Thursday, March 26, 2015

Wisdom Teeth

People often ask me if they should have their wisdom teeth removed. Some question if it's really necessary. The basic answer is that not all wisdom teeth need to be removed, but most do.

Dentists refer to wisdom teeth as third molars. We call the first big tooth a first molar. The next one is a second molar and so forth.

If we look at skulls from 10,000 years ago, it was quite common to have a fourth molar. Our diets have changed from when humans were nomadic hunters to when they settled in agricultural civilizations. When our diets softened, the human jaw eventually became smaller. We typically now only have 3rd molars. Fourth molars are now very rare.

In many cases, the size of our jaws are too small to accommodate the 3rd molar. So what is the significance of having a smaller jaw? Well, the 3rd molar is the last tooth to develop and come into the mouth. When there isn't adequate room, several things can happen. One, they don't come in at all because they are crowded out by the other teeth. Two, they come in part of the way. Three, they come in crooked and are extremely difficult to reach with a toothbrush. 

Occasionally wisdom teeth come in straight and are accessible with a toothbrush. If this is the case, then the removal of the wisdom teeth is completely unnecessary.

Decay on posterior surface of second molar
So why do wisdom teeth need to be pulled? People including dentists used to believe that wisdom teeth make the other teeth crooked. This isn't the reason why most of them need to be extracted. The main reasons for removal of wisdom teeth are infection or potential infection of the gums and bone. They are also removed when there is decay on the wisdom tooth itself or on the surface of the tooth that it makes contact with since it is a difficult area to reach.

Discuss concerns with your dentist. I have extensive training in surgery so I extract tons of wisdom teeth. Most dentist however do not feel comfortable with extracting wisdom teeth and will often refer to oral surgeons. They can be extracted at any time in adulthood. I typically prefer to extract them in patients between 18 and 25. This is an ideal time because of the relative ease of the procedure and recovery of the patient. 

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

Friday, March 13, 2015

Dentures.....You Don't Have to Wear Them!

Grandma doesn't have to wear a denture anymore!

When I was a kid my Grandma and Grandpa always took their teeth out night before they went to bed.  As a child, I thought that was just what happened when you got older. Many of us still have that image of “Mrs. Claus” grandmas in our head, but those days are long gone.  Today’s retirees are fit, active, and vibrant! Why shouldn’t their teeth reflect that? With the advances in dental technology and knowledge there is no reason why anyone needs to lose their teeth as part of “normal” aging! Let me repeat that… With proper preventative and restorative treatment, hygiene, diet and habits there is no reason a person should lose their teeth as they age.  

I am frequently surprised by the amount of people who don’t realize how valuable their teeth really are.  This sometimes happens in my office… a patient will have the option of restorative treatment for their tooth that will allow them to keep that tooth, but will want an extraction. To me, extracting a tooth unnecessarily is like amputating a finger, because you have a hangnail that is bothering you.  We don’t expect to lose our fingers as we age, why do we expect to lose our teeth? I realize that people elect for extraction most of the time because of cost.  However, while the short-term cost of an extraction can be lower than the restorative option, the long-term costs are typically more expensive.  Often times, the cost of replacing a tooth and maintaining that replacement can be significantly more expensive than the alternative option of restoring the tooth to begin with. 

You might be saying, “But, the tooth is in the back of my head.  Nobody sees it when I smile. Why should I replace it?” This is true. Cosmetically, it is not as difficult to lose a back tooth, but let’s remember our mouth is the beginning of our digestive system and its main function is to allow us to eat and nourish our bodies.  Good nourishment, exercise and having an intact immune system are keys to aging well. 

Supraeruption on top back tooth
 Let me explain the domino effect that happens when just one tooth is extracted.  When a tooth is extracted and not replaced with anything it can be compared to pulling a fence post out of the ground and not back filling the hole with dirt. What happens over time is the adjacent teeth will start to tilt or drift toward the open area where the tooth use to be.  Like soil that erodes when grass is not planted, bone starts to recede in a process known as resorption. The opposing tooth (if you are missing a lower tooth this would be tooth directly above it) will start to supraerupt, When there is not an opposing tooth every time you bite, chew, or just shut your mouth there is no equal and opposite force and the tooth starts to erupt more. Your jaw muscles are some of the strongest muscles in your body, when teeth are missing there are fewer teeth to take the force of those biting forces, this starts to take a toll on the remaining teeth, and thus begins the path towards dentures. However, if a tooth cannot be restored and saved there are replacement options that will stop this domino effect and can keep you out of dentures! (See my previous blog: Implants) 

Note the bone loss and drifting around the extractions
If you are wondering, “what’s so wrong with dentures?’ Just ask somebody who has them and they will tell you.  Most people don’t like dentures.  They don’t like taking them out at night.  They don’t like how they look without their dentures.  They don’t like eating with the hard plastic pieces in their mouth.  Many of my patients complain about not being able to tell the temperature of their food or their food not tasting right. Nobody really loves their dentures.  Moreover, properly fitted and maintained dentures are not cheap.  Dentures need to be adjusted at least once a year and should be replaced every 5 years, earlier if needed.  When adding in the cost of cleaners and adhesives, the cost is still quite considerable.  Thus, long-term costs end up being more than the restorative work that could have saved their teeth. 

The good news is that YOU DON’T HAVE TO LOSE YOUR TEETH! Advances today can help you keep your teeth for your whole life.  It’s time to re-think how we think about dentistry and what we think about dentures! 

Co-authored by Carrie Owens

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

Thursday, March 5, 2015

Dental Phobia

Approximately half of the US population will not make routine dental visits. They will only visit a dentist when there is an emergency. There are many reasons for this. One of the biggest reasons is that patients are simply scared. Visiting the dentist doesn't have to be painful nor stressful.

I often hear new patients state that they hate dentists. They tell me it's nothing personal.  Many expect their experience will be horrific. This is almost never the case. The vast majority of our patients soon realize that they had nothing to be scared of.

A relaxed and comfortable child
Why do some people hate visiting the dentist? Well, we often hear negative comments in the media about horrific or potentially horrific root canals. They'll say that some upcoming event may be like pulling teeth. Often times they'll cite negative childhood experiences. In many cases, some people play one-upmanship games as to whom has had the worst dental experiences. Many times, parents will give their children bad vibes about going to the dentist and thereby influencing and sabotaging their child's upcoming dental visit. They don't do this intentionally. They'll transmit their own fears onto their children with non-verbal communication. Parents that are fearful of dentists almost always have children that are fearful of dentists. It's noteworthy to mention that parents that have good feelings about dentistry rarely have children that are fearful of dentistry.

We can't just tell people to not be fearful. It doesn't work. We have to prove to them that what we do does not hurt. As I mentioned before, root canals have a bad reputation. People will wait to come in only when they are in significant pain. In some of these cases, they will need to have a root canal to salvage the tooth. They'll associate the pain and the root canal and assume that root canals hurt. But just like any other procedure, they don't hurt.You don't have to be tough, you just have to be numb.

So what can we do if we can't change your mind about dentistry? SEDATION! This option will allow the super scared patients to address their oral needs in comfort. I will discuss sedation in a separate blog.

The very sight of a needle can be incredibly scary for some people. Many dentists now offer painless injections using computerized anesthetic technology.  The equipment used in computerized administered anesthetic looks like a ball point pen and it delivers a very slow and controlled dose for a painless (or nearly painless) experience.

In conclusion, you don't have to be scared. If you are scared, sedation is an option that will allow you to address your oral health. The demeanor and actions of the dentist and his team are also important. Go forth and get your mouth in shape.

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