Common Sense is NOT so Common

Before reading this or deciding this is a boring and lengthy blog that you have no interest in, I have a suggestion. Skip to the very last paragraph then decide if you wish to read the entire article.

 

I could get into a discussion about many things that we do not always take the most sensible path – driving, eating, the way our government operates, etc. but here I am going to focus on protection against diseases.

 

In general humans have come a long way since we have invented the microscope, antibiotics, disinfectants for home, industrial and medical use, disposable gloves and other protective barriers. You would think that all the research and education would have produced some very good habits among us all at work or home. Ironically, however, the CDC (Center for Disease Control) call their protocol Universal precautions. As I will point out there is a wide range of understanding and compliance even among all of us health care professionals. That being the case, how can we expect average people at home and workers in all other fields to do what is right if we are not setting a great example.

 

In my observation I believe there are two major deterrents to actually developing universal precautions. One is that we have two major organizations that govern the health care professions and some other industries. One is the CDC and the other is OSHA. Neither of these important organizations disperses any false information. The problem is how some or many workers interpret their manuals. What we all should be aiming to do is to protect everyone all the time to the best of our ability. Sadly many show the greatest amount of effort to protect themselves and not enough toward protecting the patients – both current and subsequent and also their co-workers. I believe some of their habits are a potential threat to themselves. I believe this is attributed to having a false sense of security that many have when wearing disposable gloves.

 

I have been a Dentist for 40 years. Therefore I have been in the profession throughout several major transitions. Aside from the changes in procedures  – from  amalgams to composites, only dentures to the alternative of implants and many advances that have allowed higher levels of esthetics, longevity and efficiency through technology there have been a few monumental changes in infection control. Before 1986 we would do the following:

Wear gloves only when performing a surgical procedure or on any procedure when a patient was known to have been exposed to Hepatitis or Tuberculosis.

We wore masks for those and also if either the patient or we had a cold.

Surgical and Root Canal Instruments were steam sterilized. General instruments were soaked in a Gluteraldehyde solution. Equipment and surfaces were wiped with alcohol.

 

Once we learned about HIV – AIDS we went through very major changes. We began wearing gloves for all procedures for every patient. We began using more disposable items, steam sterilizing all types of instruments and more advanced chemicals for surface wiping. In addition to HIV there have also been new threats such as several other forms  of Hepatitis and Ebola. The focus on prevention also lead to further research on bacteria and viruses, parasites in our water lines. This is another topic I will address at a future date.   

 

The scare about HIV – AIDS created a very different approach than before. While we previously only wore gloves and other precautions when we were aware of hepatitis history or were experiencing cold or flu now the rules became” Treat every patient as a possible HIV contamination” . We therefore changed our regimen even for the very simplest procedures and even on family members. We certainly would use a different approach at home when being intimate with a lover or caring for a child and overlooking their flaws involving saliva or any other bodily fluid. However, for a routine exam or any treatment procedure in an office we would use those universal precautions to prevent contamination when we were 100% certain that person was not a carrier.

 

So now let us go back in time to pre 1985. This is what we were taught. When it was deemed necessary to wear gloves we first washed our hands then carefully placed the gloves. From that point we were careful to avoid touching unsterile items with the one exception being the necessary steps in treatment. When treatment was completed we carefully removed the gloves, carefully disposed of them and again washed our hands.

 

Somehow we have strayed far from that recipe. I would assume that it is still being used by surgeons in hospital operating rooms.. The rest of us have wandered far from sensible and effective and responsible actions.

 

In addition to practicing a wide range of general dentistry for the past 40 years, I have also been a patient at various dental and other medical offices and I have attended many continuing education classes. From all these encounters and also from my own office experience – trial and error, observing other dentists, Hygienists and dental assistants. I learned from those who were employed by me for over 10 years as well as those I interviewed or had for very temporary employment. I also learned from observing and being treated by Medical Doctors, nurses and medical Assistants. When I saw something good and impressive I altered my habits to mimic theirs. When I saw poor habits I made every effort to avoid repeating. Sometimes these were simply a matter of incomplete knowledge while other times it was purely being careless. Sometimes I believe that we mean well but are confused. We may have been taught proper protocol but then get caught up with the factor of time. Therefore we cut corners. We do not wash hands often. We touch multiple items some of which never should be contacted with gloved hands since they cannot be feasibly disinfected.

 

I believe that part of our confusion may stem from shows and advertising on television and magazines. Even our own professional journals and webinar classes will show dental professionals engaging in controversial behavior. One example I have often seen is the use of gloves when touching a computer keyboard or mouse. Another is when using a camera (not intraoral) but regular camera taking photos of a patient’s face. There really is no feasible way to disinfect your camera or computer. Chemicals will likely cause at least sticking of parts if not rusting and deterioration. Part of the confusion comes from crime investigation. Crime investigators wear gloves for two reasons – to avoid contamination and also to prevent placing their own finger prints. In order to end that confusion they really should separate their duties – like we should separate ours. Gloves should never be worn for taking photographs or using a computer, taking notes and many other tasks. Just put the gloves on when you are going to  contact contaminated areas. Once you are gloved touch only what is necessary and what can be sterilized, disinfected readily or disposed. Keep it simple. Keep it safe.

 

So here now is my current protocol I use in my dental practice and train my staff.

 

1. Wash hands before preparing for procedures
2. Plan ahead and get as much ready as possible
3. Position your mask and glasses or eye shields
4. Wash hands again
5. Put on gloves
6. Keep contact of instruments, supplies, equipment to minimum
7. If you need to retrieve additional supplies have a second retrieval instrument available
8. Make use of a second assistant to place and remove lead aprons for x-rays, remove bibs, fetch additional supplies, take notes, dismiss patients, etc.
9. Use gloves on both hands when cleaning up and reassembling instruments and for carting to sterilization area and discarding trash.
10. Separate trash into sharps, highly versus minimally contaminated
11. Wash hands
12. Put away clean items
13. Place a glove on one hand only for disinfection. The gloved hand holds the paper towel or cloth with the chemical disinfectant. The ungloved still clean hand contacts poles, door knobs, drawers, hoses, etc. In this way we avoid spreading more contamination than we are removing. The ungloved hand holds the spray bottle.
14. Be generous with disinfectant and purposely focus on what was actually contaminated. Be generous with amount, concentration and time spent.  
15. Remove the one glove and wash hands again.
16. One more tip – in the sterilizing room do not wear gloves for any other reason than touching contaminated not yet sterilized instruments.
     
    True this is not a sterile world. None of us no matter how hard we try are perfect. If we are going to promote the most good and do the least harm, we need to have sensible methods. We need to be much more similar and not so diverse when it comes to extremely important habits.
     
    I will end with a quiz I often give to employees:
    1] Would you remove your gloves and immediately eat your lunch without washing your hands?
    2] Is there really a “5 second rule”

Who decides your dental care?

How do you decide whether to seek dental treatment? Are you usually preventive minded and proactive? Do you only call when you sense discomfort or an obvious cavity, fracture or serious gum problem?


When you do decide to schedule with a dental office are you referred by a friend or family member or do you search the internet or telephone book or other direct ads? Do you consider any dental practice or are you strongly motivated to go where your dental insurance is in network for PPO discounts versus normal acceptance of your plan?


Do you believe there may be any difference in the quality of treatment you receive based on cost?
Is the treatment that you need so routine that you feel it makes little difference.


If you do need major procedures such as a root canal or bridge or some treatment of your front teeth would that make a difference? Do you believe that all dentists have similar experience and spend the same amount of time or use the same quality labs and supplies?


For some patients the answers to some or many of these questions is: "It does not matter at all or very much". They will then be highly persuaded to go with the "cheaper and faster the better" formula.


Many other patients do realize there is a difference.


It is true that new dental graduates will have very similar training. After that point there will be a very wide range. Doctors have choices to make regarding what equipment and supplies they purchase. They can very greatly with respect to the additional training they receive and use after dental school. They also have the ability to choose how much time they want to spend on patients and relate their focus and time to the fees they charge. The Dentist and staff spend time diagnosing your health status and then educating you. They not only perform your actual treatment but also strive to make you comfortable during that treatment and when providing you with temporaries and post op care. In addition to the amount of focus and time spent , there can be  much variation regarding quality of lab work and materials used for your treatment.


We believe patients have the right and responsibility to choose. It is a good thing to have dental insurance. It should be seen as a helpful benefit whether it pays in full or just a portion.
Unfortunately too many patients are strongly swayed by things that are not under their direct control. Your employer or union often decides which insurance plans to offer. Your insurance plan decides which procedures to cover and to what extent. The fee schedule designed by your particular plan may be anything from very basic to generous. It is really up to you, the patient to decide what you are comfortable with.


In the last 5 to 10 years there has been a great amount of change within dental insurance. As we all know, there have been major changes due to the Affordable Care Act (Obama Care). Thus fare the effect on dental and eye care has been minimal and indirect compared to medical coverage and for some the ability to sustain a full time employment.


I believe that our influence by politicians and insurance companies has already had significant effects on dental as well as medical care. While the goal was to spread health care to those less fortunate, there has unfortunately been adverse effects on those who previously had coverage and access to care. Many of us realize that there are ranges and different standards.


I will address this more in my next blog.

Post treatment guide for dental implants

**These are GENERALIZED instructions for your information only; they are not to be used for self-diagnosis or self-treatment. Please see your personal dentist for your own care.**

Post Treatment Instructions 

First 24 Hours

Completely avoid eating and brushing and touching area

Use cold pack gently outside skin for first 1 – 2 hours on and off 10 minutes

 

Usually all bleeding has subsided by time you are dismissed. There is some possibility of the return of bleeding later as the local anesthetic wears off and the Adrenaline effect on the blood vessels ends. It is normal for your mouth to have the taste of blood and for a very small amount of clotted blood to mix with your saliva. However, if you actually develop bleeding do the following:

Place a cold pack back on the outside of your face in the area and place  a wet tea bag insiden the mouth directly over the site and gently bite to allow the tea to coagulate the blood

Unlike usual extractions – DO NOT BITE ON GAUZE – pressure may disturb implant, bone graft healing process

 

Days 2 – 14  Continue to avoid eating and brushing in surgical area completely

Restrict all eating to the opposite side of the mouth. Chew carefully

The most important requirement is to avoid disturbing the area while healing is proceeding.

If a tooth was extracted, bone grafting, implant placed either separate or in combination; any force will cause shifting and will disrupt closure of the surgical site, movement of bone graft materials or membranes. Implants must be integrated within the bone for a minimum of 90 days for routine conditions before being subjected to force from chewing.

In lieu of contact even with a soft tooth brush applied gently, we recommend:

Rinse 3 – 7 times daily with  baking soda (one teaspoon dissolved in 8oz water)

There is also available a mouthwash with baking soda as the main ingredient. ( Tom's )

 

Use of temporary bridges, retainers, dentures - It is extremely important to prevent any direct forces on healing tooth sockets, bone grafts and healing implants.

 Special Instructions

Day 15 – 1 Month   sutures have been removed and the doctor has verified initial healing:

For two additional weeks after suture removal do brush the teeth adjacent to the extraction, bone graft, implant still being very gentle - only clean the teeth - do not massage the gum tissue that was involved in the surgery. Floss gently any adjacent teeth but do not force floss into crevice of gums immediately in the area of any implant or bone graft

Continue eating carefully still avoiding even soft foods on the surgical area.

 Any temporary restoration worn during the healing period should exert zero force on the area surrounding the implant and any bone grafted area.

 

Month 1  through [   ] 4    [   ]  6   [   ]  8

dependant on how many phases from toothy extraction through the time implant is determined to be fully integrated (secure in the bone)

During this time there are two very important requirements to adhere to

1) Forces upon the healing graft or implant must be avoided entirely

2) Cleanliness is imperative throughout the remaining period for healing - and forever thereafter!

 

Since there is a wide range of situations, I will describe all of them and note which ones pertain to your individual circumstances

 

Stage one - No exposed Implant structure and no temporary appliance

Avoid eating moderate to crunchy and sharp foods in the area

Brush and floss adjacent teeth like normal

 

Healing Abutment exposed to the surface

Avoid anything but extremely soft from contacting the exposed Titanium part

In addition to normal care for the neighboring teeth keep the abutment and surrounding gum tissue clean by gentle brushing in a circular motion

 

Healing Abutment with a Removable temporary appliance

Use the same above precautions to avoid forces upon the exposed metal part and to keep it clean.

Eat with the temporary appliance in place according to your previous instructions based on the durability and stability of your particular temporary. Clean the removable appliance at least three times daily - as soon as possible after each meal. If you detect any movement where the appliance transmits force to the abutment or the gum tissue around it call the office and avoid further use until adjusted

 

Multiple Implants with a Temporary Full or Partial Denture  

Avoid use of denture adhesive while stitches are in place and until gum tissue has healed closed - usually 2 - 4 weeks after extraction or implant placement.

Keep denture clean outside and under brushing soon after every meal

There should be no force upon the healing sites - any force from chewing must be on the palate and remaining teeth and ridge areas that are well healed where teeth have been missing for more than a year.

Eat only soft foods the first 30 days and only gradually to moderate chewing until your implants are integrated and a permanent denture or bridge is placed       

 

 

crown or bridge attached to implant(s)

You were supplied with a temporary attached to the implant for the purpose of shaping the surrounding gum tissue in the final stages of healing.

 In some cases (this is to be avoided since it is a compromised situation with much higher risk) a temporary may be attached to the implant immediately or much sooner than the time of full integration due to the impossibility of fitting a suitable removable temporary and a strong need for cosmetic appearance during healing.

[   ] Phase one - completely avoid all eating that would contact the temporary tooth and transmit forces - Extremely Important - not even soft contact. Do not brush the temporary but instead rinse 3 - 7 times daily with baking soda solution

 

[   ] Phase two - still continue to completely avoid eating on the temporary.

Brush with most gentle brush and method Do Not Floss the area

 

[   ] Phase three - Now we are in transition toward the final replacement tooth crown or bridge. Start eating very soft foods on the temporary. Brush with normal massage of the gum tissue like you would for any other teeth. Begin flossing around the temporary very gently with light force only against the temporary and no force from the floss exerted against the gum tissue

 

Special Instructions

You have been recommended to wear an appliance at night - either your temporary denture, a second denture or a night guard retainer. This is extremely important since we need to remove all risk of forces on the healing site, any implants with healing in progress, any implants that will stand alone (when usual day time denture is removed) even after they have fully integrated within the bone (we need to assure that they will not loosen, break screws, etc.) We also need to avoid unbalanced forces on any remaining teeth or trauma to your lips or tongue, etc. caused by clenching teeth during sleep especially when there are few remaining teeth that would be very vulnerable to problems.

In addition to protection, this allows the opportunity for soaking of removable dentures or retainers for maximum disinfection when they are out of your mouth.

Other:

 

 

 

After PERMANENT restoration

Gradually increase chewing reaching normal frequency and texture of foods.

Always avoid  extremely hard chewing such as ice, hard candy, shells, stale nuts

and  using your teeth as a tool or for bad habits.

Keep in mind that anything too strong will cause damage to natural tooth enamel, porcelain and other restorative materials, dental cements (even permanent) and can result in broken screws, loosening of crowns, bridges, posts, implants or teeth themselves.

Brush normally and often Floss gently around any Crown, etc. placed on top of the implant . Do not force floss deep under the gums around the body of the implant   gums do not attach as firmly to an implant as a tooth root  Gum and bone grow closely around an implant, but do not biologically connect

Implants will not be subject to cavities, but they are highly vulnerable to gingivitis.

Eat well without overloading  Use excellent cleaning at home and be consistent with follow up care every 3 - 6 months as recommended

 

 

 

                       Summary - Instructions for Dental implants

 

1) Day before / day of surgical placement

 

Take anti-inflammatory pain medication 1 - 12 hours in advance to prevent excess swelling and pain

Take antibiotic starting day before to prevent infection

 

 

2)After surgery through two weeks - removal of stitches

 

Completely avoid eating in area

Completely avoid brushing and flossing in area

Instead rinse gently and frequently ( 5 - 10 times a day) with baking soda solution or baking soda mouth wash only

Completely avoid use of any removable false teeth, temporary, retainer, night guard unless you were specifically instructed to do so and given special instructions for wearing and cleaning, removal

 

3) Following removal of stitches

 

brush adjacent teeth gently but thoroughly

rinse briskly with any type of mouthwash at least 3 times daily in area of implants

still do not floss the gum tissue next to any implant

If a screw or healing abutment is exposed now or becomes exposed in later weeks, begin gently brushing the exposed metal with a circular motion.

 

 

 

Under no circumstance should any force be placed from chewing upon an implant prior to a minimum 3 month period for integration (healing within your jaw bone)

 

exceptions are specially given when a patient has received a full arch set of implants that are joined by a rigid bar and a special secure temporary - still use great caution to chew very softly for the initial 3 month period

 

4) After restoration of implants

 

once any single crown, bridge or removable restoration is attached to the implant:

 

Chew softly at first then gradually increase until normal (mildly crunchy) can be accomplished - usually over a period of a week.

brush the fixed restorations the same as any natural tooth covered with a crown, bridge

Do floss the gum tissue over the implant - extremely gently - wipe gently against the implant and crown - do not use any force pushing against the gums surrounding any implant now or ever in the future

 

removable partials and full dentures are removed for cleaning three times daily and the implants should be brushed with a gentle circular motion.

**These are GENERALIZED instructions for your information only; it is not to be used for self-diagnosis or self-treatment. Please see your personal dentist for your own care.**

Broken crown or temporary? Read before you DIY

Dr. Raymond E. LaVigne practices dentistry in Palatine, Illinois.  His specialties are cosmetic dentistry, dental implants, and patient education. The focus of this article will be to help patients avoid the problems associated with delay in seeking professional care with or without an attempt to repair or glue teeth themselves at home.

F.Y.I. why D.I.Y. may not always be I.Y.B.I. ( in your best interest)

Life has its surprises. In addition to all the possible mishaps with our homes, cars, plans and the weather to mention a few; our teeth will sometimes add to our daily challenges.

Typical scenarios are a broken or lost filling, loose or lost crown or bridge or perhaps some type of breakage with a full or partial denture. Less common is a sudden problem to natural tooth enamel.

The most common reasons for these problems are:

• An extra hard shock to our tooth or restoration while eating
• Eating something of more than recommended hardness or stickiness
• Using our teeth as tools
• Clenching and tooth grinding due to stress
• Dropping our mouth appliance on the floor or sink
• Traumatic injury – falling down, running into something or somebody

The above factors can cause a good tooth or strong restoration to break or become loose.

When a tooth has already been weakened by decay or has a filling or crown that is not in good condition, even mild forces can cause damage.

Another possibility is when we are undergoing treatment and have a temporary filling or crown or bridge, denture, etc. Brushing too vigorously or chewing even the softest foods can break or dislodge temporaries. Dislodging temporaries while flossing is also a possibility.

(images of broken crowns and temporaries)

 

The problems we see or hear about most commonly are:

1) The crown or bridge does not get reinserted correctly – bite is off; restoration is raised so that repeat loosening is a probability and worse yet, decay or serious staining can get under the crown.

2) The tooth does not get cleaned and dried without having access to dental instruments and equipment and professional experience.

3) The excess glue cannot be adequately cleaned off or the crown is bumped loose in the attempt.

4) The patient secures the crown or bridge but does not follow up with the dentist. In the future significant decay is found.

5) The glue sticks to the patient’s fingers, lips, tongue or opposing teeth.

6) The restoration falls into a sink or is swallowed.

Here are some examples of products used by patients at home (real life stories from my office!) They  are absolutely not recommended to be used in the mouth or to repair any appliance that is placed in the mouth.

Temporary cements available in pharmacies or even at your dental office may be free of toxic substances in household or commercial adhesives, but still need to be used with caution as I will explain in a minute.

Below are the various cements and tools used by dentists for temporary and final cementation. In an office such as ours, we typically have 6 – 10 types over a wide range of strength. The photo in the middle shows a typical set up in a dental office for cementing or recementing. Dentists have cleansers for both the tooth and the crown. They also have water spray, suction and cotton rolls at their disposal. Their instruments include spatulas for proper mixing and loading, mirrors for looking into as well as guarding the tongue or cheek once the tooth is cleaned and dried.

Various dental products are used to decontaminate the crown and the tooth. Chemical agents are also used for preventing bleeding from the gums.
 
Also, before mixing the new cement, the old cement must be cleaned out.

The direction that the crown faces must be known.
When in doubt try laying the tooth down in various directions to determine the correct orientation.

Thank you for reading,
Dr. Ray

Dr. Raymond E. LaVigne DDS is a practicing dentist in the Chicagoland area for over 30 years.
Please call our Palatine, IL dental office for an appointment: 847-359-1292.

Dentures in full detail

Dr. Raymond E. LaVigne practices dentistry in Palatine, Illinois. His specialties are cosmetic dentistry, dental implants, and patient education. This arcile outlines various types and sizes of dentures and which one may be right for you.

This article will describe different types of dentures; i.e. treatment options when all teeth within an arch (upper or lower) are missing already or need to be extracted. 

1. Full denture
2. Full denture retained by 2 or more remaining teeth over denture
3. Full denture retained by 2 or more mini implants
4. Full denture retained by 2 or more standard implants with bars attached
5. Full denture screwed down to multiple implants
6. Long-span fixed bridge cemented or screwed onto multiple implants

1. Full Denture

• Supported entirely by resting upon the ridge bone and palate in the case of uppers.
• Retained by fitting into undercut areas.
• -Least costly investment initially; does require relines recommended about every year at the start then about every three years on the average
• teeth wear, bone resorbs so that a new denture is typically needed after every 5 years
• May require adhesive paste to provide additional retention initially for major chewing and later for all eating and speaking

Ridge bone continues to be lost due to two reasons:

• Atrophy - lack of use since no more tooth roots embedded in bone
• Resorption - forces upon bone as denture shifts during chewing causes stress

Resorption is magnified and accelerated the longer the denture is worn without relining and the more unbalanced the bite is from the start (over bite, irregularities) or has become due to uneven wear of the teeth (especially a problem when various teeth oppose the denture - some natural enamel, some porcelain, various types of filling materials).  Dentures must be made and maintained in harmony with the surrounding muscles.The tongue is an especially important factor in having success with lower dentures.

More to consider with full dentures:

• Denture can be made to be attractive and natural looking
• When initially fitted dentures allow about 25% of the chewing force possible with strong full set of natural teeth
• Undercuts give dentures retention but also can be a source of sore spots

2. Full denture retained by 2 or more remaining teeth over denture

• Two or more teeth with reasonably healthy bone and gum tissue can be saved so that a denture can be retained over them - The denture is still completely supported by resting on the gums and underlying bone The remaining teeth provide retention only.
• Saving teeth also saves bone thus avoiding even more atrophy - the bone stays around the roots as long as forces are normal
• The denture can be retained by a variety of options: silicone rubber, O- Rings or "snap "attachments, clips on a bar.
• Teeth saved must be in good condition and must be maintained by good home care and professional cleanings in order to make this feasible.
• Attachments work well when there are poor existing undercut areas and / or very strong muscles wanting to dislodge the denture.
• The forces used when chewing should still be within the 25 - 35% range. Care should be used in type of food and force used so that the attachments and remaining tooth roots are not overloaded. A night time retainer or second denture is often made to prevent clenching upon the attachments while sleeping.

3. Full denture retained by 2 or more mini implants

• Denture is supported by the gums and bone Implants provide retention typically by silicone rubber or attachments like a snap.
• The mini implants help prevent further atrophy of the ridge bone sine the implant acts similar to a tooth root.
• Mini implants are great when teeth are not available, are in poor condition, or are poorly spaced for proper balance and stability.
• Mini implants are usually one piece - that is implant and abutment all in one.
• Mini implants are indicated in the lower front area due to their size and the type of bone density found in this area - which is typically the densest bone in the mouth.
• In some cases the denture can be fit to be retained by the implants in the same appointment due to the dense bone allowing for immediate stability.

4. Full denture retained by 2 or more standard implants with bars attached

• Four or more standard size implants are strategically placed and joined by bars that are screwed down to the implants forming a frame. The denture has retention clips that fit over the bar usually in 2 - 4 places. In this case the denture rests upon the bar and is passive to the gum and bone tissues.
• Dentures supported by bars can typically allow 50 - 60 % of maximum chewing force (based on natural teeth)
• Dentures are removed for cleaning. Implants and bars require cleaning with brush and floss with moderate effort needed. As with any implant, professional exam and cleaning are recommended every 6 months and, in some cases, every 3-4.

5. Full denture screwed down to multiple implants

• Four or more standard size implants are placed and joined by bars similar to the above clip on but removable denture over bars. In this case, however, the denture is screwed onto the bar and not removable by the patient. These appliances allow 60 - 80% of maximum chewing ability. Since they can not be removed for cleaning after each meal, the denture borders are raised off the gum tissue enough to allow floss to pass under the base. Also frequent brisk rinsing and use of an irrigator such as a "Water-Pik" are highly recommended for cleaning several times each day.
• The bar under-structure is similar to the previous over denture however the denture is not removable by the patient since it is screwed down to the bars.

6. Long-span fixed bridge cemented or screwed onto multiple implants

• Multiple single crowns allow best appearance and easiest flossing.
• Implants can also be abutments for several bridge sections or one long span bridge for the entire arch.
• These restorations allow maximum cosmetic appearance since the crowns are made from porcelain which has natural translucency, many shades are available and shades can be custom blended.
• These restorations are the strongest and can deliver 80 - 90% chewing force.

Excellent daily home care is needed just like when a patient has many remaining natural teeth heavily restored by crowns or bridges. That means flossing between the implants.

Implants help maintain jaw bone since they give the bone a purpose - the bone in use with normal amount of force stays healthy - similar to exercising for muscles and joints.

In many cases a patient wears a partial or full denture as a temporary when they ultimately plan to have implants as their long term tooth replacement. Having good fitting and nice appearing partial or full dentures prevents further damage to remaining teeth and also protects implants as they heal within the bone. Having a good partial or full denture and also a dentist who knows how to customize and modify them, can be a great advantage when a patient desires implants but will need a year or even much longer before completion.

Thank you for reading,

Dr. Ray

Dr. Raymond E. LaVigne DDS is a practicing dentist in the Chicagoland area for over 30 years.
Please call our Palatine, IL dental office for an appointment: 847-359-1292.

the ultimate in cosmetic dentistry

Dr. Raymond E. LaVigne practices dentistry in Palatine, Illinois. His specialties are cosmetic dentistry, dental implants, and patient education. This article acknowledges the cosmetic aspect of restorations, i.e. matching crowns and veneers with your natural teeth.

Matching one restoration (crown or veneer) to natural enamel when the tooth being restored or replaced is right at the front of the mouth: You will need to look very closely to tell the tooth with porcelain from the others. From a distance of 12 inches or more, the restored tooth and other natural teeth are indistinguishable.

When there is decay or traumatic damage to only one tooth, we will always try to be as conservative as possible.

When this is not entirely feasible, one or more of the adjacent teeth may have to be restored as well in order to obtain the finest shade and shape match.

When patients have several teeth with decay, fractures, color or alignment problems, then of course we will will have to restore the entire group.

Thank you for reading,

Dr. Ray

Dr. Raymond E. LaVigne DDS is a practicing dentist in the Chicagoland area for over 30 years.
Please call our Palatine, IL dental office for an appointment: 847-359-1292.

New trends in dentistry

Dr. Raymond E. LaVigne practices dentistry in Palatine, Illinois. His specialties are cosmetic dentistry, dental implants, and patient education. The focus of this article will be Dr. LaVigne's office approach to the latest dental technology and how his office stays current.

New technology impresses people in different ways. Some people have to have all the latest gadgets in their life and expect that from those who they make any major purchases for products or service. On the opposite extreme are those who are highly skeptical of "new fangled ideas" or do not see the benefit for themselves.

In between are those of us who carefully learn and try out new ideas. We do test trials and compare the results obtained with the new versus the old way. We also cautiously weigh the cost versus the benefits. When we do decide to make any change or transition we are confident that we can justify our investment as well as our effort and time. Taking the "sensible approach" one step further is reflected in our decision to maintain those older products and techniques that still have validity. Rather than an abrupt revolution, we evolve by offering and utilizing both some new and some of the old materials and methods.

We get a fair amount of new patients in our office that have not been regular dental patients. Those who have not been in our office before are often impressed by several of the steps that we take and the equipment we use. The number one thing that they comment about is how we use the intraoral camera. We use it frequently for exams and also for procedures allowing before / during/ after treatment to be seen by the patient. In addition to the visual image, they are always impressed with our style of presentation. We aim to be informative and clear to understand. We will only share "the gory details" on request! By the way, our television monitors are not large flat screens. The classic ones are still working fine.

There are many other examples of new equipment, instrumentation and materials in use in our office. I do a tremendous amount of continuing education. I attend classes, reads journals and current textbooks. I see many classes on videos. In addition to researching and learning new techniques and skills, I have also tested quite a few ideas in his own mouth. With the help from other dentists and also from my team, I have tested many types of dental materials including tooth shade restorations and various adhesive cements. I also personally try numerous home care products at-home tooth whitening methods.
Another group of new patients that we impress are those that see the value of our sensible approach.
We do not hype nor do we over-sell. We always try to be helpful and fair in explaining both advantages and disadvantages. Whether we are purchasing some major new equipment or redecorating our office, we consider carefully every aspect of the decision.

Thank you for reading,

Dr. Ray

Dr. Raymond E. LaVigne DDS is a practicing dentist in the Chicagoland area for over 30 years.
Please call our Palatine, IL dental office for an appointment: 847-359-1292.

tooth repair in one day

Dr. Raymond E. LaVigne practices dentistry in Palatine, Illinois. His specialties are cosmetic dentistry, dental implants, and patient education. This article focuses on the concept of repairing a tooth and/or dental implant in one day's worth of procedures. There are many pros and cons to this practice. 

While it may seem tempting to have all of your teeth problems fixed in one day, this may not be the healthiest reality.

For example, the procedure of placing 6 implants, allowing 4-6 months for healing and later delivering a full denture that is screwed down over the implants has been a successful treatment option for over 10 years.

Recently, the concept has been advanced to placement of the implants immediately after extracting remaining teeth and also placement of the denture attached to those implants in the same visit. In addition, reducing the number of implants to 4 has been used.

This works wonders for some patients who qualify for this major treatment. However. there are many who cannot have this same treatment regimen. In order for the "all on four, teeth in one day" to be realized, there are indications and prohibited conditions. In order for implants to be placed immediately following extractions in general:

The teeth being extracted must either be distant enough from the implant sites or the bone must be adequate to allow an implant wider and f or longer than the extraction site. There should be no active infection.

Although prosthetic teeth are placed immediately, there must be absolute compliance by the patient with regard to eating extremely softly for the recommended time frame. There must also be provision made to prevent the effect of bruxism (teeth grinding during sleep) from damage to and failure of the implants healing within the bone.

The total surgical and restorative procedure is at a fairly high cost in a short period of time. Even with zero percent financing, some patients find this difficult to fit into their overall budget.

The good news is that there are other options for patients to consider. Rather than make a quantum leap to a denture loaded upon 4 implants in one appointment, patients can elect to go much more gradually. As an example, teeth can be extracted one or a few at a time. Implants can be placed one or two at a time. Extraction sites can be allowed to heal and Implants can be left unloaded in the traditional fashion for at least 3 months. The patient is fitted with a temporary partial denture or temporary plastic fixed bridges. These can be modified as the treatment progresses. Implants that have been confirmed as integrated into bone can then be used as' anchors while additional teeth are extracted and more implants placed.

The above approach allows for treatment to be phased in over a much longer time frame. While the concept of everything done quickly is appealing to some, it is not for everyone.

The advantages of the gradual phase in method are as follows:

1) Conservatively allowing time for healing of extraction wounds, bone grafts, implants
and confirming this stability before relying on their support for chewing.

2) Extend financing even further by doing the treatment in smaller phases still possibly using zero percent financing.

3) Avoiding complications from infection, night clenching.
4) Give patient opportunity to gradually become acclimated to having implants and doing the necessary daily care before they invest in everything on 4 - 6 implants.

5) Allow more opportunity to make adjustments to the appearance and occlusion (bite) by a more gradual transition and ability to do more try in visits before the prosthesis is completed.

Thank you for reading,

Dr. Ray

Dr. Raymond E. LaVigne DDS is a practicing dentist in the Chicagoland area for over 30 years.

Please call our Palatine, IL dental office for an appointment: 847-359-1292.

should I get a root canal or implant?

Dr. Raymond E. LaVigne practices dentistry in Palatine, Illinois. His specialties are cosmetic dentistry, dental implants, and patient education. This article will highlight root canal treatments, causes of needing a root canal, and possible benefits, risks, and complications of having a root canal procedure.

 

Root canal treatment involves the removal of the pulp (soft tissue from the channel within the root of a tooth). The pulp is comprised of blood vessels, connective tissue and nerve. The pulp is needed when a tooth is in active growth stages. The blood vessels provide calcium as the tooth matures from the inside. The walls of the root (as well as the visible coronal part of the tooth) grow thicker as the calcium is transformed into dentin.

Roots typically reach maturity in length and thickness of the walls within about 2 – 3 years after the tooth erupts into the mouth.

After that time, additional calcification may continue. Additional calcification comes as a response to such stimuli as:

• Hot or cold temperatures – the tooth attempts to further “insulate” itself

• Decay – the tooth attempts to repair itself as decay advances from the outside

• Unusual biting or clenching forces – the tooth calcifies inside the pulp canal as a response to the on and off pressures felt at the apex of the root where the blood vessels enter and exit the end of the root.

Common reasons for needing a root canal include:

1) Decay has accelerated beyond the ability of the repair process so that bacteria enter the pulp from the outside. In some cases there is direct entry of bacteria. In other cases, the acidic excretions of bacteria cause the irritation and pain, but there is no actual infection.

2) Tooth fractures allow bacteria or their acidic excretions to come in contact with the pulp.

3) Tooth trauma. Sudden force can cause the tooth to be intruded into the bony socket. This can sever the blood vessels so that the tooth no longer has live blood flow within. This causes the remaining soft tissue of the pulp to break down ("dead nerve"). Having a dead nerve or necrotic pulp can temporarily mean no pain but later can lead to infection from the toxic debris.

4) Teeth clenching. Constant, repetitive forces can cause the same cutting off of the blood flow. Clenching can slowly cause the pulp to calcify along the canal walls. As the channel becomes smaller in diameter, blood flow gradually decreases. Another response to abnormal forces is a pulp stone. Instead of or in addition to narrowing of the canal walls, a pulp stone accumulates in the pulp chamber. At some point it can also cut off the flow of blood.

5) Restoration needs.  Sometimes a root canal is recommended or necessary in order to provide proper strength or adherence of a filling or crown. Sometimes there is no direct exposure of the pulp however, the preparation for the filling or crown will either expose the pulp or come so close that the tooth will be extremely sensitive and have a high

Some teeth having previously large fillings or crowns or having major fractures will need a post in order to retain a new crown. A post can only be placed if a root canal is performed first.

 

Factors that make root canals highly successful:

• Vital: fresh pulp – little or no bacterial contamination
 
• Normal to fairly large canals
 
• Straight to slightly curved root forms
 
• Technique, details followed during treatment
 
• Good to excellent placement of temporary filling

• Good and timely placement of permanent restoration following root canal

Factors that complicate root canal treatment:

• Some bacterial contamination of the pulp
 
• Significantly small diameter canals 
 
• Highly curved or irregular root forms
 
• Intersecting or lateral accessory canals – tiny side branches from the main canal
 
• Significant wall calcification or pulp stone making entry and negotiation difficult
 
• Delay is seeking initial treatment or completing permanent restoration
 
• Challenging situations such as location of tooth, ability to open wide, ability to effectively isolate the tooth with a rubber dam, alignment issues that make taking accurate x-ray difficult

• Re-treatment of root canals with no structural challenges but with return of bacteria from a recurrent cavity allowing bacteria to reach the previously sealed canal

Factors that make root canal treatment highly risky:

• Gross bacterial contamination, long-term and beyond the canal into surrounding bone, possibly sinus involvement
 
• Extremely curved and also very small diameter combinations
 
• Complete calcification so that a canal cannot be entered even with the finest file size
 
• Extremely large pulps such that walls are thin and vulnerable to fracture
 
• Failure by patients to follow through with permanent restoration
 
• Re-treatment of root canals with major complications such as blocked passages and other obstacles

• Teeth that have been grossly exposed to bacteria for an extended time so that the tooth structure is highly compromised – Softened or thin and brittle will not allow long term success with restorations – fillings will not hold, cemented crowns will not adhere long term or there is a high chance of fracture simply from normal chewing.

Implants may be a better option rather than perform extensive procedures (i.e. getting a root canal) with great risk.

With all the advancements, implant placement and restoration has become much more reliable and predictable.

Thank you for reading,
Dr. Ray

 

 

Dr. Raymond E. LaVigne DDS is a practicing dentist in the Chicagoland area for over 30 years.
Please call our Palatine, IL dental office for an appointment: 847-359-1292.

Stem cells in teeth

Dr. Raymond E. LaVigne practices dentistry in Palatine, Illinois. His specialties are cosmetic dentistry, dental implants, and patient education. This article provides an overview of a growing trend and ethical issue in today's healthcare industry: stem cells. You may not realize that stem cells are also in teeth!

What are the benefits of stem cell use?

Stem cells are used to create many other types of live cells which are grown into various body tissues. The live tissue is then used to repair or possibly even make an entire new organ.
Stem cells are the seeds of life having the ability to transform into all other types of cells that make up skin, bone, nerves, muscles, blood vessels and blood cells and also the variety of specialized organs, even heart and brain. This is how nature creates entire individuals. This is how our bodies repair themselves and replenish older cells.

On the contrary, currently used surgery and drug therapy are either only partially helpful or totally mask symptoms but do absolutely nothing to really repair an injury or cure a condition.

There are already known and also potential yet unproven reasons to believe that stem cell treatment will be far superior compared with currently used medical treatment.

Imagine being able to repair damaged bone, muscle, tendons and joints with perfectly healthy new tissue that is made from your own cells (or possibly a closely matched family member).
Some of these techniques are already being done. Use of stem cells can already replenish immune blood cells and produce bone.

Now imagine being able to create a new kidney rather than live on dialysis or have the risks associated with donation. Perhaps at some point in the future it may be possible to create a new heart or even a brain rather than live with one that has been patched or compromised by removing some parts.

What is the history?

Stem cell harvesting is a spin off from blood donation. Donation of whole blood came first followed by filtration of platelets (the cells that form blood clots). Later it was discovered that a similar filtration process could be used to harvest blood stem cells that can be transformed into other blood cells especially those needed for the immune system. Cells obtained by either blood filtration or bone marrow donation have replaced or supplemented immune systems of patients destroyed by cancer such as leukemia.

The ability to create new bone and blood cells is already in use.

The use of stem cells to transform into nerve, muscle and to form organs is still under research.


How can stem cells be obtained?

Stem cells are currently found available in the following:
-Bone marrow
-Blood donation / filtration
-Umbilical cord of newborns
-Teeth

What are the moral and ethical issues?

This is a complex topic. Some people believe that any use of stem cell engineering is beyond what should be done by humans – “Playing God”. Some are more specific about the unlimited possibilities with main concerns about:

1) Eventually allowing genetic engineering – ultimate “test tube babies”
2) Abuse and spread of abortion (for umbilical tissue if not worse)
3) Black market and other cost / profit-related issues.

Stem cells harvested from blood, bone marrow, teeth and umbilical cords, placentas are called adult stem cells. While these can be transformed into various types of cells, tissues and probably organs in the future; they cannot create new humans or any other animal.

Only embryonic stem cells can create a new individual. This is not the intent of current research and use of adult stem cells.

More about tooth stem cells

Stem cells found in teeth can be both hemopoetic and mesenchymal.

Therefore there is a potential to direct transformation into any other type of tissue cell needed not only for blood or bone but also for muscle, tendon, nerves, skin, and specialized types found in various organs.

Stem cells are found in many teeth but are most feasible to obtain in the following teeth at the following stages:

1) Primary (baby teeth) that are at the front of the mouth and are just getting ready to be lost naturally.
2) 3rd molars (wisdom teeth) that are still actively growing and do not yet have complete root formation.
3) Bicuspid teeth that are planned for removal for orthodontic crowding and also have roots that are not fully developed.

There are other situations that can provide stem cells, however the above are the the best due to:
1) Greatest number of healthy stem cells.
2) Greatest opportunity and least risk in removal and successful harvesting.
3) Stem cells are a bonus added to an already needed tooth removal or natural loss.

How do I learn more and actually apply?

More information and application to participate can be found online at www.StemSave.com or by calling 877-StemSave (877-783-6728).

A word about cost: When you first see the fees for long-term storage of your tooth stem cells, you will probably think, “that is a lot!”. When you make a comparison with the cost of having currently available surgeries and other medical treatments, you may see the potential for your investment now to be completely justified.

Thank you for reading,

Dr. Ray

Dr. Raymond E. LaVigne DDS is a practicing dentist in the Chicagoland area for over 30 years.
Please call our Palatine, IL dental office for an appointment: 847-359-1292.