Q: Are all implants successful?

A: No, but the vast majority are. The over-all success rate for dental implants is well over 90%. Some dental implants have been "in service" for over 30 years and are still functioning well. How long a dental implant will last is dependent on several factors, including the health and habits of the patient, skill of the surgeon, skill of the restorative dentist, skill of the dental lab, and ability of the patient to maintain scrupulous oral hygiene.

Q: Do implants come with any kind of guarantee or warranty?

A: No, there is no way that we can guarantee anything which is implanted in the body and then is under the control of the individual patient. We can guarantee you that we will do our best to place and to restore the implant properly, give you the information you need to care for the implant, and will be available for periodic follow-up. The success of any implant is directly related to the commitment of 4 people-- the surgeon, the restorative dentist, the dental lab tech, and (perhaps most importantly) the patient.

Q: Are implants expensive?

A: This is a relative term. What is perceived to be expensive to one person may seem to be a bargain to someone else. Implant cases involving complex surgical and restorative procedures can require a significant investment. However, the vast majority of our implant patients are very satisfied with their results and feel that they spent their money wisely.

Q: Will my insurance cover dental implants?

A: This depends on the policy you or your employee purchased. Some do, and some don't.

Q: What does TMJ mean?

A: TMJ is simply an abbreviation for the temporomandibular joint, which is the joint between the lower jaw (mandible) and the skull. In other words the TMJ is the jaw joint. Everyone has 2 TMJ's-- 1 on each side. When a patient says "I have TMJ" what they really mean is that they have problems with their jaw joint(s). You might hear someone say "I have TMD". TMD is the abbreviation for temporomandibular joint disease, and is technically a more correct description of the conditions affecting the jaw joints.

Q: What are the main types of TMD?

A: There are 3 main conditions that can affect the TMJ and result in conditions of pain and/or dysfunction. They are degenerative joint disease (DJD, or osteoarthritis); disorders of the jaw muscles, termed myofacial pain dysfunction (MPD); and a breakdown of the internal structures of the jaw joint, which is termed internal derangement (ID). The symptoms of all 3 conditions can be similar (pain, locking of the jaw, abnormal joint noises, malocclusion, etc.), and the conditions themselves can overlap in the same patient. Confused yet? Let's continue and see if we can clarify things a little.

Q: How do you treat the various types of TMD?

A: Sort of like porcupines make love-- carefully! We don't treat a DJD patient the same way we treat an MPD patient or a patient with internal derangement of the TMJ because the conditions causing the symptoms are different even if the symptoms are similar. Here is a breakdown of the 3 conditions, their symptoms, and their treatment.

Remember, the conditions may overlap and the symptoms may be similar:

As you can see, it is very important to differentiate the various types of TMD before initiating therapy. A thorough history, a physical exam, and various types of radiographs and scans help us make the correct diagnosis. Many cases of TMD can be satisfactorily treated without surgery. However, if conservative therapy fails or is hopeless, surgery may be indicated.

Q: Why is surgery sometimes needed in cases of TMD?

A: Because surgery sometimes provides the best hope for relief of pain and dysfunction associated with TMD. For example, in cases of severe and advanced degenerative joint disease in which the ball and socket and other joint structures are basically destroyed by the disease process, the bony structures can be reconstructed with prosthetic components to alleviate pain and restore function. In cases of internal derangement, the cartilage of the joint (also called the disc or meniscus) is frequently the source of the problem(s). You have probably heard of someone having a "slipped disc" in their back-- the same thing can happen in the TMJ. The disc of any joint is simply the cushion or the shock absorber that separates the bony structures and dissipates force during function of the joint. In the TMJ, the disc separates the ball and socket. The disc must move smoothly within the joint for the joint to function smoothly and in a pain-free manner. If the disc is displaced, the patient will frequently experience pain and either popping or locking of the joint. The pain may be confined to the joint area, or may be referred to the jaw, the ear, the eye, and the head. In these cases, surgical correction of the disc abnormalities (termed an "arthroplasty") frequently offers the most effective treatment modality.

Q: What can I expect if my surgeon recommends TMJ surgery? Is there any kind of guarantee that my joint problems will be cured?

A: TMJ surgery is performed in the hospital operating room, and the patient usually spends the night in the hospital and is discharged the following morning. Patients are quickly started on physical therapy to maximize function and minimize scarring within the joint. Patients are kept on a very soft diet for 6-8 weeks post-op. There is no guarantee that all your joint problems will be completely eliminated, but in most cases patients notice a significant improvement in the symptoms and in many cases they are "cured". I tell my TMJ surgery patients that the goal of this type surgery is to reduce pain and increase function. I do not tell them that the goal is to eliminate pain completely, but in reality this is frequently the case.

Q: My TMJ pops sometimes, but I don't have any other symptoms. What does this mean? Do I have to have it treated?

A: It probably means you're getting old. You don't have to have it treated. If someone tells you that you must treat an otherwise asymptomatic popping joint, run -- do not walk -- away.

Q: What are wisdom teeth?

A: A lot of trouble (in most cases)! Wisdom teeth are the 3rd and final set of molar teeth. They are the last teeth to form and to erupt, and are located in the very back part of the jaws.

Q: Why do they cause problems? Do they always cause problems? Do they always need to be removed?

A: The most common reason that they cause problems is that many people simply don't have room for all the teeth, and since the wisdom teeth are the last ones to form the other teeth have taken up all the available room in the jaws. They don't always cause problems, and if they are able to erupt into a normal position and normal occlusion AND if the patient is able to keep them clean they may not need to be removed.

Q: What kind of problems can they cause?

A: If they are blocked from normal eruption they can become impacted (trapped) in the jaw in abnormal positions. They may grow sideways or even backwards, and may damage the adjacent teeth, the bone, nerves, or gum tissue. If they apply enough pressure on the adjacent teeth the patient may develop crowding of the other teeth. If the wisdom tooth only comes in partially, it may become infected. Occasionally cysts or tumors may form around impacted wisdom teeth.

Q: When should wisdom teeth be removed?

A: Many oral surgeons feel that wisdom teeth should be removed between the ages of 1 5 and 20, before the roots have a chance to form completely and before the bone of the jaws becomes too dense. Fewer complications are encountered if the wisdom teeth are removed sooner rather than later, and if they are removed before they have caused damage, become infected, or form cysts.

Q: Are there any risks or complications associated with removal of wisdom teeth?

A: Yes, although the complication rate is low. All surgical procedures can be followed by bleeding, infection, discomfort, and swelling. Complications unique to the removal of wisdom teeth include numbness or other alteration of sensation of the lip, chin, tongue, gum, etc.; an opening from the mouth into the sinus of the upper jaw, possibility of bone fractures, and damage to adjacent teeth. Other remote risks are beyond the scope of this discussion.

Q: What is orthognathic surgery?

A: Orthognathic Surgery is performed to correct a poor relationship between the jaws. The word orthognathic is derived from the Latin words "ortho" (straight, or correct) and "gnathos" (jaw). When one or both of the jaws are too large or too small, too wide or too narrow, too far in or too far out, orthognathic surgery is frequently performed to correct the problem(s). It is almost always performed in conjunction with orthodontic therapy.

Q: Why can't the orthodontist correct the problem by moving the patient's teeth into a normal bite?

A: In most patients - those who have an abnormal bite that is caused by rotation or crowding or malposition of the teeth only - that is exactly what happens. However, if the patient has a problem not only with the position of the teeth but also with the position of the jaw(s) as well, orthognathic surgery may be the only solution.

Q: Do patients look different after orthognathic surgery.

A: Most of the time there is a change in appearance, and in most cases it is a pleasant change. If someone has a malformed jaw or a very obvious discrepancy in size or position of the jaws, it is frequently noticeable, even to casual observers. When the surgeon establishes a proper relationship and facial balance, most patients are very pleased with the results.

Q: Will my insurance cover orthognathic surgery?

A: In most cases, yes. It is dependent on your policy.

Q: Are you going to hurt me?

A: No. Well, probably not. Oral and maxillofacial surgeons and our other dental colleagues do our very best to make patients comfortable and to provide care in a pain-free manner.

Q: How can you do surgery in a pain-free manner?

A: Simple cases are often done using local anesthesia to "deaden" or "freeze" the area we are treating. Often, however, it is necessary for the patient to be asleep (general anesthesia) or sedated for more complex cases or to overcome anxiety.

Q: What is the difference between general anesthesia and sedation?

A: A patient who is undergoing a true general anesthesia is completely asleep, cannot be aroused by physical or verbal stimulation, and has decreased protective reflexes. Intravenous sedation patients are very sleepy and somewhat amnesic, can be aroused, and retain their protective reflexes. The determination of which type of anesthesia will be used is based on a number of factors, some of which include: complexity of the case, health of the patient, anxiety of the patient, and age of the patient

Q: What do I need to do if I am to have a general anesthetic or intravenous sedation?

A: Don't have anything to eat OR drink for at least 6 hours prior to the appointment, bring someone with you who will stay in the office during the procedure and can drive you home, show up on time, and leave the rest up to us.

Q: My aunt says that she always gets sick after general anesthesia and that I will, too. What's the deal?

A: She's a little bit crazy, remember? She's the same one who was abducted by space aliens and swears that Elvis is working at the 7-11, isn't she? Well, anyway, you probably won't get sick just because your aunt / brother / mother / father / priest / boyfriend / gardener / dog did. But you might. It doesn't happen very often, but it does happen occasionally and if it does, we'll take care of you.

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