Fort Myers Dentist

Seek Second Opinion Before Gum Surgery

Q: My dentist told me I need gum surgery to “get more mileage” out of my teeth. Are there alternatives? Les in Jupiter

: A common topic on my radio show Tooth Talk is “When to Get a Second Opinion.” When you are told you have deep pockets, get a second opinion before your hands reach into your own deep pockets looking for cash. Firstly, how are the pockets being measured? A hi-tech hygienist will use one of the computerized probing systems (Florida Probe or STM Probe) where a computer generated voice will speak the pocket measurements and display them on a hard copy print-out or save the data to a computer’s hard drive for comparison at each check -up visit. This can be more accurate compared to the metal periodontal probe used for nearly a century. Computerized probing eliminates the variation in your hygienist’s hand pressure as she inserts the probe into the space between the tooth and gum, called the sulcus. (My childhood hygienist, “Deadly Debbie”, had the hands of a bricklayer.)

If you have periodontal pocketing of 5mm or greater with bleeding and or puss, a non- surgical treatment consisting of deep scaling, root planning and curettage with placement of antibiotic granules, called Arestin would be the first line of treatment. No incisions and no stitches. If pocketing is 6 to 12 millimeters and digital X-rays show significant bone loss, it could make more long term economic sense to replace the teeth with implants before all the bone is lost .

CT Scans and Dentistry

Q: I need dental implants. My dentist wants me to have a type of  3-D “CAT scan” with something called an iCat machine. It is expensive and not covered by my medical or dental insurance. Must I have this scan done; he has my X-rays?..Gigi on Jupiter Island

A: As strange as this may sound, I can answer this question due to my love for  steak. My local implant study club has changed the venue of our monthly meeting to Morton’s Steak House. Now, I never miss a meeting. (Denny’s, just never got me to show up.) Last week, a well known University of  Florida dental educator, Dr. Bill Martin, gave a presentation on implants. He informed us that only 8% of patients going through the university affiliated implant clinic required this expensive and sophisticated type of scan. A recent article in the NY Times showed that the companies that make these 3D scanners are paying some dentists to promote the device on the lecture circuit and pose in ads in dental journals. Currently, regular digital X-rays are just fine for evaluating the bone for implants and use much less radiation than any CT scanner.

Osteoporosis Meds and Dental Surgery

Q: I need some teeth pulled and some implants, but have heard medication I take for osteoporosis can put me in danger of getting complications in my jawbone. Should I be worried? Doris in Wellington

A: Sometimes the media gets on a topic like orange on a Home Depot apron. They just love juicy stories that scare the public half to death.

A comprehensive article in the November Journal of the American Dental Association now sets the guideline straight. “The prevalence of patients getting ONJ (osteonecrosis of the jaw: areas of dead bone that protrude through the gum tissue.) Is .10 percent”. (As in one 1/10^th of one percent i.e. small.) And, “no validated diagnostic test including the CTX test, predicts a patient’s risk level of developing ONJ. There is insufficient evidence to recommend a holiday form these drugs (Boniva, Aredia, Actonel,  Fosamex, etc.) or waiting periods before performing dental treatment for prevention of ONJ”. If you have any questions please give us a call at 239-936-5252.

Q:I would like you to address how often dental X-rays should be taken. It seems like I am always getting Xrays.- Ruth in Boynton

A: I don’t know why, but women with biblical names seem to be my biggest fans. I bet lady Gaga can’t say that! As you might have read in a previous column I did express that as long as you are going to an office that is using digital X-ray systems and lead aprons with thyroid collars, you will not have any ill effects from the minimal radiation used. The US Food and Drug Administration Guidelines for prescribing dental X-rays was published in 2006. For an adult or adolescent new patient who has had a history of extensive dental work or currently has generalized dental issues, a full mouth set of eighteen individual X-rays consisting of bitewings which show the posterior teeth (and in between) and periapicals which show the entire root and surrounding bone are needed. If the adult or adolescent new patient does not have any history of major dental work or has no evidence of current dental disease upon examination, then a panoramic X-ray and four bitewings is acceptable. At check-up time, four bitewings need to be taken of the posterior teeth EVERY six to eighteen months, again depending on the past history of decay, periodontal disease and quantity of dental work. Periapical X-rays should be taken every three years to examine the roots of the teeth to void missing abscesses and other boney pathology.

Question: I get annoyed every time I am asked to fill out a medical history at dental offices. Many times I am only in for a

cleaning. Why do they need to know what I am taking? -Frank in Vero

Answer: Hey Frank,  you may only need a cleaning today, but one day you may require some emergency or elective dental care where the dentist will need to give you one or more of various medications that may cause adverse reactions with one you are already taking. Many medical

conditions dictate the course of dental treatment as well as the medications the dentist will prescribe. For patients taking birth control pills (not you, Frank),certain antibiotics render the pill ineffective. Aspirin can result in severe bleeding in patients taking Coumadin, Plavix and other blood

thinners. Patients taking tricyclic antidepressants such as Amitriptyline can have very adverse reactions from being given local anesthetic shots of Novocain-type drugs, resulting in high blood pressure, chest pain, headaches and irregular heartbeats.

Brown Spots in Mouth after Implants; Very Rare

Ask the Dentist: Replacing a Bridge with an Implant

Q: I have a bridge that I can’t floss, one of the anchor teeth looks gray at the gum line and I have a large gap underneath the dummy tooth. Can I remove the bridge and do an implant or is it too late?...MP in Ft. Lauderdale

A: Many a beer bottle has cause a dental dilemma. Some via blunt trauma; others by using the teeth as a tool to pop the cap off to impress the ladies.

The answer is “yes”, if certain criteria are met. A digital X-ray of the missing tooth area will show if you have enough height of bone stretching from the base of the nasal cavity to your gum line. Palpating the area with fingers and/or use of 3-D imaging can determine if you have enough thickness of bone. The smallest implants are about 9mm and about 3mm in diameter. If the bone is skimpy, we can add grafting material.

If one or both of the bridge’s anchor crowns are in good shape, the “dummy” tooth can be sectioned away from the rest of the bridge, saving the two crowns on the adjacent teeth and saving money too!

In your case, I would remove just the one ugly, gray anchor crown, place the implant and then make a two-unit cantilevered temporary bridge while the implant is taking it’s usual four-month healing period. This will eliminate the need for wearing a removable denture called a “flipper” until the permanent crown is made.

 Q: I am thinking of having some cosmetic dental work (veneers and some crowns), but I am afraid they will look fake. I see a lot of people with very artificial looking teeth. How can this be prevented? Dale in Palm Beach

A: Nobody wants to look like they swallowed a piano or a box of Chiclets. Many of the techniques we use in cosmetic dentistry to create natural looking veneers and crowns involve the artistic communication between the doctor and his dental lab technicians.

Firstly, the shade that one chooses should be appropriate for their skin, eye and hair color. Olive skin patients should not pick a ‘refrigerator’ white shade of porcelain, but those patients with fair skin, blue eyes and light blond hair can often get away with “Regis Philbin” white teeth.

 Secondly, when we design a case, we don’t like a bowling ball surface texture. We prefer an irregular, pebbled surface to break up the light for a more natural appearance. We call these subtle “waves” in the front surface of the porcelain: facial lobes or flutes. Natural teeth have these irregularities that form during the embryonic development of the adult teeth.

 And thirdly the shape of the teeth is paramount in creating a natural smile and is dependent on the patient’s age, personality and facial contours. A square face, a heart shaped face and a round face might dictate a completely different shape and contour of the veneers or crown.

For more information or questions please call Dr. DeCarlo at 239-936-5252.

Q: One month after having dental implant surgery, I noticed brown spots inside my mouth. Is this normal and is it something to worry about?