Wisdom Tooth's Collateral Damages

This case involves the surgical removal of a completely impacted wisdom tooth. The horizontal impaction had caused a subgingival carious lesion in the adjacent tooth. Because of the extent of the subgingival cavitiy, the adjacent tooth now could not be saved, and required to be extracted at the same time of the wisdom tooth.

 Panorex examination revealed 4 impacted wisdom teeth (1,16, 17, 32). Teeth # 17 and #32 are completely horizontally impacted and are causing the large carious lesion subgingivally for its adjacent teeth # 18 and # 32. A diagnosis of impacted wisdom teeth 1,16,17,32 and acute abscess teeth # 18, 31.

 

 

Due to the level of the carious lesions, teeth # 18 and 32 were determined to be non-restorable and required extraction as well. Because of financial constraint, the patient requested for the surgical removal of the affected teeth lower left side (#17 & #18) at this time only.

 

 
The patient was anesthetized locally. We began by sectioning the tooth # 18 in half. Due to the carious lesion subgingivally, the distal half of the crown # 18 was undermined and broke off, leaving the distal root behind.

 

 
A closer view showing the level of subgingival carious lesion on tooth # 18.

 
A closer look at the occlusal cavity on the impacted wisdom tooth #17. 

 The distal root of tooth # 18 was then extracted.

  

The mesial half of crown and the mesial root of tooth # 18 then extracted.

A full thickness periosteal flap was raised to expose the crown of tooth # 17. A trench was made with a 703 surgical carbide around the buccal aspect of the tooth. Mobility was accomplished using the #301 and 34 straight elevators respectively.

The crown of the wisdom tooth # 17 was sectioned, so that the tooth can be extracted mesially.

 

 
Impacted tooth # 17 were elevated out mesially.

 
All wound was irrigated copiously with normal saline.

4-0 chromic suture was used to close the surgical flap. Patient tolerated procedure well. Postoperative instruction was given in writing and by caesy video.

 
Closer look at the final wound with the suture in place. Antibiotic and pain killer were prescribed. Patient is scheduled to follow up in 1 week in our office.







So, the lesson from this case for the doctors is to remove the from the front-to-back. This is the exception to the general rule of back-to-front in oral surgery. The lesson for the public is to remove the impacted tooth early in late teen or early twenty before it destroys the adjacent tooth.


Thank you for viewing.

Houston dentist
Minh Nguyen, D.D.S.

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Houston dentist
Minh Nguyen, D.D.S.

Teletron Tempur-pedic Sale Scam Houston, Texas

This video clip describes in detail the problem we have with Teletron for the amount of 8,117.67 charged on September 17, 2012.

Teletron claims that it is the Elite Dealer for Tempur-Pedic manufacturer and advertise on TV as well as on youtube about the 90 day free-trial (see www.youtube.com/watch?v=mD29zw84K2g). This 90 days free trial has been offered from the Tempur-Pedic manufacture and it is documented from official Tempur-pedic website (www.Tempur-pedic.com) as well as a quote we receive from their sale representative.

Since my mother does not speak English well she prefers to purchase the Tempur-pedic mattress (queen-size Grand Bed style) at the local Vietnamse store, Teletron.  The saleman,  Hoang Huynh, whose name is printed on the Sale Order, promised my mother that the mattress would certainly help with her back pain. In addition,  because Teletron ads  states that she can have 90 days trial and can return if she is not satisfy with it,  my mother decided to get brand new Grand Bed mattress at full price.   I used my credit card to pay for her and the mattress was delivered to her house on the same day.

After sleeping on the mattress for 6 days, my mother was not satisfy with it and she wanted to return it to Teletron.  She called the Mr. Hoang Huynh (saleman), but he did not want to come and pick up the mattress.  I called the store and spoke to the store manager (Phillip) and he told me that Teletron would not accept the mattress back.  Phillip said that the store general policy is shown on the back of the sale order, which handed to us in the envelop when we paid.   I explained that Teletron should honor what it had been advertised on TV and youtube regarding the 90 day trial, as Tempur-pedic manufacturer also has the same policy online.  If Teletron is one the Elite dealers, then Teletron should be able to pick up the mattress and return it to the manufacturer.  Surprisingly, Phillip disagreed, became angry, and directed me to contact Tempur-pedic manufacturer for further service.  In an attempt to document that we wanted to return the mattress on this date, September 22, 2012, I had faxed the written request to Teletron. 

After further investigation about Teletron, I found out that its name is not currently listed on the Tempur-pedic official website as one their elite dealers.  Accordingly I suspected  that Teletron is a scam, and therefore I called the credit card right away  to dispute the charge.


Houston dentist
Minh Nguyen, D.D.S.

Dental Surgery Review: Partially Impacted Wisdom Teeth

Surgically removal of two lower partially impacted wisdom teeth. This procedure was done under local anesthesia in our office on May 16, 2012 for a young female patient.

 

Panorex xray shows partially impacted wisdom teeth (#17 and #32) on mandible.  Noted there is also a completed bony impacted on the maxillary left wisdom tooth (#16) as well.

Our patient was a young healthy female.  She came to our office with a complaint of pain on her lower right jaw and difficult in chewing.  A diagnosis of acute operculitis was made and she was treated immediately with incision and drainage procedure.  The patient was discharged with antibiotic and rescheduled for surgery in 1 week.

A picture of her lower right wisdom tooth (#32) a week after.  Noted that the inflammation was reduced.  Also noted for a carious lesion on the chewing surface and partially erupted condition. The tooth also had slight rotation counter-clockwise.

Lower left wisdom tooth was also partially impacted and rotated.  There was a carious lesion on the chewing surface as well.

After the wisdom tooth was anesthetized, a small incision was made to expose the crown of tooth.

Standing from behind the patient,  a dental forcep was used to extracted the wisdom tooth in standard fashion.

Extraction socket of the lower right impacted wisdom tooth was irrigated with normal saline.

Partially impacted right wisdom tooth showing calculus on the distal surface and carious lesion on the occlusal surface

The wisdom tooth on the left side was then extracted in similar fashion. Photo showing the extracted socket after normal saline irrigation.

Lower left partially impacted wisdom tooth extracted.  Note for the fused roots and the carious lesion on the distal surface in addition to the one on the occlusal surface.

Photos of the 2 extracted partially impacted wisdom teeth.  The patient tolerated procedure well and she was scheduled for a follow-up visit in one week.


Houston dentist
Minh Nguyen, D.D.S.

Case review: CEREC porcelain onlay restoration, May 9, 2012

 The 60 year old patient complained of a "broken tooth."  Examination showed a defective filling with recurrent carious lesion extending to all four surfaces (FDOL) of the tooth.  Because the extensive of the decay, the strength of the tooth was compromised and the onlay restoration was recommended.

Preop picture of tooth #28 , showing a defective amalgam (silver) filling and a cavity is forming in the area between the tooth

closeup view of the defective filling and the cavity on the tooth #28

Preparation of the onlay was done in the patient mouth.

The onlay data was being prepared by the CEREC program

Computer generated a drawing of the onlay 3-D shape

The onlay was ready to be fabricated by the CEREC milling chamber as the CEREC program calculated how much time required to mill out the onlay.

A view at the milling chamber, showing the square porcelain block which will be used to mill out the onlay

the precised porcelain onlay was milled out by the CEREC machine and is ready to try-in the mouth

The porcelain onlay was trying-in to make sure it has proper seating and fit

After the onlay was completely cemented in the mouth

A closeup look at the final CECEC restoration for tooth #28

Thank you for viewing the note.  I hope it is informative and educational.

Wishing a good health to all of us!!



Houston dentist
Minh Nguyen, D.D.S.

Mother Day Story Contest Results

1. to be name
2. to be name 
3. to be name
4. to be name

Houston dentist
Minh Nguyen, D.D.S.

Impacted Wisdom Tooth - Surgically Removal

This is a case report of a surgically removal of the impacted wisdom teeth done in our office today.  The patient is an 18 years old Asian healthy female.

 

 Panorex shows partially impacted wisdom tooth on low right and left jaw. Plan was to remove the wisdom tooth on the lower right side under local anesthesia. Softdental - Minh Nguyen, D.D.S.

Oral exam shows the tip of the right wisdom tooth erupted, the rest of the tooth still submerged under the gum. Softdental - Minh Nguyen, D.D.S.


 

 After the area was anesthetized, the incision was made on the area of the wisdom tooth (#32) and the molar tooth in front of it (#31). Softdental - Minh Nguyen, D.D.S.

Full thickness periosteal flap was raised and the wisdom tooth was dissected and visualized.

Softdental - Minh Nguyen, D.D.S.

The wisdom tooth was elevated with an extraction elevator through the incision out to the oral cavity. Softdental - Minh Nguyen, D.D.S.

The wisdom tooth was surgically removed and inspected. Softdental - Minh Nguyen, D.D.S.

The remain extraction socket of the wisdom tooth, showing minimal bleeding. Softdental

- Minh Nguyen, D.D.S.

The surgical flap was closed with 2 dissolvable stitches (chromic gut suture). Softdental

- Minh Nguyen, D.D.S.

Patient tolerated procedure well, no complication noted for this wisdom tooth surgery. We will follow her up in one week. Softdental - Minh Nguyen, D.D.S.


Her prescription:

1. Decadron 4mg x2 tabbles right away in office
2. Amoxil 250mg one three times a day x 30
3. Vicodin ES one every 6 hours as needed for pain x 30

Houston dentist
Minh Nguyen, D.D.S.

Your Child's Teething

Yesterday my wife asked me,"a friend of mine, her child is having a problem with growing a new tooth.  Both of them could not sleep well. Is there anything that she can do to help her baby?"

Since this is one of the most common dental questions, I think it is best for me to write down my recommendation in this blog, so that the information can be shared to all mothers when needed.

Teething is the process by which a baby tooth erupts (or cuts through) the gum.  It usually occurs between 6 to 24 months of ages.  As the tooth is coming from beneath the surface of the gum, the area may appear slightly red or swollen.  Sometimes a fluid-filled blister similar to a bruise may be seen over the erupting tooth.  The surrounding teeth may also feel more tender.

Common signs and symptoms of teeth include irritability, tender and swollen gum, increased drooling, restless, not sleeping well, refusal of food, and sucking fingers (perhaps.. because he or she is trying to reduce the discomfort in the mouth).

What can you do to help your child?

First, you need to make sure that your child does not have a flu or bacterial infection (like ear infection).  Normally with teething, your child's symptoms should not have fever, cough, and diarrhea.  If your child have any of the "cold" symptoms, it is best to take your child to see the doctor right away.

Second, you can use:

1. Oral over-the-counter pain relievers like children Tylenol or Motrin
2. Topical lidocaine gel (Note that topical medication containing bezocaine may have severe side effect and should not be used to treat teething problem)

Finally, your child's teething problem should be naturally resolved within a few days.  If the problem continues for more than one week, or if the problem is getting worse, then your child may need to be evaluated by your dentist.   Often a quick surgical procedure can be performed in the dental office to assist with the tooth eruption.

Houston dentist
Minh Nguyen, D.D.S.