Gray and Black Market Dental Products: Are You at Risk?

 

By: Consumer Guide to Dentistry

 

💉 Have you heard about the gray and black market before? To avoid the risks and harmful effects of using these products, let us be aware of how they are made and labeled before they are sold. The Oral Surgery DC Team

 

Imagine you’re in the market for a new camera, but you’re not interested in paying top dollar. In an effort to save money, you decide to browse through one of countless stores offering “deep discount” pricing on name brand, top-of-the-line cameras. Chances are, those cameras made their way to the retailers via the “Gray Market” or, worse yet, are counterfeit or even “Black Market” products. In other words, they might not be the real deal, the warranties — if any — are questionable, and as a buyer, you’d better beware.

Unfortunately, Gray and Black Market products aren’t limited to high-priced consumer electronics. Dental materials — everything from the composites used to create minimally invasive composite bonding veneers, to the impression materials used to create moulds of your teeth for precision crowns and porcelain veneers — also are being sold in unauthorized ways to unsuspecting dentists.

What are Gray Market and Black Market Dental Products?

Gray Market dental products are those sold legitimately by a manufacturer intended for export or sale elsewhere, or those that are counterfeit to look like the real deal, which make their way back to the United States and are ultimately sold to dentists through unauthorized channels.

Black Market dental products are either stolen or otherwise transported and distributed in ways that avoid regular taxes and fees, making their way to the end user through risky and unknown supply chains.

More often than not, both types of products are outdated and expired, repackaged and relabeled. Usually the cost for these dental products and materials is significantly less than manufacturers originally intended. However, the ultimate cost in terms of treatment longevity and patient safety could be high, according to dental material science experts.

Poor Product, Material and Treatment Performance

When Gray Market, Black Market or counterfeit dental materials are used, dentists cannot be sure how those materials will perform, or how long the restorations they’re placing will last. That’s because most Gray and Black Market products travel back and forth between multiple countries via long shipping and handling processes that subject them to harsh stress and strain that negatively impact their effectiveness.

This is particularly true for the adhesives used to secure dental restorations in place, and for the impression materials used to create molds of your teeth. Inaccurate and faulty impressions ultimately result in improper and poorly fitting restorations that could chip, fracture or result in tooth decay. However, other dental materials — such as sealants, ceramics and composites — and products sold on the Gray or Black Market also could perform poorly or below acceptable standards.

Legitimate products that are sold to dentists through the proper channels are manufactured nearby to control the materials, prevent expiration and prevent exposure to extreme temperatures that could negatively affect performance when used in dental treatments.

How Gray and Black Dental Markets Happen

Many businesses these days are trying to compete in the “global marketplace.” Unfortunately, not all countries can afford to pay the same prices for products that we pay here in the United States. As a result, many companies have different prices for their products throughout the world, and sometimes there’s quite a big difference between what consumers in one country pay for a product and what that product is sold for in another country. It’s no different with dental products and materials.

Because dental product pricing fluctuates between countries, it becomes more profitable for distribution chains to find unauthorized ways to sell the products back in the United States. The price will be lower than what U.S. dentists usually pay, but more than what overseas dentists are paying, so those unauthorized sellers make a bigger profit.

The Law Isn’t Black and White

The dental products, equipment and materials sold and used in the United States are regulated by the Food and Drug Administration (FDA) to ensure they meet appropriate standards, as well as confirm their safety and efficacy. For this reason the FDA inspects dental manufacturing facilities to ensure compliance with federal guidelines. The FDA also must approve products, materials and equipment before they are marketed and sold in the United States. Those approved by the FDA carry specific serial numbers on their packaging.

Gray and Black Market products making their way back into the United States typically were intended for sale in other countries and may not be approved by the FDA for use. As such, their packaging is usually altered or changed to appear consistent with other “for sale in the U.S.” products. Therefore, there’s no way to guarantee that Gray or Black Market products meet FDA standards or are FDA approved.

Experts have pointed out that while Black Market products are illegal according to the laws of most countries, the sale and purchase of products on the Gray Market approved by the FDA typically are not illegal. Again, however, because these products usually have been tampered with, it’s hard to determine if they’re the real thing.

What Can You Do?

Sometime in 2011, the FDA is expected to announce stronger rules for material and product labeling that will affect anything considered a medical device, including dental products, materials and equipment. Such packaging will enable manufacturers and their authorized dealers to better track and identify discrepancies in the distribution chain.

Additionally, dental product manufacturers are working harder to label and package products intended for foreign countries as a completely different product or material brand. This will make it harder for unauthorized channels to reintroduce the product into the United States on the Gray Market.

That’s comforting to know. It’s also good to know that dentists are concerned with the oral health of their patients and strive to deliver the best possible care using scientifically proven materials. Reputable dentists purchase legitimate and tested products from well-known and respected manufacturers and product dealers and likely will be willing to answer your questions about the materials they use and the manufacturers from whom they’ve purchased them.

Therefore, do not be afraid to ask about the type and brand of dental products your dentist will be using for your treatment. Understanding what’s involved with your treatment will enable you to have confidence in your dentist and participate actively in the process.

Source: https://www.yourdentistryguide.com/gray-market/

A Guide to Common Dental Problems

Woman running water and holding a toothbrush
By: Sally Solo, Real Simple
😄 Keep this guide to common dental problems handy so you’ll achieve the perfect smile everybody would want to see! The Oral Surgery DC Team

Problem: Tooth Decay

Also known as dental caries or cavities, tooth decay occurs when plaque, a sticky film of bacteria that forms when you eat sugars or starches, is allowed to linger on teeth for too long.

Who’s at risk: Anyone can get a cavity, but children and older people are the most prone. The incidence among children has been declining, thanks to community water fluoridation and the increased use of fluoride toothpaste, but “more than half of all children have cavities by the second grade,” according to the U.S. Department of Health and Human Services report Healthy People 2010. Older adults are prone to cavities at the root because protective gum tissue often pulls away.

What to do: Don’t give plaque a chance: Brush with a fluoride toothpaste and floss every day. Children can also benefit from sealants (plastic coatings applied to the chewing surfaces of their back teeth) as soon as their adult molars come in. Older people should be particularly vigilant: “Those who have a tendency toward dry mouth should receive regular fluoride treatments from a dentist and use a fluoride-containing mouth rinse,” says Bruce Pihlstrom, D.D.S., acting director of the Center for Clinical Research at the National Institute of Dental and Craniofacial Research (NIDCR).

Problem: Gum Disease

A bacterial infection caused by plaque that attacks the gums, bone, and ligaments that keep your teeth in place. The early stage is known as gingivitis, the advanced stage as periodontitis.

Who’s at risk: Everyone. The National Institute of Dental and Craniofacial Research (NIDCR) estimates that half of all adults have some signs of gingivitis. Most at risk are people with poor oral hygiene; those with a systemic disease, such as diabetes, that lowers resistance to infection; and smokers. Women also have a tendency to develop gingivitis during pregnancy. Other risk factors are stress, which weakens the immune system, and genes. “Some people can have gingivitis all their lives and never progress to periodontitis,” says Bruce Pihlstrom, D.D.S., acting director of the Center for Clinical Research at the NIDCR. “It depends on a person’s susceptibility to the disease.”

What to do: See a dentist regularly, and tell her if your gums feel tender or bleed. Gingivitis can be reversed with regular brushing and flossing. To combat periodontitis, a dentist or periodontist may perform a deep cleaning around the teeth and below the gum lines and prescribe medication to combat the infection. If the disease has progressed to affect your gums and bone, your dentist might suggest surgery, such as a gum graft.

Problem: Tooth Infection

The pulp inside the tooth (which contains nerves) is damaged or becomes infected because of decay or injury. The root canal, which connects the top pulp chamber to the tip of the root, may become infected, too.

Who’s at risk: Anyone with a deep cavity or a cracked tooth, which can let in bacteria. An injured tooth can have a problem even if it’s not visibly cracked or chipped.

What to do: If you feel pain in or around a tooth, see your dentist. He may refer you to an endodontist, who specializes in root-canal procedures. In one to three visits, the dentist will perform the notorious root canal (which is much less painful than it used to be). He will remove the pulp, clean the pulp chamber and root canal, then fill the tooth. Finally, he may seal the tooth with a porcelain or gold crown.

Problem: Gum Disease

A bacterial infection caused by plaque that attacks the gums, bone, and ligaments that keep your teeth in place. The early stage is known as gingivitis, the advanced stage as periodontitis.

Who’s at risk: Everyone. The National Institute of Dental and Craniofacial Research (NIDCR) estimates that half of all adults have some signs of gingivitis. Most at risk are people with poor oral hygiene; those with a systemic disease, such as diabetes, that lowers resistance to infection; and smokers. Women also have a tendency to develop gingivitis during pregnancy. Other risk factors are stress, which weakens the immune system, and genes. “Some people can have gingivitis all their lives and never progress to periodontitis,” says Bruce Pihlstrom, D.D.S., acting director of the Center for Clinical Research at the NIDCR. “It depends on a person’s susceptibility to the disease.”

What to do: See a dentist regularly, and tell her if your gums feel tender or bleed. Gingivitis can be reversed with regular brushing and flossing. To combat periodontitis, a dentist or periodontist may perform a deep cleaning around the teeth and below the gum lines and prescribe medication to combat the infection. If the disease has progressed to affect your gums and bone, your dentist might suggest surgery, such as a gum graft.

Problem: Tooth Infection

The pulp inside the tooth (which contains nerves) is damaged or becomes infected because of decay or injury. The root canal, which connects the top pulp chamber to the tip of the root, may become infected, too.

Who’s at risk: Anyone with a deep cavity or a cracked tooth, which can let in bacteria. An injured tooth can have a problem even if it’s not visibly cracked or chipped.

What to do: If you feel pain in or around a tooth, see your dentist. He may refer you to an endodontist, who specializes in root-canal procedures. In one to three visits, the dentist will perform the notorious root canal (which is much less painful than it used to be). He will remove the pulp, clean the pulp chamber and root canal, then fill the tooth. Finally, he may seal the tooth with a porcelain or gold crown.

 

Source: https://www.realsimple.com/health/preventative-health/dental/preventing-treating-common-dental-problems

Paresthesia (nerve damage) after wisdom tooth removal or injection. Causes | Duration | Treatment

By: Animated-Teeth.com

 

😱 Have you heard about Dental Paresthesia? Discover its signs, symptoms, causes, and treatment before you’re at risk! The Oral Surgery DC Team

 

What is paresthesia?

Dental paresthesia is a possible postoperative complication associated with the removal of teeth (most frequently lower wisdom teeth), or in some cases receiving a dental injection.

(This condition can also be a post-op complication of root canal treatment or dental implant placement but that is not the focus of our coverage here.)

Causes – The onset of paresthesia is a result of nerve trauma. It involves the situation where during the patient’s procedure a nerve lying in the immediate area has received some type of insult. In most cases, the event involved has crushed, bruised, stretched or otherwise irritated the nerve. Less likely, it may have actually been nicked or severed.

Signs and Symptoms – As a result of the traumatic event, the person experiences a change in, or loss of, sensation in the tissues and structures that are serviced by the nerve. The lip, facial skin, tongue and lining of the mouth are all commonly affected areas.

Outcomes – The altered state typically persists for an extended period (days, weeks, months), ultimately resolving on its own without specific treatment. In some cases, the change in sensation that’s noticed may be permanent, or only partially resolves.

Details.

As mentioned above, dental paresthesia may be a complication associated with tooth extraction or receiving a dental injection. We discuss each situation separately:

a) Paresthesia as a complication of tooth removal.

Most cases of paresthesia following an extraction occur in conjunction with the removal of lower 3rd molars (wisdom teeth) and to a lesser extent lower 2nd molars (the next tooth forward).

Tooth roots lying in close proximity to the Inferior Alevolar nerve.

A person’s risk generally correlates with the positioning of their tooth.

A) The tooth’s roots may lie in close proximity to the primary nerve running through the jawbone (see illustration).

B) Or the position of the tooth may be such that surrounding soft tissues must be incised and reflected back so adequate access can be gained. If so, the prominent nerve running through these tissues may be traumatized or even severed.

Which nerves are usually affected?

The major nerves that lie in close proximity to 2nd and 3rd molars (wisdom teeth), and thus are at risk for receiving trauma or damage during the extraction process, are:

  • The Inferior Alveolar nerve. – This nerve runs the length of the lower jawbone in its Mandibular canal (a tunnel-like structure through which the nerve and associated blood vessels run).

    The canal lies more or less in the center of the jawbone, at a level lying just below the roots of the teeth it holds (when they are fully erupted, thus explaining why the roots of impacted teeth tend to lie close to this nerve, see illustration above).

    At a point near its end, the Inferior Alveolar nerve gives rise to a branch called the Mental nerve. It exits the jawbone and runs to and services the tissues of the lower lip and chin region. (If the Inferior Alveolar nerve displays symptoms of paresthesia, this branch will too.)

  • The lingual nerve. – This nerve runs through the soft tissues that cover over the inside surface of the lower jaw. It provides services for these tissues, and also branches off to and provides sensory perception for the tongue.

What can cause nerve trauma that leads to paresthesia?

Nerve bruising or stretching can result in significant levels of nerve irritation. Compressive forces may physically crush the nerve. Less likely, the nerve may have been partially or even completely severed.

  • Compressive forces might be generated by the movement of the tooth as it’s loosened up or removed, or by the extraction instruments being used. (An explanation of how teeth are removed.)
  • The dental drill or hand instruments used to remove bone tissue or section the tooth during the extraction process may nick or sever the nerve.
  • To gain access to the tooth, a gum tissue flap may need to be created. During events associated with incising and/or retracting this tissue, the nerve that lies within it may be traumatized or even severed.

b) Paresthesia associated with dental injections.

Other than surgical procedures, some cases of paresthesia are caused by routine dental injections.

Which nerves are most often affected?

The greatest risk of paresthesia lies with injections given to numb up lower back teeth. This is termed an inferior alveolar nerve block injection.

  • The lingual nerve. – This is the same nerve mentioned above that runs through the soft tissues that cover the inside surface of the lower jawbone. 70% of cases involve the Lingual nerve.
  • The Inferior Alveolar nerve. – This is the nerve mentioned above that runs through the jawbone’s Mandibular canal. However, as related to injection paresthesia, the location at which the nerve is traumatized is prior to its entry into the bone (at a point during which it courses across the inside surface of the posterior jawbone).
  • The Maxillary nerve. – While rare, this nerve that services aspects of the upper jaw may be affected.

(Smith 2005) [reference sources]

What creates injection nerve trauma?

The irritation or damage caused may be due to:

  • Direct trauma caused by the needle itself.

    The largest gauge needle used in dentistry has a diameter of .45mm. In comparison, the size of the nerves that lie at risk are on the order of 4 to 7 times larger (on the order of the size of a spaghetti noodle).

    For this reason, a nerve receiving a nick is the most likely event, as opposed to being severed completely.

  • Hematoma formation.

    The movement of a needle through soft tissues may rupture blood vessels, thus causing the release of blood. Constriction of the hematoma (swelling of clotted blood) that then forms may place pressure on nerve fibers that pass through it.

  • Neurotoxicity of the anesthetic. – The anesthetic that’s been injected may cause localized chemical damage to the nerve.

Signs and symptoms of paresthesia.

Paresthesia is a sensory-only phenomenon (meaning symptoms involving muscles, like paralysis or spasm, are not involved).

In most cases, the nerve damage is not identified during the dental procedure itself but instead first noticed as a postoperative complication during the hours following.

Paresthesia – Signs and symptoms.

  • The person experiences an altered, diminished, or even total loss of sensation.

    (A diminished sense of feeling is termed “hypoesthesia.” The total loss of sensation is referred to as “anesthesia.”)

  • The extent of the affected area reveals the region serviced by the damaged nerve(s), and hence which are involved. Inferior Alveolar nerve = lip, chin. Lingual nerve = tissue lining on inside of jaw, tongue.
  • One or more sensations may have been affected: touch, pain, proprioception, temperature or taste.
  • The effects may affect a person’s speech, chewing function or cause drooling. They may interfere with activities such as playing a musical instrument.

Even when the effects experienced are just minor, they can be difficult for a person to cope with. Their quality of life may be significantly affected. Social interactions may be inhibited.

Other characteristics.

  • For some people, the sensation they experience may be a persistent tingling, numbness or “pins and needles” effect (similar to the feeling they experience when having a tooth anesthetized for a dental procedure).
  • Some people may experience “dysesthesia” (the feeling of painful or unpleasant sensations).

Characteristics unique to dental injection paresthesia.

On occasion, while receiving a dental injection a person may experience an “electrical shock” sensation as the needle makes physical contact with their nerve. (This would be most common with inferior alveolar nerve block injections, the type of “shot” used to numb up lower back teeth.)

Having experienced a shock is not necessarily an indication that paresthesia will occur but there is a relationship.

  • As many as 15% of people who experience this sensation go on to experience some degree of paresthesia.
  • 57% of people who ultimately do experience paresthesia did experience the shock effect.

(Smith 2005)


How long does the numbness/sensory loss of paresthesia last?

For those patients who are affected, one of 3 scenarios will play out.

  • In most cases, the paresthesia is transient, resolving on its own after a short period, usually measured in one or two to several weeks.
  • With cases lasting longer than 6 months, the condition is classified as being persistent.
  • For a small number of cases, the loss (complete, partial or partially resolved) is permanent.

We discuss statistics and events associated with case progress and outcomes in greater detail below.

Evaluating a patient’s risk for paresthesia.

A) Location, location, location.

As discussed above, one primary risk factor for paresthesia is simply the proximity of the tooth being extracted to nearby nerves (and therefore increased likelihood that they’ll be traumatized during the extraction process).

Identifying risk using x-rays.

In the case of the mandibular nerve, the dentist’s pretreatment x-ray evaluation of the tooth can give a hint as to what configuration exists.

The outline of the canal inside the jawbone that houses the mandibular nerve can usually be seen on x-rays. And its apparent closeness to the roots of the tooth planned for extraction can be evaluated.

2-D vs. 3-D imaging

One difficulty associated with using x-rays to make this determination is that common dental radiographs are just a 2-dimensional representation (a flat picture) of a 3-dimensional configuration. And for this reason, only an educated guess can be made about the precise relationship that exists.

A more definitive determination can be made using 3-D imaging, such as a Cone Beam CT scan. This technology is becoming more and more commonplace in the offices of oral surgeons, and even some general practitioners.

It does however come at a greater expense, both in financial terms and in the level of radiation the patient is exposed to.

Is 3-D x-ray imaging really necessary?

Only the dentist performing the patient’s work can determine if this level of evaluation is indicated. But we can report that studies (Deshpande 2013, Kositbowornchai 2010) have shown that traditional 2-D imaging can reliably provide a practitioner with a high level of information regarding the configuration that exists, especially when a multi-x-ray technique is used.

But similar in how a dentist’s clinical skills are an important factor in reducing their patient’s risk for paresthesia (discussed next), a dentist’s experience in interpreting the telltale signs to be discovered on 2-D radiographs would be expected to be an important factor too.

Risk and impaction type.

A tooth’s precise orientation in the jawbone plays a role in paresthesia risk in two ways: 1) Tooth-nerve proximity. 2) It can greatly affect the surgical difficulty (and thus level of trauma) associated with removing the tooth.

As general rules:

  • Any lower wisdom tooth that’s angled or positioned toward the tongue-side of the jawbone places the lingual nerve at greater risk.
  • Lower full-bony impactions, especially horizontal and mesio-angular ones (pictures), are the type of extraction most likely to result in trauma to the mandibular nerve.

B) Surgical factors / Clinician skill.

Research has demonstrated that: 1) The dentist’s level of experience, 2) The surgical technique they use, and 3) The amount of time they require to complete the extraction process – will each play a role in the patient’s risk for experiencing paresthesia.

A research paper by Jerjes (2010) bluntly states that one of the main risks for developing permanent sensory loss as a complication of nerve damage experienced during tooth extraction was the surgical skills/experience of the operator.

Clearly, this is a primary reason why a general dentist will refer wisdom tooth extractions they anticipate will be challenging and thus lie beyond their skill level to an oral surgeon.

C) Age as a risk factor.

After the age of 25, a person’s risk for experiencing paresthesia is generally considered to increase.

Relatively “older” patients (those over the age of 25, and especially over the age of 35 years) usually have wisdom teeth that have more fully formed roots and denser surrounding bone. Both of these factors tend to increase the difficulty of performing the tooth’s extraction, and thus raise the level of trauma involved.

This is one reason why asymptomatic full-bony impacted wisdom teeth that show no sign of associated pathology are often left alone in people over the age of 35.

C) Dental injections.

The vast majority of cases of paresthesia resulting from dental “shots” involve those used to numb up lower back teeth (specifically inferior alveolar nerve blocks).

But as opposed to oral surgery where the patient’s risk can be evaluated during their procedure’s planing stage, there’s no way for a dentist to anticipate beforehand which dental injections might result in this complication.

Paresthesia occurrence – Statistics.

a) As related to wisdom tooth extraction.

In a review of research studies evaluating paresthesia after wisdom tooth extraction, Blondeau (2007) found incident rates ranging from 0.4% and 8.4%.

One large study (Haug 2005) evaluated the outcome of over 8,000 third molar extractions. It found an incidence rate of less than 2% for subjects age 25 years and older (as mentioned above, an age group that’s relatively at-risk for this complication).

b) As related to dental injections.

It’s been estimated that roughly 1 out of 27,000 Inferior Alveolar Mandibular blocks (the type of dental injection used to numb up lower back teeth, and the one most associated with this complication) will result in paresthesia.

At this rate, it’s been estimated that during the course of their career a dentist will have 1 to 2 patients develop this complication. (Smith 2005)


How long does paresthesia last?

In most cases, a patient’s paresthesia will resolve on it’s own over time, with the amount of time ranging from just a few days, to several months, to over a year. In some cases a person’s sensory loss, complete or partial, is permanent.

Generalities about recovery.

A person’s level of sensory loss, their potential for recovery (full or partial), and the timeline associated with it will all correlate with the type (nerve irritation, crushing, nicking or severing) and extent of the original injury. Unfortunately, these are factors that are usually unknown.

Experiencing altered or diminished sensation implies that the nerve is still at least partially intact, a situation that favors recovery. But the complete loss of sensation doesn’t necessarily mean that the nerve has been completely severed. A nerve that’s been crushed can display this same symptom.

a) As related to wisdom tooth extraction.

Spontaneous recovery.

In cases associated with wisdom teeth, Queral-Godoy (2005) found that most recoveries took place within the first 3 months. At 6 months, one-half of all of those affected experienced full recovery.

Persistent paresthesia.

(This classification refers to cases where the patient’s condition lasts longer than 6 months.)

Pogrel (2007) reviewed studies that had evaluated complications associated with wisdom tooth removal and found reported incidence rates of persistent paresthesia ranging between 0% and 0.9% for the Inferior Alveolar nerve, and 0% and 0.5% for the Lingual nerve.

Paresthesia recovery – General rules of thumb.
  • If a patient’s condition has not completely resolved within a two month time frame, the probability of their having some degree of permanent sensory deficit increases (although full resolution may still occur).
  • If some level of deficit still remains after nine months, it’s unlikely that complete resolution will occur.

(Bhat 2012)

b) As related to dental injections.

Spontaneous recovery.

In 85 to 94% of cases, spontaneous complete recovery typically occurs within 8 weeks.

Persistent paresthesia.

Symptoms lasting more than 8 weeks are less likely to fully resolve.

(Smith 2005)

What can be expected during recovery?

Signs of paresthesia resolution.

Recovery from paresthesia, just like with any type of healing, is a process. And for that reason, any progress toward returning to normal can be expected to be a gradual transformation over a period of time. However, as the statistics above indicate, the time frame involved can be quite variable, ranging from just days to many months, to over a year.

  • As sensation in the area starts to reappear, the degree of detail it provides should sharpen over time, hopefully returning all of the way back to normal parameters.
  • Since the nerve fibers that transmit different types of sensations have different structural characteristics, one type of sensation may make a quicker recovery than others.
  • As you might expect, the sooner the first signs of renewed sensation appear, the more favorable the chances are for complete recovery (see statistics above).
  • It may be that no progress is experienced for a period of time (weeks, months), and then signs start to appear.
Why paresthesia recovery rates vary.

The most important determining factor in a person’s rate of recovery (and also how complete their recovery will be) is the nature and extent of the insult/damage that the nerve has received. As simple examples:

  • A nerve that is still structurally intact (like those that have been bruised, stretched or compressed) can be expected to make a quicker, fuller recovery than one that has been severed.
  • Nerves that have been nicked, as opposed to completely severed, have the quicker, more-favorable prognosis.

Of course, in most cases the nature and extend of what’s occurred isn’t known. And as such, developing any specific rules about patient recovery rates are simply impossible to make.


Treating permanent paresthesia.

Establishing a baseline for comparison.

Testing / mapping the affected areas.

As a way of documenting the extent of a patient’s condition, both initially and as recovery occurs, the affected area should be mapped.

To do so, different types of sensory tests are performed, and those regions (lip, facial skin, tongue, etc…) that respond with no or altered sensation are recorded.

The mapping may include:

  • Light Touch – A small cotton ball is brushed against the skin to see if it can be felt, and if the patient can discern the direction of the ball’s movement. Moist tissues (like the lining of the mouth) can be difficult to evaluate with this test.
  • Sharp vs. dull discrimination – Areas are prodded with a pin or other sharp-pointed tool. The patient is asked if they can feel a sensation, and if so whether it feels sharp or dull. A comparison to the same location on the patient’s unaffected side is made also.
  • Two-point Discrimination – A pair of calipers having a pair of sharp points is systematically touched to the affected area, using various distance settings. The patient is asked if they are able to feel this contact as one or two individual points.
  • Taste stimulation – Cotton balls soaked in saline (salt), sugar (sweet), vinegar (sour) or quinine (bitter) solution are drawn across the side of the tongue to see if a taste response is triggered.
Testing frequency.

After the results of a person’s initial testing has been documented, comparisons can then be made periodically to evaluate the patient’s progress towards returning to normal.

Some sources suggest that evaluations should be conducted every 2 weeks for 2 months. Then every 6 weeks for the following 6 months. After that, every 6 months for 2 years, followed by yearly evaluation as long as full recovery has not occurred. (Smith 2005)

Surgical repair. / Microsurgery.

In cases of persistent or permanent paresthesia, surgical repair may be possible.

Timing.

It’s difficult to know what to report in terms of what’s considered the best timing for the nerve’s attempted repair. It’s best said the a decision to attempt a repair, and subsequently the timing for it, depends on the nature of the sensory loss experienced (full, partial, recovering, etc…) and therefore best evaluated by the doctor (oral-maxillofacial surgeon, neurosurgeon or micro-neurosurgeon) who will provide the treatment.

  • Surgery is frequently delayed until a point 6 to 12 months after the original injury, so to allow time for a repair to occur on its own if it will.

    Some studies however (see below) seem to report that prompt repair increases the chances of case success.

  • It may be that in situations where it is positively known (visualized) that the nerve has been cut that proceeding promptly with a repair attempt makes the best plan.
  • Surgery may be attempted even much later on. The studies we cite below report surgeries having been performed multiple years following the patient’s original injury, although we don’t know the outcome of these cases.
Microsurgery success rates.

A paper by Pogrel (2007) reports that results for surgical intervention vary widely. Success rates appear to range between 50 and 92%, however some reported successes only involve partial recovery. Even if just partial recovery was achieved, many patients still considered the attempt worthwhile.

A sampling of findings reported by research studies:

  • Strauss (2006) evaluated the outcomes of Inferior Alveolar nerve repair experienced by 28 patients treated by one surgeon.

    50% reported significant improvement in their condition, 43% slight improvement and 7% gained no benefit. The average wait period before surgical repair was attempted was 6.6 months following the patient’s initial injury.

  • Bagheri (2012) evaluated the outcome of 186 Inferior Alveolar nerve repair surgeries performed by multiple surgeons. On average the surgeries were performed 10.7 months following the patient’s initial injury, with the range being 0 to 72 months).

    It was determined that 81% of cases resolved favorably, resulting in either a functionally useful (partial) or complete recovery. The study noted a drop in case success for surgeries performed at a point 12 months and beyond the patient’s initial injury.

  • In an evaluation of 222 Lingual nerve microsurgeries performed by multiple surgeons, Bagheri (2010) reported 66% of cases experienced complete recovery, 25% functionally useful recovery and the remainder no or inadequate improvement.

    On average, the surgeries were performed 8.5 months after the patient’s initial injury (range 1.5 to 96 months). The study noted that shorter intervals tended to improve case outcomes. It also found a significant drop in case success for surgeries performed at a point 9 months and beyond the patient’s initial injury.

Much less information exists about the surgical repair of paresthesia resulting from dental injection. In some cases, long-term drug therapy is used to help these patients manage their condition.

 

Source: https://www.animated-teeth.com/wisdom_teeth/t7-wisdom-tooth-paresthesia.htm

Common Types of Oral Surgeries and What You Can Expect

 

By: Dental Pointe

 

💉From wisdom tooth removal to a reconstructive operation, each oral surgery type has different functions. Determine which of them is suitable for your needs. The Oral Surgery DC Team

 

There are several conditions that may warrant getting oral surgery in Naperville. Sure, no one relishes the idea of surgery; however, your Naperville oral surgeon is ready to share some facts that will ensure that you’re prepared for your upcoming procedure. Here are some of the most common types of dental surgeries and what you can expect when you come into our office:

Impacted Wisdom Teeth

These third molars are the last teeth to develop. While sometimes these teeth may erupt and not cause the patient any issues, more often than not these teeth either don’t fully erupt or aren’t properly aligned. This causes them to become impacted between the gums and the jawbone, which will also affect the health of surrounding teeth.

Dental Implants

To replace a missing tooth, we will surgically implant a metal post into the jawbone, which will fuse with the gum tissue and bone over time. This creates a strong foundation on which to place a realistic-looking artificial tooth (or crown). Dental implants are great for those with tooth loss who are looking for a long-term treatment option.

Biopsies

If you have a lesion in your mouth that looks suspect, we will perform a biopsy to check for oral cancer. We will remove a small piece of tissue and then send it to the lab for analysis.

Jaw Surgery

If your jaws aren’t properly aligned, this can cause problems not only with appearance but also with function. Surgery is often necessary to correct this problem and restore function.

Sleep Apnea

If other conservative treatments don’t help serious sleep apnea sufferers, then we can remove excess tissue from the back of the throat to significantly reduce symptoms.

Reconstructive surgery

Knocked-out teeth and facial injuries can make even the most everyday functions a challenge (e.g. eating). These procedures replace missing or damaged teeth, treat jawbone and gum damage, and correct jaw joint issues.

Pre-procedure

Before surgery, we will provide you with an outlined treatment plan. We will also discuss anesthesia options with you and you can feel free to ask any questions you may have about your surgery. Most surgeries are done under general anesthesia to ensure that the patient doesn’t experience any discomfort.

Post-procedure

As with any surgery, there will be a recovery period. If you’re under general anesthesia, you will not be able to drive yourself home afterward. You will want someone to pick you up, as you will be groggy and tired. We may prescribe painkillers for treating recovery-related pain. We will provide you with some detailed do’s and don’ts for after surgery.
Source: http://www.mydentalpointe.com/blog/post/common-types-of-oral-surgeries-and-what-you-can-expect.html

What Are the Most Common Dental Problems?

 

By: Tammy Davenport, Very Well Health

 

😄 Understanding common dental problems allow you to take preventive measures to keep a healthy smile. Remember, your mouth can tell you many things about your body. The Oral Surgery DC Team

 

Dental problems are never any fun, but the good news is that most of them can be easily prevented. Brushing twice a day, flossing daily, eating properly and regular dental check-ups are essential steps in preventing dental problems. Educating yourself about common dental problems and their causes can also go a long way in prevention. Here is a list of common dental problems.

1. Bad Breath

Bad breath, also called halitosis, can be downright embarrassing. According to dental studies, about 85 percent of people with persistent bad breath have a dental condition that is to blame.

Gum disease, cavities, oral cancer, dry mouth, and bacteria on the tongue are some of the dental problems that can cause bad breath. Using mouthwash to cover up bad breath when a dental problem is present will only mask the odor and not cure it. If you have chronic bad breath, visit your dentist to rule out any of these problems.

2. Tooth Decay

Tooth decay, also known as cavities, is the second only to the common cold as the most prevalent disease in the United States. Tooth decay occurs when plaque, the sticky substance that forms on teeth, combines with the sugars and/or starches of the food you eat. This combination produces acids that attack tooth enamel.

You can get cavities at any age—they aren’t just for children. As you age, you can develop cavities as your tooth enamel erodes. Dry mouth due to age or medications can also lead to cavities.

The best way to prevent tooth decay is by brushing twice a day, flossing daily, and going to your regular dental check-ups. Eating healthy foods and avoiding snacks and drinks that are high in sugar are also ways to prevent decay. Your dentist can recommend further treatments that may help reduce your risk.

3. Gum (Periodontal) Disease

Gum disease, also known as periodontal disease, is an infection of the gums surrounding the teeth. It is also one of the main causes of tooth loss among adults. Some studies have indicated that there may be a link between heart disease and periodontal disease.

Everyone is at risk for gum disease, but it usually occurs after age 30. Smoking is one of the most significant risk factors. Diabetes and dry mouth also increase your risk. The symptoms include bad breath, red, swollen, tender, or bleeding gums, sensitive teeth, and painful chewing.

The two major stages of gum disease are gingivitis and periodontitis. Regular dental check-ups along with brushing at least twice a day and flossing daily play an important role in preventing gum disease. You should see your dentist if you have any signs of gum disease so you can get treatment to prevent further complications, such as tooth loss.

4. Oral Cancer

Oral cancer is a serious and deadly disease that affects millions of people. The Oral Cancer Foundation estimates that someone in the United States dies every hour from oral cancer, but it is often curable if diagnosed and treated in the early stages. It is most often seen in people over the age of 40.

The biggest risk factors are tobacco and alcohol use, including chewing tobacco. HPV—a sexually transmitted wart virus—also increases the risk.

The symptoms of mouth or throat cancer include sores, lumps, or rough areas in the mouth. You may also have a change in your bite and difficulty chewing or moving your tongue or jaw.

Regular dental visits can help catch oral cancer early. You may ask your dentist whether an oral cancer exam is part of their usual checkup. If you notice any of the symptoms or have trouble chewing, swallowing, or moving your tongue or jaw, see your dentist.

5. Mouth Sores

There are several types of mouth sores and they can be pesky and bothersome. Unless a mouth sore lasts more than two weeks, it is usually nothing to worry about and will disappear on its own.

Common mouth sores are canker sores (aphthous ulcers) that occur inside the mouth and not on the lips. They are not contagious and can be triggered by many different causes. They are only a concern if they don’t go away after two weeks.

Fever blisters or cold sores are caused by the Herpes simplex virus and occur on the edge of the outer lips. They are contagious and will come and go but are not completely curable.

Mouth sores are also seen in oral thrush or candidiasis, a yeast infection of the mouth that can be seen in infants, denture wearers, people with diabetes, and during cancer treatment.

6. Tooth Erosion

Tooth erosion is the loss of tooth structure and is caused by acid attacking the enamelTooth erosion signs and symptoms can range from sensitivity to more severe problems such as cracking. Tooth erosion is more common than people might think, but it can also be easily prevented.

7. Tooth Sensitivity

Tooth sensitivity is a common problem that affects millions of people. Basically, tooth sensitivity involves experiencing pain or discomfort to your teeth from sweets, cold air, hot drinks, cold drinks or ice cream. Some people with sensitive teeth even experience discomfort from brushing and flossing. The good news is that sensitive teeth can be treated.

Sensitive teeth can also be a sign of a cracked tooth or a tooth abscess, which needs to be treated by your dentist to prevent losing a tooth or getting an infection in your jaw bone. If you suddenly develop tooth sensitivity, make an appointment with your dentist to see if there is a source that needs to be treated.

8. Toothaches and Dental Emergencies

While many toothaches and dental emergencies can be easily avoided just by regular visits to the dentist, accidents can and do happen. Having a dental emergency can be very painful and scary. Common problems that require an urgent trip to your dentist include a broken or cracked tooth, an abscessed tooth, or a tooth knocked out in an accident.

Go to a hospital for trauma care if you have a fractured or dislocated jaw or severe cuts to your tongue, lips, or mouth. If you have a tooth abscess that is causing difficulty swallowing or you have developed a fever or facial swelling, get emergency care as well.

9
Unattractive Smile

While an unattractive smile is not technically a “dental problem,” it is a major reason why many patients seek dental treatment.

An unattractive smile can really lower a person’s self-esteem. Luckily, with today’s technologies and developments, anyone can have a beautiful smile. Whether it’s teeth whiteningdental implants, orthodontics or other cosmetic dental work, chances are that your dentist can give you the smile of your dreams.

 

Source: https://www.verywellhealth.com/top-common-dental-problems-1059461

Ibuprofen And Acetaminophen Together May Give Profound Pain Relief With Fewer Side Effects After Dental Surgery

By: Colgate

 

👍🏻 A study conducted by dental experts shows that combining Ibuprofen and Acetaminophen together provides a pain-relief after a wisdom tooth removal. Learn more about their findings! The Oral Surgery DC Team

 

Taking ibuprofen and acetaminophen (APAP) together can help manage pain after dental surgery without significantly increasing the side effects that often are associated with other drug combinations, according to an article in the August issue of The Journal of the American Dental Association.

Taking combinations of drugs to manage pain after oral surgery has been advocated in the last few years as a substitute for taking over-the-counter drugs—such as ibuprofen, naproxen and APAP—by themselves because the drug combinations can provide greater pain relief. The most common combination is APAP and an opioid—a prescription drug. The ibuprofen-APAP combination has been suggested as an alternative to taking opioid-APAP combinations to help patients avoid the potential adverse reactions associated with opioids.

Drs. Paul A. Moore, chair of the Department of Dental Anesthesiology, School of Dental Medicine, University of Pittsburgh, and Elliot V. Hersh, professor of pharmacology, Department of Oral Surgery and Pharmacology, School of Dental Medicine, University of Pennsylvania, evaluated the scientific evidence for using the ibuprofen-APAP combination to manage pain in patients after they had their wisdom teeth (third molars) removed.

They found that the ibuprofen-APAP combination may provide more effective pain relief and have fewer side effects than many of the opioid-containing combinations. They also found evidence indicating that the ibuprofen-APAP combination provided greater pain relief than did ibuprofen or APAP alone. The adverse effects associated with taking the ibuprofen-APAP combination were similar to those of the individual component drugs.

“The demonstrated improvement in postoperative pain relief for the combination of ibuprofen and APAP provides another strategy for pain management, and an alternative to prescription opioid formulations after third-molar extraction surgery,” stated Drs. Moore and Hersh in their article.

© 2018 American Dental Association. All rights reserved. Reproduction or republication is strictly prohibited without the prior written permission from the American Dental Association.

 

Source: https://www.colgate.com/en-us/oral-health/procedures/tooth-removal/ada-08-ibuprofen-and-acetaminophen-together-may-give-profound-pain-relief-with-fewer-side-effects-after-dental-surgery

Soda After Wisdom Teeth Removal

By: Brynne Chandler, Livestrong

 

😷 Diarrhea may occur after the wisdom tooth extraction, however, this is preventable. Check out these foods recommended to manage this condition. The Oral Surgery DC Team

 

Wisdom teeth, which are also called third molars, generally grow in at the very back of your mouth when you are between the ages of 15 and 25. According to the researchers at the University of Maryland Medical Center, most peoples’ mouths are too small to fit four extra teeth. This can cause crowding, pain, infection, and swelling, leading most dentists to extract wisdom teeth. Wisdom tooth extraction is minor surgery, and requires careful aftercare for proper healing. Drinking carbonated soda just after having your wisdom teeth pulled can lead to problems.

Soda

The first carbonated sodas were made from naturally carbonated water. In 1772, British scientist Joseph Priestly dripped sulfuric acid onto chalk. The result was carbon dioxide, which makes the bubbles in your soda. Most sodas also contain large amounts of sugar, which can lead to tooth decay, and sodium, which is very drying to the tissues inside of your mouth.

Extraction

Wisdom tooth extraction is usually performed under a general anesthetic, though many dentists and oral surgeons offer conscious sedation. This means that you can’t feel anything, but are still awake. Wisdom teeth that have already erupted through your gums are pulled out with dental pliers, while extracting them before they erupt may involve cutting open your gum tissue to free the tooth. Either way, the entire tooth is removed, leaving an empty socket.

Aftercare

The University of Oregon Health Center advises that you keep a gentle pressure on the gauze that will be packed into your tooth socket to control bleeding so that the socket can form a clot. Avoid brushing your teeth or rinsing your mouth out for at least 24 hours after the extraction, and avoid very hot or cold drinks–including sodas–and solid foods. The Consumer Guide to Dentistry recommends that you avoid soft drinks, because the bubbles caused by the carbonation can dislodge the blood clot that needs to form in order for the tooth socket to heal.

Misconceptions

Drinking through a straw may seem like a good idea after tooth extraction, but the suction needed to draw the liquid up through the straw can dislodge blood clots. Drinking soda through a straw will also not reduce the amount of bubbles, or keep them away from the extraction sites.

Warning

Dislodging a blood clot before it forms completely causes alveolar osteitis, or dry socket. The absence of the blood clot before the bone and gum tissue has a chance to heal and replace it exposes your bone to the air, and to anything that you put into your mouth. The pain this causes is too severe to be treated with over-the-counter pain relievers and requires medical attention from your doctor or oral surgeon.

Source: https://www.livestrong.com/article/300789-diet-after-the-removal-of-wisdom-teeth/