Some months ago, I was at one of my most favorite places in the world.  It’s not tropical or touristy, It’s certainly not even elegant. It’s my dad’s “ranch”. I use the term loosely because the only cattle that are on it are the ones that come through the holes in the fences.

“Geezer Ranch”, as I affectionately have termed it, is peace. It’s calm. It’s a hideaway I’ve gone to since I was 5. There isn’t a tree on the 120 acres that I haven’t walked under and I’ve climbed all the big ones. It’s a place of reflection.

One evening I was laying on top of my truck contemplating the pinholes in the sky. Other people call them stars of course. But to me they became pinholes. Stars with other solar systems. The point being that the little spot of light stood for much more but just about everyone gos through life and pays them no attention. Oh they look at the stars but do they stop to think about what lies within?

I lay there and as I thought about it, I decided to change a basic aspect of myself. I swore that I would scan less and pay more attention to the details. Pay attention to what lays behind the pinholes that most people gloss over.

When Michelangelo was painting the Sistine chapel he painted while laying on his back for years. And while painting he could only focus on a small aspect of the larger whole. In doing so created one of the most beautiful works of  art ever wrought.

How many details had I missed? What lay beyond the pinholes? How many opportunities did I miss out on, Because  I wasn’t  focused on a deeper level?

Opportunity.

A chance.

How many questions get asked in a day? How many yes? how many no?

One answer the wrong or right  way and the whole timeline after that is affected. One wrong answer and an amazing opportunity could be lost forever.

Small decisions making large impacts.

Pinholes.

Opportunity. I’d better say yes at the right time. I’d better be more aware.

One Amazing Star among billions. If you don’t check the pinholes how do you find them?

Can the impossible be found?

When making choices, pay attention to what you can’t see. Look at the glimpses. Look behind the curtain. The glimmer on the edge meant something. And by all means, look beyond the pinholes. There just might be a wonder beyond the brilliance.

CLEBURNE DENTAL CARE

Sid Davis, DDS

These instructions are for my patients, under my care. If you have randomly found these on the net then always consult with your doctor when have problems.

Some of the instructions you can intuitively apply to other pain management issues.

The purpose of home care instructions is to do 3 things.

1)      Control Bleeding.

2)      Minimize Pain.

3)      Prevent a Dry Socket.

It’s very simple to control bleeding. Simply bite on some gauze. Changing it every 10 minutes or so. If at 5 minutes the gauze is soaked dark red with blood, you need to call us. Some tricks to try if it seems like it’s taking its sweet time to clot. Soak the gauze in some ice water or instead of gauze use a tea bag soaked in ice water. (tannic acid in tea helps constrict the blood vessels.)

In any event, always better to call when in doubt about bleeding issues.

I always recommend the first night or two to put an old towel or pillowcase on the pillow while sleeping. If you drool a little bit this will save a good pillowcase.

For pain control:

Take some kind of pain pill before the anesthetic wears off. Don’t wait to “see how it feels.” It’s always easier to keep it from hurting than to wait until it hurts and bring it back down to a comfortable level.

If you have a low pain tolerance or aren’t sure, take the prescribed narcotic medication and follow the directions. That’s what it is for. If you are one of those that stuff hardly ever bothers, then as long as you don’t have any stomach issues, ibuprofen is a great medication.

Some notes on Ibuprofen. (IB)

For the average healthy, adult patient the following applies. Ask if you aren’t sure about you personally. If elderly or on a lot of medicines this may not apply as well.

OTC Ibuprofen dosage rules:

Most OTC Ibuprofen is packaged as a 200mg pill/capsule. Read the bottle.

Maximum safe dosage rules are no more than 800mg in one dose and no more than 2400mg in a 24 hour period.

2IB=400mg= 4 hour intervals minimum.

3IB=600mg= 6 hour intervals minimum. <==My personal favorite when only taking IB.

4IB=800mg= 8 hour interval minimum.

For most people I consider 800mg at one dose to be overkill. It just tends to irritate the stomach more than is worth it. I like the flexibility of 2 or 3 at a time much better.

Another thing to do is if having more than the normal amount of pain is to stagger the narcotic with IB. This assumes the narcotic doesn’t already have IB in it. (the ones I prescribe almost never do. I would tell you if it did.) By staggering it instead of taking everything at once you always have something fresh working for you.

Most important thing to do for pain management:

During the first 24 hours Ice the injured area as directed below. After an injury your body sends chemicals to it called pain mediators. These chemicals make it hurt more. The ice slows those chemicals down and thus minimizes the discomfort. Standard icing rules are: 20-30 minutes on the area. 20-30 minutes off. If you don’t have an ice pack a Ziploc bag with Ice works fine.

Standard question: What can I eat?

Standard answer: If it hurts, don’t eat it… J

Prevention of dry socket:

It’s been over 10 years since I’ve had a patient have a dry socket from an extraction. I don’t even remember the last time. Follow my rules and your odds of getting one are about as low as you can get.

First, what is a dry socket? Short answer is a dry socket is what occurs when the blood clot in the socket is lost. This exposes the bone to air. And air and bone do not mix well. People who have had one have said it was the worst pain they ever had. Don’t tempt the Fates. Follow my rules. Minimize your risk.

All my rules for dry socket prevention are 24 hour rules. You must wait 24 hours to do any of the following:

1)      No vigorous rinsing i.e. swishing. (washes out the clot)

2)      No using straws. (sucks out the clot)

3)      No tobacco products!!!!!! <==number one no no. it inhibits the bond of the clot to the bone.

4)      Don’t use the irrigation syringe for 24 hours. (washes out the clot)

5)      No carbonated beverages. (bubbles loosen the clot)

After 24 hours, you can rinse the socket out with salt water. Proper concentration is 1 tsp of salt in a cup (8oz) of water. By all means gently use the supplied irrigation syringe for at least a week post op. This will keep the socket clean and lower the chance for infection.

Do not use alcohol based mouthwashes after an extraction.

Final note: Be aware of your own health. Be cognizant of how it feels. Severe pain is not normal. Swollen and/or tender lymph nodes under the jaw line are indicative of an infection. Always call me/your doctor should there be any doubts or concerns post op.

Ask a dentist what they enjoy doing the most and inevitably most of us will say Cosmetics. The reasons are many but I can tell you the main reason isn’t money. It’s the fulfillment that we get via expressed appreciation from our patients.  The thank yous. The hugs. The tears. That first smile. The moment they realize that they no longer have to hide their teeth with their hands. No longer have to turn their head or tighten their lips  as they talk. As I list the reasons specific cases come to mind and it always moves me to tears. That’s fulfillment. As dentists and humans we live for that. We strive for that. It makes everything worthwhile.

The departure from the standard blog occurs here. The rest doesn’t involve dentistry but life.

There are people in all our lives who need to hear thank you more often than they do. I’m as guilty as anyone of being appreciative of many things people do, but not expressing it. We all just assume that people know.

My request for anyone and everyone who reads this is to look at who is close to them in their lives. Look at what they do for you. Look at what they did for you. Spouses, children, parents, friends, people you work with, neighbors. Tell them thank you. If you’re really ambitious throw in a heartfelt hug.  A hug means just as much as the thank you.

If you  read this and feel unappreciated  then this blog was all for you.  I guarantee that somewhere there is someone that does appreciate what you do.

This is for anyone and everyone.  If you’re feeling down come by my office and request  a free hug and a thank you. I will happily acquiesce.
Much love to everyone in my life,
Sid

There are basically two schools of thought among dentists when it comes to this subject.

One group leans more towards: “Wait until they cause a problem.”

The other group of dentists is more on the side of “Almost always get them removed. (The earlier the better.”)

Where do I stand personally?

I’m in the second group. I explain my philosophy on 3^rd molars (wisdom teeth) several times a week to patients and/or their parents.

Here are my reasons for almost always recommending extraction.

They almost always will eventually cause some kind of problem. It’s just a matter of time.

The problems that wisdom teeth cause almost always affect other teeth. If the problems they caused where limited to just themselves then I’d be more likely to lean towards the other camp.

But many problems that occur involve the neighboring teeth.

Some examples:

Crowding of lower anterior teeth.

Decay on the distal (back) side of the 2^nd molar.  This is usually below the enamel and often results in Root canals or even extraction of the 2^nd molar as well. I have an album of xrays that demonstrates this. It’s totally preventable. Anyone that wishes to see them can ask.

Soft Tissue infections around wisdom teeth that are partially erupted. The gums are loose around the tooth and the tooth can’t come in all the way. It’s a matter of time for the infection to hit. Also usually will get decay up underneath the flap of gum tissue.

Even when there is room for the wisdom teeth to come in probably 95% of the time the patient can’t keep them clean. They are simply too far back. There isn’t the room around the tooth to clean it properly.

Also another reason to get them out early: The younger you are the easier it is on the body to remove these teeth and the faster you heal. Ask any 40 year old if something heals on them as fast as it did when they were 18. It’s no different from a dental extraction. Plus the roots aren’t usually fully formed yet so there is less resistance and the bone is a bit easier to manipulate.

The exact age varies from patient to patient as to when I recommend extraction of their 3^rd molars. 15-18 is the most common age range however.

A Panoramic radiograph is a quick easy way to evaluate wisdom teeth. Who knows? Maybe you are one of the lucky ones that is missing a few (or all) of them congenitally.

(how to save money on dentistry)

Bad Gallon of Milk analogy

If you go to the ‘fridge and get out the milk and open the top and this horrendous odor comes out you immediately know you have bad milk. If you put the top back on and put the milk back inside the ‘fridge and wait 6 months. Do you think that the milk got better or worse?

Some years ago I came up with this analogy. To me it best illustrates the most frustrating thing about being a dentist.

Dentists are just like any other professional that gives advice. We feel better about ourselves and our patients when they listen to what we have to say. And then take the appropriate action.

Almost daily we will get a phone call or someone will show up in pain. When I pull up the records and read the history it is quite often a tooth that has already been diagnosed as having a problem and needing to be fixed. Many times it’s even caused pain before.

So we have a patient that has an infection/abscess. It’s hurt them before. We’ve treated the infection. Tooth stops hurting. Patient doesn’t fix tooth. A month, 6 months or maybe longer goes by. Tooth starts hurting again. (Usually worse). Now we have another emergent situation. The situation has escalated when we know it didn’t have to.

Certainly in many cases fixing toothaches can be costly. However, the longer you wait the more expensive it will be.

The Tree:

You need a filling- $100-$200. It doesn’t get done. Tooth breaks maybe.

You need a crown- $800-$1000. It doesn’t get done. It starts to hurt.

You need a root canal $600-$1500 and also the crown $800-$1000. It doesn’t get done… It hurts again. It hurts again. It hurts again… etc etc.

At this point it either gets fixed as above or it gets extracted. $120-$200. (cheaper to extract it seems.. but is it really??? If we want to replace it we’re going to need to do…

A fixed bridge $2300-$3000 or an implant with a crown $3000-$3500.

Or we elect to do nothing. The space remains empty. And the cycle of missing teeth starts. Teeth shift. Decay happens elsewhere. Spiraling eventually to the point where partial or full dentures are the only options.

Over time what do full dentures cost? Ignoring wisdom teeth we have 28 other teeth. If someone ends up in full/full all those teeth will have been extracted or will be. 28x $150 =$4200. Dentures top and bottom= $2000-$3500. So that’s probably somewhere between $6000-$8000 if you end up with dentures. But here’s the real kick in the pants. Those dentures aren’t anchored in bone like teeth. Dentures just rest on the tissue. Chewing efficiency with dentures is at the absolute best 30% of what people with teeth or implants anchored in bone can do.

Moral of the story: If you want to save money. Do the maintenance. See the hygienist routinely. Get the exams done routinely.

Cleburne Dental Care

Sid Davis, DDS

Devi Jones, RDH

www.cleburnedental.com

Facebook: http://www.facebook.com/cleburnedental

Twitter: http://twitter.com/cleburnedental

Cleburne Dental Care- 817-641-9866

www.cleburnedental.com

Facebook: http://www.facebook.com/cleburnedental

Twitter: http://twitter.com/cleburnedental

Sid Davis, DDS

Devi Jones, RDH

First this isn’t a cutting procedure the Laser is used in a non cutting mode that merely bathes the lesion with photonic Laser energy. There is virtually zero discomfort during or following laser treatment of cold sores or apthous ulcers. For cold sores it destroys the virus responsible for the sore. For ulcers it dries them out and deadens nerve endings and for both it speeds up healing. There is no injection of anesthesia. It’s simply not needed.

The only sensation you might feel as we treat these lesions is a warm feeling as the laser works.

Cold sores (oral herpetic lesions) can be uncomfortable, unaesthetic, and inconvenient. They generally break out in response to trauma, or whenever physical or psychological stress levels spike.

Once you experience the tell-tale tingling sensation, it’s only a matter of time before a full-blown sore appears. Then healing can take as long as two weeks, and quality of life may be significantly compromised. Therefore, it is critical to begin laser treatment before the sore has a chance to develop.

Catch it in time with laser treatment, and the cold sore will not break out.

Apthous Ulcers- Laser treatment is very effective on apthous ulcers for the same reasons. The stinging sensation is eliminated in seconds and healing is rapid and uneventful. \

Benefits of laser treatment on cold sores and mouth ulcers can be summed up as follows.

• It is high tech and yet is surprisingly affordable and is insurance reimbursable in certain situations.
• Photonic Laser energy destroys the virus responsible for cold sores.
• Most of out patients who are treated when the lip starts tingling/burning never develop a sore.
• Profound pain relief is immediate.
• If the sore has already broken out, it will progress no further after treatment.
• The lip or ulcerated area will return to normal in a matter of days instead of weeks.
• Not only will the area go back to normal more quickly but it will remain comfortable during the healing process.
• Each laser treatment takes just a few minutes.
• The laser’s light  energy promotes healing through gentle photo-biostimulation deep within the lip.
• After treatment sores occur with less frequency and less intensity at the same location.
• Remember virtually zero discomfort during or following laser treatment of these lesions.

The laser works by doing the following:

• 1. Destroying virus particles.
  2. Drying out the lesion.
  3. Pain relief occurs from deadening the raw nerve endings.
  4. Healing is promoted through biostimulation which results in increased collagen formation.

We are constantly learning and striving to advance the standard of patient care in our office. As such we have added a new procedure to our patients routine cleaning to help fight Periodontal (gum) Disease.

We have implemented this for the last 6 months or so and have had amazing results. I’ve been practicing dentistry for 17 years and nothing has excited me more in the field of dentistry than soft tissue laser and most importantly this particular application of the laser.

Periodontal disease is the result of a chronic infection in the mouth and never before have we had a great way to kill bacteria. We’ve always treated Periodontal disease after we see it and dentistry has never been all that great about preventing it.

To sum it up by simply circling the teeth with the laser in a non-cutting mode we are able to “kill off” the bacteria. As an example in a periodontal pocket there are billions of bacteria. This is around just one diseased tooth. The application of the laser will take the counts from the billions down to the hundreds. This is a 99.99999% reduction in bacteria counts.

The procedure lasts about 5-7 minutes and so far our patients have raved about it. This is not a substitute for anything that we’ve done before but an additional procedure that we offer and provide to better your care.

Periodontal Disease affects approximately 80% of adults and is a growing epidemic in our society. Understanding of this disease has increased greatly over the last few years. We now know that this disease is a bacterial infection in the pockets around the teeth. As such, we now not only treat Perio with removal of mechanical irritants and diseased tissue but are also addressing the underlying infection that causes it. With that in mind we recommend that all of our patients have their teeth decontaminated prior to cleaning appointments for 3 reasons.

1)      To reduce or eliminate bacteremias. During the normal cleaning process most patients will have some areas that may bleed, this allows bacteria that are present in all our mouths to flood into the bloodstream and sometimes settle in weakened areas of our body such as a damaged heart valve or artificial knee or hip, etc. Latest research has shown that these oral pathogens  have now been linked to a number of other diseases such as cardiovascular disease, rheumatoid arthritis, low birth weight babies, diabetes etc. Needless to say anything that we can do to reduce or eliminate these bacteremias is a positive for our patients.

2)      To prevent cross contamination of infection in one area of your mouth to other areas. Decontamination minimizes the chance that we may inadvertently pick up bacterial infection in one area of your mouth and move it to others.

3)      To kill Periodontal Disease Bacteria and stop their infections before they cause physical destruction or loss of attachment around your teeth.

The laser decontamination process is painless and normally takes 5-10 minutes.

Laser decontamination is $30 and is NOT covered by insurance. Unfortunately, insurance coverage is almost always behind the leading edge in high tech healthcare.

If you want to be more proactive instead of reactive to the prevention of Periodontal Disease then please call us at 817-641-9866 to schedule an appointment or to ask us any questions.

The above is just one application of our lasers. More blogs will be posted on the many ways that lasers have improved the quality of dentistry that we are able to provide our patients.

Cleburne Dental Care

Sid Davis, DDS

Devi Jones, RDH

www.cleburnedental.com

Facebook: http://www.facebook.com/cleburnedental

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