Thursday, February 28, 2013

Bone Graft

I have family that lives all over the world and am often asked for advice over the phone. My cousin that lives in Los Angeles was recently informed that she has a bone defect and will be undergoing a bone grafting procedure. She asked if and why she needed a graft. Unfortunately, this is like diagnosing a car problem over the phone. So for her benefit, I am writing in general terms about bone grafts.

What is a dental bone graft? There are many different types. Basically it's bone or bone-like material, or bone regeneration inducing materials. We place them in bony defects. The grafts can be one's own bone, from another human, from animal bone, synthetic bone or collagen based materials that promotes bone growth. Each material has it's advantages.

So why do we place bone grafts? Generally, there is either a bone defect or there is insufficient bone. This can occur for a variety of reasons. For example, trauma, periodontitis, and tooth loss to name a few.

Bone loss from trauma and localized periodontitis

Trauma is self-explanatory. Some forms of tooth trauma are preventable such as in athletics. Therefore you should always wear an athletic mouthguard in sporting events in which trauma is highly likely.

There is often significant bone loss in people suffering from periodontitis. This is from chronic inflammation and infection of the gums and bone.

What most people do not realize is that when teeth are lost, bone is also lost; and as time progresses, more and more bone is lost since the bone is not in function.

The loss of bone shortens the face and lip support is lost.

Bone loss from missing teeth and periodontitis

Bone grafts allow for more predictable and ideal outcomes. They allow us to salvage a tooth (teeth), they improve the fit and comfort of dentures, they allow us to place implants and allows us to get a more aesthetic result.

Bone grafts allow placement of implants
No graft placed resulting in unaesthetic defect

If you have bone loss or a bone defect, discuss potential options with your dentist. He or she should help you make a decision that is right for you.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Monday, February 18, 2013

Sodas: The Good, The Bad and the Ugly

I'm in DC visiting my brother right now. I've observed the dietary habits of my eleven year old nephew these past few days. I'm concerned with what I'm seeing. I mentioned some things about the sodas he's been drinking. He asked "what's wrong with drinking sodas?"

In the last 100 years, sodas have become one of the most commonly consumed beverages. They are readily available and can be found anywhere. They are available in every store, restaurant school and public venue.

The reason why they have become so ubiquitous is because they taste very good. I enjoy an occasional soft drink. There's nothing wrong with drinking them on occasion and infrequently.

Some cities have enacted laws to curb their consumption. New York City for example has banned the sale of sodas in containers larger than 16 ounces. Opponents have argued that individual rights and choices are being violated. I will not get into the legal aspects of this. I don't believe that this is something the government should be involved with anyway. I will simply state the facts.

So what are the issues with sodas? They taste so good. Well, here are some health concerns:
  • Obesity
  • Diabetes
  • Osteoporosis
  • Tooth decay
  • Strokes
  • High Cholesterol
  • Gastro-esophageal reflux disease
The reason why they are so bad for you is primarily because of the high concentration of refined sugars and because of the the acidity of these products. There are different biochemical mechanisms why the issues mentioned above are more likely. The mechanisms are beyond the scope of this blog. I may discuss them in more detail in future writings.

A poster I found online. I'm not sure about the asthma link.

These are some of the issues with regular sodas. I'm not even talking about the popular energy drinks. These are certainly much worse for you and account for a dramatic increase in emergency room visits in recent years. Perhaps I'll write about these in another blog.

I hope this provides enough rudimentary information that may help you decide to reduce or eliminate your soda intake. Speak to your health care professional for advice.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Wednesday, February 6, 2013

What is an abscess?

An abscess is a collection of pus. It occurs as a result of an inflammatory response to bacteria, parasites or foreign bodies such as a splinter. It's the body's way of responding to a threat. A large number of white blood cells will be drawn into the area in an attempt to kill or eliminate the threat. A wall of cells forms around the source of infection in an attempt to isolate it. This can occur anywhere in the body.

A tooth abscess is simply an abscess that forms in the jaw bone surrounding an infected tooth. This most commonly occurs when the pulp (the space within each tooth that contains nerves and blood vessels) becomes infected. The bacteria and necrotic tissue then leaches out at the apex of the root. The pulp can become infected when untreated decay, cracks or periodontal disease occur.

You may notice pain when you bite or push on the affected tooth. In many cases the pain can become incredibly severe. Abscesses occur on teeth that are dead. So, you may not notice any temperature sensitivity.

Sometimes you may not experience any pain whatsoever. This occurs when the pus is draining through a "bump" on the gum in close proximity to the root of the tooth. The reason why it may not hurt is because the draining of the pus is preventing the tissues from expanding like a water balloon. It's as if the water balloon has popped. This is good and bad. Obviously it's good because there isn't any pain. But it's bad because people aren't prompted to do anything about it.

Tubes placed to allow drainage

If you suspect that you have an infection, get it checked out immediately. Infections can significantly worsen in an extremely short period of time and can become life-threatening. Yes, life threatening! There are a couple reasons why. First, the swelling can become so severe that it can compromise your airway. Breathing is kind of important. I certainly like to breath. A second reason why it could become life-threatening is because the bacteria is circulating throughout your blood stream. You run the risk of becoming septic. This is when the concentration of bacteria has become so severe that it has overwhelmed your ability to fight it off. People have succumbed to septic shock originating from odontogenic (tooth borne) infections.

There are a several treatment options. If the tooth is salvageable, then simply removing the bacteria and necrotic tissue from within the tooth is indicated. After the internal part of the tooth is thoroughly cleaned out, it is sealed in order to prevent migration of bacteria back into the tooth. We then rely on the immune system and antibiotics to remove the bacteria inside the the bone. Most people refer to this treatment as a root canal. By the way, root canals don't hurt. A second option should only be considered when the tooth is not salvageable. In these cases, the only remedy is the removal of the offending tooth. A third treatment is only necessary when there is significant swelling. Incision of the lump of pus will allow it to drain. It sounds gruesome to cut into a lesion, but patients get significant relief immediately.

Dog afflicted with a tooth abcess

Many people believe that antibiotics alone will solve the problem. This is only a temporary fix. The only solution is the complete removal of the source of infection with either a root canal or an extraction. Antibiotic treatment without removal of the source is encouraging the development of antibiotic resistant strains of bacteria.

As soon as you notice an unusual bump, get this evaluated and treated right away. Delays in treatment can result in dire consequences.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit