Fluoride? What's The Big Deal

Once upon a time, it was not uncommon to drink from the pure, clean water of a stream.  Today, you are unlikely to see anyone drinking water from a natural source without running it through a Brita pitcher first.  As sad as it is to admit, society is taking a hard toll on Mother Nature.  Things that were once safe and abundant are now unsafe, limited, and treated with chemicals.  All of these treatments for something as common as water might have you wondering exactly what is coming out of your kitchen sink.

Super Water Right From The Tap

One of the most common additives to water is fluoride.  For those that are adamant against any additives in their water, this is actually a favorable additive.  Fluoride helps prevent tooth decay.  While fluoride is found naturally in water, the fluoridation process only boosts the natural fluoride levels to the best level for the highest amount of protection.  In other words, water already contains the cavity fighter – society is simply making it stronger.

The addition of fluoride to water has been a common practice for over 65 years.  The process reduces tooth decay by up to 40%.  Even though fluoride is available in other products, like toothpaste and mouthwash, the “super” water is still providing essential protection.  In this age of excess, particularly sugar, the added fluoride can mean the difference between a cavity and a healthy tooth.

If you worry about the treatment process of your water, mark fluoride off the list.  This helpful additive has kept millions of people in better oral health. It will continue to serve millions more in the future.  The next time you drink a glass of tap water, think of it as part of your daily dental routine.  Dr. Rigby and your teeth will thank you every six months.

Tooth Extraction

Unfortunately for some, tooth extraction is an inevitable adventure!  Teeth often have to be removed to ensure adequate infection control and to improve the overall health of a patient, but before it "needs" to be done understanding the why or why not is important.  

Webster's dictionary states, "tooth extraction is the removal of a tooth from its socket in the bone".  If a tooth has been damaged by decay or a fracture, dentists try to repair it and restore it with a filling, crown or other treatment. Sometimes, though, the damage is too extensive for the tooth to be repaired and the only logical solution is to remove it, and this is the most common reason for extracting a tooth.

Here are some other common reasons for tooth removal:

• Extra Teeth --- these often can block other teeth from erupting into the mouth.
• Orthodontic Work --- teeth may need to be extracted to create room for the teeth that are being moved into place.
• Head and Neck Radiation Therapy --- these people may need to have teeth in the field of radiation extracted.
• Chemotherapy Patients--- individuals undergoing this treatment may develop infected teeth.  Chemotherapy weakens the immune system and increasing the risk of infection.
• Organ Transplant Patients--- teeth that are at risk of being potential sources of infection after the transplant when immuno-suppressive medications are given may need to be removed.
• Wisdom Teeth --- are often extracted for preventative reason.  They can be removed before or after they come in and are most often extracted in the late teens or early twenties.  Wisdom teeth may be impacted (partially or completely covered by bone or soft tissue) or have dental decay present causing pain requiring their removal.  Similarly, a wisdom tooth that has emerged partially may be blocked by other teeth or may not have enough room to come in completely and this can irritate the gums, causing pain and swelling, requiring the tooth/teeth to be removed.

 

Extracted Wisdom Teeth (Third Molars)

Preparation For The Appointment

Through medical and dental histories will be collected, this helps to determine if any medical/dental condition will increase the risk for tooth removal.  A radiograph (x-ray) of the area will be taken, this helps in seeing and planning the best way to remove a tooth.  If you are having all of your wisdom teeth removed, you may have a panoramic x-ray, which takes a picture of all of your teeth at once.  This type of x-ray shows the relationship of your wisdom teeth to your other teeth, as well as the upper teeth’s relationship to your sinuses and the lower teeth’s relationship to the inferior alveolar nerve, which provides sensation to your lower jaw, lower teeth, lower lip and chin.

Some health care professionals prescribe antibiotics to be taken before and after surgery, but this varies by practitioner. Antibiotics are more likely to be given to people with infection at the time of surgery or with weakened immune systems, those who will be undergoing longer surgeries, or very young or elderly people.

If you’re going to have conscious sedation or deeper anesthesia, wear clothing that has short sleeves or will allow you to roll the sleeves up easily so that an intravenous (IV) line can be placed in a vein. You will be told not to eat or drink anything for six hours before the procedure. You should also make sure you have someone available to drive you home.

How It’s Done

• Simple extraction --- is performed on a tooth that can be seen in the mouth.  Most can be done under a local anesthetic, with or without anti-anxiety drugs.  In a simple extraction, the tooth will be grasped with forceps and move the forceps back and forth to loosen the tooth before removing it.  Sometimes, an instrument called a luxator or elevator, which fits between the tooth and the gum, is used to help loosen the tooth.
• Surgical extraction --- involves teeth that cannot be seen easily in the mouth, either because they have broken off at the gum line or because they have not come in yet.  Another reason for a surgical extraction is that the tooth to be removed requires a flap be cut in the gum for access to remove bone or a section of the tooth.  They can be done with local anesthesia or conscious sedation.  Patients with special medical conditions and young children may be given general anesthesia.  In a surgical extraction, the dentist will need to make an incision in your gum to reach the tooth.  In some cases, the tooth will need to be broken into sections to be removed.

 

Removal of An Upper Tooth

If you are having teeth extracted and are receiving conscious sedation, you may be given steroids in your IV line to help reduce postoperative swelling.

If you need all four wisdom teeth removed, they usually are taken out at the same time. Or if you wish and depending on the practitioner, they can be removed in halves, left at one appointment and the right at another.......there are pros and cons to each method, which Dr Rigby is happy to expound upon.  The top teeth usually are easier to remove than the lower ones.

Here are the types of wisdom teeth in order from easiest to remove to most difficult to remove:

• Erupted (already in the mouth)
• Soft-tissue impacted (just under the gum)
• Partial-bony impacted (partially stuck in the jaw)
• Full-bony impacted (completely stuck in the jaw) 

Also, if your wisdom teeth are tilted sideways, they can be harder to remove than if they are vertical.

Follow-Up After Extraction
 

Most simple extractions do not cause much discomfort after the procedure.  You may take an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil, Motrin and other brand names) for several days, or you may not need any pain medication at all.......everyone is different when it comes to healing.

Because surgical extractions are more complicated, they generally cause more pain after the procedure.  The level of discomfort and how long you have discomfort depend on the difficulty of the extraction.  You may be prescribed a pain medication for a few days and then suggest switch to an NSAID.  Most postsurgical pain disappears after a couple of days.  It is possible you will be tender over the area for a few weeks, but there should not be any major discomfort long term.

A cut in the mouth tends to bleed more than a cut on the skin because the incision cannot dry out and form a scab.  So after an extraction, you’ll be asked to bite on a piece of gauze for about 20 to 30 minutes to put pressure on the area and allow the blood to clot.  The area may still bleed minimally for the next 24 hours or so and taper off after that.  Don’t disturb the clot that forms on the wound.

You can put ice packs on your face to reduce postoperative swelling.  If your jaw is sore and stiff after the swelling dissipates, try warm compresses.  Eat soft foods for a few days then try other food as you feel comfortable.  Rinse with warm salt water (1/2 teaspoon of salt in a cup of water) for the first few days to help keep the area clean.  Most swelling and bleeding ends within one or two days of the surgery.  Overall healing takes between one and two weeks.

If the extraction needs to be closed with stitches, the stitches are usually dissolvable and should disappear in one to two weeks.  Rinsing with warm salt water will help the stitches to dissolve.

You should not smoke, use a straw or spit after surgery.  These actions can pull the blood clot out of the hole where the tooth was.  That causes more bleeding and can lead to a dry socket, which occurs in about 5% of all extractions.  It is most common when lower back teeth are removed and happens more often in smokers and women who take birth control pills.

Risks To Be Aware Of

Infection can set in after an extraction, although you probably won’t get an infection if you have a healthy immune system.

A common complication called a dry socket occurs when a blood clot doesn’t form in the hole or the blood clot prematurely breaks off or breaks down.  In a dry socket, the underlying bone is exposed to air and food.  This can be very painful and can cause a bad odor or taste.  A dry socket needs to be treated with a medicated dressing to stop the pain and encourage the area to heal.

Please contact us if pain is a persistent problem!

Other potential risks and complications include:

• Accidental damage to adjacent teeth --- such as fracture.
• An incomplete extraction --- a tooth remnant remains.  Most often the remnant is removed to prevent infection, but occasionally it is less risky to leave a small root tip in place, if needed.
• A fractured jaw --- caused by the pressure applied during the extraction.  This is a risk most often encountered in older people with osteoporosis of the jaw.
• A hole in the sinus during removal of an upper molar.  A small hole will usually close up by itself in a few weeks but may require additional surgery if it doesn’t heal spontaneously.
• Sustained numbness in the lower lip and chin, caused by trauma to the inferior alveolar nerve (during removal of the lower wisdom teeth). Complete healing of the nerve may take three to six months. In rare cases, the numbness, although not disfiguring, may be permanent. 

When To Call a Professional
 
If a swelling gets worse instead of better, or you experience fever, chills or redness in an area, please give us a call.  If you have an infection, antibiotics will usually be prescribed.  Also please call, if after 3-4 days post surgery an extraction site becomes very painful or prolonged, this may be a sign that you may have a dry socket.  Similarly, If the area continues to bleed after the first 24 hours please give us a call.

Broken Implant Screws........No Problem!!

One of the things we do here at Rigby Advanced Dental is complex dentistry.......Dr. Rigby loves a good challenge!  We regularly have patients sent to us from other practitioners in need of a helping hand.  Not to long ago an oral surgeon gave us a call and referred a patient that was having problems with some existing dental implants that were placed over 20 years ago.  After a  through work-up Dr. Rigby determined the problems present as follows;

1. The existing "bridge" had fallen off and the patient could no longer eat food on that side.
2. The existing screws that held the "bridge" on were fractured and still inside the implants under the soft tissue that had grown over the implants since loosing the prosthesis.
3. The existing "bridge" was inadequate to repair and use again due to fractured porcelain and failure to use proper dental engineering principals to prevent catastrophic failure some time in the future.
4. Determine the implant system, size and diameter to order necessary parts for restoration if the screw remnants could be removed without damaging the dental implants. 

Here a few of the initial x-rays taken;

Panorex of the patients existing broken screws. 

A close up view of the broken screws in the implants.  If you look very closely you can see the front implant screw remnant is actually broken in two pieces.......this of course was discovered upon retrieval of the fragments.

One of the biggest difficulties dentists run into when considering restoration of older dental implants is what type are they, whether or not the original parts are still made and if the implant manufacturer is still in business or who owns the rights to the system.  This is one of the reasons other practitioners often decide to refer cases to a Prosthodontist......like Dr. Rigby.......they often have specialty training and experience with older systems and, when in doubt, have the necessary contacts to get things figured out!

Luckily, Dr. Rigby was able to determine all of the above information drawing on his years of experience with dental implants and previous clinical experiences.  Dr. Rigby recommended removal of the screw fragments once the overlying soft tissue had been excised.

In true prosthodontic fashion, Dr. Rigby was able to retrieve the screw remnants on the first attempt using his large bag of tricks and a bit of luck.........Dr. Rigby often jokes that if everything goes according to plan then he knows he's living right!  Healing abutments were placed to allow the soft tissue to heal properly before a final prosthesis was fabricated.

The Healing Abutments in place.  They allow for proper soft tissue healing around the implants.

Final prosthesis adjusted and torqued to place.

Once an appropriate amount of time had passed for the soft tissue to heal a final prosthesis was completed and the patient was once again able to function normally and enjoy eating.  The final prosthesis was fabricated differently using an all gold splinted restoration allowing proper dental engineering techniques to avoid screw fracture in the future.  Upon final adjustment and seating the patient stated, "You have no idea how much this means to me.......not only did you save me money and from having to get more implants, but you actually made me feel like this was a fun experience......don't even ask me how you did that!"

If you or someone you know is having a problem with existing implants or has other concerns please do not hesitate to contact Rigby Advanced Dental for a free consultation today.

Implants in One Day

Implants in one day?  Is it really possible?  Believe it or not, if you fit the right criteria, you can go from having teeth to implants in one day.  You may have seen commercials for this procedure or perhaps a friend recommended it and your interest is peaked.......well never fear, Rigby Advanced Dental is on the cutting edge of technology and offers this procedure right here in Bee Cave & Lakeway, TX.  As a trained Prosthodontist, Dr. Rigby has the extensive knowledge and experience to perform these difficult implant procedures to ensure the best possible outcome.  With that being said, there is a lot you should know about this treatment, so please before any decision has been made, thoroughly research the topic to familiarize yourself with the procedures involved and discuss you concerns with Dr. Rigby.

How does it work?

Once you have had a thorough exam, we will discuss your treatment options.  If we have decided that your teeth require removal, you may be interested in implants.  You can have implants to support your new teeth. You may not even need to wear dentures – ever.

In one procedure we will take out your remaining teeth, place implants (4 to 6 in each jaw), and place a temporary implant bridge for each jaw.  You will leave the office with your new implant bridges – they look just like teeth.

Example of Upper and Lower Implant Locations

Breakdown Model of Denture, Screws, Abutments, and Dental Implants

Expect several follow up visits and a soft food diet for the next 3 to 4 months.  After that time, we make your final implant bridges.  This healing period is designed to allow the implants to fuse to the bone and your gums to heal. It allows us to make any needed changes to the teeth for the best cosmetic outcome.  The temporary implant bridges prevent you from needing to wear a removable denture.

Upper and Lower Implant Supported Dentures

Panorex Radiograph - Showing Implants and Final Prostheses

Final Smile Immediate Implant Dentures

Important Facts:

• You can receive treatment like this right here in the Lake Travis Austin, TX area.

• A Prosthodontist has been specially trained to perform these procedures
• Involving a dental specialist in your treatment puts you in the best trained hands possible.

• There is a lot of planning that goes into this kind of treatment. 
• While the actual surgery may take place in one day, there will be several other appointments to plan and finish your implants.

• Not everyone is a candidate for this treatment, but many are. 
• There are different ways to provide the same end-result.  Sometimes it is not possible to place the temporary implant bridge on the day of surgery, but it can be placed later.  You will be able to wear at least a removable denture in most cases.

• Finances are a concern for everyone – we can help you.

Call (512) 992-2822 or email Rigby Advanced Dental for a free consultation with Dr. Rigby.  Please remember that this is a general overview for your information only; please see us or your dentist to discuss this kind of treatment.

Another Implant Case!

This case was started in January of this year that was evaluated this week for implant integration (bone growth onto the implant surface) and stability.  From the clinical testing and x-ray exam Dr. Rigby was able to give it a thumbs up and recommended proceeding with treatment.  Dr. Rigby placed the dental implants in our office located in the Hill Country Galleria in Bee Cave, TX in about an hour under local anesthetic.  The patient and Dr. Rigby had a fun chat about his Ohio State Buckeyes and their recent win..........Dr. Rigby firmly believes, "There is always time to talk college football in my practice, especially when it's about my Buckeyes".

The patient came to us in a last chance effort to find someone who was willing to work with his insurance and be able to fabricate a CUSTOM set of complete dentures the OLD SCHOOL way.  After wearing dentures for over 30 years the patient recently had a new set made and found them to be "inadequate" compared to others he had had over the years.  The patient said, "They handed me these dentures after 2-3 appointments and I knew then that something was wrong with their philosophy of making custom dentures."  After some research and looking into the backgrounds of several practitioners he choose Rigby Advanced Dental to not only make a new set of custom dentures, but also upgrade the situation in the lower arch with two dental implants. 

Before Implant Placement

After Implant Placement (3 month)

One of the best treatments we offer here at Rigby Advanced Dental is being able to place two dental implants in the lower arch (mandible) for an experienced denture wearer.  They truly experience a world of difference in the stability and retention of their lower denture and they love us for what we've been able to do for them.  I can't tell you how many times I hear "this is the best thing I've ever done for my mouth and I have no idea why I waited so long".  In my opinion these are often the happiest friends I have in our dental family.  Of all the treatments and therapies available in dentistry I honestly believe this is one of the best life changing procedures we can provide. 
                                                                                ---Brent Rigby DDS, MS---

If you live in the Austin, Bee Cave, Lakeway, Barton Creek or other Lake Travis, TX areas and are in need of a dental specialist please contact us for a Free Prosthodontic Consultation.  Dr. Rigby will personally sit down with you and discuss your concerns regarding your dentures, implants, partials, and other dental esthetic/cosmetic needs, Rigby Advanced Dental (512) 992-2822.

Prosthodontic Awareness

Prosthodontic awareness week is right around the corner and we wanted to get an early start on it.  Check out the following video from the American College of Prosthodontists (ACP) to help increase puplic awareness of the specialty of prosthodontics.

Dr Brent Rigby is proud to be an active member of the ACP and is the only Certified Prosthodontic Specialist in the Lake Travis, TX area.  We serve the people of Bee Cave, Lakeway, Barton Creek, Westlake Hills, Oak Hill, Marble Falls, and Dripping Springs Texas with gratitude and thankfulness for their trust in us to care for them.  Please visit our website Rigby Advanced Dental to schedule a FREE Prosthodontic Consultation with Dr Rigby.

Pregnancy and Dental Work.......What To Expect and Do! Part 2

Part one in our series on “pregnancy and dental work” discussed pregnancy gingivitis and granulomas. Part two in this series discusses a few more things you should watch for when you’re pregnant: Pregnancy cavities, dry mouth, excessive saliva and tooth erosion. Today we’ll tell you what causes these things, and what you can do to prevent each of them.

• Dental cavities -- While simply being pregnant doesn’t increase your risk, those crazy cravings can be the culprit. Women often crave sweets and starches during pregnancy. This can make you more susceptible to developing cavities. Again, simply being aware of your diet and paying close attention to your oral hygiene routine can help decrease your risk.
• Dry mouth -- Dry mouth is a common symptom suffered by pregnant women. It really makes sense when you think about it: Dehydration often leads to dry mouth. When a woman is pregnant, her metabolic processes change dramatically, and her body starts storing water. This, along with increased urination, can lead to dehydration. Drinking plenty of water and chewing sugarless gum or candy can stimulate your saliva production and help fight off that dry mouth feeling.
• Over salivating -- On the flip side of dry mouth is excessive salivation. Typically over salivating occurs in early pregnancy and may coincide with feeling nauseated.
• Tooth erosion -- Frequent vomiting can erode tooth enamel. Bring on the morning sickness, and therein lies the problem. If you’re suffering from severe morning sickness, contact your dentist. They may be able to provide you with some preventative techniques to help combat tooth enamel erosion.

For more information on how to keep your teeth in good condition while you’re pregnant, or just to schedule an appointment, contact Rigby Advanced Dental. Check in again for more in the coming days in our series on “Pregnancy and Dental Work.” We’ll try to answer some frequently asked (and maybe even some not-so-frequently-asked) questions.

How to care for dentures

Complete dentures are replacements for missing teeth that you can take out of your mouth and put back on your own. While dentures are not real teeth, it’s just as important to take care of them just as you do your natural teeth.  Here are some tips and tricks from Dr Rigby's bag of helpful hints:

A compete upper and lower customized set.

• Handle with care. Dentures are delicate, so when you’re handling them, stand over a plush towel (or at least a sink) in case you drop them. Be sure to store them out of the reach of children or pets, who may easily knock them to the floor or use them as a chew toy.
• Keep them clean. Brush and rinse your dentures daily. Just like natural teeth, food, bacteria and plaque can build up on them. Brushing also helps keep them from getting stained. Many stores sell toothbrushes specifically designed to clean dentures.  Brush your dentures with water or for a fresh taste use mouth rinse. Brushing your dentures with a toothpaste or baking soda can abrade and scratch the outer surface leaving them dull and more prone to plaque build up.  Don’t forget to clean your gums and tongue as well. Even if you don’t have any natural teeth, you want to keep your mouth as healthy as possible.
• Don’t let them dry out. When you’re not wearing your dentures, keep them soaking in water or a solution.  Don’t use hot water because that can warp their shape over time. While you can certainly find many ultrasonic cleaners on the market (and they’re great tools), these are not a replacement for regular brushing. Look for products with the American Dental Association (ADA) seal.
• Avoid using denture adhesives and creams.  If used, these materials are a short-term solution for improving function and retention of a prosthesis.  It is best to have the dentures evaluated by a qualified dental professional if long-term use of these products is needed, as they may cause more harm to the body and tissues used to support the dentures than warranted. 
• Consult with a Pro when having concerns with your existing dentures.  Find a Prosthodontist in your area at the American College of Prosthodontics (ACP) website.  A Prosthodontist can help guide you towards the denture care routine that will work best for you. If you have any problems with your dentures, consult a Prosthodontist as soon as possible. Don’t attempt to repair them yourself.

It is important that you take good care of your dentures to ensure they last as long as possible. Even with excellent care, you should still have your dentures relined, rebased or even remade every five years or so.  Dr Rigby recommends that an annual exam be performed to not only check on the fit and function of the prostheses, but also for a routine head and neck cancer screening.  Dentists and other dental specialists are often the first to find and report these lesions, saving many people lives.  For more information about how you can care for your dentures, or to schedule a dental appointment, contact Rigby Advanced Dental today!!!