More Clinical Tips from the Editor

gingival enlargement, laser, systemic disease

Top causes of gingival enlargement and treatment options

Scott Froum, DDS, editorial director of Perio-Implant Advisory, describes the various causes and dental treatment options for gingival enlargement, a condition mistakenly used synonymously with gingival hypertrophy and gingival hyperplasia. He also presents a new form of surgical treatment that can assist in correcting certain types of gingival enlargement.

dental implants, osseointegration

Are we there yet? A new instrument that determines when dental implants are ready to be restored

Dr. Scott Froum, editorial director of Perio-Implant Advisory, says osseointegration of dental implants is dependent on a variety of patient-related factors, and because each patient heals differently, load time is different. He explains how using resonance frequency analysis (RFA) to measure implant stability is a simple, fast, noninvasive way to test maturity of bone around the implant without exposing patients to radiation.

infection, periodontic, teeth, endodontic

5 questions to ask when determining if teeth with perio-endo infections can be saved

When faced with an infection from an endodontic, periodontic, or combination lesion, is it worth trying to save the tooth involved versus replacing it with a dental implant or bridge? Dr. Scott Froum, Perio-Implant Advisory's editorial director, and Dr. Marcus Johnson explain how to diagnose the infection and suggest questions to ask as you decide upon treatment.

dental implant, dental implant complications

Top 5 sources of dental implant pain when 'there is nothing wrong with the implant'

While clinical signs and radiographic evidence sometimes point to dental implant complications, ascertaining the etiology of a patient’s perceived pain post implant placement when all parameters are within normal limits can be daunting. Dr. Scott Froum, editorial director of Perio-Implant Advisory, focuses on five factors that can elicit pain post implant placement that are often elusive and obscure diagnosis unless a good knowledge base is present.

dental implant, implant abutment

Top factors leading to dental implant abutment/implant fixture misfit: The dreaded macrogap

Dr. Scott Froum, Perio-Implant Advisory’s editorial director, says recognizing the leading causes of dental implant abutment misfit can prevent implant failures from occurring. Because vertical misfit can have serious repercussions on the life span of the implant complex, careful attention must be paid to details at the time of insertion. In this article, Dr. Froum elaborates on six things that can cause implant abutment misfit and explains how you can avoid each.

paresthesia, tooth extraction, socket debridement, dental implants

Socket debridement paresthesia: A popular method of unintentionally making a patient numb after tooth extraction

Although the complication rate of tooth extraction is low, and complications are often minor, the incidence of overall paresthesia after tooth extraction is on the rise due to an increase in the number of extractions over the years. Injuries to the inferior alveolar nerve and lingual nerve can cause problems with speech and mastication, leading to complaints and possible litigation as these injuries begin to affect the patients’ quality of life. Perio-Implant Advisory Editorial Director Scott Froum, DDS, reviews one iatrogenic cause of mandibular nerve injury post tooth extraction and explains steps the dentist can take to prevent such injuries in the future.

halitosis, bad breath

Halitosis: Etiology, diagnosis, and treatment

Halitosis, also commonly known as “bad breath,” is a concern of many patients seeking help from health-care professionals. Scott Froum, DDS, editorial director of Perio-Implant Advisory, discusses the etiology, diagnosis, and treatment of halitosis. Due to its multifactorial complexity, patients should be treated individually, rather than categorized. Diagnosis and treatment needs to be a multidisciplinary approach involving the primary health-care clinician, dentist, an ENT specialist, nutritionist, gastroenterologist, and clinical psychologist.

EpiPen, epinephrine, anaphylaxis

An alternative to the EpiPen for the dental office and home that can save you hundreds of dollars

EpiPen, an epinephrine auto-injector manufactured by the drug company Mylan, has recently seen a substantial price increase that caused a national outcry. Once sold for $57 in 2007, the price for an EpiPen has skyrocketed to more than $500 today, with an average store selling it for $615. George Felt, DDS, a periodontist practicing in Meredith, New Hampshire, provides us with this month’s clinical tip on how to protect yourself, your family, and your patients from allergic reactions and anaphylaxis without having to pay such an expensive price.

tongue, pathologies, dental examination, oral pathology

5 pathologies most likely to affect the tongue: Importance of proper examination and diagnosis

Although the dental technology that can identify oral pathology has greatly improved in the past decade, dental professionals should still understand the importance of conducting visual exams and be able to accurately diagnose disease when present. Perio-Implant Advisory Editorial Director Scott Froum, DDS, offers dental health professionals an aid to examining the tongue, recognizing characteristics of a normal disease-free tongue, and identifying the top five pathologies most likely to affect the tongue that could represent larger systemic issues.

dental implants, craniofacial growth, fixed partial denture

The ideal esthetic dental implant restoration: Will it still look like that in 10 years?

Craniofacial growth continues for humans even into adulthood. Because the tissues and teeth continue to move around a fixed, osseointegrated implant, restorations placed as many as five to 20 years ago can look vastly different from when they were first inserted. Thus ideal placement for dental implants and restorations may not continue to be ideal as the years progress. Perio-Implant Advisory Editorial Director Scott Froum, DDS, explains the implications craniofacial growth has on the position of dental implants and the types of patients who are at the highest risk for craniofacial growth that will impact dental implant positioning in future years.

flossing, oral hygiene, dental hygiene, interproximal cleaners

Lies, damned lies, and statistics: The truth behind the importance of flossing

Last week the Associated Press released an investigative report citing “weak evidence” behind the importance of flossing. This week Scott Froum, DDS, editorial director of Perio-Implant Advisory, gives the history behind this investigative report, examines what the term “weak evidence” means in the larger scheme of things, and offers dental professionals talking points when patients ask about the importance of flossing.

street drugs, narcotics, periodontal disease, dental caries, Scott Froum, DDS, Joseph Palamar, PhD, MPH

The new street drugs some of your patients may be using that you have never heard of

Perio-Implant Advisory’s Editorial Director Scott Froum, DDS, teams up with Joseph Palamar, PhD, MPH, to highlight how some of the more well-known street drugs are being adulterated by new synthetics that are less expensive to make yet cause even greater damage to the person taking them. They discuss a few of the more potentially deadly street drugs that your patients may be taking with or without their knowledge—a synthetic opiate that produces a heroin-like high but is thought to be 10,000 times more powerful than morphine, a new psychedelic with stimulant properties much more dangerous than LSD, and the very potent $5 insanity. You’ll learn to spot the signs and symptoms of drug abuse on the oral cavity.

medication-induced bleeding, anticoagulant medications, vitamins and supplements, herbal supplements

Medication-induced bleeding when your patient 'doesn't take any medication'

It is estimated that $28 billion per year is spent on herbal medications and supplements, and more than 29,000 different types of these medications exist. It is, therefore, safe to say that many patients you encounter will be taking or will have taken over-the-counter (OTC) medications. Patients often do not consider this type of vitamin and/or herbal supplementation to count when you ask, “Are you currently taking any medication?” Unfortunately, treating dentists and patients are not always familiar with all of these OTC herbal medications and supplements and their effects on hemostasis. Perio-Implant Advisory Editorial Director Scott Froum, DDS, lists his top five medications in this category in terms of popularity of patients’ use, explains their anticoagulation effects, and discusses what you can do to ensure that they don’t wreak havoc on your dental treatment plans.

bone graft, socket debridement, mechanical debridement, postextraction treatment - Scott Froum, DDS

Postextraction treatment: Did your bone graft fail, or did you fail your bone graft?

Patients who are about to undergo dental treatment, especially surgery, will often inquire as to the success rate of the procedure to be performed. When we look at the etiology of poor bone fill or bone-graft integration postextraction, many factors can influence the outcome, including medical history, medications, social factors, etc. Perio-Implant Advisory’s Editorial Director Scott Froum, DDS, says there are also iatrogenic factors, including sterility of the procedure, surgical technique, and—one of the most important and often-overlooked factors—complete debridement of the postextraction socket.

Have infection, will travel: Paving the path to dental implant failure by Scott Froum, DDS - dental implants - pathology - dental infection

Have infection, will travel: Paving the path to dental implant failure

Why did this dental implant fail? You did everything right during your implant treatment. You properly diagnosed and treatment planned the patient’s implant therapy. The implant was surgically placed in a prosthetically driven orientation. You (or the restorative dentist) placed the abutment and crown on the implant with the correct contours, perfect fit, and (if not screw retained) without excess cement. The patient adhered to the follow-up appointments and had good oral hygiene. Follow-up visits showed good bone levels around the implant . . . and then one day there was implant infection and loss of integration. In his clinical tip, Perio-Implant Advisory’s Editorial Director Scott Froum, DDS, talks about one huge oversight that—if detected early and treated properly—is highly preventable and can change the entire outcome of your case.

peri-implant mucositis - Scott Froum, DDS - dental implants - soft-tissue recession

Peri-implant mucositis: Are you a clairvoyant or a charlatan?

As clinicians, we are trained to believe that achieving disease resolution is tantamount to giving the patient a successful result. Is this true when disease resolution is achieved, but esthetics are sacrificed and the patient is unhappy? Can this type of dissatisfaction be precluded by informing the patient of the potential esthetic outcome prior to treatment initiation and allowing the patient to become part of the decision-making process? Absolutely. In his clinical tip of the month, Perio-Implant Advisory Editorial Director Scott Froum, DDS, explains that when treating peri-implant mucositis, it is imperative to let patients know prior to therapy that tissue recession can be a result of treatment and that they must consent to this possible outcome.

Saving teeth: They must not teach that as the first therapeutic response in dental school by Scott Froum, DDS

Saving teeth: They must not teach that as the first therapeutic response in dental school

As I look back on a consultation appointment I had with a patient named Martin five years ago, I realize how poignant that conversation has become in recent years. Martin presented to my office for consultation after seeing multiple dentists, including a few periodontists. After hearing that he had a “severe amount of bone loss” and “many of his teeth needed to be extracted” and his “teeth were beyond repair,” Martin asked me a simple question, “Can you save my teeth?” Martin is better at describing his story in his own words, but the following is the clinical part of his journey through periodontal treatment.

So you shot a lion and you are public enemy No. 1: Now what do you do? by Scott Froum, DDS

So you shot a lion and you are public enemy No. 1: Now what do you do?

During the summer of 2015, Dr. Walter Palmer, a dentist from Bloomington, Minnesota, sparked both national and international outrage when he killed a lion in Zimbabwe named Cecil. This tragic event led to a public outcry calling for Dr. Palmer’s dental license to be revoked, forced the closing of his office for more than a month, led to death threats against him and his family, and a barrage of negative reviews against his private and professional life. This event raises the question of what steps a person (in this case, a dentist) who relies on public sentiment should take when a negative event occurs in order to “mitigate a crisis.” In his clinical tip of the month, Perio-Implant Advisory Editorial Director Dr. Scott Froum lists some key elements of post-crisis management that must not be ignored, according to Matthew Berritt, a New York City-based publicity executive and director of the Lifestyle Division at EVINS Communications.

how much do you guarantee a dental implant for?

'If I choose the dental implant option, how long do you guarantee it?'

This question can be a tough balancing act for the dentist being that you do not want to give patients false expectations, but at the same time, you do not want to have your patients forgo treatment they need or go to another dental office. Perio-Implant Advisory’s Editorial Director Dr. Scott Froum posed this question to 100 different dentists of varying years in practice, in various locations throughout the United States, of those who place dental implants. Here is a sample of responses from some of the leaders in the dental implant industry.

anxious girl - Dreamstime.com

It's 10 p.m.; do you know where your patient's hemostasis is?

If you are a dentist who performs surgical treatment, such as extractions and/or implant therapy, a dreaded phone call can be from your emergency service regarding a patient you treated earlier in the day who now has uncontrollable bleeding. This is of greater concern if the patient has a medical history that warrants anticoagulation medication and the physician did not let your patient go off medication prior to surgery. Dr. Scott Froum, editorial director of Perio-Implant Advisory, introduces the feature article on hemostasis that will help you answer pertinent questions prior to surgery.