Posts for: December, 2015
Office cleanings and other minor procedures are a routine part of regular dental care. For some people, though, a routine visit could put them at slight risk for a serious illness.
The reason for this concern is a condition known as bacteremia. This occurs when bacteria, in this case from the mouth and conceivably during an office cleaning or other routine dental procedure, enters the bloodstream. Although for most people this isn’t a great issue, there’s been concern that bacteremia could further compromise the health of patients with or susceptible to other conditions like endocarditis (heart inflammation), prosthetic joints or compromised immune systems.
This concern grew out of a number of studies in the early 20th Century that seemed to show a link between dental bacteremia and infective endocarditis. At about mid-century it became a common practice to administer antibiotics before dental work (usually 2 grams of amoxicillin or an equivalent about an hour before) to high risk patients as a way of protecting them against infection. The practice later expanded to other health issues, including many heart conditions.
Beginning in 2007, however, guidelines developed jointly by the American Heart Association and the American Dental Association reduced the number of conditions recommended for antibiotic therapy. Based on these guidelines, we now recommend pre-procedure antibiotics if you have a history of infective endocarditis, artificial heart valves, certain repaired congenital heart defects, or heart transplant that develops a subsequent heart valve problem. Patients with prosthetic joints or immune system problems are no longer under the guidelines, but may still undergo antibiotic therapy if believed necessary by their individual physician.
If you have a condition that could qualify for antibiotic therapy, please be sure to discuss it with both your dentist and physician. We’ll work together to ensure any dental work you undergo won’t have an adverse effect on the rest of your health.
If you would like more information on antibiotic therapy and dental care, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Antibiotics for Dental Visits.”
The most important thing you can do for good oral health is brush and floss your teeth daily. But we’re not born knowing how to do either — they’re skills we must learn and practice to be effective in removing disease-causing bacterial plaque.
It helps then to have a good understanding about technique, implements or problem situations you may run into. So then, here are answers to 4 typical hygiene questions that can help you improve your brushing and flossing.
How often should I brush and floss? You should brush and floss at least once a day to prevent a buildup of plaque, the cause for both tooth decay and periodontal (gum) disease; if you have some form of dental disease, we may advise a different frequency. Be sure to use a gentle technique — it doesn’t take much pressure to remove plaque and being too aggressive can harm your gums and tooth enamel.
When should I change my toothbrush? If you use it correctly (gentle vs. aggressive), your toothbrush should last several months. When you begin to notice the bristles becoming worn or splayed, it’s time to get a new, soft bristle brush.
What kind of toothpaste should I use? You may have a preference among the dozens available when it comes to flavor and texture. But from a hygiene standpoint you should choose one that contains fluoride to strengthen enamel and an anti-tartar agent to inhibit the formation of hardened plaque deposits (calculus). While we’re on the subject, don’t rinse out the toothpaste right after brushing — you may be washing away fluoride too early, which takes time to work in contact with tooth enamel. Just spit it out.
What if my teeth are sensitive when I brush? If you encounter problems when you brush, visit us to find out the cause. The most common cause for sensitivity is gum recession, usually due to gum disease, which has exposed the roots. This can cause discomfort when you encounter hot or cold foods, or pressure on the teeth when you brush. You should then receive treatment for the underlying condition; we may also recommend toothpaste that reduces tooth sensitivity. And, of course, be gentle when you brush.
If you would like more information on brushing, flossing and other aspects of oral hygiene, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Oral Hygiene Behavior.”
While oral hygiene, a nutritious diet and regular dental visits are all crucial to long-term oral health, these efforts complement what your body already does to keep your mouth healthy. One of the major players in this function is saliva.
Produced by hundreds of glands located throughout the mouth, saliva does much more than help you swallow and wash away food. As you chew, an enzyme in saliva known as amylase breaks down starches in your food to make it easier to digest in the stomach. Saliva also contains antibodies, similar to what’s in tears, which can fight bacteria and other disease-causing organisms.
Perhaps its most important function, though, is its ability to protect and maintain healthy tooth enamel. The strongest substance in the body, enamel nevertheless has one primary enemy — the acid found in certain foods or as a byproduct of bacteria feeding on sugar and other carbohydrates.
When the ideally neutral pH level of the mouth becomes too acidic (nearly every time you eat), minerals in the enamel begin to soften and dissolve. The increased saliva flow when we eat floods the mouth with buffering agents that neutralize the acid and restore the mouth’s normal pH level. Not only does saliva stop demineralization, but it also restores a good bit of the enamel’s mineral content.
In recent years, a new role for saliva has begun to emerge as a means to diagnose disease. Like blood, urine and other bodily fluids, saliva contains molecules that serve as biological markers for disease. Given the right equipment, saliva has the potential to indicate early signs of cancer (including oral), diabetes and other systemic conditions. As the means to examine saliva for these markers increases it promises to be easier and less expensive to collect and sample than blood, while reducing the chances of transmitting bloodborne diseases to healthcare workers.
It’s a lot to consider with this fluid that you hardly notice, except when it isn’t there. Saliva is proof that our efforts at keeping our mouths healthy cooperate and depend on our bodies’ amazing systems.
If you would like more information on saliva and other ways your body maintains a healthy mouth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Saliva.”
So you’re tearing up the dance floor at a friend’s wedding, when all of a sudden one of your pals lands an accidental blow to your face — chipping out part of your front tooth, which lands right on the floorboards! Meanwhile, your wife (who is nine months pregnant) is expecting you home in one piece, and you may have to pose for a picture with the baby at any moment. What will you do now?
Take a tip from Prince William of England. According to the British tabloid The Daily Mail, the future king found himself in just this situation in 2013. His solution: Pay a late-night visit to a discreet dentist and get it fixed up — then stay calm and carry on!
Actually, dental emergencies of this type are fairly common. While nobody at the palace is saying exactly what was done for the damaged tooth, there are several ways to remedy this dental dilemma.
If the broken part is relatively small, chances are the tooth can be repaired by bonding with composite resin. In this process, tooth-colored material is used to replace the damaged, chipped or discolored region. Composite resin is a super-strong mixture of plastic and glass components that not only looks quite natural, but bonds tightly to the natural tooth structure. Best of all, the bonding procedure can usually be accomplished in just one visit to the dental office — there’s no lab work involved. And while it won’t last forever, a bonded tooth should hold up well for at least several years with only routine dental care.
If a larger piece of the tooth is broken off and recovered, it is sometimes possible to reattach it via bonding. However, for more serious damage — like a severely fractured or broken tooth — a crown (cap) may be required. In this restoration process, the entire visible portion of the tooth may be capped with a sturdy covering made of porcelain, gold, or porcelain fused to a gold metal alloy.
A crown restoration is more involved than bonding. It begins with making a 3-D model of the damaged tooth and its neighbors. From this model, a tooth replica will be fabricated by a skilled technician; it will match the existing teeth closely and fit into the bite perfectly. Next, the damaged tooth will be prepared, and the crown will be securely attached to it. Crown restorations are strong, lifelike and permanent.
Was the future king “crowned” — or was his tooth bonded? We may never know for sure. But it’s good to know that even if we’ll never be royals, we still have several options for fixing a damaged tooth. If you would like more information, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Repairing Chipped Teeth” and “Crowns and Bridgework.”
After a dental examination revealed you had periodontal (gum) disease, you began undergoing treatment. Now after several cleaning sessions, the infection has subsided and your gums have returned to a healthy shade of pink.
But your gum care isn’t over — depending on the infection’s severity you may need to visit us more often than the normal six months between regular checkups.
Gum disease arises from dental plaque, a thin film of bacteria and food remnants built up on tooth surfaces due to poor oral hygiene. The bacteria cause an infection in the gums, which initiates a response from the body’s immune system that triggers inflammation.
Without proper treatment, periodontitis can come back in which the infection spreads deeper below the gum line. Pockets of infection can reoccur as gum tissues weaken and lose their attachment to teeth. This continuing damage can ultimately lead to both tooth and bone loss.
To stop the disease it’s necessary to remove all the infection-causing plaque and calculus (hardened plaque deposits) from tooth surfaces, including around the roots. This is performed manually and could require surgery once again to access areas below the gum line.
To guard against this it’s necessary for you to undergo regular periodontal maintenance (PM). Besides cleaning, PM gives us an opportunity to check for signs of returning gum disease and, if found, plan for another round of treatment.
Although not written in stone, the interval between PM appointments that seems the most effective for preventing recurrence is every three months. In cases of advanced, aggressive gum disease, appointments may need to occur at even shorter intervals, for example every two months.
PM for susceptible patients with decreased resistance to disease require extra time and effort for the hygienist, along with a renewed daily hygiene habit of effective brushing and flossing by you to keep the disease at bay. But preventing another occurrence of gum disease and its consequences is well worth this extra attention for the health of your teeth and gums.