How to Help Patients Feel Calm and Confident When Facing Surgery

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Making your patients feel comfortable when you refer them to us for treatment is our No. 1 priority. Our team understands that dental treatment, especially oral surgery, can cause fear and anxiety.

We have the expertise in treating a variety of conditions and solving problems related to missing teeth, impacted teeth, decayed teeth and oral pathology. However, just as importantly, being prepared to handle those anxious moments to ensure the best outcome possible requires training and experience. We pride ourselves in having both.

As a team, we have years of experience in managing patients for oral surgery treatment. Three of our six team members have worked with me for more than 18 years each, and all are well-versed in making sure patients are put to ease knowing they are receiving the finest care possible.

And as an oral surgeon, I have special training in a variety of anesthesia techniques to keep patients comfortable during treatment.

A consultation is recommended to review treatment and also gives us an opportunity to talk about the options that will make patients comfortable during their procedure. Many simple modalities are available once a medical history has been obtained.

  • Oral premedication with medicines like halcion (a benzodiazepine) and clonidine (an alpha agonist) allow for relief of mild anxiety. In addition, nitrous oxide (laughing gas) has the added benefit of relieving pain and anxiety during oral surgery treatment.
  • For patients with moderate anxiety, IV sedation provides a deep state of relaxation to allow for performance of procedures in a comfortable manner. In addition, IV sedation is chosen when procedures are more complex or longer in duration. Patients must be in good physical condition, have a good airway and not be severely obese.
  • A third option is general anesthesia where patients are asleep for their procedures. This option is chosen for younger patients or for those with extreme anxiety. Again, like those patients selected for IV sedation, patients must be healthy, not be at extremes of age, have a good airway and not be severely obese.

Once patients meet our experienced team, see our office and review options for treatment, they will feel confident that we can manage their oral surgery experience in a comfortable manner.

Maintaining communication, especially prior to a patient’s consultation with our office, and sharing information about what causes a patient’s anxiety or any special needs they may have will help us best manage your patient.

 

Dr. David W. Todd, DMD, MD, Oral SurgeonDr. David W. Todd, DMD, MD, has been active in his profession. He has authored 18 articles in various publications and made numerous presentations at state, regional, and national meetings. For Dr. Todd’s full bio click here.

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When is the Right Time for Wisdom Teeth to be Extracted?

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Parents shouldn’t wait until their children’s wisdom teeth (third molars) have erupted or are causing pain to bring them to the dentist. Generally, wisdom teeth are developed enough in a person’s late teen years to assess whether there is enough room for eruption into the mouth.

If there is adequate room for the wisdom teeth to erupt and push up through the gums, and those teeth are hygienic and functional (in the bite plane), then they can be maintained just as other teeth in the mouth.

However, wisdom teeth, which develop behind the second molars in the posterior aspect of the upper and lower jaws, are the most frequently impacted teeth and often need treatment to prevent further complications.

An impacted tooth is one that has developed, but cannot erupt into a hygienic and functional position. If the tooth is impacted, the smooth shiny enamel surface of the tooth’s crown does not allow the surrounding tissue to “seal the crown,” which can potentially create a space for bacteria to reside.

All impacted teeth have the potential to develop problems, especially periodontal (gum) disease. For many patients, periodontal disease develops around the wisdom teeth and moves forward.
Other problems with impacted wisdom teeth include decay of the tooth or adjacent tooth, infection, contribution to crowding, pain and, in rare instances, cysts and tumors that can develop around impacted teeth.

Have your general dentist evaluate the position of your child’s wisdom teeth and determine if there is adequate room for eruption into the mouth. If there is not enough room for proper eruption, it is preferable to intervene and remove the teeth before the roots are fully formed.

The most thorough assessment is best done by an oral surgeon. An examination includes a panoramic type X-ray and, in some cases, a CBCT (Cone Beam CT scan) is used to further define and study the relationship of the wisdom teeth to other structures, such as the sensory nerve in the lower jaw or the sinus in the upper jaw.

Although some general dentists remove wisdom teeth, oral surgeons are considered the experts in the management of these teeth.

When wisdom teeth are identified as impacted, it is recommended to treat the teeth before disease develops. While other strategies are available, extraction is the most common management of impacted wisdom teeth.

The extraction is generally performed in the oral surgeon’s office with local anesthesia and IV sedation or general anesthesia. Oral surgeons are trained in anesthesia and board-certified to provide in-office sedation.

Recovery generally requires 3- 4 days off from full activities and about 10 – 14 days before a completely normal diet can be resumed. Side effects from surgery, including discomfort, swelling, limitation of opening, infection and, in some instances, bony splinters (sequestrum) can be expected and are usually easy to treat. Additionally, numbness to the lower lip and, rarely, the tongue can occur.

As summer approaches and kids are out of school, now is the best time to have your child’s wisdom teeth checked and, if necessary, scheduled to be removed.

 

Dr. David W. Todd, DMD, MD, Oral SurgeonDr. David W. Todd, DMD, MD, has been active in his profession. He has authored 18 articles in various publications and made numerous presentations at state, regional, and national meetings. For Dr. Todd’s full bio click here.
 
 

The Fixed Hybrid: Why It May Be Right for Your Patients

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You have a patient with terminal dentition and they are looking to you, their dentist, for solutions.

The options for treatment include:

  • Extraction and conventional denture treatment
  • Conventional dentistry
  • Fixed hybrid options

What do you tell that patient?

A fixed hybrid prosthesis is a good option for patients who have multiple missing teeth and whose remaining teeth are heavily repaired. Compared to other fixed options, the fixed hybrid is a more cost effective treatment and more predictable in the long term than conventional dentistry.

Conventional dentures are inexpensive, but the function they offer compared to natural teeth or a fixed hybrid is dramatically lower, especially in the lower arch. Removable options are also generally less pleasing than a fixed option, causing more stress on the abutment teeth and often leading to early failure.

And, while crown and bridge, root canals and removable prostheses can be considered, the cost is high, the predictability is low and long term success rate does not match a fixed hybrid.

The fixed hybrid option requires 4 – 6 implants per arch. It usually requires minimal grafting and rarely calls for the graft to heal before implants can be placed.

The implants are placed to avoid the maxillary sinuses in the upper jaw and avoid the inferior alveolar nerve in the mandible. Osteotomy is performed that allows for inter-arch space and generally allows for more bone width after bone reduction is carried out.

Not all patients are candidates for a fixed hybrid prosthesis.

There are two indications for an overdenture prosthesis. One is when the transition line cannot be hidden on animated smile. The other is when the patient requires the labial flange of an overdenture for lip support. Evaluation to determine if a patient is a candidate for a fixed hybrid includes assessment of medical history, evaluation of tooth display, smile line, occlusion and a cone beam CT scan.

The procedure is carried out under either IV sedation or general anesthetic. The fixed hybrid cannot always be delivered the day of the procedure. If the implants do not have high primary stability, the patient may have to wear a temporary denture for several months before the hybrid can be converted. Patients will be on a very soft diet the first six weeks after the procedure while initial healing takes place.

Regular visits are required to ensure proper maintenance of the prosthesis.

A fixed hybrid prosthesis is not only a highly successful option, it allows patients to eat normally and feel good about how their teeth look.

 

Dr. David W. Todd, DMD, MD, Oral SurgeonDr. David W. Todd, DMD, MD, has been active in his profession. He has authored 18 articles in various publications and made numerous presentations at state, regional, and national meetings. For Dr. Todd’s full bio click here.

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Location

Oral and Maxillofacial Surgery in Lakewood

120 Southwestern Drive
Lakewood, New York 14750

Office Hours

Monday: 8AM-5PM
Tuesday: 8AM-5PM
Wednesday: 8AM-5PM
Thursday: 8AM-3PM
Friday: 7:30AM-4PM

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