Download Dr. John Miller is a true “local”. He was born in Georgetown and

Dr. John Miller is a true “local”. He was born in Georgetown and attended kindergarten through 12th
grade there. He then earned a BS in Biology from Francis Marion College and attended the Medical
University of South Carolina College of Dental Medicine. After completing his doctorate in dental
medicine in 1988, Dr. Miller started his practice in Georgetown. With the growth of his practice, he
decided to open a second location in Murrells Inlet in 2008. Dr. Miller has taken post-doctoral training
in many specialized areas of dentistry, including dental implant surgery, Invisalign Orthodontics, Laser
surgery, Conscious Sedation, and Cosmetics.
Dr. Miller lives near Georgetown with his wife, Kristi Miller, RN, FNP, and their sons. Their oldest son is in
college and the other boys are in 12th and 6th grade. The entire family enjoys the outdoors, including
hunting, fishing, and scuba diving. Dr. Miller served as Scoutmaster for the Pawleys Island Boy Scouts
and his two oldest sons are Eagle Scouts and the youngest is on his way to becoming one as well.
Dr. Miller brought on another dentist who is from Pawley’s Island, Dr. Chris Cerasaro, and together they
provide advanced dental care to the residents of coastal South Carolina.
Please welcome Dr. John Miller.
Oral Health and Pathology
for the
Nurse Practitioner
John A. Miller, DMD
Doctor of Dental Medicine MUSC 1988
Cosmetic Training at Center for Esthetic Excellence in Chicago
Member of American Academy of Cosmetic Dentistry
Laser training at The Nash Institute in Charlotte
Implant training at multiple locations since 1988
Member of American Academy of Laser Dentistry
Invisalign trained since 2005
Conscious Sedation training 2003 in Memphis
Member of the American Dental Association
Member of the South Carolina Dental Association
Family is not an important thing. It’s everything.
Michael J. Fox
Goals of the class:
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•
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Help participants develop a better understanding of the many diseases that present in the oral
cavity and surrounding tissues
Show how to perform a thorough head and neck exam
Provide visual examples of different types of dental problems and treatments they may
encounter during their examination of patients
•
Enhance the ability of the participants in understanding when a referral to a dental professional
is appropriate.
Healthy mouth…
are we sure?
How do we know what unhealthy looks like?
It begins by knowing how a healthy, normal mouth should look.
There are so many diseases and conditions associated with the mouth, face, and jaws that there is a
specialty in the profession of dentistry:
Oral and Maxillofacial Pathology
Oral and maxillofacial pathologists (OMP) are uniquely trained to:
Efficiently address both diagnosis and treatment of oral disease.
Rapidly and reliably establish the critical connection between oral disease and systemic disease.
Combine expertise in histo-pathologic diagnosis, clinical diagnosis and treatment.
So what can you do to help your patients?
Recognize NORMAL vs. ABNORMAL
And then know what to do next…
What is oral cancer?
Close to 43,250 Americans will be diagnosed with oral or pharyngeal cancer this year.
8000 people will die of oral cancer (1/hr 24 hrs/day) and more than 15,000 if you add in
oropharyngeal cancer
Of those diagnosed, only about half will be alive in 5 years
Higher death rate than cervical cancer, Hodgkin’s lymphoma, thyroid cancer, or skin cancer
Due primarily to failure to detect early
What are Oral Cancer risk factors?
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•
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Tobacco use
Alcohol use
Sun exposure (lips)
Previous diagnosis of head or neck cancer
Human Papilloma Virus (HPV) infection
HPV Cancers
HPV-related cancers affect the base of the tongue, tonsils and other pharyngeal tissues significantly
more often than tissues in the oral cavity proper and they are affecting a younger population often
with no history of tobacco or alcohol use.
A dramatic increase of HPV-related oropharyngeal cancers worldwide have researchers scrambling to
determine the impact this will have on the future.
What are the warning signs?
Typically oral cancer is painless
Can become painful as it spreads
Changes in the way teeth fit together
Oral sores that bleed easily or don’t heal
Lumps, thickening, rough spots, or crusty eroded areas in the mouth
Difficulty chewing, swallowing, speaking, or moving the jaw or tongue
Jaw assymetry
The obvious and not so obvious
Betel Nut
40 surgeries & 3 million dollars later
Objectives of the Head and Neck and Intraoral Exam
The Intraoral and Extraoral Exam
Nancy W. Burkhart, BSDH, M.Ed., EdD;
Leslie DeLong, RDH, AS, BSHS, MHA
General appraisal to obtain or update the medical and dental history of the patient.
Diagnosed squamous cell carcinoma.
Check the hands for evidence of habits such as nail biting, HPV infections, nail infections, nail pitting,
signs of arthritis, systemic disease states and tobacco use.
Facial Symmetry
Profile Type
Cutaneous lesion of discoid lupus.
Gingival Inflammation
Normal lip tissue.
Commissures should be clear of lesions.
Observe the eyes for any abnormalities.
Bilateral palpation of the occipital nodes. Be sure to also observe the skin in this area.
Postauricular nodes.
Preauricular nodes.
Palpation of the anterior cervical nodes.
Palpation of the posterior cervical nodes.
Bilateral palpation of the supraclavicular lymph nodes.
Palpate the submandibular lymph nodes using a cupped hand as shown.
Digital palpation of the submental lymph nodes.
Palpation of the parotid gland
Palpation of the submandibular glands.
Bimanual palpation of the thyroid gland.
Hold the fingers lightly over the gland while the patient swallows.
Proper positioning of the fingers on the TM joint.
Have the patient open and close slowly.
Normal anatomy of the oropharyngeal area.
Streptococcal infection of the tonsils. Note the purulent exudate.
Palpating the hard palate. Use firm pressure and try not to slide the fingers along the tissue.
Normal structures of the anterior hard palate.
Normal structures of the posterior hard palate. Observe the dimensions (height and width) of the
vault.
Normal maxillary tuberosity.
Extreme example of a multilobulated torus palatinus.
Stretch the tissues making sure you look under the areas covered by your fingers.
Stretch the tissues away from the retromolar area.
Palpating the buccal mucosa.
Traumatic fibroma associated with chronic cheek biting.
Leukoplakia associated with spit tobacco.
Visual examination of the upper labial mucosa.
Visual examination of the lower labial mucosa.
Bidigital palpation of the upper labial mucosa.
Use the mirror to stretch the tissue away from the inferior border of the mandible.
The mirror is used to visualize the anterior lingual portion of the mandible.
Use digital palpation pressing the tissues against the body of the mandible for both the lingual and the
facial aspects.
Painful pericoronitis surrounding partially erupted #32.
Visual examination of the floor of the mouth. Note the normal structures of the area.
Extraoral view of proper palpation technique.
Intraoral view
Traumatic ulcers resulting from intraoral radiographs.
Examination of the lateral borders of the tongue.
Proper use of the mirror to aid in the visual examination of the tongue.
Visually examine the ventral surface of the tongue.
Grasp the tip of the tongue with gauze while palpating the body of the tongue.
Fissured tongue
Scalloped tongue
Benign migratory glossitis
Normal attached gingiva, facial surfaces of the maxilla and mandible.
Digital palpation of the mandibular facial attached gingiva.
Extensive exostoses on the maxillary facial surfaces.
Using gauze to dry the area and watching the flow by pressing above Stenson’s duct is a good
indicator of salivary flow.
When was your last cleaning?
Why such an extreme tissue response?
We have to consider medications a patient is taking along with physiological response to disease.
This patient is taking Azor (Amlodipine & Olmesartan) for HBP. Gingival hyperplasia with Calcium
Channel Blockers is a consideration.
Do you think these gums bleed?
Some people just don’t like going to the dentist.
For those folks, we provide conscious sedation.
Trauma- teeth meet parking lot while here on vacation.
Temporary fix until returning home.
More Facial Trauma- wrench slipped
Simple suture
What do you see? They are in pain.
Same patient, now what do you see?
What do you treat?
Ok, you have an x-ray. Now what?
Bilateral Mandibular Tori & Exostoses
What do you see?
What could this be?
5 yo referred by school nurse
What is wrong with this picture?
Same patient. Now what happens?
No sensitivity. Where’s the cavity?
Dental Caries is not always visible to the eye in an oral exam
Obvious Decay on Visual Exam
Same patient having teeth replaced with implants
Laboratory work for implant treatment
Completed implant crowns
What do you think this is?
Where is the decay?
Cracked Tooth
Cracked Tooth Syndrome
Epulis Fissuratum
Erosive Bullous Lichen Planus
Eruption cyst
Fibroma Biopsy with Laser
Fissured tongue
Fordyce granules
(sebaceous glands)
Leukoplakia
(pre-cancerous?)
Hemangioma
Herpangina
(Coxsackie virus)
Herpes Zoster
(Shingles)
Inflammatory Papillary Hyperplasia
Kaposi’s Sarcoma
Leukoedema
Lingual varicosities-what else?
Lupus Erythematosus
Malignant Melanoma
Median Rhomboid Glossitis
Melanotic Macule
Post treatment for adenocarcinoma
Prosthesis for this patient
Metastatic Carcinoma
Mucocele
Mucosal Burns
Nicotinic Stomatitis
Primary Syphilis
Pyogenic Granuloma
(pregnancy tumor)
Recurrent Herpes
Smokeless Tobacco Keratosis
Verrucous Carcinoma
(Snuff Dipper’s Cancer)
Erythema Migrans
(Geographic tongue or benign migratory glossitis)
Candidiasis (Thrush)
Torus Mandibularis
Torus Palatinus
Traumatic Ulcer
Pericoronitis
White Hairy Tongue
Black Hairy Tongue
Tuberculosis
Remember to consider “meth mouth”
Treating Decay after Braces
Broken tooth repair
Laser Surgical Treatment of
Tongue-tied Patient
(Ankyloglossia)
Tongue extension after Laser Frenectomy
Laser Surgical Treatment
of Labial Frenum
Low Frenum causes
Midline Diastema
Removal of Frenum allows Orthodontic Correction
Cosmetic Treatments
Before
After
Cosmetics can help patients
self-esteem
Before
After
New Smiles can make a big difference!
Before
After
Improving Function & Esthetics
Before
After
Diastema closure
What happens to people when they lose all their teeth?
Does it impact their self esteem?
Does it impact their overall health?
Does it matter?
The reduced chewing efficiency accompanying tooth loss can compromise nutritional status, plus put
you at higher risk for chronic illness like diabetes, cancer, hypertension and heart disease.
The average person exerts 125-150 pounds of pressure when biting or chewing, denture wearers may
only exert 15-17 pounds of pressure.
Implants can help stabilize Dentures
Lower Partial Denture with small diameter implants
Loss of Jawbone over time after teeth are lost.
Maxilla
Mandible
Dental Implants can help patients that have trouble using their dentures.
Remember what we covered in the beginning.
WHAT DO YOU NEED TO DO?
If needed, manage the patient with emergency palliative treatment until they can be seen by a dental
professional.
Postponing treatment will result in more complicated problems for the patient.
Just as you would refer for other specialized medical problems, it is important to get patients to a
dentist for evaluation and treatment as soon as possible.
You can help be sure your patient gets the best oral care by the appropriate professional just like this
lorakeet trying to clean my teeth in St. Thomas!
Our Office
Dr. Chris Cerasaro and Dr. John Miller
IMPLANTS FAMILY DENTISTRY INVISALIGN
SEDATION
COSMETICS