Then, three years later, he comes back, and he\u2019s got multiple issues here.\u00a0 We\u2019re not going to be crowning any teeth.\u00a0 We need to remove all of his teeth.\u00a0 He can\u2019t control his caries risk. We can\u2019t control his caries risk with the lack of saliva.\u00a0 So, the ability to see this guy in one day, remove his teeth on the lower arch, degranulate the whole site, we able to place in implants on the lower arch, suture everything nice and clean, and do the same thing for the upper arch and have him, in three months, to heal like this is just tremendous service.\u00a0 This is just for the lower arch.<\/p>\n
Now, for the upper arch, if you\u2019re not producing saliva, it\u2019s going to be hard to produce a posterior palatal seal.\u00a0 So, implant-supported dentures are going to be the way to go.\u00a0 So, that\u2019s exactly what we did.\u00a0 We degranulated this area.\u00a0 We removed all his teeth.\u00a0 We did bilateral internal sinuses for this patient, placed implants on the maxillary anterior and posterior regions, let him heal for three months.\u00a0 He came back in, and his tissues looked amazing.\u00a0 What a service for a patient.\u00a0 So, what we did was we didn\u2019t give him a palatal strap.\u00a0 The denture rests on these implants.\u00a0 It\u2019s a metal-reinforced complete denture.\u00a0 The patient is an amazing guy, a great friend now.<\/p>\n
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Dr. Lavine:<\/p>\n
Danny, can we go back to a couple of questions I\u2019m seeing right here?<\/p>\n
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Dr. Domingue:<\/p>\n
Yeah.<\/p>\n
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Dr. Lavine:<\/p>\n
Talking about the uncontrolled diabetes patient, is there a specific A1c value that you\u2019re comfortable with for those patients?<\/p>\n
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Dr. Domingue:<\/p>\n
A1c value, I actually don\u2019t recall that.\u00a0 That\u2019s a good question.\u00a0 I don\u2019t recall that data right now.\u00a0 I have it in my notes somewhere, but I basically say to get the patient controlled, to get the levels under control.\u00a0 Get it controlled.\u00a0 Make sure he\u2019s getting insulin.\u00a0 Make sure he\u2019s following up with his regular [15:21] before we go for an implant surgery.<\/p>\n
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Dr. Lavine:<\/p>\n
I mean a lot of people hear from different places.\u00a0 I believe it\u2019s 7 for the A1c is the max value.\u00a0 Anything under 7 is okay.\u00a0 The other thing is can you define what a meth mouth is?\u00a0 We have people from all over the place not understanding exactly what that term is.<\/p>\n
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Dr. Domingue:<\/p>\n
Yeah.\u00a0 Meth is just a lay term for a patient that has a previous history of drug abuse, and what meth basically does is destroy salivary flow.\u00a0 It just ruins your teeth.\u00a0\u00a0 Meth mouth is basically a dental condition characterized by severe decay and lost of teeth or fractures of teeth, enamel erosion, and other oral problems with the use of a drug called methamphetamine.\u00a0 It\u2019s the methamphetamine drug, and we just call it meth mouth.\u00a0 We just see the aftereffects of the methamphetamine abuse.\u00a0 The reason why methamphetamine is so bad is because it causes xerostomia, and it also causes other conditions like people grind their teeth and become bruxers.<\/p>\n
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Dr. Lavine:<\/p>\n
The slides that you showed before of that patient, was that a meth mouth or, you said it was a friend of yours so I\u2019m assuming it\u2019s not?<\/p>\n
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Dr. Domingue:<\/p>\n
Well, now he\u2019s a friend of the practice since he\u2019s been coming for regular visits, and he\u2019s a tremendous guy.<\/p>\n
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Dr. Lavine:<\/p>\n
But, that was a meth mouth that you shuld?<\/p>\n
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Dr. Domingue:<\/p>\n
That\u2019s what a meth mouth looks like.\u00a0 That\u2019s exactly what it looks like.<\/p>\n
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Dr. Lavine:<\/p>\n
Okay.\u00a0 What about smokers?\u00a0 Is that a contraindication?<\/p>\n
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Dr. Domingue:<\/p>\n
Okay, that\u2019s a great question.\u00a0 A long time ago we used say that a lot of research supported there was a lower incidence of implant success whenever you have people that are smokers.\u00a0 One of my good friends and I talk about this all the time.\u00a0 If I didn\u2019t place implants on patients that are smokers, I\u2019d lose half my dental population.\u00a0 That\u2019s true to a lot of extent for a lot of different reasons.<\/p>\n
You can still place implants on patients that are smokers.\u00a0 You just need to make them completely aware and say, \u201cLook, there\u2019s a lower incidence rate in people that smoke a pack, two packs a day.\u00a0 You\u2019re going to have to taper that effect, get them on a smoking cessation program.\u00a0 With that said, people still want their teeth.\u00a0 They might not quit their oral habits like smoking.\u00a0 Some people will still take the chance.\u00a0 Other people that want to quit, that want to get off smoking, that want to break the habit, it\u2019s a good excuse to. \u201cLook, I\u2019m losing my mouth.\u00a0 I\u2019m losing my teeth.\u201d\u00a0 They\u2019ll blame it on that.\u00a0 They\u2019ll blame it on cigarettes so they\u2019ll eventually stop smoking.\u00a0 I wouldn\u2019t say place implants on every single patient that walks in your door that is a smoker.<\/p>\n
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Dr. Lavine:<\/p>\n
Okay.\u00a0 Let\u2019s keep on moving.\u00a0 I want to make sure you get to your content as well, but there was just some good questions here.<\/p>\n
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Dr. Domingue:<\/p>\n
Okay. Good.<\/p>\n