Let’s say you’re new to town. Or your dentist just retired. You’re looking at choosing a new dentist, but you’re not sure what you should look for. In episode 1 of the “You Know the Drill” podcast, Saginaw dentist Dr. Alan Mead talks about a strategy to help you choose the right dentist for you.
Did you like this podcast? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title. Better yet, subscribe to the podcast on your iPhone so you can catch Dr. Mead’s weekly podcast automatically!
I wish I could tell you that we weren’t going to ruin your makeup when you come in to see us. It would thrill me to explain to you the gorgeous new filling we’re placing can be done without messing your hair up or getting your shirt wet.
But I can’t. In good conscience, I need to tell you that we’ll probably make a mess out of you.
When I’m working on people’s teeth, I use the water spray. The spray comes out of the handpiece (aka: drill) for a couple of great reasons:
When you use the handpiece on a tooth to remove diseased or broken tooth structure, it generates heat. According to research, this heat isn’t great for the pulp (nerve, blood vessels, connective tissue) in the middle of the tooth. Teeth that get overheated can become injured and may need a root canal. However, when you spray water on the tooth while you work on it, you significantly reduce the heating up of the tooth structure.
Water spray from the handpiece also removes debris. When I use the handpiece to remove diseased tooth structure, it breaks this stuff into really tiny pieces. It actually kind of pulverizes it into a dusty powder. Without the water spray this stuff smells pretty gross and keeps me from seeing what I’m doing. If you add the water spray, this debris gets gently sucked up into my assistant’s suction.
So please understand, I’m not using the water spray to mess up your makeup on purpose. In fact, you may want to skip your hair and makeup until after your dental appointment. We have a lovely bathroom with flattering lighting that you can use to put yourself together, if you like. Also, I won’t be offended if you bring an umbrella or shower cap in. I get it.
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Two words that have become familiar to anyone who watches TV. Osteoporosis, or decreasing bone density, is a common problem as we age. Although it is painless, it can increase risk of bone fracture which can precipitate all kinds of debilitating problems. So now, every time you turn on the television you see ads for medications that help prevent or slow bone loss due to osteoporosis.
Dentists see a very different kind of bone loss. Have you ever noticed that our stereotyped vision of an old person almost always includes that “caved in face” look around their mouth? That’s bone loss, too. But it’s a very specific kind of bone loss.
Our jawbones have a couple different kinds of bone. The part of the bone that holds the teeth in place is called alveolar bone. This kind of bone sits on top of the basal bone of our top and bottom jaws. The interesting thing about the alveolar bone is that it only serves to hold our teeth in place. If we lose a tooth, the alveolar bone that used to support that tooth shrinks away.
Alveolar bone shrinks away differently with different people, but for the most part a person loses 40-60% of the alveolar bone around a tooth that is removed within the first year. 40-60%! Worse than that, the more teeth someone loses, the more alveolar bone they’ll lose!
You might be thinking “what’s the big deal? So I lose a little bone. I won’t even notice it.”
Well, maybe. If you don’t want to replace the tooth this might not be that big of a deal. If you replace the tooth with something removable (a denture or a partial) you’ll find that it continues to fit more poorly as you lose bone. If you replace the tooth with a bridge you might notice a space opening underneath the “fake” tooth. Or possibly the teeth holding the bridge in place begin to lose support as well.
“O.K., Doc. I get it. I don’t want to lose bone in my jaw. What can I do?”
I’m glad you asked! So it turns out that you can maintain that alveolar bone by replacing teeth with dental implants! Most people have heard that dental implants are a great treatment for replacing missing teeth. But did you know that placing a dental implant will help you maintain that alveolar bone? What a cool side effect!
When you place a dental implant it acts a lot like the tooth that was lost. The alveolar bone is maintained to hold the implant in place and you get tooth-like function and esthetics to boot! Dental implants kind of act like a time machine for your jaw bone by turning back the effects of alveolar bone loss!
Did you find this post timely? Restorative? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.
O.K. So let’s say you’re tackling that stack of bills sitting on your desk. Maybe it’s Tuesday night, maybe it’s Saturday morning.
Writing checks and sending them in the mail is a drag. Plus, you have to allow time for the check to get there. Calling with a credit card is awesome, except you know that whoever you’re paying isn’t open. I love that feeling when I see the line that says, “pay your bill online!”
And now…you can pay Mead Family Dental online, too!
Take a look at this quick tutorial video and you’ll be all set!
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Joint replacement surgery changes lives. For some people having a knee or hip replaced can end years of pain and struggle. The procedure has become quite common and many dental patients in our office have had it done.
Orthopedic surgeons and dentists have been telling themselves and their patients a story about artificial joints and the risks involved with dental treatment after having one. The story goes kind of like this:
Dental treatment causes oral bacteria to get into the bloodstream. These bacteria find their way to artificial joints and if they do, they can get horribly infected. Sometimes the infection can cause the artificial joint to become so bad that it fails and needs to be replaced. This is a serious and expensive side effect. The solution to this problem is premedicating with an antibiotic before you have any dental work done. That will make it so any oral bacteria that make it into the bloodstream are killed off before they can get to the artificial joint.
At first glance, this story makes sense. You definitely don’t want an artificial joint to become infected. Since we know that dental work can cause oral bacteria to get into the bloodstream, having dental work is clearly the problem. Right?
Well…not really. The story might not be true. In fact, there is no scientific evidence that artificial joints are more susceptible to infection after dental work. The story seems plausible but just doesn’t line up with our available evidence.
Some would say, “the complication of an infected joint is so severe that taking a dose of antibiotics is a small price to pay to keep us safe.” It turns out that there is also no scientific evidence that taking any particular antibiotic can keep an artificial joint from becoming infected. Furthermore, it’s worth mentioning that taking antibiotics isn’t a risk-free event, either. Allergic reactions can happen even in people who have had no reactions taking the same medication in the past. On top of that, every time you take an antibiotic it affects the natural balance of all the good bugs that inhabit your body as well. If you’ve ever gotten a yeast infection after taking an antibiotic, you know exactly what I’m talking about! Furthermore, the overuse of antibiotics promotes bacteria that become resistant to the antibiotics which is bad for everyone!
So this is what we’ve been battling with in dentistry. The standard for joint premedication has been take 2000mg (2g) amoxicillin an hour prior to your dental appointment. However, it is somewhat typical for a patient who is supposed to take their premedication to forget to take it. In fact, it happens often. At least weekly in my experience. So then you try and decide whether you should send them home and reschedule their appointment, give them the premedication at the office or just skip it. We sure could use a little bit of guidance from professional organizations, right?
In 2012 the American Dental Association (ADA) and the American Association of Orthopaedic Surgeons (AAOS) published some guidelines. Some vague guidelines. Frustratingly. Vague. Guidelines. You can read about these guidelines in a blog post I wrote back in 2012. Essentially the guidelines stated that although there isn’t any scientific evidence to support the use of antibiotics prior to dental treatment in joint replacement patients, each case should be considered separately. The opinion of the surgeon, patient and dentist were essentially equally valid. There was not a strong “you should do this” or “you shouldn’t do this” attached to the 2012 guidelines.
I have been trying to explain to joint replacement patients that the evidence goes against the need for premedication. However, these patients have been taking antibiotics for their artificial joints for years and years. They have been told by surgeons, dentists, hygienists and all sorts of other health care providers that they are truly at risk if they don’t. Many patients wanted to continue the antibiotics for dental treatment “just to be sure.” And who could blame them? Many dentists weren’t willing to take the (essentially nonexistent) risk either. Our policy had been that the patient just needed to get a letter from their orthopedic surgeon stating that the surgeon felt premedication was necessary and we’d write the prescription. This was a compromise that I was willing to make so long as we were stuck with these wishy washy guidelines.
In early January 2015, the American Dental Association finally weighed in strongly on the controversy:
“In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection. The practitioner and patient should consider possible clinical circumstances that may suggest the presence of a significant medical risk in providing dental care without antibiotic prophylaxis, as well as the known risks of frequent or widespread antibiotic use. As part of the evidence-based approach to care, this clinical recommendation should be integrated with the practitioner’s professional judgment and the patient’s needs and preferences.”
Not perfect, but pretty good in my estimation. The factors that may require premedication now are people who have previously had complications with infected artificial joints as well as patients with immune system compromise.
There should be rejoicing in the streets! Think of how much less often patients will have to take antibiotics! But alas, I’ve already run into patients with concerns. I completely understand this because it’s tough to change what we’ve been doing for so long. For now, we’re going to talk to patients and explain that they really don’t need antibiotics. But we’ll keep in touch with their orthopedic doctors, too. Change happens slowly, but I think the new guidelines are a big step in the right direction!
Did you find this post disjointed? Infectious? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.