Do your gums look red and swollen? Do your gums bleed when you brush your teeth? If so, its looks like you’ve been a victim of periodontal disease. It’s estimated that nearly 75% of American have some form of periodontal disease. Periodontal disease, also known as gum disease, is a chronic inflammation and infection of the gums and surrounding tissues that support your teeth.

Gum disease is mainly caused by improper oral hygiene. If you aren’t keeping up with a proper oral hygiene you’re allowing the bacteria in plaque, that sticky colorless film, to remain on your teeth, only to infect your gums. The plaque will build up and the bacteria will infect not only your gums and teeth, but your connective tissue and bone that supports your teeth as well. There are three stages of periodontal disease: gingivitis, periodontitis and advanced periodontitis. Periodontal infections often exhibits worsening symptom as time goes on.

Gingivitis- Gingivitis is the mildest form of gum disease. It causes your gums to become red, swollen and bleed easily. At this stage there’s usually little to no discomfort. This is the only stage of gum disease that is reversible since it has yet to affect the connective tissues and bone. Only reversible with professional treatment and proper oral hygiene.
Periodontitis- When gingivitis is untreated it will progress to periodontitis. At this stage the supporting bone and tissues are irreversibly damaged. Your gums start to separate from the teeth, then form pockets that become infected. As periodontitis progresses, the pocket deepen and more of the gum tissue and bone are damaged. With proper treatment and improved oral hygiene you can typically prevent further damage.
Advanced Periodontitis- Advanced periodontitis is the final stage of gum disease. At this point the supporting bone and tissues are destroyed, which can cause your teeth to shift, loosen or even fall out. This can affect your bite, and if extensive professional treatment can’t save you teeth, your dentist may have to remove them.

Gum disease can occur at any age, but it’s more common in adults. If gum disease is detected in its early stages, it can be reversed. If you condition is more advanced, professional treatment in the dental office will be required.

Be sure to stick to a good oral hygiene routine and visit your dentist regularly for checkups to prevent gum disease. If you suspect you have gum disease, contact Berry Hill Dentistry at 516-921-1717 or visit our website at www.berryhilldentistrypc.com to learn more about gum disease.

When you think of a root canal, does it send chills down your spine? If so, you are not alone. Root canals are considered to be the most feared dental procedure around.

Root canal therapy has received such a bad reputation over the years, but fact is, root canals aren’t quiet as scary or painful as one may think. With all of the technological advances in dentistry, root canal therapy can now be comfortable and quick.

I’m sure you’ve all hear all of the myths about root canals, which have lead you to believe the contrary, but it’s about time that these root canal myths are put to rest. While told being you need a root canal can be frightening, rest assured that most of the things you’ve heard about root canals are likely untrue.

Myth #1: A root canal is painful.

Root canals are done to relieve the pain. A local anesthetic is used to numb the tooth and surround area during the procedure. Root canal therapy is virtually painless. However, the same thing cannot be said for an infected tooth, which is likely what lead you believe that root canals were.

Myth #2: Root canals are only required when you experience tooth pain.

Some teeth that require root canals don’t always cause pain. In some cases, teeth that have already died may need root canals to prevent it from becoming infected. There are many tests that your dentist can run, like percussion testing and temperature testing, which allows them to confirm that a tooth is dead and needs root canal therapy.

Myth #3: A root canal means having the roots of my tooth or my tooth removed.

The entire point of root canal therapy is to save a tooth, not extract it. The canals inside of your tooth are cleaned and scraped. To ensure that all of the bacteria has been removed, your dentist will remove the nerve tissue and pulp along with some of the inside part of your root. Your tooth and tooth roots are not removed.

Myth #4: Root canals causes illness

This common myths indicates that root canals can lead to negative health risks, such as heart disease, kidney disease or arthritis. The myth stems from research done by Dr. Weston Price almost a century ago, and has since been debunked. Not only is root canal therapy safe and effective, it eliminates harmful bacteria from the tooth, improving your oral health and overall health.

Myth #5: Having my tooth removed is a better alternative to root canal therapy.

Having a tooth pulled is traumatic procedure that actually allows harmful bacteria to enter the blood stream. There’s also nothing that can completely replace your natural tooth, and replacement alternatives require elevated costs. Not only is root canal therapy cost effective, it allows you to keep your natural tooth.

 

These root canal myths have mislead several people over the years, don’t let them steer you away from having both good oral health and overall health.

If you’re concerned that you may need a root canal, contact Berry Hill Dental at 516-921-1717 to schedule a consultation today. For additional information regarding root canals visit www.berryhilldentistrypc.com.

Remodel – Customized Breast Enhancement – Let the Lucas Center, Plastic Surgery offer you a customized approach.

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Are you a breast augmentation patient who either had surgery in the late 1990’s during the silicone false claim crisis or a patient who was misled into thinking that saline is an equivalent to the modern silicone gel implants? Or you were a fan of the 1990’s Bay Watch series and at the time felt that Pamela Anderson’s breast shape and size was the ideal standard. Just like houses with bathrooms and kitchens that seem dated after ten to fifteen years, requiring attention to remodeling to keep the house fresh and modern, so are breast enhancements. Stylistic changes and technology advancement of breast implant materials and fat grafting have come a long way, making your old decisions for your breast enhancement seem out of date and behind the times. Just like clothing styles and cars from the 1990’s seem dated now, so is the oversized sagging breast with saline implants, complete with rippling and pleating requiring an industrial strength bra to keep them in place. Ladies you don’t have to compromise any longer. Does your kitchen and bathroom still have brass fixtures? Then you should not have to put up with these heavy oversized misshapen breasts that are neither comfortable nor stylish. Consult a board certified plastic surgeon to review your options today.

Options not available 10-15 years ago.

First and foremost a modern plastic surgeon who has kept up with the current techniques and evidence based medicine related to breast enhancement will perform a complete tissue based diagnosis of the breast. Gone are the days hopefully of a surgeon standing in front of you without any measurements and eyeballing a one size fits all approach and telling you he or she will make you a “D” cup and you will love it. The facts are the 1990’s approach of shoving in multiple sizers or placing the largest possible smooth round saline implant under the breast without individualizing fit based on the patients breast tissue parameters lead to a revision rate of breast enhancement of 25% which manufacturers submitted to the FDA in the early two thousands. If gallbladders and knee replacements had that high of a revision rate insurance companies and Medicare would have a moratorium on the procedures. Fortunately our though leaders in plastic surgery have evaluated and re-engineered the procedures to minimize complications of capsular contracture, incorrect size placement, and avoidance of soft tissues being permanently thinned and distorted requiring complex revision procedures to correct poor outcomes. Most importantly the surgeon needs to determine the correct diameter of the devise both in width and height. The soft tissue thickness of the upper and lower pole (area above and below the nipple) is important as well as the tissue length from the fold to the nipple-areolar complex. The overall geometry of the chest and breast bone need to be noted requiring modification of procedures. It does not take an engineer to understand a women who is five feet tall and one hundred and ten pounds with a relatively short breast fold to collarbone and narrow chest with minimal breast tissue cannot have the same implant placed as a five feet, nine inch tall female with one hundred and sixty pounds with a wide frame and a large “B” cup breast. Unfortunately some surgeons did feel this way and some still do detracting from a customized approach that minimizes revision rates and unhappy patients.

Three dimensional imaging such as the Vectra has revolutionized my patient education and consultation for breast enhancements.  We can produce a very representative imaging of a women’s breast and torso and with computer simulation can demonstrate how any implant available in the United States can appear with your tissue parameters and allow the patient to see the proposed outcomes before a decision is made. This avoids wrong size surgery and allows patient expectation to be matched thus avoiding revision surgery. However the technology does not exist to provide this information if a breast already has an implant. This simulation also allows patients to see the limitations of an implant alone based on enhancement depending upon the individual’s soft tissue or bony deficiencies. This is where the discussion of fat grafting can be very beneficial to hiding the anatomic variances such as wide sternums that produce wide cleavages to provide an improved outcome and patient satisfaction. We can also demonstrate using a slightly smaller implant which has less weight and drag on poor quality soft tissue and supplementing the overall volume with large volume fat grafting to minimize implant malposition due to failure of soft tissues holding the implant in place.

Breast implants themselves have evolved over the last few decades. Today plastic surgeons can offer patients more options in size, shapes, and types of silicone than ever before also allowing for a more customized approach. I particularly have found the fifth generation silicone gel implants (Gummy Bears) to be particularly useful in petite women and very tall, thin women to exploit the positioning of the implant with differential heights and widths to maximize outcomes. I never use saline implants because they put too much strain on tissues, have excessive rippling, only can function as a round devise and can spontaneously deflate creating emergency surgical situations for patients. Based on clinical evidence, texturing of the implant can reduce capsular contracture, minimizing migration of the devise laterally over time and can maintain pocket size better than a smooth devise. Downsides include late seromas (fluid collections) and possible linkage with a very rare but easily treated form of implant related lymphomas. In my mind the benefits outweigh the small risks with texturing.

Lastly, the techniques of the actual surgery have evolved in the last ten years. These techniques include more precise, less traumatic dissections of the breast pocket, avoiding biofilm (a leading cause of capsular contracture) by minimizing the manipulation of the pockets with implants, and no touch techniques with the surgeon’s hands or patients’ skin on the devises that can minimize revision rates and improve outcomes.

In conclusion if you are a breast enhancement patient and are less than satisfied with your outcome don’t learn to live with compromise explore the modern day breast augmentation procedures available at board certified plastic surgeon’s offices around the country. Remember cell phones, cars, computers and styles have all rapidly evolved for the better compared to the 1990’s refresh yourself you will be glad you did.

For further information into customized breast enhancement procedures please visit www.thelucascenter.com or contact The Lucas Center, Plastic Surgery, PLLC in Knoxville, Tennessee 865 218 6210.

 

Remodel – Customized Breast Enhancement – Let the Lucas Center, Plastic Surgery offer you a customized approach.

FullSizeRender (005)

Are you a breast augmentation patient who either had surgery in the late 1990’s during the silicone false claim crisis or a patient who was misled into thinking that saline is an equivalent to the modern silicone gel implants? Or you were a fan of the 1990’s Bay Watch series and at the time felt that Pamela Anderson’s breast shape and size was the ideal standard. Just like houses with bathrooms and kitchens that seem dated after ten to fifteen years, requiring attention to remodeling to keep the house fresh and modern, so are breast enhancements. Stylistic changes and technology advancement of breast implant materials and fat grafting have come a long way, making your old decisions for your breast enhancement seem out of date and behind the times. Just like clothing styles and cars from the 1990’s seem dated now, so is the oversized sagging breast with saline implants, complete with rippling and pleating requiring an industrial strength bra to keep them in place. Ladies you don’t have to compromise any longer. Does your kitchen and bathroom still have brass fixtures? Then you should not have to put up with these heavy oversized misshapen breasts that are neither comfortable nor stylish. Consult a board certified plastic surgeon to review your options today.

Options not available 10-15 years ago.

First and foremost a modern plastic surgeon who has kept up with the current techniques and evidence based medicine related to breast enhancement will perform a complete tissue based diagnosis of the breast. Gone are the days hopefully of a surgeon standing in front of you without any measurements and eyeballing a one size fits all approach and telling you he or she will make you a “D” cup and you will love it. The facts are the 1990’s approach of shoving in multiple sizers or placing the largest possible smooth round saline implant under the breast without individualizing fit based on the patients breast tissue parameters lead to a revision rate of breast enhancement of 25% which manufacturers submitted to the FDA in the early two thousands. If gallbladders and knee replacements had that high of a revision rate insurance companies and Medicare would have a moratorium on the procedures. Fortunately our though leaders in plastic surgery have evaluated and re-engineered the procedures to minimize complications of capsular contracture, incorrect size placement, and avoidance of soft tissues being permanently thinned and distorted requiring complex revision procedures to correct poor outcomes. Most importantly the surgeon needs to determine the correct diameter of the devise both in width and height. The soft tissue thickness of the upper and lower pole (area above and below the nipple) is important as well as the tissue length from the fold to the nipple-areolar complex. The overall geometry of the chest and breast bone need to be noted requiring modification of procedures. It does not take an engineer to understand a women who is five feet tall and one hundred and ten pounds with a relatively short breast fold to collarbone and narrow chest with minimal breast tissue cannot have the same implant placed as a five feet, nine inch tall female with one hundred and sixty pounds with a wide frame and a large “B” cup breast. Unfortunately some surgeons did feel this way and some still do detracting from a customized approach that minimizes revision rates and unhappy patients.

Three dimensional imaging such as the Vectra has revolutionized my patient education and consultation for breast enhancements.  We can produce a very representative imaging of a women’s breast and torso and with computer simulation can demonstrate how any implant available in the United States can appear with your tissue parameters and allow the patient to see the proposed outcomes before a decision is made. This avoids wrong size surgery and allows patient expectation to be matched thus avoiding revision surgery. However the technology does not exist to provide this information if a breast already has an implant. This simulation also allows patients to see the limitations of an implant alone based on enhancement depending upon the individual’s soft tissue or bony deficiencies. This is where the discussion of fat grafting can be very beneficial to hiding the anatomic variances such as wide sternums that produce wide cleavages to provide an improved outcome and patient satisfaction. We can also demonstrate using a slightly smaller implant which has less weight and drag on poor quality soft tissue and supplementing the overall volume with large volume fat grafting to minimize implant malposition due to failure of soft tissues holding the implant in place.

Breast implants themselves have evolved over the last few decades. Today plastic surgeons can offer patients more options in size, shapes, and types of silicone than ever before also allowing for a more customized approach. I particularly have found the fifth generation silicone gel implants (Gummy Bears) to be particularly useful in petite women and very tall, thin women to exploit the positioning of the implant with differential heights and widths to maximize outcomes. I never use saline implants because they put too much strain on tissues, have excessive rippling, only can function as a round devise and can spontaneously deflate creating emergency surgical situations for patients. Based on clinical evidence, texturing of the implant can reduce capsular contracture, minimizing migration of the devise laterally over time and can maintain pocket size better than a smooth devise. Downsides include late seromas (fluid collections) and possible linkage with a very rare but easily treated form of implant related lymphomas. In my mind the benefits outweigh the small risks with texturing.

Lastly, the techniques of the actual surgery have evolved in the last ten years. These techniques include more precise, less traumatic dissections of the breast pocket, avoiding biofilm (a leading cause of capsular contracture) by minimizing the manipulation of the pockets with implants, and no touch techniques with the surgeon’s hands or patients’ skin on the devises that can minimize revision rates and improve outcomes.

In conclusion if you are a breast enhancement patient and are less than satisfied with your outcome don’t learn to live with compromise explore the modern day breast augmentation procedures available at board certified plastic surgeon’s offices around the country. Remember cell phones, cars, computers and styles have all rapidly evolved for the better compared to the 1990’s refresh yourself you will be glad you did.

For further information into customized breast enhancement procedures please visit www.thelucascenter.com or contact The Lucas Center, Plastic Surgery, PLLC in Knoxville, Tennessee 865 218 6210.

 

All plastic surgeons undergo rigorous training to perform the core plastic surgery procedures. They attend four years of medical school to earn their M.D. degree and often residency training at a hospital which focuses on surgical training in order to perform certain types of surgery life facelift surgery. Some plastic surgeons continue on with additional residency training in areas that are more specific areas such as ear nose and throat or general surgery which focuses on techniques for a wide range of procedures that are not aesthetic in nature.

Facial plastic surgeons focus their training on the anatomy, physiology, and pathology of the nose, face, head, and neck structures. They are likely to have completed 1-2 years or more of general residency training and 4 years of specialty training in head, neck and facial plastic surgery. Plastic surgeons focus on 3-5 years of general surgery training and 2 or more years of plastic surgery training. Plastic surgeons focus their training on all areas of the body. There are some expectations to this rule as of late because board certification and continuing education has become a hot topic from both consumer and professional prospectives.

Both plastic surgeons and facial plastic surgeons may take continuing education courses to further build on their skills and techniques used in nose surgery. Continuing education is an important factor to explore when considering nose surgery today. Continuing education courses are usually very specific. Such courses may be designed to address wound healing issues. Other courses may be focused on the anatomical dynamics of the nose.

In fact, it is highly advantageous to consumers that surgeons must obtain hospital privileges to perform nose surgery at a hospital. In order to obtain hospital privileges, plastic surgeons must have their skills and educational background reviewed by a panel of peers. So, it's wise to ask your nose surgeon if he or she has hospital privileges to perform nose surgery. Finally, some plastic surgeons that focus on nose surgery demonstrate their expertise in this area by publishing their own papers in trade journals to better educate other surgeons about nose surgery. They may lecture about the various aspects of nose surgery.

Since the nose brings balance and harmony to the face, it is an important feature for plastic surgeons to consider with great care when it comes to nose surgery. It is equally important for people to consider the credentials of the plastic surgeon when deciding onnose surgery.

For more information on facial plastic surgery contact Carmel Valley Facial Plastic Surgery located in San Diego California.

 

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jaw pain-tmjYou’ve been dealing with a nasty toothache for a while now. The pain is becoming excruciating so you finally suck it up and make a dental appointment. Sadly, you need to have a root canal. Great. But, what exactly is that going to entail? Do you need a driver? Is it going to be painful? Why did this happen in the first place? Well, a root canal will require one or more office visits, depending on the severity of the case. It will either be performed by a dentist or endodontist. We all know what a dentist is, but an endodontist is a dentist who specializes in the diseases and injuries of the human dental pulp or the nerve of the tooth. The choice of which type of dentist to use depends to some degree on the difficulty of the root canal procedure needed in your particular tooth and the general dentist’s comfort level in working on your tooth. After a brief consultation, your dentist will be better able to tell who might be best suited to perform the work in your particular case.

At your appointment, you will take an X-ray to see the shape of the root canals and determine if there are any signs of infection in a surrounding bone. Once everything is ready for surgery, your dentist or endodontist will then use local anesthesia to numb the area near the tooth. Anesthesia may not be necessary, since the nerve is dead, but most dentists still anesthetize the area to make the patient more relaxed and at ease. The anesthesia used will determine whether or not you will need to bring someone with you to drive you home.

Next, to keep the area dry and free of saliva during treatment, your dentist will place a rubber dam (a sheet of rubber) around the tooth. Once your mouth is prepared, an access hole will then be drilled into the tooth. The pulp along with bacteria, all of the decayed nerve tissue and other debris is then removed from the tooth using root canal files. A series of these files of increasing diameter are each subsequently placed into the access hole and worked the full length of the tooth to scrape and scrub the sides of the root canals. Water or sodium hypochlorite is used periodically to flush away the debris.

Once the tooth is thoroughly cleaned, it is sealed, which may take up to a week, depending on the doctor. If there is an infection, your dentist may put a medication inside the tooth to clear it up. Others may choose to seal the tooth the same day. If the root canal is not completed on the same day, a temporary filling is placed in the exterior hole in the tooth to keep out contaminants like saliva and food between appointments.

At the next appointment, to fill the interior of the tooth, a sealer paste and a rubber compound called gutta percha is placed into the tooth’s root canal. To fill the exterior access hole created at the beginning of treatment, a filling is placed. Once filled, you may have a tooth restoration procedure, but that’s it. You’re done and no more toothache. Because a tooth that needs a root canal often is one that has a large filling or extensive decay or other weakness, a crown, crown and post, or other restoration often needs to be placed on the tooth to protect it, prevent it from breaking, and restore it to full function. Your dentist will discuss the need for any additional dental work with you. Pain will be involved, but you are already in pain. This pain will eventually go away and your tooth will be good as new.

If you think you may need a root canal, contact Casler Dental Group at 918-376-0549 to schedule a consultation today. Or visit www.caslerdentalgroup.com for additional information.

Casler Dental Group proudly serves Tulsa and the surrounding areas.

Porcelain veneers are a wonderful way to transform your smile from drab to fab! How long your beautiful, flawless restorations last ultimately depend on you and how well you care for them.

As durable as porcelain veneers are, they will not last the 15 to 20 years they are intended to without proper care and maintenance.

The list below includes a few aftercare tips to help ensure that you enjoy your porcelain veneers for years to come:

Take proper care of your veneers. The best way to do this is by practicing good oral hygiene habits. This is extremely important to prolong the life of your porcelain veneers and to maintain good oral health. Be sure to brush for two minutes twice a day, floss once and rinse with mouthwash to increase the lifespan of your porcelain veneers.

 

Use a soft-bristled toothbrush. While porcelain veneers are quite durable, they can be damaged by brushing with a hard-bristled toothbrush. Stay away from hard-bristled toothbrushes and stick to using soft-bristled toothbrushes instead. Also, be sure to use a toothpaste without harsh abrasives. If you need recommendation for a toothpaste without harsh abrasives, be sure to ask your family dentist.

 

Visit your dentist regularly. Visiting your dentist regularly not only helps keep your teeth and gums healthy, but also allows for your dentist to monitor your porcelain veneers and to make repairs to them, if needed.

 

Prevent Gum Disease. Gum disease leads to gum inflammation and may even cause your gums to recede. Gum recession may expose the top of edge of your porcelain veneer, which can result in an unattractive smile. Gum disease can be prevented by practicing good oral hygiene and visiting your dentist for regular checkups and professional cleanings.

Avoid Bad Habits

Properly maintaining and caring for you porcelain veneers also includes avoiding bad habits that can damage your veneers. The following are a few things you should avoid after getting porcelain veneers:

Don’t chew on hard objects. As mentioned earlier, porcelain veneers are durable, however, they aren’t exactly as strong as your natural teeth. Be sure to avoid chewing on hard objects such as ice, pens, and even your nails. Chewing on hard items can cause your veneers to crack or chip. Same goes for clenching and grinding your teeth.

 

Avoid stain causing food and beverages. While porcelain veneers are stain resistant, your teeth and the adhesive used to bond the veneers are not. Be sure to avoid food and beverages that may stain your teeth. If you drink coffee or soda, use a straw to minimize the contact with your teeth.

 

Quit Smoking. The detrimental effects of smoking have long been made known to the public, yet people still smoke. Even big tobacco companies are quick to point out that their products aren’t exactly safe. So if you ever needed another reason to quit, this may be it, smoking is also bad for your veneers. As mentioned earlier, porcelain veneers are rather stain resistant, however, smoking can result in staining and discoloration of your veneers.

Porcelain veneers can give you the smile that you’ve always dreamed of, and as long as you properly care for your veneers they will last for many years to come!

If you’re interested in transforming your smile with the help of porcelain veneers, contact Berry Hill Dental at 516-921-1717 to schedule a consultation today! Or visit www.berryhilldentistrypc.com for more information regarding porcelain veneers.

Have you ever taken a look in the mirror and wondered how in the world your teeth got so yellow or stained? If so, I promise you’re not alone. There are many people who have wondered the same exact thing. Seeing that our teeth yellow over time, it can be easy overlooked. However, you’re not out of luck when it comes reviving your pearly whites, as there are many ways to go about getting whiter teeth. However, before you can do that, you must first identify what’s causing your stained or yellow teeth, and how you can best avoid or at least limit the exposer of those thing.

You’re Growing Older- Of course aging comes into play, because as you age the white protective coating, called enamel, starts slowly waring away. Aging and the daily use of your teeth can slowly lead to revealing your teeth dentine, which happens to be yellow.
You Smoke- It’s no mystery why you would eventually have stained or yellow teeth using products such as chewing or smoking tobacco. If you do use these products, there’s no doubt that your teeth will darken over time.
Poor Oral Hygiene- If you’re skipping out on routinely brushing twice a day, flossing at least once a day and using mouthwash to remove plaque buildup and tartar, your teeth can become yellow, stained or discolored.
You’re Taking Medication- There are certain types of medication, such as antibiotics doxycycline and tetracycline that can darken and discolor the teeth of children younger than the age of eight years old. Other types of medication such as antihistamines, antipsychotics and drugs for high blood pressure can stains adult teeth.
You Have an Illness- While a less common cause for discolored teeth, disease that effects enamel, or the treatment of disease, like chemotherapy or radiation used to treat cancer can all affect the color of ones teeth.
It’s in Your Genes- It’s very possible that you may have inherited enamel with more of a yellow tone than that of other with different genetics.
Specific Foods and Drinks- There are many beverages that can stain teeth, such as coffee, tea, wine and soda. As for food, blueberries, cranberries and even balsamic dressing can stain your teeth if there is too much exposer.

What to Do about Yellow or Discolored Teeth.

Unfortunately, unless Ponce De Leon has given you the location of the fountain of youth, there’s not much you can do to reverse the effects of aging and what you’ve inherited cannot be changed. The same applies to select illness and treatments, there isn’t much you can personally do to reverse the effects. However, when it comes to stains because by foods, drinks and tobacco products, it’s up to you to limit or avoid them all together.

While practicing proper oral hygiene routine can help reduce the effects of yellowing teeth, doing so won’t brighten them much more. However, using over-the-counter teeth whitening kits, such as whitening strips, to help brighten your teeth a few shades. Be sure to ask your family dentist about teeth whiten strips if you’d like to learn more.

Speaking of a family dentist, they can provide you with custom teeth whitening kits that you are able to take home. Custom teeth whitening kits are much are effective and can dramatically whiten your teeth within a few weeks or months. Another popular option many people opt for is in-office teeth whitening, which can whiten your teeth up to ten shades, in only one visit. Veneers and dental bonding are also available in cases where discolored teeth don’t respond to whitening strips or in-office teeth whitening treatments. Ranging from whitening strips to dentist trips, there are several ways to brighten those pearly whites of yours.

If you’re looking to brightening your smiles and would like to find out which treatment suits you best, contact Berry Hill Dental at 516-921-1717 to schedule a consultation today. Or feel free to visit www.berryhilldentistrypc.com for additional information regarding teeth whitening.

Do you have any damaged or missing teeth that you need to have replaced? Have you ever considered looking into dental implants? Dental implants can be a great option for people who have lost a tooth or teeth due to periodontal disease, trauma, or some other reason. A dental implant is an artificial root that is integrated into your jawbone to hold a replacement tooth or bridge. There are two types of dental implants that the ADA (American Dental Association) considers safe, and those include the following:

Types of Dental Implants

Endosteal (in the bone) – Endosteal is the most commonly used type of dental implant. This type of dental implants is typically shaped like small screws, blades, or cylinders and are surgically installed into the jawbone. Each dental implant will hold one or more artificial teeth. Endosteal is generally used as an alternative for patients with removable dentures or bridges.
Subperiosteal (on the bone) – This type of dental implant is placed on top of the jaw with the metal framework post sticking through the gums to hold the prosthesis. Subperiosteal implants are usually used in patients who have minimal jawbone height and who are unable to wear traditional dentures

The most ideal candidates for dental implants should have optimal general and oral health. Patients must have healthy gum tissues that are free of periodontal disease and must also have adequate bone in your jaw to support the dental implant.

To figure out if you’re an ideal candidate for dental implants, contact Berry Hill Dentistry in Syosset, NY at 516-921-1717 or visit our website at www.berryhilldentistrypc.com to learn more about the dental services we offer.

While the harmful effects of periodontal disease, commonly known as gum disease, have been documented and highly publicized within the last few years, what people don’t seem to realize is how bad periodontal disease really is for you oral health and overall health.

Not only does periodontal disease cause bleeding gums and in worst cases tooth loss, recent studies have shown that it may also be linked to other major health complications. One possible reason may be that it is a bacterial infection, and bacteria can travel anywhere throughout the human body. With that being said, listed below are a few ways periodontal disease can affect your overall health:

It can harm your heart. Patients suffering from periodontal disease are twice as likely to suffer from heart complications, such as coronary artery disease, compared to those who don’t have periodontal disease. One theory is that harmful bacterial from your mouth can enter the blood stream and attach to fatty plaque in your hearts blood vessels, which can cause inflammation and increase the risk of blood clots. Gum disease can also worsen existing heart conditions.
It may affect your respiratory system. Inhaling harmful bacteria has been known to cause respiratory infections. Research has shown that the bacteria that grows in your mouth can be inhaled, which can cause respiratory infections such as pneumonia.
It can affect your memory. Some studies have suggested that people with periodontal disease may be at a greater risk for developing Alzheimer’s disease. While other research has suggested that gum disease may be associated with mild cognitive impairment, such as memory problems that make daily life or tasks more difficult. Experts believe that the oral bacteria may spread to the brain through the nerve channels connected to the jaw or through the blood stream.
It can make blood sugar tough to control. People who have diabetes are more likely to develop gum disease, than those who don’t. This is probably because those with diabetes are more susceptible to infection, including gum disease. Research has found that diabetics with gum disease can lead to increased blood sugar and diabetic complications.
It may cause problems with conception. Aside from pregnant women being more at risk to develop periodontal disease, it seems it can also cause problems with conception. Those with periodontal disease may have a tougher time conceiving. Another study found that pregnant woman with periodontal disease may have an increased risk for miscarriage.

Now that you’re a little more informed about the additional harmful effects of periodontal hopefully you will take your oral care much more serious. If you are suffering from periodontal be sure to schedule an appointment with your dentist.

For prevention or treatment options regarding periodontal disease, contact Berry Hill Dentistry at 516-921-1717 or visit our website at www.berryhilldentistrypc.com for more information regarding periodontal disease.

 

ThinkstockPhotos-184785879As we embark on the next school year, we have to begin to think about how we should convert our kids from summer mode to school mode. From age six to twelve, your kids’ mouths are very busy places.  They will shed twenty baby teeth, which they acquired by age three, en route to building a finished, full set of 28 adult teeth. Their jawbones and new teeth grow while their baby teeth fall out to make room. A great start to the year would be a quick dental appointment. Your dentist can take a look at what the summer sweets have done to their tiny smiles, and if anything needs to be looked after, it can be taken care of before it gets progressively worse. Just because they are baby teeth, doesn’t mean that they can be forgotten. What goes on with their baby teeth will dictate what goes on when their adult teeth come in.

Most kids’ teeth do not come in perfectly straight. It’s very common to see new adult teeth crowded by other teeth, especially in a still-growing jaw. Bite misalignments may appear that cause awkward chewing and even jaw pain or teeth damage. Early intervention with orthodontics is a great way to stay ahead of problems and make the transition to permanent teeth a happy one. In the past, dentists typically waited for patients to enter adolescence before intervention, but today’s technology allows pre-emptive treatment in children as young as six or seven. When the first signs of crowding appear, dentists can proactively help incoming adult teeth emerge into better positions in the mouth and sometimes even avoid pulling teeth. Children with crossbites, protruding teeth and small dental arches are good candidates and work done earlier may shorten the treatment term.

Once the checkup is done and you have some tips to keeping their teeth nice and clean until the next appointment, now it’s time to think about maintenance. While you are out and about picking up school supplies, why not pick up a new toothbrush? It isn’t the most exciting of things to start the school year off right, but a fresh soft bristled toothbrush will help maintain that smile you love throughout the year. If they are active and involved in sports, it’s the perfect time to pick up a mouth guard while you’re at it. Protecting your child’s teeth is definitely something that needs to be considered when you have a little athlete.

Now that you know what to expect from your child’s teeth throughout the upcoming year (thanks to your dentist’s advice), and you are about to break in a new toothbrush to handle the day-to-day upkeep, there really is only one more box you need to check to ensure your little one has a great school year – a good diet. There are lots of fruits and vegetables that actually help keep cavities away. Foods with lots of protein and calcium help their teeth from the inside by building up the enamel, making them stronger. Don’t deprive them of the sweet treats they long for, but keep moderation in mind as you pack their lunch boxes. Read the nutritional labels and choose the healthier options, but throw in a little something to let them know you love them.

If you would like to make your child a back to school dental appointment, contact Casler Dental Group at 918-376-0549 to schedule a consultation today. Or visit www.caslerdentalgroup.com for additional information.

Casler Dental Group proudly serves Tulsa and the surrounding areas.

Do you have one of those annoying little spots where you always get food stuck? Perhaps you have an area where the stringy things like beef and chicken pack themselves into.  If you can’t get up from a meal without taking some of it with you, you may have a bigger problem than you think.

If food is packing in there, so is plaque and bacteria. Unless you are an Olympic worthy flosser, this situation is a time bomb waiting to go off.  First your gums can become inflamed.  This red, spongy, bleeding tissue makes it easier for bacteria to thrive.  In addition to gingivitis, this bacteria can cause loss of bone support and receding gums.  This is periodontal disease, and it will progress until treated.

You could be one of the lucky ones and have a low level of periodontal causing bacteria. In that case, you more than likely have an abundance of decay causing germs.  This means the food trap is allowing these bugs to attack the teeth on either side of the space.  This decay often is hard to detect until it has caused some very large cavities. These food trap cavities often involve so much tooth structure that crowns are needed and sometimes teeth are not repairable and must be extracted.

Most people fall somewhere in between. A little inflammation, some tissue recession and often some decay.  Even without all these potential problems, isn’t that spot just plain annoying?  Then tell your dentist or hygienist.    There are so many times in our office that we find a problem area and the patient will say, “Yeah, I’ve been getting food trapped in there for quite a while.”

If addressed early, food traps can often be fixed with minor procedures. Please don’t wait until we find a deep periodontal pocket or a huge cavity under that old filling. Let us know you are getting food caught in there so we can help you.

Unless you enjoy carrying a snack with you everywhere you go?

Thanks for reading,

Dr. Bruce

Our natural teeth are supposed to last a lifetime, however, that’s not always the case. Our teeth don’t fall out due natural causes, but we can lose a tooth or teeth due to periodontal disease, injury, and various other reasons. Replacing missing teeth isn’t just vital to our overall health but also the health of our remaining teeth. When teeth aren’t replaced it can cause our remaining teeth to be lost, tipped or crowded; and you could also lose chew abilities. There’s also the more obvious issues such as poor appearance or even loss of self-confidence.

Fortunately, you can regain all of those lost attributes with the help of dental implants. Dental implants are consider a permeant option, and are an ideal and effective dental treatment when it comes to replacing your missing or damaged teeth. Dental implants are also consider more predictable compared to alternative dental treatments. There are various lifelong benefits that stem from replacing missing or severally damaged teeth with dental implants. A few of those benefits including the following:

The Benefits of Dental Implants

Comparable to natural teeth. Dental implants are durable, strong and stable due to the fact that the implant fuses into the jaw bone. This makes the implants feel and function like your natural teeth would. Not to mention, dental implants seamless blend in with the rest of your natural teeth.
Designed to last. As mentioned earlier, dental implants are considered a permanent option compared to the alternatives. However, how long your dental implants last ultimately relies on how well you practice proper oral hygiene.
Preserves the jaw bone. Missing teeth lead to empty spaces between teeth, which may lead to further problems, such as jaw bone deterioration. Implants are the only dental restoration that can maintain stimulate bone growth.
Improves speech. Missing teeth can lead to speech problems, such a pronunciation problems and slurred speech. Replacing those missing teeth with dental implants can improve and/or correct these problems.
Retain facial profile. When natural teeth are missing it can sometimes cause our wrinkles, or a sunken and saggy facial profile. Dental implants have can help improve and even retain your natural facial profile.
Enhance daily life. By choosing to replace missing teeth with dental implants over the alternatives, it can improve your quality of life. Unlike alternative dental treatments, dental implants won’t be going anywhere while eating your favorite foods. Implants also eliminate the need for messy adhesives.
Restores self-confidence. Not only can dental implants improve your smile, they can also improve your overall self-esteem. Dental implants have the power to restore confidence in daily activities, such as eating, drinking, socializing or being intimate.

As you can see there are several benefits that come along with replacing your missing teeth with dental implants. Not only can dental implants improve your smile, they also provide several benefits, both emotionally and physically.

If you’re interested in replacing your missing teeth with dental implants, contact Berry Hill Dentistry in Syosset, NY at 516-921-1717 to schedule a consultation today. Or visit www.berryhilldentistrypc.com for additional information regarding dental implants.

There are many risk factors that can lead to tooth loss, such as gum disease, injury and various other reasons. Thankfully, modern dentistry has come a long way and there are many ways you can go about replacing missing or damaged teeth. While there are many dental options that can replace or improve teeth, we are going to focus on dental crowns and bridges.

What are Dental Crowns and Bridges?

Both dental crowns and bridges are knowns as fixed dental prosthetics appliances. They are placed by cementing them to the affected tooth, or in some cases, to a dental implant. The dental prosthetics consists of false teeth in the middle and one or more anchoring crowns on either side of the space. Unlike alternative dental appliances, such as dentures, dental crowns and bridges can only be removed by a dental professional. The upside to this dental treatment is that it doesn’t typically require oral surgery.

How Do Crowns and Bridges Work?

Dental crowns are used to cover the entire damaged tooth, and are a solid replacement for a damaged natural tooth. Dental crowns fit just like you natural tooth because it is created from an impression of your teeth. Porcelain crowns are the most popular option. After a crown is placed the tooth is much stronger and lasts longer as well. As far as bridges go, they are recommended if you have one or more missing teeth. Bridges are cemented to either your natural tooth or a dental implant. Just like crowns, the material used to create dental bridges are made of porcelain fused to metal or ceramics. You dentist can help you decide which option best fits your individual case.

Are Any Benefits?

There are many benefits that come along with replacing missing teeth with dental crowns and bridges. They can improve alignment, appearance, bite and shape of teeth. Empty spaces between teeth can result in your teeth shifting, which can cause a bad bite. Crowns and bridges can help prevent this from happening.

If you would like more information regarding crowns and bridges, contact Berry Hill Dentistry at 516-921-1717 today. Or visit our website at www.berryhilldentistrypc.com for additional information.

We are now continually learning strategies to strengthen our practice and the things one can offer to you. One important change is in the battle tooth damage. We at this moment see that cavities, can become avoided and even undone if offered the right set of scenarios . Our team has engineered a program that would allow our patients at standard to very high risk for corrosion to benefit from the most recent knowledge that is available . Here at Berry Hill Dentistry - Our Cavity Prevention Program will provide education on what causes you to produce cavities and what you can do to lower your corrosion rate . Some of the things that we are able to evaluate with you will likely be your own saliva flow , saliva pH , sugar intake , snack rate of recurrence and timing , and food consistency . We will be able to supply you with the most effective toothpaste available to re-mineralize teeth , as well as a summary of products that will help cut back on your decay rate . Then we will take the next step with a second appointment to assess how well you are doing with the program . Our main goal is to lessen your decay rate as years pass by following the programm, and to help you utilize it for maximum physical health now and in the course of your lifetime .

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Berry Hill Dentistry in Syosset , NY presents your family with all-all-embracing all round dental care and attention in a very comfortable , home-like setting . Experience dental care from Dr . John Cottone and Dr . Carol Anne Schmitz , who utilize only the most modern technological know-how and solutions available to give you attractive results in less time and with less discomfort than ever before . Many men and women even refer to their expert dental care by the DDS as “pain free !”

Summer is a fun, favorite time of year for all of us. From beach vacations, pool parties, backyard barbecues, and simply having more hours of daylight to enjoy the outdoors are some of the wonderful ways we enjoy summer and make wonderful memories. Try as we might to load up on sunscreen, wear large brimmed hat and sunglasses, our skin can still experience cellular damage. UVA rays can cause damage to the skin membrane, UVB rays damage the DNA of the cells and IR-A damages the mitochondria. Unfortunately, the SPF (sun protection factor) number of a sunscreen indicates only the level of protection from the UVB rays and UVA rays are 50 times more prevalent than UVB rays. They penetrate deeply into the skin cell layers damaging collagen and cells. It is very likely that some of these dangerous rays took a negative toll on our skin over the course of the summer months. Thankfully, there are ways we can correct some of the damage and prevent the unwanted photo-aging. The use of topical cosmeceuticals can rejuvenate the skin, growth factors help support the skin’s natural ability to support itself and anti-oxidants are free radical scavengers and help fight the signs of aging. In-office chemical peels are a must for reversing the damage and photo aging process. I recommend that all of my clients have a single chemical peel or series of peels at this time of year to correct sun damage. Chemical peels come in several different strengths. A treatment plan can be customized for each person based on their skin type, concerns, level of damage and desired outcome. Sometimes results can be achieved with a single peel, other times a series of two to three peels are necessary to work on more stubborn or deeper issues. I would encourage everyone to start planning now for their chemical peels. Minimal downtime can be expected post procedure. The skin will start off pink the day of the peel and will be very tight until peeling starts, generally 48 to 72 hours after the procedure, and can last 2 to 5 days. I would recommend looking ahead at your schedule and setting up a time to accommodate this process since it’s not too early to plan your fall skin rejuvenation. If you are unsure what your skin needs, please call 865-218-6210 to set up a complementary consultation.

Get to know this dentist in Middletown Ohio.

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Closed Rhinoplasty to widen a narrow nose

Some patients are born with an unnaturally narrow nose and would like to have it cosmetically widened. Other patients are born with an “hourglass deformity” which means they have pinched or very narrowed upper lateral cartilages in the mid-portion of the nose. Typically these patients have wide nasal bones, a dorsal hump, and a wide tip. The inverted upper lateral cartilages appear concave and relatively speaking, can make the tip look more bulbous and the bridge look wider. To widen a narrow nose requires osteotomies placed in the nasal bones, which include both medial and lateral osteotomies. The medial osteotomies are placed at the junction between the upper lateral cartilage and the lower portion of the nasal bones. Instead of narrowing the nasal bones, they’re actually cantilevered out more widely, also known as reverse osteotomies. Cartilaginous spreader grafts are then inserted in the space where the medial osteotomies were placed to hold the nasal bones open in their new wider position. The cartilaginous spreader grafts can be harvested from the dorsal hump that’s been removed or from inside the nose from nasal septal cartilage. The spreader grafts are also placed in a sub-perichondrial and sub- periosteal pocket. It’s also important to make sure the tip of the nose balances with the new bridge line. In some patients the tip may need to be narrowed, and other patients, the tip needs to be widened. A conservative cartilage removal is required to narrow the tip, while cartilage-grafting techniques are required to widen it. Rhinoplasty is a very difficult endeavor, so is very important to choose a rhinoplasty specialist based on extensive experience performing osteotomies, spreader grafts, and advanced bone and cartilage work to create a natural appearance. Dr. Portuese performs all of his nasal surgery procedures at the Seattle Rhinoplasty Center, which is a state-of-the-art Medicare certified outpatient surgery center located in Seattle Washington

closed-rhinoplasty

Why would you want to work in peoples’ mouths? That is a question I hear a lot.  But the same type of question could be asked of anyone.  Why do we do what we do?  The answers vary from person to person.  For some, it’s what their dad or mother did.  For others it’s just the best job they could find.  For the lucky few, it is something they are passionate about.

I got very lucky. A family friend was a dentist, and he steered me toward dentistry.  He had good arguments.  You are your own boss, you set your own hours, you make decent money and you get to help people.  All of that sounded great to a teenage kid from a small town.

The next lucky thing happened at college. I became friends with another student who wanted to go to dental school.  Our discussions solidified my desire to become a dentist.  Entering dental school was a little less scary with a friend at my side.

As I began practicing, dentistry went from something I wanted to do to something I love. I embraced continuing education and I love the fact that dentistry is always changing.  I employed coaches to help me be the best dentist and leader I could be. I hired great people and gave them excellent training.  Being surrounded by awesome people makes every day a good one.

So here I am working good hours, making decent money, in a profession that continues to grow and improve. I have a great team making every day enjoyable and superb coaches keeping us on the right path.  The only boss I answer to is my wife Sara, and I don’t mind that at all.  It’s not a bad gig.

But guess what, none of that is my why. Why do I love dentistry?  Because of the people!  I get to interact with so many people every day.   I get the satisfaction of talking a terrified patient through a procedure and showing them dentistry doesn’t have to be painful or scary.  I get the joy of performing the first filling on a child and having them happy and comfortable the whole time.  This usually astounds mom, which gives me even more happiness.  I love helping people obtain the oral health they want, need and deserve.  Most importantly is the relationships I have formed over the last 30 years.  If I’m having a bad day or things don’t seem to be going right, I spend a few extra minutes chatting, joking and catching up with the patients in the schedule.  This always cheers me up and makes my day better.

I got lucky to land here and I am blessed to call Wayland my home. The people in the Wayland area have been very good to me. They are my “WHY”!

Thanks for reading,

Dr. Bruce

Ever since we were old enough to have candy, we have been more than delighted by the offer of a stick of gum. As kids, it was a sweet treat to chew on as we challenged each other to blow the biggest bubbles. As adults, we pop in a stick when we have a hot date and want fresh breath. But regardless of our ages, chewing gum has been a go-to candy staple we’ve loved as far back as the Neolithic period. Yes, the actual Neolithic period! It isn’t exactly what we now know as chewing gum. Originally, it was made from trees and thought to have medicinal benefits. Today, chewing gum is more of a confection than it is a medicine. So is it still good for us? While sugar is never going to be considered an all-around good thing for us, you’d be surprised just how good gum actually is.

Of all of the reasons we decide to chew a stick of gum, fresh breath is one of the main ones. Something that may surprise you is the fact that lots of gum contains natural oils that fight bad breath causing germs, instead of just covering them up. Some of the best odor-fighting flavors are cinnamon, citrus and any minty flavor you can get your hands on. But beyond the fresh burst of flavor, chewing gum also perpetuates saliva production. Saliva helps fight against dry mouth and the odors created as it helps clean your teeth and stave off sugary snacks in between meals, thus further combatting bad breath.

While there is lots of sugary gum is available on the market, there have also been advances in chewing gum production that can help PREVENT cavities and promote other health benefits than the more cavity-inducing versions. The substitution of Xylitol for sugar has not only reduced cavity production, but it also attacks micro-organisms that damage teeth so our teeth can re-mineralize faster. Add calcium lactate to the mix and now Xylitol has help in the re-mineralization of our tooth enamel.

If you want to go even further with the health benefits of chewing gum, doctors have also used chewing gum to help patients with their cognitive brain functions, gastroesophageal reflux disease, and even abdominal or gastrointestinal surgery recovery time. So not only is gum good for your oral health, it can also help out lots of other issues!

Of course, what goes up must come down and chewing gum is no different. But I will say that the down sides of it aren’t quite as harsh as you may think. Yes, chewing sugary gum is bad for you and will give you cavities and other issues with your teeth if you don’t take care of them. Yes, some artificial sweeteners they swap out to make sugar-free gum (like aspartame) aren’t great for us either. They can cause diseases we would never even link with chewing gum. And yes, you can also develop issues with your jaw from chewing it so much. But these are all issues of excessive use. To deflect these issues, don’t make chewing gum an obsession. Just look at what happened to Violet Beauregarde in Charlie and the Chocolate Factory…

If you love to chew gum and would like to find out if chewing gum is beneficial, contact Casler Dental Group at 918-376-0549 to schedule a consultation today. Or visit www.caslerdentalgroup.com for additional information.

Casler Dental Group proudly serves Tulsa and the surrounding areas. 

When I think back to my first plastic surgery rotation as a medical student in the early 1990’s breast reconstruction was performed much differently then. During this time period the silicone implant crisis was at its peak, women were skeptical of breast implants, and the majority of reconstruction surgeries were with TRAM (Transverse Rectus Abdominus) flaps requiring large skin paddles because the breast surgeons were much more invasive in the way breasts were removed. Today silicone breast implants are safe and available in many sizes and shapes, providing patients and surgeons many more options than ever before. The technique of breast removal (mastectomies) have become much more selective, even being able to spare the nipple-areolar complex in many cases; therefore the need to transport new skin into the area is less often required in primary reconstruction. The advent of soft tissue regeneration with the addition of bio-matrices such as Acellular dermal matrices and guided tissue regeneration materials such as textile silk meshes have revolutionized the outcomes in prosthetic reconstruction. Without question one of the greatest advances in breast reconstruction is the art and science of fat grafting which can augment selected areas of volume deficiencies, improve the overall shape, and restore the health of the overlying tissues which has been previously damaged by radiation therapy.

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Dr. Pat Maxwell coined the term “the bio-engineered breast” which utilizes acellular dermal matrix grafts and fat grafting to rejuvenate the soft tissues surrounding breast implants after mastectomies. I have been modifying these two techniques in my practice since 2004, which has vastly improved outcomes in both primary and revision breast reconstruction. Fat grafting has provided plastic surgeons the ability to selectively sculpt and shape breasts like never before. Implants can only occupy and provide shape and volume in specific locations on the chest and breast. Fat can influence any area desired to be modified similar to photo shopping in pictures. Fat already occupies the majority of a natural breast volume therefore restoring a reconstructed breast to normal form and function with less donor site morbidity is seen with harvesting large flaps from the abdomen and buttock region. This truly is an exciting time in plastic surgery to provide excellent results with less invasive techniques, especially compared to the past.

In addition to the soft tissue restoration procedures the new silicone gel implants have also contributed to better outcomes. The fifth generation silicone gel implants (Gummy Bear Implant) are a very cohesive polymer which maintains three dimensional shape. This for me has two advantages; the first is that we can offer implants which can more easily match a patient’s unique chest wall architecture such as creating an implant narrower in width and taller in height (for a tall thin lady) or shorter and wider for a small wide chested woman combined with a fuller projection in the lower half of the breast mirroring a normal breast shape that will have adequate volume but will not encroach on the arm pit region or have an over expanded upper pole appearance. The second advantage of these implants are the result of a stiffer polymer which resists forces of capsular contracture that have been demonstrated to be a major cause of revision breast implant surgery. With the use of bi-dimensional conceptual planning through meticulous measurements we can offer a more customized approach to reconstruction and we can educate patients on their options with a three dimensional imaging system (Vectra) to demonstrate the effect of different shapes and volumes on their potential outcomes.

Even women who have been diagnosed with breast cancer and elected to undergo “breast conservation techniques” with a lumpectomy and radiation therapy can frequently experience distortions of the breast. The affected breast can shrink in volume and change in shape compared to its baseline and with the opposite breast as a result of surgical removal of tissue coupled with imposed radiation fibrosis changes to the tissues which are permanent and progressive. In my practice I see a number of these women and have been successful in reducing deformities and restoring shape and volume with the use of internal scar release combined with fat grafting. The amount of hard woody scarring of the overlying skin can often be suppler after treatment. Contour deformities which often occur directly in the surgical field where tissue was removed can be restored in shape and volume leaving a softer breast that is more symmetric with the opposing side.

I am very proud of my field of plastic surgery which by its very nature attracts thoughtful and innovating disciples of this surgical specialty leading to a continuous evolution of scientific insights that opens the door for continuous improvements in the care we can provide patients. Breast cancer reconstruction is just one small piece that is being tackled by our field of study.

Being a mom is one of the most challenging, frustrating, yet rewarding experiences a woman can have. You put forth blood sweat and tears, not to mention an untold strain on your whole body during pregnancy. It really boils down to the genetics of your skin and fascia as to how well you can bounce back after the weight gain and abdominal stretching from your baby. Many women lament that despite dieting, exercising and lots and lots of willpower your body is never the same as it was prior to child bearing. Fortunately for the masses of dissatisfied women there are options in Plastic Surgery to boost your self- confidence and your body image. Here is a list of body corrections (Mommy Make-over) that can be performed in tandem or separately to improve the shape and how you feel about your physique.

pregnancy

Breast:
During pregnancy the glandular component of the breast must enlarge to ready for the enhanced production of milk. Additionally weight gain with fat storage all governed by the hormonal changes can increase the breast size immensely. Unfortunately fetal regulation also makes skin “stretchy” to accommodate the increased girth of the breast and abdomen. After the resumption of normal non-pregnant hormones and the lack of need for lactation the breast volume will revert back to baseline and can even reduce in overall size compared to the original baseline. Unfortunately many times the skin does not have the ability to shrink to the original size and will stay expanded resulting in a larger skin brazier with same or even less fill than before resulting in “saggy” breast shape. With increased skin length from the breast fold to the nipple it moves the breast mound lower on the chest with less upper pole fullness. I hear many women call their breasts “sad” in appearance when they come in for consultation. Ok enough depressing thoughts… what can be done? If the skin is not excessively enlarged, the nipple-areolar complex is correct and the fold to nipple distance is not greatly elongated the solution can be to place a silicone gel implant to act as a shaper and a filler of the breast envelope restoring a pleasing breast shape. If the breast has a low positioned nipple-areolar complex, with or without increase skin length from the fold to the nipple-areolar complex, then a mastopexy (breast lift) is required. Often times tissue volume might need to be enhanced to provide better shape and upper pole fullness, thus an implant or fat grafting can be incorporated at the same time. Sometimes upper pole fullness can be accomplished by transposing extra breast tissue in the lower pole and positioning it on the chest wall deep to the rest of the breast to enhance fullness.

Abdomen:
Hormones during pregnancy direct adaptive body changes that allow healthy growth of the baby but unfortunately create lasting changes to a women’s body. The abdominal skin stretches and often can result in stretch marks (tears in the dermis with intact epidermis). Excess skin rarely retracts in these cases leading to hanging skin that drapes over the pelvis. Next the abdominal wall is distorted to accommodate the growing fetus resulting in separation of the paired rectus muscles leading to increased abdominal circumference with permanent bulges in the abdominal wall both above and below the umbilicus. This unfortunately cannot be reduced with abdominal exercise because the stretched fascia between the muscles is not contractile and will not respond to muscle strengthening. Additional weight changes with aging often can be manifested with increased abdominal girth from excess fatty tissue. So what can a Mommy Make-over achieve in the abdomen?
If skin quality is excellent and the abdominal wall is only minimally distorted often liposuction with the addition of additional energy sources such as ultrasonic energy (VASER), oscillating power hand-piece (PAL), or hydraulic power can result in removal of excess fat and create skin retraction/redistribution to improve contour. However, many women will need a full abdominoplasty with correction of excess fat with liposuction, removal of excess lower abdominal skin with tissue resection, and abdominal wall restoration by returning the rectus muscles together with a permanent suturing technique. This can result in excellent contour of the abdomen but you will trade the contour for a scar. I find most people are surprised how long the scar has to be to create the contouring necessary. Once acquainted with the results, most women will gladly trade a scar for the results of a flat smooth abdomen.

Back and Flanks:
Some women can realize their goals by correcting the anterior abdomen by itself. However many women if given the opportunity would love to three dimensionally correct their torso by sculpting their midback (bra line folds) and flanks (muffin tops) at the same time as their abdomens to circumferentially adjust their shape. This can make a tremendous change on how clothing can be worn and how the individual feels about themselves. Liposuction with either PAL or VASER makes a great deal of improvement by releasing all the ligamentous attachments between the back and flanks and the superficial skin (which results in rolls on the back) and allows even removal of fat and the skin to re-drape much smoother.

Legs:
Some women naturally store adipose tissue in their lateral or medial thighs. Depending on the skin quality and the potential for the tissue to re-drape or tighten, fatty tissue can be sculpted just as on the back. Some have significant adipose tissue below the knee down to the ankle. I generally do not add the additional power source with liposuction in this area and have achieved good results.

Buttock:
Popular trends in body shape can change just like in fashion over time. The introduction of the Latin culture into the United States in conjunction with pop culture personalities have made the appearance of a full contour buttock something to aspire to. My preference for buttock augmentation is with fat grafting and not with a prosthesis. Utilizing concepts of tissue equilibration and liposculpturing we can remove unwanted fatty tissue, harvest it as a graft, and utilize the fat as a volumizer of the buttock- while improving the contour of the rest of the body. Women who have gained and lost weight may have loose sagging skin of the buttock and restoring volume can shape and lift the buttock with little or no scarring.

Women who are unhappy with their physical appearance after giving birth to one or multiple children can restore the body to a better place with a Mommy Make-over. To me this represents more than one area of the body to be rejuvenated simultaneously to make the woman feel refreshed and erase some of the “battle scars” of pregnancy so she can feel more confident in her appearance.

Breast Implant Exchange with Fat Enhancement

Amanda’s first implants were placed by another surgeon approximately 15 years earlier

425cc anatomical saline implants were placed under the muscle

She was unhappy with the implant rippling, breast gap and muscle flexion distortion

Even under the muscle, the implants were still very visible as coverage was so thin

Being very lean also made her naturally wide breast gap seem even more prominent

Displacement and flattening of the implants occurred with every muscle contraction

Implants placed above the muscle would have resulted in more visibility due to less coverage

Implant placement under the muscle also created a wider breast gap visible in clothes

Rippling was more pronounced with saline implants especially when leaning forward

Amanda first presented to our practice 10 years earlier for her tummy tuck

Her satisfaction and trust allowed her to feel confident in having breast surgery as well

Correction involved removing the implants and restoring the muscle to its original position

Placing cohesive, gummy bear, anatomical, silicone gel implants in a new pocket above the muscle

Then filling the overlying skin envelope with fat grafts to add cover, volume and cleavage

Amanda is seen at her initial visit (left image) four years earlier with her original saline implants

The center photos show her four years after initial implant exchange to 350cc smooth, round, silicone gel implants (still under the muscle) with 50 cc of fat placed above

There was significant improvement but she still wanted to reduce the gap and muscle animation even more

As she was lean and also very athletic, she wanted complete muscle correction

Mentor MH 440 CC, anatomical, textured cohesive gel implants were placed over the repaired muscle

75 CC of fat was also placed into the overlying breast envelope for coverage, volume and contour

She is now seeing (right images) with her final results 2 months after implant relocation and fat transfer

The fat grafts have completely integrated and have the potential to last a lifetime

There are no visible or palpable irregularities and full natural breasts have been achieved

Amanda went from a C to her desired D cup and… she finally has cleavage

The animation deformity is completely corrected and a soft natural appearance is finally hers

462039415It never seems to fail…you are just about to indulge in your favorite food when all of a sudden, you have a shooting pain in your mouth. That food has now forever been tainted. It seems you’ve gotten yourself a whopper of a toothache and it’s time to visit the dentist.

How did we end up in this kind of pain? A toothache is one of the most jarring pains we have and it seems like we never know we’re about to have one when it sneaks up on you. There are actually lots of different ways a toothache can occur. It can be as simple as a cracked tooth, cavities or exposed roots from not taking care of our teeth like we should. But it can also be something more serious, like your ears or sinuses causing the issue.

When it comes to pain, each one of us has a different degree pain tolerance. Some of us can work through a headache, while others are taken out at the first signs of one developing. Denying yourself a solution to your frequent headaches is only delaying the inevitable, and possibly making your situation worse. If your headaches persist, you need to figure out what is causing these frequent migraines or they will only continue to worsen. Similarly, headaches and toothaches are detected by the same trigeminal nerve in your head, which means one can be the cause of the other without being aware that is the case. Unfortunately, there is no real way to dissect the problem without the help of your dental professional.

There are, however, ways for you to give yourself some temporary relief while you are waiting to see the dentist. Of course there are always over-the-counter remedies, like Ibuprofen or pain relieving gels, but there are also some natural ways to help ease your pain. Try chewing on a piece of garlic for a while every day. In addition to being a pain reliever, it is also a way to strengthen your teeth. The soothing heat and salt combination your mouth gets from gargling with hot saltwater for a few minutes also help relieve a toothache. Vitamin C from citrus juice also does a great job with pain relief. If it’s sinuses or another infection causing the pain, take a day to relax. Lots of water and sleep in a dark room will do wonders to help your aches and pains.

In the end, it is important to pay attention to the signals your body gives you when something is wrong. Ignoring the pain will only lead to more problems, so make an appointment to see your dentist as soon as you find headaches or toothaches are persistent. The technological advancements in dentistry makes dental procedures easily accessible, convenient and virtually painless. The best solution is to take care of your teeth. Good oral hygiene is the best line of defense.

If you’re having tooth pain and would like to find out how to sooth them, contact Casler Dental Group at 918-376-0549 to schedule a consultation today. Or visit www.caslerdentalgroup.com for additional information regarding toothaches.

Casler Dental Group proudly serves Tulsa and the surrounding areas. 

Being a mom is one of the most challenging, frustrating, yet rewarding experiences a woman can have. You put forth blood sweat and tears, not to mention an untold strain on your whole body during pregnancy. It really boils down to the genetics of your skin and fascia as to how well you can bounce back after the weight gain and abdominal stretching from your baby. Many women lament that despite dieting, exercising and lots and lots of willpower your body is never the same as it was prior to child bearing. Fortunately for the masses of dissatisfied women there are options in Plastic Surgery to boost your self- confidence and your body image. Here is a list of body corrections (Mommy Make-over) that can be performed in tandem or separately to improve the shape and how you feel about your physique.

pregnancy

Breast:
During pregnancy the glandular component of the breast must enlarge to ready for the enhanced production of milk. Additionally weight gain with fat storage all governed by the hormonal changes can increase the breast size immensely. Unfortunately fetal regulation also makes skin “stretchy” to accommodate the increased girth of the breast and abdomen. After the resumption of normal non-pregnant hormones and the lack of need for lactation the breast volume will revert back to baseline and can even reduce in overall size compared to the original baseline. Unfortunately many times the skin does not have the ability to shrink to the original size and will stay expanded resulting in a larger skin brazier with same or even less fill than before resulting in “saggy” breast shape. With increased skin length from the breast fold to the nipple it moves the breast mound lower on the chest with less upper pole fullness. I hear many women call their breasts “sad” in appearance when they come in for consultation. Ok enough depressing thoughts… what can be done? If the skin is not excessively enlarged, the nipple-areolar complex is correct and the fold to nipple distance is not greatly elongated the solution can be to place a silicone gel implant to act as a shaper and a filler of the breast envelope restoring a pleasing breast shape. If the breast has a low positioned nipple-areolar complex, with or without increase skin length from the fold to the nipple-areolar complex, then a mastopexy (breast lift) is required. Often times tissue volume might need to be enhanced to provide better shape and upper pole fullness, thus an implant or fat grafting can be incorporated at the same time. Sometimes upper pole fullness can be accomplished by transposing extra breast tissue in the lower pole and positioning it on the chest wall deep to the rest of the breast to enhance fullness.

Abdomen:
Hormones during pregnancy direct adaptive body changes that allow healthy growth of the baby but unfortunately create lasting changes to a women’s body. The abdominal skin stretches and often can result in stretch marks (tears in the dermis with intact epidermis). Excess skin rarely retracts in these cases leading to hanging skin that drapes over the pelvis. Next the abdominal wall is distorted to accommodate the growing fetus resulting in separation of the paired rectus muscles leading to increased abdominal circumference with permanent bulges in the abdominal wall both above and below the umbilicus. This unfortunately cannot be reduced with abdominal exercise because the stretched fascia between the muscles is not contractile and will not respond to muscle strengthening. Additional weight changes with aging often can be manifested with increased abdominal girth from excess fatty tissue. So what can a Mommy Make-over achieve in the abdomen?
If skin quality is excellent and the abdominal wall is only minimally distorted often liposuction with the addition of additional energy sources such as ultrasonic energy (VASER), oscillating power hand-piece (PAL), or hydraulic power can result in removal of excess fat and create skin retraction/redistribution to improve contour. However, many women will need a full abdominoplasty with correction of excess fat with liposuction, removal of excess lower abdominal skin with tissue resection, and abdominal wall restoration by returning the rectus muscles together with a permanent suturing technique. This can result in excellent contour of the abdomen but you will trade the contour for a scar. I find most people are surprised how long the scar has to be to create the contouring necessary. Once acquainted with the results, most women will gladly trade a scar for the results of a flat smooth abdomen.

Back and Flanks:
Some women can realize their goals by correcting the anterior abdomen by itself. However many women if given the opportunity would love to three dimensionally correct their torso by sculpting their midback (bra line folds) and flanks (muffin tops) at the same time as their abdomens to circumferentially adjust their shape. This can make a tremendous change on how clothing can be worn and how the individual feels about themselves. Liposuction with either PAL or VASER makes a great deal of improvement by releasing all the ligamentous attachments between the back and flanks and the superficial skin (which results in rolls on the back) and allows even removal of fat and the skin to re-drape much smoother.

Legs:
Some women naturally store adipose tissue in their lateral or medial thighs. Depending on the skin quality and the potential for the tissue to re-drape or tighten, fatty tissue can be sculpted just as on the back. Some have significant adipose tissue below the knee down to the ankle. I generally do not add the additional power source with liposuction in this area and have achieved good results.

Buttock:
Popular trends in body shape can change just like in fashion over time. The introduction of the Latin culture into the United States in conjunction with pop culture personalities have made the appearance of a full contour buttock something to aspire to. My preference for buttock augmentation is with fat grafting and not with a prosthesis. Utilizing concepts of tissue equilibration and liposculpturing we can remove unwanted fatty tissue, harvest it as a graft, and utilize the fat as a volumizer of the buttock- while improving the contour of the rest of the body. Women who have gained and lost weight may have loose sagging skin of the buttock and restoring volume can shape and lift the buttock with little or no scarring.

Women who are unhappy with their physical appearance after giving birth to one or multiple children can restore the body to a better place with a Mommy Make-over. To me this represents more than one area of the body to be rejuvenated simultaneously to make the woman feel refreshed and erase some of the “battle scars” of pregnancy so she can feel more confident in her appearance.

Twins

Although the birth rate for twins has risen dramatically since 2009 to about 1 in every 38 births, the birth rate for identical twins is significantly more rare: about 1 in every 285 births. The result of a single egg that splits in two, identical twins share more than just their DNA. Emotionally and physically, identical twins can be so alike that people can’t tell them apart. Which can make the job of a plastic surgeon operating on identical twins extremely challenging. Dr. Peter Fodor, an international leader in the field of aesthetic plastic surgery who has operated on a number of identical twins in his Los Angeles, CA practice, shares some of these challenges.

by Katherine Stuart
and Peter Fodor, MD

Almost a No-Win Situation

While all twins gestate together in the same womb, often speaking without words, identical twins go one step further. They share DNA, making them physically the same. This can create a very interesting, but challenging situation for a plastic surgeon. Emotionally, most identical twins adore each other, in Dr. Fodor’s experience, and want to be the same in every respect from voice to dress to what they eat. There’s even a set of twins in Australia who share the same boyfriend. For twins such as this, if a plastic surgeon doesn’t make them exactly the same then he or she has failed. However, there’s also a smaller sub group of identical twins who are extremely competitive and don’t really like each other at all. But they, too, want to look exactly the same post surgery or else their competitiveness will escalate. This can create a bit of a no-win situation. As Dr. Fodor puts it: “Identical twins whether they love each other or don’t like each other quite as much, you better make them look identical after surgery.”

Two Twins at Once

In order to ensure the most successful outcome possible, Dr. Fodor likes to work on both twins. Ideally, assuming the procedures aren’t too long, on the same day. For example, if he’s performing a rhinoplasty, he will do the first twin’s nose, followed by the second twin’s nose, making sure to go through exactly the same steps in exactly the same order. But some procedures have more predictable results than others. A breast augmentation performed with the same size implant will deliver similar results while a nose job can be more difficult partly due to facial asymmetry.

Twins-Rhinoplasty
Rhinoplasty-Twins

Facial Asymmetry is the Norm

Everyone’s face is asymmetrical. If you take a photo of a patient and split it down the middle, the right and left side won’t match up. In fact, Dr. Fodor has a trick mirror in his office that he uses with patients where one side is a regular mirror, and the other is a prism mirror that reverses the right and left sides of the face. Most patients don’t recognize themselves in the prism mirror. “The two sides of the face oftentimes though they look very similar, they’re not identical” says Dr. Fodor. This is true for twins as well.
Twins-and-Rhinoplasty

One Set of Twins. Two Different Surgeons

Another challenge of working on twins is when you only get to work on one because a different surgeon has already worked on the other. It’s allows for the kind of direct comparison that’s hard to capture elsewhere and can be “kind of an ego builder when the twin that you did looks better” or more natural.

Twins and Facial Aging

Aging identical twins are also fascinating since they often don’t age at the same rate due to lifestyle choices. In fact, a 2009 study used identical twins to determine which outside factors contribute most to facial aging. The main culprits were smoking and sun exposure. This definitely comes into play for Dr. Fodor when he’s performing a facelift on identical twins. For him, the most fascinating thing is following up with these patients years down the road and seeing whether or not changes such as stopping smoking will cause them to age at the same rate again.

Needless to say, working on identical twins may be technically challenging, but it’s also a fascinating learning experience for any plastic surgeon.

High risk wedge crack.
High risk crack with a dark halo around it.

Your teeth have cracks. It’s a fact.  Most cracks are in the enamel only and very rarely cause problems.  These are caused by temperature changes and biting forces in your mouth.  Most of the time you don’t even know they are there unless they are on a front tooth.

However, some cracks go into the inner tooth structure called dentin. Cracks in dentin are potential problems.  Since most of these cracks do not cause any discomfort or pain, it is important to have a dental professional evaluate them.  In our office we classify cracks into the dentin as low, medium and high risk.

Low risk cracks are straight up and down on the tooth, are not stained and follow the grooves of the tooth. These cracks we make note of and may take a picture in order to monitor it, but treatment is usually not needed.

Medium risk cracks often detour from the anatomy of the tooth. They may run diagonal across a tooth.  They can be associated with an older filling.  They are V-shaped and are wider at the top, and may be stained.  Medium risk cracks need to be evaluated individually.  If there is sensitivity or undermining of an existing filling, treatment is needed.  This treatment may be anywhere from a bite adjustment, to a small filling, to a full coverage crown.

High risk cracks often run diagonally across a tooth. They can emanate from a restoration. High risk cracks can have a halo of darkness around them indicating bacterial penetration (top right image).  Multiple cracks are a red flag, especially if they outline a cusp or biting surface of the tooth creating a wedge of unstable tooth (top left image).  High risk cracks need treatment.  These cracks will get larger over time.  As the cracks progress into the tooth, several things can happen.  The most common result of a high risk crack that is not treated is a broken tooth.  Hopefully that break leaves enough tooth to restore.  This almost always involves a full coverage crown.  The biggest risk is that the crack will proceed into the nerve area of the tooth.  This will cause sensitivity and then nerve damage that requires root canal therapy.  If unchecked, a high risk crack can fracture the tooth in half.  If this happens, the tooth is usually lost.

If we find a high risk crack on one of your teeth we will let you know what treatment we recommend. Often patients are reluctant to proceed because they do not have any symptoms or sensitivity.  Our experience with patients over the years is that these teeth will break at some point.    The problem is we don’t know if it will be tomorrow, next week or next year.  We just know it will break.

So if we start talking about a crack in your tooth, sit up and listen. If you don’t, the next time you see us, we could be explaining why that same tooth has to be extracted.

If we have already talked to you about a cracked tooth and you haven’t proceeded with our treatment recommendation, call us today. We are willing to give you a special offer just for reading this blog.

Thanks for reading,

Dr. Bruce

p.s. This dentist has an excellent YouTube video on cracked teeth: https://www.youtube.com/watch?v=0SaR7x7u9io

 

Fighting Fifty

Today, women in their 40’s and 50’s are looking younger than ever. We no longer look frumpy or matronly like many of our grandparents did at the same age. These days we have more choices than ever before to turn back the clock. I had an opportunity to sit down with Dr. Peter Fodor, an international expert in aesthetic plastic surgery and ask his thoughts about “Fighting Fifty”. Click To Watch The Video

“The way I would think about fighting fifty, is fighting fifty and WINNING!” ~Peter B. Fodor, MD, FACS

It Begins with the Skin

“They need to exercise, they need to diet, they need to take care of themselves, and they need to use good skin care,” says Fodor. He says good skin care, is critical for this age group. As you reach your 40’s and beyond, you may be seeing dullness, uneven tone, rough texture, fine lines and some sagging in your skin.

Here’s a basic check list of what you need to know about skincare as you reach your forties.
1. Gentle cleansing. Many women will experience drier skin as they age and need to switch to a more gentle cleanser that doesn’t strip the skin. A few to try are Cetaphil and Purpose to be used morning and night.
2. For fine lines and pigment issues, start thinking about skin care with effective Look for a retinoid cream which works to resurface the skin and increase collagen in the dermis. They are best used at night and you may want to start out slow to avoid peeling and redness. Once your skin becomes more accustomed to the cream, you can increase the frequency.
3. Wear sunscreen every day. Your best choice is a broad-spectrum sunscreen which protects skin from UVA (aging rays) and UVB (rays that burn).

The Aging Eye

You may have heard, the eyes are one of the first areas of the face to show the aging process. The skin around the eye is thin and more susceptible to dryness and wrinkling. When the eye starts to sag it can create dark circles, bags and crow’s feet. Dr. Fodor says, “The upper eyelids can really make people look much older than they are at times. It can be genetic; it can come with the family. But a blepharoplasty procedure can make people look fresher and a lot less tired.”

Injectables for Immediate Results

If you really want to turn back the clock, “Botox and facial fillers such as Juvederm and Restylane work well,” states Fodor. Botox, Dysport, and Xeomin are neurotoxins for erasing lines in the upper face and around the crow’s feet.

Facial fillers can replace volume loss in your temples, cheek area and the nasolabial folds. They can also help plump up your lips.

Hormones Play a Big Part in the Aging Process

Fodor explains that as we get closer to menopause our hormones change. When this happens, “certain parts of the body that were once harmonious to the rest of our body, may start to change. It can be in the hips, the knees and the stomach. Liposuction can be a great approach for these patients,” says Fodor.

Fodor is quick to state, that the main message is for patients to take care of themselves. He says going in for an injectable or a surgical procedure that addresses the facial or the body part that you are most concerned about can bring about a rejuvenation that is as much physical as mental.
As with any procedure, make sure you go to a qualified board certified physician who is well-trained in their specialty.

Reshaping the contour of the abdomen is frequently requested in my office consultations. The most common techniques are various forms of liposuction with or without an abdominoplasty. Another tool in our repertoire which can yield effective results is the “Reverse Abdominoplasty.” The classic indications for a regular abdominoplasty is a torso which has loose excess inelastic skin of the lower abdomen, abdominal wall rectus muscle separation (diastasis), and varying degrees of excess fatty tissue. The technique eliminates the excess skin and fatty tissue in the lower abdomen, reconnects the rectus muscle together to tighten the abdominal wall, and excess abdominal fatty tissue can be reshaped with liposuction to provide a pleasing shape. A Reverse Abdominoplasty is chosen for the individual who has loose excess skin in the upper abdomen, who generally does not have a full diastasis which is affecting the lower abdominal contour, and may have excess fatty tissue in the lower abdomen without skin excess. The technique is to start with incisions that follow the lower breast fold then cross the lower sternum to connect both sides of the abdomen. These scars generally hide very well even in two piece bathing suites. The full thickness skin is elevated down the abdomen preserving the vital blood supply on either side of the belly button. If upper rectus muscles need to be tightened this can proceed. Any abdominal fatty excess can also be corrected with liposuction at this time. The elevated released excess abdominal skin can be addressed in several ways depending on the needs of the patient:

1. If a women who has the upper abdominal skin excess and also desires rejuvenation of the breast the excess elevated skin of the abdomen can be utilized as a self-augmentation under the breast to provide added fullness and shape. This is often done in conjunction with a breast lift (Mastopexy) and can avoid the need and expense of an implant. I have even performed this procedure with a woman who many years ago had bilateral mastectomies for breast cancer and we reconstructed her with implants. She had experienced some weight fluctuation and was becoming very active and requested the elimination of her breast implants but still desired a smaller breast to remain. We utilized a reverse abdominoplasty skin excess, removed the outer skin, and placed it in her implant space to fill the void and added tissue volume and shape provided with fat grafting harvested from her back, thighs, and lower abdomen giving her a smaller but still reasonable breast shape.

2. The Reverse Abdominoplasty could be incorporated as part of a treatment plan to tighten the upper abdominal contour. After the incision and elevation of the abdominal excess loose skin, the surgeon can remove the undesirable portion and fixate the remaining tissue to the rib fascia of the lower breast fold to avoid the scars from migrating inferiorly thus preventing the exposure of the scars on the upper abdomen. I have used this as a primary surgical procedure for women with loose skin of the upper abdomen that would not respond favorably to liposuction alone. I have also used this as a secondary procedure on women who have previously had an abdominoplasty with good results but over time the lower abdomen has maintained its results yet the upper abdomen has become loose and has excess as a result of weight changes, sun exposure, and of course gravity. The excess skin can be removed providing a nice tight appearance to the whole abdomen.

3. Another situation for the reverse abdominoplasty is for a women with loose upper abdominal skin combined with previous augmentation mammoplasty in which the implants have become mal-posed and have drifted inferior and lateral to the correct position. In this case the excess elevated tissue can be utilized as a autologous (meaning from your own body) soft tissue sling to help reposition and stabilize the implant similar to an Acellular Dermal Matrix (ADM) graft without the significant added cost of the product to provide long lasting results.

One of the aspects in my profession of plastic surgery I am most proud of is the innovative nature of the field. We take problem sets that patients present to our office and we create unique methods that achieve a sound result with the least amount of surgery and the lowest costs to ensure successful and happy patients. The Reverse abdominoplasty is an example of one of these off shoot procedures which fills a vital niche in my practice.

Jay H. Lucas, MD
Board Certified Plastic Surgery, MOC 2012
The Lucas Center, Plastic Surgery
Knoxville, Tn.
thelucascenter.com

High risk wedge crack.
High risk crack with a dark halo around it.

Your teeth have cracks. It’s a fact.  Most cracks are in the enamel only and very rarely cause problems.  These are caused by temperature changes and biting forces in your mouth.  Most of the time you don’t even know they are there unless they are on a front tooth.

However, some cracks go into the inner tooth structure called dentin. Cracks in dentin are potential problems.  Since most of these cracks do not cause any discomfort or pain, it is important to have a dental professional evaluate them.  In our office we classify cracks into the dentin as low, medium and high risk.

Low risk cracks are straight up and down on the tooth, are not stained and follow the grooves of the tooth. These cracks we make note of and may take a picture in order to monitor it, but treatment is usually not needed.

Medium risk cracks often detour from the anatomy of the tooth. They may run diagonal across a tooth.  They can be associated with an older filling.  They are V-shaped and are wider at the top, and may be stained.  Medium risk cracks need to be evaluated individually.  If there is sensitivity or undermining of an existing filling, treatment is needed.  This treatment may be anywhere from a bite adjustment, to a small filling, to a full coverage crown.

High risk cracks often run diagonally across a tooth. They can emanate from a restoration. High risk cracks can have a halo of darkness around them indicating bacterial penetration (top right image).  Multiple cracks are a red flag, especially if they outline a cusp or biting surface of the tooth creating a wedge of unstable tooth (top left image).  High risk cracks need treatment.  These cracks will get larger over time.  As the cracks progress into the tooth, several things can happen.  The most common result of a high risk crack that is not treated is a broken tooth.  Hopefully that break leaves enough tooth to restore.  This almost always involves a full coverage crown.  The biggest risk is that the crack will proceed into the nerve area of the tooth.  This will cause sensitivity and then nerve damage that requires root canal therapy.  If unchecked, a high risk crack can fracture the tooth in half.  If this happens, the tooth is usually lost.

If we find a high risk crack on one of your teeth we will let you know what treatment we recommend. Often patients are reluctant to proceed because they do not have any symptoms or sensitivity.  Our experience with patients over the years is that these teeth will break at some point.    The problem is we don’t know if it will be tomorrow, next week or next year.  We just know it will break.

So if we start talking about a crack in your tooth, sit up and listen. If you don’t, the next time you see us, we could be explaining why that same tooth has to be extracted.

If we have already talked to you about a cracked tooth and you haven’t proceeded with our treatment recommendation, call us today. We are willing to give you a special offer just for reading this blog.

Thanks for reading,

Dr. Bruce

p.s. This dentist has an excellent YouTube video on cracked teeth: https://www.youtube.com/watch?v=0SaR7x7u9io

 

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I love experiencing the sun and all the activities surrounding its presence such as boating, swimming, hiking, and cycling. My mood is immediately elevated witnessing its warm glow. Yes there are many benefits to the sun’s rays such as stimulating the production of Vitamin D which is essential in calcium and bone metabolism as well as supporting the immune system. It chases away the blues of seasonal affective disorder and is essential for life. However there is a risk benefit ratio to being exposed to the sun’s ultraviolet rays. Following is a list of downsides to sun exposure. File May 11, 2 23 07 PM

1. The ultraviolet rays of the sun damages the DNA in our skin cells which can result in malignant transformation of cells such as basal, squamous, or melanoma. The latter can be lethal. Therefore minimizing the harmful UVB rays can reduce the risk of developing skin cancer. Sun screen is not a one -time application for a whole day of exposure. It needs to be repeated at least every two hours or more often depending on water or perspiration which can reduce the effectiveness of the prevention. Sun damage is additive over a life time but taking breaks from the harmful rays can allow the tissue to heal and repair some of the mild DNA damage. Therefore year- long tanning such as tanning beds should be discouraged.
2. Exposure of both UVA and UVB rays will damage the elastin fibers in the skin permanently resulting in loose less compliant skin. This will result in the skin of the face, arms, breast, abdomen, thighs, and knees to hang and appear loose. No exercise will tone the damaged skin. Therefore protect your largest organ system, the skin, by shielding the sun with appropriate hats, clothing, and sun screen.
3. Splotchy color changes to the skin. With increased sun exposure the skin will upregulate melanin production resulting in pigmentation changes that are less than attractive and are extremely difficult to reverse.
4. Thinning of the dermis which can result in the appearance of capillaries giving a red appearance around the nose and cheeks.

Everyone wants to have that sun kissed glow to the skin. I wish I had a dollar for every time a women says tan fat looks better than pale fat. Just remember the list above and understand a large sun exposure that creates a nice tan for around a week or so causes a lifetime of damage that can result in potential skin cancer and many vexing maladies of the skin giving a marked aged appearance over time.
Fortunately if you have experienced the above sun damage we can help. A combination of good home skin care with Skin Medica products, chemical peels to remove damaged skin and remove pigmentation changes, and microneedling which can result in collagen induction and improved dermal thickness and skin tone. More educational BLOGS are available on our website. www.thelucascenter.com

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Stephen M. Miller, MD and Axiom Spa Open House

May 25, 2016 5-7 PM

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Please RSVP at Dr. Stephen M. Miller and Axiom Spa Open House

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Non-invasive aesthetic procedures have come a long way in the last ten years. The American Society of Plastic Surgery’s yearly statistics continue to demonstrate strong demand for procedures such as neuromodulators (Botox and Dysport), and hyaluronic acid filler agents (Juvederm, Voluma, Restalyn). Recently, non-invasive contouring systems that perform the techniques of cryolipolysis, such as Cool Sculpting and radiofrequency skin-tightening Ultherapy, have emerged in the marketplace. Now Allergan has added Kybella to the mix as a non-invasive injectable material to dissolve fat under the chin.

Before and After

Before and After

The key to success with these treatments is consulting a comprehensive center that offers a full array of non-invasive and surgical options, and will direct you to the ideal treatment modality for your unique circumstances. Just as with any medical and surgical procedure, there are appropriate candidates and patients with contraindications.

The most important step to avoid dissatisfaction is to be evaluated by a physician who is properly trained to perform comprehensive evaluation and care for all patients with a particular aesthetic concern.

Board-certified plastic surgeons have the most comprehensive education and background experience to correctly evaluate your anatomy and determine which treatments will yield the best outcomes. The statement “if all you have is a hammer the whole world is a nail” rings true for medical spas and dermatologist offices which only have one option, such as Cool Sculpting or Kybella. Just because a treatment option is non-invasive does not mean it is inexpensive. If you factor in the cost of multiple treatments, it may be as expensive as surgery and still fall short of expectations.

When is Kybella the right choice?

With the current status of the injectable form of deoxycholic acid (Kybella) the ideal candidate must have reasonably tight skin with only mild to moderate adipose excess in the submittal and chin neck angle. The patient should not have a significant mandibular jaw discrepancy with the midface or have a particularly steep mandibular plain angle.

When is Kybella the wrong choice?

Any patient with lax skin of the neck or a significant deflation of the neck related to weight loss with demarcated platysmal bands is not a candidate. Taking away fat in this circumstance only worsens the deformity. Any patient with a deep underbite and a small chin with a very oblique chin-neck angle should also avoid Kybella. Deoxycholic acid is mostly created to dissolve fat but does produce some inflammation with the caustic material to encourage collagen production and skin retraction. Skin excess with an oblique chin neck angle and recessed chin will not yield overwhelming positive results.

Instead of Kybella, the better option is placement of a chin implant (genioplasty) with aggressive liposuction to encourage skin retraction. A middle facial third with significant skin excess and deflation combined with loose-hanging skin with platysmal bands is best treated with a corset platysmaplasty in conjunction with a neck/face lift.

Non-invasive aesthetic procedures can be a wonderful adjunct to helping people age gracefully with limited down time. Kybella in the right situation may improve necks and make people happy with the results.

Avoid being pushed into this option without a thorough three-dimensional analysis of your face to determine if it’s right for you. Nothing is more frustrating than spending a great deal of money and not realizing your desired results. Even with surgery, some deformities may not be able to be corrected. Take advice from a board-certified plastic surgeon to maximize your goals and to feel good in your own skin.

Our VELscope for Vets campaign has been going strong so far in 2016.  In the first quarter of the year we donated over $600 to the Grand Rapids Home for Veterans.  If you are not aware, our office is donating 20% of our fees for our cancer screening VELscope exams to this veteran’s facility.  We chose to do this to raise awareness of oral cancer and the need for early diagnosis.

There will be over 45,000 Americans diagnosed with some type of oral cancer this year. In that time, over 8500 people will die from oral cancer.  That is roughly one person every hour of every day.  Over 40% of those people who are diagnosed with oral cancer will not survive 5 years.  This mortality rate is higher than cervical cancer, Hodgkin’s lymphoma, laryngeal cancer, cancer of the testes and thyroid cancer.  The reason for this high death rate is because oral cancer is routinely discovered late in its development, often after it has metastasized to another location.

In its early stages, oral cancer may not be noticed by the patient. It frequently prospers without producing pain or recognizable symptoms.  It also develops in areas that are not easily observed like the back of the tongue, floor of the mouth, tonsils and throat.

Dentists and hygienists are trained to look for and detect oral cancers. At our office this exam is done at every hygiene visit.  While the dental profession does a great job of cancer screening, the high mortality rates continue.  Recently there has been an introduction of several cancer screening devices.  Our research found VELscope to be the best device for our office.

VELscope uses ultraviolet light frequencies to make abnormal tissue look darker than normal tissue. This darker tissue is often below the surface and cannot be seen with the naked eye.  This dark tissue can then be examined and follow-up testing can be done if needed.  All of our new patient exams now include a VELscope exam.  Existing patients are offered an optional exam yearly.  The cost is minimal and the peace of mind is enormous.

As adults we all go through routine cancer screening tests like mammograms, pap smears and prostate exams. Please consider having a VELscope exam yearly.  It may save your life!

And, if you start this year, a veteran will benefit.

Thanks for reading,

Dr. Bruce

http://www.brucesextondds.com

Fashion trends change, and so do accepted ideals for body appearance. The influences of Latin culture on American norms have triggered an explosion in the demand for buttock enhancement with fat grafting, which was first popularized in Brazil. Another trend patients are requesting is a more conservative and natural looking breast enhancement. A recent survey in California found that women are not looking for an oversized breast enhancement and desire a more subtle appearance. This is a healthier choice for women to choose.

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Due to the prevalence of evidence-based medicine and FDA demand for data on silicone gel breast implants, findings indicate that revision breast surgeries after a primary augmentation mammoplasty are as high as 25 percent. The main reason for these revisions is capsular contracture, but size change is a factor. Thanks to the work of Dr. John Tebetts, Bill Adams and Dr. Dennis Hammond, the concept of calibrating the correct implant size for a given individual based on breast tissue characteristics allows for customization and has reduced revision rates for surgeons who incorporate these findings into their practices.

The idea of putting the largest possible implant into a women’s breast is fraught with potential complications including excess stretch on the tissues leading to thinning of the breast which may result in increased prominence of rippling of the implant, as well as mal-positioning of the device either laterally or inferiorly. This causes an unsightly aged appearance of the breast. The cost of revision can be high if treatment plans include the need for added soft tissue support utilizing acellular dermal matrices or a silk textile mesh to restore soft tissue support of the implants.

Today is a very exciting time in the field of augmentation mammoplasty, because we surgeons have a wide variety of shapes and sizes and silicone gel consistencies to choose from to provide customized results for our patients.

I strive to deliver a primary augmentation of the breast with a correct implant that is sustainable by the body to provide a long-lasting aesthetic result free of revision until the integrity of the implant has failed.

I think in terms of the height and width and projection of the breast independently and choose styles and shapes to match my patient’s desired outcome. I never want people to say that all my breast augmentations look the same. Just as all faces are unique and different, so are breasts. I want to make an individual’s breast look and feel as attractive as possible with long-lasting results. Proportionate breast enhancement is key to achieving these results.

Furthermore, now fat grafting can be performed simultaneously with implant placement, allowing surgeons to correct volume and shape asymmetries, as well as fill in spaces where an implant cannot be placed, such as the cleavage region and the chest wall/implant interface.

If you’re considering an augmentation mammoplasty, take a look at a three-dimensional analysis imaging of yourself. Then discuss your tissue type and pre-existing breast tissue with your surgeon, who will devise a plan to make a customized result that will look attractive and proportional with your frame. A skilled board-certified plastic surgeon will choose an appropriate implant with or without fat grafting to highlight your own unique figure with long-lasting results.

Non-invasive aesthetic procedures have come a long way in the last ten years. The American Society of Plastic Surgery’s yearly statistics continue to demonstrate strong demand for procedures such as neuromodulators (Botox and Dysport), and hyaluronic acid filler agents (Juvederm, Voluma, Restalyn). Recently, non-invasive contouring systems that perform the techniques of cryolipolysis, such as Cool Sculpting and radiofrequency skin-tightening Ultherapy, have emerged in the marketplace. Now Allergan has added Kybella to the mix as a non-invasive injectable material to dissolve fat under the chin.

Before and After

Before and After

The key to success with these treatments is consulting a comprehensive center that offers a full array of non-invasive and surgical options, and will direct you to the ideal treatment modality for your unique circumstances. Just as with any medical and surgical procedure, there are appropriate candidates and patients with contraindications.

The most important step to avoid dissatisfaction is to be evaluated by a physician who is properly trained to perform comprehensive evaluation and care for all patients with a particular aesthetic concern.

Board-certified plastic surgeons have the most comprehensive education and background experience to correctly evaluate your anatomy and determine which treatments will yield the best outcomes. The statement “if all you have is a hammer the whole world is a nail” rings true for medical spas and dermatologist offices which only have one option, such as Cool Sculpting or Kybella. Just because a treatment option is non-invasive does not mean it is inexpensive. If you factor in the cost of multiple treatments, it may be as expensive as surgery and still fall short of expectations.

When is Kybella the right choice?

With the current status of the injectable form of deoxycholic acid (Kybella) the ideal candidate must have reasonably tight skin with only mild to moderate adipose excess in the submittal and chin neck angle. The patient should not have a significant mandibular jaw discrepancy with the midface or have a particularly steep mandibular plain angle.

When is Kybella the wrong choice?

Any patient with lax skin of the neck or a significant deflation of the neck related to weight loss with demarcated platysmal bands is not a candidate. Taking away fat in this circumstance only worsens the deformity. Any patient with a deep underbite and a small chin with a very oblique chin-neck angle should also avoid Kybella. Deoxycholic acid is mostly created to dissolve fat but does produce some inflammation with the caustic material to encourage collagen production and skin retraction. Skin excess with an oblique chin neck angle and recessed chin will not yield overwhelming positive results.

Instead of Kybella, the better option is placement of a chin implant (genioplasty) with aggressive liposuction to encourage skin retraction. A middle facial third with significant skin excess and deflation combined with loose-hanging skin with platysmal bands is best treated with a corset platysmaplasty in conjunction with a neck/face lift.

Non-invasive aesthetic procedures can be a wonderful adjunct to helping people age gracefully with limited down time. Kybella in the right situation may improve necks and make people happy with the results.

Avoid being pushed into this option without a thorough three-dimensional analysis of your face to determine if it’s right for you. Nothing is more frustrating than spending a great deal of money and not realizing your desired results. Even with surgery, some deformities may not be able to be corrected. Take advice from a board-certified plastic surgeon to maximize your goals and to feel good in your own skin.

Rhinoplasty is cosmetic facial surgery that’s ordinarily done to further improve a person’s physical appearance or to reconstruct their nasal area for health related purposes. A rhinoplasty surgery involves adjusting the cartilages and bones of the nostril , or sometimes tissue is added in order to maximize the cosmetic appeal. The surgery is also commonly executed to fix nasal fractures as well. If rhinoplasty is performed to repair someone’s nasal fracture, the surgeon tries to recondition the nostril to its pre-injury condition. A related procedure often known as septorhinoplasty is done on patients that in addition have a nasal obstruction. Septorhinoplasty works to greatly enhance the look of the nasal area , but also stabilizes the overall structure and reduces any internal obstacles that might be blocking the patient’s nasal breathing.

Any aesthetic worries and expectations you have needs to be completely discussed before rhinoplasty surgery treatment . The recommendations of your plastic surgeon along with any special limitations concerning the structure of your nose , skin , or face in general are essential to have thoroughly stated you. Make-up free snap shots are typically taken prior to operation to assist with both the preoperative and post surgery planning stage in order to document the results .

Make inquiries and express your concerns.

Finding a professional , qualified doctor to perform your rhinoplasty surgery should be your main priority when thinking of getting any type of cosmetic operation . ASAPS ( American Society for Aesthetic Plastic Surgery ) has recommended that each patient should ideally consider the following tips for best results :

• Consult at least 3 different surgeons before choosing one

• Be sure the cosmetic surgeon you choose is board certified

• Ask where your surgeon is privileged to legally practice to ensure his credibility

• Request to see before and after photos of previous patients

• Talk in-depth about the surgery as well as the results and recovery and any potential things that may possibly go wrong or happen unexpectedly

• Ask about the surgeon’s rhinoplasty experience . How many has he done ?

• Does the surgeon have malpractice insurance ? If not , get up and leave

• Ask about the follow-up procedures

• Request to contact former patients about their own experience

• How much does the procedure cost ? What about insurance ?

The results of rhinoplasty

Rhinoplasty results could possibly be minor or major , based on the type of modification you want done, but they are however permanent. It’s very important that both you and your cosmetic surgeon are on the same page relating to the goals of your process. If you have realistic expectations and your plastic surgeon like Ernesto J Ruas MD FACS, the outcome will likely be very positive overall.