Posts for: June, 2015
It’s hard to imagine, but little more than a century ago today’s “minor” bacterial and viral infections were often deadly. This changed with the advent of antibiotics, drugs which kill disease-causing microbes. Decades after the development of penicillin and similar antibiotics, we routinely rely on them for treating infection. They’re quite prominent in dental care in treating advanced forms of periodontal (gum) disease or reducing bacteria that cause tooth decay.
But the age of antibiotics may be in danger: their overuse in medicine and the food industry has led to the rise of resistant microbial strains — “superbugs” — that no longer respond to first line antibiotics or, in some cases, to second or third line drugs. The U.S. Center for Disease Control (CDC) estimates more than two million people annually will contract one of these superbugs of which more than 20,000 will die. If current practices continue, the growth of resistant strains (as well as allergic reactions among users of antibiotics) will increase. The answer is a more modified use of antibiotics.
For healthcare providers, this means adopting new protocols in which we attempt to prescribe antibiotics that specifically target an identified microbe (which we’ve determined through more rigorous diagnostic testing), and in limited amounts. We must also rein in the practice of antibiotic use in the food industry, routinely administered to livestock to prevent disease or to enhance growth. Many countries, including the U.S., are now moving toward a more limited practice in which only animals that are demonstrably sick receive antibiotics. This will limit their release into the greater environment, which is a contributing factor to growing microbial resistance.
Patients also play a role in the better use of antibiotics. We must first change the perception that antibiotics are a “cure-all” — the answer to every illness. It’s also important for patients who’ve been prescribed antibiotics to complete the course of treatment, even if after a day or two they feel better; stopping antibiotic treatment prematurely increases the chances targeted microbes develop a resistance to that particular drug.
Altering our perception and use of antibiotics will require a tremendous effort for all of society. But making these changes will help ensure antibiotics continue to serve humanity as an important health benefit well into the future.
For a predictable outcome, a dental implant should be placed as soon as the bone and gum tissues following a tooth extraction have healed. But what happens if the tooth has been missing for months or years? You might then run the risk of not having enough bone to properly place an implant.
This can happen because of a disruption in the growth cycle of living bone tissue. As older bone cells dissolve (resorption), new bone develops to take its place. This is a dynamic process, as the amount and exact location of the new growth is in response to changes in the mouth, particularly from forces generated by the teeth as we chew. If, however, this stimulation transmitted to the bone no longer occurs because the tooth is missing, the bone will tend to dissolve over time.
In fact, within the first year after a tooth loss the associated bone can lose as much as a quarter of its normal width. This is why we typically place bone grafting material in an empty socket at the same time as we extract the tooth. This encourages bone growth during the healing period in anticipation of installing a dental implant or a fixed bridge. If, however, the bone has diminished to less than required for a dental implant, we must then use techniques to encourage new bone growth to support a future implant.
One such technique for restoring bone in the back of the upper jaw is to surgically access the area through the maxillary sinus (a membrane-lined air space within the bone structure of the face) positioned just over the jawbone to place grafting material. During surgery performed usually with local anesthesia, the surgeon accesses the sinus cavity, lifts the tissue membrane up from the sinus floor and applies the grafting material on top of the bone. Eventually, the new bone growth will replace the grafting material.
If successful, the new bone growth will be sufficient to support an implant. Thanks to this renewed growth, you’ll soon be able to enjoy better function and a transformed smile provided by your new implant.
If you would like more information on forming new bone for implants through sinus 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 “Sinus Surgery.”
More than likely your child already receives fluoride from your drinking water or toothpaste. So, is it really necessary for them to receive topical fluoride during their regular office checkups?
We highly recommend they do. A naturally occurring chemical, fluoride has the ability to make enamel more resistant to acid attacks that lead to tooth decay. It’s most effective when it works its way into the structure of the enamel during early teeth development.
Both fluoridated drinking water and dietary fluoride supplements (recommended by a doctor or dentist) can be the vehicle for this to occur while the teeth are still forming in the jaw before eruption (when teeth become visible). After the teeth have erupted, fluoride applied directly to the enamel surface (topically) can become infused with it as it continues to develop during early growth.
But can’t fluoride toothpaste accomplish the same result? No — the fluoride added to toothpaste and other hygiene products is relatively low, and only strong enough to maintain and protect enamel. The fluoride levels in topical applications like gels, foam or varnishes are much higher (in the tens of thousands of parts per million) and remain in contact with the teeth during a treatment session for much longer. Some fluoride varnishes, in fact, will continue to leach fluoride into the tooth surface for a month or more.
Topical fluoride applications are especially beneficial for children who are growing up in an area without fluoridated drinking water or without the proper means for good oral care and hygiene. But even for children with access to fluoridated water and oral care, a topical application can still be helpful.
A topical fluoride treatment isn’t a stand-alone application, but a regular part of your child’s dental care of daily brushing and flossing and semi-annual dental cleanings and checkups. Topical fluoride enhances the care they already receive to help produce stronger enamel for future healthy teeth.
If you would like more information on topical fluoride applications, 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 “Topical Fluoride: How Fluoride will Benefit Your Child.”
When considering “smile makeover” options, it’s easy to focus on whitening, veneers or implants — techniques and materials focused mainly on the teeth and gums. But if you don’t also consider the bigger picture of how your upper and lower teeth come together to form your bite, these efforts may be a lot like picking out paint colors for a house with foundation problems.
That’s why orthodontics, the dental specialty concerned with the bite, could be a consideration in your smile makeover plan. Moving teeth into better positions not only improves your teeth’s function and health it could also help facilitate any cosmetic changes that follow.
The first step, of course, is to visit an orthodontist, a dentist with advanced training and experience in tooth alignment and function, for a comprehensive evaluation. Orthodontists are also knowledgeable in the growth and development of the bite, and so can develop a treatment approach that reflects the patient’s needs, whether a child or adult.
Treatments vary, depending on your particular needs. Fixed appliances like metal or clear braces that can’t be removed by the patient are the standard treatment for most malocclusions (bad bites). Clear aligners, removable trays that fit over the teeth with programmed incremental movements of the teeth, find the greatest application with adults. Orthodontists may also use specialized appliances, like temporary anchorage devices (TADs), which work to isolate teeth that need to be moved from those that don’t.
In comprehensive makeovers, orthodontists will work with a team of other dentists and specialists, including periodontists (specializing in the gums, bone and other supporting structures of the teeth) and oral surgeons. In these cases, orthodontic treatment may occur before or after other treatments with the overall goal of producing a beautiful, transformed smile.
If you would like more information on how orthodontics can transform your smile, 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 “The Magic of Orthodontics: The Original Smile Makeover.”