Denis Miller: Good morning, thanks for having us.
Lou George: Good morning, Bill. How are you?
Bill Zortman: Let’s talk wisdom teeth to start, and then we’ll double back and talk a couple about the questions that people are asking. So, wisdom teeth. What is important for people to know about Siouxland Oral Surgery?
Denis Miller: One of the things that people should know is oral surgeons are trained for another 4 to 6 years after dental school specifically to do these surgeries. When you come out of dental school, you’re really not trained to do this. So, one of our mottos is, “let the oral surgeons do the oral surgery.” Just like if you hurt your knee or your hip and you needed orthopedic surgery, you’d go to an orthopedic surgeon. That’s kind of what you do. Cardiology, you need a stent or a bypass, see a cardiologist. So for us regarding the wisdom teeth, this is what we do. If you were to take either one of us right out of school and we only did one surgery a week, versus us doing ten or twelve a day, well, who’s going to be better at it? Over time, it’s just an experience level. So for people who are contemplating getting their wisdom teeth out, we’ve got four office locations to make it easy. You don’t have to drive all the way to Sioux Falls. Nobody likes another two-hour drive to go back home because they had to drive to Sioux Falls if we’re in Mitchell or Yankton or Brookings, so there’s the convenience factor. There’s the training and experience factor. But, for us, one of the main things that makes it easier and reduces the complication rate is that the roots of the wisdom teeth are about a third formed. Once they’re about a third formed, it makes them really easy to take out. The complication rates go down. Typically, it’s the younger generation, the teenagers, so 14, 15, 16, 17, right around there. That’s just a good age to get them out if you need them out.
Lou George: And also in addition to what Denis said, only oral surgeons should be doing true IV anesthesia in the office setting. So, we utilize those skills to make sure the patient has a completely peaceful experience, and because we’re very efficient at what we do, the surgery takes a lot less time. So, not only does the patient get to have a quiet, peaceful, relaxing little nap, it’s also done quite efficiently, and they’re back with their family and always telling us, “I can’t believe it was that fast. I can’t believe you guys took care of business so quickly.” And they’re always very pleased with that.
Denis Miller: Yeah, just to build on what Dr. George said, a typical set of uncomplicated wisdom teeth should take us about ten to fifteen minutes to do. That’s our surgical time. And then there’s the recovery time, anywhere between half an hour to an hour before they’re ready to go home and pass the criteria for discharge. So, that’s kind of the standard. So, if you’re getting a set of wisdom teeth out and it’s taking an hour, two hours, three hours, the whole afternoon, you’re probably not in the right spot.
Bill Zortman: You know, I just wonder if things have changed. I had my wisdom teeth out way too many years ago.
Denis Miller: You’re thirty. I thought you were thirty.
Bill Zortman: You’re a gentleman. Thank you. But they took all four out in one sitting. And it was kind of like, did I need all four out at the same time, or would it have been wiser to maybe have done a couple at two different settings?
Denis Miller: Typically, we take out all four because you don’t want the person to go through all of that trauma a second or a third or a fourth time. The other thing to remember is the lower jaw is paired, and even if you only take out one wisdom tooth on one side and leave the other one, it’s still going to hurt because you still have to move the jaw. It’s not like your leg. I need surgery on both my legs. I’ll do one first because then I can baby it, and I can kind of be more load-bearing on the other one, and then I can flip-flop and do the other surgery on the other leg. It doesn’t work that way in the oral cavity. So, for the vast majority of people, we do all four at the same time.
Lou George: And we also know, especially with, say, older patients and folks with much more complicated wisdom teeth, when to not do surgery. Meaning that if a tooth is asymptomatic and looks like it’s not going to ever become a problem for the patient, but yet the host of complications associated with surgery are looming, we kind of know when it’s OK to say we’re not going to operate on this area, we’ll monitor it. That decision usually should come from us.
Bill Zortman: You know the other thing that happens with you guys is you’ve got a few more years of experience. You have a few more teeth that you’ve pulled, rather than somebody that they only do one surgery a week.
Denis Miller: Right, and that speaks to the experience level and being a specialist. So of course, and a specialist in any field is going to have more experience and more training than somebody who’s not a specialist trying to do the same thing. That applies for medicine and for dentistry. One of the things is the advent of CT scanners. We’re trained to read CT scans as part of our residency training, not because we bought one and the rep is teaching us how to do it on a weekend course. And why is that important? Well, for a lot of the wisdom teeth that we remove, there’s a nerve that’s relatively close by, and it’s about a one percent chance you end up with a permanent numb lip or a tongue. But in some people, those chances are higher. And then we use our CT scanner and we can look at things in cross-section and three dimensions, and we can find out a little bit better where that nerve is actually, and then we can modify our surgical technique to stay away from it and minimize your risks.
Lou George: We have a wonderful group of general dentists and other referring practitioners that we work with who appreciate how we go about doing this for patients. Any time a patient is referred to us, we take that very seriously, whether it’s the most completely set of routine wisdom teeth or the most difficult set, we’re very honored and happy with the fact that the referring doctor trusts us to take care of his or her patients. That’s something, like I said, we take very seriously.
Bill Zortman: When we talked in November, we talked about a brand-new, all-ceramic dental implant. You got some questions on that?
Denis Miller: A lot of people are coming to us for the placement of dental implants in the setting of they’re losing a front tooth. So, we call that the “aesthetic zone.” So, the aesthetic demands in that zone are higher than maybe where your molars are. That’s more of a functional concern. And both are equally important, that’s something maybe we can talk about on another day, but a lot of people are asking for implants that have aesthetics as their priority, and the ceramics satisfy that need. They have a better soft tissue response than the titanium, and if there is some bone or some gum tissue that dies back a little bit, instead of getting the graying of the titanium, the white of the ceramic implants doesn’t tend to cause any kind of discoloration of the gum tissue. So you get a better cosmetic result overall. And so far, we’ve probably placed about forty of them. They just became available in February. So, we’ve got a good track record now. Probably about eight to ten of them have been restored with the final prosthetics. So far, everyone has been quite happy with them.
Lou George: The dentists are happy with them, and the patients seem very, very pleased. It’s just another tool in the box that we can utilize.
Bill Zortman: And I’m sure with the years of experience, you want to make sure that they’re healthy before they go into a surgery. The heart needs to be checked. What else needs to be checked?
Lou George: Well, you know, we do a medical screening of all of our patients. If anything kind of pops up on their medical history, or a multitude of things pop up on their medical history, we will set them aside for a consultation first and then we decide if we need to involve their primary care physician or other members of their health team. Usually, if there’s a cardiologist, let’s say that the patient sees quite regularly, of course, we want their input. Again, that’s part of our training that we have one boot in the dental world and one boot in the medical world. We try to bring harmony to both sides, so we know when to call on our medical friends to step in and take a look at some things for us to make sure our patient is not only going to have a smooth surgery from us but that it’s going to be safe and minimize any complications.
Bill Zortman: How do people get started?
Denis Miller: Typically, they’ll either call our office directly for either wisdom teeth, or get a tooth pulled, or for a dental implant. But a lot of times, they talk with their general dentist to form an overall treatment plan, and then their general dentist will refer the patient over. Typically, that’s what we prefer, just to make sure everyone’s all on the same page. Especially when it comes out to taking different teeth out. Sometimes, from a restorative standpoint, it’s better to try and keep some of these teeth, whereas from an oral surgery standpoint it might be better to get them out. So there’s typically a meeting of the minds between the restoring doctor and us when we come up with a plan for the patient. So we call that the team approach.
Lou George: And it’s also important to note in addition to doing these casts for the patient and so forth, we also like to kind of give a shout-out to our friends in the general dental community and restoring dentists. And for those that have any thoughts about possibly using us to help them out with a case or treating some of their patients, we encourage them to give us a call if they want. Talk to us about what we offer and the length we’re willing to go for their patients, and I think they’ll be very pleasantly surprised.
Bill Zortmanv: Dr. Lou George, Dr. Denis Miller, Siouxland Oral Surgery. I appreciate the visit.
Denis Miller: Thanks for having us, Bill.
Lou George: Thank you, as always.