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Medical Intel

Dec 26, 2018

Missing teeth is never easy. It can cause some people to feel uncomfortable smiling for pictures, while others experience difficulty eating. Discover why Dr. Ravi Agarwal says dental implants can be the perfect solution.



Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine.

Host: Thanks for joining us today. We’re speaking with Dr. Ravi Agarwal, an oral and maxillofacial surgeon and the residency program director for the Department of Oral and Maxillofacial Surgery at MedStar Washington Hospital Center. Welcome, Dr. Agarwal.

Dr. Ravi Agarwal: Thanks for having me here today.

Host: Today we’re discussing dental implants which help support dental prosthetics such as bridges, crowns and dentures. Dr. Agarwal, could you explain what a dental implant is?

Dr. Agarwal: Sure. The dental implant is essentially an artificial tooth root in the shape of a metal screw. These screws are surgically anchored to the bone and, once anchored, the body will grow bone on to them and stabilize them. Once that fusion happens, these posts then can be used by your dentist to make supporting teeth such as crowns, bridges and dentures. This is currently the best long-term solution that we have today for tooth replacement. Overall, our success rates are 95 percent, especially when a patient sees a surgical specialist for placement.

Host: So, this sounds like something a patient might see a dentist for instead of coming to the hospital center. Could you explain why that’s a better idea for people who need dental implants?

Dr. Agarwal: Correct. Most of the patients who come to see us start with their dentist because it is a team effort for a patient to have a tooth replacement. However, most commonly a dental implant is a surgical procedure, so you want to see a surgeon who’s specialized in training to take care of all the surgical aspects of placements of dental implants. However, it is a team effort and once the surgery’s done and healed, the patient would then return to their dentist to have the prosthetic made.

Host: What are some of the most common dental implants that your patients need?

Dr. Agarwal: The need for dental implant varies amongst the population. In general, any patient who wishes to replace a tooth can be a candidate for a dental implant. Generally, the most common patients that we see are those requesting a single tooth replacement. This can be a patient who’s missing a front tooth affecting their smile. This could be a patient who’s missing a back tooth affecting the way they eat. However, as the baby boomer generation continues to grow, we’re starting to see a larger population requiring replacement of all their teeth. Most of these patients may have already been in dentures or they have a failing dentition. So, failing dentition is patients who have had a long history of dental work. They’ve had a lot of work done to their teeth. Their fillings or crowns are starting to fail, and it really becomes more and more expensive to repair all these things and it gets to a point where they may be better off considering replacing all of those teeth. So, our team has an excellent reputation in this area to help patients with solutions to replace either one of their teeth or all of their teeth. In the end, we work with all of our patients and their dentists to help come up with surgical solutions.

Host: So, you mentioned the baby boomers. Could you describe your patient population for dental implants?

Dr. Agarwal: Yeah. As I mentioned, we see a variety of different needs that come through our department and our clinic. I have maturing teenagers who are naturally missing some of their front teeth that we’ll replace implants for them. And I also have a 75-year-old patient who’s had a denture for 15 years and says, “Hey, I really want to taste my food better. I want to eat better. I want to chew better. I want to smile better.” So, our dental implant team can help manage all of them with some of the best experience in the region.

Host: What does a patient have to do to prepare for getting a dental implant?

Dr. Agarwal: There’s not a lot to prepare. Most of the patients - we generally request that they have a dental provider. As I mentioned earlier, this is a team effort. You can consider a dental implant like a foundation. I need an architect to tell me how they want the tooth designed so that I can lay the foundation in the correct place. So, most of our patients, we’ll require that they’re working with a dental provider. Otherwise, if they’re missing a tooth or a tooth is failing, the best thing to do is have a consultation with us because there’s not much more preparation before that.

Host: The day of an appointment, do they have to do anything differently - maybe change their eating or medication?

Dr. Agarwal: Well, the day of the procedure...usually we’ll see the patient prior for consultation to determine what their medical conditions are, what medication is taken - any of that can affect the surgery. So, if someone’s on blood thinners, we may require them to stop or discontinue it for a few days during the surgery. And occasionally we start patients on antibiotics or mouth rinses. Usually we’ll work these things out during a consultation appointment.

Host: Could you describe the process of creating and then placing that dental implant?

Dr. Agarwal: So, very simply, placing a dental implant is a short office procedure. An incision is made in the gums to access the bone. We use specialized equipment to create space in the bone for us to anchor the screw that we put in. We then will suture the gums with dissolvable stitches. And most of these procedures, for example a single tooth implant, can be as short as 30 minutes in the office.

Host: It sounds like a very painful procedure. How do you keep your patients comfortable getting them in there, making sure that they’re nice and calm when they go in?  And then how do you keep them comfortable and pain free during?

Dr. Agarwal: You know, surprisingly, this is a very common concern amongst the patients who come to see us. Dentistry, in general, has always been thought as a painful...but nowadays our techniques and local anesthesia have really improved, the office environment has really improved. For most patients, we see them first for consultation. At that time, you really get to develop a relationship with a patient - explain to them what the expectations are. However, anxiety is still a concern and, since we are oral and maxillofacial surgery specialists, we have the ability to offer pain, anxiety reducing techniques, such as office anesthesia. Most dental providers cannot provide this same service, so this is another reason that a patient may want to come see our team, is that we can also provide office sedation for these surgical procedures.

Host: What is the recovery period after receiving a dental implant?

Dr. Agarwal: Very similar to having a tooth removed. Most patients will be uncomfortable for a few days, most often requiring over-the-counter pain medications. Depending on the procedure, they may have a little bit of swelling, which mostly resolves after 3 to 5 days. We ask them to modify their diet, avoiding hard, crunchy foods. And, we also put an emphasis on oral hygiene, that brushing their teeth and we prescribe oftentimes antibiotics and antibiotic mouth rinses. So, for the most part, you know, for procedures done at the end of the week, most patients can return to doing most of their daily activities through the weekend.

Host: One thing I would be concerned with is would I be able to drink coffee or hot beverages or eat right away after I got my implant.

Dr. Agarwal: Sure. The day of the procedure we generally ask everyone to take it easy, possibly more of a soft, mushier diet, considerations to avoid extremes of temperature, but there would be no harm in someone having a warm tea or warm coffee.

Host: Why should a patient choose a dental implant instead of another treatment option?

Dr. Agarwal: Over the years, there have been a lot of methods to provide tooth replacement, but the dental implant is the one that is...generally has a high success rate. It’s a treatment that, if done well and done properly, can be there for a lifetime. The other number one reason to have a dental implant is that as you lose teeth, you start to lose the supporting bone. It’s just a natural process that the body has. By placing a dental implant, it stimulates the bone and the patient will lose a lot less bone.

Host: Do you have any treatment success stories regarding dental implants from your practice?

Dr. Agarwal: Well, every patient who comes to us and gets a tooth replaced is a success story for us. However, there is one gentleman that comes to my mind. There was a patient we treated who had sustained a fall while he was on vacation and he suffered a significant amount of trauma to his face, breaking some of his bones in the face, but also losing some of his front teeth. He was initially treated outside, at the hospital where he was on vacation, but once he came back to the D.C. area, he came to see our team to help reconstruct his jaw and his teeth. When I first started seeing him, I could tell he was a little dejected and had a little bit less motivation about his smile and his mouth, and you could tell, even when he was with his wife, that he was just sensitive about the topic. We worked with him. We got him in touch with a dental provider to help him restore the teeth. And our team ended up doing it first -  a reconstructive procedure for his jaw bone. But once that was done, we replaced all his top teeth that he had lost, and the ones that were failing, with dental implants. Once we did that surgery and anchored that teeth that same day for him, I remember seeing him the following week and thought this was a completely different person. I’d never seen anyone talk so much. He was chatting with all our team members. He was just so excited. He was telling us how he was looking forward to seeing his grandkids. And it really, at that point, gave him a new lease on life with something sometimes we think as such a simple procedure. 

Host: Why is MedStar Washington Hospital Center the best place to receive a dental implant?

Dr. Agarwal: So, our dental implant program is one of the earliest centers in the country that dedicates one and a half days a week to dental implant related procedures. One of the unique aspects of our program is that every patient gets both a surgical and prosthetic consultation. As an oral maxillofacial surgeon, we concentrate on doing the surgical procedures. However, having a prosthodontist, who is an individual who specializes in complex dental prosthetics, as a consultant has only enhanced our ability to provide the best care to our patients. For example, our program has key opinion leaders in the field of dental implants who actually go out and train and teach other practitioners around the country, who then use our protocols developed at MedStar Washington Hospital Center. We’re on the cutting edge of digital technology, having virtual implant planning, in-house 3D printing for surgical guides and even an implant navigation equipment. All of these technologies have allowed us to reduce treatment time, minimize errors and provide temporary teeth on the same day as the dental implant surgery. Even with all of this technology, I think the biggest reason to choose our team is the ability to provide all this advanced care at a reduced cost.

Host: Thanks for joining us today, Dr. Agarwal.

Dr. Agarwal: Thank you for having me.

Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting or subscribing in iTunes or iHeartRadio.