Temecula Facial Oral Surgery

September 2017 Blog by Oral Surgeon, Dmitry Y. Tsvetov, DDS, MD

Dental Vacation in South of the Border?

Dental Tourism is becoming mainstream nowadays… Lots and lots of folks head south across the border to have their dental needs addressed. “After all” they say “it’s cheaper and the doctors are mostly American-trained, so why not?”

While it’s true that the prices for dental services are lower south of the border it’s hard to argue that the quality of work is often lower as well. It has to do with the differing standards of care between the US and Mexico. Doctors in Mexico don’t have to adhere to the high US standard of care, because well, they are not in the US. So even though they are American-trained, they don’t necessarily adhere to the American care standard and patients first practice.

Patients often come back to the US only to find that in order to treat the complication that arose as a result of their treatment in Mexico they either have to head back south or pay a local dentist to fix the problem – neither of the two possibilities are particularly appealing.

As far as prices go, yes, they are lower across the border … but oftentimes so is the quality of the dental materials used… dental fillings and crowns don’t last as long and cheaper dental implants end up failing at a higher rate.

Just like the old proverb says: “Stingy man ends up paying twice”. So by all means, enjoy your trip south of the border… just make sure to have your dental work done stateside. ☺

September 2017 Blog by Oral Surgeon, Dmitry Y. Tsvetov, DDS, MD

Worrisome Dental Trends

In the last 5 days I received two frantic phone calls from concerned patients. Both had their teeth recently removed in a general dental office and both ended up with bad complications. The first patient had a part of the tooth accidentally pushed into the sinus cavity underneath his eyeball. The second patient ended up with a numb lip after a wisdom tooth removal.

Neither of the two dentists who did the wisdom tooth extraction procedure were able to help the patients after the surgical turned complications. The patients were forced to look for an Oral Surgeon who can help treating the wound in their mouth before the complication spreads too far. As if that wasn’t unfortunate enough, having paid for the procedures out of pocket at the general dentist’s office they were now looking at spending more money so that the Oral Surgeon can fix the problem.

In the old days, when a patient needed a complex dental surgical procedure done, they were sent to a specialist to do it. They would see an Endodontist for a root canal, a Periodontist for gum surgery, or an Oral Surgeon for tooth extractions and implants. These days, general dentists are trying to do everything on their own to keep revenue rolling in to their practice. I am not saying general dentists shouldn’t do root canals or extractions or place dental implants. If they are properly trained in the procedure and most importantly, are able to handle the complications of their work, then by all means, go for it. But if you do a procedure and cannot treat a complication of your work, if you end up leaving the patient hanging and can’t do anything to help them….well, that’s just not fair to the patient and it’s not good professional dentistry.

As a patient, be empowered and be educated! Be involved in your own care and try to make good medical decisions concerning your health. If you feel more comfortable undergoing the procedure in a specialist’s office there is a good reason why you feel that way!

Happy Ending

Both patients were seen in my office, their wisdom tooth extraction turned complications were treated right away and they are well on their way to recovery.

Here at Temecula Facial Oral Surgery, we do everything possible to accommodate with same day appointment to ALL patients in pain! We do same day extractions and do not push for general anesthesia. All procedures can be done under local anesthesia. FREE (Dental Implants, Wisdom Teeth) Consultation including X-rays!

Friday morning…Weekend coming up…

Phone rings…”Hi, I was wondering if you can fit me in today. My wisdom tooth hurts a lot…I was referred to another office, but they can only see me late this afternoon. And they told me they wouldn’t pull the tooth until next Monday anyway, since they don’t do surgeries in the afternoon. And they want to put me to sleep just to take out one tooth… Is that really necessary? I am in pain! I can’t go on like this all weekend. Can you help?”
We say: “Of course”
Patient comes in, and 30 minutes later she is walking out of the office having had:
Same day free consultation
Same day free x-ray
Procedure completed—removal of one wisdom tooth (without being put to sleep)
Finally, looking forward to the weekend free of pain and discomfort.
What I am trying to say here is that as a patient, when you need treatment that only an Oral Surgeon can provide, YOU HAVE CHOICES. The office where you are being referred to, MAY NOT necessarily be capable or be equipped to serve YOUR BEST INTERESTS in the best possible manner, in the time frame that is convenient to you.
So do your research. There are doctors who are willing and able to help you. Who are capable of providing the service that you need in the manner that does serve YOUR BEST INTERESTS.
Sincerely,
Temecula Facial Oral Surgery

Patient presented to my office with an abscess involving tooth #8.  As can be seen from the radiograph, a very large periapical lesion is associated with the tooth.  The lesion has destroyed a lot of bone, making immediate implant placement impossible in this situation.

Tooth #8 was extracted and the periapical cyst biopsied.  Results of the biopsy confirmed the diagnosis of a large, infected periapical cyst.  Followup imaging at 3 months reveals a healing bone defect, but still not enough bone for placement of implant.

After 3 more months of healing the defect is smaller, but still not enough bone to place an implant.

Onlay bone grafting utilizing cadaver bone and membrane with tacks was performed.  Four months after the bone graft, patient now has enough bone to allow for placement of implant.

Implant is placed and the patient is looking forward to having it restored.

I would like to share with you a heartbreaking story of a patient who came into my office.  This 45 year-old male patient had two lower left teeth removed at another dental office two months ago.  The patient never quite “felt right” after the extraction, having pain, swelling and not being able to open his mouth fully.

Every time he would go back to the dentist he would be reassured that “everything is fine”, that it is “just taking a little longer to heal” and would be prescribed antibiotics.

Finally he came in to see me for a second opinion.  Let us look at some pictures:

This is a picture of the site where the teeth were removed.  Notice the large growth of the tissue at the extraction site.  The mass was solid and definitely concerning.

This is the xray of the patient.  Please note the dark resorption of the jaw bone at the extraction site.

This was a very, very concerning situation.  The two most likely scenarios in this case would be either a deep infection of the bone after extraction (osteomyelitis of the jaw) or cancer.

Biopsy was done, and unfortunately the diagnosis was cancer.  Now, think about the two months that patient kept coming back to the dentist and was being reassured that “healing is just taking a bit longer”.  All that time the cancer was invading deeper into the bone.

Had the problem been identified right away, the patient could have been definitively treated sooner.

Who is extracting your tooth?

We often see patients who had teeth extracted at another dental office. On multiple occasions, the stories they share are not pleasant. They tell us that it took “two hours” to get a tooth out, that “they were in pain” when the doctor was removing the tooth and that they were “black and blue” afterwards.
They come to our office wanting to have a dental implant done, to replace the tooth that was extracted. Imagine their unpleasant surprise when they find out that the tooth was not removed completely and that a piece of tooth was left behind.
That means that before a dental implant can be placed, the remaining piece of tooth needs to be removed, followed by more “waiting for the bone to heal”. That prolongs treatment time, increases the financial burden on the patient, and in general complicates an already complicated situation.

Let us look at a few examples:

I think the take home point is that to avoid unpleasant surprises, it is best to have a tooth removed by an oral surgeon. That way a patient can be sure that there will be no “root tip shock” later on and a dental implant can be placed in a routine, straightforward manner.

In today’s blog we are going to discuss three common problems that impacted wisdom teeth cause. Impacted wisdom teeth are teeth that develop inside the jaw bone, but fail to erupt/come out into the mouth. As a result, they can cause a variety of problems with adjacent teeth.

1. Decay/Caries on the adjacent teeth
a. This happens because it’s nearly impossible to maintain good oral hygiene around impacted teeth.
b. Food, plaque and bacteria get stuck between the wisdom tooth and the other erupted tooth, causing tooth decay on adjacent teeth.
c. This requires additional treatment (Root canals, crowns, etc…) on a tooth that was otherwise completely fine before the nearby wisdom tooth started to push into it.
d. The problem could have been easily avoided had the wisdom tooth been removed early on, before it started to cause damage to the adjacent tooth.

2. Wisdom teeth preventing eruption of the other teeth
a. Sometimes, the wisdom teeth grow on top/over the second molar teeth.
b. As a result, second molars fail to erupt/come out into the mouth normally.
c. This leads to poor occlusion/bite, poor hygiene due to teeth being “crooked”, extensive orthodontic treatment (prolonged treatment with teeth braces), and of course more surgery.
d. The problem could have been easily avoided had the wisdom teeth been removed before they started to cause problems.

In the first picture, the upper second molars on both sides (red arrows) are being prevented from coming into the mouth normally because the wisdom teeth up above are “squeezing” or “pushing” the second molars into the first molars. As a result, the second molars are stuck, and can’t come out into the mouth normally. As you can see, their counterparts on the lower jaw (second molars) are out in the mouth already.
In the second picture, the lower right wisdom tooth is blocking the lower right second molar from erupting normally. As a result of the second molar being stuck lower (blue arrow), the upper second molar is “hypererupting”(red arrow) or reaching lower, below other teeth to get to touch the second molar. This creates bad problems with the bite, or the way teeth are coming together, requiring extensive orthodontic work in order to correct the problem.

3. Impacted wisdom teeth can damage/resorb the adjacent teeth
a. Sometimes, due to the fact that impacted wisdom teeth push on the other teeth, the adjacent teeth can get resorbed/damaged/eaten away, much the same way as adult teeth resorb baby teeth.
b. This oftentimes leads to patient loosing not only the wisdom tooth, but also the adjacent resorbed tooth, that the patient was using for chewing previously.
c. This unfortunate problem could have again been easily avoided if the wisdom tooth was removed before it started to cause problems.

As you can see from this blog entry, impacted wisdom teeth have a potential to cause a lot of damage to adjacent healthy teeth, which, in turn, leads to more extensive treatment of the resulting problems.
We offer free consultations regarding wisdom teeth, so please give our office a call and come in for an evaluation, so that if you have a problem with impacted wisdom teeth, the problem can be identified and treated early.

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In this video Dr. Tsvetov explains advantages of dental implant over dental bridge for a single missing tooth. Should you have questions, please do not hesitate to schedule a complimentary implant consultation with Dmitry Y. Tsvetov, DDS, MD.

https://www.youtube.com/watch?v=NBZseh1baiE&feature=youtu.be