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As you age, it becomes even more important to take good care of your teeth and dental health. According to the Centers for Disease Control and Prevention, approximately one-fourth of adults age 65 and older have no remaining teeth. What's more, nearly one-third of older adults have untreated tooth decay.

Oral health, regardless of age, is crucial to overall good health. Ideally, we all want to keep your natural teeth, but whether you're caring for natural teeth or dentures, advancing age may put older adults at risk for a number of oral health problems, including:

• Dry mouth
• Diminished sense of taste
• Root decay
• Gum disease
• Uneven jawbone caused by tooth loss
• Denture-induced tissue inflammation
• Overgrowth of fungus in the mouth
• Attrition (loss of teeth structure by mechanical forces)
• Oral cancer

These conditions may not be diagnosed until it is too late. If you want to feel good, stay healthy, and look great throughout life, you might be surprised what a difference a healthy mouth makes.

Here are some tips for maintaining and improving your oral health as you become older:

• Brush twice a day with a toothbrush with soft bristles. You may also benefit from using an electric toothbrush.
• Clean between your teeth once a day with floss or another interdental cleaner.
• If you wear full or partial dentures, remember to clean them on a daily basis. Take your dentures out of your mouth for at least four hours every day. It’s best to remove them at night.
• Drink tap water. Since most contains fluoride, it helps prevent tooth decay no matter how old you are.
• Quit smoking. Besides putting you at greater risk for lung and other cancers, smoking increases problems with gum disease, tooth decay, and tooth loss.
• Visit Alpine Oral and Facial Surgery regularly for a complete dental checkup.

If you have any questions about keeping up with your oral hygiene at home, please give us a call!

No one really looks forward to a wisdom tooth extraction, even a straightforward one. Fortunately, you can be confident that your oral and maxillofacial surgeon has the experience and the skill to make your extraction experience as safe and comfortable as possible.

But what happens when your situation is not quite so straightforward? Dr. Holtzen and our team have the experience and the skill to diagnose and treat these more complex extractions as well.

One of the potential complications with an impacted wisdom tooth is its close proximity to the Inferior Alveolar Nerve (IAN) of the jaw.  When the roots of the impacted tooth are fully developed, they can rest very close to, put pressure on, or, in rare cases, even wrap around this nerve.

Why is this a problem? Because these nerves supply feeling to the lower lip, gums, chin, and teeth. If a nerve is damaged during extraction, a patient might be left with pain or numbness in these areas, which can affect sensation, speech, and eating. While this nerve damage is usually temporary, in rare cases it can be permanent.

But an impacted tooth, left alone, can also have serious consequences—pain, infection, and damage to neighboring teeth and bone. So what’s the answer in this complicated case?

Talk to Dr. Holtzen. We have the training and skill to detect any potential nerve involvement when you need a wisdom tooth extraction, and we have a procedure to help prevent damage to the nerve if it lies too close to the roots. The coronectomy is a specialized surgery used only to treat impacted teeth when the nerves of the lower jaw might be compromised.

What is a coronectomy, exactly? The tooth can be thought of in two distinct segments—the crown, which is the part of the tooth that rises above the gum when the tooth erupts, and the roots below, which anchor each tooth in the jaw. A “coronectomy” means the removal (“ectomy”) of the crown (“corona”) of the tooth.

In this procedure, we will divide the tooth into two parts. After making a small incision to expose the tooth, the crown will be removed, and the root section left in the jaw. When the procedure is completed, the incision in the gums will be closed with sutures. Recovery is much like recovery for any other tooth extraction.

Once the coronectomy is completed, you might be asking, “What happens to those roots that were left behind?” Another good question!

• Very rarely, the roots become infected or cause irritation to surrounding tissue and will need to be removed.
• Occasionally, root fragments can start to emerge through the gums, just as a whole tooth would. But since they must move away from the nerve in order to erupt, they can be extracted without endangering the nerve.
• The most common result? The remaining root segment becomes permanently encased by bone tissue within the jawbone, never to cause problems again.

Are there times when, even though a wisdom tooth is bordering on a nerve, this procedure might not be advisable? Yes. Infection and decay in the tooth, tooth mobility, periodontal disease near the tooth, a horizontal tooth (where sectioning the tooth could damage the nerve), and other conditions might mean that a coronectomy is not possible. In that case, Dr. Holtzen can discuss further options with you.

No one really looks forward to wisdom tooth extraction. Fortunately, even in complicated situations, your oral and maxillofacial surgeon has the experience and the skill to provide the answers you need for an extraction experience that is as safe and comfortable as possible.

Any more questions? Contact our Missoula or Hamilton office to see if a coronectomy is the answer for you.

When you chip a tooth badly, it can be a very nerve-wracking situation. Dr. Holtzen and our team want to provide you with some information that can help if you ever suffer a chipped or broken tooth. The most common ways people break their teeth are by biting down on something hard, getting hit in the mouth, falling down, or developing cavities that weaken the tooth and allow it to be broken easily. There are a few things you can do if you find yourself in this situation, however.

First, we recommend that you investigate whether the tooth is partially chipped or completely broken. Unless you are experiencing a lot of pain or bleeding, this should not be treated as an emergency. You may call our office and we will try to schedule an appointment with you as soon as possible. Once we have evaluated the tooth during your appointment, we can start to treat it. For minor chips or cracks, we may simply smooth out the area or fill in the space so the crack doesn’t spread.

If your teeth show severe damage such as a serious break, split tooth, split root, or a decay-induced break, Dr. Holtzen may need to take more time to fix the problem. If you need emergency dental care because a tooth has fallen out, call our practice immediately to schedule an appointment for that day. If you’re waiting for an emergency appointment, you can rinse your mouth with warm salt water and apply slight pressure to the area to stop the bleeding. We recommend using an ice pack to reduce swelling, but do not take any aspirin because that may increase the bleeding.

If your tooth has completely fallen out of the socket, hold it by the crown and rinse it under running water. Do not let the tooth become dry; instead, place it in salt water or milk until you get to our office. Dr. Holtzen will determine whether the broken tooth can be salvaged or will need to be completely replaced.

We know how upsetting it can be to chip or break a tooth, which is why we want to guide you through this process. Most chipped teeth are usually just cosmetic problems, fortunately, but we know that dental emergencies can come up rather suddenly. Be sure to schedule an appointment at our Missoula or Hamilton office as soon as an emergency situation occurs.

If wisdom tooth extraction is on your calendar, it’s a good idea to visit your grocery store ahead of time to stock up on smart diet options for post-surgery meals. It might be a few weeks before you heal completely, so we have some shopping list suggestions which are safe, soothing, and nutritious to get you through your recovery.

Smart Choices

Soft, Smooth, and Creamy

• Soft-serve ice cream
• Frozen yogurt
• Yogurt
• Pudding

Now is a good time to indulge yourself, and ice cream, yogurt, and pudding are easy on sensitive tissue and filled with protein, calcium, and vitamin D. Just remember—choose soft flavors with no crunchy, sticky, or chewy additions.  This means no cones, as well. Most important? Nothing with a straw. Suction can cause the dislodgement of the protective clot over your extraction site. And dislodgement of this protective cover can lead to a painful condition known as dry socket.

Sometimes we recommend a wait on milk products immediately after surgery due to anesthesia, medication, or other considerations—we’ll let you know if that’s the case, and when you can safely enjoy dairy products.

Comfort(able) Foods

• Broth
• Pureed soups
• Applesauce
• Gelatin desserts
• Clear liquids

Foods that don’t require much chewing won’t irritate tender mouth and gum tissue. You can also find a wide variety of flavors to tempt your palate. Choose broths with higher concentrations of protein, and soups which provide minerals and vitamins. Nothing too hot, though—heat can affect the protective clot over the wound site. Applesauce is not only soothing and flavorful, but is a good source of fiber and vitamin C. Gelatin desserts and clear liquids will help you keep hydrated, which is extremely important as you heal.

Blender-Friendly Creations

• Smoothies
• Pureed foods

Want to get creative in the kitchen? Create your own smoothies and purees to suit your individual taste! Blended foods are easy to eat, and you can add vitamins with your choice of fruits and vegetables and proteins or protein powder for nutritional value. (Sip or eat smoothies with a spoon, as straws are still off-limits.)

You can gradually add semi-solid foods such as mashed potatoes, oatmeal, cottage cheese, and scrambled eggs as you recover. Don’t worry—we’ll give you aftercare instructions that will include what you should be eating and drinking right after surgery, and what you can add to your diet as you heal.

Unwise Diet Selections

It wouldn’t be sensible to leave you without some idea of which foods to avoid for the next few weeks. Talk to us about how and when to re-introduce these items to your diet.

• Grainy, seedy, or crunchy foods, which become tiny particles as you chew, can lodge in the surgical site.
• Spicy, carbonated, and acidic foods can irritate delicate gum tissue.
• Sticky and chewy foods can be hard on the extraction side.
• Hot beverages can interfere with the protective clot that forms over the wound.
• Alcohol can interact with medications and, according to several studies, potentially slow healing.
• Anything that requires a straw. Any kind of suction risks dislodging the protective clot at the surgical site. Eat your milkshake with a spoon—it’s still delicious!—and absolutely no cigarettes.

And one final word to the wise: seeing Dr. Holtzen for wisdom teeth extraction and follow-up is an excellent idea!

Oral surgeons like Dr. Holtzen have a minimum of four years of advanced studies in a hospital-based residency program, where they train with medical residents in the fields of general surgery, anesthesiology, internal medicine, and other specialties with a specific focus on the anatomy of the face, mouth, and jaw. They are uniquely qualified to make sure your wisdom tooth extraction and healing are successful.

If you have any questions about the procedure, and what you can do at home to help the healing process, give our Missoula or Hamilton office a call. We want to help you make the wisest choices for diet, pain relief, wound care, and all of your other aftercare needs.

Oral and maxillofacial surgeons like Dr. Holtzen are specialists in diagnosing and treating complex conditions of the face, jaw, and mouth, using the most advanced medical and surgical procedures to treat their patients. They also make use of the most advanced technology to provide the best care for their patients, so when it comes to the latest in X-ray technology, digital X-rays are rapidly replacing traditional radiographs. 

Traditional X-rays

Traditional X-rays, or radiographs, make use of film just like traditional cameras. When you have an intraoral X-ray, for example, the film is sealed in a moisture- and light-proof packet, and placed inside the mouth to capture images of specific teeth and the bone around them.

The X-ray machine is aligned precisely with the film and an exposure is taken. The image at this point is latent, and won’t show on the film, because, just like photo film, traditional radiographs need to be chemically processed before they produce a visible image.

Digital X-rays

Digital technology, on the other hand, uses an electronic sensor instead of film. For an intraoral digital X-ray, a small sensor is positioned in the mouth just like a film. When the X-ray is taken, a digital image capture device produces an image which is formed by a matrix of pixels instead of a photo-like film exposure. This format allows the image to be sent directly to a computer for immediate display without requiring processing.

Even though these methods seem very similar, digital X-rays offer some significant advantages over traditional films. Let’s look at how they compare, more or less.

• More Diagnostic Advantages

A traditional X-ray is a fixed image. It cannot be modified or enhanced. Here the digital X-ray offers a clear advantage in diagnosis.

Just as you can enlarge certain types of images on your computer without blurring or losing detail, a digital X-ray uses computer software to magnify images while keeping their details sharp. They can also be enhanced through brightness and contrast applications to make details stand out even more. Both of these benefits are extremely helpful for diagnosis, especially when looking for small injuries, subtle irregularities, or early stages of disease.

There is even digital subtraction radiography software available that can be used to compare recent images to older ones, removing (“subtracting”) all the similarities in the two images to display only the changes in the two—even small changes—that have taken place over time.

• Less Exposure to Radiation

Even with modern improvements in traditional X-ray technology, digital X-rays expose patients to significantly less radiation. A patient can reduce radiation exposure by 10%, 20%, or more with a digital radiograph. And while all types of dental X-rays expose you to very little radiation, it’s always best to reduce exposure whenever possible.

• More Convenient for Sharing and Transmitting

If you need to share your X-rays with another dentist or physician, digital technology allows you to simply have them e-mailed to another office or multiple offices. You no longer need to worry about preserving physical copies, either.

• Less Waste

Unlike traditional X-rays, digital X-rays don’t need to be processed, so you save time in the office. And while the processing time is not significant (usually several minutes), if you need to repeat some X-rays for a clearer picture, or require different images for several teeth, this time can add up.

Digital X-rays are also more eco-friendly.  The fact that they don’t need to be developed means that the chemicals used to process traditional films are no longer necessary—which also means that there is no need to dispose of chemical waste products afterward.

Why Are X-rays Necessary?

Oral and maxillofacial surgeons treat a great variety of medical issues. An X-ray can be an important tool for discovering and/or evaluating a number of dental and jaw concerns, including:

• Abscesses
• Bone Loss
• Congenital or developmental abnormalities
• Cysts and tumors
• Fractures or other injuries to tooth or bone
• Implant placement
• Wisdom teeth

Our goal is to provide you with the safest, most efficient, and most effective care possible. Digital X-rays are an important tool for oral and maxillofacial surgeons, enabling us to discover and to treat injuries and potentially severe conditions before they have the chance to become more serious. If you have any questions about digital X-ray technology, contact our Missoula or Hamilton office. We’re happy to explain the science—and the benefits—behind this high-tech diagnostic tool.

Fear of going to the dentist is more common than you may think. That’s why Dr. Holtzen and our team want to make your visit as relaxing as possible.

Your anxiety about pain or routine procedures doesn’t have to stop you from visiting our Missoula or Hamilton office; we offer various types of sedation to remove the pain and stress from your dental procedure.

Nitrous Oxide Sedation

Nitrous oxide combined with local anesthetics ensures both pain relief and reduced anxiety for many patients. It’s useful because the dosage can be regulated during treatment, and patients are usually able to drive shortly after the procedure is completed.

Oral or Injected Sedation

With oral sedation, you may be given a pill or liquid to consume several hours before your treatment. Make sure someone will be available to drive you to your appointment, because you will not be able to drive yourself.

An oral liquid is often given to children before any shots or intravenous anesthesia. An intramuscular injection may be given at the office to provide relaxation benefits for 20 to 30 minutes.

Nitrous Oxide with an Oral Sedative

For patients with higher levels of anxiety, an oral or injected sedative can be offered before nitrous oxide begins. This can also be effective for reducing anxiety about the injection of local anesthetics itself. A liquid medication followed by nitrous oxide is beneficial for children to produce a deep sedation level.

General Anesthesia

This type of anesthesia can be offered as an inhaled gas or intravenous liquid. If no oral sedative is given before the general anesthesia is administered, you should wake up quickly after your procedure.

To reduce your anxiety, we can offer a pill or liquid medication before intravenous sedation starts. Intravenous sedation can also be used at moderate-to-deep sedation levels without complete loss of consciousness.

Dr. Holtzen and our team are happy to go over your sedation or pain prevention options when you visit. We’re here to ensure all your questions are answered and your procedure is a relaxing one.

You have probably counted a hundred reasons to stop smoking. It’s unhealthy. It’s expensive. It annoys the people around you. You have to schedule your day around the next cigarette. But here’s reason number 101: Did you know that one of the many side effects of smoking is the damage it does to your smile?

Your Appearance

One of the most obvious results of smoking is the constant yellowing and discoloration of your teeth. Tobacco stains can take longer to remove with home brushing and whitening. And, while a professional cleaning and whitening will make a world of difference, all that good work is undone once you start smoking again.

More important, no smile looks its best with periodontal disease and tooth loss. Smoking has been linked to the presence of more harmful oral bacteria and higher occurrences of cavities and gingivitis (early gum disease). Periodontitis, or severe gum disease, is much more common among smokers. Tooth loss is also much more likely.

Healing after Dental Surgery

Smoking slows the healing process. It has been linked to a weaker immune system, so it’s harder to fight off an infection or to heal from one.  And because of the harmful effect of smoking on bone tissue, there is a higher failure rate for dental implants among smokers. Bone density can be so compromised that an implant is not even an option.

Healing after Extractions

If you have a tooth extracted, the formation of a blood clot at the site of the removal is essential to avoid a condition called dry socket. Dry socket can lead to pain, serious infection, and other complications. Luckily, this clot is resilient and pretty hard to dislodge—unless you apply suction such as sipping through a straw or drawing smoke from a cigarette.

Oral Cancer

Research has shown that smoking is the single most serious risk factor for oral cancer. The good news is that this risk is cut dramatically if you quit!

Let Dr. Holtzen help you maintain your smile. We can offer many more reasons to give up the smoking habit, and we are happy to offer suggestions for quitting during your next visit to our Missoula or Hamilton office. We want to protect your smile and your health as well. It doesn’t really matter which number on the list finally leads you to quit—every number on that list is your lucky number!

Unless you're aware of the signs and symptoms of gum disease and how it's caused, it's possible that you may have unknowingly developed it. Often painless, gum disease -- or periodontal disease -- becomes progressively more serious when left untreated. As you learn more about the common causes of gum disease, you'll be better-equipped to maintain the best oral health possible.

Gingivitis & Periodontitis: Common Causes of Gum Disease

• Bacteria & Plaque. Bacteria in the mouth creates a sticky film over the teeth. Good hygiene practices help remove the bacteria and the plaque they cause. When plaque is not removed, it develops into a rock-like substance called tartar. This can only be removed by a dental professional.
• Smoking & Tobacco. If you're a smoker or use tobacco, you face a higher risk of developing gum disease. Additionally, tobacco use can lead to stained teeth, bad breath, and an increased risk of oral cancers.
• Certain Medications. Some medications that are taken for other health conditions can increase a person's risk of developing gum disease. If you take steroids, anti-epilepsy drugs, certain cancer therapy medications, or oral contraceptives, speak to Dr. Holtzen about how to maintain healthy gums.
• Medical Conditions. Certain medical conditions can impact the health of your gums. For instance, diabetics face an increased risk of gum disease due to the inflammatory chemicals present in their bodies. Always talk to our team about other health conditions to ensure we take that into account when treating you.

Take a Proactive Stance

Good oral hygiene practices and regular visits to our Missoula or Hamilton office can help you eliminate or reduce the risks of developing gum disease. A thorough cleaning with your toothbrush and dental floss should take about three to five minutes. Brush your teeth a minimum of twice per day and floss at least once each day. Keep these tips in mind and you’ll be ready to prevent gum disease.

Labor Day is upon us, and that means the non-official end to summer. Before the kids head back to school and temperatures start to cool down, this is your last chance to barbeque in the beautiful Missoula or Hamilton community, head to the lake, and wear your favorite pair of white pants.

About Labor Day

Each year, Labor Day is celebrated on the first Monday of September. It is the one day of year Americans celebrate their achievements in work, which the US Department of Labor says has contributed to prosperity and well-being of America as a whole. Americans have been celebrating Labor Day since the 1880s, and today it is an official federal holiday.

Interesting Facts About Labor Day

• Every year, more than 30 million Americans travel over Labor Day weekend.
• Canada was the first to celebrate Labor Day, and the US soon followed.
• President Cleveland made Labor Day and official US holiday in 1894.
• Labor Day marks the beginning of the NFL and NCAA sports seasons for fans.
• Labor Day marks the end of hot dog season, when Americans consume seven billion hot dogs.

Thanks for being a valued patient of our Oral Surgeon office. Our staff would like to wish you a safe and happy Labor Day weekend. Enjoy your time off!

Labor Day, celebrated on the first Monday each September here in the United States, is a holiday devoted to the American working community. The purpose of the holiday is honoring the country's workers and their contributions to the strength of our country as a whole.

How Labor Day Started

There is actually some debate as to the origins of Labor Day. It is uncertain whether Peter McGuire, a cofounder for the American Federation of Labor, or Matthew Maguire, who was the secretary of Central Labor Union of New York, had the great idea. However, the Central Labor Union's plans were what launched the first Labor Day in America.

The First Labor Day

The very first Labor Day was celebrated on September 5th, 1882. The Central Labor Union then held annual celebrations on September 5th for what they called a working man's holiday. By the year 1885, the Labor Day celebration had spread to many different industrial areas, and after that it began spreading to all industries in the United States.

Labor Day Today

Labor Day today is a huge United States holiday during which we honor the country's workers with a day of rest and relaxation or a day of picnics and parades. This holiday is truly one to honor the many people who work hard to contribute to the economic well-being of our great country!

Our team at Alpine Oral and Facial Surgery hopes all of our patients celebrate Labor Day, and every holiday, safely and happily. Whether you stay in the Missoula or Hamilton area, or travel out of town, have fun, and don't forget to brush!

We often have patients who ask, “Can drinking alcohol affect my oral health?” There are, in fact, a few reasons why that martini may not be good for your pearly whites.

In addition to creating an overly acidic environment in your mouth, alcohol severely dehydrates oral tissues because of its desiccant and diuretic properties. Because alcohol saps oral tissues of their moisture so readily, saliva glands can't keep enough saliva in the mouth to prevent dry mouth. In addition, saliva contains antibacterial properties that inhibits growth of anaerobic bacteria, a destructive type of oral bacterial responsible for tooth decay, gingivitis, chronic bad breath, and periodontitis.

What are anaerobic bacteria?

When there is a lack of saliva flow in the mouth and the mouth cannot naturally cleanse itself of oral debris (food particles, dead skin cell, mucous), conditions develop that promote activity of anaerobic bacteria, or bacteria that thrive in dry, airless places. These anaerobes also flourish when an unending supply of proteins (food debris) are available to consume, creating rapidly multiplying layers of plaque that stick to teeth and demineralizes tooth enamel unless removed by brushing and professional dental cleanings.

Oral Cancer and Alcohol

Acetaldehyde is a chemical compound leftover after the liver has metabolized alcohol. Capable of causing genetic mutations, acetaldehyde is also a known carcinogen that contributes to the ill feelings of hangovers. Although most metabolism of alcohol is done in the liver, evidence shows that metabolism also occurs outside the liver and that enzymes in the mouth could encourage accumulation of acetaldehyde in oral tissues.

When combined with poor oral health, smoking, and other detrimental lifestyle factors, alcohol may be considered a primary contributory factor in the development of oral cancer.

Even if you don't drink or drink only occasionally, remaining aware of symptoms that may indicate oral cancer will improve your chances of recovering successfully when you start treatment in the early stages of oral cancer. Signs include red or while speckled patches in the mouth, unexplained bleeding, lumps/swellings, chronic ear or throat pain, and areas of numbness in the mouth or on the face.

If you have any questions about alcohol and its connection to oral health, don’t hesitate to ask Dr. Holtzen at your next visit to our Missoula or Hamilton office.

For most people, the word “surgery” immediately conjures a hospital setting where you’re put under for a procedure that involves a lengthy recovery. While some dental problems can be that complex, you might be surprised to learn what actually qualifies as “oral surgery.”

Oral surgeons receive additional training to learn about the diagnosis and treatment of a number of different dental problems that result from injury, disease, and defects. You may have heard the term “maxillofacial surgeon,” which simply refers to a specialist in the range of different tissues that may require repair during oral surgery.

The average surgical procedure is actually performed in your dentists’ office, not a hospital. Tooth extraction, for example, is so common you probably wouldn’t think of categorizing as surgery. However, the removal of impacted, rotted, or damaged teeth, and even assisting in the removal of stubborn baby teeth, all fall into the oral surgery category.

Other common procedures include:

• Realignment of the jaw to form a proper bite
• Repairing damage to facial bones following an accident
• Removal of a cyst or growth in the mouth or jaw
• Replacing permanent teeth with implants

Does your condition require a surgical procedure?

In the majority of cases, you will be referred to an oral surgeon after a problem has been discovered and determined to go beyond the scope of your dentist’s practice.

When discussing whether or not you will require oral surgery, a number of factors are likely to be considered. One of the most pressing is how your daily life is, or will be, affected should you choose to forgo the procedure. Many dental problems are accompanied by severe pain and can have a negative effect on your ability to eat and even speak properly. Non-cosmetic issues like these play a large role in determining the best course of action.

Before you flee in the opposite direction, take the time to speak with Dr. Holtzen or any of us at Alpine Oral and Facial Surgery about the procedure. While you may need to make special arrangements to travel to and from the office, and take a day or two for recovery, the results make it all worth it. Avoiding a necessary oral surgery will likely cost you more money and pain in the long run.

Okay, perhaps “everything” is a bit of an exaggeration—but we do have the answers to some essential questions if you’re thinking about replacing a missing tooth with an implant.

• What Are Dental Implants?

The construction of dental implants is simple and elegant. Most often, a titanium cylinder or screw is implanted into the jawbone. After several months, the implant becomes fused with the bone, a process called “osseointegration.” An abutment can then be secured inside the implant, extending above the gum line, and a crown is securely attached to this abutment. The result? A tooth that looks and functions just like a natural tooth.

• How Long Do Implants Last?

Unlike dentures and partial bridges, which may need to be replaced every five to seven years, an implant can last a lifetime. The material usually recommended for implants is titanium, a metal that integrates well with human bone and is resistant to corrosion, although non-metallic alternatives are also available. Over a period of months, the implant fuses into the bone. The result is a base that is as strong and stable as your natural root.

• Are There Any Preconditions for the Procedure?

Because the stability and longevity of an implant depend on its fusion with the bone surrounding it, your jawbone must have healthy density and the necessary depth and width to support an implant. When we lose a tooth, the bone underneath begins eroding as well. The longer you wait to replace a tooth, the more the jawbone beneath it shrinks. Advanced gum disease can also lead to bone loss.

Dr. Holtzen can often restore jawbone strength and density with a procedure known as bone grafting. This is a type of surgery which uses your own bone, a synthetic grafting material, or a processed bone grafting material to repair and replace damaged bone. After three to four months of healing, the jawbone is generally strong and dense enough to accept an implant.

• What Takes Place during the Implant Procedure?

The procedure takes place under local anesthesia. Sedation dentistry is also an option if you feel it would make your experience more comfortable. Dr. Holtzen will make a careful incision in the gum tissue. A drill will be used to create a small opening for the implant within your bone, and the implant will be gently positioned. A healing cap will be placed over the implant which will extend through the gum tissue, or the site will be closed and a healing cap applied in a second procedure after the bone heals.  The entire process takes about an hour for a single implant, and you will be given careful and detailed instructions for aftercare.

Once the implant has fused with the jawbone, which takes several months, you are ready for restorative work. The dentist you choose to do the restoration will oversee the fabrication of a crown designed to match your natural teeth and to fit perfectly in the space left by your missing tooth. An abutment piece will be fitted into the implant, and the crown will be attached to the abutment. The result will be a stable, anchored tooth that functions and feels like a natural tooth.

• Why Choose an Oral Surgeon for Your Implant?

Oral surgeons like Dr. Holtzen are specialists. They have a minimum of four years of surgical education and training in a hospital-based residency program. They train with medical residents in fields of study such as general surgery, anesthesiology, internal medicine, plastic surgery, and otolaryngology (the study of the ear, nose, and throat).

Because oral and maxillofacial education and training are focused on the bone, muscles, skin, and nerves of the face, mouth, and jaw, an oral surgeon is the best choice for your implant surgery and, in fact, any kind of oral surgery.

We gave it a try, but we probably haven’t answered “everything” you’d like to learn before deciding on a dental implant. But there is someone who has the knowledge and experience to assess whether you are a suitable candidate for an implant procedure and to perform your implant surgery safely, comfortably, and successfully: Dr. Holtzen. Make an appointment at our Missoula or Hamilton office today with someone who really does know everything you need to know about dental implants!

When you think of a dental emergency, you may picture teeth that have fallen out or severe tooth pain. But it is not uncommon for wisdom teeth to develop conditions or problems that require urgent care from Dr. Holtzen and our team at Alpine Oral and Facial Surgery. Wisdom teeth are the third set of molars that erupt in the late teen years to early 20s. Spacing and crowding problems often cause impaction and infections, which is why many people elect to have their wisdom teeth removed. If you are experiencing discomfort or pain related to your wisdom teeth, call our office to schedule a wisdom teeth consultation.

Perisoronitis and Infections

You may develop perisoronitis if you have a partially-erupted wisdom tooth that has become inflamed. Often, inflammation is caused by food lodged beneath the gum. Here at Alpine Oral and Facial Surgery, we can gently search for and remove food debris, as well as clean the affected area and treat it with antibiotics. Do not avoid treatment, however, as untreated perisoronitis can lead to infection, which ultimately places your health at risk.

Crowding and Impaction

When your wisdom teeth erupt, they may cause overcrowding of your teeth, which can have a negative effect on their alignment. This can make it harder for you to clean your teeth properly, and it also increases the chances for developing tooth decay and other oral health problems in the future. For some people, the wisdom teeth never erupt, becoming impacted beneath the gum and causing problems with the neighboring teeth.

If you have an impaction or wisdom tooth crowding, make an appointment with our office soon. We will be happy to evaluate the progress of your wisdom teeth, as well as their effect on the rest of your jaw. Depending on our analysis, we will then discuss your options for treatment and whether extraction might be right for you.

Complications from Wisdom Tooth Extraction

If you have recently had your wisdom teeth extracted, blood clots will have formed in the open sockets the teeth previously occupied. In most cases, the gums heal normally, assuming you follow post-surgical care instructions. However, a small percentage of wisdom tooth extractions do not heal according to plan. If you continue to experience pain or other unusual symptoms following a wisdom tooth extraction, please give us a call. We’ll do everything we can to minimize discomfort and help you heal safely and quickly.

Remember, our team is here to support your dental health in every capacity. We are dedicated to providing excellent service before, during, and after all wisdom tooth procedures, so you can rest assured that your oral health is in good hands.

It’s human nature to delay tackling problems. We even have the clichés to prove it:  “Leave well enough alone.” “Out of sight, out of mind.” “If it’s not broken, don’t fix it!” But when it comes to your health, proactive care is always best. And when it comes to dental health, your wisdom teeth are certainly something to be proactive about!

Children have 20 baby teeth that are replaced over time with 32 adult teeth. The last to arrive, in our late teens and early twenties, are the four third molars, or wisdom teeth. But that “32” total is a little flexible. Some people never develop wisdom teeth at all. You can stop reading here if you are one of this carefree group. The rest of us have from one to four wisdom teeth, and it’s a smart idea to ask our dental professionals just what we have going on below the gumline.

Your dentist might be the first to mention your wisdom teeth at your regular checkup, or you might be surprised to see a new tooth emerging while you are doing your nightly brushing and flossing. Wisdom teeth can remain trapped under gums and bone, a condition called “impaction,” they can erupt partially, or sometimes even erupt completely. They can be symptom-free, or may present with pain, redness, swelling, or bad breath. But whenever the first signs of wisdom teeth appear, in an X-ray or in your mirror, it’s time to discuss your options.

Completely Impacted Tooth

A wisdom tooth may never erupt, remaining trapped below your gums because it has no room to emerge. Even though it isn’t visible, an impacted wisdom tooth can pose serious risks requiring its extraction:

• Other teeth might be pushed out of alignment as the tooth tries to emerge
• The roots of neighboring teeth can be damaged by pressure from the trapped tooth
• A cyst can develop around the impacted tooth which can damage neighboring teeth, nerves, and bone
• Rarely, a tumor can develop. While these are usually benign, they can require the removal of bone and tissue.

Even if you are symptom-free, regular exams and X-rays are important for monitoring the condition of impacted wisdom teeth to make sure that they remain problem-free.

Partially Impacted Tooth

A wisdom tooth can also begin to erupt, but never break completely through the gums. The partially exposed tooth and the gum tissue are very difficult to clean effectively, trapping food particles and bacteria. Partially erupted teeth:

• Have a greater chance of serious decay
• Increase the risk of gum disease
• Can also cause problems as they emerge when they are angled toward neighboring teeth.

When infection and rapid decay are present, or the tooth is emerging at an angle which can damage nearby teeth or bone, extraction is often considered the best treatment option.

Preventive Extraction

Some people have enough room in their mouths to accommodate wisdom teeth without affecting the alignment of their other teeth or their bite. Some wisdom teeth never erupt at all, staying within the jawbone without affecting other teeth. If there are no problems with these teeth, your dentist and oral surgeon might recommend leaving them in place and monitoring them carefully.

If there is the potential for crowding, damage to nearby teeth, or any other future problems, extraction could be recommended as a preventative measure. Age can be an important factor in recommending extraction as well. Patients in their late teens and early twenties often have an easier time with wisdom tooth surgery because:

• The roots of the wisdom tooth aren’t as developed
• Jawbone structure is not as dense
• Shorter roots aren’t as likely to impact sinuses in the upper jaw
• Shorter roots are less likely to cause interference with nerves in the lower jaw
• Bone healing and regeneration is more efficient at this age.

If you are considering the best plan of action for your wisdom teeth, an appointment with Dr. Holtzen at our Missoula or Hamilton office is a very good idea. Oral and maxillofacial surgeons have a minimum of four years of advanced studies in a hospital-based residency program, where they train with medical residents in the fields of general surgery, anesthesiology, internal medicine, and other specialties with a specific focus on the bones, muscles, and nerves of the face, mouth, and jaw.

Oral surgeons like Dr. Holtzen are experts in dealing with wisdom teeth and surgical extractions. And while most extractions are fairly straightforward, their surgical training and experience is invaluable where extractions are more complicated due to the position of the tooth in the jaw, the degree of impaction, and the length and development of the roots. They are trained in all forms of anesthesia, and can provide whichever method you choose for your most comfortable experience, whether it be local anesthesia, sedation, or general anesthesia.

When you’re dealing with your health, the only cliché that really applies is “An ounce of prevention is worth a pound of cure”! Whether your wisdom teeth are best treated with extraction or regular monitoring, Dr. Holtzen can help you decide on the best plan for your dental health both today and for your future.

X-rays have been a function of dental healthcare for a long time. That in and of itself should be good news, because it means we've had plenty of time to improve them. While there is always some risk in exposure to radiation, dental X-ray exposure has decreased significantly due to all the advances in technology. So there’s risk, but X-rays are quite safe.

Think of X-rays as you would about a car. Automobiles these days have all kinds of technology to make them as safe as possible. There's still a chance that you’ll suffer an accident. Would you stop using a car because of that risk? When it comes to dental X-rays, Dr. Holtzen and our team believe the positives clearly outweigh the negatives.

X-rays can be done digitally or with film. For film, X-rays require different exposures at different speeds to produce the image. Digital X-rays have software that automatically adjusts the exposure and produces the X-ray in a digital file. Since they substantially reduce your exposure to radiation, digital X-rays are the current standard in dental offices.

In addition to digital X-rays, lead aprons are an essential piece of X-ray safety. They help protect internal organs from X-rays by acting as a shield. They usually come with a thyroid collar as well, since that is one of the most vulnerable areas to X-rays in the body. Lead aprons can absorb up to 95% of any scatter rays that result from an X-ray. Not bad, right?

Although dental X-rays involve some radiation exposure (not all of it can be eliminated), so does everyday life. Getting too much sun, for example, can be dangerous. The truth is, we accumulate radiation in our bodies over a lifetime, so it’s worthwhile to be aware and avoid as much unnecessary exposure as possible. When it comes to your dental health, though, getting an X-ray — especially when your doctor says you need it — offers more benefits than risks.

Ask us about the type of dental X-rays we use during your next visit to our Missoula or Hamilton office!

Today’s braces have come a long way. Braces are less conspicuous, easier to keep clean, and, often, treatment takes less time than it did in the recent past. With early intervention and modern treatment techniques, orthodontists are able to help make your orthodontic journey more confident, carefree, and efficient.

Even with all of the benefits of modern orthodontics, though, there are still some reasons that a tooth should be extracted to give a patient the best, healthiest alignment and bite. When might your orthodontist recommend an extraction?

• Large teeth and/or a small jaw can mean that there’s just not enough space for your overcrowded teeth.
• The placement of a tooth or teeth make it impossible to correct a bite problem.
• Your wisdom teeth are impacted or erupting, and are likely to interfere with your bite and/or crowd your teeth.
• You have an extra, or supernumerary, tooth—a rare occurrence which can cause crowding, tooth displacement, or even block a healthy adult tooth from erupting.

If your orthodontist recommends extraction, it makes a lot of sense to ask for a referral to an oral and maxillofacial surgeon like Dr. Holtzen. Why an oral surgeon?

• Anything other than a simple extraction requires surgical treatment, and your oral surgeon has spent years of additional specialized medical study and training after dental school focusing specifically on facial, jaw, and dental surgeries.
• Oral surgeons know how to deal with complicated extraction issues and potential complications. Teeth that lie close to a nerve, teeth that are impacted, or teeth with long, curved roots most often mean that surgical extractions are the best and safest options.
• Your oral and maxillofacial surgeon is trained to administer all forms of anesthesia, including not only local anesthesia but a variety of sedation options as well. You can decide on the method that will make you most comfortable.
• Oral surgeons have a wealth of experience in extractions, whether simple or complicated, because this procedure is performed regularly in their offices.

If your orthodontist has recommended an extraction in order to achieve your healthiest bite and alignment, ask about our Missoula or Hamilton oral and maxillofacial surgery office.

If you snore, you know it can be an annoying disruption during an otherwise good night’s sleep. For many of us, changing sleep positions, on our own, or thanks to a loved one’s gentle prompting—or unhappy elbow—takes care of the problem. But snoring can be a symptom of a potentially serious medical condition. Let’s take a quick course in sleep apnea.

Is It Snoring or Sleep Apnea?

Both snoring and sleep apnea result from obstructions in your airway as you breathe during sleep. Soft tissues relax in the throat area, partially blocking the airway, and vibrate with the passage of air. This vibration causes that distinctive snoring sound. But sleep apnea is more than just noise caused by vibrating tissue.

The word “apnea” is derived from the Greek word for “breathless.” If you suffer from sleep apnea, you actually stop breathing during sleep for a brief time, often choking or gasping for breath. Your body responds by waking every time you need to start breathing properly again, and this can happen dozens of times each hour you are asleep. While you may think you have slept through the night, you have never gotten the deep sleep your body needs to restore itself.

What Are Some of the Consequences of Sleep Apnea?

You’re probably well aware of the nighttime miseries of sleep apnea. But this condition can also impair your health and quality of life during the day. Sleep apnea sufferers often experience:

• Constant drowsiness
• Falling asleep at work or while driving
• Morning headaches
• Sore throat
• Dry mouth (which can lead to gum and dental problems)
• Memory and attention problems
• Moodiness or depression
• Decreased libido

As if these reasons weren’t cause enough to find a solution to your sleeping disorder, the longer term results of sleep apnea can be devastating. Many serious conditions and consequences have been linked to sleep apnea, including:

• High blood pressure
• Heart disease
• Stroke
• Dangerous reactions to medication
• Problems with general anesthesia
• A higher risk of accidents

What Causes Sleep Apnea?

Sleep apnea occurs in three forms:

• Obstructive Sleep Apnea

This is the most common form of sleep apnea. It can be the result of the muscles in the back of the throat relaxing during sleep to obstruct the airway. Obstruction can also be caused by a physical condition such as a deviated septum, excess throat tissue or enlarged tonsils.

• Central Sleep Apnea

Central sleep apnea is caused by the brain failing to transmit the proper signals to breathe during sleep. The sleeper either stops breathing, or takes such shallow breaths that he or she can’t get enough air into the lungs.

• Complex Sleep Apnea

This condition is a mix of both obstructive and central sleep apnea.

What Kind of Treatments Are Available?

Many treatments, ranging from behavior modification to surgery, have proven successful in providing patient’s with a better night’s sleep.

• Behavior modification—Losing weight, abstaining from alcohol, even changing your sleep position can be effective in mild cases.
• Oral appliances—These specially-fitted devices, which resemble mouthguards, can advance the jaw or hold the tongue forward to maximize airway space as you sleep.
• Positive Airway Pressure (PAP) machines—For those with moderate to severe sleep apnea, PAP machines, which provide pressurized air through a tube attached to a mask, deliver a gentle flow of air to keep airways open.
• Surgery—There are several different surgical procedures used to treat obstructive sleep apnea, depending on the cause and location of the obstruction.

These and other options might be recommended based on the reasons for and severity of your sleep apnea. An oral and maxillofacial surgeon like Dr. Holtzen is uniquely qualified to provide an expert diagnosis of your condition and to recommend the most effective treatment for your sleep apnea, whether surgical or non-surgical.

Why an Oral Surgeon?

Oral and maxillofacial surgeons are dental specialists. They pursue a minimum of four years of additional advanced studies in a hospital-based residency program, where they train with medical residents in the fields of general surgery, anesthesiology, internal medicine, and other specialties with a specific focus on the bones, muscles, nerves, and skin of the face, mouth, and jaw.

Oral and maxillofacial surgeons have the skill and experience to diagnose the often complex causes of sleep apnea, based on a careful analysis of each individual patient’s unique throat, nose, and jaw structures, airway flow patterns, and potential breathing obstructions as the air moves from nose to lungs.

After taking your medical history and performing a careful examination of your head and neck, Dr. Holtzen might recommend a sleep study where your sleep patterns will be monitored and evaluated. If a sleep disorder is diagnosed, you and your surgeon can decide on the best course of treatment.

Now that you’re up on the basics of Sleep Apnea 101, if you suspect that you might be suffering from sleep apnea, make an appointment at our Missoula or Hamilton office. It’s time to graduate to a restful, healthy night’s sleep!

While there is no definite evidence that if your prevent gum diseases, like periodontitis, that you may be able to prevent a heart condition or heart disease. The only thing experts, like Dr. Holtzen, know for sure is that if you take care of your gums it can lessen atherosclerosis, (build-up of artery clogging plaque) that may result in a heart attack or stroke.

Could periodontal disease cause heart attacks?

Regardless of your oral health, if you're at a high risk for heart disease, you need to take action.

• Maintain a healthy weight or lose weight.
• Consume healthy foods and beverages.
• Exercise several days the week. Walking is a powerful and lightweight exercise and will clear your head while helping your body get or stay healthy.
• Control any medical conditions you may have such as high cholesterol, diabetes, or high blood pressure.
• Reduce your stress. Have lunch with a friend, go for a walk in the park, take a bubble bath, mediate, or do whatever you find relaxing.
• Get a social life. Laughing reduces stress and “feel good” hormones. Everyone needs to feel like they are a part of something: join a book club or any activity where you can interact with other people at least once or twice a week
• Be sure to get enough sleep. The recommended amount is eight to nine hours a night. It has been proven that a lack of sleep increases your risk for angina, strokes, and heart attacks.
• Practice good oral hygiene to keep bacteria in check and your mouth healthy.

Contact our Missoula or Hamilton office if you have questions about your heart and oral health. If you take practice good oral hygiene, both your mouth and your heart will thank you.

Do you ever find yourself gnawing at your nails? Nail-biting is a very common and difficult to break habit which usually has its beginnings in childhood. It can leave your fingers and nail beds red and swollen. But if you think that your nails are the only ones getting roughed up by nail-biting you'd be mistaken—so are your teeth!

According to a study by the Academy of General Dentistry, those who bite their nails, clench their teeth, or chew on pencils are at much higher risk to develop bruxism (unintentional grinding of the teeth). Bruxism can lead to tooth sensitivity, tooth loss, receding gums, headaches, and general facial pain.

Those are some nasty sounding side effects from chewing on your nails. Most nail-biting is a sign of stress or anxiety and its something you should deal with. So what steps can you take if you have a nail-biting habit?

There are several things you can do to ease up on nail-biting:

• Trim your nails shorter and/or get regular manicures – Trimming your nails shorter is an effective remedy. In so doing, they'll be less tempting and more difficult to bite on. If you also get regular manicures, you’ll be less likely to ruin the investment you’ve made in your hands and fingernails!
• Find a different kind of stress reduction – Try meditation, deep breathing, practicing qigong or yoga, or doing something that will keep your hands occupied like squeezing a stress ball or playing with a yo-yo.
• Wear a bitter-tasting nail polish – When your nails taste awful, you won't bite them! Clear or colored, it doesn't matter. This is also a helpful technique for helping children get over the habit.
• Figure out what triggers your nail-biting – Sometimes it's triggered by stress or anxiety and other times it can be a physical stressor, like having hang nails. Knowing what situations cause you to bite your nails will help you to avoid them and break the habit.
• Wear gloves or bandages on your fingers – If you've tried the steps above and they aren't working, this technique can prove effective since your fingernails won't be accessible to bite.

If you're still having trouble with nail-biting after trying these self-help steps, it's best to consult your doctor, dermatologist, or Dr. Holtzen. For some, it may also be the sign of a deeper psychological or emotional problem.

Whatever the cause, nail-biting is a habit you need to break for your physical and emotional well-being. If you have any questions about the effects it can have on your oral health, please don't hesitate to ask Dr. Holtzen during your next visit to our Missoula or Hamilton office.

If there’s one meal that can claim the title of “Sweetest Meal of the Day,” it’s almost certainly breakfast. Sugary cereals, syrup-covered waffles, oatmeal with honey, cinnamon toast (which is literally sugar poured on toast)—it’s hard to imagine another menu even coming close. But you’re trying to keep your diet as healthy as possible. What to do?

First, no need to deprive yourself of the occasional pastry or stack of pancakes. The real problem with breakfast isn’t so much sugar as it is added sugar.

• Just a Spoonful of Sugar? What’s So Bad About That?

Nothing! Many healthy foods have natural sugars. Milk contains lactose sugar, and it also contains calcium and is enriched with vitamin D—both of which are essential for strong bones and teeth. Fruits get their sweetness from a sugar called fructose, and deliciously provide vitamins, minerals, antioxidants, and fiber to our diets.

Even processed sugar is surprisingly low in calories. In fact, a teaspoon of white sugar has only about 15 calories. But this teaspoon is also rich in nutrients for cavity-causing bacteria. The oral bacteria in plaque use sugars and carbohydrates from food particles as a fuel source to produce acids. These acids erode enamel and lead to cavities.

Choosing breakfast foods without additional sugars, then, is an easy way to reduce the number of empty calories in your diet while safeguarding the health of your teeth. We have a few suggestions.

• Be Selective with Cereals

If the word “sugar” or “honey” or appears on the box, that’s a hint that your favorite cereal is heavy on the sugar. But there’s a more scientific way to tell just how much sugar is in that spoonful.

While the colorful packaging and playful mascots are eye-catching, check the black-and-white panel with nutritional facts found on every box. If one serving equals 27 grams, and the sugar in that serving equals 15 grams, you know you have a problem. And cereals marketed to children are especially “rich” in added sugar.

But luckily, you don’t need to give up your morning bowl. Many cold cereals are available that offer whole grains, protein, and fiber without a lot of added sugar. Spend some time in the cereal aisle comparing, or, to make life easier, there are many online sites which recommend the best (and worst) cereals in terms of sugar content.

• Use Your Judgment with Juices

Fruits are packed with important nutrients. Not only do they provide essential vitamins and minerals, they’re a great source of water and fiber. If you drink 100% fruit juice, you are getting the benefit of most of the vitamins and minerals found in fruit. (You’re also getting less of the fruit’s natural fiber, and more of the fruit’s natural sugar, so consider fresh fruit as an option occasionally.)

But when fruit juice comes with “cocktail,” or “punch,” or “ade” attached to the end of it, there’s often something else attached—added sugar. For natural fruit flavor and the least amount of sugar, stay with 100% unsweetened fruit juice.

• Search Out “Surprise” Sugars

Remember the childhood excitement of searching through your cereal box for the prize inside? Fun! What’s not so much fun? The surprises you might find when you search through the labels on your favorite breakfast items—because added sugars make their stealthy way into many of our morning favorites.

When you compare plain, Greek, and low-fat yogurts, for example, the low-fat options are often higher in added sugar. A container of low-fat yogurt can provide 19 grams of sugar—that’s a tablespoon and a half!

And while you’re at it, be sure to compare the sugar content in granola bars. Some are full of nuts and grains, and some are full of added sugar.

Going out for a breakfast smoothie? Those can contain 70 grams of sugar and more. Making your own at home might be a little more time-consuming, but if you use fresh fruit as your sweetener, you can make sure that what you’re not consuming is added sugar. If you’re on the go, check out all-fruit options at your favorite smoothie shop.

Dr. Holtzen and our team aren’t asking you to eliminate sugar from your breakfast diet altogether. (Everyone loves a doughnut now and again.) But substituting some alternatives for your regular menu choices can reduce the amount of added sugars by tablespoons every meal. That’s another great reason to greet the morning with a smile!

Health gurus rave about replacing unhealthy food choices with healthy ones in your diet. If you want to maintain your beautiful smile as well as your waistline, choose foods that are good for your teeth and good for losing weight. This article will discuss some of the worst healthy foods for your teeth and gums, and what you can do to continue to enjoy them.

When watching your weight, snacks heavy in sugar and starch are the first target for elimination. You want to trade those empty calories for something with more nutritional value. A healthier snack is fruit and vegetables. When you are substituting empty calories with whole foods such as fruits and vegetables, consider a few implications for your dental health.

The most acidic fruits are grapes, grapefruit, and strawberries. Want to know the number-one worst healthy food for your tooth enamel? Apples! An apple a day may keep the doctor away but you may soon be calling your dentist.

Another healthy food often incorporated into dieting is salads. But consider what you put in those salads. Salad dressings are filled with vinegar and sweeteners. These make a salad very acidic and can change the pH of your mouth from alkaline, which is good for your teeth and gums, to acidic, which puts your smile at risk for erosion and decay.

Last but not least is diet soda. You might be cutting down on the calories but you are still putting your teeth at risk for decay. Though calories are reduced, the acid is not.

You do not need to eliminate any of these foods from your diet. Simply alter what you do after eating these foods to decrease the amount of acid your teeth are exposed to.

During your next visit to Alpine Oral and Facial Surgery in our Missoula or Hamilton office, we can discuss your diet. We may recommend using certain products to fortify your teeth or change the way you routinely care for your teeth.

Please enjoy the wonderful whole foods that are great for a healthy waistline. A healthy waistline and a healthy smile have a positive influence on your general health. A healthier you is a happier you. The happier you are, the more you smile. Keep your smile brilliant and beautiful with the care your teeth deserve at the practice of Dr. Holtzen.

Many smokers believe that chewing tobacco is a safer alternative to smoking cigarettes. This simply isn't the case! In fact, smokeless tobacco can cause serious health concerns.

Smokeless tobacco comes in many forms and goes by many names: dip, snuff, snus, or simply chewing tobacco. Use of these products usually involves sucking or chewing on shredded or loose tobacco leaves, sometimes flavored, for a prolonged period. There are even products that emulate a dissolvable candy-like consistency which are made of compressed tobacco powder.

What are risks and smokeless tobacco?

Whichever form a tobacco product takes, the dangers of using or consuming them is very real. According to a 2007 study by the World Health Organization's International Agency for Research on Cancer, there are upwards of 28 cancer-causing chemicals in smokeless tobacco that are known to cause cancer. And these products are habit-forming just like any other tobacco product that contains nicotine. Using them will increase your risk for many serious diseases including but not limited to: cancer (especially oral and esophageal), gum and heart disease, cavities, and pre-cancerous mouth lesions.

At the end of the day, long-term use of smokeless tobacco can cause serious health issues. These products really take a toll on both your oral and overall health. They put a strain on your immune system and make it less capable of warding off infection and disease.

Dr. Holtzen and our team strongly advise you to stop using smokeless tobacco—or any kind of tobacco product—and not to pick up the habit if you aren't. There is no safe level of tobacco use, smokeless or otherwise.

Need to quit smoking or using smokeless tobacco products?

You can and should always talk to your doctor, healthcare practitioner, or Dr. Holtzen for help quitting. But there are many other resources available today for those who'd like to quit. The National Cancer Institute offers information, support (local and online), and tools to help smokers and smokeless tobacco users quit. They offer live online chat with cessation counselors Monday through Friday and even have a smartphone application available to help people who are serious about quitting.

You can take a look at their website at smokefree.gov or call them toll-free at 1–877–44U–QUIT (1-877-448-7848). There is also help available from your state's quit line at 1-800-QUIT-NOW (1-800-784-8669).

Make the best choice for your health and well-being; avoid the bad habit of tobacco products. If you have any questions about how tobacco related products affect your oral health and hygiene, please don't hesitate to ask one of our Missoula or Hamilton staff members.

Oral surgery can be intimidating, especially if you show any signs of an infection afterwards. Dr. Holtzen and our team want you to be informed about what to watch for after you’ve undergone surgery.

Oral surgery procedures are intended to reduce pain and prevent infection. Sometimes complications occur after your surgery, and if infection ensues, it will require swift medical attention.

People undergo oral surgery for many reasons, such as:

• Impacted or infected teeth
• Tooth loss, jaw problems
• Facial injuries or infections
• Birth defects
• Sleep apnea

Symptoms of Infection

• Pain that won’t go away with medication
• Steadily swelling of gums, jaw, or face
• Redness or oozing of pus from the area
• Fever that doesn't subside
• Difficulty opening the mouth or jaw
• Excessive bleeding for 24 hours
• Difficulty breathing or swallowing (emergency situation)

After the initial surgery, don’t become worried right away if you notice any of these symptoms. It’s normal to show some blood and swelling after surgery, but that should stop fairly soon with the help of gauze and medication.

You will most likely be numb from the procedure and we will advise you to avoid hard foods for the first day. Pain medication will be administered, and you should take it before you begin to notice pain. A cold compress can also help with swelling and initial pain.

You will be advised not to brush your teeth in the region where the surgery occurred. You may use a prescription mouth rinse, or you can gargle with warm salt water to reduce the swelling. If you follow these directions, you can speed the healing process for a quick recovery.

Don’t fret: a post-surgery infection is not a common development. It happens most often to people who have a compromised immune system or diabetes. Let Dr. Holtzen know beforehand if you have either of these and we may prescribe an antibiotic to help prevent the spread of infection in the areas of your mouth that get worked on.

If you think you may be experiencing complications after a surgery, please don’t hesitate to reach out to our Missoula or Hamilton office for advice.  

Thanks to today’s advances in dental technology, we can replace missing teeth with implants for a smile that looks healthy, natural, and complete. If you’re worried that you’re too old for dental implants, good news! While younger patients must wait until their jaw bones are completely developed before implant surgery, there is no upper age limit for dental implants.

In fact, studies have shown that patients aged 65 and over have high rates of successful implantation, long-term implant retention, and minimal complications. Of course, as our bodies age, there are changes that take place. And some of these changes can make an implant procedure more challenging.

Fortunately, oral surgeons like Dr. Holtzen have the training, experience, and advanced techniques to make implants possible even in challenging circumstances. Two important concerns for older patients are bone density and healing ability. What can Dr. Holtzen do to address these concerns?

• Bone Grafting

A complete tooth replacement consists of an implant that serves as a “root” to anchor the tooth in the bone, an abutment that is secured in the implant and extends above the gum line, and a crown restoration that is attached to the abutment.

Dr. Holtzen will drill a small hole in the jawbone for the implant and carefully place it in position in the jaw. Over a period of months, this implant will become integrated into the bone just like a natural root. You can see why one of the most important requirements for a successful implant is having enough healthy bone in which to anchor it.

But after losing a tooth, the bone under the missing tooth gradually shrinks without the pressure and stimulation of chewing. As time passes, more bone loss occurs.

If there is not enough bone size and density to support an implant, you can still regain the structure you need for success with surgical bone grafting. This is a type of surgery which uses your own bone, a synthetic grafting material, or a processed bone grafting material to repair and replace damaged bone. After approximately three to four months of healing, the jawbone has recovered enough volume and density to accept an implant.

And one wonderful bonus? An implant gives your jawbone the same pressure and stimulation that your natural tooth did, preventing future bone loss.

• PRP Treatment

One consequence of aging is that older bones simply don’t heal as rapidly as younger bones.  If this is a concern for you, an encouraging new treatment for implants in older patients is Platelet-Rich Plasma (PRP). This plasma is rich in platelet growth factors and has shown promising results in bone and tissue regeneration as well as faster healing.

After drawing a small amount of your own blood, the blood is immediately centrifuged to separate and collect the platelet-rich plasma. This plasma is then mixed with bone grafting material. And, because the PRP is composed of your own blood cells and plasma, there is no chance of rejection, reaction, or disease transmission.

If you have any concerns about your age, the implant procedure, bone health, healing time, or any other issue, talk to Dr. Holtzen.

After all, as oral surgeons, we are specialists. We have a minimum of four years of surgical education and training in a hospital-based residency program. We train with medical residents in advanced studies, which include general surgery, anesthesiology, internal medicine, plastic surgery, and otolaryngology (the study of the ear, nose, and throat). We are experts not only in implant procedures, but in adapting procedures successfully for your individual needs.

There is nothing like the look and feel of a natural smile. Make an appointment at our Missoula or Hamilton office to talk about dental implants. After all, a healthy, attractive smile is something we deserve at any age.

If you or someone you know is going to require oral surgery, you may have many questions about what exactly will occur during the surgery, what to do (or not do) before and after surgery, and what your options might be. Here, we’ve covered the most common ten questions pertaining to oral surgery.

What is Oral Surgery?

Maxillofacial and oral surgeries is a dental practice consisting of the diagnosis and the surgical treatment of injuries, defects of the mouth, face, jaw and related structures, and of diseases.

Will I be Awake During the Procedure?

It depends on the actual procedure, but many of the more intensive surgeries require that you be anesthetized, or put to sleep for the duration of the procedure. Wisdom tooth removal and dental implant procedures are examples where anesthesia may be required.

What are Dental Implants?

A dental implant is used to replace missing teeth. A titanium fixture is implanted into the jaw if there is sufficient bone to provide anchorage for the implants.

How Long do Implants Last?

With proper care and good hygiene practices, a dental implant can last a lifetime.

Is the Dental Implant Procedure Painful?

Most patients are surprised to find that it was less painful than they expected. Regular Tylenol® is often enough to control the discomfort until it fades after a few days.

What are Wisdom Teeth?

Many people have more teeth than they have room for in their jaw. Wisdom teeth are the "third molars" and they try to erupt into a jaw that is too small when children are in their late teen years.

Why do Wisdom Teeth Need to be Removed?

Today most wisdom teeth end up getting impacted because they have nowhere to go thanks to a mouth full of healthy teeth. When they are not in a normal position they can cause discomfort, pain and even damage to other teeth or nerve endings. Therefore, if your X-rays show that your wisdom teeth are impacted, we may recommend their removal.

Will I Miss Work Due to Oral Surgery?

Taking one day off for the surgery and rest afterward is advised. We'll let you know on a case-by-case basis if more time off is needed, though after most oral surgeries people can go back to work the next day.

Is Exercise a Problem After Oral Surgery?

We usually recommend a week of rest before resuming your exercise regimen. If we think more rest would be better, then we'll let you know.

When Can I Eat After Surgery?

In most cases, you can eat after you get home from the surgery, and soft foods are best.

If you have any specific questions or concerns in the Missoula or Hamilton area, we are here to help, and put your mind at ease. Please contact our team at Alpine Oral and Facial Surgery. We’d love to hear from you!

Happy Independence Day from Dr. Holtzen and team! The Fourth of July celebrations in America may have changed a lot over the years, but there is no doubt that we Americans love to celebrate the anniversary of our country's independence! Today we're devoting the Alpine Oral and Facial Surgery blog to some fun facts about the Fourth!

• My, how we have grown! This year the United States Census Bureau estimates that our country has 313.9 million residents celebrating the Fourth of July this year, but back in 1776 there were just 2.5 million members of the country.
• Our country loves to show how proud that we are of our independence. Did you know that there are 31 United States places with the word “Liberty” in their names? The state of Iowa actually has four towns with the word Liberty in the name: Libertyville, New Liberty, North Liberty, and West Liberty.
• The United States loves Fourth of July food! It is expected that around 150 million hot dogs are eaten on the Fourth each year. One of the Fourth's most popular sides, potato salad, goes just perfectly with the hotdogs and hamburgers that are standard Fourth of July fare. Some people choose potato chips instead, but we wouldn't have such a plethora of potatoes if not for the prodigious production of the states of Idaho and Washington -- they provide about half of all the potatoes in the United States today!
• Americans love celebrating the Fourth outdoors: About 74 million Americans fire up their BBQ grill every Fourth of July.
• The Chinese contribution: Did you know that Americans have spent more than $211 million on fireworks that were imported from China?

No matter how your family chooses to celebrate the Fourth, stay safe, take precautions, and don't forget to brush after your fabulous Fourth feast!

The Fourth of July is a great time to get together with friends and family members for BBQ, games, fireworks, and other celebrations in honor of our country’s independence. While your fellow revelers eat hot dogs and wave flags, you can impress them by sharing these fascinating facts and historical tidbits about some of our country’s traditions and symbols from the team at Alpine Oral and Facial Surgery.

The Statue of Liberty

With a torch in one hand and a tablet in the other, the Statue of Liberty is one of the most iconic and recognizable symbols of our country. However, as recognizable as certain parts of the statue are, not many people know that broken shackles, which represent oppression and tyranny, are lying at Lady Liberty’s feet. According to the Statue of Liberty-Ellis Island Foundation, the copper-plated lady weighs in at a whopping 450,000 tons and has been holding her torch up for more than 125 years, which must make for some impressive arm muscles.

Nathan’s Hot Dog Eating Contest

Since 1916, people have been flocking to Coney Island on the Fourth of July to witness what some people call the “superbowl of competitive eating.” Nathan’s Hot Dog Eating contest challenges competitors to devour as many hot dogs as they can in just ten minutes, with the current record holder swallowing a whopping 68 hot dogs! If you’d like to witness this bizarre and frenzied eating competition but you won’t be anywhere near Coney Island on the fourth, don’t worry. ESPN has been broadcasting this popular event for several years, so you can watch from the comfort of your couch while you eat a reasonably portioned meal.

The History Behind Fireworks

Viewing the nighttime fireworks display is exciting way to finish off the fourth. Many people know that these brilliant displays probably originated with the Chinese. However, many historians also believe that fireworks were stumbled upon when the Chinese roasted bamboo sticks over fires and watched them explode. After many years of roasting the sticks, a group of alchemists created an early form of gunpowder, which they stuffed into the bamboo sticks to create an even more powerful explosion, paving the way for the today’s modern fireworks.

Whether you’re planning on visiting the Statue of Liberty, watching fireworks in Missoula or Hamilton, or even participating in a hot dog eating contest, Dr. Holtzen and our team hope you have a safe and fun-filled holiday. Happy Fourth of July!

Dental floss is similar to a lot of products that depend mainly on the consumer’s preference. Fact is, floss comes in a wide variety of flavors, coatings, and other variations, but all types of floss essentially do the same thing. After all, that is what is most important: that the dental floss you buy is functional—cleaning the areas in between your teeth. If you want to know what the best dental floss is, the answer is the kind that enables you to successfully and regularly clean those areas. So to help you find the right type of floss for you, here are some options.

Flavored Dental Floss

Many people that floss prefer a flavored dental floss because it freshens their breath even more than unscented floss. The latter can also take on the smells associated with bacteria in your mouth. And we all know how bad that can be. So, if flavored dental floss is what you prefer, and it allows you to floss your teeth regularly, then it is automatically best for your mouth.

Flossers

There are also products on the market called flossers, which usually consist of a plastic instrument with strung floss and a pick on the opposite end. This option can be both effective at cleaning the areas in between your teeth and scraping off plaque. These flossers also come flavored in mint and various other varieties.

Gentle Dental Floss

Some people find that typical dental floss is too harsh on their gums. For that reason some companies make floss with soft coatings that are less abrasive on the gums. For the most part these types of floss are just as effective as regular floss, and for those people that require a more sensitive approach to flossing, especially when just starting out, this is the best option.

Of the aforementioned options, it is difficult to name an absolute best type of floss. However, Dr. Holtzen and our team say that the type of floss that works best for you, giving you the greatest chance of succeeding at regular flossing, is the best. For more information on floss, contact our Missoula or Hamilton office.

You have probably heard of dry socket before, but have never investigated exactly what it involves. This is understandable, after all, nobody really wants to think about having complications when they have a tooth pulled. You may be surprised to learn that dry socket, medically known as alveolar osteitis, only happens to a tiny percentage (between two and five percent) of people having tooth extractions, and that it is quite easy to treat.

Dry Socket Symptoms

Dry socket symptoms generally begin with pain in the area where the tooth was pulled. Over time, untreated dry socket can result in pain that radiates to the ear area as well. Other typical symptoms include bad breath and having a consistently bad taste or smell in the mouth.

You may notice dry socket symptoms immediately after a tooth extraction, or it could take a few days. This all depends upon the formation of the protective blood clot that should exist over the area where the tooth used to be.

How Dry Socket Happens

After a tooth extraction, a small protective blood clot should form in the area where the tooth had been. The purpose of this blood clot is to cover, and thereby protect, the now-exposed bone and nerve network. Occasionally, this blood clot can dissolve prematurely or it can move away from the proper area, leaving the area fully exposed to everything that goes into the mouth. When air, food, beverages, mouthwash, and any other substances touch the delicate nerves and exposed bone, infection — and the pain that goes along with it — is often the result.

Help for Dry Socket

It is important to contact Dr. Holtzen to get help for dry socket as soon as you think there may be a problem. We can help by cleaning the socket, extracting any debris that has gotten into the area, and packing the area with a medicated paste or gauze. This medicated dressing will need to be changed regularly to promote the fastest healing.

Dr. Holtzen may also give you a prescription for antibiotics that will assist in faster healing, if necessary. Generally, you can use ibuprofen or acetaminophen for pain relief.

The third molars have long been known as your “wisdom teeth,” because they are the last teeth to erupt from the gums – usually sometime during the late teens to early twenties. This is a time in life that many consider an “age of wisdom”; hence the term, “wisdom teeth.”

Extracting the third molars does not have any effect on your actual wisdom … and Dr. Holtzen and our staff are sorry to say that holding on to them can’t make you smarter, either. So if you somehow feel that you became wiser and smarter when your wisdom teeth appeared, chalk it up to age rather than teeth.

In fact, you may just be showing how smart you are by having your wisdom teeth removed. Mankind once relied on the wisdom teeth to replace teeth that were damaged or missing, thanks to a poor diet. But dietary changes and advances in modern dentistry make it possible for many people to hold on to their teeth for many decades, which eliminated the need for third molars.

For many people, wisdom teeth cause nothing but problems: becoming impacted, irritating surrounding gum tissue, or even causing other teeth to become crooked or overlap. By removing them, patients often enjoy a lower risk of decay, infection, and aesthetic complications.

So rest assured that extracting your wisdom teeth will have no effect on your immediate or long-term intelligence.

If you’re scheduled for oral surgery at our Missoula or Hamilton office in the near future, you probably have a lot of very important questions:

• Will it help? Your oral and maxillofacial surgeon has the skill and experience to diagnose and treat conditions affecting the face, mouth, and jaw with a number of different surgical procedures. Oral surgeons are the experts in these surgical specialties, so you are in good hands!
• Will it hurt? Your oral surgeon has been trained in all types of anesthesiology, so you can choose the sedation experience which will make you most comfortable.
• What should I do after surgery? Don’t worry! Dr. Holtzen will give you clear instructions on caring for the surgical site, selecting soothing diet options, cleaning your mouth, and all of the other practices that will enable a speedy and smooth recovery.
• What should I wear? Wait—fashion questions?

Yes! Part of being prepared for your surgery is being as comfortable as you can be during and after the procedure. Happily, there is no strict oral surgery dress code. It’s more a basic list of recommendations for what not to wear.

• Don’t wear something you’re not comfortable in. Generally, loose fitting clothing is best.
• Don’t wear clothing that might be difficult to clean. While you and your clothing will be well protected, blood, irrigation, and other staining hazards are all occasionally part of the surgical process.
• Don’t wear something that will be difficult to remove after surgery. No one wants to struggle out of a tight turtleneck even at the best of times!
• Don’t wear jewelry. And, by the way, this includes tongue and facial piercings.
• Don’t be afraid to layer. While the office staff will try to make sure you are as warm or as cool as you would like to be, it’s a good idea to bring a jacket or sweater for extra warmth.
• Don’t wear tight sleeves. Short sleeves or sleeves that can be rolled up easily allow access to your arm if you are having IV sedation or blood pressure monitoring.
• Don’t wear contact lenses, especially if you are planning on IV sedation or a general anesthetic, because your eyes might be closed throughout the procedure.

If you have any questions in advance of your oral surgery, give our Missoula or Hamilton office a call. Planning ahead is always in fashion!

After your son or daughter departs for college, the last thing you want to get is a call or text to learn he or she is in pain. Dr. Holtzen and our team at Alpine Oral and Facial Surgery will tell you there aren’t many emergency situations that can be avoided when it comes to dental health, but one crisis that can easily be prevented before your teen heads hundreds of miles away for college is wisdom tooth extraction.

What are wisdom teeth?

Wisdom teeth are the third set of molars that erupt in the late teen years to early 20s. Spacing and crowding problems often cause impaction and infections, which is why many people elect to have their wisdom teeth removed. Wisdom teeth can go from barely noticeable to extremely painful in a very short period of time.

When your teen’s wisdom teeth erupt, they may cause overcrowding of his or her teeth, which can have a negative effect on their alignment. Most people’s mouths do not have enough room for wisdom teeth to erupt fully and remain perfectly aligned. Thus, pain, swelling, infection, damage to adjacent teeth, and decay are often the most common problems associated with wisdom teeth. These problems can brew beneath the surface for weeks or months, offering no warning before painful symptoms hit.

If your child does elect to go through wisdom tooth extraction, we want to inform you that the first few days of recovery consist of careful measures to control bleeding and swelling, an adherence to a special soft diet, as well as a medication routine that must be followed as recommended by Dr. Holtzen after surgery.

Dr. Holtzen and our team are dedicated to providing exceptional service before, during, and after your wisdom tooth procedure, so you can have peace of mind knowing that your child’s oral health is in good hands. We will do everything we can to minimize discomfort and help your child heal safely and quickly.

Summer break is the perfect time to remove wisdom teeth so that your child can avoid the stressful scenario of experiencing this medical emergency far away from home. If you have any questions on wisdom teeth removal or to schedule an initial consultation with Dr. Holtzen, give us a call today!

Patients have a variety of options in dental providers, and it can be tricky to know which type of dental professional is best for your current needs. Understanding the differences between general dentists and oral surgeons, like Dr. Holtzen, can help you make an informed choice for dental care.

Education

Both general dentists and oral surgeons must complete dental school after receiving a bachelor’s degree. In dental school, which typically takes four years of full-time study, students take coursework in anatomy, physiology, pharmacology, pathology, and oral surgery. Dental students also complete clinical practicum experiences, gaining hands-on training in how to diagnose and treat dental problems.

After completing dental school and earning the Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD) degree, a general dentist must complete a licensure exam to practice in a particular area. In contrast, oral surgeons (often called oral and maxillofacial surgeons) complete a four to six year surgical residency. The residency program must be accepted by the Commission on Dental Accreditation, ensuring that each resident receives the training in oral pathology, anesthesia, oral surgery, and other areas needed to competently practice. Following the surgical residency, a person completes a board certification examination.

Scope of Clinical Practice

General dentists serve as primary care providers for dental medicine. At the general dentist’s office, you will receive teeth cleaning, X-rays, and a comprehensive screening for dental problems. General dentists most often provide gum care, dental fillings, root canals, veneers, bridges, and crowns. They also make recommendations for how to prevent common dental problems. Although a general dentist may perform simple tooth extractions, more complex surgeries may be outside of the scope of a general dentist’s competence.

Oral and maxillofacial surgeons receive specialized training to treat a variety of conditions affecting the face, mouth, and jaw. Patients are typically referred to an oral surgeon when a problem is beyond the scope of a general dentist’s expertise. Oral surgeons perform simple and complex tooth extractions, including wisdom tooth extraction. They also provide care to accident victims who need reconstructive dental surgery. Oral surgeons may also perform soft tissue biopsies, tumor removal, jaw realignment surgery, soft tissue repair, or positioning of implants.

It can be difficult to determine what dental professional best fits your needs. Contact our Missoula or Hamilton office to determine if an oral surgeon can best meet your needs.

The effects of bad oral habits are something our team sees all too often. You might have bad oral habits that stem from childhood, possibly because your parents did not know about proper oral care or force you to follow it. Or, your bad habits could develop gradually, like slacking on your frequency of brushing.

Bad oral habits can lead to tooth decay, gum disease, and consequences such as losing teeth and experiencing bad pain. They may be deeply ingrained and easy to continue, but you can break them with a little effort. Focus on developing good habits to replace your current ones, and eating a diet that is healthy for your teeth.

Replace Bad Habits with Good

Breaking your bad oral habits may not be as difficult as you expect when you focus instead on developing good habits. These new good habits can naturally replace your bad habits.

• Brush your teeth after each meal or at least twice a day.
• Visit a dentist every six months for an exam and a professional cleaning.
• Floss your teeth every day.

These good habits may not seem natural, so you can take steps to make sure you follow these behaviors. For example, make a daily checklist with your scheduled sessions of brushing and flossing your teeth and using mouthwash. You can also set a timer to be sure you brush your teeth for the full recommended two minutes.

Eat Properly

Poor eating habits can be detrimental to your teeth. A common mistake is to let food, especially carbohydrates such as starch and sugar, stay on your teeth for a long time. You can stop doing this by rinsing your mouth with water after each meal or snack. Also, avoid candy and soft drinks between meals, since the sugar sits on your teeth.

A healthy diet provides the nutrients you need to maintain strong teeth. The mineral calcium is key for healthy teeth, so try to get your three daily servings of high-calcium foods, such as low-fat milk or yogurt, canned fish, or fortified soy or almond milk. Also include vegetables and fruits, which have a high water content.

If you need more tips about breaking your bad oral health habits, contact our Missoula or Hamilton office and speak with Dr. Holtzen or a member of our team.

If you have a hard time understanding your dental insurance plan, particularly the treatments and services it covers, you’re not alone. That’s why Dr. Holtzen and our team have put together a cheat sheet to help you through them.

It’s common for patients to get lost in the morass of the terms and phrases that surface when you’re dealing with a dental insurance plan. Knowing the commonly used terms can help speed up the process and enable you to get the most out of your coverage.

Common Terms

Annual Maximum: The most your policy will pay per year for care at Alpine Oral and Facial Surgery. It is often divided into cost per individual or per family.

Co-payment: Typically, a small amount the patient has to pay at the time of service before receiving care, and before the insurance pays for any portion of it.

Covered Services: A list of all the treatments, services, and procedures the insurance policy will cover fully under your contract.

Deductible: An amount you must pay out of pocket each year before the insurance company will contribute for any treatments or procedures. The amount can vary according to your plan.

Diagnostic Services: A category of treatments or procedures that most insurance plans will cover before the deductible, which may mean services that occur during preventive appointments with Dr. Holtzen, including X-rays or general screenings.

Exclusions: Dental services not covered under a dental benefit program.

In-Network: An insurance company will usually cover a larger portion of the cost of the care if you see an in-network provider for treatment.

Out-of-Network: If you visit someone who is not a part of your provider’s network, the insurance company may pay for a portion of the care, but you will be responsible for a significantly larger share out of your pocket.

Lifetime Maximum: The most that an insurance plan will pay toward care for an individual or family over the entire life of the patient(s).

Limitations: A list of all the procedures the insurance policy does not cover. Coverage may limit the timing or frequency of a specific treatment or procedure, or exclude some treatments altogether.

Member/Insured/Covered Person/Beneficiary/Enrollee:  A person who is eligible to receive benefits under an insurance plan.

Premium: The regular fee charged by third-party insurers and used to fund the dental plan.

Provider: Dr. Holtzen or other oral-health specialist who provides treatment.

Waiting Period: A specified amount of time that the patient must be enrolled with an insurance plan before it will pay for certain treatments.

It’s essential to understand the various insurance options available to you. Knowing what your insurance covers can save you major costs in the future.

Dr. Holtzen and our dental staff hope this list of terms will help you understand your dental insurance plan better. Be sure to review your plan and ask any questions you may have about your policy the next time you visit our Missoula or Hamilton office.

Memorial Day didn't become an official holiday until 1971, but Americans started gathering annually in the spring to remember those who lost their lives in war during the 1860s, right after the Civil War. Celebrated on the last Monday in May, people still decorate the grave sites of war veterans and hold memorial services, but Memorial Day has also evolved into a day that signifies the beginning of summer.

During the summer months, many people take road trips to visit family members. Some head off to the airport to enjoy a long-awaited vacation far away, while others look forward to spending time with friends and family at home. However you spend Memorial Day and the subsequent summer months, there are a few things you can take care of to ensure your summertime is enjoyable.

Checklist for an Enjoyable Summer

• Have the AC Checked. During the hottest days of summer, many families find themselves sweating it out due to a broken air conditioning system. Be proactive so you can avoid waiting for hours or days because the HVAC repair person is booked solid. Have your air conditioning system checked before or around Memorial Day each year.
• Ensure Security While You're Away. When you leave for vacation, the last thing you should have to worry about is the security of your home. Install a home security system, if possible, and put a timer on your lights so they go on and off at normal hours. You can also alert your local police department that you'll be gone, and ask them to drive by your house once in a while to make sure everything is okay.
• Visit Dr. Holtzen Before Vacation. Many people put off exams until after summer vacation. Avoid the crowds and make sure your physical and oral health are in top shape prior to vacation time so there are no unpleasant surprises.

Our team at Alpine Oral and Facial Surgery wants you to look forward to Memorial Day and the days of summer by preparing to spend the time safely and comfortably. As you plan ahead, take care of your health and secure your home, you can place your focus on creating memories with family members and friends while enjoying your favorite Memorial Day traditions.

“The purpose of all war is peace.” - Saint Augustine

Fire truck sirens, baton twirlers, marching bands covering patriotic tunes, colorful floats, costumes, and millions of red, white, and blue American flags being waved in the air on a beautiful day in late May, that is what Memorial Day is all about. It is a federal holiday celebrated with town parades, remembrance, and a sense of unity and community togetherness.

Our team at Alpine Oral and Facial Surgery wants to take this time to wish you and your family a happy Memorial Day, as well as pause for a moment to reflect on what this holiday means and how it has changed over time. No, this is not a history lesson, but just a couple of thoughts and observances for you to take with you on your way to the next barbecue.

On the last Monday in May, America observes Memorial Day as a time to remember and celebrate the men and women who have lost their lives while serving our country in the Armed Forces. The holiday originated after the Civil War; at that time it was known as Decoration Day. While holidays like Thanksgiving, Christmas, and Easter remain the same from year to year, Memorial Day has changed over time, and in the 21st century we observe a far different holiday than what Americans did after the Civil War, or even the World Wars.

While many people place flags at cemeteries and visit national memorials in order to honor those who have passed away serving the country, Memorial Day is also a time for family barbecues, pool parties, trips to the beach, blockbuster movies, long weekend getaways, and fireworks. In America, Memorial Day has come to represent the unofficial start of the summer – a long, sunny, warm weekend devoted to family togetherness, outdoor events, and community.

It is time to load up the potato salad and the apple pie and head over to the neighbor’s house for their annual barbecue. And yes, contrary to popular belief, we do eat sweets, especially homemade apple pie! Everything in moderation, of course.

So whether you’re in the Missoula or Hamilton area or beyond, Happy Memorial Day to you and yours from Dr. Holtzen!

Nobody likes bad breath, and although it can sometimes be difficult to tell if you have it, it is always better to practice good oral health than risk having a smelly mouth. There are many ways to reduce or eliminate bad breath, some are definitely more effective and longer lasting than others. Check out ways to do so below.

Floss Regularly

As difficult as it can be to remember to floss regularly, when it comes to bad breath, flossing is one of the easiest and most cost effective ways to freshen your mouth. See, flossing reduces the plaque and bacteria found in areas of your mouth that a toothbrush simply can't reach, and in turn, it rids your mouth of the smell associated with that bacteria. While flossing may not eliminate bad breath on its own, if you do it along with other health oral hygiene habits like brushing, then you may just develop a fresher smelling mouth.

Use Mouthwash

Using some sort of mouthwash can really freshen up your breath, especially if you find it still smells after brushing and flossing. There is a wide variety of mouthwash products on the market, however, you can also create your own by simply using baking soda mixed with water.

Always Brush after You Sleep

Whether after taking a nap, or having a full night of sleep, you will want to brush your teeth in order to reduce bad breath. The truth is, bacteria accumulates in your mouth while you are sleeping (even during a short nap) and that is ultimately the source of bad breath. So next time you wake from a good slumber, give your mouth some brushing and you will find it makes a big difference in the freshness of your breath.

There are many ways to freshen your breath beyond just using gum or mints, the above mentioned are just a few for you to try. Test them out and you will likely find your bad breath problem is solved, or at least considerably reduced. Of course, you can always ask Dr. Holtzen at your next visit to our Missoula or Hamilton office.

There are many ways in which your oral health has an impact on your overall general health. There are naturally occurring bacteria in the mouth. Some of those bacteria, including strep and staph, are harmful, while other bacteria are essential for the balance of intestinal flora. The healthier your mouth is, the less likely it is the harmful bacteria will travel to other parts of your body to infect it and make you sick. There is much more to good dental hygiene than brushing and flossing.

Historical Methods of Maintaining Oral Health

Ancient civilizations relied on natural remedies for maintaining oral health. Around 250 AD, the Kemetic Egyptians used myrrh and other herbs as antiseptics for treating infected gums. Two centuries later, the Nubians, who lived in the Nile River valley, drank beer to ease the pain of infected teeth. That probably sounds crazy, but their beer was effective because they used grains that were contaminated with the same bacteria that produce the antibiotic tetracycline.

Today's Biggest Dental Hygiene Challenge

In the past, tooth decay was more of an issue because there was no routine dental care, and problems that are routinely treated today went untreated. Thanks to fluoridated water, and toothpastes containing fluoride, tooth decay is far less problematic than it was a century or more ago. Gum disease has replaced tooth decay as the most serious dental problem facing people today. According to the American Dental Association, a staggering 80 percent of Americans over age 65 suffer from some form of periodontal disease.

Ironically, if that infection attacked any other part of your body, especially in a place where it was clearly visible, you would head to your doctor for treatment immediately. People tend to ignore gum tenderness and bleeding. When the tenderness and bleeding aren't treated, the inflammation can turn into periodontitis. The longer you allow the inflammation to go untreated, the greater the likelihood that it will affect other body parts. Make sure to visit Dr. Holtzen at Alpine Oral and Facial Surgery regularly to be proactive about dental health!

Researchers are now discovering that untreated inflammation in the mouth acts as a driving force for multiple chronic illnesses, including clogged arteries, heart attacks, arthritis, and even cancer. That inflammation is one of many hypotheses that may explain how chronic infections can trigger systemic diseases, and even intensify existing ones. Bacterial overgrowth in the inflamed gum tissue can enter the bloodstream through the food you eat, and from daily brushing.

Caring for your mouth at home is just as important as visiting our office for exams!

If you have lost a tooth or teeth, dental implants can restore your smile. Implants look natural, don’t impact the healthy teeth around them, and protect the underlying bone from the bone loss that can be caused by a missing tooth.

One important prerequisite for a successful implant: the bone in the jaw that will hold the implant must be healthy, and must be the appropriate size and strength to allow osseointegration (the fusion of the implant with the jawbone) to take place. If the bone isn’t wide enough, high enough, or dense enough, the success of the implant will be in jeopardy.

An implant, unlike a denture or a bridge, is rooted in the jaw much like your tooth. A cylinder is implanted in the bone, and will later hold the abutment which attaches to the final crown. Because a great deal of pressure is placed on our teeth with everyday functions such as chewing, the bone must be strong enough to successfully fuse with the implant.

Fortunately, Dr. Holtzen can actually restore the density and shape of your jawbone if the bone isn’t suitable for an implant. This reconstruction is accomplished with bone grafting.

Why Would You Need a Bone Graft?

The bone structure which supports our teeth can be compromised in a number of ways. We might recommend a bone graft if you have insufficient bone due to causes such as:

• Bone Loss Caused by Tooth Loss

The bone tissue which supports our teeth needs the stimulation of biting and chewing to stay healthy. Without that stimulation, the bone area under the missing tooth gradually shrinks. The bone tissue is resorbed into the body, which, in a relatively short amount of time, can lead to a noticeable sunken spot where the tooth used to be. Bone grafting will rebuild this area—and a dental implant will provide the tissue stimulation that a natural tooth would, helping to prevent future bone loss in the jaw.

• Gum Disease

As gum disease progresses, the gums pull away from the teeth, leaving the bone and connective tissue exposed to infection and bacteria. Infection and the body’s own response to bacteria can cause deterioration in the bone structure supporting the teeth. Bone loss cannot be reversed, but a graft can replace lost bone and allow healthy tissue to regenerate.

• Pre-existing Bone Conditions or Traumatic Injuries

In the case of bone structure that is naturally less thick or dense, or bone which has been damaged by accident or injury, a bone graft can provide a solid basis for an implant.

What Takes Place in a Bone Grafting Procedure?

Bone grafting is a type of oral surgery. Bone tissue for grafting may be taken from your own body, or a graft material composed of safe and sterile donor tissue or synthetic substitutes can be used. This second kind of graft will be absorbed gradually by the body as your own new, healthy bone tissue replaces it.

If you decide a bone graft is your best option, we will discuss the options for grafting with you during your appointment at our Missoula or Hamilton office, and use imaging to map out the area of bone loss and to create the best individual treatment plan for you.

After anesthesia, an incision will be made in the gum tissue to reveal the damaged bone. Grafting material will be shaped and secured to the affected area, and sutures are generally used to close the incision. We will give you careful instructions for after care and follow-up visits. The time it takes for you to heal completely will depend on the type and size of the graft.

We recommend bone graft surgery when it will provide the best, most successful foundation for your dental implant procedure. Oral surgeons have years of medical and surgical training in the complex relationship and interaction of bone, muscle, and nerve. We are uniquely qualified to provide a skillful, safe, and effective bone grafting procedure.

When you choose an implant, one of your primary goals is the aesthetic restoration of your smile. Just as important, you are also making sure that the bones supporting your teeth will remain heathy and strong. Talk to us about bone grafting, and how we can start you on your way to a lifetime of beautiful smiles.

As with any surgery, post-procedure care is of utmost importance after getting periodontal surgery. Bleeding, pain, swelling, and other sensations are common and should be expected to a degree. This can manifest as small amounts of blood in your saliva, pain after anesthesia wears off, and swelling around the lips and cheeks. However, these symptoms should start improving after a several days.

Below you'll find recommendations from Dr. Holtzen on what you should do to make your post-procedure experience as quick and painless as possible:

Don't smoke - After your surgery you should definitely not smoke. Smoking will inhibit your body's ability to heal the surgical site.

Don't drink alcohol - If you are taking prescription or over-the-counter pain relievers, don't drink alcohol. And it is a good idea in general to avoid alcohol after surgery, since excess alcohol consumption suppresses immune system function and slows the healing process.

Take pain medication as prescribed or an alternative - Pain is to be expected for at least the first week after your procedure. If you choose to take the prescription medication that is prescribed to you, do so as directed. However some patients have found over-the-counter pain medication works for them. You may also consider natural herbs instead of pharmacological solutions. Try turmeric, arnica, or white willow bark (which is what aspirin is derived from, so the same warnings for aspirin apply to white willow bark.)

Eating with your surgical site in mind - It is best to chew on the other side of your mouth for the first several days so as not to irritate the surgical site. Avoid overly cold or hot foods as well. Softer foods like mashed potatoes, oatmeal, and fruit will be more comfortable to chew.

Avoid brushing the surgical site - You can start brushing and flossing your teeth the day after the procedure but avoid the surgical site.

Don't rinse for the first 24 hours - After the first day has passed you can rinse with a mild mouthwash to keep your mouth, dressing, and surgical site clean.

We're here to answer any questions you have after your procedure and will help you as best we can. Pay special attention to any excessive bleeding or discomfort. Contact our Missoula or Hamilton office immediately if you have tried addressing the issue on your own but are still having trouble.

It's a habit many people have and not only can it be annoying to the people around you, it can be detrimental to your dental health. Chewing ice is so common that it even has its own name, pagophagia. We're not talking about a slushy or shaved ice (although those artificially sugary treats should be avoided too!) but more like the hunks of ice rattling around in the bottom of your glass.

Ice chewing can be a sign of emotional problems like stress or obsessive-compulsive disorder, but it can also be a marker for iron deficiency anemia and other physical problems. Then again, some people just like to have something to chew on. For whatever reason you find yourself chewing on it, it's a habit you need to break.

Chewing on ice can cause:

• Chipped and cracked teeth
• Damaged enamel
• Sore jaw muscles
• Damage to dental work such as crowns, fillings, or other appliances

If chewing on ice is becoming a problem in your life, don’t hesitate to speak with Dr. Holtzen about it. But if you find yourself still wanting to chew on something, here are a few alternatives to ice:

• Baby carrots
• Celery sticks
• Sugar-free (xylitol) gum

We know you need to chill sometimes, but chomping down your entire glass of ice is not the way to do it. If you have any other questions on the topic, feel free to talk with a member of our Missoula or Hamilton team. It may be beneficial in solving the issue and helping to remediate any damage to your teeth.

If you’re suffering from sleep apnea, you already know the short-term consequences. Your nights are marked by snoring, gasping for breath, and waking up dozens of times each sleep cycle. Your days are no more enjoyable. You might be plagued by drowsiness, morning headaches, sore throats, dry mouth, memory problems, depression, and decreased libido.

And the long-term consequences can be even more serious. Obstructive Sleep Apnea (OSA) has been linked to high blood pressure, stroke, dangerous responses to medication or anesthesia, and falling asleep while working or driving.

In other words, OSA can have devastating consequences for your health and your quality of life.

You may have already tried out various non-surgical options. Perhaps your doctor has suggested behavior modification, oral sleep appliances or splints, Positive Airway Pressure machines—these and other methods have proven very helpful for some sufferers. But if these options don’t work for you, it could be time to talk to Dr. Holtzen about OSA surgery.

Obstructive sleep apnea is caused by an obstructed airway. The throat muscles may relax as you sleep and make it impossible to inhale fully with each breath. Or you may have a physical condition such as a large tongue, enlarged tonsils or excess throat tissue that blocks the free passage of air into your lungs. The size and position of your jaw can affect breathing as well, or your nasal passages may be involved.

In other words, Obstructive Sleep Apnea can be caused by a complex set of variables as air attempts to travel from nose to lungs, so your individual OSA diagnosis and treatment will vary depending on your individual anatomy. For this reason, an oral and maxillofacial surgeon like Dr. Holtzen is the specialist you need.

Oral surgeons pursue advanced studies for a minimum of four years in a hospital-based residency program. There, they train with medical residents in the fields of general surgery, anesthesiology, internal medicine, and other specialties with a specific focus on the bones, muscles, nerves, and skin of the face, mouth, and jaw.

Because your anatomy is unique, Dr. Holtzen will first carefully assess the causes of your breathing obstruction and, if surgery is indicated, will recommend a procedure or procedures tailored to treat your specific needs.

Among the specialized surgical procedures used to treat OSA are:

• Nasal Surgery—treats a variety of nasal passage obstructions such those caused by a deviated septum or a nasal valve collapse
• Uvulopalatopharyngoplasty (UPPP)—removes or remodels excess tissue in the area of the soft palate and throat
• Pillar Procedure—a minimally invasive procedure which uses small implants to reinforce the soft palate and reduce vibration in the tissue
• Tongue Base Reduction—excess tissue can be removed surgically, or shrunk through the application of radiofrequency waves
• Genioglossus Advancement (GGA)—the tongue muscle is moved forward and tightened to prevent the tongue from collapsing backward during sleep
• Hyoid Advancement/Suspension—the small bone above the Adam’s apple is repositioned to expand the airway and prevent upper airway collapse
• Maxillomandibular Advancement (MMA)—the upper and lower jaws are moved forward surgically to open the upper airway, after which the jawbone is stabilized in its new position.

These and other surgical procedures may be performed in a hospital or in our Missoula or Hamilton office, with traditional surgical techniques or using technologies such as radiofrequency waves, and can be minimally invasive or require a hospital stay.

It’s important to note that surgery is not always the solution to OSA, but we are uniquely qualified to diagnose the cause of your OSA and to recommend the most promising treatments, surgical or non-surgical.

If you—or a partner, family member, or friend—have noticed that you suffer from thunderous snoring, or episodes of gasping for breath, or that you wake up dozens of times each night, it’s a good time to make an appointment at our Missoula or Hamilton oral surgery office. It could be the solution of your dreams!

Some foods are just terrible for your teeth — think cookies and candy bars — but there are certain foods that are beneficial to your oral health. Below, Dr. Holtzen and our team have covered five of the top foods to keep your teeth and gums healthy!

1. Crispy, low-acid fruits and vegetables: Fruits like apples and vegetables such as carrots and celery act like “natural toothbrushes,” helping to clear plaque from your teeth and freshen your breath.

2. Kiwis: These little green superstars are packed with vitamin C which is essential for gum health. The collagen in your gums is strengthened when you consume foods that are high in vitamin C, like kiwis, thus helping to prevent periodontal problems.

3. Raw onions: Onions have long been studied for their antimicrobial, antibacterial, and antioxidant properties. Proliferation of bacteria is what leads to tooth decay and cavities. By including raw onions in your diet, you'll be doing your part to wipe out those little microbes before they can multiply!

4. Shiitake Mushrooms: A specific compound in shiitake mushrooms, lentinan, has been shown to have antibacterial properties that target the microbes that cause cavities while leaving other beneficial bacteria alone. It may also help prevent gingivitis, or inflammation of the gums.

5. Green Tea: Often lauded for its high antioxidant content and many health benefits, it turns out green tea also benefits your oral health! A Japanese study found men who drank green tea on a regular basis had a lower occurrence of periodontal disease compared to men who drank green tea infrequently. It's believed this is due to the catechins in green tea, a type of flavonoid that may help protect you from free radical damage, but more research needs to be done. Either way, drink up for your overall health, as well as your teeth!

If you have any questions about your oral health, or are looking for even more oral health tips, contact our Missoula or Hamilton office!

Getting to the Root of the Problem

While our roots are well protected, they’re not indestructible! Several conditions can damage them. But we’re not just about problems—we also have some suggestions to keep your roots solid and intact for a lifetime.

• Traumatic Injury

A blow, a fall from a bike, a sports injury—any trauma which can hurt your visible tooth can hurt your roots as well. And it’s not just accidents that cause harm. Cracks in the tooth caused by oral habits like chewing on ice, pencils, or other hard objects can lead to root fractures.

You can help prevent root injuries by wearing a mouth guard whenever you are engaged in contact sports or any physical activity that might cause damage to your face or mouth. If you have harmful oral habits, talk to Dr. Holtzen about how to break them. And if you do suffer a dental injury, see us as soon as possible to avoid more serious complications.

• Bruxism

Bruxism, or tooth grinding, is most often an unconscious habit that takes place while you sleep. Grinding puts enormous pressure on teeth and their roots. The damage can be obvious, with cracked and worn crowns, but your roots can be affected, too. The strain of this constant pressure can stretch the periodontal ligament, causing loose teeth.

Night guards are one of the easiest ways to relieve pressure on individual teeth and roots. Your dentist can fabricate a night guard which will provide comfortable, effective protection for your teeth and jaw.

• Infected or Injured Roots

Any infection or trauma which injures the pulp of the tooth will affect the roots as well. Most of us are familiar with root canal treatment, where infected or damaged pulp is removed, and the insides of the pulp chamber and canals are cleaned, shaped, and filled. A crown is usually placed afterward to cap and protect the tooth. 

Sometimes, however, an infection can persist after root canal treatment. An oral surgeon is a specialist in treating complex medical conditions of the face, mouth, and jaw. We may have been recommend to you if a surgical procedure is needed to treat infection around or in the root.

When infections persist near the tip of a root, an apicoectomy is a common surgical treatment. In this procedure, Dr. Holtzen will carefully remove a few millimeters from the tip of the tooth, then clean the infected parts of the root and the tissues around it before sealing the root tip.

Other surgical options are available to help prevent extractions when there’s a root problem. A healthy molar with only one root seriously damaged by infection, trauma, or decay can be treated with a root amputation. Here the injured root is surgically removed, preserving the remaining roots and crown. If part of the crown is damaged as well, Dr. Holtzen can perform a hemisection, dividing the tooth to save as much of the undamaged root and crown as possible.

• Gum Recession

Taking care of your gums is one of the best ways to protect your roots.

Gums often recede as we age, leaving part of the root exposed. Gum disease, failure to brush and floss regularly, and heavy-handed brushing can also lead to gum recession. The newly revealed cementum is now exposed to the plaque and acids that cause cavities in our enamel, and, since it’s not as strong as enamel, cementum is more vulnerable to erosion and cavities progress more quickly.

When more severe recession takes place, the gums pull away from the teeth, creating pockets which become home to plaque and bacteria. Left untreated, infection and inflammation can develop, attacking teeth, connective tissue, and bone.

Scaling and planing procedures which clean the root surface can help. If you could benefit from soft-tissue grafting to replace lost gum tissue, schedule a visit to our Missoula or Hamilton office to discover your options.

Healthy roots help you keep your teeth for a lifetime, so it’s important to see Dr. Holtzen as soon as possible if you have any symptoms of potential problems:

• Constant pain in tooth, gums, or jaw
• Pain when biting down
• Loose teeth
• Tooth discoloration
• Sensitivity to hot and cold
• Swelling or pain in the gums around a tooth

Do your part by keeping up with daily brushing and flossing, visiting Dr. Holtzen for exams as recommended, and making an appointment if you are feeling any pain or discomfort. If you could benefit from surgical treatment, talk to your oral surgeon about the most effective treatment options for your individual needs. Strong roots are essential to our oral health, and a lifetime of healthy smiles is something we’re all rooting for!

The idea for Earth Day was the brainchild of Gaylord Nelson, a senator from Wisconsin. He envisioned an Earth Day that would be a kind of environmental teach-in. The first Earth Day celebration took place on April 22, 1970, and a surprising 20 million people participated on that day. Ultimately, it became the largest organized celebration in US history.

Earth Day Over the Years

Over the years, the recognition of the day, and the number of people celebrating it all over the world, turned Earth Day into an international celebration. Because it is celebrated throughout the world, it is not only the largest international environmental observation, but it is also more widely celebrated than any other environmental event in the world. Today, Earth Day is celebrated in 175 countries where over 500 million people participate in celebrations.

The Earth Day Movement

The Earth Day movement is credited with developing the idea that people should “think green”. It encouraged congress to enact laws, including one that resulted in the creation of the Environmental Protection Agency. It also inspired the passage of the Endangered Species Act.

The Five R's and Their Importance

• Reduce – Reduce by avoiding unnecessary purchases. Reduce your use of materials that wind up in landfills. Reduce the use of chemicals around your house. Reduce your use of disposable bags, plates, cups, eating utensils, and batteries.
• Reuse – Instead of using plastic bags for your groceries or purchases, bring your own reusable bags. When you go to buy coffee at Starbucks, take a travel mug so you don't have to get your coffee in a disposable paper cup. Instead of storing food in disposable refrigerator containers, buy containers that can be washed and reused. Don't use regular batteries. Whenever possible, opt for rechargeable batteries that you can reuse.
• Recycle – Most cities offer a recycling program to collect used bottles, cans, and newspapers. Recycling includes collecting recyclable materials that would otherwise be considered waste, sorting and processing recyclables into raw materials such as fibers and manufacturing raw materials into new products.
• Re-buy – Make an effort to purchase things that are made through recycling. When purchasing furniture, look for items that are made from reclaimed wood. When buying paper for kids school work, computer printer paper, holiday cards, or anything else, make a point of purchasing recycled paper products. Instead of buying clothing at full retail price, shop for second hand clothing. You will save a lot of money by doing so!
• Rethink – Rethink the way you do things so that you do them in an eco-conscious way at all times. Instead of driving to work alone, consider taking the bus or going in a carpool. Walk or ride your bike when you're only going a short distance. Plan your shopping trips and errand runs so that you can do everything on one day, and do it in a way where you can save time and gas.

Other ways to "think green" include growing your own food, composting yard waste and food scraps, or by participating in local recycling programs. Join a group like Freecycle so you can share your unneeded and unwanted possessions with people who can use them. Likewise, you'll be able to get things you need or want for free.

Earth Day teaches people that the planet belongs to everyone, so everyone is equally responsible for protecting it. Although Earth Day is an environmental celebration, our team at Alpine Oral and Facial Surgery wants to remind you that you don't have to wait until then to make changes that will allow you and your family to live a greener life.

Happy Earth Day from the team at Alpine Oral and Facial Surgery.

During the early days of the environmental awareness movement, those who demonstrated against pollution, toxic chemicals, and the general public health were known as hippies. The early 1970s were a time of change, and assertions that we needed to pay more attention to the Earth's atmosphere were generally dismissed. But within a couple decades, it had become clear that the previous generation was right; the citizens of the world needed to become more environmentally conscious.

Many people feel that they can't make a difference if they don't do something big. But caring for the environment doesn't have to be an all-or-nothing concept. In fact, the little things you do can add up to make a great impact, especially in our community. Here are a few ways you can help the environment on Earth Day, April 22nd and all year around.

Four Small Ways to be Environmentally Friendly

• Recycle Your Textiles. Nearly 21 million tons of textiles are added to American landfills each year, according to the Environmental Protection Agency. Donating your unwanted clothing to a secondhand store or an organization that repurposes fabric helps cut down on solid waste and conserves natural resources.
• Reduce Usage of Disposables. Plastic bottles and bags, disposable diapers and other things we can use and toss out are convenient, but they're not necessary. Simply choosing to replace one of type of disposable with a reusable product can help you cut down on waste that has a large negative impact on our environment.
• Conserve Water. If everyone in the United States turned off the water while brushing their teeth, more than 1.5 million gallons of water could be conserved. Turn the water on long enough to wet your toothbrush for brushing and rinsing, and then immediately turn the water off again.
• Turn Off the Lights. Flip the light switch to "Off" if you're going to leave a particular room for 15 minutes or more. This will conserve energy on incandescent light bulbs and cut down on cooling costs.

It's not necessary to be an activist or install solar panels all over your home to help the environment. Although you can do these things, the little everyday measures make a big difference in helping to conserve energy and the environment, while reducing your carbon footprint. Our team at Alpine Oral and Facial Surgery wants to remind you to celebrate Earth Day and help the environment, knowing that it will benefit your and your children's generation.

Our bodies give us clues, sometimes, when there is something going on that requires a visit to a dental professional. Tender gums can be a sign that you’re at risk for gingivitis. Temporary sensitivity to heat and cold can indicate a cavity. Morning headaches can mean you’re grinding your teeth in your sleep.

And sometimes, there are more urgent warning signs. You should see Dr. Holtzen immediately if you experience any of the following symptoms:

• Severe or continuous tooth pain
• Painful, swollen, or inflamed gums, or a sore on the gums near the root that looks like a pimple
• Pain or stiffness in the jaw, or swelling in the face and cheek
• Pressure-induced pain when biting down or chewing

The common denominator here is clear: significant or lasting pain is a symptom that you should never ignore. Pain in any of these areas could be caused by a tooth that is badly damaged or cracked, an abscessed tooth, pulp damage or infection, problems caused by an impacted wisdom tooth, or periodontal disease that has spread to tissue and bone.

Does severe pain always mean you will need an extraction?  No. Even in the case of serious injury or infection, your dentist, orthodontist, periodontist, or endodontist will do their best to save your tooth. After all, these professionals are in the business of saving teeth.

So if pain is a strong indication, but not always a conclusive one, what is the number one sign that you might need a tooth extraction?

• Your dentist, orthodontist, periodontist, or endodontist recommends it.

After all, dentists are in the business of saving teeth, and have devoted years to studying the very best techniques to do so. If your dental professional tells you that a compromised tooth requires extraction, you need to take that recommendation seriously—not just to relieve your pain, but to prevent damage to nearby teeth, gums, and bone.

And sometimes, although there might be no uncomfortable warning signs, your dentist or orthodontist might advise extraction. Impacted wisdom teeth, even if you don’t see or feel them yet, could damage nearby teeth as they erupt. Your orthodontic treatment might require a tooth extraction because of serious overcrowding. Rarely, you might even have an extra (“supernumerary”) tooth that is blocking your permanent teeth from erupting.

If you need a tooth extraction for any reason, but especially when a tooth is seriously damaged or impacted, your dentist or orthodontist will often recommend that you see an oral and maxillofacial surgeon. Why?

• Education and Training—Oral surgeons have advanced surgical training. They study at a hospital-based residency program for an additional four to six years. Here they train with medical residents in treating the hard and soft tissues of the face, mouth, and jaw.
• Experience—Because oral surgeons are surgical specialists, they regularly perform extraction procedures of all kinds.
• Complications—If your case should prove to be more difficult than a simple extraction—if, for example, the tooth’s roots lie close to a nerve—your oral surgeon has the knowledge and training to treat your specific circumstances.
• Anesthesia—Oral surgeons are experts in all forms of anesthesia, so whether you opt for a local anesthetic or would prefer sedation dentistry, you will be able to select the anesthesia you feel will provide the most comfortable experience.

If, sometimes, your body lets you know that a tooth needs attention, take that warning seriously! And, if your dental professional has recommended a tooth extraction, making an appointment at our Missoula or Hamilton office with Dr. Holtzen is a good idea—every time.

It's a moment many of our patients have experienced. One second you're chewing on a piece of gum, then suddenly you forget to keep chewing and swallow the entire rubbery gob whole! It's at this point you remember your mother warning you as a child that if you swallow gum it will stake a claim and take up residency in your belly for seven years. Dr. Holtzen and our team at Alpine Oral and Facial Surgery hate to take all the fun out of the mystery, but the truth is that chewing gum, when swallowed, will enter your stomach and move through your digestive system just like any other piece of food. So, if you ever accidentally swallow a piece of gum, there is no need to worry!

That being said, it's important to know that gum does not have any dietary benefits, so while it’s not exactly harmful to swallow, you still want to avoid swallowing it. If you are an avid gum-chewer, we encourage you to chew sugarless gum, especially if you are wearing braces, because gum with sugar can lead to cavities. Sugarless gum still has the same amount of flavor, but has fewer cavity-causing ingredients. In fact, many brands contain an additive called xylitol, a natural sweetener known to fight cavity-causing bacteria. Xylitol is also known to increase salivary flow as it rinses away plaque and acid.

The fact is, when the bacterium in your mouth breaks down sugar, what’s left behind is acid. This acid eats away at the enamel coating of your teeth, causing holes that we call cavities. Cavities can lead to other long-term mouth problems if they are not treated in time, so it is best to try and avoid overexposing your teeth to too many harmful substances!

If you have any questions about chewing gum, please contact our office. Happy (sugar-free) gum chewing!

What is oral cancer?

April is Oral Cancer Awareness Month. If you have been putting off a visit to our Missoula or Hamilton office, now is an excellent time to schedule one. Regular visits to Alpine Oral and Facial Surgery can be the first line of defense against oral cancer, by identifying early warning signs of the disease, or helping you with preventive care tips to lower your chances of developing it.

Oral Cancer Rates in America

Nearly 40,000 people in the U.S. will be diagnosed with oral cancer this year, and more than 8,000 die every year from this disease. It is a devastating illness: most people who are diagnosed with it do not live more than five years beyond their diagnosis. Oral cancer has a higher death rate than many other common cancers, including cervical cancer, testicular cancer, Hodgkin’s lymphoma, and thyroid or skin cancers. The high death rate results from the fact that most oral cancers go undiagnosed until the disease is well advanced and has spread to another part of the body—most often, the lymph nodes in the neck.

What causes oral cancer?

While there is no way to predict exactly which individuals will get oral cancer, there are some potential causes you should know about—because in some cases, you can minimize these risk factors.

• Age (most patients diagnosed with oral cancer are over the age of 40)
• Tobacco use, either from cigarettes or smokeless chewing tobacco
• Excessive alcohol consumption (especially in combination with tobacco use)
• Persistent viral infections, such as HPV16
• A diet low in fruits and vegetables

In addition, oral cancer tends to occur at a rate six times greater in men than in women, and more often for African Americans than other ethnic groups. No genetic links have been identified to explain the higher incidence in these populations, so lifestyle choices remain the likeliest cause.

Oral Cancer Treatments

Once a diagnosis has been made, treatment of oral cancer usually involves a multi-disciplinary team that includes surgeons, oncologists, dentists, nutritionists, and rehabilitation and restorative specialists. Our team will decide on the best approach for each patient, depending on the risk factors and how far the cancer has progressed. The strategy will be different in every case. Some of the most common methods include chemotherapy, radiation, and potential surgery.

Finding out you have cancer can be devastating news. If you are concerned that you might be at risk for developing oral cancer, talk to us about screenings and other things you can do to reduce your risk.

Happy Oral Cancer Awareness Month! We know oral cancer can be kind of a scary topic, but it’s worth using this opportunity to learn about the disease and spread knowledge so everyone becomes more aware. The more we know, the better we can work to prevent it!

Oral cancer is exactly what it sounds like: cancer that occurs anywhere in the mouth. It could occur on the tongue, the lips, the gums, the tongue, inside the cheek, or in the roof or floor of the mouth. Every  year, more than 8,000 people die from oral cancer. It’s a truly deadly disease.

The reason oral cancer scores a higher death rate than other common cancers such as testicular cancer, Hodgkin’s disease, thyroid cancer, cervical cancer, or even skin cancer, is because it often goes undetected until it's become too advanced and has spread to another part of the body.

So what causes this devastating disease? There is no clear answer, but some potential causes have been identified. By being aware of these, we can be alert and promote prevention of this illness:

• Age: Most patients who develop oral cancer are above the age of 40. If you’re over 40, make sure your doctor checks for signs of oral cancer and that you stay on your dental hygiene regimen.
• Tobacco: Excessive tobacco use, whether in the form of cigarette smoking or tobacco chewing, can be a substantial contributor and cause of oral cancer. So that’s another reason, among many, you should avoid tobacco.
• Alcohol: Excessive alcohol consumption can put you at risk because alcohol converts into a chemical called acetaldehyde, which damages the body’s DNA and blocks cells from repairing the damage. When paired with tobacco, the dehydrating effects of alcohol make it even easier for tobacco to infiltrate mouth tissue.
• Sun exposure: Your lips need SPF, too! Repeated sun exposure increases your risk of contracting cancer on your lips, especially the lower lip.
• Diet: Not getting all the nutrients you need, from vegetables and fruits for instance, can weaken your immune system and make you more vulnerable to the disease.

Obviously, many of these causes relate to lifestyle choices, which we have control over. It's all about balance, being aware, and making small tweaks to our habits if we need to.

If you’re concerned that you may be at risk for oral cancer, give us a call to talk about a screening. And if you’ve been putting off a visit to our Missoula or Hamilton office, now is an excellent time to schedule one. Regular visits to the dentist can be the first line of defense against oral cancer!

Your visit your medical doctor and dentist for your regular health care needs, you see your orthodontist to treat problems with your bite and alignment, and your periodontist looks after your gum health. If one of your medical or dental professionals recommends that you receive treatment from an oral surgeon, you probably have some questions. First of all, why recommend an oral surgeon?

Oral and maxillofacial surgeons are specialists. They have a minimum of four years of surgical education and training in a hospital-based residency program. They train with medical residents, and focus on studies in general surgery, anesthesiology, internal medicine, plastic surgery, otolaryngology (the study of the ear, nose, and throat), among other fields of specialty.

Because oral and maxillofacial education is centered on the face, mouth, and jaw, these surgeons are experts in diagnosing complex medical conditions in these structures and treating them. Your doctor or dentist might recommend an oral surgeon if you require medical or dental care in any of the following fields:

• Anesthesia

Oral surgeons are trained in the administration of local anesthesia, sedation, and general anesthesia.

• Craniofacial Surgery

Oral surgeons work, often as part of a team of specialists, to treat congenital conditions such as cleft lips, cleft palates, and cranial anomalies.

• Facial Cosmetic Surgery

Training in the surgical treatment of the muscles, skin, and bones of the face makes oral surgeons especially qualified to perform cosmetic procedures which enhance aesthetic appearance and improve function.  Ask your oral surgeon about procedures such as chin surgery, cheekbone implants, ear surgery, skin treatments, and other cosmetic surgery options.

• Facial Injuries and Traumas

Oral surgeons are skilled in repairing complex fractures of the upper and lower jaws as well as treating other facial injuries.

• Jaw and Temporomandibular Joint (TMJ) Surgery

If you have difficulty biting or swallowing, TMJ pain, sleep apnea, a protruding or receding jaw, or other jaw complications, corrective surgery can restore better, healthier function to your jaw or temporomandibular joint.

• Oral Cancer Diagnosis and Treatment

Early diagnosis and treatment are critical for recovery, so see your oral surgeon immediately if you or your dentist detect any of the warning signs of oral cancer.

• Oral Surgeries

Oral surgeons also perform extractions; dental implant surgery; procedures to save a damaged tooth such as apicoectomies, hemisections, and root resections; procedures to treat soft tissue, including frenectomies, soft tissue grafts, and crown lengthening; and surgeries which treat sleep apnea.

Oral surgeons like Dr. Holtzen are experts in preserving and restoring the health, the function, and the appearance of your face, mouth, and jaw. If your doctor or dentist recommends that you visit our Missoula or Hamilton office, rest assured that you will be treated by a specialist who is exceptionally qualified to diagnose and treat you.

Here is some surprising yet worthwhile advice you might be hearing for the first time: Brushing after a meal can be incredibly bad for your teeth if you do it after eating certain foods.

Enamel is an extremely hard mineral on the exterior of each of your teeth. It’s actually the hardest substance in the human body: It’s even stronger than your bones! Its only weakness is that acids in the food we eat can easily destroy enamel.

Healthy teeth thrive in an environment that has the proper pH balance. That ensures your mouth doesn’t start the process of demineralization. That’s what happens when alkaline turns into acid, which attacks and softens the enamel on the surface of your teeth. Pores and fissures form, and that’s when the harmful bacteria go to work.

Our mouth’s pH level fluctuates depending on what we eat throughout the day. Examples of the most common highly acidic foods include citrus fruits, soda, and sugary foods. Highly acidic foods tip the balance of pH in your mouth from a healthy alkaline to a dangerous acid.

Can brushing your teeth immediately after a meal lead to even more damage? The answer is yes!

Eating highly acidic foods causes your teeth to be more susceptible. If you brush your teeth when they have been weakened by acids, even more destruction can happen to your enamel. Your toothbrush’s bristles will actually wear away some of your enamel. So it’s healthier to wait at least an hour after eating or snacking to brush.

Good preventive measures to take instead of brushing after you eat include:

• Rinsing or drinking water
• Chewing sugarless gum
• Consuming dairy or non-acidic foods to conclude your meal

These practices help produce saliva, which in turn restores a healthy pH level in your mouth and coats the teeth with minerals they need.

Once you’ve allowed time for your mouth to be restored to a healthy pH level, you may brush your teeth as you normally would. Keep in mind that acidic foods can weaken the enamel on your teeth and take the right measures to prevent spiking pH levels.

Most important, don’t forget to wait to brush at least one hour after you eat!

Still have questions? Call our Missoula or Hamilton office and schedule an appointment with Dr. Holtzen.

Sometimes people feel a tiny bit nervous when they sit in the dental chair. And sometimes it’s more than a tiny bit. If your anxiety over oral surgery is leading you to postpone necessary wisdom tooth extraction, if worrying about an apicoectomy outweighs saving an infected tooth, if dreading an implant procedure means you would rather live with tooth loss than give us a call—give us a call! Sedation dentistry might be just the procedure you need to make dental anxiety a thing of the past.

Depending on your preferences, there are several levels of sedation Dr. Holtzen can provide to make your visit more comfortable.

• Minimal Sedation—this type of sedation leaves you calm and conscious, and you respond normally to verbal directions.
• Moderate Sedation—sometimes called “conscious sedation,” this option will leave you awake, relaxed and able to follow directions, but you will probably have little memory of the procedure afterward.
• Deep Sedation—a deeper level of sedation where you cannot be roused easily or respond to instructions. It is unlikely you will remember much or any of the dental treatment.

Oral and maxillofacial surgeons have four to six years of advanced education in hospital-based surgical residency programs following dental school. As part of their surgical studies, they train to administer and monitor all forms of anesthesia. Because anesthesia in all its varieties is a regular part of our practice, we have the medical knowledge and skill to provide you with a safe and comfortable sedation experience.

And we will prepare you with all the information you need to decide on any dental treatment, including sedation. We will describe the procedure in detail, and discuss any possible risks. If you have any health conditions or take any medications that might interfere with sedation, we can discuss your options with you and your doctor to make sure you are a good candidate. We will explain any preparations you should take, and let you know if there is a window of recovery time needed in our office while the sedation wears off.

Don’t let yourself suffer dental pain or discomfort because you suffer from dental anxiety! Please call our Missoula or Hamilton office to discuss your sedation options. Whatever you choose oral, inhaled, or IV sedation, we are trained to administer your treatment gently and safely. Above all, we want to help you keep your smile the heathiest it can be, and that only happens with proper dental care. Let us work with you to make that care as comfortable and stress-free as possible.

When most patients ask Dr. Holtzen this question, they're thinking strictly about sugar content — cut out the bacteria-feeding sugar that's present in regular soda by opting for a diet soda and it will be better for your teeth. That seems logical, right? Well, there's a bit more to it than that. Let's take a closer look at how any kind of soda can affect your dental health.

Diet Soda – Why it can also lead to tooth decay

The main culprit in these drinks that leads to decay is the acid content. Diet sodas and other sugar-free drinks are usually highly acidic, which weakens the enamel on your teeth and makes them more susceptible to cavities and dental erosion. The level of phosphoric acid, citric acid, and/or tartaric acid is usually high in sugar-free drinks so it's best to avoid them.

Some patients also enjoy drinking orange juice or other citrus juices. These drinks are high in citric acid and have the same effect on the enamel of your teeth.

So what about regular soda?

We know the acidity of diet sodas and sugar-free drinks contributes to tooth decay, so what about regular soda? Like we alluded to earlier, regular soda is high in sugar — a 12 ounce can contains roughly ten teaspoons of sugar — and sugar feeds the decay-causing bacteria in the mouth. This also includes sports drinks and energy drinks, which are highly acidic and loaded with sugar too. So these drinks are a double-whammy of sugar and acidity your teeth and body simply don't need.

The problems caused by both diet and regular soda is exacerbated when you sip on them throughout the day. If you drink it all in one sitting, you won't be washing sugar and/or acids over your teeth all day long and your saliva will have a chance to neutralize the pH in your mouth.

The best beverages to drink and how to drink them

Drinking beverages that are lower in acid is a good step to take to keep your enamel strong. According to a study conducted by Matthew M. Rodgers and J. Anthony von Fraunhofer at the University of Michigan, your best bets are plain water, black tea or coffee, and if you opt for a soda, root beer. These drinks dissolved the least amount of enamel when measured 14 days after consumption of the beverage.

If you still choose to drink soda, diet soda, sugar-free drinks, or juices here are some other tips to lessen tooth decay:

• Drink your soda or acidic beverages through a straw to minimize contact with teeth
• Rinse with water immediately after consumption of the beverage
• Avoid brushing your teeth between 30 minutes to an hour after drinking the beverage as this has been shown to spread the acids before your saliva can bring your mouth back to a neutral pH
• Avoid drinks that have acids listed on the ingredients label

Still have questions about soda, sugar, and acid? Give our Missoula or Hamilton office a call and we’d be happy to help!

On March 17, everyone has a little Irish in them. St. Patrick’s Day is a joyous celebration of Irish heritage. The holiday originated as a commemoration of Saint Patrick, who brought Christianity to Ireland. The saint arrived in Ireland in 432 and earned the reputation of a champion of Irish Christianity. March 17th, the day of St. Patrick’s death, has been commemorated by the Irish for over 1,000 years. St. Patrick’s Day is still observed as a religious feast day by several Christian denominations, but it is better known in the public imagination as a rich celebration of Irish culture.

St. Patrick’s Day has been an official public holiday in Ireland since 1903. Each year, the Irish celebrate with a several-day festival that includes theater performances, music, fireworks, and festive parades. The celebration is also a public holiday in Northern Ireland, Montserrat, and Newfoundland and Labrador. In other parts of the world with heavy Irish populations, it is an unofficial celebration of Irish heritage. Parts of Great Britain, Canada, Argentina, South Korea, Switzerland, New Zealand, the United States, and Australia commemorate the holiday each year. Typical celebrations in these countries include drinking green beer, wearing green, eating traditional Irish foods, parades, and shamrock decorations.

Many people, Irish and non-Irish alike, take part in the “wearing of the green” on St. Patrick’s Day. In fact, the color originally associated with Saint Patrick was blue. His use of shamrocks to explain the Holy Trinity to the Irish made the green clover emblematic of the holiday, leading to the traditional green attire worn by thousands on St. Patrick’s Day. Other little-known facts about St. Patrick’s Day include the following:

• Each year, the United States and Ireland face off in a rugby competition called the “St. Patrick’s Day Test.”
• Montreal celebrates the holiday with an annual parade, which has been held each year since 1824. The Montreal city flag even features a shamrock in its corner, as a nod to its Irish heritage.
• The Guinness World Records named St. Patrick’s Day the “Friendliest Day of the Year.”
• Along with Valentine’s Day, St. Patrick’s Day is one of the most widely celebrated saint’s day in the world.

No matter your cultural heritage, St. Patrick’s Day is a great time to let loose and celebrate your inner Irish-ness! Don your greenest attire and exclaim “Erin go Bragh!” (Ireland forever!) to everyone you meet. From Dr. Holtzen - have a great St. Paddy’s day!

“St. Patrick's Day is an enchanted time -- a day to begin transforming winter's dreams into summer's magic.” Adrienne Cook

Lucky green shamrocks, leprechauns, and pots of gold – it must be St. Patrick’s Day! If you’re not Irish, how do you go about celebrating St. Patrick’s Day? It’s easy: You just put on one of those tall leprechauns hats, dress in green from head to toe, and wear one of those carefree pins that say “Kiss Me, I’m Irish”. On St. Patrick’s Day, everyone is Irish, and that is the universal beauty of the holiday. Celtic pride does not discriminate.

Wondering what our team at Alpine Oral and Facial Surgery is doing to celebrate March 17th? Well, we’ve thought about doing everything from handing out lucky gold coins (you know, the fake ones that are made of chocolate) to shamrock stickers. Maybe we’ll even give away green toothbrushes and floss! You’ll never know unless you come in to see Dr. Holtzen !

All kidding aside, St. Patrick’s Day is an important cultural and religious holiday. There are lavish parades and church services across Ireland on March 17th. Over time, however, the holiday has developed into a day to observe Irish culture in general. In places like England and the United States, where there is a large Irish Diaspora, the holiday has greater significance than other countries. From the streets of Boston to St. Patrick’s Cathedral in New York, it is a day of celebration, and many Americans of Irish descent will cook up a traditional meal of corned beef and cabbage.

So, to all of you with Irish ancestry, and to all of you who have decided to be Irish for the day, our office wishes you a Happy St. Patrick’s Day. Good luck looking for a pot of leprechaun gold, which is said to exist at the end of the rainbow. However, keep away from those sugary Lucky Charms; sweet cereals might taste good, but your kids’ teeth might not be feeling too lucky if they eat it for breakfast every day. Have a great St. Paddy’s Day!

Nobody likes a dry mouth. It is an uncomfortable and sometimes oddly unexplainable sensation that most people like to avoid. It is not a condition that automatically sends you into a panic about your health, however, a dry mouth can be a bother and something you certainly want to change if possible. So, if you find yourself in the unpleasant position of having a dry mouth, here is what you can do.

Chew Sugar-free Gum: Chewing sugar-free gum will stimulate saliva in your mouth. The chewing motion of your jaw and teeth should take care of at least some of your dry mouth problem.

Suck on Sugar-free Candy: Similarly to chewing sugar free gum, if you suck on sugar free candy it should create more saliva in your mouth and moisturize it in the process.

Cut out the Caffeine:Caffeine can contribute to a dry mouth so by limiting, or eliminating your intake all together, you may find that your dry mouth is no more.

Stop Using Tobacco Products: Tobacco is another cause of dry mouth. Whether it is smokeless tobacco products or cigarettes, if you stop using them your dry mouth will likely improve. And not to forget, these products are exceedingly bad for your oral health to begin with, so you will be doing your mouth a favor even more so.

Drink Lots of Water: It may seem obvious, but drinking lots of water will likely improve your dry mouth. This is because dry mouth is usually a sign of dehydration, so plenty of fluids will surely help.

Dry mouth can be unpleasant, but it is often easily solved by either drinking more water, or trying one of the previously mentioned techniques. If the problem still persists you can always visit our Missoula or Hamilton office to see Dr. Holtzen. More often than not, doing one of the above will leave your mouth more moisturized than it was previously, and hopefully it will be long-lasting as well.

Sometimes food that’s good for your body isn’t necessarily the best for your teeth. Dr. Holtzen and our team want you to know which healthy foods can harm your teeth and gums, and what steps you can take to continue enjoying these foods, even when you’re dieting.

When you begin to substitute empty calories with whole foods, make sure you also remember to focus on your dental health. The majority of people tend to switch out sugary foods in favor of fruits and vegetables when they diet.

It’s worth knowing that most fruits are highly acidic and composed of natural sugars. Some of the highly acidic fruits to watch out for include apples, grapes, strawberries, pineapples, blueberries, oranges, and grapefruit. Moderation is key here, as with all other things. Fruits can be a great source of energy to help you through your day, but try not to overdo them.

Often, people also incorporate more leafy greens into their diets, which mean plenty of salads. Salad dressing is another item you’ll want to watch out for. Many dressings are filled with vinegars and sweeteners that include harmful acids, which change the pH of your mouth. When your mouth shifts from alkaline to acidic, your smile also turns to a higher risk for erosion and decay.

Rather than get rid of these foods altogether, simply change what you do after you eat them. Rinse your mouth out with water, brush your teeth, or eat alkalizing foods after consuming these acidic foods. Healthy alkalizing foods include dairy products such as eggs and yogurt, or any type of vegetable.

If you have questions regarding your current diet and its effect on your oral health, please contact our Missoula or Hamilton office and speak with a member of our staff. If you’ve begun to make changes in your diet toward a healthier lifestyle, we hope these tips can help your make positive changes to your oral health. Our team at Alpine Oral and Facial Surgery wants a healthy lifestyle to be a top priority in your life.

An article was released to the public stating that dental X-rays contribute to a type of brain cancer. After reading an article like this, your first thought may be to avoid dental X-rays, but you may want to hold off on that quick judgment. As with any treatment we offer at Alpine Oral and Facial Surgery, education is your most valuable tool in deciding what is best for you.

How often dental X-rays are taken is based on risk for infection, physical symptoms, and clinical findings. The American Dental Association (ADA) is a governing body over the dental profession. The ADA states, “ . . . healthy adults receive routine mouth X-rays every two to three years. Dental X-rays are recommended every one to two years for children and every 1.5 to three years for teens. Children often require more X-rays than adults because of their developing teeth and jaws and increased likelihood for cavities.”

A "caries risk category" often determines how often dental X-rays are taken. The most recent documented resource to determine a caries risk is Caries Management by Risk Assessment (CAMBRA). This was adopted by the ADA and is used by dental professionals giving interval recommendations for X-rays.

With knowledge of your risk for dental infection, you will be informed by Dr. Holtzen of the interval at which dental X-rays should be taken. You can rest assured that the standards published by the ADA have been researched extensively and are there to protect your personal health and safety.

Dental X-rays are most commonly digital, which significantly reduces exposure. There is more radiation exposure from the sun or in an airplane than in a dental X-ray. It is common practice to use a lead apron with a thyroid collar for protection during X-ray exposure.

Having a cavity means having an active, potentially harmful infection. Diagnosing such infection with minimal exposure through digital dental X-rays at our Missoula or Hamilton office does more good than harm.

When you have a tooth extracted, your body immediately sets to work to help protect the affected area. The blood that collects at the site of the extraction clots to cover and protect the wound. This is a normal response, and protects the nerves and bone that have been exposed with the removal of your tooth. Normally, the gum tissue will close over the area within a few weeks.

But sometimes the clot becomes dislodged or dissolved before you have a chance to heal. This condition is known as “alveolar osteitis,” or dry socket. Sensitive nerves and bone in the extraction site are exposed to air and outside substances causing intense pain. Bacteria and food particles can also contaminate the wound and lead to pain and infection in the area around the socket.

There are certain activities that should definitely be avoided to reduce the risk of dry socket.

• Straws and suction

The action of using a straw causes suction that can dislodge the clot. You can still enjoy the soothing coolness of a milkshake, but use a spoon.

• Spitting

You might be tempted to rinse and spit immediately to clean your mouth, but spitting can also dislodge the clot. We will let you know how to clean your mouth and teeth for the next few days.

• Smoking

Not only does smoking provide a suction effect that can remove the clot, but smoking and chewing tobacco can slow healing as well.

There are also steps you can take to aid the healing process.

• Caring for your extraction site

We’ll give you instructions on caring for your mouth and teeth for the next few days. Gentle care for the extraction site is vital. And treat yourself gently as well. Rest if you need to, and avoid activities that might impact your wound.

• Choose your beverages carefully

Hot drinks can loosen the clot protecting the wounded area, and alcohol, caffeine, and carbonation also put your healing at risk. Water is a safe choice not only for healing, but for keeping hydrated.

• Think about your diet

Stick to soft foods for the first day or so and chew on the side opposite your extraction site. Foods which can lodge in the teeth, like peanuts, popcorn, nuts, and seeds, should be avoided completely.

• Watch for symptoms of dry socket

How do you know if you have a dry socket? Monitor your pain and the appearance of the site after the extraction. For the first few days, you might feel some pain in the immediate area. Pain that intensifies after three or four days is usually not a result of the extraction. An unpleasant odor or taste in your mouth could be a sign of dry socket. You might look in the mirror and notice that the clot is no longer there, or appears to have been dislodged. If any of these symptoms occur, call Missoula or Hamilton at once. If you are experiencing dry socket, the extraction site will need to be cleaned and protected from further injury.

Dry socket is a relatively rare occurrence, but if you have any symptoms that concern you, we want to hear about them. Dr. Holtzen will work with you to make your extraction treatment go as smoothly as possible. Talk to us about your concerns before any oral surgery, and we will provide detailed information for the procedure and for the healing process afterward. Keep us in the loop as you recuperate, and we will work together to make your recovery a speedy one.

Halitosis is the fancy, scientific word for “bad breath.” Dr. Holtzen and our team know there are several reasons why you may have halitosis; let’s look at a few:

• Gum disease (also known as periodontal disease) – There are five main types of gum disease, and each one can range from mild to severe. For example the most common one is gingivitis; it is caused by bacteria in the plaque that has been allowed to build up, usually as a result of poor oral hygiene. A more serious and uncommon type of gum disease is called necrotizing periodontal disease. It is most common in people who have a suppressed immune system.
• Smoking
• Dry Mouth – This can be caused by something as simple as a medication you take.
• Food – Of course, if you eat something that is potent like garlic, it is going to give you bad breath.
• Diseases of the Body – Some diseases such as sinus infections and diabetes, among a few other types of infections, can also cause you to have halitosis.

How to Get Rid of Halitosis

The most obvious answer to how to get rid of halitosis is to practice good oral hygiene, although, depending on the cause of halitosis it may not be that simple. If you have an infection that is causing the halitosis then you may need an antibiotic to clear up the infection and then the bad breath will go away. Here are more tips:

• Brush your teeth after every meal and before bed.
• Floss your teeth. The more plaque you get out of your teeth, the better chance you have of not getting cavities or bad breath.
• Address any medical conditions that are not related to your teeth that can be causing the halitosis.
• Ask Dr. Holtzen for a prescription mouthwash that kills bacteria.

Halitosis (bad breath) can be an embarrassing condition to live with, but there are plenty of ways to get rid of it permanently. Start by talking to a member of our team at our Missoula or Hamilton office.

It is common to experience dentine hypersensitivity, with symptoms ranging from moderate to severe. Why does it happen and how do you know if this sensitivity is something to be concerned about? The first step is to determine the cause.

The most common cause of the sensitivity is exposure of the dentin. Dentin is the layer immediately surrounding the nerve of the tooth. It is alive and usually covered by the gum tissue. When gum recession is present hypersensitivity is common. Other contributors to temporary tooth hypersensitivity include teeth whitening and dental procedures such as fillings, periodontal treatment, and braces placement or adjustment. These are temporary and should be of no concern.

Permanent hypersensitivity, however, may require treatment. To understand the cause of sustained hypersensitivity, let us explain the structure of dentin and why it serves as a ‘hot spot’.

The dentin contains a large numbers of pores or tubes that run from the outside of the tooth to the nerve in the center. When dentin tubes are exposed, there is a direct connection between the mouth and dental pulp, which houses the nerve and blood supply of the tooth. External stimuli, such as mechanical pressure (tooth grinding or clenching - bruising the ligaments holding the teeth in place), temperature changes, as well as chemical stimuli (sweet–sour) are transmitted to the pain-sensitive dental pulp and activate nerve endings. A short and sharp pain is the result. These external stimuli cause fluid movement in the open tube that is transmitted as pain sensations. Something needs to be placed into the dentin tube to plug it and stop this fluid movement.

The first step in doing something about dental hypersensitivity is to determine the cause; our professional team at Alpine Oral and Facial Surgery can help you with this. Whether the sensitivity is due to exposed dentin or an underlying cause such as abscess or decay, corrective measures are needed. Contact us sooner rather than later so Dr. Holtzen can reduce the sensitivity, and provide you with some relief!

When patients of Alpine Oral and Facial Surgery hear any mention of oral or dental hygiene, they probably think of brushing and flossing their teeth. Although these are extremely important, the term dental hygiene encompasses much more than that. Your mouth’s health, including your teeth, has an important impact on your overall physical health. The National Institute of Dental and Craniofacial Research published the surgeon general's first ever report on dental health. It is called A National Call to Action to Promote Oral Health. In that report, the Surgeon General states that the 1948 World Health Organization expanded its earlier definition of health to "a complete state of physical, mental, and social well-being, and not just the absence of infirmity."

The Importance of Oral Health to Total Overall Health

One of the most important themes that the dental health report stressed is that you cannot be healthy without oral health. It went on to explain that oral health and general health are inextricably linked, and therefore can't be seen as two separate things. Because oral health is so critical to overall health, it should be included in all community health programs. For individuals, this means that it is just as important to take care of your mouth, your teeth, and your overall oral health as it is to take care of the rest of your body. The two most prevalent dental diseases are caries (cavities), also known as tooth decay, and periodontal (gum) disease.

Ways that Oral Health Impacts Overall Health

One important way in which good oral health contributes to better overall health is seen in the findings of several studies in which the blood sugar levels of diabetic patients were significantly lowered when their periodontal (or gum disease) was successfully treated. Your mouth has roughly 500 different species of bacteria. Many are harmless, and some are even good bacteria that help maintain the balance of your intestinal flora. Harmful bacteria can infect your gums, causing gingivitis. Your body's immune system may try to fight off the alien invaders, but they attack your gums, causing inflammation and bleeding when you brush.

Now that you know how important good dental hygiene is, be sure to see to get your teeth cleaned every six months, have regular dental checkups, brush and floss your teeth at least twice daily, and replace your toothbrush at least every couple of months. Call us to schedule your next appointment at our convenient Missoula or Hamilton location.

Now that you’re having your wisdom teeth removed at our Missoula or Hamilton office, you’re probably looking forward to spending a few days on the couch with a cool dish of ice cream in hand. Good! Give yourself time to heal, and choose foods that will be soothing and safe for your mouth as you recover. We’ll provide you with detailed instructions on how to take care of yourself immediately after your surgery, and that includes suggesting the best menu options.

But while you’re making your post-wisdom teeth shopping list, there are several kinds of foods and beverages that should be crossed right off. If it’s small, spicy, sticky, or steamy, put it back on the shelf. Spirits? Not this round. Drinks with straws? Absolutely not. Items like these can undermine your healing and recovery.

• Small and Crunchy

Any small particles, such as seeds or grains, or items like cookies, crackers, nuts, and popcorn which turn into small particles, can wind up lodged in the surgical site where your tooth was removed. These particles can also interfere with the blood clot that forms to protect the socket as it heals. If the clot is dislodged, there is a chance that a painful condition called “dry socket” can develop.

• Spicy

Spicy and acidic foods can irritate delicate gum tissue. It’s best to wait until your gums are back to normal before uncapping the hot sauce.

• Sticky

Sticky, crunchy, and chewy foods can be hard on the extraction site, so stick to a soft diet until you have healed. Now is the time to try all the pudding flavors!

• Steamy

Piping hot foods and drinks can interfere with the protective clot—ask us about the best time to resume your morning coffee.

• Spirits

Mixing pain medication and alcohol can be dangerous. Talk to Dr. Holtzen about possible interactions. And some studies have suggested that alcohol use slows healing, so even without pain medication, it could be a good idea to wait until you are healed to toast your beautiful smile.

• Straws

And last, but by no means least, leave the straws in their little paper wrappers! Any kind of suction brings a real risk of dislodging the protective blood clot that has formed at the surgical site. Milkshakes are delicious, but eat them with a spoon. (And please, no cigarettes!)

Follow our suggestions for a soothing, safe diet, and you will be enjoying your regular menu favorites in no time. So rest, relax, eat sensibly, and enjoy that second bowl of ice cream. Doctor’s orders!

Did you know the actions leading to the beginnings of Valentine's Day were actually centered on the avoidance of war? A Catholic priest named Valentine defied the orders of the Emperor Claudius II and secretly married young men and their brides after the emperor had declared it illegal because only single, young men could be sent to war. Rather than lose potential soldiers to fight his war, Claudius attempted to hoard them by proclaiming marriage illegal.

Valentine continued to marry young couples anyway and, eventually, was put to death for it in 270 AD. Before his death, he sent a letter to a secret love and signed it “From your Valentine”. Nearly 1,800 years later, people are still signing letters and cards in this manner. This year, carry on the tradition started long ago, while adding your own twist. Here are a few suggestions.

Simple and Creative Valentine's Day Ideas

• Memorialize it with a Photo. Couples often have photos taken around Christmas, but Valentine's Day photos allow you to capitalize on romance. Famous couple Julia Child and her husband, Paul, had their picture taken together every Valentine's Day and included their sense of humor with silly props.
• Return to Your First Date Location. Even if your first date together was at a local hotdog stand, its sentimental value can make it a fun part of your Valentine's Day agenda. Be creative and make a treasure hunt with clues that lead your partner to the original date location, where you can express your love with flowers or a gift.
• “From Your Valentine” Messages. Deliver your message in a creative way to make this Valentine's Day stand out from the others. Bake your partner's favorite treat and write a message on it with a tube of icing, or draw a note on the steamed up mirror so it shows up when your partner takes a shower.

Although Valentine's Day is a day to celebrate love, it doesn't have to be a special day only for couples. If you're single, use this special day to shower yourself with love, because you're worth it! After all, the priest Valentine believed so strongly in the sanctity of love that he was willing to risk his life for it. Whether you're in a relationship or single, young or old, romantic or not, Valentine's Day is for you. Happy Valentine’s Day from the Oral Surgeon office of Dr. Holtzen.

The American Academy of Periodontology stresses the importance of good oral health since gum disease may be linked to heart disease and stroke. Thus far, no cause-and-effect relationship has been established, but there are multiple theories to explain the link between heart disease and periodontal disease. One theory suggests that oral bacteria may affect heart health when it enters the blood and attaches to the fatty plaque in the heart's blood vessels. This can cause the formation of blood clots. Another theory suggests the possibility that inflammation could be a contributing link between periodontal disease and heart disease. Gum disease increases plaque buildup, and inflamed gums may also contribute to the development of swollen or inflamed coronary arteries.

What is coronary artery disease?

Coronary artery disease is caused in part by the buildup of fatty proteins on the walls of the coronary arteries. Blood clots cut off blood flow, preventing oxygen and nutrients from getting to the heart. Both blood clots and the buildup of fatty proteins (also called plaque) on the walls of the coronary arteries may lead to a heart attack. Moreover, periodontal disease nearly doubles the likelihood that someone will suffer from coronary artery disease. Periodontal disease can also worsen existing heart conditions, so many patients who suffer from heart disease need to take antibiotics before any dental procedures. This is especially true of patients who are at greatest risk for contracting infective endocarditis (inflammation of the inner layer of the heart). The fact that more than 2,400 people die from heart disease each day makes it a major public health issue. It is also the leading killer of both men and women in the United States today.

What is periodontal disease?

Periodontal disease is a chronic inflammatory disease that destroys the bone and gum tissues around the teeth, reducing or potentially eradicating the system that supports your teeth. It affects roughly 75 percent of Americans, and is the leading cause of adult tooth loss. People who suffer from periodontal disease may notice that their gums swell and/or bleed when they brush their teeth.

Although there is no definitive proof to support the theory that oral bacteria affects the heart, it is widely acknowledged better oral health contributes to overall better health. When people take good care of their teeth, get thorough exams, and a professional cleaning twice a year, the buildup of plaque on the teeth is lessened. A healthy, well-balanced diet will also contribute to better oral and heart health. There is a lot of truth to the saying "you are what you eat." If you have any questions about you periodontal disease and your overall health, give our Missoula or Hamilton office a call!

You’ve chosen Dr. Holtzen for your extraction because oral surgeons are experts in this surgical procedure. When an extraction is necessary, whether because of impaction, injury, or infection, for orthodontic purposes, or for any other reason, we have the skill and experience to ensure that patients have the best possible surgical outcome.

And you want the best possible outcome for your recovery as well. What are some basic steps you can follow at home to speed the healing process? Here are the ABC’s of aftercare to help make your post-extraction recovery a speedy and healthy one.

• Antibiotics

Antibiotics aren’t generally necessary after oral surgery, but, if they are prescribed to prevent infection, be sure to take them as directed. Always finish the entire prescription to ensure that the antibiotics work properly. And, if you have any allergies to medications, always tell us in advance.

• Brush carefully

Don’t brush or floss in the area of your surgical site until you get our approval. You don’t want to damage delicate tissue or sutures. Be sure to brush and floss the rest of your teeth normally, because you want your mouth its cleanest while you heal, but no swishing or spitting! After the extraction, a clot will form to protect the socket, and you’ll need to be careful to avoid dislodging it. Otherwise, a painful condition called “dry socket” can result.

• Clean the extraction site as directed

The directions we will give you for cleaning the extraction site will depend on your specific surgery, but gentle rinsing is usually the recommended way to keep the area clean after oral surgery.

After 24-48 hours, depending on our instructions, you might be asked to use a salt water solution or a prescription rinse to gently cleanse the extraction area. Just remember, the “no forceful swishing or spitting” rule still applies! Rinse after eating and snacking to keep the extraction area clean and free from food particles. A good general rule is to avoid over-the-counter mouthwash for now, because the alcohol it contains can be irritating.

Even with careful attention, sometimes the wound site can become infected. If you notice any signs of infection, including severe pain, redness, prolonged swelling, pus or other discharge around the extraction, or fever or chills, call our Missoula or Hamilton office immediately. Other symptoms such as nausea, heart pain, or shortness of breath should also be reported at once.

• Diet

Eating a nutritious diet after oral surgery can help speed wound healing. Foods rich in proteins, vitamins A and C, and Zinc have been found to assist healing, while alcohol and smoking have the opposite effect.

And while you’re eating for health, eat for comfort, too. The traditional diet choices after an extraction are still the best. Soft, creamy foods such as yogurt, applesauce, pudding, or soft-serve ice cream are gentle on your healing tissue. Drink plenty of fluids in the days after surgery, including clear broth and non-acidic and non-carbonated beverages.

Temporarily eliminate foods from your diet that are grainy, seedy, or crunchy to keep particles out of the extraction site. Avoid sticky and chewy foods, which can dislodge the clot. And while you’re at it, take acidic and spicy foods off the menu—they can irritate sensitive tissue.

Be sure that you protect the clot that protects your socket. Foods that are too hot can interfere with clot formation over the wound, and any use of a straw or other suction can dislodge the clot completely. Use a spoon for your milkshake, and, of course, don’t smoke.

• Every patient is different!

While all of the above suggestions are good generally guidelines, we will have information that has been specifically tailored to your needs. Which leads us to the most important recommendation of all . . .

• Follow our aftercare instructions

You will receive detailed instructions after surgery. Following this advice to the letter is the very best way to make sure your mouth is its cleanest and healthiest.

Taking care of yourself after an extraction isn’t quite as easy as ABC (DEF), but with guidance from Dr. Holtzen, careful attention to the extraction site, and patience as you allow the healing process to take place, you have all the basics you need for a healthy recovery.

You might suspect that your wisdom teeth are starting to emerge, but knowing the signs of impacted wisdom teeth can help you be more proactive about your dental care. Impacted wisdom teeth can be extremely painful and can make your life truly miserable until they are removed. Therefore, looking for the early warning signs listed below, and seeing Dr. Holtzen if you experience them, can help you conquer the problem before it conquers you.

There are three primary signs of impacted wisdom teeth. While every person may not have all three of these signs, you can usually expect to experience at least one of these if your wisdom teeth are impacted.

Unusual Pain

If you are feeling a type of teeth pain you've never felt before, especially when it is focused in the back area of your jaw, this may be a sign that you have a tooth impaction. You may be fortunate enough to catch it early, before all of your wisdom teeth become impacted, if you see Dr. Holtzen as soon as you feel the pain.

Swollen Jaw

If your jaw is suddenly swollen and the area feels tender to the touch, you have a high chance of having an impacted tooth. Since the wisdom teeth are set so far back in your jaw, the swelling tends to show itself low in the jaw, towards the ears, when they are impacted.

Bleeding Gums

If your gums are bleeding, something you may notice when you see a pink or red tinged toothbrush, you may be dealing with a wisdom tooth issue. When the wisdom teeth are impacted, they put a lot of pressure on your back teeth and gums, which often leads to bleeding.

Visit our Missoula or Hamilton office as soon as possible if you have any of the above signs of impacted wisdom teeth. The sooner you get treatment, the sooner the pain will be behind you for good!

We do our best to plan for our health. We eat right, we exercise, we see our doctors and dentists for regular checkups. But despite our best efforts, we can’t plan for accidents. A bike rider’s encounter with a pothole can mean a broken jaw. A clumsy elbow knocks out a basketball player’s tooth. A car collision leaves the driver with fractured facial bones and lacerations.

These are all very different injuries, but they are all considered facial trauma. When you are the victim of an accident, it’s always important to get the best treatment as quickly as possible. That’s why, if you should ever find yourself in the emergency room with facial trauma, it’s a very good idea to ask for a consultation with an oral and maxillofacial surgeon like Dr. Holtzen.

Oral and maxillofacial surgeons are trained specifically in the treatment of facial traumas. They have a minimum of four years of surgical education in a hospital-based residency program. They train with medical residents, and focus on studies in general surgery, anesthesiology, internal medicine, plastic surgery, and otolaryngology (the study of the ear, nose, and throat), among other fields of specialty.

Because their training is centered on the face, mouth, and jaw, these surgeons are experts in diagnosing and treating the complex interrelationship of these structures. Let’s look at our unfortunate cyclist, for example.

A broken jaw involves bone, muscle, ligaments, and teeth. Bones need to fit back together properly; the joint that connects the jawbones needs to function smoothly; and not just the jaw, but the teeth need to be back in alignment. Because they know just how these structures must work together, oral surgeons are experts in restoring function after facial trauma.

But treating facial trauma involves more than restoring functionality. Oral and maxillofacial surgeons are also concerned with restoring the patient’s appearance for both physical and psychological healing. Oral surgeons are extensively trained in techniques to reduce scarring and to maintain the balance and symmetry of facial features.

If you suffer facial trauma, an oral and maxillofacial surgeon has the specific knowledge and training to provide you with the very best treatment for your injuries. Oral surgeons are also, because of their wide-ranging experience, able to discover even difficult-to-detect injuries, putting you on the fastest track to recovery. Their medical expertise includes the treatment of:

• Injuries to the teeth and surrounding bone and tissue

An injury to the mouth can lead to a lost or displaced tooth and damage to the bones and tissues surrounding it.

If a tooth is knocked out, reimplantation can be successful if it takes place promptly—after 30 to 60 minutes, the odds of successful reimplantation go down. Oral surgeons are also trained to discover and treat any injuries or fractures to the alveolar bone which contains the tooth sockets.

• Bone injuries

An accident can cause broken or fractured bones anywhere on the face. Oral and maxillary surgeons work with bones in the upper and lower jaws, around the eyes and nose, and in the cheeks and forehead. Just like a broken arm, fractured facial bones must be put back in place and stabilized. Unlike a broken arm, injuries to the facial bones cannot be treated with a plaster or fiberglass cast.

Depending on the nature of the fracture, treatment can involve letting the bones “rest” to heal in place, or placing screws and plates or wiring to keep the bones in their proper positions while they heal. Your surgeon will know if your injuries should be treated surgically or non-surgically, and whether reconstructive surgery might be necessary.

• Soft tissue and special tissue injuries

Accidents can damage more than tooth and bone. When facial lacerations occur, an oral surgeon is skilled at making sure that any necessary suturing is done with an eye toward the best cosmetic outcome. Intra-oral lacerations might mean not only attention to delicate gum tissue, but treatment of the salivary glands and ducts. Facial trauma can also affect the nerves around the eyes, face, and mouth, which require expert diagnosis and treatment in case of injury.

You can’t plan for facial trauma, but you can make sure to involve Dr. Holtzen as possible. If you or a family member suffers a facial injury, don’t be reluctant to ask for a consultation at our Missoula or Hamilton office as part of your treatment.

Bad breath, or halitosis, is probably not a matter of life or death. But it can make you feel self-conscious and have a negative impact on your life. The majority of people suffering from bad breath are dealing with oral bacterial. However, there are other causes of this embarrassing problem. Learning more can help you fight this solvable problem.

Five Causes of Embarrassingly Bad Breath

1. Dry Mouth. A decrease in saliva flow can be caused by several things. Most often, medication or mouth breathing are the culprits. As saliva helps wash away food particles from your mouth, it prevents bad breath. Dry mouth can be dealt with by stimulating salivation.
2. Gum Disease and Poor Oral Hygiene. Not brushing and flossing well enough or with enough frequency can lead to gum disease, which leads to bad breath. Halitosis can be a sign that plaque is present on your teeth.
3. Food-Related Bad Breath. Food particles that aren't brushed or flossed away attract bacteria that leads to bad breath. It's especially important to brush after eating strong-smelling foods, such as garlic or onions.
4. Smoking and Tobacco. Tobacco is bad for your health, and that includes your oral health. Smoking or chewing tobacco can contribute toward the development of gum disease, as well as oral cancer.
5. Mouth Infections and Other Medical Problems. A mouth infection, sinus infection or even the common cold can cause you to temporarily have bad breath. Even conditions such as diabetes and reflux can cause halitosis. It's always wise to see Dr. Holtzen to help determine the cause.

We are Your Ally

Even if you maintain good oral hygiene, it's important to see Dr. Holtzen at our Missoula or Hamilton office to deal with or avoid problems with bad breath. We can help you uncover the cause of halitosis, while also providing solutions that allow you to enjoy fresh breath without relying on mints and breath fresheners. As is the case with all things related to oral health, we are your number-one ally when it comes to eliminating the problem of bad breath.

Watching the clock tick down the final seconds until midnight, many of us- Alpine Oral and Facial Surgery included- feel nostalgic about the passing year and hopeful about the new one to come. New Year’s Eve is one of the most widely celebrated holidays in the world, with over-the-top celebrations taking place in dozens of countries. The Gregorian calendar, which is widely used in Western nations and around the world, was implemented in 1582. Since that time, December 31st has marked the final day of the year, with midnight heralding the beginning of a brand new year. In the United States, New Year’s Day is a public holiday; government offices, schools, public organizations, and many businesses are closed for the day. Ponder the following fun facts as you think about your plans for the holiday:

• Approximately one billion people watch the New Year’s Eve ball drop in Times Square, New York City. This televised event is one of the most iconic New Year’s celebrations in the world. For many years, watching the ball drop meant tuning in to Dick Clark’s Rockin’ New Year’s Eve, an iconic television special dear to the hearts of many viewers.
• The idea for the New Year’s Eve ball came about because of a citywide ban on fireworks. Before 1907, when fireworks became illegal in New York City, celebrations included an elaborate fireworks show. The large, glittering, illuminated ball was developed as an alternative. Although the first ball was heavy at 700 pounds, the modern New Year’s Eve ball is made of Waterford crystal and tips the scale at six tons!
• The top five New Year’s resolutions are: to lose weight, quit smoking, get a new job, return to school, or increase personal savings. However, approximately 88% of New Year’s resolutions fail. But don’t let that discourage you! Resolutions are most likely to succeed when they are clear, achievable goals. Setting out a concrete plan to achieve your resolution also boosts your chances of success.
• Eating black-eyed peas on New Year’s Day is said to bring good fortune in the new year. Collard greens, cabbage, and ham hocks are also considered lucky foods to enjoy. Just steer clear of the chicken or turkey dinners; eating poultry is a bad omen for the year to come.

Whether you plan to stay in Missoula or Hamilton, or head out into the crowds to watch the ball drop in Times Square, New Year’s Eve is a time to enjoy friends and family. Send your loved ones well wishes for the New Year, and look for that special someone to share a midnight kiss with for good luck!

Cancer has become a common word, and it seems like there is new research about it every day. We know antioxidants are important. We know some cancers are more treatable than others. We know some lifestyles and habits contribute to our cancer risk.

Smoking increases our risk of cancer, as does walking through a radioactive power plant. But there is a direct link to oral cancer that you many may not know about—the link between HPV (Human Papilloma Virus) and oral cancer.

This may come as a shock because it has been almost a taboo subject for some time. A person with HPV is at an extremely high risk of developing oral cancer. In fact, smoking is now second to HPV in causing oral cancer!

According to the Oral Cancer Foundation, “The human papilloma virus, particularly version 16, has now been shown to be sexually transmitted between partners, and is conclusively implicated in the increasing incidence of young non-smoking oral cancer patients. This is the same virus that is the causative agent, along with other versions of the virus, in more than 90% of all cervical cancers. It is the foundation's belief, based on recent revelations in peer reviewed published data in the last few years, that in people under the age of 50, HPV16 may even be replacing tobacco as the primary causative agent in the initiation of the disease process.” [http://www.oralcancerfoundation.org/facts/]

There is a test and a vaccine for HPV; please discuss it with your physician.

There are some devices that help detect oral cancer in its earliest forms. We all know that the survival rate for someone with cancer depends greatly on what stage the cancer is diagnosed. Talk to Dr. Holtzen if you have any concerns.

Please be aware and remember that when it comes to your own health, knowledge is power. When you have the knowledge to make an informed decision, you can make positive changes in your life. The mouth is an entry point for your body. Care for your mouth and it will care for you!

When a child is born, he or she will have 20 primary teeth and 32 permanent teeth. But sometimes kids are born with additional teeth, and our team at Alpine Oral and Facial Surgery calls this oral condition "hyperdontia." Primary teeth are the first set of teeth that erupt in your child's mouth, typically by the time they are 36 months old, and are shed by the time your child reaches the age of 12. Permanent teeth then take the place of the primary teeth and are usually fully-erupted by the time your son or daughter reaches 21 years of age. Anyone who develops more than 20 primary teeth or more than 32 permanent teeth has hyperdontia, and the additional teeth are referred to as supernumerary teeth.

While the cause of hyperdontia is not entirely clear, it is believed that there may be a genetic factor. Oral professionals have found that patients with extra teeth often have syndromes like cleidocranial dysplasia, Ehler-Danlos syndrome, Gardner syndrome, or cleft lip and palate. The prevalence of hyperdontia affects between one and four percent of the population in the United States, and the majority of cases are limited to a single tooth.

So, what is the best way to deal with hyperdontia? It really depends on the case. The treatment plan your doctor suggests varies according to the potential problem posed by the supernumerary teeth, as well as their type. Orthodontic treatment may certainly may help, but extraction can also be a good option. We recommend that children receive an oral evaluation or checkup no later than the age of seven. In addition to hygiene evaluation, this helps ensure your child does not experience hyperdontia problems.

If you suspect you or your child may be suffering from hyperdontia, please give us a call to schedule an appointment at our convenient Missoula or Hamilton office to be evaluated.

There are many understandable reasons why you might be feeling less than enthusiastic about your upcoming implant procedure, extraction, or any other dental surgery.  Perhaps anxiety is an issue, or your teeth are extremely sensitive. You may have a low pain threshold, an easily triggered gag reflex, or require longer or more complex work during your visit. These are also excellent reasons to consider sedation dentistry.

Of course, Dr. Holtzen will always try our best to make sure that every procedure is pain free. A local anesthetic will be provided to numb the surgical area completely. You might decide that this all that you need, especially for relatively simple procedures. But if you would prefer to remain completely aware, but feel less anxious, if you would like deep sedation throughout the entire procedure, or if you want something in between, talk to us about making sedation part of your treatment.

The most common methods of sedation include:

• Oral Sedation

Usually, oral medications that reduce anxiety are given in pill form. The level of sedation and how much you will be aware during your procedure will depend on the dosage, and you will need time to recover from the drug’s effects after we are done.

• Nitrous Oxide

Commonly referred to as “laughing gas,” this has been used since the 1800’s to relieve dental anxiety and reduce pain.  Today’s equipment is designed to provide a precise mixture of nitrous oxide and oxygen inhaled through a mask that you will wear throughout the procedure. Once the mask is removed, you will recover quickly.

• IV Sedation

Medication will be delivered through an intravenous line placed in a vein. This delivery system allows the sedative to take effect very quickly, unlike oral sedation, and adjustments to the sedation level can be made throughout the procedure. This method will also require recovery time when your work is complete.

Because your concerns and condition are unique, we will tailor your sedation to fit your specific needs, and our experience and training enable us to recommend the sedation that is best for you. We will take a careful health history to make sure that whichever medication is used won’t interact with your other medications or affect any pre-existing medical conditions.

Oral and maxillofacial surgeons are trained in a hospital-based residency program to administer and monitor every type of sedation. Because sedation in all its varieties is a regular part of our practice, we have the medical knowledge and skill to provide you with a safe and comfortable surgical experience. If you think sedation dentistry might be right for you, this procedure is something we are happy to discuss before your appointment at our Missoula or Hamilton office.

If you need oral surgery, Dr. Holtzen and our team will use our expertise and training to ensure that you have the best possible surgical outcome. And we want to make sure you have the best possible outcome for your recovery as well. Here are a few of the most common aftercare suggestions for making your healing as comfortable and rapid as possible.

• Reduce Swelling

Ice packs or cold compresses can reduce swelling. We’ll instruct you how to use them if needed, and when to call our Missoula or Hamilton office if swelling persists.

• Reduce Bleeding

Some amount of bleeding is normal after many types of oral surgery. We might give you gauze pads to apply to the area, with instructions on how much pressure to apply and how long to apply it. We will also let you know what to do if the bleeding continues longer than expected.

• Reduce Pain or Discomfort

If you have some pain after surgery, over-the-counter pain relievers such as ibuprofen might be all that you need. We can recommend those which are best for you. If you need a prescription for pain medication, be sure to take it as directed and always let us know in advance if you have any allergies or other reactions to medications.

• Recovery-friendly Diet

Take it easy for the first few days after oral surgery. Liquids and soft foods are best for several days following surgery. We will let you know what type of diet is indicated and how long you should follow it depending on your particular procedure. We might, for example, recommend that you avoid alcohol and tobacco, spicy, crunchy, and chewy foods, and hot foods or beverages for several days or several weeks.

• Take Antibiotics If Needed

If you have been prescribed an antibiotic, be sure to take it as directed. If you have any allergies to antibiotics, let us know in advance.

• Protect the Wound

Do NOT use straws, smoke, or suck on foods. Avoid spitting.  Part of the healing process can involve the formation of a clot over the surgical site which protects the wound. If the clot is dislodged by suction or spitting, it can prolong your recovery time, or even lead to a potentially serious condition called “dry socket.”

• Maintain Oral Hygiene

Depending on your surgery, we might recommend that you avoid rinsing your mouth for 24 hours, use salt water rinses when appropriate, and keep away from the surgical site when brushing. It’s important to keep your mouth clean, carefully and gently.

• Take it Easy!

Rest the day of your surgery and keep your activities light in the days following.

These are general guidelines for recovery. If you have oral surgery scheduled, we will supply you with instructions for your specific procedure, and can tailor your aftercare to fit any individual needs. Our goal is to make sure that both your surgery and your recovery are as comfortable as possible.

At Alpine Oral and Facial Surgery, we love to celebrate the holidays with vigor! Dr. Holtzen would love to share some unique ways of celebrating Thanksgiving from beyond the Missoula or Hamilton area to the national level!

When Americans sit down to dinner on the last Thursday of November, the day that Abraham Lincoln designated as the day on which Thanksgiving would be celebrated, they do so thinking that the first Thanksgiving feast was held at Plymouth in 1621. According to National Geographic, the Spanish explorer Francisco Vásquez Coronado and his men celebrated a feast of Thanksgiving in Texas in 1541, giving Texas the distinction of being the first place where Thanksgiving was celebrated.

Different Types of Celebrations

Native Americans had rituals around which they celebrated in hopes of ensuring a bountiful harvest. The Cherokees had a Green Corn Dance that they did for this very purpose. The Pilgrims (not to be confused with the Puritans,) rejected any type of public religious display. They held a three-day long non-religious Thanksgiving feast. Although they said grace, the focus of their celebration was on feasting, drinking alcohol (they did have beer,) and playing games.

The Pilgrims at the Plymouth Plantation celebrated a different day of Thanksgiving in 1623. Plagued by a crop-destroying drought, the settlers prayed for relief. They even fasted. A few days later, they got the rain they so desperately needed. Soon thereafter, they received another blessing when Captain Miles Standish came with staples they couldn't otherwise get. He also told them that a Dutch supply ship was en route. In gratitude for the abundance of good fortune, the Plymouth settlers celebrated a day of prayer and Thanksgiving on June 30, 1623.

The Story of Squanto

No discussion of Thanksgiving is complete without a discussion of Squanto, or Tisquantum, as he was known among his people, the Patuxet Indians. It is believed that he was born sometime around 1580. As he returned to his village after a long journey, he and several other Native Americans were kidnapped by Jamestown colonist, Thomas Hunt. Hunt put them on a ship heading to Spain where they were to be sold into slavery.

As fate would have it, some local friars rescued him and many of the other kidnapped natives. Squanto was educated by the friars. Eventually, after asking for freedom so he could return to North America, he ended up in London where he spent time working as a ship builder. By 1619, he was finally able to get passage on a ship headed to New England with other Pilgrims.

Upon arriving at Plymouth Rock, he learned that his entire tribe was wiped out by diseases that accompanied earlier settlers from Europe. In gratitude for passage on their ship, he helped them set up a settlement on the very land where his people once lived. They called the settlement Plymouth. Since they knew nothing about how to survive, let alone how to find food, Squanto taught them everything, from how to plant corn and other crops, how to fertilize them, how and where to get fish and eels and much more.

After a devastating winter during which many settlers died, thanks to Squanto's teaching, they had an abundant harvest. After that harvest, they honored him with a feast. It is this feast of 1621 which was celebrated between the Pilgrims and Wampanoag Indians that is widely considered the first Thanksgiving celebration.

About the Meal of the Plymouth Settlers

Surviving journals of Edward Winslow that are housed at Plymouth Plantation indicate that the first Thanksgiving feast was nothing like what Americans eat today. The meal consisted of venison, various types of wild fowl (including wild turkey,) and Indian corn. There were no cranberries, stuffing, pumpkin pie, potatoes, or any of the other “traditional” foods that appear on modern menus.

Today, Thanksgiving is celebrated on the fourth Thursday of November, the day that Abraham Lincoln designated as the holiday. It is still a day of feasting, and for some, a day of prayer and thanksgiving. For others, it is a celebration of gathering, especially for families. Still others may celebrate in entirely different ways, including watching college football bowl games, or by playing family games.

If you ever wonder why you're so tired after the Thanksgiving meal, it's because turkey contains an amino acid, tryptophan, and it sets off chemicals whose chain reaction combine to make people sleepy.

If you suffer from dental anxiety, we understand that paying a visit to our office can seem like a nearly impossible mission. Regardless of what the root of that anxiety might be, we’re here to tell you that at Alpine Oral and Facial Surgery, you have no need to be nervous. Our office is dedicated to making your dental experience as comfortable and stress-free as possible.

One of the best things to do if you experience dental anxiety is call our office in advance to let us know. By notifying us in advance, you give us the opportunity to provide you with the dental care you need in the way you need it.

We can prescribe a relaxation medication for you. During your appointment, we can provide a little bit of laughing gas to put you more at ease, teach you some behavioral techniques for relaxation, and make sure you’re never in the dark about what’s happening.

If dental anxiety makes you feel embarrassed, please be assured that you’re not alone. Studies show that as much as 75% of adults suffer some degree of dental anxiety! It might be helpful to remember that your doctor’s goal is the same as yours: We are here to keep your oral health in check so you can be your healthiest self. We certainly don’t want to make you uncomfortable in the process.

If you have any questions about other ways in which we can accommodate you during your visits, please don’t hesitate to contact our Missoula or Hamilton office!

If you have oral surgery scheduled at our Missoula or Hamilton office, you have many options for your choice of anesthesia. After all, Dr. Holtzen and our team are trained in all forms of anesthesia and sedation therapy, so you will be able to choose the anesthesia experience that best suits your needs—and your comfort!

One such option is general anesthesia. If you choose this type of anesthesia, you will be carefully monitored at all times. While you are under our care, we want to make sure your treatment is safe, painless, and free from anxiety. And to make your experience go as smoothly as possible, there are some recommendations you can follow even before you arrive at the office.

• Communication is Key

Part of our job is to let you know all about your general anesthesia beforehand. If you have any questions or concerns, please voice them. And communication is a two-way street! If you have any medical conditions, or are taking any medications, or have a cold or the flu, please let us know in advance.

• Diet Restrictions

Talk to us before your surgery to learn about any diet restrictions you should observe before general anesthesia. You will need to abstain from food and drink for a set number of hours before the procedure, so we’ll give you directions based on whether your surgery is scheduled for morning or afternoon.

• Dress for Success

Wear loose, comfortable clothing. Make sure your sleeves are short or easily rolled up above your elbow if you’ll need an IV line or blood pressure monitoring. Leave your make-up, jewelry, and contact lenses at home.

• Go Along for the Ride

Ask a friend or a family member for a ride home after surgery. We want you to travel safely, and, even if you think you are good to go, your thinking and decision making, your reflexes, and even your memory can be impaired for up to 48 hours after general anesthesia. If you have arranged for a cab or a ride share, don’t call for your ride until our office gives you the all clear.

• Plan Ahead!

For the very same reasons you shouldn’t drive for several hours after general anesthesia, there are some normal everyday activities you should postpone as well. You shouldn’t operate machinery. Cooking can wait. Arrange for help with childcare if you have young children. The effects of general anesthesia will wear off over the course of a day or two—ask us for a timeline for returning to your normal activities.

We’re experts in providing you with a safe and comfortable anesthesia experience when you have oral surgery. And part of that expertise is letting you know the specifics about preparing for your general anesthesia. If you have any questions for how to get ready for the hours both before and after your surgery, give us a call!

You’ve chosen an oral surgeon for your extraction procedure because oral surgeons have years of surgical training in the diagnosis and treatment of medical conditions in the face, mouth, and jaw. If you need a tooth extraction, whether for an impacted wisdom tooth, a badly damaged tooth, or for any other reason, Dr. Holtzen and our team will use our training and experience to ensure that you have the best possible surgical outcome.

And we want to make sure you have the best possible outcome for your recovery as well. What can you do at home to speed the healing process? Here are a few of the most common aftercare suggestions for making your post-extraction healing as comfortable and rapid as possible.

• Reduce Swelling

Ice packs or cold compresses can reduce swelling. We’ll instruct you how to use them if needed, and when to call us if swelling persists.

• Reduce Bleeding

Some amount of bleeding is normal after many types of oral surgery. We might give you gauze pads to apply to the area, with instructions on how much pressure to apply and how long to apply it. We will also let you know what to do if the bleeding continues longer than expected.

• Reduce Pain or Discomfort

If you have some pain after surgery, over-the-counter pain relievers such as ibuprofen might be all that you need. We can recommend those which are best for you. If you need a prescription for pain medication, be sure to take it as directed and always let us know in advance if you have any allergies or other reactions to medications.

• Recovery-friendly Diet

Take it easy for the first few days after oral surgery. Liquids and soft foods are best for several days following surgery. We will let you know what type of diet is indicated and how long you should follow it depending on your particular procedure. We might, for example, recommend that you avoid alcohol and tobacco, spicy, crunchy, and chewy foods, and hot foods or beverages for several days or several weeks.

• Take Antibiotics If Needed

If you have been prescribed an antibiotic, be sure to take it as directed. If you have any allergies to antibiotics, let us know in advance.

• Protect the Wound

Do NOT use straws, smoke, or suck on foods. Avoid spitting.  Part of the healing process can involve the formation of a clot over the surgical site which protects the wound. If the clot is dislodged by suction or spitting, it can prolong your recovery time, or even lead to a potentially serious condition called “dry socket.”

• Maintain Oral Hygiene

Depending on your surgery, we might recommend that you avoid rinsing your mouth for 24 hours, use salt water rinses when appropriate, and keep away from the surgical site when brushing. It’s important to keep your mouth clean, carefully and gently.

• Take it Easy!

Rest the day of your surgery and keep your activities light in the days following.

These are general guidelines for recovery. If you have oral surgery scheduled at our Missoula or Hamilton office, we will supply you with instructions for your specific procedure, and can tailor your aftercare to fit any individual needs. Our goal is to make sure that both your surgery and your recovery are as comfortable as possible.

Halloween is fast approaching, and Dr. Holtzen wanted to be sure to wish our patients a happy day, no matter how you might celebrate this holiday. The Halloween that is familiar to most people today bears little resemblance to the original Halloween; back in the "old days" it wasn't even called Halloween!

Festival of the Dead

Halloween started out as a Celtic festival of the dead that honored departed loved ones and signified a change in the cycle of the seasons. The Celtic people viewed Halloween, then called "Samhain," as a very special day – almost like our New Years day in fact, as their new calendar year began on November 1st. Samhain was the last day of autumn, so it was the time to harvest the last of the season's crops, store food away for winter, and situate livestock comfortably for the upcoming cold weather. The Celts believed that during this day, the last day of winter, the veil between this world and the spirit world is the thinnest, and that the living could communicate with departed loved ones most effectively on Samhain due to this.

Modern Halloween

Halloween as we know it today started because Christian missionaries were working to convert the Celtic people to Christianity. The Celts believed in religious concepts that were not supported by the Christian church, and these practices, which stemmed from Druidism, were perceived by the Christian church as being "devil worship" and dangerous.

When Pope Gregory the First instructed his missionaries to work at converting the Pagan people, he told them to try to incorporate some of the Pagan practices into Christian practices in a limited way. This meant that November 1st became "All Saints Day," which allowed Pagan people to still celebrate a beloved holiday without violating Christian beliefs.

Today, Halloween has evolved into a day devoted purely to fun, candy, and kids. What a change from its origins! We encourage all of our patients to have fun during the holiday, but be safe with the treats. Consider giving apples or fruit roll-ups to the kids instead of candy that is potentially damaging to the teeth and gums.

Remind kids to limit their candy and brush after eating it! Sweets can cause major tooth decay and aggrivate gum disease, so to avoid extra visits to our Missoula or Hamilton office, make your Halloween a safe one!

When we were small, a loose tooth wasn’t a reason to be worried. On the contrary! It was a time to celebrate: A permanent tooth on the way. A sign that you were growing up. Perhaps even a lucrative visit from the Tooth Fairy. Losing a baby tooth had quite a few benefits.

Now that we’re grown, no such benefits are in store for us, because a lost adult tooth is gone for good. That’s why any time you notice a loose tooth you need to call your dentist immediately. With prompt dental care, that tooth might be saved.

But first, a word about how our teeth stay firmly rooted in the jaw.

• The visible part (crown) of a tooth is protected by a layer of enamel. The root below is covered with a protective layer called cementum.
• There is a socket for each tooth in the alveolar bone of the jaw, where each root is firmly attached within the socket by the periodontal ligament which surrounds it.
• This ligament is made up of connective tissue, which attaches both to the cementum covering the root and to the alveolar bone. It not only holds the tooth in place, it cushions the tooth from the daily pressure of biting and chewing.
• The gums surround the teeth and bone, protecting them from bacteria.

If the tooth, bone, ligament, or gums suffer damage, the result can be a loose tooth.

Treating a loose tooth

The treatment you receive will depend on the reason your tooth is loose. There are many situations which can lead to a loose tooth or teeth, and many treatment options available to you. Some of the common causes and potential treatments include:

• Accident or Trauma

If you have suffered a tooth or jaw injury as a result of an accident or trauma, it’s very important to see your dentist or doctor immediately. You should be carefully examined to determine whether there is damage to other teeth or the jaw.

Often, dental or bone injuries are best treated by an oral surgeon. Oral and maxillofacial surgeons are the specialists in facial trauma, with years of surgical training and experience in the diagnosis and treatment of traumatic injuries. Any time surgery is recommended for bone or tooth trauma, ask for a referral to an oral surgeon.

In some cases of damage to the periodontal ligament or tooth, even if your tooth is loose or extruded (partially out of its socket), it can be stabilized in place so that the ligament and tissue around it has time to heal.

If the root, nerves, and blood vessels are still intact, the tooth can be placed back in its socket, and then anchored to the adjacent teeth with a flexible splint for several weeks. In the case of an alveolar or a root fracture, a rigid splint may be used.

Splinting gives the periodontal ligament and bone surrounding it time to heal while keeping your injured tooth from further displacement.

• Bite problems & Bruxism

Your teeth are designed to withstand a lot of pressure—in fact, in some ways, pressure is essential for healthy teeth and bone. The normal pressure of chewing and biting stimulates bone tissue in the jaw. When a tooth is lost, that stimulation is gone and the result is gradual bone loss in the area underneath the lost tooth.

But sometimes, the pressure exerted by a malocclusion (bad bite) or bruxism (tooth grinding) is too forceful. The connective tissue which holds the teeth in place is damaged by these forces, and loose teeth can be the result.

If you grind your teeth, a night guard can be custom fitted to provide relief from the pressures and impact of tooth clenching and grinding. This special kind of mouth guard is known as an occlusal splint.

• Osteoporosis

Osteoporosis causes a loss of bone density throughout the body. Studies suggest that this disease can affect bone in the jaw, leading to weaker bone and looser teeth. Your physician will provide your best medical alternatives, and be sure to let us now if you are taking medication for osteoporosis before we plan your dental treatment.

• Periodontal Disease

Gum disease is one of the major causes of loose—and lost—teeth. Early gum disease, called gingivitis, should be treated promptly to avoid a more serious condition called periodontitis. Periodontitis can cause the gums to pull away from the teeth, creating pockets for bacterial growth and infection. Left untreated, this infection results in connective tissue and bone loss.

Oral surgeries such as flap surgery or bone and tissue grafting can help reverse the effects of periodontitis. Bone loss cannot be reversed, but a graft can replace lost bone and allow healthy tissue to regenerate.

• Pregnancy

Hormonal changes can cause the ligaments and bone around your teeth to loosen, which can lead to loose teeth. While this might be an alarming development, it’s generally a temporary condition. Talk to your dentist about how to take care of your teeth and gums during your pregnancy.

Hormonal changes can also make your gums more vulnerable to irritation and infection. In fact, swollen and tender gums are often one of the first signs of pregnancy. That’s another reason it’s very important to keep up with dental hygiene during pregnancy. If your gums are red, swollen, bleeding, or tender, give your dentist a call.

What to do if you have a loose tooth?

• Call your dentist immediately. Timely professional care can mean the difference between saving your tooth and losing it.
• Avoid wiggling the tooth. This could loosen it further.
• Protect your loose tooth. Eat soft foods, and try not to chew near the affected area. And while a liquid diet might sound like a good idea, no straws, please. Straws require suction, which can further dislodge your tooth.
• Keep the area clean, gently.

What to do if a tooth can’t be saved

Baby teeth become loose and fall out because the permanent teeth coming in erode the smaller roots holding them in place. That’s why it’s so easy for parents to help their child’s wiggly baby tooth find its way from mouth to Tooth Fairy.

Adult roots, however, involve alveolar bone, ligaments, blood vessels, and nerves, so an extraction is often best performed by an oral surgeon. Dr. Holtzen will also examine you carefully to discover the reason for the tooth loss, and to prevent further damage with additional treatment as needed.

Finally, if you do lose a permanent tooth, there is still much that can be done to restore your smile. Modern implants are almost indistinguishable from natural teeth, and, what’s more, they function just like natural teeth to stimulate the bone beneath them.

If you have any worries about your teeth, give our Missoula or Hamilton office a call. A loose tooth is never a cause for celebration, but, with proper dental care, a loose tooth doesn’t always lead to a lost tooth. Restoring a firm bite and a heathy and confident smile? That’s a reason to celebrate!

Preparing for oral surgery is much like preparing for any other outpatient procedure. The steps you take leading up to the operation play a significant role in the safety of your procedure and your recovery experience. It is important that you speak with Dr. Holtzen prior to an oral surgery to find out what you should expect and the ways you can facilitate a quick and complication-free recovery.

Food and Drink

If you will be under anesthesia or IV sedation during your surgery, you will be asked to fast from food and drink in the hours leading up to your procedure. If your surgery is scheduled in the morning, Dr. Holtzen may ask you to avoid eating or drinking after midnight the night before. Otherwise, a fasting period of at least eight to 12 hours must be observed. However, there may be exceptions for people with certain medical conditions, such as diabetes. Talk to our team if you have questions about pre-operative fasting.

Clothing and Hygiene

You should arrive at your appointment dressed comfortably in short-sleeved, loose-fitting shirt. Avoid wearing valuable clothing, and leave all jewelry at home. If you wear a removable dental prosthetic, such as dentures or a bridge, bring a case to store it in during the procedure. You should also avoid wearing contacts or makeup, though you may wish to bring apply lip moisturizer or balm to prevent chapping during the procedure.

Transportation

You will need to arrange transportation to and from your oral surgery at our Missoula or Hamilton office, as you will not be allowed to drive yourself home after the procedure. The person you choose should be a responsible adult who will remain in the office for the duration of your surgical appointment. Depending on the type of anesthetic used during your procedure, you may need someone to stay with you at home in the hours immediately following your appointment.

Recovery

Take steps now to prepare for the days following your procedure. It can take weeks for your mouth to fully heal after surgery, although most swelling subsides within a few days. If you have young children, arrange for someone to care for them during the days immediately following your appointment. Purchase soft foods that are safe to eat after oral surgery, such as yogurt or soup, and freeze an ice pack to help minimize swelling.

Adults are no strangers to feeling like there is never enough time in the day to get everything done. Your alarm clock rings and within minutes you ping pong around trying to spread peanut butter on sandwiches, answer your cell phone, remove the dog hair from your clothes, and make sure your child has completed his or her science fair project. Brushing your teeth can easily fall to the wayside. That is why our office promotes a simple, daily oral health regimen that you can easily incorporate into your busy lifestyle.

The American Dental Hygienists' Association (ADHA), in partnership with the Wrigley Jr. Company, is celebrating National Dental Hygiene Month (NDHM) during October. The ADHA encourages people to "Brush. Floss. Rinse. Chew...Keep it Clean, Keep it Healthy!" and offers some great tips for a quick and effective home oral health routine, below:

Oral Health Routine at Home

• Brushing your teeth twice daily is the most important thing you can do to diminish the accumulation of plaque and the potential for other oral problems such as cavities and gingivitis.
• Flossing once daily removes plaque and food from beneath the gums and between teeth that brushing alone cannot remove. Tooth decay and gum disease often begin in these areas.
• Rinsing your mouth with an antibacterial, non-alcohol based mouthwash kills plaque and gingivitis germs that brushing and flossing do not catch. We recommend using a mouthwash with the ADA Seal of Acceptance.
• Chewing sugar-free gum helps produce saliva, which battles cavities. The gum also neutralizes plaque, strengthens enamel, and removes remaining food. It is especially important to chew gum after eating or drinking.

It's easy to put the toothbrush down in order to take care of matters you feel are more urgent, but remember, a good oral health routine at home is the best way to prevent periodontal disease. "Periodontal disease is the most common cause of tooth loss in adults. An estimated 75 percent of Americans reportedly have some form of periodontal disease," said the ADHA. Periodontal disease also is linked to more serious illnesses such as diabetes and stroke.

Also, remember to keep regular visits with our office. Dr. Holtzen can help you learn more about proper care for your teeth and gums.

If you’re feeling a bit nervous before you visit our office for a surgical procedure, we want to make your visit as worry-free as possible. We are happy to explain procedures, equipment, and sedation options so you know just how safe and comfortable your experience can be. And if X-rays are a concern, we can put your mind at ease here as well.

What Exactly Are X-rays?

Sometimes patients feel reluctant about the process of imaging because X-rays are a kind of radiation. But the fact is, radiation is all around us. We are exposed to radiation naturally from our soil and water, sun and air, as well as from modern inventions such as cell phones, WiFi, and air travel.

Why is radiation so common? Because matter throughout the universe constantly gives off energy, and the energy that is emitted is called radiation. This radiation takes two forms—as particles (which we don’t need to consider!) and as traveling rays. This second type is known as electromagnetic radiation, created by photons traveling in regular waves at the speed of light.

We are exposed to electromagnetic radiation every day, because, whether we can see them or not, these different wavelengths and frequencies create various forms of light. Radio waves, microwaves, infrared, visible, and ultraviolet light, X-rays, and gamma rays are all part of the electromagnetic light spectrum.

Different types of radiation on this spectrum have different wavelengths and different frequencies, and produce different amounts of energy. Longer wavelengths mean lower frequencies and less energy. Because X-rays have shorter wavelengths and higher frequencies than, for example, radio waves and visible light, they have more energy.

How Do Dental X-rays Work?

An X-ray machine produces a very narrow beam of X-ray photons. This beam passes through the body and captures images of our teeth and jaws on special film or digital sensors inside the mouth (intraoral X-rays), or on film or sensors located outside the mouth (extraoral X-rays). These X-ray images are also known as radiographs.

Why are X-rays able to take pictures inside our bodies? Remember that higher energy we talked about earlier? This energy enables X-rays to pass through the softer, less dense parts of our bodies, which are seen as gray background in a radiograph. But some substances in our bodies absorb X-rays, such as the calcium found in our bones and teeth. This is why they show up as sharp white images in radiographs. 

There are many medical and dental conditions which can be treated by oral surgeons. When the problem is primarily a dental one, we have several different X-ray options which can be used as necessary, including:

• Periapical X-rays, which allow us to look at one or two specific teeth from crown to root.
• Panoramic X-rays, which use a special machine to rotate around the head to create a complete two-dimensional picture of teeth and jaws.
• Cone Beam Computed Tomography, which uses an external machine to produce digital images creating a three-dimensional picture of the teeth and jaws.

Why Do We Need X-rays?

If all of our dental conditions were visible on the surface, there would be no need for X-rays. But since they are not, we use X-rays to discover such conditions as infection in a tooth’s root or bone, a decrease in bone density, and fractures or other injuries. And to properly plan treatment, we often require 3-D images, which show the spatial relationship of teeth, roots, bone, nerves, and sinuses.

Many dental procedures benefit from X-ray imaging for diagnosis and treatment planning, among them:

• Extraction of a seriously decayed or damaged tooth
• Wisdom tooth extraction
• Dental implant surgery
• Treatment of traumatic injuries
• Root surgeries such as apicoectomies and root amputations, which can save a tooth when infection recurs after a root canal
• Replacement of an avulsed, or knocked out, tooth

How Do Oral Surgeons Make Sure Your X-rays Are As Safe As They Can Be?

First of all, the amount of radiation you are exposed to with a dental X-ray is very small. In fact, a typical panoramic X-ray provides roughly the same amount of radiation we are exposed to through our natural surroundings in just one day. Even so, Dr. Holtzen and our team are committed to making sure patients are exposed to as little radiation as possible.

Radiologists, the physicians who specialize in imaging procedures and diagnoses, recommend that all dentists and doctors follow the safety principal known as ALARA: “As Low As Reasonably Achievable.” This means using the lowest X-ray exposure necessary to achieve precise diagnostic results for all dental and medical patients.

The guidelines recommended for X-rays and other imaging have been designed to make sure all patients have the safest experience possible whenever they visit the dentist or the doctor. We ensure that imaging is safe and effective in a number of ways:

• We take X-rays only when they are necessary.
• We provide protective gear, such as apron shields and thyroid collars, whenever needed.
• We make use of modern X-ray equipment, for both traditional X-rays and digital X-rays, which exposes patients to a lower amount of radiation than ever before.
• When treating children, we set exposure times based on each child’s size and age.

And now that we’ve talked about some things you might like to know,

Please Let Us Know If . . .

• You have X-rays from another doctor. We’ll let you know if your earlier X-rays might be useful, and how to transfer them. (With digital X-ray technology, this transfer can be accomplished electronically!)
• You’re pregnant, or think you might be pregnant. Even though radiation exposure is very low with dental radiographs, unless there is a dental emergency, dentists and doctors recommend against X-rays for pregnant patients.

X-rays play a vital part in helping us diagnose and treat our patients. If you have any concerns, contact our Missoula or Hamilton office. When it comes to making sure you’re comfortable with all of our procedures, including any X-rays that might be necessary, we’re happy to give you all the inside information!

You may have bitten down on a hard food or object, or perhaps you had a cavity that weakened your tooth. Either way, your tooth is now broken, and the steps you take to care for it will determine whether you get to keep your natural tooth or not. Millions of people suffer from broken teeth every year, so you are not alone. However, that does not mean your newly cracked tooth does not need immediate attention.

What is a broken tooth?

A broken tooth is one that has been fractured, chipped, cracked, broken apart, or completely knocked out of the mouth. You may or may not feel your tooth break, depending on the extent of the break and whether your tooth was decaying prior to the break. It is usually very easy to diagnose a broken tooth, because the evidence will be visible. In the case of hairline cracks in the teeth, you may start to note a sensitivity to hot or cold in the neighborhood of the fracture.

The Right Way to Handle a Broken Tooth

As soon as you know your tooth is broken, chipped, or fractured, make an appointment to visit our emergency dental office. Even the tiniest fractures require attention: bacteria can infect the fractured area, which could cause you to lose the tooth altogether.

Until you are in our office, you can manage your pain using over-the-counter pain medication, such as Tylenol, or you can apply a cold compress to prevent swelling and inflammation. Be sure to rinse your mouth with warm salt water after every meal until you are able to visit us.

Keep in mind that while pain medication is an effective way to manage a broken tooth at home, it is only a temporary fix. Broken teeth should not be treated solely at home, and over-the-counter solutions are not substitutions for professional dental care. Failing to make an appointment with Dr. Holtzen after breaking or chipping a tooth can place your health at risk.

Treatment

Treating your broken tooth will depend on the type of break you have and how much of the tooth is affected. A minor chip or tiny fracture line may easily be repaired with bonding. On the other hand, a more serious break that exposes the tooth's pulp may require a root canal or extraction to prevent infection. Ultimately, our team here at Alpine Oral and Facial Surgery will explain to you the best treatment plan based upon our evaluation of the condition and extent of your break.

If you have broken, cracked, chipped, or fractured one or more of your teeth, don’t hesitate to contact our office immediately. We specialize in emergency dental care and are available to serve you 24 hours a day, seven days a week.

Women using medication to treat a variety of medical conditions are often unaware of the potential side effects. One common side effect of medications such as blood pressure medication, birth control pills, antidepressants, and cancer treatments is dry mouth. The technical term for dry mouth is xerostomia.

Xerostomia can lead to undesirable effects in the oral cavity including periodontal disease and a high rate of decay. Many women who have not had a cavity in years will return for their routine exam and suddenly be plagued with a multitude of cavities around crowns and at the gum line, or have active periodontal disease. The only thing that the patient may have changed in the past six months is starting a new medication.

Saliva washes away bacteria and cleans the oral cavity, and when saliva flow is diminished harmful bacteria can flourish in the mouth leading to decay and gum disease. Many medications can reduce the flow of saliva without the patient realizing the side effect. Birth control pills can also lead to a higher risk of inflammation and bleeding gums. Patients undergoing cancer treatments, especially radiation to the head and neck region, are at a greatly heightened risk of oral complications due to the possibility of damage to the saliva glands.

There are many over the counter saliva substitutes and products to temporarily increase saliva production and help manage xerostomia. One great option for a woman with severe dry mouth or high decay rate is home fluoride treatments. These work in a number of ways, including custom fluoride trays that are worn for a short period of time daily at home, a prescription strength fluoride toothpaste, or an over the counter fluoride rinse. If you have more questions on fluoride treatments, make sure to ask Dr. Holtzen at your next visit to our office.

The benefits of many of the medications on the market outweigh the risks associated with xerostomia, however, with regular exams you can manage the risk and prevent many oral consequences of medications.

It's the end of summer, and fall is just around the corner. Soon the temperatures will cool down, the leaves will start to change, and Dr. Holtzen and our team at Alpine Oral and Facial Surgery are sure that you’ll soon be thinking about Halloween costumes and Thanksgiving plans in no time. But wait! First, we want to know about your favorite parts of the summer! Did you go on a wonderful family trip? Did you pick up a new hobby? Did you try to spend as much time outside and in the sun as possible?

Share your favorite memories, stories, or photos with us by leaving a comment below or on our Facebook page.

Labor Day honors the contributions that workers have made to this country, and for many Americans, the holiday is a great time to relax at home with family and friends. But there are quite a few people who celebrate the holiday by getting out of town, with an estimated 33 million people traveling more than 50 miles over Labor Day weekend each year. If you’re dreaming of a great Labor Day escape but you’re not quite sure where to go, here are a few ideas from our team at Alpine Oral and Facial Surgery to give you some travel inspiration.

Explore a National Park

On a national holiday like Labor Day, it’s only fitting to experience the beauty of America’s landscapes by heading to the nearest national park. If you’re confined to an office most days of the year, national parks can provide a relaxing and scenic escape, whether you’re by yourself, traveling with a group of friends, or bringing the whole family along. Depending on how close you live to the nearest park, you can stay for an afternoon or for longer than a week. With 58 parks located in 27 states, there are plenty of beautiful areas to choose from.

Chow Down in a BBQ Haven

Barbecuing is a popular Labor Day activity, but instead of sweating over your own grill or oven, try visiting one of the country’s BBQ capitals. U.S. News and World Report names Memphis as the top BBQ destination, with more than 80 BBQ restaurants in the city, most notably Corky’s BBQ and Central BBQ. Kansas City is also known for the sweet taste of its sauces, while central Texas is said to have perfected the technique of smoking tender and flavorful brisket.

Relax on the Beach

Many people think of Labor Day as the unofficial start of fall, which brings cooler temperatures, more rain, and for many people, an end to lazy days at the beach. End your beach days with a bang by taking a trip to one of the coasts or to a lakeside beach. For an added dose of festivity, find a city or town that celebrates the occasion with a fireworks display over the water.

Whether you’re looking to turn your getaway into a full week affair or you simply want to experience a quick escape, make the most of your holiday by changing your surrounding scenery. Happy Labor Day from the Oral Surgeon practice of Dr. Holtzen!

By no stretch is it rare for your gums to hurt during and after flossing. Even some bleeding is to be expected. This is especially true if you have not flossed in a long time. However, if your gums do indeed hurt when you floss, and unbearably so, there are some things you can do.

Be Gentle

Perhaps the most obvious way to combat gum soreness and bleeding is to be gentle. One of the most common occurrences of these gum problems is over-aggressive flossing. In other words, if you are too rough on your gums while flossing, either because you are out of practice or because you are in a hurry, soreness and hurting is to be expected. Instead, try taking your time and be gentle. Also, if you are just starting out, be patient and consistent, your gums will become more conditioned over time.

Use an Alternative Method

If being consistent and gentle does not work, there are other alternative methods of flossing that you can try. You can also try a water floss machine, or what is sometimes called a water pick. The device essentially shoots water into the crevasses between your teeth, and in other areas of your mouth, in order to dislodge food and plaque. These oral instruments also come with different attachments that allow you to reach many of the hard to see and reach areas of your mouth. And lastly, you can always buy floss that is not as abrasive to your gums. There is floss that comes with soft and gentle coatings that will do less harm to your gums while they are adjusting to the good oral hygiene habit you are creating.

Flossing is one of the easiest parts of oral hygiene to overlook. When you first start out, it is common that you may want to stop because of the pain it can initially cause. However, if you try one, or all, of the above mentioned methods, you will give yourself the best chance of being success with your flossing, and it won't hurt as much.

For more flossing tips, schedule an appointment at our Missoula or Hamilton office and askDr. Holtzen or a member of our team!

The electronic toothbrush has undergone several technological advances since the 1960s. Everything from design and bristle motions to rotation, oscillation, and sonic vibration has led to dramatic changes in this necessary tool over time.

Rotation oscillation happens when the head of the toothbrush rotates from one direction to the other. The benefit of powered toothbrushes is that they can produce 50,000 strokes per minute, compared to 300 strokes with a manual toothbrush.

When you’re thinking about brush head size, smaller brush heads are best for hard-to-reach areas and small mouths. Brush heads should be replaced every three to six months as needed. A good way to save money is to designate a brush head for each family member which can be taken on and off a shared base motor.

Having a base motor or rechargeable toothbrush can deliver enough power on a full charge for a week of brushing, which makes it convenient for travel or when life gets busy. Some toothbrushes include audible signals that let you know when to switch the area of your mouth you’re brushing or when a full two minutes has gone by.

Do you have sensitive teeth? Studies have indicated that people tend to apply more pressure on their teeth when they use a manual toothbrush. This makes an electric toothbrush a preferable option if you’re having issues with sensitive teeth or gums.

There are even electric models with pressure sensors that will stop the brush from spinning when you press too hard against your teeth!

Everyone can benefit from having an electric toothbrush. A large handle size can be taken into consideration if a member of the household is young, or has a physical disability or arthritis. They’re even recommended for children in order to maintain good oral hygiene from a young age.

Biofilm is a term used for plaque or debris that builds up in your mouth. If not properly addressed, this can cause serious bacterial infections to your gums and teeth. If you want to remove biofilm in the most efficient way, an automatic toothbrush is the way to go.

When you're ready to make your decision, make sure to consult with Dr. Holtzen at our Missoula or Hamilton office to decide which electric toothbrush is right for you!

Oral surgery can be used to treat many jaw related issues and is performed by an oral surgeon like Dr. Holtzen. Surgery that is performed on the jaw can ultimately help a wide variety of dental issues and also can help improve your appearance.

Corrective Jaw Surgery

Corrective jaw surgery is performed on patients who need dental abnormalities improved; this could include skeletal issues or even misalignment of the teeth and jaw. After surgery the patient will notice a quick improvement of breathing, speaking, and even chewing.

The most common jaw surgeries include the following issues:

• TMJ or TMD is caused when the joint that located in front of the ear causes a patient to suffer with headaches as well as pain in the face. Surgery is a last resort for this problem since many patients can get relief by taking medication, using splints, or going to therapy.
• People who are getting dentures can have surgery performed that will make sure that their new dentures will fit perfectly. Also, after a patient wears dentures for an extended amount of time it can cause the bones to deteriorate. A surgeon can add a bone graph that will stop this process from getting any worse.
• If a patient has a problems with their jaws not growing equally, surgery can help. Without surgery there may be issues with being able to eat or swallow as well as breathing and speaking clearly. Sometimes these issues can be addressed by wearing braces, but with severe cases surgery will be required.

Some other conditions that may need jaw surgery can include the following:

• Extreme wear and tear on the teeth
• Difficulty swallowing
• Difficulty chewing
• Open bite
• Birth defects
• Breathing through the mouth
• Sleep apnea

Jaw surgery can dramatically change your life. Dr. Holtzen will be able to tell if you will be a good candidate for jaw surgery to correct any dental issues you currently have. Contact our Missoula or Hamilton office to find out more.

It’s useful to know what your dentist does in comparison to an oral surgeon. You may end up needing to see the latter at some point in your life, so Dr. Holtzen and our team want you to understand the difference if you need to schedule an appointment with one of us.

Both dentists and oral surgeons are taught the skills to maintain a healthy mouth for their patients. They are both required to obtain a medical license after years of schooling, and some choose to go through additional to schooling to be able to treat specific areas of oral health.

Your general dentist is equipped to perform preventive care and treatment of teeth that show decay and damage. Cosmetic procedures such as teeth whitening and veneer placement are also common. However, in some circumstances, you may need an oral surgeon if the procedure you need to undergo exceeds your dentist’s abilities.

If you’ve been referred to Dr. Holtzen, it may be because you need the following procedure done:

• Dental implant surgery
• Removal of a problem tooth
• Oral cancer biopsies
• Removal of tumors or cysts
• Reconstructive surgery of the jaw or face to resolve various problems
• Corrective surgery of the jaw to improve structure and alignment
• Grafting of the bone or soft tissues in order to resolve defects and injuries
• Repair of birth defects that have affected the face or jaw

Staying vigilant about your daily oral health routine and bi-yearly dental appointments may prevent problems that require these services. However, it may be impossible to avoid some of these procedures.

If you have noticed a serious issue involving your oral health, contact our Missoula or Hamilton office and schedule a consultation. Our team will create a plan to treat you quickly and effectively.

Dr. Holtzen and our team at Alpine Oral and Facial Surgery get this question a lot. Wisdom teeth are the last teeth to come in, once young people get their adult teeth. Because they are the last teeth to break through the gums, they are often called the third molars. There are four wisdom teeth: two on each side of the top and bottom of the mouth.

There is no hard-and-fast rule that says everyone must have the wisdom teeth removed. There are certain situations in which they either cause problems directly, or create a situation where there is a greater likelihood problems will arise eventually.

Impacted wisdom teeth

If Dr. Holtzen and our team say you have a soft tissue impaction, it means your wisdom tooth is covered by gum tissue that is preventing it from erupting — most likely because your mouth is too small to provide the tooth with the room it needs to emerge.

The term “partial bony impaction” means that gum tissue is covering the wisdom tooth, but part of the jaw bone is also covering it, in which case there is no room in your mouth for the tooth to erupt. The opposite end of this spectrum is a complete bony impaction, where the wisdom tooth is completely covered by gum tissue and the jawbone, which prevent it from ever erupting.

The importance of removing impacted wisdom teeth

Dentists often want to remove impacted wisdom teeth because of the likelihood that they will cause problems, or because a problem already exists. One such problem is pericoronitis, an acute abscess that affects partially impacted wisdom teeth. Food, bacteria, and other mouth debris can become lodged under the gum flap that covers the wisdom tooth, which prevents it from erupting. Pericoronitis symptoms include pain, swelling, and the presence of an abscess.

Regular dental checkups will enable your dentist to keep an eye on your wisdom teeth, especially if they have some type of impaction. Dr. Holtzen and our team at Alpine Oral and Facial Surgery typically recommend removal of impacted wisdom teeth because of the likelihood that severe infections such as pericoronitis will develop.

If you have any questions about wisdom teeth, or if you would like to schedule an appointment with Dr. Holtzen, please give us a call at our convenient Missoula or Hamilton office!

You’re parents, so you worry. It comes with the job description! That’s why you make regular appointments with your children’s doctors and dentists for preventive care and examinations. That’s why you make sure your kids wear mouth guards and other protective gear when playing sports. And that’s why you want to know all about the X-rays that are used when your children need dental treatment.

First of all, it’s reassuring to know that the amount of radiation we are exposed to from a single dental X-ray is very small. A set of bitewing X-rays, for example, exposes us to an amount of radiation that is approximately the same as the amount of radiation we receive from our natural surroundings in a single day.

Even so, doctors are especially careful when children need X-rays, because their bodies are still growing and their cells are developing more rapidly than adults. And children often have different oral and dental needs than adults, which can require different types of imaging.

In addition to the usual X-rays that are taken to discover cavities, fractures, or other problems, young patients might need X-rays from their dentists or orthodontists:

• To confirm that their teeth and jaws are developing properly.
• To make sure, as permanent teeth come in, that baby teeth aren’t interfering with the arrival and position of adult teeth, and that there’s enough space in the jaw to accommodate them.
• To plan orthodontic treatment.

And if your child has any dental or medical conditions that can best be treated by an oral surgeon, diagnostic X-rays might be needed. Dental X-rays are used, for example, in order to:

• Check the progress and placement of wisdom teeth before they are extracted.
• Locate fractures, breaks, or other damage to the teeth and jaws after an accident or injury.
• Discover and treat damage or infection which recurs after root canal work.
• Diagnose and plan treatment for conditions which might require corrective jaw surgery.
• Facilitate the placement of dental implants when children have lost or missing teeth. Because young jaws are still growing, this placement requires special care.

So, how do oral surgeons and radiologists make sure your child’s radiation exposure during any X-ray procedure is as minimal as possible?

Radiologists, the physicians who specialize in imaging procedures and diagnoses, recommend that all dentists and doctors follow the safety principal known as ALARA: “As Low As Reasonably Achievable.” This means using the lowest X-ray exposure necessary to achieve precise diagnostic results for all dental and medical patients.

Moreover, radiologists are devoted to raising awareness about the latest advances in imaging safety not only for dental and medical practitioners, but for the public, as well. With children in mind, pediatric radiologists from a number of professional associations have joined together to create the Image Gently Alliance, offering specific guidelines for the specific needs of young patients.

And because we are always concerned about the safety of our patients, medical and dental associations around the world, including the American Association of Oral and Maxillofacial Surgeons, the Academy of Pediatric Dentistry, the American Dental Association, the American Dental Hygienists’ Association, the Canadian Academy of Pediatric Dentistry, and the Canadian Dental Hygienists Association, are Image Gently Alliance member organizations.

The guidelines recommended for X-rays and other imaging for young people have been designed to make sure all children have the safest experience possible whenever they visit the dentist or the doctor. As oral surgical specialists, Dr. Holtzen and our team work to restore children’s smiles through many different procedures, and we ensure that imaging is safe and effective in a number of ways:

• We take X-rays only when they are necessary.
• We provide protective gear, such as apron shields and thyroid collars, whenever needed.
• We make use of modern X-ray equipment, for both traditional X-rays and digital X-rays, which exposes patients to a lower amount of radiation than ever before.
• We set exposure times based on each child’s size and age, using the fastest film or digital image receptors.

We know your child’s health and safety are always on your mind, so you’re proactive about medical and dental care. And your child’s health and safety are always on our minds, too, so we’re proactive when it comes to all of our medical and dental procedures.

Please free to talk with our Missoula or Hamilton team about X-rays and any other imaging we recommend for your child. We want to put your mind at ease, knowing that X-rays will be taken only when necessary, will be geared to your child’s age and weight, and will be used with protective equipment in place. Because ensuring your child’s health and safety? That comes with our job description!

At Alpine Oral and Facial Surgery, we have been creating beautiful smiles for years. Whether you have visited Dr. Holtzen and our team for a week or for your entire life, we would love to hear your thoughts about your experience! In fact, we encourage you to leave a few words for us below or on our Facebook page!

We look forward to reading your feedback!

The dog days of summer are upon us, and what better time for Dr. Holtzen and our team to ask our patients about their summer!

Whether you visited our nation’s capital, went on a camping trip, or just stayed in Missoula or Hamilton and relaxed, we want to know how you’re all spending your summer! Please feel free to share your summer plans and experiences with us below or on our Facebook page as summer rolls on!

Every year, Americans all over the world celebrate the birth of the country and its independence on the Fourth of July. There are countless ways that people celebrate and they range from community parades and large scale gatherings to concerts, fireworks displays, and smaller scale celebrations among family and friends. For some people, July 4th is synonymous with baseball, while for others it is all about the beach of barbecues. However you celebrate, you can be sure that red, white, and blue is visible everywhere throughout the area.

The Beginnings of Fourth of July Celebrations

Although it wasn't officially designated as a federal holiday until 1941, the actual tradition of celebrating Independence Day goes back to the time of the American Revolution (1775 – 1783). At the time of the American Revolution, representatives from the 13 colonies penned the resolution that ultimately declared their independence from Great Britain. The continental congress voted to adopt the Declaration of Independence on July 2nd of 1776. Two days later, Thomas Jefferson's famous document that is now known as the Declaration of Independence, was adopted by delegates representing the 13 colonies.

First States to Recognize the Fourth of July

In 1781, Massachusetts became the first state (or commonwealth) whose legislature resolved to designate July 4th as the date on which to celebrate the country's independence. Two years later, Boston became the first city to make an official designation to honor the country's birth with a holiday on July 4th. In that same year, North Carolina's governor, Alexander Martin, became the first governor to issue an official state order stipulating that July 4th was the day on which North Carolinians would celebrate the country's independence.

Fun Facts About the Fourth of July

• The reason the stars on the original flag were arranged in a circle is because it was believed that would indicate that all of the colonies were equal.
• Americans eat over 150 million hot dogs on July 4th.
• Imports of fireworks each year totals over $211 million.
• The first “official” Fourth of July party took place at the White House in 1801.
• Benjamin Franklin didn't want the national bird to be the bald eagle. He believed that the turkey was better suited to the coveted distinction. John Adams and Thomas Jefferson disagreed with him, and he was outvoted, so the bald eagle became the official bird of the United States.

For many, the tradition is something entirely different. Along the coastal areas of the United States, people may haul out huge pots to have lobster or other types of seafood boils. Others may spend the day in the bleachers at a baseball game, or at a park, cooking a great traditional meal over an open fire. No matter how or where you celebrate, one thing is certain: all Americans celebrate July 4th as the birth and independence of our country.

Dr. Holtzen and our team at Alpine Oral and Facial Surgery wish you a safe and happy Fourth of July!

The community health awareness group Oral Health America has reported that 82 percent of adults are unaware of the role that infectious bacteria can play in tooth decay or cavities, and almost three out of five children aged 12 to 19 have tooth decay. Since June is National Smile Month, Dr. Holtzen and our team at Alpine Oral and Facial Surgery thought we’d remind our patients about the importance of good oral hygiene visits between office visits.

To keep your family’s smiles healthy and beautiful for years to come, be sure to:

• Brush at least twice a day with fluoride toothpaste
• Floss every day to clean between your teeth
• Eat a healthy, well-balanced diet
• Reduce your intake of sugary foods and drinks
• Visit Dr. Holtzen for scheduled appointments

If you want to know more about healthy home care habits, feel free to ask our team at your next appointment, or ask us on Facebook!

Memorial Day is not only a federal holiday in the United States, but it is a day of observance and remembrance of those who died in service. Originally known as Decoration Day, this solemn day has been marked on calendars since the end of the American Civil War as a day to commemorate both the Confederate and Union soldiers who fought and died in the war.

Marking the graves of fallen soldiers with flowers, wreaths, or other tokens has been practiced throughout history, but it wasn't until the mark of the end of the Civil War that a special day was decided upon as the one to spend in remembrance. By 1890, every state in the country was observing Decoration Day. It wasn't until 1967 when the name formally changed from Decoration Day to Memorial Day, in order to encompass all fallen American soldiers in all wars and conflicts. In June of 1968, Congress moved the official date of Memorial Day to the last Monday in May in order to create a three day weekend.

Today, while there is certainly an air of remembrance on Memorial Day, it has become more a day of spending time with family, friends, and other loved ones. This day is also heralded as the start of summer, with many schools finishing for the year around this time. Our team at Alpine Oral and Facial Surgery remembers it as a day to take solace and remembered those lost.

Traditional observances of Memorial Day are still held, and they often involve raising the American Flag then lowering it to a half-staff position until noon, and then raising it once again to its full height afterwards. The flag is lowered to remember those who've lost their lives while in service to their country, and then it is raised to signify our willingness to not let their sacrifice be in vain.

From community parades in the Missoula or Hamilton area, backyard cook-outs, and fireworks to formal ceremonies, Memorial Day is commemorated in many different ways. No matter how you choose to spend this day, take a moment to remember those who've lost their lives in an effort to preserve our freedom.

If you’ve been following a vegetarian or vegan diet, you know that there’s much more to living a healthy life than simply avoiding meat products. Making sure your diet includes enough protein, as well as any nutrients that are primarily available in animal products, takes planning, and there’s no one-menu-fits-all solution.

Why? Because there’s no one menu that will suit all vegetarians. Specific vegetarian diets can allow for many different options:

• Vegan—a plant-based diet which excludes meat, fish, dairy, and egg products
• Ovo-vegetarian—includes eggs as a dietary option, but no dairy
• Lacto-vegetarian— includes dairy as a dietary option, but no eggs
• Lacto-ovo-vegetarian—a meat-free diet which allows both dairy products and eggs

If you are a pescatarian, who eats fish on occasion, or a flexitarian, who sometimes includes meat in a meal, your menu options are even broader.

So let’s look at the big picture—a healthy vegetarian diet is really more concerned with the foods you do eat for nutrition rather than the foods you don’t. You can create a meal plan rich in all your essential nutrients with a little research, no matter which type of vegetarian diet is your go-to choice.

And while you’re constructing your ideal menu guidelines, don’t forget about your dental nutrition!

In terms of keeping your teeth and gums their healthiest, what important vitamins and minerals are often missing from vegetarian and vegan diets? Let’s look at three of them.

• Calcium

Calcium is essential for maintaining strong bones and tooth enamel. Without enough calcium, a weakened jawbone leads to loose, and even lost, teeth. The acids in our food and the acids created by oral bacteria also weaken the minerals in enamel, including calcium. These weak spots can eventually become cavities. A diet rich in calcium not only supports the bones holding our teeth, but can even help repair, or remineralize, enamel which has been weakened by acidic erosion.

For vegetarians who include dairy in their diets, dairy products are a great way to include calcium. Milk, cheese, and yogurt are traditional and rich sources of this mineral.

For vegans, it’s a bit more challenging, but still doable! Non-dairy foods providing calcium include dark green vegetables (kale, broccoli, spinach), certain types of tofu, and fortified cereals, juices, and non-dairy milks.

• Vitamin D

Now you’re ready to put that calcium to work by making sure you have enough vitamin D in your diet. Vitamin D not only helps keep our bones healthy, it also enables our bodies to absorb calcium. Bonus—it’s been linked to better gum health in several studies.

So how to get more vitamin D? If you eat dairy, most dairy products have been fortified with vitamin D. If eggs are a part of your diet, egg yolks are a great source. Pescatarians can enjoy the benefits of vitamin D from fatty fish such as tuna and salmon.

Because we get most of our vitamin D from sun exposure or foods derived from animals, plant-based foods are not a practical way to obtain the vitamin D you need. But, just as non-vegetarians can get plentiful vitamin D from fortified dairy products, vegans also have options. Try adding cereals, juices, and non-dairy milks fortified with this essential nutrient to your diet, or take a vegan vitamin D supplement.

• Vitamin B12

Vitamin B12 is essential for healthy red blood cells, nerve cell development, brain function, and DNA production. (This is why it’s especially important for pregnant and nursing women.) Vitamin B12 can also impact your oral health. A B12 deficiency can cause a swollen, sore, or inflamed tongue, loss of taste, and gum, tongue, and mouth ulcers.

Unfortunately, vitamin B12 is reliably found only in animal foods and nutritional yeasts. If you would prefer an egg-free and dairy-free diet, look to B12 supplements or B12-fortified cereals, plant-based milks, energy bars, and other vegan options. This is a good subject to discuss with your physician, because even supplements and fortified foods might not provide enough B12.

In fact, Dr. Holtzen can be vital resources when you’re planning your healthiest vegetarian diet. The next time you visit our Missoula or Hamilton office, ask for recommendations for supplements if you’re concerned that diet alone can’t provide for all of your nutrition essentials. Finally, care should be taken to ensure that, even with supplements, you get the proper amount of the vitamins and minerals you need.

As a vegetarian, you are used to the concept of care. Whether it was concern for nutrition, the planet, the animal world, or another reason that drew you to a vegetarian diet, be sure to care for your body as well as your dietary choices. Careful planning can ensure a diet which supports not only your general health, but your oral health, for a lifetime of nourishing—and well-nourished—smiles.

TMJ is the quick way of referring to your Temporomandibular Joint. Pardon the pun, but that’s quite a mouthful! What is this joint, what does it do, and, if your doctor or dentist has told you that you have a TMJ disorder, what can Dr. Holtzen do to help?

The Temporomandibular Joint

Your two temporomandibular joints are amazing works of anatomical design. These are the joints where the temporal bone in the skull meets the mandible bone of the jaw, and allow our mouths to open and close, move back and forth, and slide from side to side. Muscle, bone and cartilage work together to provide easy movement and to cushion the joint. But sometimes, the joint doesn’t work as smoothly as it should, and this can lead to Temporomandibular Joint Disorder, or TMD.

When Should You Suspect You Have TMD?

You might have TMD if you experience any of these symptoms:

• Painful chewing
• Pain around your TMJ, or in your face or neck
• Earaches
• Changes in your bite
• Jaws that are limited in movement or lock open or shut
• Clicking, popping or grating noises when you open and shut your jaw

There are many conditions linked to TMD. If you grind your teeth at night, have arthritis in the jaw, have suffered an injury or infection in the area, or have problems with your bite, for example, you might be more likely to experience TMJ problems. If you suspect you have TMD, or suffer from any of the symptoms listed above for an extended period, an oral surgeon like Dr. Holtzen can provide the answers you’re looking for.

Why Choose an Oral and Maxillofacial Surgeon?

Oral and maxillofacial surgeons have a minimum of four years of advanced studies in a hospital-based residency program, where they train with medical residents in the fields of general surgery, anesthesiology, internal medicine, and other specialties with a specific focus on the bones, muscles, and skin of the face, mouth, and jaw. They are uniquely qualified to diagnose and treat a complex disorder such as TMD.

How Do We Treat TMD?

First, we will check your medical history, and begin with a careful examination of the joint, its movement, and the structures of the head and neck surrounding it. When necessary, we will use imaging studies for further examination of the joint. If indicated, a conservative treatment plan might be recommended:

• Anti-inflammatory drugs and/or over-the-counter pain relievers, ice packs, moist heat compresses
• A custom-fitted mouthguard, bite plate, or bite splint to reduce the effects of bruxism, or teeth grinding
• Orthodontic treatment for a malocclusion (bad bite)
• Physical therapy, which might include exercises for the jaw muscles
• Behavior modification, with techniques to avoid jaw pain (giving up gum chewing, jaw clenching, nail biting), and techniques for relaxation and stress relief.

If these treatments aren’t successful, or if there is damage to the joint, we might suggest surgical options.

• Arthroscopy, a minimally invasive surgical procedure performed under anesthesia, in which a thin tube with a video lens and light is inserted through a small incision in front of the ear. This technology allows us to get a good look at the joint and the area surrounding it. Depending on the results of our examination, arthroscopic surgery might be used to repair joint damage.
• Arthroplasty, surgery performed under anesthesia, can repair, replace, or reposition damaged parts of the joint. For example, surgery can remove bony growths, repair damage to the articular disc (which cushions your joint) or replace it, and access areas which an arthroscopy can’t.

Luckily, most cases of TMD are temporary and don’t become worse over time. But any persistent discomfort is a good reason to visit our Missoula or Hamilton office. Whether you have TMD, or any other problem causing you pain in the head or jaw, the causes for your temporomandibular joint discomfort can be complicated. We have the unique surgical training and experience to diagnose and treat these remarkable joints.

Sometimes, despite our best care, we lose a tooth. If it is a front tooth, it will probably be a high priority for replacement. But if a missing tooth doesn’t show when we smile, what’s the hurry? Let’s look at the reasons why prompt replacement with an implant is always a good idea, no matter which tooth is involved.

1. Appearance

Implants look like natural, individual teeth, but that is not the only aesthetic reason to replace a lost tooth. Without some type of tooth replacement, missing teeth can eventually affect the structure of our jawbones and change our facial appearance. Cheeks, lips, profiles—all are impacted by the changes in our bones resulting from tooth loss.

1. Better Bite

Nature abhors a vacuum, and so do our teeth. When a space is left by a missing tooth, the teeth around the area can shift position, affecting the even pattern of our bite. And without a tooth to keep it in place, a tooth above or below the missing one might begin to grow longer to fill the void in your bite. This lengthening, in turn, can cause even more bite problems.

1. Chewing

With the loss of only a single tooth, there is a negative impact on the remaining teeth. More pressure is placed on the other teeth in order to chew properly, front teeth not meant for chewing might be used for that purpose, or food is not chewed as thoroughly as it should be. The first two problems are not healthy for our teeth, and the last one is not healthy for digestion!

1. Don’t Delay

Changes in bite and chewing problems probably won’t happen overnight, so is putting off the process really a big deal? It can be! Time is not on our side when a tooth is lost. The bone tissue which supports our teeth needs the stimulation of biting and chewing to stay healthy. Without that stimulation, the bone area under the missing tooth gradually shrinks. If there is not enough bone area left, you might need surgical bone grafting to achieve the right bone height to hold an implant, or it could lead to the impossibility of placing an implant at all.

1. Expense

Replacing a lost tooth quickly requires less restoration of the gums and bone in the future and prevents other serious problems from developing.

We could continue through the alphabet, but instead, come talk to Dr. Holtzen about all the reasons a tooth implant might be your best option. Oral surgeons have years of advanced surgical training, and specialize in the diagnosis and treatment of medical conditions in the face, mouth, and jaw. Whether you have already lost a tooth, or if you have an extraction scheduled at our Missoula or Hamilton office, we are uniquely qualified to recommend the best treatment plan to ensure your smile is beautiful, healthy, and complete!

Earth Day began in 1970 as an event to raise awareness of our environment. What began as a single day in April is now recognized around the world to bring attention and education to global environmental issues. Conserving our natural resources, reducing water and air pollution, and developing green technologies are all ways in which we can improve the environment around us.

Reduce, Recycle, and Reuse

One of the easiest ways to participate in Earth Day is by simply reducing the amount of refuse that ends up in landfills. Many communities have recycling programs for paper, plastic, and metal refuse. By keeping recyclable items out of landfills, we reduce the need for new disposal space and the amount of energy needed for burning refuse. Recycling products also helps conserve the resources that are used in making new products.

You can save money by reducing your consumption of many everyday products. Single disposable water bottles can be recycled but they are costly. By using filtered faucet water, you can conserve your financial resources. Disposable paper towels can also be wasteful. Consider reusable cleaning rags for the majority of your chores.

Reusing items saves both the environment and your finances. A large number of products can be re-purposed to create a new item. Old furniture can be remade into a new piece. Old clothing can be used for craft items. If you are not able to find ways to reuse your old items, donate them to a charity. Remember to continue your positive environmental steps on a daily basis.

Other things you can do to improve the environment

Everyone, young or old, can find ways to participate in improving the environment. Some ideas include:

• Planting trees
• Picking up litter
• Reducing energy consumption
• Walking, bicycling, or carpooling to work or school
• Disposing of hazardous waste properly
• Using rain barrels to conserve water for plants

Earth Day is designed to appreciate and celebrate the health of the earth. Keeping the earth healthy is important, but keeping your mouth healthy is important, too. Healthy teeth and gums contribute to your overall health and well-being, so remember to call our team at Alpine Oral and Facial Surgery to schedule an appointment. Have a happy and healthy Earth Day, from Dr. Holtzen!

One of the most transformative advancements in dental restorations is the dental implant. Implants look just like natural teeth, they function just like natural teeth, and they help maintain jawbone health just like natural teeth. But the success of any implant procedure depends on the quality and quantity of the bone in which it’s placed. That’s why, before placing your implant, Dr. Holtzen might first suggest a common procedure known as ridge modification.

An implant consists of a metal post which is surgically placed in the jawbone. This post serves as the “root” of the dental implant. After several months, the post fuses with the bone surrounding it, as bone tissue grows around and attaches to the post surface. This process is called osseointegration, and it creates a strong, secure anchor for the abutment and crown which will be secured to the post when it heals.

Because of the strong pressures which biting, chewing, and clenching put on our teeth, the success of an implant depends on the strength of its integration into the jawbone. To make osseointegration possible, the bone must be healthy, with adequate size and density to hold the implant securely.

Ridge modification, also called ridge augmentation, is a kind of oral surgery. In this procedure, we use bone grafting to rebuild bone strength in the alveolar ridge (the part of the jawbone containing the tooth sockets) before placing a post. When is this procedure necessary?

Jawbone size and density can be compromised in several different ways, including:

• Resorption

When a tooth is missing, the bone ridge under the lost tooth gradually begins to shrink, a process called “resorption.” Over time, bone loss can lead to a noticeable indentation in the jawbone.

• Periodontitis

Serious gum disease is progressive. Without treatment, the gums begin to pull away from the teeth. This leaves bone and connective tissue exposed to destructive bacteria and infection, which can cause bone loss.

• Trauma

Bone damage caused by accident or injury might require bone replacement or recontouring.

• Bone structure and size

Sometimes the jaw ridge is too narrow or shallow to support an implant, especially in the back of the upper jaw near the sinus cavity, and will need added bone before an implant can be placed.  

Oral surgeons are specialists in bone grafting surgery, with years of medical and surgical training in the complex structure and interaction of bone, muscle, and nerve. We are experienced in providing patients with skillful, safe, and effective bone grafts, and will recommend this procedure when the success of your implant would be in jeopardy without it.

What will your surgery involve?

• Assessing bone quantity and quality

Using advanced imaging technology, we will evaluate your jaw’s condition, and map out any areas of bone loss.

• Designing your treatment plan

If a bone graft is your best option, we will recommend the best grafting materials for your needs. Bone grafting might use bone tissue taken from your own body, processed bone grafting material, or synthetic grafting material to replace and repair the damaged bone. We will also discuss your anesthesia and sedation options.

• Performing the Surgery

After anesthesia, an incision will be made in the gum tissue to reveal the damaged or missing bone. Grafting material will be shaped to restore the bone’s contours and secured to the affected area. The incision will then be closed. If you are here for an extraction, it may be possible to have augmentation done as part of the same procedure.

• Providing follow-up care

You’ll receive detailed careful instructions for after care and follow-up visits at our Missoula or Hamilton oral surgery office. The time it takes for you to heal completely will depend on the size and type of your graft.

• Placing your implant

Once the bone has healed, we can surgically place the post for a secure, long-lasting, and healthy implant.                  

If it’s been some time since you lost a tooth, if your jaw has been damaged by injury or trauma, if you have less-than-adequate bone size and density, it’s important to restore your bone before implant surgery can be successful. See us for an evaluation, and learn how a ridge modification procedure can help you improve your dental health and transform your smile.

Poor April. While other months celebrate romance, or giving thanks, or costumes and candy, April has—April Fool’s Day and a tax deadline. We might be forgiven for thinking these two dates seem more like warnings than celebrations.

So here’s a new topic for the April calendar: National Facial Protection Month! Take the opportunity this month to review your safety practices while you’re enjoying your favorite activities.

• Mouthguards

If you have a mouthguard for sports or athletic activities, wear it! In any activity or sport where humans come into contact with solid objects (including other humans) tooth injury is possible. A mouthguard will help protect you from dental injuries caused by falls, physical contact, or other accidents that might happen in your active life. And it’s not just your teeth—mouthguards protect your lips, tongue, cheeks, and jaw as well.

You can buy mouthguards in stock sizes or shape-to-fit models, or you can have a guard custom made especially for you at our Missoula or Hamilton office. Custom mouthguards fit perfectly and are designed to make breathing and speaking easy and comfortable. And if you wear braces or have fixed dental work such as a bridge, a custom mouthguard can protect your smile and your appliance.

• Helmets

If there’s a helmet available for your sport, use it! Helmets are especially important for protecting athletes from brain injury and concussion, and they help protect the face and jaw as well.

• Face Guards

If you’ve experienced a puck speeding toward you, or a defensive tackle hurtling your way, or a fast ball coming in at 90 miles an hour, you know the importance of wearing a face guard. These guards can help protect your eyes, face, teeth, and jaws. Many sports now recommend using face guards—it’s worth checking to see if your sport is one of them.

• Eye Protection

And let’s not forget eye protection. Whether it’s safety glasses or a visor, protecting your eyes and the bones around them is extremely important. You can even get sports goggles or protective sports glasses with prescription lenses to keep you safe and seeing clearly.

Oral surgeons, like Dr. Holtzen, have years of special training to help restore function and appearance to injured faces, mouths, and jaws. But as we will be the first to tell you, the very best treatment is prevention!

So here are a few suggestions for your calendar this month:

• If you haven’t gotten a mouthguard yet, now’s the time. Tooth and mouth injuries occur in sports beyond hockey and football. If you play basketball, ski, skateboard, ride a bike—in fact, almost any sport where you can fall or make contact with a person or object—a mouthguard is a must.
• If you need to replace an ill-fitting or damaged helmet and face guard, do it before your next game. And do replace a bike helmet if you’ve been in a crash—most likely it won’t be as protective, even if damage isn’t visible.
• Talk to your eye doctor about protective eyewear if off-the-rack products don’t work for you.
• If you are a parent or caregiver, make sure your child athlete has the proper facial protection—and uses it.
• If you are a coach, make sure your athletes have the right protective gear—and wear it.
• It’s also a great time to commit to using your protective gear every single time you’re active.

But, wait—these reminders are helpful and important, but weren’t we promised something to celebrate this April? Good catch! The great news is, using facial protection for sports and athletic activities gives you rewards you can celebrate all year: fewer injuries, fewer visits to the emergency room, and a beautiful, healthy, intact smile. Suit up!

Orthognathic surgery is surgery to correct a wide variety of abnormalities of our patients' jaw and teeth. The surgery is often done in conjunction with orthodontic treatment. While the patient’s appearance may be significantly improved as a result, the primary purpose of the surgery is to correct functional problems including but not limited to:

• Unbalanced facial appearance
• Protruding jaw
• Open bite (upper and lower teeth don’t overlap properly
• Excessive wearing down of the teeth
• Difficulty with chewing or biting
• Chronic mouth breathing
• Sleeping problems such as sleep apnea
• TMJ pain (jaw joint pain)
• Restoring facial injuries

Knowing when to start the orthodontic treatment in preparation for orthognathic surgery can also be tricky if our team at Alpine Oral and Facial Surgery is treating a teenager. It is important to know when to get started. If orthodontic treatment is initiated too soon and the teenager is still growing, the patient will either need to hold in braces until his or her growth is complete and they are ready for surgery or the braces will have to be removed and then placed again when growth is complete. Neither of these options is attractive since it requires longer time in treatment, which is something all our patients want to avoid. Our team at Alpine Oral and Facial Surgery strives to get all patients finished with treatment as quickly as possible because it is healthier for the teeth and gums and gives them a beautiful smile to enjoy for a lifetime.

If you are considering orthognathic surgery or you have been told that you need jaw surgery, give us a call to schedule your initial consultation today. Dr. Holtzen and our team at Alpine Oral and Facial Surgery will explain our treatment plan in a way you will understand and we will keep you informed every step of the way.

Whether it’s a broken tooth or injured gums, a dental emergency can interfere with eating, speaking, or other day-to-day activities. According to the American Dental Association , you can sometimes prevent dental emergencies like these by avoiding the use of your teeth as tools or by giving up hard foods and candies.

Even if you take excellent care of your mouth, however, unexpected dental problems can still arise. Our team at Alpine Oral and Facial Surgery is available 24 hours a day, seven days a week to assess and resolve your individual situation. When an emergency arises, you should immediately make an appointment with our office so we can put you at ease, give you the best possible care, and help you return quickly to your regular routine.

Damaged Teeth

For tooth damage in particular, don’t hesitate to call and schedule an emergency dental appointment. You should come in as soon as possible. However, if you have some time before your appointment there are a few things you can do to avoid further injury. If you break your tooth, clean the area well by rinsing it with warm water. To ease any discomfort, put a cold compress against your skin near the area with the affected tooth.

A dislodged tooth should be handled carefully in order to keep it in the best possible condition. Gently rinse off the tooth without scrubbing it and try to place it back into the socket of your gums. If it won’t stay in your mouth, put the tooth in a container of milk and bring it along to your dental appointment.

Injured Soft Tissues

For other problems, such as bleeding gums or an injured tongue, cheek, or lip, the Cleveland Clinic recommends gently rinsing your mouth with salt water and applying pressure to the site with a moist strip of gauze or a tea bag. If you’re also experiencing some discomfort, you can put a cold compress on your cheek near the area of the bleeding. If the bleeding continues, don’t hesitate to contact our office so you can receive further help.

A dental emergency may catch you off guard, but Dr. Holtzen can provide fast, pain-free treatment. Follow the advice above and set up an appointment with us as soon as possible so you can put your teeth and mouth on the road to recovery.

Millions of people, around Missoula or Hamilton and beyond, wear green on St. Patrick’s Day so they can show their spirit for the holiday and avoid getting pinched. While it may be easy for you to throw on a green shirt, sport a St. Patrick’s Day button, or wear a pair of emerald-hued shoes, if you’re an avid St. Patty’s Day enthusiast you may want to try something different this year. Dr. Holtzen thought of a few ideas that will help you take your holiday spirit to the next level:

Visit Chicago’s Green River

If you happen to be near the Windy City during St. Patrick’s Day or you’re thinking of planning a trip, don’t miss out on going downtown to watch the large-scale celebration that kicks off when the city dyes the river bright green. According to the Chicago Sun-Times, Chicago has been celebrating the holiday with this tradition for more than 50 years, with tens of thousands of people gathering annually to witness the mysterious dying process and the stunning result.

Don Green Face Paint

Just like an avid sports fan on game day, you can use green face paints to showcase your enthusiasm for this holiday. Avoid breakouts or allergic reactions by only using paints that are specifically meant to be applied to the skin. A little bit of face paint can cover a large area, so feel free to get creative and decorate the whole family on St. Patrick’s Day.

Eat Green All Day

Not a fan of green eggs and ham? With the increasing popularity of green smoothies, there’s no better time to get in on this health craze. To create a green smoothie without the aid of food coloring, you can simply blend a generous amount of a leafy green vegetable, such as spinach or kale, with the ingredients that you would typically use to make a smoothie, like fruit, ice, milk, or juice. Keep the trend going throughout the day by using those same vegetables to create a green soup, egg salad, or a batch of bright green pastries. As an added bonus, you’ll get a healthy dose of vitamins without changing the taste of most of these foods.

If your old holiday routine has gotten stale, leave your green T-shirt in the drawer and try one or all of these tips. Don’t be surprised if you have so much fun that you decide to start a new, annual St. Patrick’s Day tradition! Have a happy St. Paddy’s day from Alpine Oral and Facial Surgery!

Happily, a root canal is usually all that you need to treat an infection in your inner tooth. But when inflammation or infection returns at the tip of the root, or in the bone surrounding the tip, your dentist may recommend that you see an oral and maxillofacial surgeon like Dr. Holtzen for further diagnosis and treatment.

And often when pain, inflammation, or infection recur after a root canal, we may suggest an apicoectomy—a procedure that can save your natural tooth and prevent further infection or damage to the neighboring bone and teeth.

• Just what is an apicoectomy?

The tip of a root is also called its “apex.” An apicoectomy means the surgical removal (“ectomy”) of the apex (“apico”) of a tooth’s root.

• How does the procedure work?

Often local anesthesia is all that is needed. (But if you have concerns, talk to us about your anesthesia and sedation options. We are expert in all forms of anesthesia.)

After the area is numb, an incision is made in the gum tissue to allow access to the root and any affected bone tissue.

Dr. Holtzen will carefully remove the tip of the root and any damaged or infected tissue from the bone surrounding it. The root end will then be cleaned and sealed.

Stitches or sutures will be used to close the incision, which will either dissolve on their own or which will be removed on a follow-up visit. We will let you know just how to take care of the site after surgery.

In general, any pain or sensitivity after the procedure can be treated with over-the-counter anti-inflammatory pain relief such as ibuprofen. Patients should follow post-op instructions carefully to reduce any swelling, and be sure to follow any dietary suggestions and restrictions.

• Why choose an oral and maxillofacial surgeon for your apicoectomy?

An oral and maxillofacial surgeon has the training and skill to perform this specialized procedure. After dental school, oral surgeons pursue four to six years of additional advanced medical studies at a residency-based hospital.

They train with medical residents in the fields of anesthesiology, general surgery, internal medicine, and other surgical areas, concentrating on the bone, skin, and muscle of the face and jaw. They are uniquely qualified to diagnose and treat oral conditions that require a surgical solution, and routinely perform procedures such as apicoectomies.

Happily, a root canal is usually all that you need to treat an infection in your inner tooth. But if you have recurring or new pain or infection after a root canal, and if you want to preserve your natural tooth, an apicoectomy at our Missoula or Hamilton office is an option well worth investigating.

Dental implants are a marvel! They look just like your natural teeth, and, even better, they function just like your natural teeth. So, when you’re planning on a dental implant after an extraction, you want to make sure that your implant has the best chance of success—and we do, too. That’s why we might recommend a socket preservation procedure, where socket grafting takes place immediately after your extraction.

What is a socket graft, and what does it “preserve”? Let’s take a closer look.

Socket Preservation—A Logical Choice After Extraction

You’ve decided on a dental implant for some excellent reasons.

• A missing tooth can change the appearance of your smile.
• Your remaining teeth might shift to fill the empty space, causing alignment and bite problems.
• A lost tooth affects the amount, shape, and health of the bone surrounding your teeth.

No one wants to lose a tooth, but sometimes, due to injury or decay, an extraction is the only choice for your oral health. Seeing an oral and maxillofacial surgeon is especially important for complex extractions, when you have impacted or fractured teeth, roots close to nerves, or other complications which require surgical treatment.

After your tooth is extracted, if the socket bone holding the tooth is perfectly healthy, we might be able to place an implant post in the socket right away.

But often, even with a simple extraction, bone needs time to heal before placing an implant post, and you risk losing the bone size and density you need to make a future implant possible. How can you lose bone? That’s an unfortunate consequence of losing teeth. Teeth are important not just because they let us eat comfortably—they also help maintain bone health.

Without the stimulation of biting and chewing, the bone beneath the teeth begins a process called resorption. As older cells are absorbed back into the body, new bone cells aren’t produced as quickly to replace them. The alveolar bone, the thick ridge of the jaw which holds our sockets, shrinks in size. As the bone gets smaller, gum tissue shrinks around it, causing a sunken spot where your tooth used to be.

For a dental implant to anchor successfully in the jawbone, you need healthy bone that is high enough, wide enough, and dense enough to hold the implant post securely as it fuses with the bone.

A socket graft at the time of extraction provides two important benefits: grafting material fills the empty socket immediately, preserving the bone and gum area around it, and the graft material acts as scaffolding for new bone growth, creating a firm, dense foundation for your implant.

Grafting materials are gradually and safely absorbed as your new, healthy bone tissue replaces them. The result, after several months of healing, is an alveolar ridge with normal height and width and with the density needed to anchor an implant successfully.

The Grafting Procedure

Grafting material comes in different forms, including allografts (made from donor bone), synthetic grafts (made from synthetic materials which function like bone tissue), and autografts (bone taken from your own body). Growth factors may also be included in the grafting material to encourage new cell growth. Dr. Holtzen will recommend the type of graft which will work best for you.

A socket preservation procedure will frequently involve the following steps:

• Local anesthesia to numb the area before your extraction. You might choose sedation options as well, which we’re happy to discuss with you in advance.
• Careful cleaning of the site after the tooth is extracted.
• Filling the empty socket with bone grafting material.
• Placing a barrier or membrane over the graft to protect it as it heals.
• Suturing the surrounding gum tissue.

Aftercare Treatment

Aftercare treatment for a socket graft is a lot like the treatment for a tooth extraction. You’ll need to be careful around the graft area for several days as it heals, and we’ll give you specific instructions for your recovery. Normally, these may include:

• Don’t disturb or touch the area. Even pulling on lips or mouth to look at the site can put stress on your sutures.
• Immediately after the procedure, we can give you suggestions for reducing swelling and managing any pain you might be feeling.
• We’ll let you know when and how to rinse your mouth clean and when you can return to brushing. And no spitting!
• Eat carefully. We might recommend a liquid diet for a few days before transitioning to bland and cool soft foods. We’ll let you know the best diet for the period after your surgery. Don’t use a straw for your liquid diet, because suction can interfere with the wound.
• Treat yourself carefully for a few days by avoiding strenuous activities, including workouts.
• Don’t smoke. Smoking interferes with the healing process, and the suction involved does your graft no favors either.
• Visit our Missoula or Hamilton office for follow up appointments as recommended. We’ll monitor your healing, and give you a timeline for your future implant.

Preserving your socket now instead of repairing it later has many advantages. Immediate placement of a graft protects bone size and density, eliminates the need for a potential bone grafting procedure in the future, and makes it possible for you to enjoy the natural look and feel of a dental implant as soon as possible. If you’ve scheduled an extraction with us, let’s discuss why socket preservation might be your best path to an efficient, timely, and successful dental implant.

When your wisdom teeth start to emerge it can definitely be painful, but it can be even worse if your wisdom teeth become impacted. Impacted wisdom teeth are trying to erupt but are unable to do so because there is not sufficient room for them to emerge. This usually means that your wisdom teeth are painfully lodged in your jawbone.

While you may not see any real signs of the emerging wisdom teeth when they are impacted, what you can’t see can still definitely hurt you. Some of the indicators of impacted wisdom teeth are listed below.

• Jaw Pain: Pain in the back of your jaw is a common indicator of impacted wisdom teeth. The pain often concentrates in the area around your gums.
• Changes in the Mouth: You may notice some changes in your mouth when you have impacted wisdom teeth. Reddish gums, swelling in the jaw, bleeding gums, and bad breath can all be indicators that you are dealing with impacted wisdom teeth.
• Headaches: If you suddenly start having headaches, especially at the same time as some of the other issues mentioned above, they may indicate impacted wisdom teeth.
• Chewing Issues: Problems with chewing normally can indicate impacted wisdom teeth. If you are having trouble making the chewing motions because your mouth won’t quite open and close as easily as it used to, impacted wisdom teeth may be the culprit.

The Solution

If you are suffering from impacted wisdom teeth, the best solution is usually going to be removal. This is not a problem that will resolve naturally, and in fact, your pain and other symptoms may worsen as your wisdom teeth become increasingly impacted. At Alpine Oral and Facial Surgery, Dr. Holtzen can review the details of wisdom teeth removal surgery with you and help you determine if this is the best solution for your situation.

You and your oral surgeon are partners in making sure you have the best medical and dental care. You do your part by eating a tooth-healthy diet, brushing and flossing as recommended, seeing your dentist regularly, and making an appointment with Dr. Holtzen when you need specialized care.

And one more essential step you can take for your dental health? Let your oral surgeon and your dentist know which prescriptions and over the counter medications you’re taking.

Medications Have Oral/Dental Side Effects

We’ve all grown used to hearing “Possible side effects include . . .” at the end of every pharmaceutical commercial. That’s because those unintended side effects can affect our health in any number of unexpected ways—and this includes oral health.

For example, a common side effect of many medications is xerostomia, or “dry mouth.” Because saliva helps keep our teeth and gums healthy by washing away food particles and oral bacteria and by reducing acidity in the mouth, a reduction in saliva production means a greater risk of cavities, gum disease, oral infections, denture discomfort, and bad breath.

Knowing a patient is taking one of the hundreds of medications that cause xerostomia allows a dentist to both monitor the condition and suggest the most effective treatment options to counteract these unpleasant symptoms.

Medications can cause not only dry mouth, but excessive gum tissue growth, oral sores, tooth discoloration, and changes in taste, among other side effects, so knowing which medications you are taking can provide essential information for your dentist to diagnose and treat these conditions.

Medications Interact

Oral and maxillofacial surgeons are experts in diagnosing and treating medical conditions of the face, mouth, and jaw. Medication might be a necessary part of that treatment. Because certain drugs and supplements can affect the way our bodies metabolize, absorb, and respond to other medications, your oral surgeon needs to know which medicines you are taking to arrive at your best treatment options.

• There are different classes of antibiotics used to treat oral infections. Knowing your medical history enables your oral surgeon to choose an antibiotic option that won’t interact with your other medications.
• Local anesthetics such as lidocaine, which numb the area to be treated, can also interact with certain medications. Dr. Holtzen can prescribe an alternative local anesthetic or adjust the dosage as needed.
• If you will be using sedation during your procedure, you have several options, including nitrous oxide gas, oral sedation, or IV sedation. Be sure we know about all of your medications beforehand because of possible interactions. Oral surgeons are experienced in all types of sedation, and can make changes to the type of sedation and/or the dosage as needed.

Medications Impact Treatment

It’s important for Dr. Holtzen to know if any of your medications will affect your treatment.

Anticoagulants, for example, are medications which prevent blood clots from forming, and are often prescribed for certain heart conditions, after joint replacement surgery, or for anyone at risk for developing clots. Because these medications prevent the blood from clotting normally, your oral surgeon will need to know if you are taking any such drugs before surgery.

If needed, Dr. Holtzen can work with you and your doctor to create a treatment plan which will be safe, effective, and designed to work with any of your medications. You should never discontinue taking your prescribed medications before dental work or surgery without medical approval, as this can be dangerous.

We need the most up to date information about your health to provide you with the best care possible. Knowing which medications you take and why you take them can help us:

• Diagnose and treat any side effects from non-dental medications which have affected your oral health,
• Prevent drug interactions from occurring, and
• Tailor your treatment to your specific medical needs.

Your prescriptions, over the counter medications, and even herbal supplements and vitamins are essential information. It’s a good idea to make a list before your next appointment at our Missoula or Hamilton office so you have specific medications and their dosages at hand. It’s one small—but vital—step you can take to partner with Dr. Holtzen for your best medical and dental health.