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Sacramento, CA 95815
(916) 929-3898
(917) 646-6315 fax


900 E. Bidwell St. #400
Folsom, CA 95630
(916) 983-6655
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By Drs. Jeff DiMariano & Shaina DiMariano
October 23, 2014
Category: Oral Health
Tags: osteoporosis  
CertainDrugsTakenforOsteoporosisCouldAffectDentalCareOutcomes

If you have osteoporosis, one of the drugs you may be taking is alendronate, more commonly known by the brand name Fosamax®. Alendronate is a member of the bisphosphonate drug family, which inhibit bone resorption (the loss of bone mass). While an effective treatment of osteoporosis, alendronate may cause an opposite side effect in other areas of the body, the inhibition of new bone growth. This effect on the jaw in particular could result in an adverse reaction after dental surgery.

The main concern is a condition called osteonecrosis, or literally “bone death.” Bone tissue normally goes through a cycle of resorption (the dissolving of bone tissue) and new growth to replace the cells that have been lost through resorption. Osteonecrosis disrupts the growth phase so that the bone doesn’t recover properly after resorption. This results in the bone becoming weaker and less dense.

There have been a number of cases of increased osteonecrosis in patients on alendronate after experiencing trauma to the mouth. This includes dental surgery, particularly tooth extractions. In addition, patients with certain risk factors like diabetes, tobacco use or corticosteroid therapy appear more vulnerable to osteonecrosis.

Although the risk of osteonecrosis after dental surgery is small, many dentists recommend stopping the use of alendronate for three months before the procedure if you’ve been taking the drug for more than three years. This recommendation is based on a number of studies that seem to indicate three or more years of bisphosphonates therapy makes patients especially vulnerable to osteonecrosis. These studies also indicate stopping the therapy for three months significantly reduces the risk of developing the condition.

There’s still much to be learned about this link between alendronate therapy and dental health. It’s a good idea, then, to let us know what medications you’re taking (especially bisphosphonates) whenever you visit us for an exam. Knowing all your medications will help us develop the safest and most effective treatment plan for your dental care.

If you would like more information on bisphosphonates and their effect on oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Fosamax and Surgery.”

By Drs. Jeff DiMariano & Shaina DiMariano
October 15, 2014
Category: Oral Health
Tags: gum disease  
OtherFactorsBesidesHygieneCouldContributetoGumDisease

Periodontal (gum) disease is an infectious condition that if left untreated could lead to tooth loss. While gum disease is primarily caused by a thin layer of bacterial plaque and calculus left on the teeth due to poor hygiene, you may also have extenuating factors that may make you more susceptible to the disease.

Gum disease is actually a group of infectious diseases in which some forms are more difficult to control than others. All these forms arise from interactions between the bacteria in the dental plaque and your body’s immune system. Depending on both your body’s individual response and the disease form, your resistance to the resulting bacterial infection may be low.

That low resistance to certain strains of bacteria may be genetic — something you’ve inherited from your parents. Your stress level, particularly when it’s high, can also diminish your body’s ability to resist disease. There are also numerous strains of bacteria that could lead to gum disease — your body may not be able to effectively resist the particular “mix” of strains contained in your dental plaque.

Aside from lifestyle issues like stress or oral hygiene, we can at least test and verify any susceptibility you may have due to uncontrollable factors like genetics or the particular bacterial makeup within your plaque. Unfortunately, a minority of people will continue to deal with gum disease even after treatment and adopting a more effective hygiene regimen. Although we can’t cure the disease, we can certainly control it with regular monitoring and treatment when necessary.

The key is to adopt a long-term strategy that will seek to preserve the teeth for as long as possible. In some cases, the best treatment approach is to prolong the life of the affected teeth for as long as possible to give you time to prepare emotionally and financially for eventual tooth replacement.

Indeed, any patient experiencing some form of gum disease should seek professional treatment, followed by a daily oral hygiene program and regular checkups and office cleanings. Taking the right steps in consultation with your dentist will assure you’ll preserve your teeth for as long as possible.

If you would like more information on treatment for periodontal disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Periodontal (Gum) Treatment and Expectations.”

By Drs. Jeff DiMariano & Shaina DiMariano
October 07, 2014
Category: Dental Procedures
Tags: root canal  
SettingtheRecordStraightonRootCanalTreatments

If there was an “Unsung Hero” award for dental procedures, the root canal treatment would win hands-down. Much aligned in popular culture, today’s root canal treatment is actually a valuable tool for saving teeth that would otherwise be lost. And contrary to popular belief, root canal treatments don’t cause pain — they relieve it.

To help you understand its true worth, here are some common questions and answers about the root canal treatment.

What problem does a root canal treatment fix?
A root canal treatment stops a bacterial infection that has invaded the innermost part of a tooth — the pulp — and is advancing toward the end of the root through small passageways known as root canals. Most people first notice the problem as a sharp pain in the affected tooth that may suddenly dissipate in a few days. The infection has attacked the inner pulp tissue, rich in nerve fibers; when the nerve fibers die they stop sending pain signals. The infection, however, hasn’t died: as it advances, you may then begin to experience pain when you bite down or when you encounter hot foods. You may also notice tenderness and swelling in nearby gums.

How does the procedure stop the infection?
A root canal treatment removes all the infected or dead tissue and cleanses the pulp chamber. We enter the pulp chamber through a small access hole created in the tooth’s biting surface. After tissue removal, we then “shape” and prepare the empty chamber and root canals (often with the aid of microscopic equipment) to be filled with a special filling. After filling, the tooth is then sealed to prevent re-infection (most often, we need to install a permanent crown at a subsequent visit for maximum protection).

How much pain can I expect during and after the procedure?
During the procedure, none — the tooth and surrounding gums are fully anesthetized before we begin the procedure. Afterward, you may experience mild discomfort for a few days that can be relieved with over-the-counter medications like aspirin or ibuprofen.

What’s the ultimate value for a root canal treatment?
The procedure can save a tooth severely damaged by the infection. Even covered by an artificial crown, a living tooth continuing to exist and function normally within the mouth is usually more conducive for optimum oral health than an artificial tooth replacement.

If you would like more information on root canal treatments, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Common Concerns About Root Canal Treatment.”

By Drs. Jeff DiMariano & Shaina DiMariano
September 29, 2014
Category: Dental Procedures
ChippedTeethHarmoniouslyMadeGoodasNew

“Break a leg” is a well-known theatrical expression for wishing good luck to an actor about to go on stage. Singers should have one of their own…“Chip a tooth”! Apparently collisions between microphones and pearly whites are an occupational hazard for crooners. Taylor Swift became one of the latest casualties during a concert in Pittsburgh while belting out her hit “I Knew You Were Trouble.” The consummate professional, she didn’t miss a beat and kept on singing despite seeing a tooth chip hit the floor.

After all, while chipping a tooth is an inconvenience, it’s not a permanent smile wrecker. Modern dentistry offers several options for restoring a damaged tooth to its original symmetry and luster, or even better!

Bonding
Dental cosmetic bonding is the quickest and lowest-cost option to repair a chip. This involves application of a composite filling material that is colored and shaped to match the original tooth. Bonding material can be used to replace the lost portion of tooth or to seamlessly reattach the lost portion if it has been preserved and is otherwise undamaged. Little to no removal of existing tooth surface is needed.

Veneers
A veneer can be used for slightly larger areas or discolored teeth. This is a thin, custom-made shell placed on the front of the tooth to give it a new “face.” Some removal of existing tooth surface may be necessary to fit a veneer so it is flush with the surfaces of surrounding intact teeth.

Crowns
When a relatively large portion of the tooth is missing, a crown is often the better choice. It fully encases the visible portion of the remaining tooth above the gum line and is shaped and sized to match the original. It can be made of tooth-colored porcelain fused to metal crowns or all-ceramic (optimal for highly visible areas). A small amount of the existing tooth surface will be removed to allow the crown to fit over it.

If you would like more information about repairing a chipped tooth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Artistic Repair of Front Teeth With Composite Resin.”

By Drs. Jeff DiMariano & Shaina DiMariano
September 26, 2014
Category: Dental Procedures
Tags: dental implants  
FrequentlyAskedQuestionsaboutFixedDentures

Q: Is there much of a difference between fixed and removable dentures?
A: There’s a BIG difference! Removable dentures are the type your grandparents might have had — and possibly their grandparents, too. They work well enough after you get used to them, but there’s always the issue of slippage, poor fit, limited function… and potential embarrassment. Modern fixed dentures, however, get their stability from today’s state-of-the-art system for tooth replacement: dental implants. They won’t loosen or slip, they function and “feel” like your own natural teeth, and they can last for years and years to come.

Q: How are fixed dentures supported?
A: Each arch (set of teeth comprising the top or bottom jaw) of a fixed denture is anchored into the jaw bone by four or more dental implants. These small screw-like devices, made of titanium metal, are placed into the jawbone in a minor surgical procedure. Once set in place, they remain permanently attached by both mechanical forces and osseointegration — the process in which living bone cells actually become fused with the metal implants themselves.

Q: What is the procedure for getting dental implants like?
A: Before having any work done, you will receive a thorough examination and have a set of diagnostic images made. Implant surgery is normally performed in the dental office, using local anesthesia or conscious sedation. If any failing teeth must be extracted (removed), that will be done first. Next, small openings are made in the gums and the jawbone, and the implants are placed in precise locations. Sometimes, a set of temporary teeth can be attached to the implants immediately; other times, the implants will be allowed to heal for a period of time.

Q: Besides added stability, are there other advantages to fixed dentures?
A: Yes! As they become integrated in the jaw, dental implants actually help preserve the quantity and quality of bone in the jaw; removable dentures, on the other hand, decrease bone quantity and quality. This is important because the jawbone plays a vital role in supporting facial features like lips and cheeks. When the facial features lose support, it can make a person look prematurely aged. Also, people who wear removable dentures often have trouble eating “challenging” foods like raw fruits and vegetables (which are highly nutritious), and opt for softer, more processed (and less nutritious) foods. With fixed dentures, however, you can eat the foods you like.

Q: Aren't fixed dentures with dental implants more expensive?
A: Initially, the answer is yes — but in the long run, they may not be. Unlike removable dentures, which inevitably need to be re-lined or remade as the jawbone shrinks, fixed dentures can last for the rest of your life. They don’t require adhesives or creams, and you will never have to take them out at night and clean them. In fact, you can think of them as a long-term investment in yourself that pays off with a better quality of life!

If you’d like more information on fixed dentures, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine article “Dental Implants: Your Best Option for Replacing Missing Teeth.”





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