Artificial Joints- Do I Need To Take Antibiotics Before Dental Treatment?

Many people with prosthetic hips and knee joints have been taking antibiotics before dental treatment on the advice of their Orthopedic Surgeons.  They were afraid that the bacteria in the mouth could get into the bloodstream and infect the artificial joints, which could lead to having to replace the joint.  Some people were told to premedicate with antibiotics before dental visits for two years after their joint surgery.  Others were told they must do it for the rest of their lives.  If dental work leads to infected prosthetic joints, then it would surely be wise to take antibiotics before dental visits.  But does it? The American Dental Association (ADA) and the American Association of Orthopaedic Surgeons (AAOS) completed a systemic review of the literature last month and came up with the following recommendations: 1- “The practitioner might consider discontinuing the practice of routinely prescribing prophylactic antibiotics for patients with hip and knee prosthetic joint implants undergoing dental procedures.” 2- “We are unable to recommend for or against the use of topical oral antimicrobials in patients with prosthetic joint implants or other orthopaedic implants undergoing dental procedures.” 3- “In the absence of reliable evidence linking poor oral health to prosthetic joint infection, it is the opinion of the work group that patients with prosthetic joint implants or other orthopaedic implants maintain appropriate oral hygiene.” HUH?  What does this all mean?  Here’s my interpretation: 1- There is no evidence that dental treatment causes joint infections, but they’d like to see more studies done before they stick their necks out and actually say it doesn’t.  So, doctors might not want to give patients antibiotics before...

How To Save Money At The Dentist

Let’s face it, dentistry is not cheap.   While you’re likely to spend far more on cars than you do on your teeth and mouth during your lifetime, it takes more than pocket change to get your teeth fixed.  So how can you save money at the dentist? First and most importantly, an ounce of prevention is worth way more than a pound of cure.   Here’s how to prevent the two most common diseases in the world (tooth decay and gum disease). The bottom line is this: Don’t feed the sugar bugs between meals! Floss daily, especially at the gumline When you come in to see the dentist, consider spending a little on preventive measures to save a lot in the long run. Examples include:- sealants to seal off the grooves where sugar bugs hide and most decay occurs fluoride treatments to harden the teeth- gels and foam are good; varnish is better splints (aka- nightguards) to prevent “occlusal disease”, which occurs when clenching and grinding your teeth at night causing cracked/broken teeth, worn/failed dental restorations, sensitive teeth and TMJ problems If you already have lots of decay or gum disease, remember the four goals of dentistry, which are listed somewhat in order of priority: Remove/manage dental disease- tooth decay, gum disease, occlusal disease Replace what’s missing Preserve what’s left Cosmetic dentistry Make sure to treat dental disease early.  All dental disease is progressive!   The longer you wait, the worse (and more expensive) it gets.  Here’s what can happen when you wait to fix your teeth. When it comes to fixing your teeth, you will usually have...

Are Dental X-rays Safe?

This is one of the most common questions dentists get, and it’s a good one.  Our exposure to x-rays is cumulative over the course of our lives, meaning it constantly adds up and never goes away.  Dentists have known this for many decades (long before we entered dental school).  So we are very interested in minimizing the amount of radiation we are all exposed to.  I have to say dentists have done an excellent job. I just stumbled across a group called the Health Physics Society.  They help provide health physicists with the information they need to do their job, which is “to manage the beneficial use of ionizing radiation while protecting workers and the public from potential hazards”.  (I’d never heaerd of a “health physicist” before.)  Their website has a lot of great information on our radiation exposures- everything from airport screenings and cell phones to tanning salons. Their page about dental patient issues has some great comparison numbers.  Normal background radiation dose is about 360 mrem per year.  That’s your annual exposure just by living on this planet.  The dose for four bitewing (check-up) x-rays is 0.2 – 0.3 mrem, or less than half of what we are normally exposed to in a day.  A full mouth set of x-rays is equivalent to a little more than one days normal background radiation. On another page, they state, “differences in background levels between different parts of the country are larger than the effective dose for a bitewing. For example, moving from a lower-background region such as Minneapolis, Minnesota, to a higher-background region, such as Denver, Colorado, for a year...

What To Expect As A Dental Patient?

I got an email from a prospective patient asking what he could expect as a patient.  I’ve seen different versions of Patient Bill Of Rights which often center around your right to choose your own dentist, your right to be seen in a timely manner, etc.  But I look at this question more along the lines of “what should a patient expect from a dentist?”. I posed the question on our Facebook page and got the following replies: “A friendly atmosphere and very knowledgeable staff.” “A very thorough experience from the best Dentist(s) and staff in the WORLD!” I think a couple of our loyal patients were just buttering us up to be nice to them at their next visit. Here’s what I think a patient should expect from a dentist: You should expect us to make your dental health our top priority. You should expect a very thorough exam when you first come in. You should expect an honest evaluation of what is good and bad about your teeth, gums and surrounding areas. You should expect clear explanations of the pros/cons of the different treatment options as well as the costs so that you can make the best decision that is right for you. You should expect that when you come in for treatment, we will provide technically excellent treatment as comfortably as we possibly can. Oh, and you should expect a friendly atmosphere and very knowledgeable staff and a very thorough experience from the best Dentist(s) and staff in the WORLD! Dr. Steve Dr. Steve Dr. Steven Lee graduated from the UCLA School of Dentistry in 1985. He was a...

Veneers- How Much Tooth Needs To Be Removed?

This really depends on what the veneer is being used for.  A veneer can as thin as 1/2 mm, or about the thickness of a fingernail.  So if we are adding bulk and length to a tooth, very little enamel needs to be removed.  But if a dentist is trying to make teeth appear straighter or reshape them, we often need to take away more enamel where the teeth stick out too far.  Also, if we are trying to cover dark, stained teeth, the veneer needs to be thicker so the porcelain can hide the dark tooth underneath without looking too “chalky”.  In addition, if the tooth already has fillings, we will extend the veneer to cover the fillings.  One thing to keep in mind is that the thicker the veneer, the more creative the lab man can be in creating an esthetic, natural looking tooth.  On the other hand, the less tooth we remove, the more enamel is left to bond to. What about “no prep” veneers?  I am not a fan of true no-prep veneers.  At the very least, I like to slightly prepare the margin of the veneer near the gumline so that the veneer does not jut out like a speed bump there.  A smoother transition is easier to keep clean and it is less visible.  Some dentists claim that no-prep veneers are completely reversible, but our ability to bond is so good, that it would be extremely difficult to remove a veneer without damaging the enamel underneath. Often, especially when veneering more than one tooth, we will take a model of the teeth and add...

To Brush Or Not To Brush After Eating?

When is the best time to brush your teeth?  All our lives, we’ve heard it’s important to brush and floss out teeth right after eating.  Dentists have been telling this to patients since toothpaste was invented.  But some people in the industry are wondering if this is such a good idea.  Whenever we consume something acidic, or something sweet which gets turned into acid, the outer layer of our tooth enamel is weakened by the acid attack.  So some people recommend waiting 30-60 minutes after eating before scrubbing, and possible abrading the weakened enamel. So, is it better to brush and floss immediately to remove  food and plaque which may be contributing to tooth decay?  Or, is it better to wait for the mouth to be less acidic and decrease the chance of eroding enamel away?  At this time, there really is no clear answer.  It’s mostly speculation at this time.  There’s not much research to show which is really better for teeth.  Either way, you’re doing more good than harm.  Here’s what I recommend: -Limit the number of times a day you eat or drink acidic and sugary foods and drinks -Use soft-bristled toothbrushes with gentle circular cleaning motions rather than back and forth scrubbing -Remember that flossing and brushing are more for preventing gum disease than for preventing decay, so floss daily and brush at least twice daily, whenever it makes the most sense to  you -And lastly, don’t worry too much about it If any new research comes out clearly favoring one over the other, I’ll let you know! Dr. Steve Dr. Steve Dr. Steven Lee...