Q: I have a heart problem called atrial fibrillation and am worried about starting my dental treatment which includes extractions, implants and bridge work. Should I be worried?…LBJ in Manalapan

A: I’m glad someone is putting their heart into their writing! (Better than a bunch of corny jokes and dental puns)

Atrial fibrillation (AF) is a cardiac rhythm disturbance arising from disorganized electrical activity in the chambers of the heart. Very often patients are treated with the drug Coumadin to prevent the formation of clots and the possibility of a stroke and beta blockers such as Atenolol to control the heart rate.

Several precautions should be considered: Your hygienist should avoid using ultrasonic scalers during teeth cleanings, but instead use hand scalers. Some local anesthetics containing drugs that constrict blood vessels (vasoconstrictors) need to be used in ways that prevent direct injection into blood vessels. Certain antibiotics, pain medications and anti-anxiety agents prescribed during dental treatment can decrease the effectiveness of the drugs used to treat AF.

You may have all the above needed dental procedures as long as your dentist keeps a few points in mind, starting with a chat with your physician.

For a copy of a recent article on this subject matter, contact us.

Dr. Josephs practices in Palm Beach and can be reached at drjosephs@palmbeachdentist.com , 1-888-DRTOOTH or visit www.palmbeachdentist.com

Q: I had a tooth pulled and was told that I need a bone graft before the placement of an implant. Is this necessary?

A: As Shakespeare’s lesser known dentist- third-cousin once said: “To graft or not to graft, that is the question.”

Often times the socket left behind after an extraction is too large or the bone is too thin. Sometimes a graft is necessary to create a more substantial foundation for the implant site, says periodontist, Dr. Mauricio Gutierrez.

We in the ‘tooth biz” use three types of grafts: autogenous bone= bone from your own body, xenografts=bovine (cow) bone, allografts=human cadaver bone and more and more popular, alloplast grafts=synthetic bone.

The graft material serves as a scaffold, allowing your own bone to grow from within.

For a free tip sheet on bone grafts, contact us.

Q: Very recently I had a porcelain crown placed on my upper right molar. There was a little bubble on the new crown which I became aware of only after my long time dentist cemented it in place. After I brought it to his attention, he smoothed it down. I am angry because it is not smooth, was not perfect and I paid $1300 for it! What do you think?

A: Cool. My favorite category to write about: The “don’t- shoot- your -dentist” category.

It is not uncommon for a bubble to be present on the porcelain. If it is not in between the teeth or on the edge near the gum line and does not interfere with the bite, it is perfectly acceptable for the DDS to adjust, smooth and polish the crown. Sometimes we are able to fill these small areas with tooth colored materials and special adhesives that stick to porcelain.

To get a smooth surface, I use a special polishing kit that uses a series of fine grit, diamond dust rubber wheels to make the crown as smooth as the linoleum floor in my Aunt Rose’s kitchen in Queens.

Q: A friend of mine told me that she paid $10,000 for a set of dentures. Is this not excessive?

A: I have an unusual philosophy about dentures. (And an even stranger philosophy about life in general, but we will save that one for the analyst’s couch) To a patient, a denture that fits well, is comfortable, looks decent and can actually cut food is worth $30,000. A denture that spends most of the time inside a Tupperware container is worth $0.00.

B: Toothless areas will shrink a couple of millimeters every year, eventually leaving very little ridge for dentures to hang on to at any cost. If you don’t have enough bone for implants or are limited by finances, you must resort to full dentures.

For years I thought there was not much progress in the denture world until I attended seminars given by a famous denture dude named Dr. Barotz of Colorado. On average a good set of upper and lower full dentures run about $4000.

A set made for $10,000 would have custom porcelain teeth (not acrylic), special matching pink fake gums with artificial capillaries to mimic real human oral tissues, fake fillings in the back teeth, and intentionally crooked teeth for “realism”.

Q: I take a lot of medications, including Zocar for lowering cholesterol. I am about to have extensive dental work including implants, crowns and root canals. Should I be concerned?

A: I remember my old pharmacology professor, Howard Katz BS, DDS, MS, PHD (He had more degrees than a thermometer in Phoenix!) He once said that patients today are walking “pharmacopeias”, or “drug soups”. All health care professionals need to be on top of their game in knowing which drugs don’t mix.

After placement of an implant, we put patients on antibiotics for a week to ward off infection. Patients who are allergic to Penicillin are often prescribed Erythromycin. EXCEPT IF YOU ARE TAKING ZOCAR! This can result in a bad reaction called myopathy (muscular weakness) and rhabdomyolysis (muscle breakdown). There fore these patients would best be prescribed a “Z”-Pack (azynthromycin) or a cephalosporin.

For a free consumer tip sheet on this subject, contact us.

Dr. Josephs practices in Palm Beach and can be reached at drjosephs@palmbeachdentist.com , 1-888-DRTOOTH or visit www.palmbeachdentist.com

Q: I have a long five-tooth permanent bridge that has come loose above just one of the support teeth. Can it be saved or do I need to replace the whole bridge?

A: You are lucky that I stopped watching TV after the Seinfeld went off the air. Instead, I took up this “kooky” hobby called “reading”. My folks always wanted me to take it up.

In this month’s JADA (Journal of the American Dental Association) A Utah dental researcher, Dr. Gordon Christiansen, addressed this dilemma. If the X-ray and clinical exam show no decay, a small hole can be drilled through the loose abutment, followed by a flushing out of the old cement with a bleach-like solution called Dakins solution. Then, while the doctor exerts a pulling force on the loose end of the bridge, he expresses a special cement called Glass Ionomer into the hole, followed by the patient biting down as the cement dries.

For a copy of this article, contact us.

Dr. Josephs practices in Palm Beach and can be reached at drjosephs@palmbeachdentist.com , 1-888-DRTOOTH or visit www.palmbeachdentist.com

Q: I need some urgent dental work, but leaving the dental office with a numb face and lip will ruin an important speech I need to make. What can I do to get rid of the numbness?

A: Every day I eat lunch with three items: a tuna melt, a car magazine and a dental journal. Last Monday in the JADA (Journal of the American Dental Association), a study of a recently approved drug called Ora Verse was approved by the FDA to help reverse the numbing action of dental local anesthetics when it is no longer desired.

It was shown that the duration of anesthesia was shortened by as much as two thirds. This could eliminate the occurrence of patients accidentally biting their lips, cheeks and tongues. (And could prevent you from drooling your way through your speech)

For a free reprint of the abstract of this article, contact us. (For the tuna melt, you’re on your own.)