The Benefits of Dental Bone Grafting

When I first started my practice back in the early 1980s, dental bone grafting was still a relatively complex surgical procedure that required live donor bone or bone marrow, usually harvested from healthy bone in another part of the patient’s body, in order to be successful. Dental implants were still a fairly new procedure, and the success rates of both treatments were variable at best, mostly due to higher risks of infection.

Today, dental bone grafting and implant placement are safer and more effective than ever before. Advances in synthetic bone materials have almost eliminated the infection risks that were so much more common when working with live donor bone. The process is much easier on the patient, requiring less surgical time and reducing post-operative pain to a minimum. In the last few years, the addition of bioactive proteins to these synthetic bone materials has improved grafting even further by speeding the process of wound healing and enhancing both bone and gum regeneration around tooth roots and implants.

Even for patients who are not considering an implant to replace a tooth that needs extraction, a bone graft now offers us the chance to preserve the shape and strength of the bony ridge long after the tooth is gone. This is important not only for the health and strength of the teeth surrounding the extraction site, but also for the possibility of implant, bridge, denture, or partial placement in the future.

The bony ridges of our jaws get their shape from actively holding the roots of our teeth in place. When a tooth root is extracted and not replaced with an implant or a bone graft, the ridge begins to resorb and reshape itself. Without that root tip, implant, or another section of bone to hold onto, the ridge will shrink in both height and width over time. The result over a period of years is often a section of bone that is narrow, short, and fragile. Implant placement becomes far more complicated in these areas, and sometimes is simply not possible.

But implant placement isn’t the only tooth-replacement option that can be complicated by thin, fragile bony ridges. Traditional dentures and partials always fit better when the bony ridge is thick and strong. Ideally, modern dentures and partials are now anchored with implants as well, in order to avoid the slipping, clacking, and messy adhesive solutions that were so common for our parents or grandparents. Even bridges placed over extraction sites can be esthetically compromised by bone resorption if the bone shrinks away from the suspended false tooth enough to show a gap. Simply put, thin and fragile bony ridges make every tooth replacement option more difficult, less comfortable, less successful, and sometimes even impossible.

A bone graft after an extraction may increase the cost of the procedure initially, but the cost of not replacing that bone over a period of years may add up to far more discomfort and expense than the initial savings justifies. I encourage everyone facing a tooth extraction to talk with your dentist about the pros and cons of proactive bone grafting in order to make the right long-term decision for your body. As always, current patients of mine are encouraged to call the office or bring their questions and concerns to any regularly scheduled dental appointment. Our goal is to offer you the most complete information about the potential long-term effects of all the treatment choices available to you, and to help you make the decision that best supports your health goals.

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Keeping Your Mouth Cancer-Free

It’s hard to offer any solid guarantees about any type of cancer prevention. Genetics and environment can certainly play a role. Some cancers have been correlated to habits like smoking, while others appear to sometimes have a viral component, and still others seem to simply come out of nowhere. But even though we still don’t know everything about why cancer starts in one person and not another, we do know a great deal about the everyday habits that can significantly increase your chances of developing cancer in the mouth regardless of other factors. In fact, as far as researchers can tell us so far, the risk factors for oral cancer are overwhelmingly related to controllable lifestyle choices.

Of all the potential risk factors for oral cancer, smoking tobacco, using smokeless tobacco products, and drinking alcohol regularly and in excess continue to be the highest-risk lifestyle choices a person can make. And for those who combine smoking or smokeless tobacco with drinking regularly, this risk is compounded significantly.

Now it is true that in comparison to the incidences of other types of cancer, statistically oral cancer is still relatively rare. However, individuals are not statistics, and for those people who do develop oral cancer, the effects can be devastating. Whole portions of the tongue, cheek, and jawbone can be lost in the most severe cases. Even with the current advances in prosthetic reconstruction, the structure of the face and the function of the jaw will never be quite the same after that kind of damage. So why risk it at all when the simple choice to not use tobacco and to drink only in moderation could be the key to preventing oral cancer from ever developing?

Unfortunately, the answers are not that simple. Alcohol and the nicotine found in tobacco both have addictive properties, and once a person starts a habit with one or both, it can be very difficult to break it. Certainly, helping our children to avoid starting these habits at all is the best first step in the fight against oral cancer. But many pre-teens, teens, and young adults still remain unaware of the risks. It is an undeniable characteristic of youth to believe in invincibility, but it is also striking how undereducated many young people still are about how the choices they are making right now could affect their health in the long-term.

Of specific concern right now is the growing use of smokeless tobacco products among teenagers. A recent study published in the Journal of the American Academy of Pediatrics, indicates that 5.6 percent of American teenagers use smokeless tobacco products. That seems like a small number, but it shouldn’t. The most recent 2012 US Census data estimates that there are 21.2 million 15 to 19 year-olds living in the United States. That means that well over a million American teenagers are likely using smokeless tobacco products right now. What is even more disturbing about the research findings is that the majority of these students using smokeless tobacco tend to perceive all tobacco products, smokeless or not, as less harmful overall.

Clearly, we need to do a better job of informing young people of all the dangers associated with excessive tobacco and alcohol use. In that effort, I have created a new resource this month discussing the multiple ways that cancer can affect the mouth so that you will be able to have more informed conversations with your children about all the potential dangers of starting these habits.

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Self-Care for the Holidays

At this time of the year as the holidays come into full swing, it’s easy to forget all the little things we might normally do to take care of ourselves. Our schedules are packed with social gatherings, holiday shopping, and family commitments, leaving many of us tired, stressed out, and quite often more headachy than usual.

Getting lost in all the excitement and activity that always seem to define these final weeks between Thanksgiving and the New Year happens to all of us, so be kind to yourself and don’t waste time with regrets about what you should have done these last few weeks. Take a breath, let whatever is in the past stay there, and start again today with a few simple steps to keep you on the right track for self care in the New Year.

We all tend to indulge a little too much in holiday food, alcohol, and caffeine at this time of year, so if you find that you are having headaches more often than usual – or you aren’t sleeping well – start by taking a look at those areas first. Make sure you are drinking enough water each day. Monitor how many hours you are spending in front of the computer shopping for gifts or making travel arrangements, and make sure you take breaks to stretch your legs, neck and shoulders – and to rest your eyes.

You might also try stretching your jaw a few times a day, especially if you notice yourself clenching or grinding your teeth. Ice or a cold pack on the back of the neck, forehead, or over the eyes can also provide significant relief from many types of tension headaches.

If you have a little more time to spend on yourself, you might also take a moment to review some of our articles in The Headache Series. Each one deals with a specific subset of headache triggers that might very well contain a suggestion or solution to the headache that you may be having right now. This month, we’ve also added a new section to the series covering hormone imbalances, medication interactions, and rebound headaches, as well as several other possible environmental irritants and triggers.

Identifying the source of your tension headache or migraine is always the first step in finding a way to prevent them from occurring in the future. I hope you’ll take a moment for yourself during this busy time of year to check in with your body and start making a few simple changes to your daily routine right now instead of waiting for the New Year to begin.

It’s never too soon to start taking better care of yourself, and what better gift for the holidays could you receive than a pain-free transition into the coming year?

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Exercise, Nutrition, and Your Teeth

Exercise and a healthy diet are the cornerstones of a healthy lifestyle. But being healthy is about much more than simply looking slim and fit. Many very athletic adults and teenagers believe that their boosted metabolisms allow them to eat pretty much anything they want to so long as they continue to look slim and fit. But the consequences of a poorly constructed diet on the internal systems of your body, on your teeth, and even on your athletic performance, are the same regardless of how much you weigh or how healthy you may appear on the outside.

A diet filled with excessive amounts of highly refined sugar and grains, as well as foods and beverages that are high in acid, can have equally negative effects on the teeth and bodies of extremely active people as they do on sedentary individuals over time. And when it comes specifically to the teeth, very active individuals may actually be at a higher risk of tooth decay when consuming sugary or acidic foods and beverages during workouts in order to stay fueled and hydrated.

A quick burst of energy from a gel, sports beverage, or even a candy bar, may be exactly what you need to push you through the last leg of your athletic performance or training session, but that quick energy generally comes from a highly-concentrated combination of simple sugars and caffeine. Citric acid, and other acidic flavor enhancers, are often in the mix as well. Sugar and acid in the mouth create the perfect environment for cavity-causing bacteria to multiply and thrive. And introducing these elements into the mouth during intense exercise, when the saliva flow is often compromised, leaves your teeth even more vulnerable to these bacteria and accelerated tooth decay.

Certainly, there are many preventive measures that we can all take before, during, and after exercise to help protect our teeth and our bodies from the negative effects of the concentrated forms of sugar and acid we might consume during a workout. Our newest resource article, entitled Oral Health for Athletes, outlines several adjustments you can make the way you care for you teeth and fuel your body during a workout or race in order to better protect your teeth from accelerated decay.

For everyone, regardless of your level of athleticism, the first and best preventive measure you can take in protecting the health of your teeth and your body is to eat a well-balanced diet low in sugar and refined carbohydrates, and filled with plenty of whole fruits and vegetables, lean sources of protein, some whole grains, and moderate amounts of healthy fats. A strong metabolism should never be an excuse to regularly offer your body inferior sources of nutrition. No matter how athletic any of us may aspire to be, we should all be practicing healthy dietary choices every day and teaching our children that eating well isn’t just about protecting our health today or fueling an athletic performance next week – it’s about building and maintaining a healthy foundation for a vibrant and active lifestyle for years to come.

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What Your Child’s Sleeping Habits May Be Telling You

It’s easy to misinterpret certain types of sleep behavior in children as simple signs of deep sleep or dreaming. A little snoring or minor limb movement on occasion are certainly nothing to worry about, but when your child begins to snore chronically, breathe irregularly, or thrash physically during sleep, it may be time to consider whether or not he or she might have some form of sleep disordered breathing.

Obstructive Sleep Apnea (OSA) is one of the most common forms of sleep disordered breathing in adults, but children can also suffer from it – especially when there are other contributing factors present like excessive weight, chronic allergies, or specific jaw and bite alignment issues. Unfortunately all of these conditions can be intricately interrelated, sometimes making it difficult for a parent and a medical provider to successfully treat the OSA completely without addressing multiple factors at once.

What makes OSA so serious for both children and adults is that in its most severe form, it can be fatal. Thankfully, those cases are still extremely rare. However, medical research is now demonstrating that OSA and other types of sleep disorders in children and adults can manifest daytime symptoms that mimic mild to moderate forms of ADD and ADHD. Mistreating these cases with ADHD medication (typically stimulants) is dangerous on two levels: Your child could potentially be taking medication he or she does not need; and he or she could still have an underlying sleep disorder that remains unaddressed and potentially even exacerbated by the medication. 1

This month, I’ve added a new resource to The Airway Series that expands and explains these important issues in discovering and treating breathing and airway development issues in children. It is my hope that eventually all children will be screened for the underlying conditions that can lead to OSA, and that preventive measures like functional orthodontic treatment, healthy eating, and plenty of exercise are pursued before the pathological conditions related to OSA ever have a chance to develop.

As always, I encourage you to share this material as much as possible with your friends and family, and to bring any questions you may have about your own children with you to your next regularly scheduled appointment.

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