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More Clinical Tips from the Editor

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

Jun 14, 2016

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.

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

May 16, 2016

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

Apr 19, 2016

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: Are you a clairvoyant or a charlatan?

Mar 15, 2016

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

Feb 17, 2016

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?

Jan 19, 2016

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.

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

Dec 15, 2015

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.

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

Nov 18, 2015

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.

This month's clinical tip from the editor: After a tooth extraction, are you guilty of chucking the tissue?

Oct 13, 2015

There are many etiologies behind the development of a radiolucent lesion at the apex of a tooth root. What clinicians are most familiar with are lesions of endodontic origin. But what happens when that lesion is of nonendodontic origin? What happens when the clinician proceeds with business as usual and performs an apicoectomy or extraction with subsequent implant placement because of a perceived root canal failure down the line? Perio-Implant Advisory Editorial Director Scott Froum, DDS, and Dr. Naomi Ramer, chief of oral pathology at Mt. Sinai Hospital, offer advice on how to handle these situations.

This month's clinical tip from the editor: 'The implant you put in my mouth is now bleeding; what should I do?'

Sep 17, 2015

A dreaded phone call that every dental office involved in dental implant therapy may encounter is when a patient calls and says, “Hey Doc, the implant you put in my mouth a few days (or months or years) ago started to bleed.” Most often patients will claim that the problem started “out of the blue” and they tried rinsing their mouths with various medicaments all to no avail. Perio-Implant Advisory Editorial Director Scott Froum, DDS, shares his advice and gives the top five reasons why implant restorations can bleed in his clinical tip of the month.

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