Posts for category: Oral Health
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.”
There’s really no secret to keeping your child’s teeth healthy — good, daily hygiene habits, regular dental visits and early treatment for emerging problems. It’s a lot easier for those things to happen if your child feels comfortable with dental care and visiting the dentist. Sadly, that’s not always the case: many children develop an unhealthy fear of the dentist because the initial relationship may have been mishandled.
Here, then, are 3 tips that will help you foster a healthy relationship between your child and their dentist.
Visit the dentist before their first birthday. From a health standpoint, dental visits should begin soon after your child’s first teeth emerge (erupt) in the mouth. Visiting the dentist by their first birthday also improves the chances they’ll develop a sufficient level of comfort with the visits, more so than if you waited a year or two longer.
Choose your dentist with your child’s sense of security and comfort in mind. When you’re looking for a dentist to care for your child, think of it as looking for a “new member of the family.” It’s important to find an office environment that’s kid-friendly and staff members that work well with children. Some dentists specialize in pediatric dentistry and many general dentists have additional training in working with children. The key is a dental team that has a good, trust-building rapport with children.
Set an example, both in the home and at the dentist. Children learn quite a bit watching what their caregivers say and how they react in potentially stressful situations. If dental care is important to you personally, it’s more likely to become important to your child. And when you visit the dentist with your child, be sure to project calm and a sense that it’s routine — if you display tenseness or nervousness your child may take that as a sign that visiting the dentist is something to fear.
You want your child to learn that the dentist is their friend who’s there to help them. That lesson should begin early with the right dental team — and by making dental care a priority in your own life.
If you would like more information on dental care for your child, 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 “Taking the Stress out of Dentistry for Kids.”
Since the 1950s fluoride has played an important role in the fight against tooth decay as an additive to hygiene products and many public water supplies. But although a proven cavity fighter, some have questioned its safety over the years.
To date, though, the only substantiated health risk from fluoride use is a condition known as enamel fluorosis, which occurs when too much fluoride is ingested during early tooth development as the mineral embeds in the tooth structure. Fluorosis can cause changes in the enamel’s appearance, ranging from barely noticeable white streaking to darker visible staining and a pitted texture.
Fluorosis is primarily a cosmetic problem and not a serious health issue. The staining on otherwise sound teeth, however, is permanent and more severe cases may require extensive bleaching treatment to improve appearance. The best strategy is to prevent fluorosis by monitoring and limiting your child’s fluoride intake, until about age 9.
Tooth decay is a more serious condition than fluorosis so we’re not advocating you eliminate fluoride but that you keep your family’s intake within safe levels. The first step is to determine just how much that intake is now, particularly if you drink fluoridated water. If you have public water, you may be able to find its fluoridation level online at apps.nccd.cdc.gov or call the utility directly.
You should also be careful about the amount of toothpaste your child uses to brush their teeth. Children under two need only a trace (a “smear”) on the brush, and children between the ages of 2 and 6 a pea-sized amount. And, they should brush no more than twice a day.
Another possible concern is infant formula, especially mixable powder. While the formula itself doesn’t contain fluoride, water mixed with it may. If you live in an area with increased fluorosis risk, consider breast-feeding (breast milk has little fluoride), using ready-to-feed formula, or mixing powdered formula with bottled water labeled “de-ionized,” “purified,” “demineralized” or “distilled.”
We’ll be glad to help assess your family’s current fluoride intake and advise you on making adjustments to bring it into normal ranges. Taking in the right amount of fluoride assures you and your children receive the most benefit and protection from it, while avoiding future smile problems.
If you would like more information on managing your family’s fluoride intake, please contact us today to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Development and Infant Formula.”
You have a great smile: beautiful white teeth all perfectly aligned. But unbeknownst to you, periodontal (gum) disease might even now be damaging your gum tissues, setting the stage for future tooth and bone loss — and a ruined smile.
While it’s easy to miss the early stage of this disease caused by bacterial plaque on tooth surfaces, there are a few signs if you pay close attention. Bleeding gums after moderate brushing or flossing could indicate normally resilient gum tissues have begun to weaken. You may also notice a slight redness and swelling around the margins of the gums and a bad taste or breath. As it progresses, you may experience painful abscesses (infected pockets that develop between the gums and tooth) and loose teeth, a late sign of tissue detachment and bone loss. If you are a smoker, nicotine reduces swelling and bleeding of the gums, removing signs you have a disease. If you smoke, you need to see your dentist regularly.
While renewed daily oral hygiene is important for stopping gum disease, you may also need professional care to bring it under control. The main treatment calls for the manual removal of plaque and calculus (hardened deposits of plaque) that are sustaining the infection. Dentists and hygienists both can perform scaling, which removes plaque and calculus at or just below the gum line, and root planing to clean accessible root surfaces.
In more advanced cases, though, you may need the services of a periodontist, a specialist in treating diseased or injured gums, bone and other connective tissues that support the teeth. They’re also skilled in more advanced treatments like gum flap surgery that more fully exposes a tooth’s root area for plaque and calculus (or tartar) removal, or tissue grafting procedures that improve the health and appearance of damaged gums.
If you suspect you have gum disease, the place to start is with your family dentist. They can determine if your case will respond to basic scaling, root planing or antibiotic treatment. If the disease appears more advanced or with complications, they will most likely refer you to a periodontist for treatment.
If you’ve already seen bleeding, swelling or redness, see your dentist as soon as possible. The sooner you begin treatment for any case of gum disease, the less likely it will lead to the loss not only of your teeth but your beautiful smile.
If you would like more information on the treatment of periodontal (gum) disease, 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 “When to See a Periodontist.”
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.