Posts for: January, 2019
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.
Since boxers first began using them a century ago, athletic mouthguards are now standard safety equipment for most contact sports. Without them, dental injuries would skyrocket.
But a recent study in the peer-reviewed journal, General Dentistry, indicates there’s another important reason to wear a mouthguard for contact sports or exercise: you may be able to significantly reduce your risk for a mild traumatic brain injury (MTBI), better known as a concussion. It’s believed the mouthguard absorbs some of the force generated during contact, resulting in less pressure to the brain. That reduction is even more significant if your mouth-guard has been custom-made by a dentist.
That last finding is important, because not all mouthguards on the market are equal. There are three basic categories of mouthguards — stock, “boil and bite,” and custom. Stock mouthguards come in limited sizes; they’re relatively inexpensive, but they provide the least level of protection. “Boil and bite” can be customized after purchase to the wearer’s bite, but they don’t always provide complete coverage of back teeth. Custom mouthguards are designed and fashioned by a dentist; they’re relatively expensive (running in the hundreds of dollars), but there’s ample evidence they provide the highest level of protection from mouth injuries.
The General Dentistry study also corroborates custom mouthguards’ effectiveness in preventing concussions. The study followed approximately 400 football players from six different high school teams. While all the players wore the same type of helmet, half of them wore custom-made mouthguards and the other half wore stock guards. 8.3% of the athletes wearing stock guards experienced a concussion injury; by contrast only 3.6% of those with custom guards sustained an injury — greater than half fewer occurrences.
The study also highlights the need not to rely solely on helmets or other protective headgear for concussion prevention. It’s important to include mouthguards along with other athletic protective gear to lower injury risk as much as possible.
So when considering how you can provide the optimum injury protection for you or your child, be sure to include an athletic mouthguard, preferably one that’s custom-made. We’ll be happy to advise you further on what you need to know to prevent traumatic dental injuries, as well as concussions.
If you would like more information on custom-fit mouthguards, 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 “Mouthguards.”
When is the best time to floss your teeth: Morning? Bedtime? How about: whenever and wherever the moment feels right?
For Cam Newton, award-winning NFL quarterback for the Carolina Panthers, the answer is clearly the latter. During the third quarter of the 2016 season-opener between his team and the Denver Broncos, TV cameras focused on Newton as he sat on the bench. The 2015 MVP was clearly seen stretching a string of dental floss between his index fingers and taking care of some dental hygiene business… and thereby creating a minor storm on the internet.
Inappropriate? We don't think so. As dentists, we're always happy when someone comes along to remind people how important it is to floss. And when that person has a million-dollar smile like Cam Newton's — so much the better.
Of course, there has been a lot of discussion lately about flossing. News outlets have gleefully reported that there's a lack of hard evidence at present to show that flossing is effective. But we would like to point out that, as the saying goes, “Absence of evidence is not evidence of absence.” There are a number of reasons why health care organizations like the American Dental Association (ADA) still firmly recommend daily flossing. Here are a few:
- It's well established that when plaque is allowed to build up on teeth, tooth decay and gum disease are bound to follow.
- A tooth brush does a good job of cleaning most tooth surfaces, but it can't reach into spaces between teeth.
- Cleaning between teeth (interdental cleaning) has been shown to remove plaque and food debris from these hard-to-reach spaces.
- Dental floss isn't the only method for interdental cleaning… but it is recognized by dentists as the best way, and is an excellent method for doing this at home — or anywhere else!
Whether you use dental floss or another type of interdental cleaner is up to you. But the ADA stands by its recommendations for maintaining good oral health: Brush twice a day for two minutes with fluoride toothpaste; visit your dentist regularly for professional cleanings and checkups; and clean between teeth once a day with an interdental cleaner like floss. It doesn't matter if you do it in your own home, or on the sidelines of an NFL game… as long as you do it!