Do I Need Antibiotics Before My Dental Appointment?

      In recent years there has been some debate over the need for prophylactic antibiotics before a dental appointment. Unfortunately, there are varying opinions among different medical specialties or organizations. In light on some of the more recent changes, we would like to discuss where the dental community stands and how it will affect your visits.

            There have been differing opinions on the use of antibiotics before dental treatment for those who have had total joint replacements. Some have argued to continue premedication for two years following surgery while others for your entire lifespan. While your physician should have the final say, the dental community currently only recommends antibiotic prophylaxis for the first two years following surgery. If further premedication is recommended by your doctor, we would like them to be responsible for providing the prescription.

            There are still certain situations where we will continue to  provide the prescriptions needed for antibiotics. The ADA (American Dental Association) currently recommends the following:

·         artificial heart valves

·         a history of infective endocarditis

·         a cardiac transplant that develops a heart valve problem

·         the following congenital (present from birth) heart conditions:

o    unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure

o    any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device

If you are uncertain whether or not you fall into any of these categories, we will need to consult with your cardiologist before proceeding with any dental treatment.

            There are also some conditions that have required antibiotics in the past that are no longer included:

·         mitral valve prolapse

·         rheumatic heart disease

·         bicuspid valve disease

·         calcified aortic stenosis

·         congenital (present from birth) heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy

          The future will likely bring changes to regulations and guidelines regarding the need for prophylactic antibiotics before dental appointments. While we will continue to update you with any changes, the best way to reduce the likelihood of infection related to oral bacteria is to maintain excellent oral hygiene and great homecare.

For more information, go to www.brownandkupper.com.

Lee T Brown, DDS

Brown and Kupper, DDS Inc.

(513) 860-3660

Why Should I Have My Child's Wisdom Teeth Removed?

        As your children reach their middle to late teenage years, their wisdom teeth (3^rd molars) become more fully developed and may begin to erupt from the gums. The problem that most people face is there is not enough room in their jaw for the teeth to fit. The resulting impacted wisdom teeth can cause further problems, which is why we typically recommend removal of all wisdom teeth as early as possible.
        When the wisdom teeth do not have adequate room to fully erupt, the gums can experience chronic pain. Gum tissue that partially covers the exposed tooth can create a trap for extra food and bacteria to gather and proliferate. The painful condition that results is called pericoronitis and can only be definitively treated through extraction of the wisdom teeth affected.
          We are also concerned that misaligned wisdom teeth can lead to problems with nearby teeth. If the tooth erupts horizontally into the tooth in front, the resulting gum pocket produced can become a bacteria trap and decay may start on the tooth or even the root. In some extreme cases, the adjacent tooth may be non-restorable and may need to be removed as well. And there was previously a thought that a sideways wisdom tooth could also cause crowding amongst the surrounding teeth. However, more recent studies have found that the presence of wisdom teeth do not push the other teeth together.
           If wisdom teeth remain impacted in the jaw bone, you risk developing a cyst in the bone surrounding the tooth. Cysts can destroy bone, tooth roots, and even cause issues with nearby nerves. The larger the cyst becomes, the more invasive the surgery will be to remove the problem area.   
           So when is the best age to get wisdom teeth removed? We believe the earlier they are extracted, the better. At a younger age, the jaw bone isn’t as dense around the teeth and the roots of the wisdom teeth are not fully formed. This decreases the odds of complications and makes the healing process a little easier. In nearly all cases, we recommend seeing an oral surgeon for the extractions because of their expertise with wisdom teeth extractions and their familiarity with conscious sedation. These factors help make the experience as comfortable as possible.
          Like anything else, extenuating circumstances exist where there may be some different recommendations regarding how to treat the wisdom teeth. By consulting with the dentist, oral surgeon, and even the orthodontist, we can help find the best treatment for you or your children’s teeth.

 For more information, please visit us at www.brownandkupper.com.

 Lee T. Brown, DDS

Brown and Kupper, DDS Inc
(513) 860-3660

What is so Important About Oral Cancer Screenings?

          Each time you visit our office for a professional cleaning and examination, both the hygienist and dentist perform an oral cancer screening. There are a number of different markers we look for during the exam, but the most important thing you can do is maintain regular visits to help us identify any issues as early as possible. The sooner oral cancer is identified, the better the odds are in treating the disease.

            There is a lot of controversy and debate over which method of screening is most successful. Traditionally, we have looked for unusual areas of red patches, white patches, or mouth sores. We also examine the tissue with our hands to feel for any abnormal bumps or lumps. If any area of concern is identified, we must then determine if a biopsy is needed or if we should re-examine the area in 10-14 days. This decision is usually based off the severity of the area, the location, and the patient’s medical history. For example, if there is a history of oral cancer or if the patient has used tobacco products, we are more likely to refer to a specialist for a closer look. The only definitive way to tell if you have oral cancer is to remove the abnormal cells and have them checked with a biopsy.

            Some newer technology has become available that involves rinsing with blue dye or shining a special light on the tissue during an oral cancer exam. In theory, the atypical cells will distinguish themselves using these devices and we can better detect potentially harmful areas. However, most studies reveal it is no more effective than a standard oral cancer exam. In fact, it results in a large number of ‘false positives’ in areas that are not abnormal. Until the technology produces better results, we will continue to use the same techniques in identifying potentially harmful areas.

            If you have a history of tobacco use (cigarettes, cigars, pipes, chewing tobacco and snuff), heavy alcohol use, or a history of oral cancer, you can greatly benefit from routine oral cancer screenings since you are at an increased risk. Maintaining regular visits to the dentist is crucial in early detection, and an early diagnosis can improve your odds against oral cancer.

 For more information, visit us at www.brownandkupper.com.

 Lee T. Brown, DDS

Brown and Kupper, DDS Inc.
(513) 860-3660

Does My Child Need Sealants on Their Teeth?

           We typically recommend dental sealants for children as soon as the permanent molars have erupted above the gums. In cases where the child is more prone to tooth decay, we may also advise placement of sealants on premolars (bicuspids), maxillary (upper) incisors, and even baby teeth. The goal of dental sealants is to protect the pits and grooves of the teeth in an effort to prevent the growth of decay. Children are more disposed to cavities in these locations than adults, and protecting them now can save them from larger issues in the future.

            One of the challenges of placing successful dental sealants is isolating the tooth we are working to protect. In a perfect world, we would attempt sealants as soon as the tooth has erupted above the gums. However, permanent molars typically erupt around the age of 6. Even though a single tooth can be sealed in a minute or two, a child may not have reached the point where we can maintain isolation from saliva for that long. If it becomes contaminated before completion, the sealant will not last as long.

            The expected lifetime of dental sealants last can vary. They may remain on the tooth for only a few years, but sometimes we see remnants of sealants from 10 or more years ago. We usually recommend sealants are maintained until a few years following the eruption of the second molars. But depending on the patient’s dental history and homecare, we may recommend the sealants remain for longer.

            Dental sealants are an easy and non-invasive way to protect children from tooth decay. Our hope is by limiting cavities throughout the childhood years, we can greatly reduce the need for larger and more invasive dental procedures as your children grow older. If you have any particular questions about your child’s need for sealants, I encourage you to speak with your dentist and dental hygienist.

For more information on sealants and dentistry for children of all ages, visit www.brownandkupper.com.

Lee T. Brown, DDS

Brown and Kupper, DDS

(513)860-3660

Which Toothbrush Should I Use?

                    If you have ever walked down the aisle where toothbrushes are sold, it can be a little overwhelming. With traditional brushes, there are different brands, sizes, shapes and bristle hardness. Electric toothbrushes offer different brands, shapes, brush heads, and extra features. They can range in price from around $30 to over $200! Hopefully we can add a little clarity on what works best and what is most important when purchasing and using a toothbrush at home.
                 In my opinion, an electric toothbrush offers the best opportunity to provide the good yourself with good oral hygiene at home. One of the most important features an electric toothbrush can offer is a two minute timer. It is recommended that you spend two minutes each time you brush. Unfortunately, our internal clock usually goes off a lot sooner than the full amount of time. This feature takes out that risk and helps us clean our teeth more effectively each day.
                   We must also discuss which type of brush head is most effective. Oral B offers brushes with a circular motion of cleaning, while Sonicare offers a vibrating head. I believe both can prove equally effective when used properly, but the key is to let the brush do the work. If you aggressively ‘scrub’ your teeth instead of simply moving the brush head across the tooth surface, damage can still be done to your gums. You must trust that the motion of the brush head will do the job, and extra hard scrubbing is no longer necessary. 

                    Now you need to decide how much to spend on your brush and what features are most important. For this, I think it depends what is most important to you. If used correctly, a $50 brush can work just as effectively as a $200 brush. But if having a visible timer is important to you, or having a self-cleaning function is vital, there is nothing wrong with getting a brush with all the bells and whistles. The first thing I would look for when comparing brushes at a different price would be the replacement brush heads. If the $50 brush has the same replacements heads as the $200 brush, chances are the brush itself is very similar. This is not always 100% true, but hopefully it can help narrow your search. 

                      There are lots of different brushes that can help you maintain good oral hygiene on a daily basis. The key is to find one you feel comfortable using, and make sure you are using it correctly. The most expensive brush available won’t keep you healthy unless you know what you’re doing. So whether it is an electric or manual toothbrush, be sure to consult your dentist or hygienist on proper use.

For more tips and FAQs on keeping your teeth healthy, check out  www.brownandkupper.com.

 

Lee T. Brown, DDS

Brown and Kupper, DDS

(513) 860-3660

 

 

Dental Amalgams: Are Silver Fillings Still OK?

          There has been some recent controversy about amalgam (silver) dental fillings and any issues they may present to the patient or environment. Dental amalgam is a mixture of copper, silver, tin, and zinc; trace amounts of mercury are added for strength and durability. There are claims that the amalgam is toxic and can cause serious issues. However, the American Dental Association still supports use the use of dental amalgams as an appropriate restorative material for children and adults.
           It is admirable that people today are conscientious about what materials are put into their bodies, and it is a normal to question if dental amalgam is safe. Mercury occurs naturally in the environment and also comes from industrial pollution. Nearly everyone has trace amounts of mercury in their bodies, regardless of the presence or absence of amalgam fillings. At high levels, mercury can be very dangerous. However, in the average human, the consumption of fish accounts for about 70% of the mercury present in our bodies.
           Many studies have been conducted to discover if harm is caused by the miniscule amounts of mercury released from an amalgam filling. None have shown convincing evidence of harmful effects or increased risks. In fact, the CDC, FDA, EPA, NIH, World Health Organization, and the American Dental Association have all concluded that dental amalgams are safe. And if you saw the Dr. Oz show that reported on the potential harm of mercury vapor in the mouth, I encourage you to visit www.dentalwatch.org/hg/oz.html for a full critique on that segment.
           Removing undamaged dental amalgams is typically unnecessary and potentially damaging to the teeth. Unless you have a history of high exposure to mercury or you have had classic symptoms of mercury poisoning in the past, there is no clinical reason to avoid amalgam fillings. In fact, there are still a number of situations where a dental amalgam filling is recommended over a white (composite) filling.
           At the end of the day, they are your teeth and you can decide what type of filling material you feel comfortable with. Nearly all of our fillings are tooth colored, but situations can arise where it is beneficial to consider a dental amalgam filling. At that time, we would take time to review the positives and negatives of each to help you make the best decision for your dental and overall health.

If you have other questions on dental fillings, please visit us at www.brownandkupper.com.

Lee T. Brown, DDS
Brown and Kupper, DDS Inc.
(513) 860-3660

How Does My Diet Affect My Risk of Tooth Decay?

        This time of the year it seems like we are constantly snacking on sweets both at home and at work. Our first concern may be packing on a few extra pounds over the holidays, but all of this snacking can put you at a higher risk for tooth decay. Hopefully we can share a few helpful hints to reduce the possibility of developing cavities during this time and throughout the year.
         Plaque is a term we use to refer to a sticky film of bacteria that adheres to your teeth. It forms as a result of different bacteria attaching to your teeth after eating or drinking.  If you do not properly clean our teeth, the plaque bacteria use can the sugar we ingest to make acid. The acid can attack the enamel for up to 20 minutes after consuming sugar filled food or drinks. So if you eat or drink throughout the day or for a long time, your teeth are exposed to acid attacks over and over. These repeated attacks often result in tooth decay and the need for intervention by the dentist.
         So how can you reduce your risk of tooth decay? Below are a few easy things to remember that can limit the possibility of developing cavities:

1. Limit sugary snacks and drinks between meals. This includes energy drinks and sports drinks.
2. When you do have sugary snacks and drinks, try to have them with your meals and not throughout the day with snacks.
3. Chewing sugar free gum or gum with xylitol for 20 minutes after meals has been shown to reduce tooth decay.
4. Drinking tap water throughout the day can help prevent tooth decay because it contains fluoride and can help rinse away any sugary drinks.
5. See your dentist regularly. They can help personalize a plan to limit your risk of decay. And if you do develop a cavity, they can help find in early.

For more answers or tips on good oral health, visit us at www.brownandkupper.com.

Lee T. Brown, DDS

Brown and Kupper, DDS Inc.
(513)860-3660