Thursday, January 14, 2016

Conditions and Diseases that may Require Oral and Maxillofacial Surgery

Image source:
An internationally recognized surgical specialty, oral and maxillofacial surgery (OMS) includes the diagnosis, surgical and related treatments of many diseases, injuries, defects, and aesthetic problems involving the head, neck, mouth, face, teeth, and jaws. Specialists in this field provide care options to patients experiencing such conditions as impacted wisdom teeth, facial pain, and misaligned jaws. They also offer reconstructive and dental implants, treat accident victims suffering facial injuries, and perform specific procedures for patients with tumors, cysts, and developmental craniofacial abnormalities.

The scope of OMS is wide and extensive. Specifically, it covers the following diseases or injuries, among other conditions:

  • Dental implant surgery and associated bone grafting
  • Dentofacial deformities
  • Bone augmentation
  • Oral and dentoalveolar surgery (removal of impacted teeth, cysts, etc.)
  • Congenital craniofacial deformities
  • Facial plastic surgery (rhinoplasty, rhytidectomy, blepharoplasty, etc.)
  • Snoring and sleep apnea correction surgery
  • Tumor or cancer surgery
  • Facial trauma surgery (facial bone fractures and related soft tissue injuries)
  • Reconstructive surgery of the face
  • Cleft lip and palate surgery
  • Temporomandibular Joint Disorder (TMJD)

Oral and maxillofacial surgeons do not work alone and often seek the advice, assistance, and even surgical support of other specialists such as dentists, orthodontists, pathologists, oncologists, prosthodontists, neurosurgeons, plastic surgeons, radiologists, ENT surgeons, and other medical professionals.
Image source:

Domenick Coletti, DDS, M.D., is certified by the American Board of Oral and Maxillofacial Surgeons. His practice at Central Maryland Oral and Maxillofacial Surgery, P.A. includes performing dental implants, removing impacted wisdom teeth, treating facial trauma, and administering corrective jaw surgery. For more articles on oral health, click here.

Thursday, November 12, 2015

Does Wisdom Tooth Xtraction Cause Sinus Infection?

Wisdom tooth extraction is a relatively common dental procedure. This process is done when the third molars become impacted, with many dental surgeons recommending early intervention to prevent gum disease and structural misalignment. Despite its general simplicity, wisdom tooth extraction is still considered a major operation and patients need to be reminded of the potential complication that may occur post-procedure. A certain amount of swelling is expected to occur, but this should ease after a few days.

Image source:

A less common side effect is a condition known as an oral-antral fistula, which happens when an upper molar is taken out. During the operation, a small cavity will be made from the mouth to the sinuses. Most of the time the tissue heals with no ill effects, but there is a possibility of infection. This is a recognized risk factor, and many dental surgeons warn patients to comply with their antibiotics treatment during the entire recovery duration. That said, many patients who have had their upper molars extracted are more likely to develop colds or a stuffed nose; although again, this should disappear within a few days. If the infection becomes severe, the individual may have to visit a general practitioner in tandem with his or her dentist to treat the cold while maintaining the stability of the wound healing.

Wisdom tooth extraction does not cause sinus infection though there are risks that are heavily emphasized before the operation. It is thus important for patients to have a clear understanding of the procedure, possible risks, and after-care.
Image source:

Dr. Domenick Coletti is a maxillofacial surgeon focused on wisdom tooth extraction. Learn more by following this Twitter account.

Thursday, July 30, 2015

The Link Between Oral Health and Heart Disease

Tooth decay is an oral disease characterized by damage to the outer layers of the teeth. It occurs as a result of eating foods that are high in sugar and carbohydrates, not observing proper dental hygiene, and not getting enough fluoride. It can also be caused by diabetes, smoking, and not having enough saliva.

Image source:

Tooth decay not only causes unpleasant symptoms such as toothache, sensitivity, and bad breath: It has also been linked to heart disease.

A study published in the British Medical Journal found that people who reported having poor dental hygiene had a 70 percent risk of cardiovascular disease, compared to people who brush their teeth at least twice a day. Some researchers theorize that bacteria from the infected gums can become dislodged and enter the bloodstream. The bacteria can eventually attach to the blood vessels, causing clots to form.

Chronic gum disease often occurs alongside tooth decay and begins when bacteria in plaque build up (gingivitis). If left untreated, gingivitis progresses to periodontitis, a more advanced, destructive form of gum disease.

According to the Academy of General Dentistry (AGD), people with oral health diseases are at a higher risk for heart attacks, while the American Academy of Periodontology reports that individuals with periodontal disease (a more advanced and destructive form of gum disease) are nearly twice as likely to have heart disease than those who don't. Several experts in the field of dental health came together to create a consensus report, published in the Journal of Periodontology and the American Journal of Cardiology, which touches upon the link between oral health and heart disease. One of the main takeaways from the report is that chronic gum disease is a risk factor for coronary artery disease.

Image source:

While the jury is still out when it comes to finding a definite link between tooth decay and gum disease, and heart health, individuals who are concerned about their overall health should not neglect to pay attention to their teeth. Brushing teeth with a fluoride toothpaste at least twice a day, flossing, quitting smoking, and paying regular visits to the dentist can help prevent tooth decay and gum disease and their complications.

Domenick Coletti DDS, MD is one of only 60 oral and maxillofacial surgeous inducted into the American College of Surgeons. For more articles on oral health, subscribe to this blog.

Wednesday, July 1, 2015

Gauging the Risks for Tooth Loss

Although traditionally thought as an effect of aging, tooth loss or edentulism can take place at any age. Everyone from children to adults is at risk of tooth loss, in particular when oral hygiene habits are severely lacking.

Previous generations have been prone to tooth loss at the onset of senior years and recent trends suggest that this pattern may repeat itself among older adults today due to the prevalence of gum disease and high sugar diets, accompanied by poor dental hygiene.

Images source:

Risks for tooth loss, however, vary significantly with age. For instance, while tooth decay and poor dental hygiene and healthcare are universal factors afflicting the general population, other causes are functions of the different stages of a person's life. Children, for instance, risk losing baby teeth prematurely to injury or neglect, whereas adults are more likely to increase risks of tooth loss due to smoking or serious health conditions like heart disease and diabetes.

In addition, poor dental health habits also contribute to the risks of edentulism. Some adults and children neglect to go to the dentist as needed out of either financial constraints or fears of the resultant pain accompanying the procedure.

Image source:

The fundamentals of keeping teeth health for a lifetime include ingrained habitual good dental hygiene and regular dental checkups and recommended procedures. Preventing tooth loss is a lifelong commitment that can pay off well into the golden years.

Dr. Domenick Coletti is one of the head surgeons at Central Maryland Oral and Maxillofacial Surgery. Visit this website for more on the practice's many oral health procedures.

Saturday, May 9, 2015

REPOST: Seniors with dementia eased into dental care

Seniors with dementia are a very difficult patient group to treat, dental care-wise. They easily get confused, may fail to follow instructions properly, and are confronted with other health problems. Read the following article to know how dentists are addressing this challenge:

Video source:

When Monte LeVernois is wheeled into a dental clinic at a long-term care home in Halifax, saying "Good morning" to him provokes no response. He has dementia and it's not clear what he understands. But his dentist is equipped to deal with the challenge.

Dr. Stu Kirby is the dentist who makes biweekly visits at Northwood, the largest long-term care home in the Maritimes. He provides dental care to the residents, many of whom have dementia

"It's a very challenging population to work on for a number of reasons," says Kirby.

Depending on the stage of dementia, patients may refuse care or even bite Kirby, mistaking what's in their mouth as food. He doesn't blame the patients.

"They are no longer able to follow instructions. They're confused. Things are out of the ordinary for them, which makes them very, very difficult. So the key is to get in there early. Find the problems. Deal with the problems when things are able to be taken care of."

Sometimes though, it's not possible to fix a patient's dental problems before his or her dementia has taken hold. Kirby then relies on techniques he's learned.

"You've got to be very careful in terms of how you're dealing with these patients in terms of the way you speak to them, your hand movements, your gestures. You want to make sure that they're always feeling secure and comfortable."

Sedation is an option for some patients who are particularly anxious or unco-operative. But the frail health condition of dementia patients sometimes precludes sedation.

Kirby takes advantage of the newer design wheelchairs, many of which tilt back, so he doesn't have to cause distress by moving the patient out of his or her wheelchair.

Kirby says serious — even deadly — health problems can begin in the mouth, including in dementia patients.

"You can have life-threatening infections which travel from the floor of the mouth to the brain and so people think, you know, it's just a minor abscess. Well, a minor abscess can turn into a significant problem."

Dr. Mary McNally, a professor at Dalhousie University's School of Dentistry, is passionate about improving dental care for seniors at the school's elder care clinic. She spearheaded a large research and training project, called Brushing up on Mouth Care, which outlines what dementia is and how it can affect a patient's behaviour during dental care visits.

"I think you just need to stay calm. I mean, these people are sick. They need your help. They're not doing things to cause a problem. They're doing them because they have a cognitive impairment and are declining."

McNally says a reality we need to understand about dementia is that these patients perceive their surroundings in a very different way.

"You might have someone coming into your dental operatory and they're walking over a black mat and they might think it's a puddle of water. They might not recognize what the chair is. So what's manifesting as natural losses associated with dementia is, in fact, them responding to the reality in their world … Their behaviour is a result of their lived experience. That's what makes them challenging. We don't understand what those realities are for them."

Her research and training document includes tips for dealing with dementia patients, such as:

-Set a routine time and place for oral care.
-Have the caregiver identify him or herself and what he or she is going to do.
-Use visual or verbal cues, short sentences and simple words.
-Maintain a calm and quiet atmosphere.
-Use positive reinforcement, such as nodding the head or giving a thumbs up.
-Provide oral care after a meal when a patient is most content and co-operative.
-Distract the patient by singing or giving them something to hold, such as a toothbrush.
-Put the toothbrush in their hand and guide it with your own to encourage toothbrushing.

McNally says it's also useful for dentists or caregivers to mimic an action. In other words, don't just say, "Open your mouth." You have to open your own mouth and demonstrate.

Shift away from dentures

McNally thinks consistent dental care is important given the prevalence of dental diseases such as cavities among people with dementia in long-term care, as well as the decreasing incidence of dentures among seniors generally.

"The aging population is actually aging with more of their natural teeth. So now folks are going into residential care. Even a generation ago, they mostly had dentures. Well, now we know that they mostly have natural teeth. So that has a huge impact on the care system because the care system and care providers are having to adjust to this whole level of managing an aspect of health that they didn't have to manage before."

McNally says it's clear this is becoming an issue of wider concern. Her research and training document and videos are available online and gets hits from Europe, Australia, India and South America as well as Canada and the U.S.

Gail MacDougall understands the challenges of getting a frail senior with dementia to receive dental care. Her 95-year-old mother has dementia but MacDougall says it was never a question as to whether her mother would go for regular dental visits, not only for her health but also her looks.

"My mother loves her clothes. She likes to look well. I think appearance is part of it, as well as nutrition and overall health. You don't want unnecessary infections in a body that's already compromised."

Back at the dental clinic at Northwood, Dr. Kirby finishes the procedure on LeVernois. It's not clear LeVernois has any clue what has just happened to him.

Kirby says a little compassion goes a long way.

"Many of us will be in the same situation so I think it's important that you just keep calm and do what you can."

Dr. Domenick Coletti practices the full scope of oral and maxillofacial surgery. To learn more about his expertise, click here.

Friday, April 10, 2015

REPOST: The rise of DIY dentistry: Britons doing their own fillings to avoid NHS bill

Necessity is the mother of invention and this may be true for the manufacturers of over-the-counter dental kits which are becoming a norm for those in the far end of health distribution curve in Britain. The Guardian has more about Britain’s rising DIY dental care industry.

Image Source:
Home dental treatment. Picture posed by a model.

A missed appointment and resulting £25 charge led Alex to become a DIY dentist. Using an emergency over-the-counter dental first aid kit, bought from a pound store, the 38-year-old building engineer from Glasgow began fixing his own teeth rather than run up bills. “I couldn’t justify going and getting my teeth out when we can’t afford nappies,” he said.

His partner, Tilly, gave up her teaching job when their eldest son was diagnosed with leukaemia five years ago. When the recession hit, Alex found work hard to come by. A jobcentre interview clashed with an appointment to fill some cavities, and Alex concluded that the family could not afford his dental work.

In a country that prides itself on free healthcare, DIY dentistry is an almost Victorian notion of hardship. But poverty and inequality – and the increasing stigma attached to both – are blocking access to healthcare for the poorest people in the UK, and grim tales of a black economy are on the rise.

“DIY dentistry is fairly common round here,” said Emma Richardson at the Star Project in Paisley, Renfrewshire. “They sell a lot of those first aid kits – you can buy them in Boots and Asda as well, and you’ve got people taking care of their whole family’s teeth with them.” The kits, which can be bought for a few pounds, are intended as a temporary remedy for lost fillings, caps and crowns.

In a survey of local people, the Star Project, a church-based community organisation, found people buying DIY kits online from pound shops or even from friends to do their own fillings. One client told Richardson: “My uncle takes care of his teeth and everyone in his family.”

The project also found people trading unfinished courses of sedatives, anti-depressants, beta blockers and antibiotics. “There’s a mixture of reasons,” said Richardson. “Some people only have pay-as-you-go phones – if they run out of money, they can’t make calls. They have to wait until the community centre is open at 9.30am to use the phone, by which time it’s too late to book a [doctor’s] appointment. Or they feel embarrassed to fill out the form [for free dental treatment] and prefer to get help from friends who don’t judge them as scroungers. People will maybe take half a course of a drug and keep some of them in case something comes back. If one of the neighbours or friends needs them, they’ll help out.”

Accurate figures on the extent of DIY dentistry are hard to find. One of the biggest seller of dental first aid packages, DenTek, shifts more than 250,000 kits a year, but there is no research on how they are used. In 2012, research from the oral health charity, the British Dental Health Foundation, found that one in five Britons said they would remove a tooth themselves or ask a friend to do so if they could not afford dental treatment.

The Department of Health said reports of DIY dentistry were anecdotal. “Official figures show that more people than ever are getting NHS dental treatment, which is completely free for almost everyone receiving income-based benefits and subsidised for low earners,” said a spokesperson. However, according to NHS UK, people receiving incapacity benefit, contribution-based jobseeker’s allowance, contribution-based employment and support allowance, disability living allowance, council tax benefit and housing benefit, among others, are not entitled to free treatment without other qualifying benefits.

Figures, as opposed to anecdotal evidence, on DIY dentistry and the black health economy are elusive, said John Wildman, professor of health economics at Newcastle University, because health data is gathered by surveying patients or GP surgeries.

“People at the lower end of the distribution curve – on big housing estates in the north-east, for instance – are effectively completely unreported,” he said. “They don’t take part in surveys and they don’t go into GP surgeries. Which is why you have a situation where people in the north-east have gaps in their teeth and are resorting to DIY dentistry. There’s research from the US that shows poor teeth hinder your chances of getting a job and getting married – the two fundamentals for building a stable life.”

Image Source:

Alice – one of the Star Project’s service users – resorted to popping an abscess with a fork because of worry about the costs of treatment. Dental examinations are free in Scotland and Northern Ireland, although charges are made for treatment. The cheapest, a filling, costs £7.20 with prices reaching a maximum of £384 for the most expensive treatments. In England and Wales, NHS dental examinations cost £18.50 and £13 respectively - which includes cheaper treatments - with mid-ranking treatments costing £50.50 and £42 respectively and the most expensive treatments costing £219 and £180.90 respectively.

“The majority of people would think these prices are relatively reasonable if you need work doing,” said Karen Coates, of the Dental Health Foundation. “It’s about prioritising £50. They probably would go and get their nails done or their hair, and don’t consider that the dentist is high enough on their need list, whereas for other people it is a priority to go regularly to the dentist.”

All the costs were unaffordable for Alice, whose partner had been sanctioned for arriving late at a jobcentre interview, leaving the couple with about £65 per week. Out of that, they paid £10 for gas and £10 for electricity, plus bus fares to the jobcentre. “When you add in TV licence and phone calls you’ve got £25 per week, which has to cover food,” she said.

Even an NHS dentist would have made a big hole in her meagre budget – assuming there is an NHS dentist in the area. According to Jack Toumba, professor of paediatric dentistry at Leeds University, oral health inequality is particularly bad because dentistry has in effecti been privatised. Although there are dental practices offering NHS care, they are increasingly hard to find.

“We’re finding patients who’ve rung practices across the north asking to register as an NHS patient only to be told the NHS lists are full and they can only register as a private patient,” he said.

He cites the case of a 40-year-old HGV driver who used the plastic mirror, forceps and probe from an over-the-counter dental kit to clean and prepare a cavity before plugging the hole withQuikSteel, a potentially toxic steel reinforced epoxy putty used to fix engines. “His local dentist had discontinued NHS dental services and he couldn’t afford private dental care or find another NHS dentist. He’d treated the tooth twice by himself in the three years before he came to see us.”

The imbalance in the UK’s oral health is stark. Research published in the Journal of Dental Research last autumn found that poorer Britons have, on average, eight fewer teeth – a quarter of a full adult set – than the richest by the time they reach their 70s.

Patricia Lucas, at Bristol University’s school for policy studies, said data from the city’s dental hospital showed children from disadvantaged backgrounds were significantly more likely to have early tooth decay and to need teeth extracted under general anaesthetic. In 2013 – the most recent data available – 721 children had decaying teeth extracted under general anaesthetic, the majority from poorer wards in the city. Of those, 155 were below the age of five.

Now Dentaid, a dental charity which works to improve oral health in the developing world, is preparing to launch its first UK-based project. The organisation, which offers portable dental surgeries to struggling communities in Uganda, Malawi, Cambodia and Romania, is considering mobile surgeries in the UK, or working with existing practices to pay for transport and treatment.

“It’s extremely hard for the homeless, or people who haven’t got a permanent residence, or people coming out of prison to access dental treatment,” said Andy Evans, Dentaid’s strategy director. “Homeless people normally only turn up at a dentist when they are in extreme pain – when fillings or tooth extraction are needed. They don’t do regular visits to the doctor and the only painkiller they have is alcohol so sometimes they are in no good condition to be treated when they most need it.”

Image Source:

Inclusion Healthcare is a Leicester-based social enterprise that cares for around 1,000 single homeless adults. One, Mary, struggled with addiction for years, fell out with her family, ended up on the streets and was forced into casual prostitution. By her mid-30s she had lost most of her teeth through being attacked, , falling and simply struggling to find somewhere to clean her teeth.

But as she rebuilt her life and her self-esteem, her ruined mouth damaged her chances of a job and of finding new relationships. Eventually, a Leicester dentist took her on and replaced all her teeth with dentures. The change is startling. She walks taller. She smiles with confidence.

“We don’t see teeth as being a crucial part of the health service,” said Wildman. “We see it as a luxury. But toothache stops kids sleeping and concentrating in school, a bad smile damages your chances of getting a job … and as it gets harder and harder for disadvantaged people to receive good dental care. The best way to resolve health inequality is to make social mobility possible - and someone’s smile is not a luxury add-on to that.”

Dr. Domenick Coletti leads a team of surgeons at the Central Maryland Oral and Maxillofacial Surgery P.A., serving patients with high-quality dental care treatments ranging from dental implant surgery and corrective jaw surgery to wisdom tooth extractions. Log on to this website to learn more about the Columbia, Maryland-based doctor.

Tuesday, February 17, 2015

REPOST: Too old for cavities? Think again, dentists say

Dentists warn that the risk for tooth cavities rise as people age. The article below discusses the factors that can increase a person’s risk of getting tooth cavities and the ways to maintain a tooth-friendly diet which is key to overall dental health.

Image Source:
It may come as a surprise, but even older adults can still get cavities.

Alice Boghosian, a dentist in Niles, Ill., says she was working on an 87-year-old patient recently when she discovered a cavity and exclaimed, "You have got to be kidding me."

Boghosian, a consumer adviser for the American Dental Association, was not surprised by the patient's age. She was surprised because the patient was her own mother. "Luckily, I was able to save the tooth," she says — something she cannot always do for her older patients.

Adults of all ages need to know, dentists say, that cavities are not just for kids. The risk can even rise as we age.

"It's as much a problem in seniors as it is in kids," says Judith Jones, a professor of general dentistry, health policy and health services research at Boston University.

It's also a more persistent threat now that most aging adults keep at least some of their teeth. Just 50 years ago, more than half of people over age 65 in the United States had lost all their teeth and needed dentures, Jones says. More recent data find 15% of people ages 65 to 74 and 22% of those over 75 are toothless, according to the federal Centers for Disease Control and Prevention.

But those with teeth don't always have healthy teeth: more than 20% of people over age 65 had untreated cavities in 2008, CDC says. Poor people, men and non-whites were especially at risk.

Cavities can lead to pain, infection and tooth loss. They also can come as quite a shock for aging adults, says Christine Downey, a clinical assistant professor of dental ecology at University of North Carolina at Chapel Hill.

Downey, who also is on the adjunct faculty of Duke University, says: "Many a person has come into my office saying, 'I always had really nice teeth and now I'm getting cavities. What's going on?' "

Here are some of factors that might be at play:

• Diet — especially sugar. Sugar is bad for your teeth whether you are 7 or 70. When you eat or drink sugar, bacteria in your mouth produce acid. That acid breaks down the protective enamel on teeth, allowing decay. Eating acidic foods, such as citrus fruits, also can damage enamel.

• Dry mouth. It's a side effect of more than 500 medications, including many commonly used by older adults, the dental association says. "Our saliva has a cleansing, anti-cavity effect," Boghosian says.

• Recessed gums. When you are "literally long in the tooth," decay is more likely to reach tooth roots, Jones says.

• Delayed care. Many people lose their dental insurance when they stop working and then stop going to the dentist, Jones says. Dental care is not covered by Medicare; Medicaid coverage varies state to state.

• Cognitive and health challenges. People with dementia may forget to brush or "don't care about it," and caregivers may not take up the slack, Downey says. Lost dexterity and other physical problems also can get in the way of dental hygiene, she says.

Cavity prevention, at any age, means brushing with a fluoride toothpaste at least two times a day, for two minutes at a time, plus flossing and regular dental visits, dentists say.

Some people need to take extra steps, such as using stronger prescription fluoride toothpastes and oral moisturizing products, Downey says.

Image Source:
Foods that are sticky and sweet, such as these Lifesavers, can be promote tooth decay at any age.

And everyone can benefit from watching what they eat and drink. Here are Boghosian's tips for a tooth-friendly diet:

• Recognize sugar in all its forms. Scan labels for honey, corn syrup, dextrose, fructose and other sweets, she says: "It's all sugar."

• Watch out for sticky foods. Dry fruit, caramels and other sticky sweets can promote decay. Even bread or crackers that stick to teeth can convert to sugar and cause trouble.

• Don't nurse sweet drinks or candies. Sipping a sweet tea or sucking hard candy for hours keeps your teeth bathed in sugar.

• Limit acidic foods. Citrus fruits and juices count. So do sodas, even if they are sugar-free.

• Drink water, and make it fluoridated tap water when you can. Swish water around your mouth after eating sweet, sticky or acidic foods.

• Keep up your calcium intake, with milk, yogurt, cheese and leafy greens. That can help rebuild enamel.

Dr. Domenick Coletti is a dental surgeon who currently practices at the Central Maryland Oral & Maxillofacial Surgery, a facility that provides expert oral and maxillofacial surgery procedures including oral pathologies and treatments for facial injuries, facial pain, and fractures. Click here to schedule a consultation or to learn more about the clinic’s dental services and procedures.