We are now open!

Greetings to all of our patients!  

I want to take this time to reach out to you all and reconnect so as to let you all know what we've been up to during the Novel Corona Virus Pandemic.  I want to state that our #1 priority is, and has always been the health & safety of our patients, and, of course, to provide to you the highest quality dental care we can!  

I am sure most of you have questions and concerns regarding the safety of dentistry during this time, so we'd like to share the measures and actions we are taking to ensure your safety here at our office.

First of all, the culture here will be a little bit different in the “post novel corona virus world”.  At least until researchers come up with therapies and /or a vaccine!  We will be implementing some new systems in our practice to mitigate the risk of disease transmission here.  

What to expect when you come to the office?  Prior to your appointment, when Diana calls you to confirm your appointment date and time, she will ask a few quick questions regarding your medical status, and any symptoms suggestive of an illness...We ask that if you are ill with a fever, coughing, etc. to please reschedule for when you are well.  

We ask that you please call when you arrive to the office. Diana, Chelsea or Susie will meet you at your car to take a quick, touch-less temperature scan of the forehead, also you will have a small device clipped to your finger called an oximeter. This gadget shines light through your fingertip or earlobe. It works out how much oxygen is in your blood. We will then escort you directly to your treatment room.  

We will be spacing out our patient appointments so that there is only one patient on the dentistry side with Susie and I, and only one patient in the hygiene side with Chelsea.  For the most part, no one is allowed to wait in the lobby until further notice...We will of course, accommodate people escorting children or elderly patients.

All surfaces will be disinfected with Hospital Grade Disinfectants (as we've always done in the past) between patients.  All door knobs, light switches, etc. will be disinfected every 30 minutes throughout the day!  This will mitigate the risk of any infectious disease transmission via surfaces.

Ever since the HIV epidemic in the 1980's, dentistry as an industry has employed “Universal Precautions” (masks, gloves, “single use” disposable equipment, etc.) to mitigate disease transmission.  

The most concerning of transmission routes for infection, including novel corona virus, is via “'aerosols”.  Dentists and hygienists  have used “High Volume Evacuation” (HVE) routinely for decades to capture aerosols generated by dental hand pieces (drill) and ultra-sonic scaling devices.  HVE reduces aerosols by 90% !  

We will continue to use HVE for all procedures that generate aerosols.  In addition to HVE, we've invested in Medical Grade H-13 HEPA aerosol scavengers in our operatories (basically a very powerful vacuum) with a snorkel hose that we can position adjacent to the treatment field to scavenge any aerosol the HVE misses.

We have also invested in nine medical grade H-13 HEPA air filtration units placed throughout the office which will completely clean/turn over the air every 10 minutes, or six times per hour.

Another investment made was having medical grade UVC (Ultra-Violet C) units installed in our Central  Air Conditioning/Heating units that kill Bacteria and Virus as the air passes through. 

Finally, we will fog the office with Hypochlorous Acid, a human safe, yet powerful disinfectant at the end of each day.

We want you all to know that we are taking all possible precautions and measures to ensure your safety, and the safety of our team here!

To further streamline your experience at the office, we will be scheduling return visits for you in the operatory, at the end of your appointment.  We will make available electronic payment options in order to minimize visiting the front desk.

Warm regards,

Dr. Paulerio and Team

Nerve Repositioning

In order to safely place dental implants, the structures surrounding the treatment area must be carefully evaluated. The inferior alveolar nerve, which runs along the lower jaw, controls sensation in the patient’s lower lip and chin. In rare cases, nerve repositioning, or nerve lateralization, is necessary to avoid serious complications. This includes patients who have inadequate bone or the space between the bone and nerve is too narrow. The purposes of this procedure are to protect the inferior alveolar nerve, avoid potential complications, and allow the patient to maintain feeling in the lower lip and chin.

Candidates for the Procedure

Before recommending a patient for dental implant surgery, an oral surgeon or dentist must evaluate whether there is adequate bone present to support the implant post. Once teeth are lost or extracted, the bone naturally resorbs into the body. This can significantly weaken the jaw. If socket preservation (a type of bone grafting) was performed at the time of extraction, the bone may have retained its integrity. However, insufficient bone quality or density will require grafting prior to implant placement.

Nerve repositioning can help implant patients avoid potential complications, as well as maintain proper sensation in the lower lip and chin.

If the patient requires an implant in the back of the lower jaw and bone grafting is not an option, the surgeon must determine if there is sufficient space surrounding the inferior alveolar nerve to proceed with treatment. If a dental implant comes into contact with the nerve, the patient may experience pain, numbness, or other serious issues. Nerve repositioning may be beneficial for patients who are found to lack sufficient space.

Illustration of projected implant placement with or without nerve repositioning surgery
Without nerve repositioning surgery, certain patients could experience complications during dental implant placement.

Nerve Repositioning Surgery

Computed tomography (CT) scans, an advanced type of 3-D imaging, will be used to evaluate the amount and quality of bone present, as well as the position of the inferior alveolar nerve. This information can also be combined with computer modeling techniques to create a precise surgical plan.

Traditional Surgery

Nerve repositioning surgery is typically performed as an outpatient procedure. Prior to beginning, the surgeon will administer local anesthesia to numb the area. Sedation may also be available to further ensure patients' comfort.

To begin, an incision will be made in the outer portion of the cheek to gain access to the underlying tissue. Next, the doctor will create a small window in the lower jawbone to reach the inferior alveolar nerve. The nerve bundle is then carefully pulled aside. The doctor will place the implant in the jaw while avoiding contact with the nerve bundle. Following placement of the implant, the nerve bundle can be moved back into place. The space that was created in the jawbone is then filled bone grafting material, and the incision is closed.

In most cases, nerve repositioning surgery can be performed in conjunction with dental implant surgery, but sometimes the procedures may need to take place separately. 

Piezosurgery

Although most nerve repositioning surgery is performed using traditional methods, some dentists and oral surgeons use a newer technique called piezosurgery. During surgery, a specialized instrument uses high-frequency vibrations to incise bone while sparing the surrounding soft tissues, including skin, gums, and nerves. Piezosurgery is often preferable to traditional nerve repositioning surgery because it causes less trauma, which results in reduced bleeding and expedited healing. The most notable drawbacks of piezosurgery are the higher treatment cost and the fact that the doctor must also have received special training in the technique.

Weighing Your Options

Any kind of surgery carries some degree of risk. Nerve repositioning typically results in at least some degree of numbness in the lower lip, cheeks, and jaw. This should be temporary, and the majority of patients will see improvement in a few weeks to a few months. For a small number of patients, nerve damage may be permanent, and numbness may persist indefinitely. Due to the potential for permanent damage, nerve repositioning surgery is usually recommended only as a last resort. Your dentist can help you decide whether the surgery is right for you or whether an alternative, such as a traditional bridge or denture, is advisable. 

Point Loma Family Dentistry team

Point Loma Family Dentistry

Dr. Louis E. Paulerio is a top-rated dentist who is committed to providing the latest dental treatments in a caring, warm setting. He is a member of several prestigious dental organizations, including: 

  • Academy of General Dentistry
  • International Dental Implant Association

He also uses CEREC technology to create beautiful, long-lasting dental restorations in just one appointment. Ready to schedule a consultation at our Point Loma office? Request your appointment online or call us at (619) 223-3811.

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San Diego Office

1635 Rosecrans St
Ste A
San Diego, CA 92106

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