Many people have questions about the proper use of antibiotics — especially today, as the overuse of these medications has become a concern. It isn’t necessary for most people to take antibiotics before having a dental procedure. But for a few — notably, those with particular heart conditions and, in some cases, joint replacements — pre-medication is advisable. The question may be even more confusing now, because the standard recommendations have recently changed — so let’s try and sort things out.
First, why would anyone need antibiotics before dental treatment? Essentially, it’s because of the chance that an open wound could allow bacteria from the mouth to enter the bloodstream. For people in good health, the body is capable of quickly containing and neutralizing the bacterial exposure. But people with some types of heart disease, heart transplants, and/or total joint replacements have a greater likelihood of developing a bacterial infection, which can be dangerous — or even life-threatening. The same may be true of people whose immune systems are compromised.
At one time, people with a broad range of heart problems and artificial joints were advised to pre-medicate; today, new research indicates that fewer people need to take this step. Antibiotics are currently recommended before dental procedures if you have:
- An artificial heart valve, or a heart valve repaired with artificial material
- A history of endocarditis
- A heart transplant with abnormal heart valve function
- Cyanotic congenital heart disease (a birth defect where blood oxygen levels are lower than normal) that hasn’t been fully repaired — including children with surgical shunts and conduits
- A congenital heart defect that has been completely repaired with artificial material or with a device — but only for the first six months after the repair procedure
- Repaired congenital heart disease with residual defects, such as leakage or abnormal flow
In addition, not everyone who has an artificial joint needs antibiotic premedication. Instead, your health care providers will rely on your individual medical history to determine whether this step is required in your situation. However, having a compromised immune system (due to diabetes, cancer, arthritis, chemotherapy and other factors) is still an indication that antibiotics may be needed.
The question of whether or not to pre-medicate is an important one — so it’s vital that you share all relevant medical information with your doctors and dentists, and make sure everyone is in the loop. That way, the best decisions can be made regarding your treatment.
Tooth sensitivity can be disheartening: you’re always on your guard with what you eat or drink, and perhaps you’ve even given up on favorite foods or beverages.
The most common cause for this painful sensitivity is dentin exposure caused by receding gums. Dentin contains tiny open structures called tubules that transmit changes in temperature or pressure to the nerves in the pulp, which in turn signal pain to the brain. The enamel that covers the dentin, along with the gum tissues, creates a barrier between the environment and dentin to prevent it from becoming over-stimulated.
Due to such causes as aggressive over-brushing or periodontal (gum) disease, the gum tissues can recede from the teeth. This exposes portions of the dentin not covered by enamel to the effects of hot or cold. The result is an over-stimulation of the dentin when encountering normal environmental conditions.
So, what can be done to relieve painful tooth sensitivity? Here are 3 ways to stop or minimize the symptoms.
Change your brushing habits. As mentioned, brushing too hard and/or too often can contribute to gum recession. The whole purpose of brushing (and flossing) is to remove bacterial plaque that’s built up on tooth surfaces; a gentle action with a soft brush is sufficient. Anything more than two brushings a day is usually too much — you should also avoid brushing just after consuming acidic foods or liquids to give saliva time to neutralize acid and restore minerals to the enamel.
Include fluoride in your dental care. Fluoride has been proven to strengthen enamel. Be sure, then, to use toothpastes and other hygiene products that contain fluoride. With severe sensitivity you may also benefit from a fluoride varnish applied by a dentist to your teeth that not only strengthens enamel but also provides a barrier to exposed dentin.
Seek treatment for dental disease. Tooth sensitivity is often linked to tooth decay or periodontal (gum) disease. Treating dental disease may include plaque removal, gum surgery to restore receded gums, a filling to remove decay or root canal therapy when the decay gets to the tooth pulp. These treatments could all have an effect on reducing or ending your tooth sensitivity.
If you would like more information on the causes and treatments for sensitive teeth, 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 “Tooth Sensitivity.”
Achieving a more attractive smile is often a big investment. And, like other big investments, it’s always advantageous to have the opportunity to “try it out” beforehand — especially something as visible and public as your smile.
We’ve come a long way in giving people ways to preview their smiles before the permanent restoration is in place. Computer imaging is one of the more effective ways of doing this. But what if you could actually see for yourself in a mirror rather than on a computer monitor or printed page what your new smile will look like? Now you can with a “trial smile.”
To create a trial smile, we temporarily apply composite resin, a tooth-colored dental material, directly to your teeth. We can shape and sculpt the resin to mimic the effects of veneers, crowns or other dental work proposed to create your new smile. Not only will you be able to see your smile as it will appear, you’ll also be able to get a sense of the texture and depth of the new dental work, something you can’t quite capture with two-dimensional computer imaging. And while you won’t be able to wear the trial smile home, we can certainly take photos for you to show friends and family for their opinion.
Trial smiles are also beneficial in helping us plan your smile makeover. By viewing how you interact with your new look — facial expressions, speech and, of course, smiling — we can fine tune the amount of tooth preparation necessary, as well as the color, shape and texture of the permanent restorations.
Incorporating a trial smile into your treatment will involve an additional expense, but only as a relatively small part of your overall treatment cost. But the benefit it can bring in helping us achieve a smile that’s both attractive and satisfying to you is well worth the cost. “Trying out” your smile ahead of time can give you added peace of mind that your new look is just what you expected.
If you would like more information on trial smiles and other restoration previews, 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 “Testing Your Smile Makeover.”
When decay spreads to the tooth’s inner pulp, a root canal treatment may be necessary to save it. It’s a common procedure: after removing all tissue from the pulp, the pulp chamber and root canals are filled with a special filling. The tooth is then sealed and a crown installed to protect the tooth from re-infection and/or fracture, possibly extending the tooth’s life for many years.
Sometimes, however, the tooth doesn’t respond and heal as expected: the number, size and shape of the patient’s root canals may have complicated the procedure; there may have been a delay before installing the final crown or restoration or the restoration didn’t seal the tooth as it should have, both occurrences giving rise to re-infection. It’s also possible for a second, separate occurrence of decay or injury to the tooth or crown to undo the effects of successful treatment.
It may be necessary in these cases to conduct a second root canal treatment, one that may be more complicated or challenging than the first one. For one thing, if the tooth has been covered by a crown or other restorative materials, these will most likely need to be removed beforehand. In cases where the root canal network and anatomy are challenging, it may require the expertise of an endodontist, a dental specialist in root canal treatments. Using advanced techniques with microscopic equipment, an endodontist can locate and fill unusually narrow or blocked root canals.
Because of these and other possible complications, a root canal retreatment may be more costly than a first-time procedure. Additionally, if you have dental insurance, your particular benefit package may or may not cover the full cost or impose limitations on repeated procedures within a certain length of time. The alternative to retreatment, though, is the removal of the tooth and replacement with a dental implant, bridge or partial denture with their own set of costs and considerations.
The complications and costs of a repeated procedure, though, may be well worth it, if it results in a longer life for the tooth. Preserving your natural tooth is in most cases the most desired outcome for maintaining a healthy mouth.
If you would like more information on root canal treatments, 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 “Root Canal Treatment.”
Hopefully, you’ve developed a long-term care relationship with your family dentist. Better known as a general dentist, these professionals are the central players in maintaining your oral health, and your first stop when you have a problem with your teeth or gums.
But there are times when a particular dental situation calls for a specialist, a dentist with additional training (as much as three years or more in their area of specialty) and the equipment and advanced techniques for your particular need. Here, then, are some of the other kinds of dental professionals your general dentist may refer you to if you need specialized care.
Periodontist — From the Latin peri (“around”) and dont (“tooth”), this dentist cares for the supporting structures of the teeth, particularly the gums and bone. Besides treating advanced cases of periodontal (gum) disease, they’re also adept at reconstructive and cosmetic gum procedures or the placement of dental implants.
Orthodontist — Although known commonly as the “braces” doctor, orthodontists have a much wider concern: the interaction and alignment of teeth and jaws. With a keen understanding of growth and development, orthodontists can employ a number of treatments, including braces, to bring teeth into better positions that will improve function and appearance.
Endodontist — Teeth damaged from disease or injury may need treatments that involve the interior of the tooth — the pulp and root canals. While your general dentist can perform basic root canal treatments, an endodontist has the added knowledge and equipment to treat more difficult cases.
Prosthodontist — As with a prosthetic limb that replaces a lost arm or leg, prosthodontists specialize in replacing lost teeth (prostho means “artificial”). Prosthodontists can skillfully create functional, life-like dentures, as well as natural tooth and implant crowns to replace portions of visible teeth.
Oral Surgeon — These dentists are skilled in the diagnosis and surgical treatment of conditions involving the head and neck (the “maxillo-facial” region). They often work in consultation with general dentists and other specialties for treating complex mouth conditions. Besides tooth extraction and other dental procedures, oral surgeons can also surgically correct jaw alignment or treat trauma to the face and neck area. They also place grafts to stimulate bone growth for future implants.
If you would like more information on how dental specialties can benefit your health, 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 “The Dental Universe.”
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