At What Age Should Wisdom Teeth Be Removed

This a difficult and common question.  Age is a criteria of least importance and patients should be evaluated on basis of need.  If a patient is in eminent danger of infection, cyst development, loss of adjacent teeth, TMJ problems or consist pain to the affected region, removal of the wisdom tooth should be considered.  I have encountered 12 yr old patients who exhibit more developed wisdom teeth than a 20 yr old.  Each patient is  to be evaluated on an individual basis and the proper decision is to be made accordingly.  Wisdom teeth are teeth that are typically non-functional and are usually not in occlusion.  There position in the posterior of the jaw inhibits proper hygiene and makes the m more inclined to develop caries.  This information makes it apparent that wisdom teeth erupted or impacted typically serve no function and almost always require removal.

Roger Myers DMD
Southern Georgia Oral Surgery
Hinesville and Statesboro

Wisom Teeth Can Cause Ear Pain

Southern Georgia Oral Surgery
Locations:  Hinesville and Statesboro
Oral surgeon: Roger Myers DMD

In many instances I evaluate patients that complain of a constant ear pain.  Most of the patients determine that the pain derives from an aggravating ear infection.  However, more often than not the pain is coming from an erupted or impacted wisdom tooth.  The etiology of the pain can emanate from an upper or lower wisdom tooth.  Decay and infection can exacerbate the problem and the ear pain feeling usually is identified as referred pain.  The sensory division of the trigeminal nerve, maxillary or mandibular branches can re-direct pain signals to the ear.  This is a result of  the location of the where the nerves originate at the skull base.  As the nerve becomes inflamed from infection or other stimuli, the pain to the side of the head intensifies.  Analgesics, anti-inflammatory meds, antibiotics and warm heat packs are utilized to lessen the degree of pain. 
**Important Note**
Ear pain can be a result of tooth pain

Oral Surgeon Hinesville, Ga.-Southern Georgia Oral Surgery

Southern Georgia Oral Surgery has two locations:
Hinesville, Georgia and Statesboro, Ga.
Owner:  Roger Myers DMD(oral surgeon)

Mission:
Provide quality oral surgical care to all of our patients and implement the most advanced technological techniques to do so.
Vision:  To be the premier oral surgery office in Eastern Georgia, which provides full scope oral surgery with a plethora of  facial esthetics procedures.

Procedures provided:
1.  Sedation-  Inhalational/IV/GA
2.  Removal of wisdom teeth/extractions
3.  Facial trauma repair
4.  Dental implants
5.  Surgical pathology
6.  Laser hair removal
7.  Botox
8.  Pediatric oral surgery
9.  Bone grafting

www.southerngeorgiaoms.com

Diabetes and Pre-mature Tooth Loss

Diabetes and Dental Extractions Due to Premature Tooth Loss
Roger Myers DMD-Oral Surgeon Hinesville and Statesboro, Ga.
Southern Georgia Oral Surgery


Diabetes is a disease that can affect the whole body, including your mouth. Dental care is particularly important for people with diabetes because they face a higher than normal risk of oral health problems due to poorly controlled blood sugars. The less well controlled the blood sugar, the more likely oral health problems will arise.  The ramifications caused by uncontrolled sugar level can result in kidney failure, loss of vision and oral/systemic issues.  The patients have a greater susceptibility to infections and delayed healing time recovering from trauma with resultant wounds.  This is because uncontrolled diabetes impairs white blood cells, which are the body's main defense against bacterial infections that can occur in the mouth.

What Dental Problems Are People With Diabetes at Higher Risk For?

People with diabetes face a higher risk of:

• Dry mouth. Uncontrolled diabetes can decrease saliva flow, resulting in dry mouth.  The technical term for dry mouth is xerostomia.   Dry mouth can further lead to soreness, ulcers, infections, and tooth decay.  A decreased salivatory state promotes stagnancy and reduces the bodies natural method of washing away tooth adhered bacteria.  This alone can significantly contribute to premature tooth loss, periodontal issues and fungal infections.
• Gum inflammation (gingivitis and periodontitis). Besides impairing white blood cells, another complication of diabetes is that it causes blood vessels to thicken, which slows the flow of nutrients to and waste products from body tissues, including the mouth.  However, when tissue is inflamed due to infection, the region can exhibit profuse bleeding during surgery. When this combination of events happens, the body's ability to fight infections is reduced. Since periodontal disease is a bacterial infection, diabetics with uncontrolled disease may experience more frequent and more severe gum disease.  Gum disease can lead to periodontal issues which affect the retention of teeth.
• Poor healing of oral tissues. People with uncontrolled diabetes do not heal quickly after oral surgery or other dental procedures because blood flow to the treatment site can be impaired.
• Thrush. People with diabetes who frequently take antibiotics to fight various infections are especially prone to developing a fungal infection of the mouth and tongue. The fungus thrives on the high levels of sugar in the saliva of people with uncontrolled diabetes.
• Burning mouth and/or tongue. This condition is caused by the presence of thrush.  This is also called glossodynia.  This can be of neuropathic etiology or form the presence of candida albicans(fungal).  If the cause derives from a fungal infection, anti-fungal agent can be taken.  But, if the cause is of neural origin the patient must be followed by a neurologist.

People with diabetes who smoke are at even a higher risk -- up to 20 times more likely than nonsmokers -- for the development of thrush and periodontal disease. Smoking also seems to impair blood flow to the gums -- which may affect wound healing in this tissue area.
Since people with diabetes are more prone to conditions that may harm their oral health, it's essential to follow good dental care practices and to pay special attention to any changes in your oral health and to seek a prompt dental consultation if such changes occur. Here are some tips to consider.

• Keep your blood sugar as close to normal as possible( 70-110)
• At each dental care visit, tell your dentist about the status of your diabetes. For instance, he or she may want to know your HgA1C level to determine how well controlled your diabetes is (good control is indicated by a level under 7%). If you've had a hypoglycemic episode in the past (low blood sugar, also called an insulin reaction), you are at increased risk to have another one. Tell your dentist when your last episode was, how frequently such episodes occur, and when you took your last dose of insulin, if you take it.  The A1C is a blood serum blood test.
• See your diabetes doctor before scheduling treatment for periodontal disease. Ask your doctor to talk to your dentist or periodontist about your overall medical condition before any dental treatment is performed. If oral surgery is planned, your doctor or dentist will tell you if you need to take any presurgical antibiotics or need to change your meal schedule or the timing and dosage of your insulin, if you take it. At Southern Georgia Oral Surgery, we premedicate all diabetic patients and ask each patient to take check their level prior to surgery.  If insulin dependent, the patient will take 1/2 their dose prior to surgery or calibrate it accordingly.
• Bring your dentist a list of all the names and dosages of all medications you are taking. Your dentist will need to know this information to prescribe medications least likely to interfere with the medications you are already taking if medications are needed. If a major infection is being treated, your insulin dose -- for those taking insulin -- may need to be adjusted. Check with your doctor.
• Postpone nonemergency dental care procedures if your blood sugar is not in good control.  Lack of sugar control can lead to an inevitable infection and potential prolonged healing after surgery.   However, acute infections, such as abscesses, should be treated right away.
• Keep in mind that healing may take longer in people with diabetes. Follow your dentist's post-treatment instructions closely.

Single Tooth Dental Implants-Oral Surgeon Hinesville, Ga.

Single Tooth Dental Implants


Single toooth dental implants provide replacement of esthetics and fuction for most  patients.  Implants to some patients can be an intimidating endeavor, but with proper illustations and communitation this feeling can be diminished.  Expressing to patients that this is viable option for tooth replacement can be difficult.  However, when they comprehend the overall benefits of the implant over the conventional bridge, the patient is more inclined to select the implant route.

Advantages of implants:
1. Restore form and function
2.  Estheticallly pleasing to the eye once restored
3.  Adheres to the surrounding bone for optimal support
4.  Decay or caries are obsolete
5.  Adjacent teeth are not damaged
6.  Cost comparison to other options is virtually the same
7.  Risk of infection is minimal


Disadvantages of implants:
1.  Possible multiple procedures to accommodate the implant
2.  For multiple implants the cost increases
3.  Healing time for osseointegration
4.  Difficulty of placement
5.  Soft tissue and bone (Quality/Quantity)

 

Roger Myers DMD

Southern Georgia Oral Surgery

TMJ and Upper Wisdom Tooth Position

I have discovered that when female patients are evaluated in my office for wisdom teeth, it is apparent  most of them have TMJ issues.  Issues which get progressively worse as the upper wisdom teeth develop.  These problems manifest into headaches, earaches and constant radiating jaw pain.  Therefore, I have discovered that upper wisdom tooth position may be the etiology of this problem.  The wisdom tooth acts as an obstruction or deflector to the normal arc of jaw opening.  As a result, stress and strain is directed toward the joint region and leads to dysfunction.  The radiograph above illustrates the wisdom tooth in close proximity to the coronoid process or descending ramus.  This is the typical position of wisdom teeth, when patients exclaim to having TMJ issues.
What have you observed in your practice ?  Does this complaint mainly derive from the female population of patients?
Southern Georgia Oral Surgery-  Hinesville and Statesboro, Ga. oral surgeon
Roger Myers DMD

Southern Georgia Oral Surgery-Pediatric Approach To Oral Surgical Care

Pediatric oral surgical care is very important and essential to the full scope approach to oral surgery implemented in our office.  A team approach and plan is critical as the patient is oriented to the service being provide.  I have discovered that establishing a rapport and commonality with young patients is paramount.  I provide sedation for 100% of my pediatric for all procedure types.  I do not use inhalational gases due to their ineffectiveness and time of induction.  Oral sedation is given one hour prior to any procedure in the form of halcion(0.125mg).  This approach seems to be effective and creates a degree of euphoria/anxiolysis.  Thereby allowing myself and my team to be efficient in establishing the IV.  As a result, we can immediately administer all necessary meds and perform our intended procedure.  This process has rendered great results and it appears the patients have great things to say post-operatively.

Roger Myers DMD
www.southerngeorgiaoms.com