It doesn’t happen very often when Dr. O’Neill, a dentist of 40 years, turns to you and says, “I have never seen this before.” Dr. O’Neill was looking into Hank’s mouth and frowning at the red lesions appearing behind his back teeth on his gums. Hank first brought them to our attention a week previous, and they appeared to be aggressively spreading. “Go get the camera,” Dr. O’Neill said.
We have a bunch of cameras in the office, but the one Doctor was referring to is a Canon EOS Rebel that’s probably almost ten years old at this point, but with it’s macro lens attached, it takes wonderfully detailed shots that are very useful for our diagnostic and records taking purposes. I screwed the lens on and turned on the ring flash and as an afterthought, switched the settings of the camera to CAMERA RAW, the most detailed and high quality setting available and hurried back to the operatory.
At this point, the lesions looked like this:
The doctor also contacted two oral surgeons in the area for consultation, one of whom performed a surgical biopsy. Hank also saw his physician. Each dental specialist, and his doctor were equally mystified by the red lesions in Hank’s mouth the surgical biopsy would take several weeks to get back, in the meantime, Hank was treated for bacterial and fungal infections to no effect. A mystery was brewing; one that did not sit well with the doctor, meanwhile the aggressive lesions were spreading to adjacent tissue.
A week later they looked like this:
These lesions were painful and began to effect the way Hank was eating, drinking, and sleeping. The next week that Hank came in, he was visibly skinnier and he is a tall, well built man, so the amount of weight he dropped in a week must have been significant. The color to his face looked off, more ashen and yellow. One could not help but think that the dramatic weight loss and the aggressive lesions in his mouth were related, and that something was just not right.
The doctor and I had a conversation in his office after Hank’s appointment and neither of us could escape the feeling that for unknown reasons, Hank was seriously ill, and that these aggressive gum lesions are a piece of the puzzle, so before Hank’s next appointment, the doctor and I both poured over medical texts and online resources.
This was the worst we had seen:
However, taking these photos gave me an idea. Previously, we had been searching terms and symptoms on medical sites to no avail. I easily went through a hundred permutations of ” red lesions on gums“, but for this next search, I was going to only focus on the images. “Red lesions on gums“. “Swollen red gums“. “Bleeding painful gums“. Search results returned picture after graphic picture of different gum disorders. If I was going to find anything that looked like what we were looking at in Hank’s mouth, Google Images ought to have it somewhere!
After several hundred images I came upon a pretty reasonable match:
Looks pretty close, huh?
The problem is the original website’s language was in Farsi, I believe, so making heads or tails about any of the words next to the picture I was looking at was hopeless. Except for the Google translate button on the header of the website!!! I clicked on that, and while the words changed to English they were arranged in such a way as to make the site mostly unreadable except for the terms “Wegener’s Disease” and “Strawberry Gums”. I quickly plugged those terms into Google and got a few articles about Wegener’s and had some hope that we were finally barking up the right tree.
Wegener’s Granulomatosis is a very uncommon inflammatory disease that affects the blood vessels of the lungs, kidneys, sinuses, nose, and to a lesser extent, the ears. Symptoms include general malaise, a low grade fever, sinus, eye and ear infections, loss of appetite, and kidney problems. The disease is fatal, usually from kidney or lung failure if not diagnosed and treated aggressively. Patients with this ailment often think that they are nursing a cold and within a few months rapidly deteriorate. The tests for Wegener’s are sometimes inconclusive and invasive because in a great majority of the patients, the infected tissue lies deep in the sinuses lungs and kidneys.
(Here is an interesting website about the disease, this page, for example tells you how many times the disease was mentioned on the popular medical drama, House, and tells you what episodes they are in. In one episode, they perform one of those invasive tests mentioned.)
Fortunately for Hank, we were looking at the infected tissue in his mouth! It is very rare for this very rare disease to show up in the mouth! After we asked Hank a few questions, such as, “Have you had a nagging sinus infection?” and “Any low grade fevers at night?”, we were reasonably sure that we had our prime suspect. Armed with this information, and an email from Dr. O’Neill to Hank’s doctor at Kaiser, we set them on the path, it was considered important enough to start steroid treatment, and a couple weeks later the improbable diagnosis of Wegener’s Granulomatosis was confirmed.
The treatment was aggressive and difficult for Hank, involving powerful steroids and invasive tissue tests, but his prognosis is good, and the “strawberry gums” are gone. If his condition slipped through the cracks for a few more weeks, he could have been on the raggedy edge of life…or worse.
What happened here, that allowed our clinic to be so involved in this rare diagnosis? Several unlikely things happened in concert that possibly saved Hank’s life:
1. Hank decided to get his teeth worked on. Like most guys, career and every day life take precedence over dentistry, so it had been a while since he considered a trip to the dentist and finally thought it was time.
2. It is possible that work done during his dental treatments allowed the spreading granuloma to migrate from sinus to mouth making the disease present itself in a way that was rare.
3. Dr. O’Neill and staff at Twin Aspen were alert and curious enough to notice fluctuations in Hank’s overall healthy appearance as well as the strange appearance of his gums and researched as well as documented the course of the disease over several weeks.
4. The doctor at Kaiser did not ignore the possible medical diagnosis from a dental clinic.
In this case medical and dental professionals worked together in a wonderfully efficient way. While this type of cooperation between the medical and dental industries is somewhat rare, in this case it had to work for Hank.
It is possible that Hank’s doctor could have ignored our hunch fearing that he could be sued for listening to a dentist with a possible diagnosis. It’s possible that the doctor could have re-referred Hank back to us with the same diagnosis – complications from dental treatment.
Many things could have gone wrong, delaying Hank’s treatment, but happily, they didn’t. His doctor is one of the good guys. Reflecting on Hank’s case, it is amazing how many things went right and how the communication between Hank’s medical providers mixed with the determination of Dr. O’Neill and the Twin Aspen staff ultimately helped save Hank’s life.
Dentures: They are the end of the line, right? This is where a person’s neglect of their hygiene, or unfortunate genetics, or just plain and simple old age has brought them. No more teeth, just a glass beside the bed with a foaming tablet. Pretty sexy, right?
Well, as the title of this blog suggests, I plan to argue that dentures, can be a very useful, positive, and life-altering treatment. Modern technology and materials have allowed us to create wonderful prosthetic appliances for our patients. So I’ll just come right out and say it: WE MAKE A PRETTY GREAT SET OF DENTURES. We take multiple measurements and consult with the patient about their preferences on appearance and make a custom prosthetic that our patients are often very proud of, even if it’s a secret pride.
In our office, the need for dentures typically arises when a patient’s teeth and their gum tissue is past the point of saving with modern restorative techniques. We try to save every tooth in our patients’ mouths, but there is a point where the bill for these very precise restorations and healing therapies with lasers and space age porcelain becomes unrealistically high.
And what if the patient either has a degenerative disorder, or just doesn’t care to use a toothbrush? Will you be repeating these same restorations 5-10 years later with the same unrealistically high price tag? Of course not.
Meanwhile, the bacteria and other bugs in the hypothetical patient’s mouth are entering the bloodstream and circulating around the body. There is often an odor associated with this type of dental decay, and heaven knows, most likely, this person is not winning a beauty contest any time soon. So the modern dentist is in a quandary at this point. If the dentist tells the patient that he/she ought to consider dentures, they’re going to be aghast, and if the dentist gives them the estimate for a full restoration, they’re liable to stand up, slap the dentist, and storm out of the office!
These wonderful transformations that you see on television, when outfits like those big implant offices are buying up swaths of paid programming, are hardly ever shown to be denture cases, but here’s the dirty little secret: They essentially are. Check these babies out:
These are the dentures of the future! Implant supported, full arch dentures. Just look at them. They are very pretty. They are very natural looking and feeling. They are held tight into your mouth on 12 precision placed titanium implants, 6 on the top, and 6 on the bottom. Hey, if you’re going to pull all of your teeth, this is the way to go. The advantages are very clear for this type of treatment. Your bone around the implants tends to do better. If you keep everything clean and tidy, you keep the bone that you have, instead of it eroding away so that you look like this:
What businesses like those big implant offices don’t tell you during their daily 20 minute infomercial is that this treatment, from start to finish, these amazing makeovers take more like six months instead of one day, and cost somewhere around $35,000. They also don’t tell you that every 6 months that you should schedule a cleaning that, at present, costs about $700. This is not a service that those big implant offices provide, so you’re on your own. This 6 month appointment is for another dentist to unscrew these awesome little marvels of dentistry from your skull for thorough cleaning.
So what do you do O, hypothetical patient with the bad teeth? You’re mouth is an unhealthy bacterial orgy of pain and dysfunction and not too pretty to look at, and you’re facing a $35,000 bill!
Here’s what we do: Before we even start talking about price, we ask our patients questions. We ask important questions like, “What’s more important to you, smiling or eating? What’s the thing that bothers you the most regarding your current condition? Do you think you’ll be able to perform regular maintenance and cleaning on your appliances or restorations?”
From just sitting down and finding out what is most important, Dr. O’Neill usually comes up with more than one plan to suit your specific needs, and it is usually not, “Let’s pull all of your teeth and put 12 implants in.” We use a mixture of denture, bridge, and implant technology to suit the patient’s needs so that the $35,000 bill transforms into something more realistic. Some people need that much dentistry, and some people don’t, here is one such story:
This is Wanda.
Wanda no happy.
Would you like to know why? She has some dentures that she refuses to wear because they don’t fit right, so she can’t chew with them, and they look something like this:
Which is pretty sad, because one of the first things that Wanda brought with her into our clinic was this picture:
Hubba hubba! This was to show us what actual teeth looked like, and judging from her last experience, I don’t blame her. When I first talked to her daughter on the phone, I could tell she was distraught. She was just handed an estimate for Wanda’s new dentures that totaled just over $20,000 and wanted to know what we would charge for such a service. I furrowed my brow and started to tappity-tap on the front desk’s computer knowing full well that even if you coated a new pair of dentures in gold, they wouldn’t be THAT much!
Wanda’s daughter began to reveal the dentist (who incidentally is from a local practice that makes wonderful dentures) and the services and prices that they were charging. The treatment plan, quite frankly, was a Maserati of a treatment plan. I asked a few questions about what was important to Wanda, and we estimated that we could do something similar for a little less than half the price. So check it out:
We got done, and suffice it to say, the results were somewhat emotional. Wanda was happy, her daughter was happy, and we were happy to help, because WE MAKE A PRETTY GREAT SET OF DENTURES, yes we do. When I think of the things that Wanda (Who is an amazing and fantastic lady, by the way. Just in case you couldn’t tell!) was struggling over and doing without, I get a little emotional thinking about how positively this has affected her life. Look at that smile! The world is a better place with it than without it!
So, even though dentures are often not the ideal, they can change your life if you need them, and there are many different ways to implement them for a healthier and happier lifestyle.
Interesting changes at your favorite dental clinic, ladies and gentlemen. Our neighbor dental clinic that spent so many years sharing office space with us is gone and we have decided to move in to their side of the building, expanding our practice by four more operatories!
There is a lot of work that is going into cleaning up the now-vacated side of our practice, and as we were hauling away a film processor for film-based bitewing x-rays, it occurred to me the stark difference in the level of technology used between our two offices that coexisted for so many years.
We have been taking digital x-rays for seven years! That’s almost a decade! Here’s this other dental office right next to us still using film! The benefits of digital x-rays are clear to me: There is less radiation, it takes one/tenth the time to complete a full series of x-rays, the sensors are rounded and smooth and more comfortable, the diagnostic imaging is superior and instantaneous, and copies are available immediately.
For me, all of this translates to this: Our patients will appreciate the time we have saved them, the superior diagnostic image we have taken and, most importantly, the pokey-cheek pain that we did NOT cause them taking a simple x-ray. This is an obvious win-win, right?
So I asked myself, “Self…Why don’t all dental clinics buy into this technology thing?” I don’t think that the answer is ever very simple. I hear a myriad of excuses when some of my fellow dentists are confronted with new technology, but mostly, it is fear of change. “If it isn’t broke, why fix it?” Right? Why should Dr. Pokey X-Ray take his valuable time to learn a new process or piece of technology when what he’s doing works well enough to keep him on the golf course 3 days a week?
Maybe he’s right. It definitely works for his bottom line. After all, he doesn’t have to spend the money and time to upgrade, but what about his patients? New technology, for me, is a point of pride. It tells our patients that we care enough to inconvenience ourselves to learn a new process, spend some money and time and grow so that our patients come out of our clinic with huge smiles on their faces.
We are fully aware that the dentist is not a fun place to be, but if I can buy something or learn something that effects one patient in such a way to recommend us to a friend or neighbor, to say things like, “You won’t believe this, but I actually ENJOY my visits to the dentist!” I know I’m doing the right thing, and Dr. Pokey X-Ray could take a page from our book.
On that note, check this baby out:
This is the Sirona Galileos, a 3-D cone beam X-Ray device. It creates a 3-D image of your skull and teeth.
This is the image that we worked with previously.
This is the image we work with now.
This image can be rotated, sliced, zoomed and creates a diagnostic and surgical guide that is positively unmatched in detail. If the first image up there was Apollo 11, this one here is the Starship Enterprise. This is the type of X-ray machine that those implant specialty places such as Clear Choice use to place precision implants, except this ours is newer. (Heh. Heh.)
While other clinics will slowly get on board with this technology, we are the first in this area to have it, and while we’ve only had it a month, it has proved invaluable in diagnosing persistent problems that older x-ray technology might have missed, has allowed us to surgically extract impacted wisdom teeth and place precision implants. It’s, quite frankly, amazing.
Often times, dentists will refer their patients to a custom head and neck x-ray company to obtain a scan such as this to do specialty work. We have this baby in-house, and our patients have the luxury of getting a full scan as our standard of care. Next time you’re in the office, have Mike show it to you. We have seen the future, and it is us!
Well, there has been some stress and sadness around the clinic lately as the loan for our brand new building fell through leaving us in the lurch for a new place to expand to. We reported almost three years ago that we were breaking ground on our new building and that, unfortunately, was just about the only thing that happened. There is a hole in the ground where that building was to be built. That hole has remained the same for about 3 years! Unfortunately, the great thing about the location of the now defunct building project was that it was essentially right next door to our current location at 11031 S Pikes Peak Dr, in Parker. Now, if we move, we will have to move a little farther away from our current location, so we’ll keep you posted on any changes.
We still plan to take our clinic to a newer and larger location. In some respects, our technology has outgrown our practice. We have lasers and Cerec crown milling units and surgical operatoratory equipment that we are constantly trying to fit into the small rooms in our practice. We have an amazing massage chair that we are using in our waiting room presently, but we would eventually like to have one of these amazing chairs in a “Dental Spa” room, where we would do whitenings while our clients relax in the cloud-like comfort of the Inada Sogno Dreamwave. If you haven’t been in to see it, Google it. It’s the mother of all massage chairs! Or watch this:
Anyway, we’re in the market for a new building and hopefully we can find one with some nice big windows and more space for all our gadgets and gear. Most of our patients will agree that the reason we are excedingly efficient and comfortable is that we spend a lot of money on the newest and latest technology. Speaking of which watch this: (This is cool news story. It summarizes of some of the painless technology available to you!)
This is one of the first videos that we have seen that mentions ICON. ICON is a chemical filling! Kids! NO DRILLS! Did you know that we provide the ICON Infiltration Concept treatments (The no drill filling.) and possess all the gadgetry, including the lasers, that are mentioned here in this video. On your next appointment, be sure to ask about any of these treatments involving ICON or the laser if you are curious. Often times these treatments are available for a more comfortable trip to the dentist!
