Posts for: October, 2018
Teeth damaged by decay, periodontal (gum) disease or trauma are often removed (extracted) if they’re deemed beyond repair. But there’s another reason we may recommend an extraction: a tooth is causing or has the potential to cause problems for other teeth and your overall oral health.
Some of the most frequent cases of “preventive extraction” involve the third molars, or wisdom teeth, located in the very back of the mouth. They’re usually the last permanent teeth to come in, which is related to some of the problems they can cause. Because they’re trying to come in among teeth that have already erupted they don’t always erupt properly, often at abnormal angles or not fully erupting through the gums, a condition called impaction.
Impacted or misaligned wisdom teeth can put pressure on adjacent teeth and their roots, which can cause root resorption that damages the second molar. They can also increase the risk of periodontal (gum) disease in the gum tissues of the second molars, which if untreated can ultimately cause teeth and bone loss.
Because of current or possible future problems with wisdom teeth, we often consider removing them at some early point in the person’s dental development. Such a consideration shouldn’t be undertaken lightly, since wisdom teeth extraction is often complex and fraught with complications, and it usually requires a surgical procedure.
That’s why we first conduct a comprehensive examination (including x-ray or other imaging to determine exact location and possible complications) before we recommend an extraction. If after careful analysis an extraction appears to be the best course, we must then consider other factors like planned orthodontics to determine the best time for the procedure.
Once performed, a wisdom tooth extraction can resolve existing problems now and reduce the risks of gum disease or malocclusions in the future. When it comes to wisdom teeth, removing them may be in your or your family member’s best interest for optimal dental health.
If you would like more information on wisdom 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 “Wisdom Teeth.”
Placing a dental implant within the jawbone requires a surgical procedure. For most people it’s a relatively minor affair, but for some with certain health conditions it might be otherwise. Because of their condition they might have an increased risk for a bacterial infection afterward that could interfere with the implant’s integration with the bone and lead to possible failure.
To lower this risk, dentists for many years have routinely prescribed an antibiotic for patients considered at high-risk for infection to take before their implant surgery. But there’s been a lively debate among health practitioners about the true necessity for this practice and whether it’s worth the possible side effects that can accompany taking antibiotics.
While the practice still continues, current guidelines now recommend it for fewer health conditions. The American Dental Association (ADA) together with the American Heart Association (AHA) now recommend antibiotics only for surgical patients who have prosthetic heart valves, a history of infective endocarditis, a heart transplant or certain congenital heart conditions.
But patients with prosthetic joint replacements, who were once included in the recommendation for pre-surgical antibiotics, are no longer in that category. Even so, some orthopedic surgeons continue to recommend it for their joint replacement patients out of concern that a post-surgical infection could adversely affect their replaced joints.
But while these areas of disagreement about pre-surgical antibiotics still continue, a consensus may be emerging about a possible “sweet spot” in administering the therapy. Evidence from recent studies indicates just a small dose of antibiotics administered an hour before surgery may be sufficient to reduce the risk of infection-related implant failure with only minimal risk of side effects from the drug.
Because pre-surgical antibiotic therapy can be a complicated matter, it’s best that you discuss with both the physician caring for your health condition and your dentist about whether you should undergo this option to reduce the infection risk with your own implant surgery. Still, if all the factors surrounding your health indicate it, this antibiotic therapy might help you avoid losing an implant to infection.
If you would like more information on antibiotics before implant surgery, 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 “Implants & Antibiotics: Lowering Risk of Implant Failure.”
In October, the American Dental Hygienists’ Association sponsors National Dental Hygiene Month to remind everyone that having good oral health is directly related to practicing good oral hygiene at home. This includes brushing twice each day with fluoride toothpaste and flossing at least once per day. But sometimes we forget that dental hygiene applies not just to your teeth but also to anything you regularly wear in your mouth. This includes removable dentures (full or partial), clear aligners, nightguards, mouthguards and retainers. If you (or your kids, or seniors you know) wear any of these, please review the three appliance-care tips below.
1. CLEAN IT. Just like natural teeth, an oral appliance worn every day needs daily brushing. But toothpaste isn’t an appropriate cleanser for these devices; it’s too abrasive. The grainy particles it contains are great for scrubbing plaque and bits of food from the hard enamel coating of teeth—but they can actually leave little nicks in the plastic of your oral appliance, creating areas for bacteria to hide. This can eventually cause odors and stains. Instead, clean appliances with liquid dish soap or denture paste. Buy a separate brush for your appliance—don’t use the same one that you use on your teeth. It can be a very soft regular toothbrush, nail brush or denture brush.
2. RINSE IT. After cleaning your appliance, rinse it thoroughly. But don’t use hot water—and never boil an oral appliance to sterilize it! Your device was custom-made for your mouth, and it needs to fit precisely to do its job. Hot water can warp the appliance and change the fit, possibly rendering it useless or even harmful. For example, a warped orthodontic aligner might not move teeth into the correct position. Remember: the goal is to kill bacteria, not your appliance!
3. STORE IT. Keep your appliance in a safe place—away from curious pets and toddlers. When you are not wearing it or cleaning it, your device should be packed away in its case or soaking overnight in water or a cleaning solution according to your original instructions.
If you have any questions about oral appliance care or oral hygiene, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “10 Tips for Cleaning Your Oral Appliance” and “10 Tips for Daily Oral Care at Home.”