Dental implants in patients affected by systemic diseases - By Dr Amir Mostofi -DDS, Dip. (Ortho.), MSc(Implant.)

Dental implants in patients affected by systemic diseases

The exploration of dental implant success among patients burdened by systemic diseases reveals a realm of nuanced considerations, pivotal for optimising patient care and outcomes. Authored by N. Donos and E. Calciolari and published in the British Dental Journal in 2014, this comprehensive review sheds light on the intersection between systemic health conditions and dental implantology, presenting an invaluable resource for dental professionals worldwide.

Systemic diseases, encompassing a wide array of health conditions, often necessitate medications that could influence or complicate the process of dental implant surgery. Understanding the intricate relationship between these systemic conditions and dental implant success is crucial for clinicians, as it aids in the meticulous planning and execution of implant surgeries, ensuring both the safety and well-being of patients. This narrative delves into the evidence surrounding implant survival and success in patients with systemic diseases, offering practical suggestions for clinicians and highlighting areas necessitating further research.

Dental implants represent a cornerstone in the treatment of edentulism, showcasing high survival rates and offering a semblance of natural dentition. The essence of achieving successful implant outcomes lies in judicious patient selection, entailing a thorough medical history evaluation and a comprehensive assessment of the surgical site's complexity. Certain systemic conditions, underscored by varying levels of evidence, have been identified as potential complicating factors or even contraindications to implant surgery. This increasing prevalence of medically compromised individuals seeking dental implants underscores the importance of understanding the impact of systemic diseases and associated medications on both the surgical procedure and the overall treatment outcome.

Among the systemic conditions deemed as absolute contraindications for implant surgery are recent cardiovascular events, recent major surgeries such as valvular prosthesis placement or organ transplants, heightened risk of bleeding, significant immunosuppression, active cancer treatment, and intravenous bisphosphonate therapy. These conditions pose not only a heightened risk of implant failure but also potential grave risks to the patient's overall health.

The review further explores the effect of various systemic diseases on dental implant outcomes, with a focus on bone diseases such as osteoporosis, medication-related osteonecrosis of the jaws (MRONJ), and other less common bone conditions. Osteoporosis, a prevalent bone disease, poses biological plausibility for impaired bone healing around implants, though evidence remains controversial. Antiresorptive medications, particularly bisphosphonates and denosumab, present a risk for MRONJ, influencing implant success rates and necessitating careful patient management.

Diabetes mellitus, characterised by hyperglycemia, has been shown to negatively impact bone metabolism and may impede osseointegration and implant success. The review emphasises the importance of glycaemic control in diabetic patients undergoing implant therapy, alongside the management of other complications associated with diabetes.

Cardiovascular diseases, bleeding disorders, and specific mucosal diseases such as oral lichen planus and ectodermal dysplasia are also scrutinized for their potential impact on dental implant outcomes. The review suggests tailored approaches and precautionary measures for patients with these conditions, aiming to maximise implant success while minimising risks.

The document culminates in general clinical recommendations, underscoring the limited evidence base concerning the effect of systemic diseases on dental implant success. It calls for larger prospective studies to enhance understanding and provide more definitive guidance. Despite a few conditions being labelled as absolute contraindications, the review advises dental professionals to weigh the benefits and risks of implant therapy carefully, engage in interdisciplinary communication, and adopt stringent follow-up regimens for patients with systemic diseases.

In essence, the review by Donos and Calciolari serves as a testament to the complexity of dental implantology within the context of systemic health. It beckons a holistic approach to patient care, emphasising the need for ongoing research, clinical prudence, and a deep understanding of the interplay between systemic diseases and dental implant outcomes.

Understanding Dental Bone Grafts: A Comprehensive Guide - By Dr Amir Mostofi DDS , Dip (Ortho.), MSc (Implant.)

Understanding Dental Bone Grafts: A Comprehensive Guide

Dental bone grafting is a crucial procedure for patients experiencing jawbone loss, which can significantly impact oral health and the success of dental implants. It involves adding bone material to the jaw, which can be sourced from various origins such as the patient's own body, human or animal tissue banks, or synthetic materials. This procedure acts as a scaffold, allowing the patient's own bone tissue to grow and regenerate. Dental bone grafts are often essential for individuals who have lost teeth, are planning dental implant surgery, require dentures, or have suffered bone loss due to gum disease.

Types of Dental Bone Grafts

There are several types of dental bone grafts, each serving a unique purpose:

Socket Preservation: Performed immediately after tooth extraction to prevent socket collapse.

Ridge Augmentation: Enhances the jawbone's width and volume, particularly after long-term tooth loss.

Sinus Lift: Elevates the maxillary sinuses to allow for implant placement in the upper jaw.

Periodontal Bone Graft: Targets bone loss caused by gum disease, providing stability to loose teeth.

Procedure Details

Before the Procedure The process begins with a thorough oral examination and dental imaging to assess bone loss. Based on these findings, a personalized treatment plan is developed.

During the Procedure The procedure involves administering local anesthesia, making a small incision in the gums, and placing the bone graft material in the required area. A membrane may cover the graft for added protection. Finally, the incision is closed with stitches.

After the Procedure Post-surgery, patients might experience pain, swelling, and bruising, which are manageable with pain relievers and possibly antibiotics. It's normal to find small bone fragments in the surgical area during initial healing.

Pain and Sedation Dental bone grafts are generally low in pain. Sedation options vary, from local anesthesia to general anesthesia, depending on the case complexity.

Success and Failure The success rate of dental bone grafts is high, but smoking or certain medical conditions can increase the risk of failure. Warning signs include worsening pain, pus, gum recession, and lack of jawbone improvement.

Risks and Benefits

While generally safe, potential risks include infection, bleeding, nerve damage, and anesthesia complications. The benefits include increased eligibility for dental implants and restoration of jaw structure.

Recovery and Outlook

Recovery varies, typically taking three to nine months for complete healing. Most people can resume normal activities the day after surgery.

When to Contact Healthcare Providers

Patients should watch for severe pain, increased swelling, pus around the grafting site, or fever and contact their dentist if these occur.

Summary

Dental bone grafts are vital for restoring oral health and function in individuals with jawbone loss. They play a critical role in preparing for dental implants and combating the effects of tooth loss and gum disease.

Creating Perfect Dentures at Home with a Dentist Who Comes to You- By Dr Amir Mostofi DDS Dip MSc

Creating Perfect Dentures at Home with a Dentist Who Comes to You

Dentures made in the convenience of one's own home with the assistance of a domiciliary dentist are an excellent option for those who find traditional dental visits difficult. At Clinic for Implant & Orthodontic Dentistry, we specialise in providing denture services that are tailored to the specific requirements of our patients, including those with dementia and other mental disorders. In this exhaustive guide, we will walk you through the various phases of denture creation, from initial consultations to the final fitting, while emphasising the significance of a domiciliary dentist's experience in managing complex cases.

Step 1: Consultations at the outset

The initial consultation is a crucial first stage in the process of acquiring dentures. During this appointment, our domiciliary dentist conducts a comprehensive examination of your oral health and discusses the denture options that best meet your requirements. For a number of our patients, particularly those with dementia, collecting impressions can be difficult. Our experienced domiciliary dentists play a crucial role in the management of such cases. During this phase, we also ensure that all necessary documentation, including consent forms and cost discussions, is completed.

Step 2: Extraction, if Required

When oral health issues are identified during the initial consultation, tooth extraction may be required. To minimise patient distress, tooth extraction is performed with care and frequently in stages. This period, which typically lasts between one and three weeks, allows the mouth to recuperate and reduces swelling, making future dentures fit better.

Step 3: Taking Impressions

Taking accurate impressions of your upper and lower mandible is a crucial step in the fabrication of dentures that fit securely and comfortably. Numerous elderly individuals struggle with thinning jawbones, necessitating the use of specialised impression-taking techniques. Our domiciliary dentists are well-versed in adapting these techniques to individual requirements, thereby ensuring an accurate representation of your mandible and any remaining teeth.

Step 4: Registration of the Bite

At the stage of bite registration, the complex relationship between your upper and lower mandible is established. This procedure enables the dentist to record the precise relationship between your jaws. In addition, during this phase, the colour, shape, size, and quality of the denture teeth are meticulously determined, ensuring that your dentures appear and feel natural.

Step 5: Wax trial dentures

Seeing the wax trial dentures in your mouth is a crucial step in the process of creating dentures. This phase enables both you and the dental technician to evaluate whether the desired aesthetic has been achieved. At this juncture, any necessary modifications can be discussed and implemented. At Clinic for Implant & Orthodontic Dentistry, we prioritise your satisfaction, and alterations are made at no additional cost if necessary.

Step 6: Final Fitting and Adjustments

In the final stage, the completed dentures are adjusted. If significant changes were made during the wax trial denture stage, it may be necessary to repeat appointment 4. We recognise that the process of having dentures fitted can be intimidating, especially for first-timers or those who have had negative experiences in the past. Our dedication to ensuring that you comprehend the procedure and our emphasis on both form and function ensure that you leave with dentures that inspire confidence.

Visits and Problems with Cobalt Chrome Dentures

Generally, between four and seven visits are required to complete a denture, depending on the individual's requirements and complexity. However, cobalt chromium dentures, which contain a metal skeleton, typically require more visits due to the complexity of their fabrication and adjustment. Our skilled team at Clinic for Implant & Orthodontic Dentistry is well-equipped to handle such challenges, assuring the best possible outcome for your cobalt chrome dentures.

Domiciliary dental care for patients confined to their homes or beds

We recognise that not all patients have easy access to dental clinics. For this reason, we offer home visits, also known as domiciliary dental care, to those who are bedridden or confined to their homes. We make the process as convenient and comfortable as possible for patients who can recline in a wheelchair or regular chair with space around the dentist's workspace.

If a patient is completely bedridden and inclining the bed is not an option, we do have a solution. We use intraoral digital scanners as opposed to traditional impression materials, thereby eliminating the danger of material running down the patient's throat and ensuring a safe and efficient procedure.

The conclusion

A personalised and patient-centered approach to dental treatment is the fabrication of dentures in the patient's residence by a domiciliary dentist. At the Clinic for Implant & Orthodontic Dentistry, we strive to make this journey as pleasant and rewarding as possible, particularly for patients confronting unique obstacles. We have the knowledge and skill to create dentures that restore your smile and improve your quality of life. If you would like to schedule an initial consultation, please contact us at 01903-821822. We anticipate serving you and ensuring that your dental requirements are met with the utmost care and expertise.

Dental Care for Elderly Patients with Alzheimer's and Dementia in Nursing Homes: The Importance of Experience and Adaptation- By Dr Amir Mostofi, DDS Dip MSc

Caregiving for geriatric patients with Alzheimer's and dementia in nursing homes presents unique challenges, particularly in the area of dental care. Due to their medical conditions, these individuals frequently experience a variety of dental issues, including tooth decay, periodontal disease, dry mouth, and difficulty chewing and swallowing. This article will explore the significance of dentists who have experience working with this vulnerable patient population and how they navigate the complexities of diagnosis and treatment planning while taking into account their fragility and inability to communicate pain.

Understanding the Dental Concerns of Elderly Alzheimer's and Dementia Patients:

Patients with Alzheimer's disease and dementia are susceptible to a variety of dental issues, including:

Dental Decay: Numerous factors, including poor oral hygiene, consumption of sugary foods, and medication adverse effects, contribute to tooth decay. Additionally, Alzheimer's and dementia patients may have difficulty maintaining appropriate oral hygiene.

Poor oral hygiene can result in gum disease, which can result in discomfort, oozing gums, and even tooth loss. The limited motor skills and cognitive decline of these patients may make it difficult for them to perform adequate oral hygiene.

Reduced saliva production is a prevalent problem among Alzheimer's and dementia patients. As saliva serves to neutralise acids and protect teeth, dry mouth can increase the risk of tooth decay and gum disease.

Cognitive decline and motor skill impairments can impair a patient's ability to correctly chew and swallow. This can lead to malnutrition and pneumonia from aspiration.

Dentists with experience in treating elderly patients with Alzheimer's and dementia play an essential role in providing effective and compassionate dental care. Here's why their experience is significant:

a. Specialised Knowledge: These dentists have an in-depth comprehension of the unique dental issues confronted by Alzheimer's and dementia patients. They are aware of the potential oral health complications associated with cognitive decline and are able to anticipate and proactively address them.

b. Communication and Adaptation: Patients with Alzheimer's and dementia may have difficulty expressing pain or distress; therefore, dentists must be adept at interpreting nonverbal cues and behaviour. Dentists with experience are able to modify their diagnostic methods to guarantee precise evaluations and develop treatment plans accordingly.

c. Fragility and Patient Comfort: The geriatric patients with Alzheimer's and dementia require gentle and compassionate dental care due to their fragility. Dentists with extensive experience are well-versed in handling these patients with care, employing techniques that minimise anxiety and pain throughout the treatment.

d. Collaborative Approach: Dentists with experience in treating elderly patients with cognitive decline frequently collaborate with nursing home personnel and carers. This collaboration assures continuity of care, the exchange of vital information, and the development of individualised treatment plans tailored to the specific needs of the patient.

Importance of Diagnosis and Treatment Planning: Diagnosis and treatment planning for elderly patients with Alzheimer's disease and dementia must take into account their specific circumstances. Dentists must:

a. Conduct a Comprehensive Evaluation: Comprehensive dental examinations and evaluations are essential for identifying existing oral health issues and developing the most effective treatment plans. This evaluation should include a review of the patient's medical history, an assessment of their current dental health, and an evaluation of their oral hygiene practises.

b: Individualised Treatment: Each patient's treatment plan should be tailored to his or her particular requirements and limitations. Dentists must consider cognitive abilities, motor skills, and any medical conditions that could affect the quality of dental care provided.

c. Conservative Approaches: Given the fragility and potential distress of these patients, dentists may, whenever possible, opt for conservative treatment approaches. This may involve prioritising pain management, addressing essential issues first, and implementing preventive measures to ensure long-term oral health.

Dental care for Alzheimer's and dementia patients residing in nursing homes requires specialised knowledge, flexibility, and a patient-centered approach. Dentists with experience treating this population have the knowledge and skills necessary to provide comprehensive care while ensuring their patients' comfort and well-being. By recognising the significance of their role and adopting appropriate diagnostic and treatment planning strategies, dental professionals can substantially contribute to enhancing the oral health and overall quality of life of Alzheimer's and dementia patients.