By Martin, Kissell & Pushee, PC
November 27, 2020
Category: Dental Procedures
Tags: dental implant  
TalkWithYourDentistAboutAntibioticTherapyBeforeImplantSurgery

Dental implants are far and away the most “tooth-like” restoration available today for missing teeth. Not only do they look real, they also mimic dental anatomy in replacing the tooth root.

To install an implant, though, requires a minor surgical procedure. And, as with any surgery, that includes a slight risk for a post-surgical infection. For most patients this isn't a major concern—but it can be for people with certain medical conditions.

One way to lessen the risk for implant patients whose health could be jeopardized by an infection is to prescribe a prophylactic (preventive) antibiotic before implant surgery. The American Dental Association (ADA) recommends the measure for patients with artificial heart valves, a history of infective endocarditis, a heart transplant and other heart-related issues.

In the past, their recommendation also extended to people with joint replacements. But in conjunction with the American Academy of Orthopedic Surgery (AAOS), the ADA downgraded this recommendation a few years ago and left it to the physician's discretion. Indeed, some orthopedic surgeons do recommend antibiotic therapy for patients before surgical procedures like implantation for up to two years after joint replacement.

These changes reflect the ongoing debate over the proper use of antibiotics. In essence, this particular argument is over risks vs. benefits: Are pre-surgical antibiotics worth the lower infection risk for patients at low to moderate risk in return for increased risk of allergic reactions and other side effects from the antibiotic? Another driver in this debate is the deep concern over the effect current antibiotic practices are having on the increasing problem of antibiotic-resistant bacteria.

As a result, dentists and physicians alike are reevaluating practices like prophylactic antibiotics before procedures, becoming more selective on who receives it and even the dosage levels. Some studies have shown, for example, that a low 2-gram dose of amoxicillin an hour before the procedure can be effective with much lower risks for side effects.

If you're considering dental implants and you have a medical condition you think could be impacted by the procedure, discuss the matter with your dentist and physician. It may be that pre-surgical antibiotics would be a prudent choice for you.

If you would like more information on getting dental implants, 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 “Implants & Antibiotics.”

By Martin, Kissell & Pushee, PC
November 17, 2020
Category: Oral Health
Tags: dental care  
AMildNSAIDMayBeAllYouNeedToManageDiscomfortAfterDentalWork

Undergoing dental work is for the most part a pain-free affair. But once you're home and the anesthetic begins to wear off, you may have some discomfort.

Fortunately, most post-procedure pain can be managed with non-steroidal anti-inflammatory drugs or NSAIDs. And while stronger versions of these pain relievers can be prescribed, you may only need one sold over-the-counter.

NSAIDs like ibuprofen or acetaminophen work by inhibiting the release of prostaglandins, substances that stimulate inflammation in traumatized or injured tissues. It differs in this way from the two other primary pain medications: Steroids act like natural hormones that alleviate physical stress in the tissues; and narcotics like morphine or codeine suppress the brain's reaction to nerve firings.

While these stronger types are effective for stopping pain, they can have several serious side effects. Narcotics in particular can be addictive. Although they may be necessary in serious cases of acute pain, most dentists turn to non-addictive NSAIDs first, which are usually effective with the kind of discomfort associated with dental work and with fewer side effects.

That's not to say, however, that NSAIDs are risk-free—they must be taken properly or you could suffer serious health consequences. For one, NSAIDs have a blood-thinning effect that's even more pronounced when taken consistently over a period of weeks. This can lead to bleeding that is difficult to stop and erosion of the stomach lining leading to ulcers. Prolonged use can also damage the kidneys.

As a rule of thumb, adults shouldn't take more than 2400 milligrams of ibuprofen or other NSAIDs in a day, unless otherwise directed by their doctor. For most, a 400-milligram oral dose taken with food (to minimize stomach upset) is usually sufficient to relieve pain for around five hours.

You'll usually avoid unwanted health effects by keeping within your dentist's recommended doses and taking an NSAID for only a few days. Taking an NSAID properly can help keep your discomfort to a minimum after dental work without the need for stronger drugs.

If you would like more information on managing dental pain, 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 “Treating Pain With Ibuprofen.”

By Martin, Kissell & Pushee, PC
November 07, 2020
Category: Oral Health
Tags: dental implant  
AlthoughChallengingCleaningAroundImplantsBoostsTheirLongevity

Daily oral hygiene and regular dental cleanings help keep your natural teeth and gums healthy and disease-free. But they're also a priority with dental implants. Here's why.

Unlike other restorations, an implant replaces both a tooth's crown and root, the latter by way of a titanium metal post imbedded into the jawbone. Bone cells grow and adhere to the metal surface, forming a secure and lasting hold.

But although quite durable, this hold differs significantly from natural teeth, which are actually held in place by a tough, elastic tissue called the periodontal ligament. The attachment of the ligament's tiny fibers to both tooth and bone secure the tooth in place, as well as supply it and the surrounding gums with nutrients and defensive antibodies to fight infection.

Implants don't have this relationship with the periodontal ligament. The tissues around an implant are thus susceptible to an aggressive form of periodontal (gum) disease called peri-implantitis. This kind of gum infection can progress rapidly, leading eventually to bone loss and possible failure of the implant.

Daily brushing and flossing of both natural and implant-supported teeth lowers the risk of gum disease, particularly peri-implantitis. It's also imperative that you undergo regular cleanings, at least every six months, with your dentist or dental hygienist.

These, however, won't be the typical cleanings performed on natural teeth. Hygienists don't use metal cleaning implements to remove plaque and tartar deposits because they can scratch the metal materials of the implant and crown. These microscopic scratches can then attract bacteria that trigger gum infections. Instead, they'll use instruments made of plastics or resins.

Hygienists also rely heavily on ultrasonic equipment that vibrates plaque loose on or around implants, which are then flushed away with water. The tips used with these instruments are also typically made of nylon or plastic sheathing.

Even with the extra hygiene care needed, implants still enjoy a 95% or higher survival rate after ten years. You can ensure your implants achieve that level of durability by keeping them clean and seeing your dentist at the first sign of a gum infection.

If you would like more information on maintaining dental implants, 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 “Dental Implant Maintenance.”

By Martin, Kissell & Pushee, PC
October 28, 2020
Category: Dental Procedures
WisdomTeethCanStillbeaProblemfortheWorldsYoungestBillionaire

According to Forbes Magazine, Kylie Jenner is the world's youngest billionaire at age 22. Daughter of Caitlyn (Bruce) Jenner and Kris Jenner, Kylie is the founder and owner of the highly successful Kylie Cosmetics, and a rising celebrity in her own right. But even this busy CEO couldn't avoid an experience many young people her age go through each year: having her wisdom teeth removed.

At around 10 million removals each year, wisdom teeth extraction is the most common surgical procedure performed by oral surgeons. Also called the third molars, the wisdom teeth are in the back corners of the jaws, top and bottom. Most people have four of them, but some have more, some have fewer, and some never have any. They're typically the last permanent teeth to come in, usually between ages 17 and 25.

And therein lies the problem with wisdom teeth: Many times, they're coming in late on a jaw already crowded with teeth. Their eruption can cause these other teeth to move out of normal alignment, or the wisdom teeth themselves may not fully erupt and remain fully or partially within the gums (a condition called impaction). All of this can have a ripple effect, decreasing dental function and increasing disease risk.

As Kylie Jenner has just experienced, they're often removed when problems with bite or instances of diseases like tooth decay or gum disease begin to show. But not just when problems show: It's also been a common practice to remove them earlier in a kind of “preemptive strike” against dental dysfunction. But this practice of early wisdom teeth extraction has its critics. The main contention is that early extractions aren't really necessary from a medical or dental standpoint, and so patients are unduly exposed to surgical risks. Although negative outcomes are very rare, any surgical procedure carries some risk.

Over the last few years, a kind of middle ground consensus has developed among dentists on how to deal with wisdom teeth in younger patients. What has emerged is a “watch and wait” approach: Don't advise extraction unless there is clear evidence of developing problems. Instead, continue to monitor a young patient's dental development to see that it's progressing normally.

Taking this approach can lead to fewer early wisdom teeth extractions, which are postponed to a later time or even indefinitely. The key is to always do what's best for a patient's current development and future dental health.

Still, removing wisdom teeth remains a sound practice when necessary. Whether for a high school or college student or the CEO of a large company, wisdom teeth extraction can boost overall dental health and development.

If you would like more information about wisdom teeth and their impact on dental health, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Wisdom Teeth: To Be or Not to Be?

By Martin, Kissell & Pushee, PC
October 18, 2020
Category: Oral Health
Tags: sleep apnea   snoring  
YourDentistCouldHelpYouOvercomeSleepApnea

A full night's sleep isn't a luxury—we all need it for a healthy mind and body. But 50-70 million people in the U.S. aren't getting enough sleep because of a chronic sleep disorder like obstructive sleep apnea (OSA).

OSA happens when a sleeper's airway becomes blocked (most commonly by the tongue), cutting off oxygen to the brain. The body rouses from sleep to overcome the blockage. This awakening could last only a few seconds, after which the person immediately goes back to sleep. But it can occur hundreds of times a night and interrupt deeper sleep needed for a good night's rest.

Sleep disorders like OSA are a significant medical problem that could contribute to serious health issues like high blood pressure or cardiovascular disease. If you're experiencing fatigue, irritability or your family's complaints of you snoring, you should see a physician for diagnosis and treatment options.

You should also consider another health professional who could be helpful in dealing with OSA—and may even be able to provide a treatment option: your dentist. Here's how.

A dentist could discover your OSA. Because of twice-a-year dental visits, dentists often see patients more frequently than other healthcare providers. A properly trained dentist could pick up on signs and symptoms of sleep disorder, including patients falling asleep and even snoring while in the dentist's chair.

Dentists are familiar with the mouth. Few healthcare providers focus on the oral cavity like dentists. Besides the teeth and gums, dentists also have extensive knowledge of the tonsils, uvula and tongue that often play a role in sleep disorders. As such, a dentist may notice abnormalities during routine exams that might contribute to airway obstruction during sleep.

Dentists provide a treatment option. Many OSA patients use a CPAP mask to maintain an open airway during sleep. But CPAP therapy can be uncomfortable for some. For mild to moderate cases of OSA, dentists can create an oral appliance based on the patient's mouth dimensions that prevents the tongue from sinking back into the throat.

If you believe you may have OSA or a similar sleep disorder, by all means speak with your doctor. But also mention it to your dentist—your dental provider might hold the key to a better night's sleep.

If you would like more information on how we could help with your sleep apnea symptoms, 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 “Sleep Disorders & Dentistry.”





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