Dr. George S. Lee
Will I need a sinus lift before a dental implant procedure?
When considering dental implants, there are a variety of circumstances to consider. One is the potential to need a sinus lift before a dental implant procedure. A key to the success of your implant is the quantity and quality of bone where we will be placing your implant. If you do not have enough bone mass in your upper jawbone (maxilla) for a successful dental implant procedure, a sinus lift will be discussed. A sinus lift will help to ensure you have the room in your jawbone for the implant placement. Read the rest of this entry »
When having a tooth extracted, it is important to know the after care steps you can take to avoid unnecessary pain following your extraction. If the correct after care steps are not taken, you could develop a dry socket. Tooth extraction pain should only last a few days, in most cases. If the pain does not go away within four days or it begins to intensify, you could have a dry socket. We believe it is important to point out that only 2% to 5% of people develop a dry socket after a tooth extraction. However, for those that do experience this, it can be uncomfortable.
After a tooth has been removed, there will be a hole in the bone. This is called a socket. Once the tooth is extracted, you will form a blood clot in the socket to protect the bone and nerves. There are times when the clot can become dislodged or dissolve after a couple of days post extraction. If this happens, that leaves the bone and nerve exposed to air, food, fluid, and anything else that goes into the mouth. This is called a dry socket. Dry socket’s can lead to an infection, and the pain can last for 5 to 6 days.
What is a dental CT scan?
A CT (computed tomography) scan is a noninvasive medical test that uses special X-ray equipment to produce multiple images or pictures of the inside of the body and a computer to join them together in cross-sectional views of the area being studied. Traditional panoramic X-rays performed by dentists provide only a limited two-dimensional view. While they can show the height and contour of the jaw bone, they give no indication of the bone width and density and may distort the location of the alveolar nerve. State-of-the-art, three-dimensional dental CT imaging takes the guesswork out of implants. This quick and safe diagnostic imaging exam produces life-like spatial views of the mouth that let the surgeon determine pre-surgically if a patient is an implant candidate. With 3D imaging, a surgeon can proceed with confidence, knowing the amount of bone a patient has, the distance to the alveolar nerve and the exact angles to situate the implant.
Why a CT Scan is Necessary Prior to Having Dental Implants?
A CT scan is the most effective diagnostic procedure to establish the patient’s suitability for dental implants, as it provides a 3D computed tomography (CT) image of the lower area of the skull. From the image we are able to determine the exact bone depth, width, density and condition, along with the precise position of your nerve canal and sinus cavity. This significantly decreases risk to the patient and increases implant success.
When should I consider dental CT imaging?
Dental CT imaging is used when patients are being fitted for implants. The more information a surgeon has about the anatomy of the patient’s mouth before a dental implant, the better the outcome. Important measurements for the surgeon to know include the width and density of the jawbone ridge in order to assess implant feasibility and the exact placement of the alveolar nerve in order to prevent painful nerve damage. Dental CT imaging can also help visualize nerve location prior to wisdom tooth extraction.
What Type of Image will I Have at My Appointment?
While individual problems are presented by each patient, most patients will benefit from a traditional panoramic (the exact type of image will be determined based upon your presenting clinical problem). Traditional panoramic films are used most often for obtaining screening views of the upper and lower jaw prior to performing wisdom tooth removal or for evaluation of other problems related to the jaws (including placement of dental implants). Panoramic images allow obtaining of a large amount of clinical information for relatively low radiation dosage to the patient.
Problematic however: the Panoramic x-ray is a 2 dimensional image while the jaws and facial skeleton are 3-diminsional structures. Therefore, the Panoramic x-ray is unable to provide all the information sometimes required. As a commonly encountered example, the anatomy of the inferior alveolar nerve (and its relation to the roots of the wisdom teeth) is an important consideration during the evaluation process of wisdom tooth surgery. Its relation to areas of the lower jaw in cases of dental implant planning are also critical. In addition, the evaluation of sinus anatomy (in relation to the upper jaw bone) is often less than ideal with a Panoramic x-ray.
Why can’t you use the Panoramic X-ray my general dentist took?
Many times these film images are of inadequate orientation or quality (particularly when an image has been transferred to paper) and critical areas of anatomy cannot always be adequately discerned in order to make an informed decision. When transferring radiographic data from electronic media to paper it can result in significant loss of image resolution and clarity. We can use a current panoramic x-ray obtained by your general dentist for certain surgical procedures; however, complex oral surgical cases and evaluation for placement of dental implants require an image to be obtained in our office at the day of your consultation.
Do I need a Panoramic or Cone-Beam 3D Scan or Both?
Goal: It is the desire of our doctors to obtain the highest quality needed clinical/x-ray data in the safest manner (lowest radiation dose) and lowest cost to the patient. Having stated this, please understand the following factors:
1) Individual anatomy varies from person to person
2) The Cone beam scan is more expensive than screening panoramic view, but the cone beam scan provides a vastly larger amount of clinical data upon which to make clinical decisions. Most patients will benefit from an initial screening panoramic film. In situations where the anatomy suggested from this film is uncomplicated, this may be the only images required. Some patients, based upon the information obtained from the panoramic film, will then benefit from an additional cone beam scan in order to discern more detail. Some patients should (or may choose to) proceed directly with a cone-beam scan (skip the Panoramic): i.e. implant patients, patients with complex facial skeletal problems, patients in whom a previous film has suggested close root/nerve anatomy or patients who simply choose to proceed directly to cone beam scan). Again, radiation dose with a cone beam scan is just slightly higher than a panoramic film. Some patients may choose to proceed directly with a cone-beam scan and skip the Panorex film. Given the current capabilities and low dosage of cone beam technology, this is sometimes a reasonable option
Dr. Lee has made an investment in providing the convenience and safety of digital cone-beam imaging software to evaluate your 3D scan. We have chosen to utilize an adjustable field of view cone beam scanner. This unit provides best-rated, quality images being provided.
What will my initial dental implant consultation consist of?
The initial appointment is reserved for Dr. Lee or Dr. DeFelice to learn your goals for restoring missing teeth. They will also review your medical and surgical history to ensure you are an appropriate candidate for this procedure. They will conduct a thorough oral examination and review with you the panoramic image that was taken in our office. A preliminary idea as to how many implants are needed and if a bone graft should be considered can be discussed at this time. Usually, the doctor will need additional information and he will discuss with you what other images may be needed or if a consultation with your restorative dentist is needed. We can obtain the CT scan in our office the day of your initial consultation. Your surgeon will be able to review the scan and prepare your treatment plan to discuss with you at your second appointment.
The second meeting with your surgeon will consist of reviewing the additional images, CT scan for example, and discussion of your treatment plan. Your surgeon will review with you the final treatment recommendations, any alternatives to treatment, and all risks and benefits associated with the procedure. You will meet with our treatment coordinator who will give you a break down of the associated fees in writing. She will also share with you any benefits your insurance plan will be extending for your surgery. You can then schedule for your procedure.
While we understand that these issues may sound somewhat complicated, we do feel it is important for those patients who have questions related to their unique imaging needs be aware of the issues involved in the decision-making process. Please don’t hesitate to discuss your individual situation with us!
Did you know that the month of September is National Dental Infection Control
Awareness Month? Dental infection control awareness month highlights infection control in dentistry.
“The Organization for Safety, Asepsis and Prevention (OSAP) has designated
September National Dental Infection Control Awareness Month (NDICAM) as part
of a collaborative, profession-facing effort to support dental practitioners and
help them communicate to patients the critical role infection control in dentistry
plays in preventing the spread of disease.” (www.osap.org)
What does this mean for our office?
We use hospital-grade cleaners and disinfectants to wipe down all surfaces to ensure they are cleaned and decontaminated before we treat you. Bacteria and other germs also can’t resist sterilization, even if they are resistant to antibiotics. This is why we sterilize all of our instruments.
Although you many not see it, we wash our hands before putting our gloves on, and again when we take our gloves off after treating each patient.
Our eyes are one of the first features people notice when meeting us. Eyes are a prominent facial feature. It is the surrounding skin, muscle, fat, and hair rather than the eyes themselves that convey emotion. They really are the windows to our soul. What do your eyes say about you? Are you tired or well-rested? Are you happy or sad? They even can reflect our overall health status. Prominent, bulbous eyes can be indicative of systemic disease. Many factors impact the appearance of our eyes and surrounding tissue. Of course, as we age the skin around the eyes becomes more lax and can sag. The tissue of the upper eyelids begins to sag and can obstruct our field of vision and make us look tired and angry. The skin becomes even thinner and dark circles appear. Stress and fatigue produce the bags under our eyes. Age, loss of moisture to the skin, smoking, sun exposure and hereditary factors all contribute to wrinkles, deep lines and puffiness around the eyes. The aging process can cause unwanted changes in expression, causing us to look fatigued and older than we really are.
What can be done to refresh and brighten these tired-looking eyes? I am happy to say today we have many options to give us beautiful, youthful, and refreshed eyes. Many of these treatments are non-surgical with virtually no downtime.
Periorbital Laser Skin Resurfacing
Over the years, technology has evolved to help patients look and feel better about their damaged skin by improving the skin texture, wrinkles, acne scars, and imperfections.
Dr. George Lee utilizes the advanced Starlux 500 system from Palomar; offering a less invasive alternative replacing traditional, very painful CO2 lasers fraught with potential postoperative sequelae. This includes prolonged recovery, redness, scarring, and possible lines of demarcation of treated and untreated skin. With advances in fractionated laser technology, one will get all of the benefits of a CO2 laser, but with minimal down time. Fractionated laser treatment can be ablative and non-ablative.
Lumps and bumps in the mouth can not only be annoying, they can indicate a more troublesome problem. While most lesions are benign, it is important to have them fully examined by your dental health provider. Some lesions are painful, bleed after brushing or flossing, and even unsightly. However, many lesions are painless and only identified during a routine oral exam.
What are benign oral lesions?
Not all oral lesions are cancerous. Some causes of irritation and masses in the oral cavity include:
- Candidiasis (Thrush)
- Aphthae Ulcers (Canker Sores)
- Herpes (Cold Sores)
- Geographic Tongue
- Hairy Tongue
How do I manage a benign oral lesion?
If your healthcare provider determines that your oral lesion is benign and does not require treatment, these are some things you can do to decrease the discomfort in your mouth. If the lesions do become bothersome (painful, itchy or overly-sensitive), there are some ways to ease discomfort: brushing with a soft toothbrush (to minimize irritation), flossing, and avoiding acidic or spicy foods and beverages which have been known to cause flare-ups. Managing stress is also helpful, and a topical steroid may be prescribed for more severe outbreaks. Read the rest of this entry »
When you think about insurance, you think about full coverage. There are a lot of things to consider when it comes to insurance coverage, and all insurance plans are not created equal. We purchase insurance to safeguard ourselves against unforeseen, large expenses. Dental insurance provides a limited benefit for dental services. It is important to understand the unique differences of dental insurance when attempting to utilize its benefits. Here are 6 things you need to know about your dental insurance.
- Most insurance companies offer a variety of dental benefit plans with different features. Each plan a dental insurance company has is different. Even if you and a friend use the same insurance company that does not guarantee that you will have the same plan or coverage. If your plan is through your employer, the benefits have been determined by your employer in order to contain costs. One plan may allow an x-ray every year while another only covers it once every 5 years. Coverage or lack of coverage is not related to the medically necessity of the service. Just because it is not covered does not mean you do not need it.
- Your dentist may not “participate” in your dental plans network. An office needs to be “contracted” with your insurance plan to be in network. Being contracted is commonly referred to as being a “participating” or “preferred” provider. It really only means that the office has agreed to accepting a reduced fee from the insurance company and also must agree to the rules that the insurance company has created. These rules are not always based on accepted clinical standards of care, but instead on the ways to minimize the insurance company’s expenses. If the office is not contracted, they are considered out-of-network. Some plans have very generous out-of-network benefits, some have limited, and some have none. Sometimes is is more advantageous to use an out of network provider when the insurance plan restricts the procedures an in-network provider is allowed to perform on its members. Stepping outside the insurance company’s network of “preferred” or “participating” providers allows for more freedom for you and your doctor to determine the best course of treatment for you. It is important to consider more than your doctor’s network status with your plan when decided on treatment.
There are many reasons for a teenager to have missing teeth. Some teens lose a tooth (or teeth) from playing or being involved in an accident. Teeth may be extracted due to decay, and sometimes teeth are congenitally missing, meaning the teen was born without the tooth or teeth.
When replacing a tooth for a teenager, timing is everything. Dental implants are considered the best option for replacing a missing tooth. As the jaw grows the implant will not move with the jawbone as they are imbedded in the jaw.Permanent restoration of a missing tooth in a teenager needs to wait until the jaw has completely developed. Premature implant placement could cause a misalignment with adjacent teeth. Boys usually have complete jaw growth by the early 20’s and girls by their late teens.
While waiting for the jaw to fully develop, it is important to maintain the bone health at the site of the missing tooth. Bone grafts are used to preserve the integrity of the existing bone and stimulate new bone growth that will allow for a solid foundation when it is time to place the implant. Read the rest of this entry »
Why is a current panoramic x-ray important?
When coming to our office for a dental procedure, it is very important for us to have a current x-ray. Current x-rays (also known as radiographs), are essential for accurate diagnosis. It is important for our doctors to see all areas of the face and jaws that are adjacent to surgical areas. Due to changes that can occur in the face or jaw, it is important that our doctors have a new x-ray to view for quality care. The acceptable age of the x-ray is dependent on what you are being evaluated for. For routine extraction of wisdom teeth that are not currently causing any problems, our surgeons will utilize an e-ray that was taken within the past year. However, if you are being evaluated for a cyst in your jaw bone, a more current x-ray is required. Our surgeons are able to use past x-rays to compare to newer images to see changes overtime. Surgery cannot be planned without a current image. If you were to visit an orthopedic surgeon for knee surgery that doctor would need a current x-ray. He or she cannot recommend surgery with an x-ray that is 2 years old. It is the same for oral surgery. Unfortunately, most dental plans limit the frequency that an x-ray is covered to once over 3 to 5 years. Read the rest of this entry »
If you have been referred to our office by your doctor or dentist, you are probably wondering about the care you will receive in our office. At Cumberland Surgical Arts we understand that there can be some apprehension when being referred to an oral surgeon, so we do everything we can to make your appointment with our office go smoothly. Continue reading to find out what to expect at your consultation appointment!
Scheduling Your Appointment
Upon calling the office to set up your consultation appointment, whether you’re referring office does this or you call in on your own, we will be more than happy to work with your availability and schedule your appointment when it is convenient for you. We will need all of the patient’s information (Name, Date of Birth, SSN, Insurance, Etc.) when making the appointment, so make sure you have all of that information on hand. Since we see patients for a variety of conditions that can be filed under both medical and dental insurance, please provide us with all of your insurance information. Two days prior to your appointment, your insurance will be verified and you will be made aware of any co-pays that may be associated with your appointment at this time, as a courtesy to you. Read the rest of this entry »