen combination therapy may be alternatives in treating dental pain.
-In two single dose studies, patients who took naproxen sodium (Aleve) 440 mg. reported significantly reduced pain compared to those taking acetaminophen plus codeine (Tylenol #3) 660 mg./60 mg. from the three hour mark onward.
-In a single dose, 12 hour study, 1 and 2 pills of the single pill combination of ibuprofen/acetaminophen 200 mg./500 mg. were statistically and significantly more efficacious than placebo and acetaminophen/codeine 500 mg./15 mg. Also, the 2 pills offered significantly superior pain relief to ibuprofen/codeine 200 mg./12.8 mg.
The side effects to opiate use besides addiction liability are also that its use is not recommended for the young pediatric population. Dry mouth and constipation are also annoying side effects to this medication. As always, having a conversation with your doctor/dentist about his/her plan for dealing with post-operative pain is always recommended.
The second topic I wanted to touch on today is our use of a hydrogen peroxide pre-rinse before dental treatment in our office. Hydrogen peroxide has been shown to be very effective in killing the coronavirus in laboratory studies. Lowering the viral load within the oral cavity should be a clinical aim in undergoing treatment. We ask our patients to swish for one minute prior to being seen. As we all know, the taste and oxygen release and bubbly that takes place on swishing with this mouth rinse is particularly annoying. But due to the fact that asymptomatic carriers are probably a part of our daily schedule, we ask all of our patients be compliant with this request. This pandemic has been highly stressful for all of us but treating you safely and effectively has been and will always be a central goal at Spring Lake Dental Group.
Author: Dr. Rima Solanki, DMD
Many times, we have patients ask when we recommend the extraction of a tooth, “why don’t we pull all the teeth and get dentures?” We understand your frustration associated with having to keep coming to the dentist when extensive dental work is involved, however there is nothing better than trying to save our own teeth and reasons are many. Replacing teeth can be more costly than saving them, especially when implants are involved and not all patients are candidates for implants. After the extractions of teeth, remaining teeth will start to move, opposing teeth will supra-erupt since they have nothing to bite against and gaps between teeth may start to appear, especially when immediate teeth replacement is not done. Removable teeth replacement options (dentures or partial dentures) are there, however it requires a bit of adjustment with talking and eating with them and many times, patients stop wearing them. Some patients are not comfortable with having removable teeth replacement. Remember to talk to your dentists at the Spring Lake Dental Group for the best treatment option!
Kids fall. Kids hurt themselves. When these incidents happen, and it involves their teeth, it can be scary, more so for the parent. When your little one damages their tooth, there are actions that we take to promote continued health of the tooth. One example we will discuss is when the baby tooth is displaced (pushed towards the roof of the mouth, tongue or lip) and immobile. This is called lateral luxation. According to the American Academy of Pediatric Dentistry, if there is no interference with the opposing tooth, the tooth is allowed to reposition spontaneously. If there is minor interference, slight grinding of the tooth is needed. If severe interference is present, repositioning of the tooth is required. If there is severe displacement and the crown is towards the lip, removal of the tooth is recommended. Follow up appointments are required starting at one week post trauma up to one year. Parents are advised to watch for discoloration of the tooth and the appearance of a pimple on the gums in the area of the trauma. Kids will get their cuts and bruises. When these things happen and the tooth is involved, always contact your dental provider for appropriate care.