All-On-X Implant Dentures - FAQ

For hundreds of years, dentures have been the only option when it comes to replacing a full mouth of teeth, with the earliest set dating back to 700 BC. While dentures do provide the patient with ‘teeth,” they are bulky, cover the roof of the mouth, can be easily dislodged when eating or drinking, and cannot typically be tolerated by patients with have a sensitive gag reflex. Thankfully, dental implants have dramatically improved the treatment options and outcomes for patients who are unable to keep their natural teeth.

There are numerous ways dental implants can be utilized in replacing missing teeth. Designer Dental offers a variety of options when considering implants to replace multiple teeth, but specifically we want to highlight a type of procedure called “All-On-X” (often times called All-On-4’s) or “implant supported” prosthesis.

All-On-X implant prosthetics almost completely eliminate the need to ever have something removable that comes in and out of the mouth. In an implant-supported prosthesis case, Dr. Nagao will extract all of the remaining teeth, smooth the bone, graft any necessary sites, and then place a number of implants in the jaw bone. Then, instead of using a traditional, removable denture, the patient receives a temporary set of teeth completely attached to the implants that does not come in and out of the mouth. These are held in by very small screws that engage with the implants. After a healing period, the temporary set of teeth is removed and a permanent set is fabricated. This permanent set can be made from a number of different materials, but the strongest and most natural looking material is ceramic.

Below are some frequently asked questions regarding implant-supported dentures.

I’ve been told I’m going to lose all my teeth. What happens next?

Once a treatment plan has been decided on, the first step is to collect records. This involves a series of photos, a digital scan of your mouth, 3D radiographs, and deciding what shade or color the dentures should be. Our goal is to design a beautiful smile that people assume is real. Once the records appointment is finished, the information goes to a dental lab where they design the first temporary set of teeth that will be used on the day of surgery.

How painful is the surgery? Will I need to be off work for an extended period of time?

Many of our patients are surprised at how smooth the recovery process can be after surgery. Peak swelling is anywhere from 3-5 days post-op. There will be some tenderness, possible bruising of the face, and swelling but more often than not our patients are able to return to work after a few days of rest.

Will I be able to eat like normal after surgery?

For the first few days following surgery, patients will want to be on a liquid-only diet. Here are some ideas for a liquid diet:

• Protein shakes

• Broth

• Milkshakes

• Tea

• Frozen yogurt

• Ice cream

• Coconut water

• Cream soups

Once you are cleared from the liquid diet, you can work up to foods with a bit more consistency. The general rule of thumb is if it can be cut with a spoon, it is generally ok to eat.

• Steamed veggies

• Mashed potatoes

• Oatmeal

• Soft bread

• Eggs

• Cheese

• Bananas

After about four months of healing, the permanent set of teeth is fabricated and delivered. At this point, a normal diet may be resumed. Patients in All-On-X implant dentures enjoy eating foods such as corn on the cob, ribs, steaks, nuts, and crackers.

How much does it cost to have an All-On-X procedure?

Because there are a number of different combinations of materials, numbers of implants, type of hardware, etc. it’s best to schedule a consultation with Dr. Nagao to determine what plan best suits your needs and budget.

If I don’t have teeth anymore, I don’t need to come in for cleanings and exams anymore, right?

Wrong! If anything, routine maintenance and prevention is more important than ever. Even though implants cannot decay, they can still fail. Poor home care, smoking and lack of proper hygiene can lead to gum and bone disease and ultimate failure of the implant(s). It can also be tricky to clean underneath an implant supported prosthesis. Your hygienist has special instruments that can clean underneath the prosthesis and around the implants. Patients are still seen every three to six months for a cleaning, and a panoramic x-ray is taken every year to ensure the surrounding bone and structures are healthy.

How long do implants last?

Studies show that with proper care, implants can last well over 20 years. The denture prosthesis itself can experience normal wear and tear, but it is not uncommon for the teeth to last at least 10 years. As with natural teeth, it is important to maintain proper home care, come in for routine visits, and avoid using teeth for things they shouldn’t be, such as opening bottles.

What happens if an implant fails?

Just like anything else in the body, nothing in dentistry is ever really permanent. The name All-On-4 means a prosthesis is supported by a minimum of four implants. While four implants can certainly get the job done, it’s risky in the event one fails because replacing and remaking a denture becomes costly and time-consuming. Dr. Nagao believes that adding a few more implants creates a more predictable outcome and insurance that in the event an implant fails, the prosthesis is still stable and no additional implants need to be placed.

I have been using traditional dentures for years now. Is it possible to add implants to an existing denture?

It is possible, depending on the amount of bone present. Over time, bone levels can drop if the teeth have been missing for quite some time. A CBCT, or 3D x-ray, will provide detailed information that Dr. Nagao will read to determine if there is enough bone to place implants.

There seem to be a lot of pros to an All-On-X. What are the cons?

As mentioned above, patients need to have adequate bone levels to be able to place implants. If there is not enough bone, sometimes grafting procedures can be done, but not in all instances, and extensive grafting can add significant cost to the treatment plan. The overall cost of doing an All-On-X procedure is also a significant investment.

How many All-On-X procedures has Dr. Nagao done? Should I see an oral surgeon instead?

Dr. Nagao has extensive experience with implants and All-On-X cases. In fact, he is part of the American Academy of Implant Dentistry and International Congress of Oral Implantologists. He also teaches dentists across the country how to place implants and perform more advanced surgical procedures such as the All-On-X at a training facility in Phoenix. Patients are welcome to see an oral surgeon if they feel more comfortable, but Dr. Nagao is able to perform every aspect of your All-On-X treatment plan in one office from start to finish. With a complete understanding of your dental background, health history, extensive training in IV sedation and oral surgery, and a close relationship with the lab technicians who design and fabricate the teeth, you can rest assured that you will be in good hands at Designer Dental.

Fluoride 101

Fluoride has been an essential part of dentistry for many decades. It is found naturally in soil, rocks, air, water, plants, and foods. It is also synthetically produced for use in drinking water, toothpaste, mouthwashes and various other products. However, concerns have risen regarding fluoride's effect on health, including problems with bones, teeth, and neurological development. It can be overwhelming to do independent research and decide if fluoride is a good option for you or your family. In this article, we hope to share some myths and facts that will help you determine if fluoride is right for you.

How Fluoride Can Be Beneficial

Teeth are in a constant state of two processes, demineralization and remineralization. When we eat foods high in carbohydrates or sugars, bacteria colonies that live in the mouth will have a feast and then spit out acid onto the teeth as a byproduct. This acid attack will cause mineral loss (demineralization) from the tooth’s outer layer of enamel. The tooth recovers by using minerals derived from foods or water such as fluoride, calcium, and phosphate to redeposit (remineralize) the enamel layer. If the teeth are constantly fighting off acid without enough time or resources to repair the damaged enamel, this can lead to tooth decay. Fluoride helps prevent tooth decay by making the tooth more resistant to demineralization. It can even reverse the early stages of decay. In young children, fluoride can even help strengthen the still-forming adult teeth that have not yet erupted, giving them an early, powerful defense against acids. Fluoride also disrupts acid production in already erupted teeth of both children and adults.

How To Incorporate Fluoride into Dental Health Care Routines

There are a few different ways to incorporate fluoride into your dental health care routine.

·         Drink fluoridated water – you can visit the following link and see if the drinking water in your area is fluoridated (https://nccd.cdc.gov/DOH_MWF/Default/Default.aspx)

·         Use an over-the-counter or prescription-strength fluoride toothpaste

·         Have fluoride applied directly to the teeth at our office

·         Take prescription fluoride tablets, usually indicated for ages 6 months to 16 years old in non-fluoridated water communities

At Designer Dental, we encourage our patients to consider a topical application of fluoride at every regular scheduled cleaning or periodontal maintenance visit. We believe it is important for every age group, young or old, to implement fluoride into their dental health care. Everyone can benefit from added fluoride protection, but those who can benefit particularly are people who:

·         Follow a diet high in sugars and carbohydrates

·         Struggle with at-home dental hygiene (routine brushing and flossing)

·         Have had bridges, crowns, braces, and other restorative procedures

·         Have a history of tooth decay/cavities

Concerns About Fluoride

As the common saying goes, too much of a good thing can be bad. Fluoride is safe in appropriate doses, but if consumed in excess can lead to side effects such as fluorosis (discoloration of enamel in children,) weakened bones and ligaments, and muscle weakness. The amount of fluoride added to public water supplies are regulated and do not exceed a certain dose. Products applied in-office, such as fluoride varnish, are also safe for routine use, along with over the counter toothpastes and mouth rinses.

One of the main arguments against fluoride in water is that people believe it is unethical for the government to force fluoride on people without giving them a choice. When fluoridation first began, fluoride was not as readily available to the public like it is now. Most health issues that opponents claim to be linked to fluoride are from sources of water with much higher fluoridation levels than what is found in our water systems. A lot of the studies linking fluoride to cancer have been inconclusive and have shown neither an increase nor decrease in risk of diseases such as osteocarcinoma.

Fluoride is approved by the CDC. Although there may be many rumors about the effects of fluoride, all of the common concerns have no real connection. It is also endorsed by more than 100 health organizations including the American Medical Association, World Health Organization, American Dental Association, and the American Academy of Pediatrics.

Closing Thoughts

We respect all of our patient’s concerns and wishes. Dr. Nagao may recommend fluoride treatment at your next visit, but you are free to decline. However, we firmly believe in the benefits of routine fluoride treatment, whether in-office or in supplemental use at home, and we want to ensure that your teeth will last you a lifetime. We recommend it for anything from desensitizing teeth that are sensitive to cold, to application around crowns and bridges, or to children with signs of decalcification or early stages of decay. We hope that our efforts to educate our patients on the use of fluoride in our office have been successful and that we have answered any questions or concerns. Feel free to call or email our office with any additional questions, or simply ask about fluoride treatment at your next visit.

Dental X-rays and Radiation

Dental x-rays are one of the most important tools available in monitoring the status of your oral health. You’re probably aware of the dentist “poking” around your teeth every 6 months after your cleaning. Dr. Nagao checks each tooth for any signs of wear, stickiness, or discoloration that could indicate a cavity is starting. However, a lot of cavities can’t be seen with the naked eye. This is where x-rays are important!

X-rays give your dentist the ability to see between and around the teeth. Not only is he checking for cavities starting to form between the teeth (called flossing cavities), but he’s also looking at the end of the root and at the sinuses and bone for cysts, abscesses, or other abnormal masses that would otherwise be nearly undetectable without x-rays.

Often times, patients want to decline x-rays out of concern for the exposure to radiation. Ideally, patients have bitewing x-rays (four x-rays) done every year, and a full series of x-rays (eighteen x-rays) done every five years. Patients often think, “Oh what’s another six months? I’ll get them done next time.” However, next time can easily turn into two, three, or four years without these vital checkup x-rays. What started as a small cavity that would only need a filling could turn into a large cavity, requiring a root canal and crown, which are considerably more costly than a filling. Unfortunately, there’s no magic timeline for how quickly a cavity can progress – every patient is different. Therefore, it is very important to stay on top of the scheduled dental x-rays. The benefits of having these x-rays done routinely far outweigh the exposure to radiation risks!

Digital x-rays have become quite popular, despite being significantly more expensive than traditional film x-rays. They are fast (no developing in chemicals), convenient (easy storage), and actually much lower in radiation than their film counterparts! Often times they are up to 80 percent lower in radiation!

People often ask, “Well if x-ray radiation is so minimal, why do I have to wear a heavy lead blanket? And why does everyone leave the room during my x-rays?”

The heavy lead blanket is there to protect your neck and upper torso. Despite the radiation being minimal and very concentrated, there is no need to expose these areas to radiation if it isn’t necessary. Same goes for the assistant or hygienist taking the x-rays: they do this all day long. They make take 10 series of x-rays that day, which is 10 times the exposure the patient gets. Minimizing any exposure to x-rays is ideal. 

Going off of the above chart, you can see the radiation we get from dental x-rays is very minor. You’ll be exposed to more radiation on a daily basis just from being in the Arizona sun for a few minutes! At Designer Dental, we are always willing to respect our patient’s wishes when it comes to the frequency of dental x-rays. However, we hope that this article has cleared up any concerns about dental radiation and put your mind at ease when it comes time for your next visit!

Sedation Dentistry

As dental procedures have become less invasive over the past few decades, it’s no longer necessary to be put to “sleep” for a procedure that might have meant a noon-day nap not so long ago. What should you know about sedation dentistry? What are the benefits, and why is it used?

How Sedation Dentistry Can Help

Sedation dentistry is generally used to create an anxiety-free experience for the patient. As much as 30 percent of the population suffers from “dental phobia” or a fear of going to the dentist, according to the Dental Organization for Conscious Sedation (DOCS). This phobia can mean that patients do not receive routine dental care, which can compromise their oral, and overall, health.

Using sedation, a dentist is able to relax and calm a patient before any type of dental procedure. Levels of relaxation vary, from minimal to moderate to deep sedation. Techniques to achieve sedation include traditional methods of inhalation, including “laughing gas” (or nitrous oxide), or intravenous (or IV) sedation – delivered through injection into the blood vessels of the arm or hand. The most common approach to calm patient fears is through “no needle” oral sedation.

How Does It Work?

Sedation lets the patient maintain a level of consciousness, which allows them to cooperate and follow commands, but prevents them from remembering much of what happened. Sedation shortens one’s impression of the amount of time the procedure actually takes – many patients think that procedures undertaken while sedated last “only a few minutes.” This can act as a time-saving benefit because more work is able to be completed in a single appointment, and fewer appointments are needed.

Dentists must receive thorough additional training or even get accredited to practice sedation dentistry, and it is widely believed that any risks of sedation are far outweighed by the risks of you not getting the care you need. So, be sure to ask about sedation during your next appointment. 

Dr. Nagao has undergone advanced training to become certified in sedation dentistry.  He completed his certification through advanced classroom education, direct hands-on learning in a teaching hospital and observation and review by licensed oral surgeons. 

As a sedation dentist, Dr. Nagao can cater to the unique needs of those patients who have dental fears.  Dr. Nagao will deliver the comfortable and personalized care the patient needs with the use of sedation to ensure a positive experience at Designer Dental.

What’s Up with All that Poking at My Gums During Cleaning?

What’s Up with All that Poking at My Gums During Cleaning?

Have you ever wondered why Dr. Nagao or the hygienist starts rattling off a series of numbers in the middle of your cleaning? 2, 2, 3, 2, 4, 5! What’s going on there? What they are doing is checking the depth of tissue pockets that surround your tooth. It’s a proactive way to identify your risk for periodontal disease, and when done regularly, can help catch it early. Dental probing is a pretty interesting exercise in dentistry, can save you from surgery and extractions, and here’s why.

Dental Probing Catches Problems Early

One reason to visit our office regularly is to identify problems in your mouth that you are completely oblivious to. Subtle changes in the health of our gum tissue can be missed by the naked eye, and some people – even those who visit a dentist regularly – can be prone to an excess buildup of plaque and tartar that can result in gingivitis and periodontal disease. Thankfully, your dental team can catch these changes early through the use of yearly X-rays and the practice of dental probing.

The reason for probing is straightforward. As periodontal disease progresses, the visible markers of the disease (plaque and tartar) migrate down along the side of the tooth into the natural “pocket” between the ridge of the gumline and the tooth’s enamel. This inflames the gum tissue and widens this naturally slim gap between the tooth and gum. As this gap becomes wider, even more bacteria are allowed access to the sensitive tissue fibers along the root’s outer surface, causing more damage. This process may result in bone loss, and the need to extract a tooth. This is why probing is so important. 

The scary thing about Periodontal disease is that it doesn't cause pain.  The first symptoms you may notice are loose teeth and by that time it may be too late to have them.

How Does Dental Probing Work?

“Probing” is quite simple and is accomplished by using a dental “probe” to measure the depth of a tooth’s pocket. The probe acts like a ruler, and has markings along its side measured out in millimeters. To measure the depth of your tooth’s pocket, your dentist gently places the probe into this pocket and makes note of the depth. Those numbers you hear are the millimeter depths of your pocket. Six measurements are taken per tooth, three along the outside, and three along the inside of each tooth. A depth of three millimeters or under without any bleeding is generally accepted as healthy. Above that number, your dentist may suggest more thorough cleanings, including scaling and root planing, or something even more comprehensive if the number is above a five and nearing ten. 

Maintaining pocket health is critical, and proper brushing and flossing can help clear away plaque and prevent the tartar buildup that expands a pocket. Your dentist also plays a critical role in ensuring you’re staying ahead of gum disease, so be sure to keep your regular appointments – particularly if you have been identified as having periodontitis and recommended for more frequent, thorough cleanings. With a good routine and frequent visits to the dentist the only numbers you’ll be hearing moving forward should be 1, 2 and 3! Keep up the good work.

Oral Health Care and Baby Teeth

For those of you who are parents, you can probably remember how stressful life is after you have your first child. Suddenly, the world looks very large, scary and seems filled with all kinds of germs and dangers to our precious little ones!

Cooper, my son, was born in October of 2015, and I couldn’t tell you how many hours I’ve spent on Google. My husband jokingly refers to it as “Dr. Google,” because any time our son coughed, sneezed, or wheezed I was instantly on Google  to see what the best remedy was to cure what ailed him!

However, when his first two bottom teeth came in, I was confident in how to best care for his pearly whites. After all, I AM pretty well-acquainted with teeth!  I started thinking that many new parents may not be familiar with caring for their baby’s teeth! Here are some tips and tricks on how you can start your baby off with a healthy smile, as well as teaching him or her healthy habits to last a lifetime.

Most babies don’t get their first teeth until at least 6 months old, but my little sister got her first tooth at 3.5 months old. Every "little one" is different. This chart is a pretty good representation of what sort of time frame you can expect to start seeing some teeth sprout through the gums.

Oral hygiene should begin well before babies cut their first tooth. The best way to care for babies’ gums is by taking a wet wash cloth or gauze and gently wiping their gums, especially after feedings and before bed time.

Once the first baby teeth start to pop up you can graduate to a toothbrush. Choose one with a soft brush, small head and a large handle. At first, all you will need is a wet tooth brush. Tooth paste isn’t really necessary until about 3 years old. Finding a tooth paste with fluoride will help strengthen the enamel and help prevent tooth decay. Brush all around your baby’s teeth including the tongue side, the biting surface, and the cheek side.

Parents should be brushing their children's teeth until the child is old enough to hold the toothbrush, but even then it’s likely a good idea to supervise the process until they can rinse and spit on their own (which is usually around 7 or 8 years of age.) Even at this age it is important to establish flossing as a habit.  Primary teeth usually have much more spacing than adult teeth and can trap food easily.  As a parent, you can gently use your own floss or find flossers for kids that your child can learn to use on their own.

As far as dental visits, many pediatricians recommend seeing a dentist once the first teeth erupt. The visit is more for educating parents about baby tooth care, fluoride, teething, etc. Babies likely won’t tolerate much of an exam, let alone a professional teeth cleaning done by a hygienist, but this visit will start to introduce the idea of the dentist to the child. We will reward them after their visit with a toy from our treasure chest which will leave with a positive image of what to expect at our office.  No matter the age of your child, keep your dentist's phone number on hand in case of emergencies.  Falls, bumps and other accidents that relate to teeth are better handled by a dentist than an emergency room staff. 

Most importantly, try to avoid using trigger words or phrases like “Okay, it’s time to be brave at the dental office!” By implying the child needs to be brave they then begin to wonder what is there to fear. Dentistry has come a long way in the last few decades. While many of us remember the early days of dentistry as being anxiety-ridden and terrifying, technology and advancements in the field have made dentistry much more comfortable. In the event your child needs restorative dental work done (fillings, crowns, or even extractions) we have many tools in our office available to make your child’s experience as pleasant as possible. From laughing gas, to topical numbing jelly, to drill-free fillings with our laser, you can rest assured that your child won’t be white knuckled in the dental chair with faces like this hovering over him! 

Oral health care starts first and foremost with the parents. Set a good example by brushing and flossing often and making routine appointments with your dentist. We know children might be apprehensive about the dentist so we take extra care to make them feel safe and comfortable. After their visit to Designer Dental, we know they'll be grinning from ear to ear and excited to come back and see us!!

- Jessica, Dental Assistant (and Cooper!)

Why Dentistry?

Since we are relaunching our website, I thought this would be the perfect time to introduce myself and explain what I have to offer patients in our practice.

People always ask me why I decided to become a dentist.  To be frank, I can't remember a single event that made my decision for me, but ever since I can remember the very first thing I have always noticed about people is their smile.  I feel that our teeth and eyes are the two features that reveal the most about a person.  This strong interest in smiles naturally led me to a profession where I could help people convey who they truly are with their teeth.

I completed my undergraduate degree in Exercise Science and Kinesiology at Utah State University, the same school where Tami studied, only a few years later.  After graduating from Utah State I attended "the" Ohio State University and graduated with a Doctorate of Dental Surgery.  During my time in Ohio, I had the opportunity to work very closely with an oral surgeon in advanced surgical cases.  I learned to remove complicated third molars, place implants and manage patients during general anesthesia.

While I love Ohio, my wife, Lacey, and I wanted to be closer to our families so we decided to move back west.  We landed in Tucson and fell in love!  I worked as an associate for a few months here in Tucson and then after meeting Dr. Sailer, had the opportunity to join his practice as a partner.  Dr. Sailer has since fully retired to the sandy beaches of Santa Barbara, but continues to be an influence on the type of dentistry we do and the way we treat our patients here at Designer Dental Group.

My promise to you is that you will be treated like family and that our office will meet your highest expectations!      

Josh