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For many patients taking a precautionary dosage of antibiotics prior to dental work is considered routine. Those with joint replacement, certain heart diseases, or evenLas Vegas Cosmetic Dentist Marielaina Perrone DDS congenital heart defects have been instructed to do so in the past. New findings have caused  The American Heart Association to redefine the guidelines to account for new research information.

American Heart Association Findings

The American Heart Association recommends that only patients who have the greatest risk of a bad outcome from infective endocarditis (IE) should receive short-term preventive antibiotics before routine dental procedures. Infective endocarditis is an infection of the heart’s inner lining or the heart valves, which results when bacteria enter the bloodstream and travel to the heart. This can occur during routine dental procedures like a teeth cleaning.

These new guidelines now remove certain conditions from the list that have been there in the past. The following list shows the conditions that no longer need to be premedicated with antibiotics:

-Mitral valve prolapse

-Rheumatic heart disease

-Bicuspid valve disease

-Calcified aortic stenosis

-Congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.

Antibiotics Risk

These new guidelines are based on scientific evidence that shows the risks from taking preventive antibiotics outweigh the benefits received for most patients. The risks can include allergic reactions to antibiotics, stomach discomfort, yeast infection, or the development of antibiotic resistant bacteria.

The research also showed that infective endocarditis is far more likely to occur from everyday activities than from any dental procedures. Daily activities like brushing and flossing can expose bacteria from the mouth into the bloodstream just as easily as a dental procedure. The American Heart Association emphasized that patients should maintain good oral hygiene maintenance to reduce the risk of developing infective endocarditis.

Disease Conditions That Still Require Antibiotics

Some condition still require antibiotic premedication and these include:

-Patients with artificial heart valves.

-Previous history of having had infectious endocarditis.

-Presence of a congenital (born with) heart conditions.

-Heart transplant patients who develop issues with a heart valve.

 

Henderson Cosmetic Dentist Marielaina Perrone DDS

The patients with conditions listed above would be at greatest risk of very bad outcomes if they were to develop infectious endocarditis. This is why the American Heart Association recommends antibiotic premedication for these patients. The benefits outweigh the risks for the groups listed above.

Conclusion

Patients should always ask their physician or cardiologist first, to assess their possible need for antibiotic premedication. You should also ask your dentist if you have any questions regarding antibiotic premedication. It is important that this is to be an informed decision between patient and provider, and done on an individual basis. The guidelines are just that, general guidelines, both you and your doctor will decide what is best for you.

Patients also need to be aware that overuse of antibiotics is not a good thing either. Overuse of antibiotics has led to an increase in the number of bacteria now resistant to antibiotics. When this occurs, new antibiotics must be developed to kill these new resistant bacteria. The new resistant bacteria are typically stronger and can cause more serious illnesses.

As always, maintain a good dental hygiene regimen and visit your dentist regularly for dental examinations and professional cleanings.

 

Flossing is one of those tasks in life that we know we should do, we know the benefits of it, and we know how little time it takes but most of us, just do not do it regularly.

Flossing your teeth every night can be a hard habit to develop and maintain, but it’s one that comes with great benefits.  Simply having a cleaner feeling mouth, avoiding bad breath , preventing tooth cavities or even avoiding loss of teeth can be accomplished with flossing. Regular tooth brushing cannot reach all the areas of our mouth. Brushing supposedly is only able to clean about 60% of the mouth whereas flossing is able to get to the other 40%. Flossing is able to reach those areas if done properly. Flossing is able to remove plaque, bacteria, and food debris between teeth.

It is recommended by the American Dental Association that we floss at least once a day. Proper oral hygiene maintenance is important to stave off periodontal disease and also to keep our entire body healthy. Studies have shown less than half of Americans admit to flossing daily. In reality, that number is probably much lower.

What if there was an easier way to floss daily to maintain our teeth and gums?

 

Alternatives to Flossing

These alternatives will never be as good old fashioned flossing but they will make an improvement to your oral health versus not using them.

Flossing with Waterpik Flosser Marielaina Perrone DDS

Flossing with Waterpik

-Waterpik Oral Irrigator. As the name suggests the waterpik is able to do its job by using a stream of pulsating water to remove plaque, bacteria,  and food debris between teeth and above and below the gum line, to stimulate blood flow, and to improve overall oral health. Studies have shown when used correctly that the waterpik is actually superior  in reducing bleeding of gum tissue and is as effective in reducing plaque buildup. The beauty of the waterpik is its ability to mix antibacterial rinses or a rinse like Periogen into the irrigating chamber. This adds the benefit of being an antibacterial or anti tartar rinse as well, making it doubly effective.

-Oral-B Hummingbird Electric Flosser. The hummingbird flosser is an electric flossing tool that is able to gently vibrate to massage your gums while it is cleaning between your teeth. This is an excellent flossing tool for those lacking dexterity since it can be used with one hand vs two with traditional flossing.

-Tooth Pick, stimudents, soft piks. Yes, a good old fashioned tooth pick can be useful for cleaning in between your teeth. While it doesn’t do the best job, it is definitely  easy to use, can remove large food particles, and stimulate blood flow. Just be careful not to poke your gums and injure yourself.

-Sonicare AirFloss. This product makes it easier to keep our teeth clean between dental visits. The Sonicare AirFloss was specially

Flossing with Sonicare AirFloss Marielaina Perrone DDS

Flossing with Sonicare AirFloss

designed to give you an easy and simple, effective way to clean in between your teeth. The Sonicare AirFloss works using patented micro burst technology. This technology delivers micro droplets of air and water to remove plaque, bacteria, and food debris between teeth. Studies have proven the Sonicare Airfloss to be safe and effective as well as gentle on teeth and gum tissue.The Sonicare Airfloss is very easy to use. It features a single button and a guidance tip that allows the user to target cleaning in between teeth. Patients can complete their flossing in as little as 60 seconds. And with the narrow tip, patients are able to reach the back of their mouth very easily. This allows all the teeth in the mouth to be cleaned. The reservoir holds two teaspoons of water, mouthwash, or other oral rinse. This is enough for two uses and makes the Sonicare AirFloss doubly effective as it has an anti bacterial component as well.

Alternative Flossing Conclusion

As you can see above there are a few alternatives to flossing. Bottom line is nothing beats using a simple piece of floss and flossing like many have been for decades. But if you are unable to or unwilling, the products listed above will help improve your oral hygiene.  Use what works best for you and use it as often as you can. Keeping your teeth clean between dentist visits is very important in having your teeth last a lifetime and preventing the development and advancement of periodontal disease. So, maintain a regular schedule of complete dental examinations as well as professional cleanings along with continued at home care and you will see great results in your smile and your health.

 

 

 

Periodontal disease (or gum disease) is a serious and chronic infection of the gum tissue that can result in the breakdown of the tissue as well as the deterioration of bone that surrounds and supports your teeth. This infection process begins when bacteria and plaque form a sticky bio film on your teeth and causes inflammation of the gum tissue.  Periodontal disease will continue to progress if this is not resolved by maintaining proper dental care and hygiene. Periodontal disease is the leading cause of tooth loss in adults. Studies show that somewhere between 75% and 95% of all adults are suffering some stage of periodontal disease.

Periodontal disease and dental decay (cavities) are caused by different types of bacteria, and are considered to be two different conditions, however, you can suffer from both issues. Poor oral hygiene promotes the risk of both cavities and periodontal disease. Swollen and receding gums open up the more vulnerable areas of the tooth…The root areas, which, are not protected by enamel and can break down quickly to form root cavities.  On the flip side, In patients with significant decay, the broken down teeth allow for food trap areas which keep gum tissue chronically inflamed.

Gingivitis

Periodontitis

Stages of Periodontal Disease

The first stage of periodontal disease is gingivitis (or simply inflammation of the gum tissues). This is the most mild form of periodontal disease. Symptoms include red, swollen (or puffy) and inflamed gums due to plaque-bacteria build-up. The gums may also bleed easily during brushing or eating of hard foods. During the earliest of stages the periodontal disease process it can be reversed thru proper brushing, flossing and professional dental care to remove the excess bacterial plaque. If the required oral hygiene does not occur, the periodontal disease then progresses  to the next stage. The majority of people with this early form of periodontal disease, do not even know a dental problem exists. This is a crucial period for the patient, as the condition can be reversed (since the bone and connective tissue that hold the teeth in place have not yet been affected) at this point if it is recognized and properly treated. Gingivitis is commonly seen during puberty, pregnancy, times of high stress, and menopause, as hormones can make you more prone to inflammation. As for the rest of the population, poor hygiene is generally the most common cause, followed by medication and certain medical conditions.

Periodontitis

As the periodontal disease progresses it is now becoming harder to treat and control. The difference between gingivitis and periodontitis is that gingivitis only infects the gum tissue that surrounds the teeth while the periodontal disease process also invades the bone that provides support and stability for the teeth. The bacteria eventually invades past the initial the gum line area and destruction begins to the point that gums may begin to separate or pull away from the teeth (taking away support and connective fibers with it). What results are called periodontal pockets. These pockets allow for bacteria to invade below the gum line.  They eventually become loaded with toxic plaque and bacteria that moves and works its way deeper. It begins to erode the bone below the gum line. A patient’s bite will be affected (as the teeth shift or loosen) by the lost support which then affects chewing and other functions.

Advanced Periodontitis

As the periodontal disease process advances, the fibers and bone that provide support for the teeth is destroyed. At least half of the bone support (if not more) will have broken down at this late stage of periodontal disease. It does not grow back naturally. Teeth may begin to loosen. Deep root cleanings and surgical intervention are typical at this stage. This may include cleaning with a periodontal microscope, (Perioscope), grafting of tissue, bone, placement of growth factors, (Emdogain), periodontal antibiotic regimen (Periostat), placement of antibiotics directly into pockets, (Arestin), open flap surgery, and, possibly tooth removal.

How Do I Know If I Have Periodontal Disease?

Periodontal disease can happen to a person of any age. It is most common among adults. Remember if periodontal disease is detected in its earliest stages it can be reversed so it’s important to see your dentist if you notice any of the following symptoms:

-Gums that are red, puffy or inflamed, or tender.

Periodontitis

X-Ray showing Periodontal Disease Progression

-Gums that bleed easily during routine brushing or flossing.

-Teeth that appear longer due to recession of gum tissue.

-Changes in the way your teeth fit together when you bite or chew.

-Pus coming from between your teeth and gums

-Bad breath odor or bad taste in your mouth.

Treatment of Periodontal Disease

Periodontal Disease

Arestin use in Periodontal Disease

The earliest stages of periodontal disease is reversible. This is accomplished thru proper brushing, flossing, and maintaining a regular schedule with your dentist. A professional cleaning by your dentist or hygienist is the only way to remove plaque and tartar. The hygienist will clean (also called scaling) your teeth to remove the tartar and plaque buildup from above and below the gum line. If the periodontal disease condition worsens, then a root planing procedure may be necessary. Root planing helps smooth irregularities on the roots to make it more difficult for plaque to deposit there. Also makes it easier for you to keep your teeth clean at home. , treatment can also include use of antibiotics.

If you have advanced periodontitis, your gum tissue may not respond to nonsurgical treatments and good oral hygiene. In that case, your periodontitis treatment may require dental surgery. These may include:

-Pocket Reduction Surgery (also called Flap surgery). In this procedure, your periodontist makes tiny incisions in your gum so that a section of gum tissue can be lifted back, exposing the roots for more effective scaling and planing. Because periodontitis often causes bone loss, the underlying bone may be recontoured before the gum tissue is sutured back in place. The procedure generally takes from one to three hours and is performed under local anesthesia.

-Soft tissue grafts. Gum tissue is often lost as part of the periodontal disease process making your teeth appear longer than normal. You may need to have damaged tissue replaced to return your cosmetic appearance back to normal. This procedure can help reduce further gum recession, cover exposed roots and give your teeth a more cosmetically pleasing appearance.

-Bone graft. This procedure is needed when periodontitis has destroyed the bone surrounding your tooth. The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone.

-Antibiotics and medicaments – A wide array of antibacterial rinses(Peridex), antibiotics taken in pill form, (Periostat) or localized placement directly into the affected pockets(Arestin), can aide in and promote healing of the affected gum tissue.

-Guided tissue regeneration. This allows the regrowth of bone that was destroyed by bacteria. In one approach, your dentist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back instead.

-Enamel matrix derivative application. Another technique involves the application of a specialized gel to a diseased tooth root. This gel contains the same proteins found in developing tooth enamel and stimulates the growth of healthy bone and tissue. An example of this is the use of emdogain.

To insure a successful result following periodontal therapy, patient cooperation in maintaining excellent oral hygiene is essential. More frequent professional cleanings can help reduce the likelihood of the periodontal disease ever returning.

By scheduling regular checkups, early stage periodontal disease can be treated before it leads to a much more serious condition. If your periodontal disease is more advanced, treatment in the dental office will be required.

Dental Implants have become one of the most popular, and predictable procedures for tooth replacement offered in dentistry. They have been proven to be safe and successful for long term replacement of missing teeth. Dental implants are an artificial tooth root (usually made of titanium) that a periodontist or oral surgeon places into your jaw to support restorations that resemble a tooth or group of teeth. What can dental implants do? They can replace a single tooth, be support for a bridge, or as support for a denture (making it more comfortable and secure).

Dental implants are an ideal option for people in generally good oral health who have lost a tooth or teeth due to periodontal disease, injury, or any other reason. Dental implants are actually more tooth saving than traditional crowns and bridges, since dental implants do not cut down healthy teeth or rely on adjacent teeth for support.

Sufficient bone is needed to support the dental implants, and the best candidates have healthy gum tissues that are free of periodontal disease. Dental implants are intimately connected with the underlying bone and gum tissues in the mouth. So, proper oral hygiene is necessary for long term success. With technique and material advances, dental bone grafts are now more successful than ever and can be used to augment your natural bone. Be upfront with your dentist regarding health issues. There is an increased risk of failure in patients who smoke. For this reason, dental implants are frequently placed only after a patient has stopped smoking.

Dental Implants

Dental Implants

Dental implant success is related to surgeon’s skill, quality and quantity of the bone available at the site, and the patient’s oral hygiene maintenance. Failure of dental implants is usually due to the failure of the implant to osseointegrate (fuse with bone) correctly, or vice-versa. It is considered a failure if it is lost, mobile or shows marked bone loss around the implant. Dental implants are not susceptible to dental caries but they can develop a condition called Peri-implantitis. This is an inflammatory condition of the gingival tissue and/or bone around the implant which may result in bone loss and eventual loss of the implant. It is usually associated with chronic infection. Peri-implantitis is more likely to occur in heavy smokers, patients with diabetes, patients with poor oral hygiene and cases where the gingival around the implant is thin.

More rarely, dental implants may fail because of poor surgical placement, not having enough bone healing prior to restoring with a crown or may be overloaded initially, causing failure to integrate. If smoking and positioning problems exist prior to implant surgery, dentists often recommend to patients that implants may not be the best option.Then they will recommend a bridge or a partial denture to replace the missing tooth.

Once restored, dental implants are very natural looking and the patient will not feel any difference after it is healed. You may even forget you ever lost a tooth in the first place. A person’s self esteem is definitely affected by his/her smile. Perhaps you hide your smile because of spaces from missing teeth.  Maybe your dentures don’t feel secure.  Perhaps you have difficulty chewing. If you are missing one or more teeth and would like to smile, speak and eat again with comfort  and confidence, there is good news!  Dental implants are teeth that can look and feel just like your own! Under proper conditions dental implants can last a lifetime.  Long-term studies continue to show improving success rates for dental implants.

If you have lost a tooth or are facing tooth loss, you might wonder…….

Can I get dental implants? Ask your dentist, more often than not, the answer is yes!

 

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