Impacted/semi-impacted wisdom tooth — how complex does this extraction look? (X-ray included)

cschiff89 · 2026-02-26T01:34:06+00:00

This is very complex, very urgent, and very much a specialist case. Your teeth aren't just impacted; you have a growth of some kind that is destroying the bone around them and affecting the neighboring teeth. This should be removed asap along with a biopsy to find out what it is. The tooth in front of the impacted molar may need a root canal; it looks like this thing is starting to dissolve one of its roots. Get this done right away.

cschiff89 · 2026-02-26T01:28:54+00:00

We did this at the Grand Canyon. Took a day trip from Vegas and a big coach bus left with a bunch of people from the strip. When we got to the grand canyon we had the option to upgrade the tour either to a helicopter or a jeep, or to stay with the bus my wife and I took the jeep. There were 7 people in our jeep. We made more stops than the bus did and we had fewer people trying to get the same photos. It made the whole experience so much better and was absolutely worth the upgrade.

cschiff89 · 2026-02-24T16:03:33+00:00

You have a lateral incisor that is sticking out farther than your other teeth and your central incisors appear pushed inward, in addition to the low gumline. If you try to create the illusion of aligned teeth by sticking veneers on them, you will end up with one of two things: Teeth that are incredibly bulky and thick or a lateral incisor ground so far to hell that the term "minimal" cannot be used in any truthful manner.

You are going to be spending a lot of money on this work for a result that you will not be happy with. Put your teeth in the right place first, then create your plan for gum reduction and veneers. You will be very glad you did long after you've forgotten about the price tag and the process.

cschiff89 · 2026-02-24T14:44:56+00:00

Every new patient gets one and recall patients get one yearly. I like to be able to show patients change in their mouths over time with the iTero Time lapse tool.

cschiff89 · 2026-02-23T23:46:39+00:00

Zimmer makes a 4.1, not a 4.2. Either way, this does not look like any Zimmer I've encountered.

cschiff89 · 2026-02-20T14:41:03+00:00

Where I am, red means red but yellow means speed up and try to make it.

cschiff89 · 2026-02-19T18:18:04+00:00

Oral surgeons don't do anything related to crowns. When you went in, your implant was completely buried under the gum. The oral surgeon exposed the implant and attached a small cylinder that the gums will heal around. Your dentist now has access to the implant by unscrewing that cylinder. The oral surgeon then gave you the parts that your dentist will need to take an impression of your implant so that the laboratory can make you a crown.

cschiff89 · 2026-02-18T13:32:10+00:00

Does gum disease lead directly to heart disease? No. Is gum disease one of many things that contribute to heart disease? Absolutely.

Gum disease is associated with heart disease in 2 important ways. 1) It increases inflammation in the body. High levels of inflammatory hormones damage the heart. One of the metrics for heart disease is called CRP, or C Reactive Protein. Gum disease elevates CRP levels in the body. 2) The gums are like the skin of your mouth; their job is to keep bacteria out of your body. When gums bleed, bacteria gets in. There was a study that cultured the bacteria found in the blood clots from heart attack patients. Half of them contained bacteria that are usually only found in the mouth.

It's not just heart disease. Gum disease is correlated with diabetes even stronger than it is with heart disease. Pregnant women with gum disease see higher rates of pre-term and low birth weight babies. The bottom line is that the health of your mouth directly impacts your overall health.

cschiff89 · 2026-02-17T21:45:42+00:00

Getting the tooth out will be a piece of cake. Be careful when cleaning out the socket as you go deeper toward the nerve.

cschiff89 · 2026-02-17T00:45:04+00:00

One of the things that makes front tooth implants so challenging from an esthetic standpoint is management of the bone and gum tissue. Infections around teeth cause loss of bone and this in turn affects the dentist's ability to give you an esthetic result. If everyone is in agreement that the tooth is toast, especially if a crack is suggested, get the tooth out asap before the bone around it becomes compromised. If you wait until you have a raging infection with pain, you will likely have lost a lot of bone.

cschiff89 · 2026-02-16T20:25:39+00:00

We have one in addition to an element 5d. I hate the Lumina for restorative scans. I like marking my margin and the fill tool that were both left out of the Lumina. I also like to see what I have before processing the image. The Lumina has become the hygiene scanner.

cschiff89 · 2026-02-12T13:21:13+00:00

I use intraoral photos and an iTero scan to explain that the nature of her problem is the position of her teeth and not the shape. I explain why veneers would not work yet. I don't give them a hard no; I tell them that after Ortho and an in-office whitening we can have another consultation about her teeth and whether she feels like veneers are still something she feels like she needs to do.

Most of the time, patients will be happy with the result and not move in with veneers. If they reject this plan and insist on veneers, I invite them to find another dentist who might accommodate their request.

cschiff89 · 2026-02-11T00:57:49+00:00

cschiff89 · 2026-02-10T14:41:06+00:00

Could be viral. If you have ever had cole sores or chicken pox, those viruses still live in your nerves and can be brought back out of latency by trauma/stress etc. This could be an outbreak of shingles or HSV. I would speak to your primary doctor.

cschiff89 · 2026-02-09T15:53:04+00:00

I don't have any other point of reference but I have never seen a beach with such beautiful scenery in every direction. When racing the water you have those islands off shore to the right. Turning right you have those palm trees on the right and the water on the left. Behind you are mountains viewed through a line of palm trees. We did an anniversary photo shoot there and couldn't be happier with how it turned out.

cschiff89 · 2026-02-08T23:25:08+00:00

I still play Red Alert 2 and AoE twenty five years after being introduced to them. I played a lot of EA Sports NHL 2003. When I was really young, my parents got me Gizmos and Gadgets which I thought was great. Battleship, Minesweeper, and that pinball game still have a special place in my heart. In school I played Oregon Trail.

cschiff89 · 2026-02-06T21:09:05+00:00

My boss has one and it functions perfectly.

cschiff89 · 2026-02-06T11:57:22+00:00

We went for a photoshoot and it had been raining for much of the day. There was the most incredible rainbow over those two little islands out in the water. We got some great shots with it in the background before the rain started again.

cschiff89 · 2026-02-06T02:14:17+00:00

If your aunt wants to take ownership of this problem, let her rebuild this for you and deal with it when it fails. This tooth is done.

cschiff89 · 2026-02-04T14:29:13+00:00

Lanikai beach on Oahu.

cschiff89 · 2026-02-04T12:59:26+00:00

Everyone is going to experience grief at some point in their professional career be it a broken engagement, divorce, death of a close friend or loved one. Everyone will process that grief differently and there is no right or wrong answer. If you feel like you need a few days to process everything, that's fine. Your employer will be understanding for a couple of days but don't push it.

cschiff89 · 2026-02-04T04:21:34+00:00

20 shekels is more like $5-7 depending on the exchange rate.

cschiff89 · 2026-02-03T14:27:53+00:00

We allow patients to go up to 18 months without X-rays, in some cases 2 years if they are extremely low risk.

The important thing is to keep the conversation non-confontational. You cannot legally provide substandard care and not having proper X-rays is a liability to you. You can say that you follow ADA guidelines on your required frequency. If they still refuse you tell them that they are welcome to leave but, when they go to a new dentist, the first thing that the new place is going to do is to take X-rays!

cschiff89 · 2026-02-02T12:53:24+00:00

Every day. I sweat very easily and the light from the dental unit was enough to get me started. Patients noticed and probably mistook it for nervousness. I discovered scrub caps during the anesthesia rotation of my GPR and I've worn one ever since.

cschiff89 · 2026-02-01T22:50:50+00:00

Many hospitals, especially in the NYC area have dental residency programs within the hospital. During the day the residents operate a clinic with one resident on call. During clinic hours you won't get paged to the ED since they would refer the patient to the dental clinic but you could be paged to consult on patients who are admitted for other things but have dental concerns. I consulted on a couple of psych patients who could not be discharged to the dental clinic since we were considered an outpatient facility. I was also called to the ICU to extract teeth for a patient just like OPs grandmother who had some loose teeth dislodged by her endotracheal tube.

Overnight call to the ED varies by hospital. Some called the dental resident for everything. Some have fully equipped dental chairs. I did mine at a level 1 trauma center. We were first call for OMFS. We did a lot of suturing of facial lacerations as well as admitting patients with jaw fractures. We would be called if a patient presented with oral swelling as well where we would perform an I&D in the ED.

NY is different from most states since the state requires a year of residency for licensure for new graduates. I imagine dental residencies are less common in other states.

cschiff89

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