During the past fifteen years, we have collaborated with over 250 dentists providing oral surgical and dental implant services for their patients. But only about 20% of them have a mutually deep and engaged relationship with us. They know us well and we know them well. We have visited each other’s offices, met each other’s staff, and have learned how each of us work and communicate. We respect and admire each other’s skills and quality of work and share it openly with people we know. We talk frequently about our mutual patients’ progress, their challenges, and solutions to meet their goals. We ask questions, share thoughts, and email several times a week on news and information helpful to each other. We attend local study clubs and engage in every possible educational event together. And yes, we know each other’s families too. So when we refer patients to each other, it is with a mutual confidence, trust, and personal interest in patients’ well being. We put them in the hands of the doctors we know and trust.

I was reminded how personal this relationship is when a general dentist, who I had recently met, came to our office to see the facility and meet our staff. I had been to his office once and had heard great feedback about his practice. We gave him a tour, talked about our patient service protocols, showed him some of our communication tools, and discussed what patients experience during their visits. He met our staff and then we talked further about quality of care in dentistry, patient experiences, and the importance of taking a personal interest in their well being.

This general dentist took time to get to know us and gain the comfort that he needed before deciding to refer any of his patients. After all, they trust him and he cares about his relationship with them. No, this was not going to be a random referral because of some promotional tactic, a lunch invitation, or insurance-mandated protocol. Patient referrals should be intended, targeted, one-on-one, and indeed personal; a referral with conviction that patients feel. I know I do.

Here are what you should look for when looking at online reviews:

• Number of reviews- A dentist with one review (whether good or bad) may not be very meaningful. Whereas a dentist with twenty reviews will offer much more validity to the overall rating.
• Content of reviews- Don’t just rely on the average star ratings; Read the reviews and learn what people have experienced. You will find some of the shared information more relevant than others and help you make better choices. For example, if you are looking for dentist who is warm and has great bedside manners, you can look for people’s experiences on those features.
• Star ratings- The star ratings are usually from one (least recommended) to five (most recommended). Look for dentists with many reviews with ratings of four to five. Bad reviews (one to two stars) should be looked at within their context. A dentist with one bad review out of two postings may be more concerning that a dentist with one bad review out of twenty postings.
• Reviews with user name- I think sites who have the user names posted along with their reviews are more credible than ones without where one can not be certain about the origin of the review. Sites do monitor and track reviews and their sources in order to prevent dentists and own staff posting positive reviews for themselves as well as bad reviews posted possibly by competition or others who for whatever reason want to harm the practice. Obviously, reviews fraud can compromise a sites credibility, so they monitor them closely to make sure reviews are real and non-biased.
• Cross check reviews on different sites- Check if the reviews on a given dentist are consistent between different sites. A good dentist should have good ratings equally on all sites. Some dentists who consistently receive poor reviews may hire companies like reputation.com to fix Google results, hide unwanted links, and boost online visibility. Through this process, they can boost the positive reviews higher on search results and essentially hide the poor ones way down on the list. Obviously, this ‘manufactured’ search result is misleading as they do not show all the reviews. So make sure you read all of the reviews and cross check them in other sites. Highly rated dentists have consistently good reviews on all sites.

Salt can potentially kill bacteria and prevent infection but adding more is not necessarily better. In fact, the main purpose of salt is to make the water more physiologic or “tissue friendly” for rinsing. Simply add a tablespoon of salt to a gallon of water, shake, and use it for your rinsing needs. The real benefit from rinsing with salt water is the washing away of plaque and food debris from the tooth extraction or dental implant surgery site. For that matter, you can use plain tap water, especially if you are at school or work and don’t have salt-water on hand. It’s best to avoid rinsing with alcohol-based mouth rinses during the first week after surgery because of irritation to the healing tissues.

So remember to rinse often with salt water or just water. You will have less post surgical pain, faster healing, and less chances of developing a mouth infection.

• “Top Dentists”
• “Internationally Recognized Dentist”
• “Best Dentist”
• “World Renowned Dentist”

These are just a few common descriptions sited in various media for dentists marketing their practices. But one has to question how are they generated? Are they credible? Why are they the top dentists? Who determined this? and what were the criteria for inclusion in such lists or making such claims? Lets take a closer look at how such lists are generated.

The first strategy is simply paid advertising. Dentists can pay to be included in ‘top dentist’ lists often sponsored by advertising companies or magazines. Just look for the ‘Advertisement’ label on top of the page and you’ll recognize them. Dentists can also place regular ads and make claims as ‘premier dentist’, ‘top dentist’ or others. This is obviously without merit and even if the dentist is very good, self appointment as a top dentist should be looked at with scrutiny.

The second strategy is peer reviewed lists. Many magazines publish an annual ‘Top Dentists’ edition. They send surveys to a number of randomly chosen dentists. Dentists see one another’s work, so they ask them to name the general dentists and specialists to whom they’d send a member of their family. The practitioners who receive the most recommendations from the completed surveys are then listed as ‘Top Dentists.’ While such lists are more credible and many great dentists are included, frequent advertisers seem to get more recognition than others by having included photos, quotes, or other highlighted features.

So how can patients get beyond misleading advertising messages and find the best dentist for them? Here are some recommendations:

• Read patient reviews- Many patients write about their experiences on Google, Yelp, Dr. Oogle, or city search. Check out the reviews and rating and what they say about the dentist and overall experience.
• Ask the dental specialists- When looking for a general dentist or prosthodontist, call your local oral surgeon, endodontist, or orthodontist and ask them who they recommend as the best restorative dentist. Make sure to tell them what your needs are so they can match you better with the right dentist.
• Ask several general dentists- When searching for a specialist such as an oral surgeon, endodontist, orthodontist, periodontist, or pedodontist, call five of your local dentists and ask who they recommend most. They have had direct experiences working with the specialists and can provide you with a great feedback.
• Interview the dentist and ask about their education and qualifications- Ask about school and special trainings they have received. If they are a specialist, inquire about their completed residency program and board certification. If they are general dentists performing specialty procedures, ask about their qualifications and training and difference between their outcome and that of specialists’. Review photo albums of actual patients and their results. Finally, ask to speak to several existing patients and ask about their experiences.
• Ask friends and family members for recommendations- There is nothing like word of mouth from people you know and trust. Ask about their results, experiences and recommendations.

You can combine all or several of the above strategies to give you a consensus on the best dentist for your needs.  Dental treatment can be both costly and long requiring both financial and time commitments. Look beyond marketing titles and promotions when choosing a dentist or specialist and get more engaged in your care. You will be happy you did.

• While we recommend patients to rest for a day or two following oral surgery procedures, it is completely safe to travel or fly, even immediately after surgery.
• Airplanes have pressurized cabins therefore flying will not cause further bleeding or discomfort that some incorrectly believe is caused by changes in altitude.
• Flying will not prolong post-operative bleeding.
• If flying on the same day as surgery, try to get an aisle seat near the lavatory. You will need to get up every 30 to 45 minutes to change your gauze until bleeding stops.
• If flying on the day after your surgery, you are going to have to rinse every couple of hours with water or salt water. So again, probably a good idea to get an aisle seat near the lavatory. Take some salt with you and mix in a bottled water purchased in the terminal. One or two bottles should be enough to get you through the flight.
• If you take narcotic pain medication like Percocet or Vicodin, let the flight attendant know so they don’t become concerned with your over-sleepiness. If you have to get up, ask for their assistance in the event you get lightheaded.
• Take plenty of gauze with you as bleeding may continue for several hours following surgery. Bleeding gradually diminishes over six to eight hours. Keep biting on the gauze with firm pressure until bleeding has completely subsided.
• For food, get some shakes or soups at the terminal. Leave the prezel and chips for the next trip.
• Icing your face helps to minimize swelling after surgery. Take a couple of small-size ziploc bags and ask the flight attendant to fill it with ice. Place the ice bag on the the side of your face intermittently for 10 minute intervals.
• If you just had dental implants, don’t worry about setting off the alarms at the security check. Dental implants are made of titanium, a non-magnetic metal. Therefore, they do not set off metal detectors.

Just a few thoughts on making your air travel more comfortable following oral surgery. Bon Voyage.

In my experience, any tooth that looks easy to extract, usually is not. Here are the most difficult teeth to extract:

• Erupted visible teeth that have been in function for years- As people age, the bone surrounding teeth becomes dense and hard making extractions more difficult.
• Teeth with prior root canal treatment- Such teeth break very easily and often require surgical sectioning and unique instruments for successful extraction.
• Wisdom teeth- Third molars often have multiple curved roots and are impacted in different positions. They are also close to a nerve that if damaged, can compromise sensation to the lip and chin. These factors make wisdom teeth extractions quite challenging without the right approach, experience, and instruments.
• Baby (primary) teeth- It may be counter intuitive, but baby teeth can be very difficult extractions. The roots are usually thin, relatively long, and often partially resorbed that can break very easily. The broken root tips must be removed carefully because they are often right next to the permanent teeth that are in development to replace them.

There are some dentists who may be more skilled with extractions, but it is important that patients inquire about their experience and ask for referral to an oral surgeon when appropriate. Remember, if it looks easy,it probably isn’t.

Remember, IV sedation anesthesia is your choice and you can ask your dentist for a referral. If your dentist says you don’t need IV sedation and you will be fine with just local anesthesia, then you should ask why he or she is not giving you the options and let you make that decision. Speak to your local oral surgeon and learn about your options. You’ll be glad you did.

A patient recently came to me about replacing her missing tooth with a dental implant. She told me that through internet search, she had found a prosthdontist who she is considering for restoration of the implant. When she told me the name, I informed her that I know the doctor but he is a general dentist, not a prosthodontist. She insisted that he is according to his website! So we both took a look and realized something very interesting or perhaps unintentionally misleading! The Google search results and the website both say that the doctor is a ‘prosthodontics and implant dentist’! She made the assumption that he is a prosthodontist which of course was not true!

Lets first define a couple of terms:
The term ‘prosthodontics‘ simply refers to the fabrication of crowns, bridges, or dentures to restore teeth or replace them when missing. So by definition every restorative dentist provides ‘prosthodontics’  – nothing special there. The term ‘Implant dentist’ refers to any dentist who provides implant treatment for replacement of missing teeth. There are two types of implant dentists: A trained surgeon such as an oral surgeon or periodontist who performs the surgical placement of the implant and the restorative dentist who restores the dental implants with appropriate prosthetics (crowns, bridges, or dentures). And in-turn there are two types of restorative dentists: general dentists or prosthodontists.

To help you find a dentist who is actually a prosthodontist, ask the following questions:

• “Are you a trained prosthodontist?”: Prosthodontists receive extended post-graduate training in accredited programs. If the doctor says, they offer prosthodontics, that simply means he or she is a restorative dentist, but not necessarily a prosthodontist.
• “Where did you completed training program?”: Accredited prosthodontics training programs are only offered at dental schools. A one year program or weekend courses do not qualify.
• Ask your surgeon about the dentist’s credentials: As members of the community, they would know and can help you get on the right path.

My father always told me to never assume anything and always read between the lines.
Now a good reason to read between the letters- It makes a huge difference.

You can preserve stem cells from baby teeth that are falling out, healthy adult teeth pulled to make way for braces or other orthodontic reasons, and wisdom teeth that are extracted. Dental stem cells have already been used to regrow jaw bone and treat periodontal disease. Stem cells may also be used to treat conditions such as:

• Tooth loss and periodontal disease
• Skeletal bone loss / fractures
• Muscular dystrophy
• Parkinson’s disease
• Spinal cord injury
• Type 1 diabetes
• Stroke
• Alzheimer’s
• Myocardial infarction (heart attack)

We work with Store-A-Tooth, a company that helps us collect the teeth and process them for stem cells. Parents who have bought the service feel Store-A-Tooth is an affordable ‘biological insurance’ for their children; that they want to be prepared just in case their son or daughter ever needs a treatment that may not even be possible today, but that may help to save their life or improve their health in the future.

When you schedule for your extraction, let us know if you are interested in storing your teeth and we will make all the arrangements.

See Store-A-Tooth website for more information. To schedule an appointment to discuss your extraction needs and prepare for Store-A-Tooth, call us at (301) 654-7070 or send us an email.

Here is one of the most misunderstood points about managing infection: It is NOT necessary to be on antibiotics for a few days before surgery. The source of infection must be eliminated immediately. This means that a tooth causing an infection should be extracted (or have root canal treatment if appropriate) as soon as possible and not be delayed for use of antibiotics.

The key to treatment of any infection is early management. If you experience pain, swelling, drainage, or fever, contact an oral surgeon as soon as possible. Antibiotics may be administered until you are seen and fully evaluated. Delay in management can lead to the spread of infection and potential involvement of other parts of the face or neck. If severe, hospitalization may be required along with IV antibiotics and surgical drainage.

Treatment of infection requires ALL of the following:

• Immediate removal of the source (extraction or root canal as appropriate)
• Drainage if necessary
• Antibiotics

Contact an oral surgeon immediately if you have:

• Severe neck or facial swelling
• Are unable to swallow
• Experience any difficulty breathing

If you experience pain and swelling from teeth infection, you can contact Dr. Kazemi for an immediate evaluation and treatment.