Dr. Bob's Blog
WhatYouShouldKnowAboutAntibioticTherapyBeforeImplantSurgery

Placing a dental implant within the jawbone requires a surgical procedure. For most people it’s a relatively minor affair, but for some with certain health conditions it might be otherwise. Because of their condition they might have an increased risk for a bacterial infection afterward that could interfere with the implant’s integration with the bone and lead to possible failure.

To lower this risk, dentists for many years have routinely prescribed an antibiotic for patients considered at high-risk for infection to take before their implant surgery. But there’s been a lively debate among health practitioners about the true necessity for this practice and whether it’s worth the possible side effects that can accompany taking antibiotics.

While the practice still continues, current guidelines now recommend it for fewer health conditions. The American Dental Association (ADA) together with the American Heart Association (AHA) now recommend antibiotics only for surgical patients who have prosthetic heart valves, a history of infective endocarditis, a heart transplant or certain congenital heart conditions.

But patients with prosthetic joint replacements, who were once included in the recommendation for pre-surgical antibiotics, are no longer in that category. Even so, some orthopedic surgeons continue to recommend it for their joint replacement patients out of concern that a post-surgical infection could adversely affect their replaced joints.

But while these areas of disagreement about pre-surgical antibiotics still continue, a consensus may be emerging about a possible “sweet spot” in administering the therapy. Evidence from recent studies indicates just a small dose of antibiotics administered an hour before surgery may be sufficient to reduce the risk of infection-related implant failure with only minimal risk of side effects from the drug.

Because pre-surgical antibiotic therapy can be a complicated matter, it’s best that you discuss with both the physician caring for your health condition and your dentist about whether you should undergo this option to reduce the infection risk with your own implant surgery. Still, if all the factors surrounding your health indicate it, this antibiotic therapy might help you avoid losing an implant to infection.

If you would like more information on antibiotics before implant 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 “Implants & Antibiotics: Lowering Risk of Implant Failure.”

HaveYourChildsChronicMouthBreathingCheckedtoAvoidBiteProblems

We breathe every moment of every day and we’re hardly aware of it most of the time. But if you take the time to focus, you’ll find two possible pathways for your breath: through the nose or through the mouth.

While either pathway provides the air exchange needed to live, nose breathing offers better health benefits. Air passes through the nasal passages, which filter out many harmful particles and allergens. The mucous membranes in the nose also humidify the air and help produce heart-friendly nitric oxide.

Nose breathing also plays a role in your child’s facial and jaw development: the tongue rests on the roof of the mouth (the palate) and becomes a kind of mold around which the developing upper jaw can form. With chronic mouth breathing, however, the tongue rests just behind the lower teeth, depriving the upper jaw of its normal support. This could result in the development of a poor bite (malocclusion).

To avoid this and other undesirable outcomes, you should have your child examined if you notice them breathing mostly through the mouth, particularly at rest. Since chronic mouth breathing usually occurs because of an anatomical obstruction making nose breathing more difficult, it’s usually best to see a physician or an ear, nose and throat (ENT) specialist first for evaluation and treatment.

It’s also a good idea to obtain an orthodontic evaluation of any effects on their bite development, such as the upper jaw growing too narrowly. If caught early enough, an orthodontist can correct this with a palatal expander, a device that exerts gradual outward pressure on the jaw and stimulating it to grow wider.

Another bite problem associated with chronic mouth breathing is misalignment of the jaws when closed. An orthodontist can address this with a set of removable plates worn in the mouth. As the jaws work the angled plates force the lower jaw forward, thus encouraging it to grow in the direction that best aligns with the upper jaw.

Any efforts to correct a child’s breathing habits can pay great dividends in their overall health. It could likewise head off possible bite problems that can be both extensive and costly to treat in the future.

If you would like more information on promoting oral health in your child, please contact us or schedule an appointment for a consultation.

By Dr. Malenius
September 29, 2018
Category: Oral Health
ExpertAdviceVivicaAFoxonKissingandOralhealth

Is having good oral hygiene important to kissing? Who's better to answer that question than Vivica A. Fox? Among her other achievements, the versatile actress won the “Best Kiss” honor at the MTV Movie Awards, for a memorable scene with Will Smith in the 1996 blockbuster Independence Day. When Dear Doctor magazine asked her, Ms. Fox said that proper oral hygiene was indeed essential. Actually, she said:

"Ooooh, yes, yes, yes, Honey, 'cause Baby, if you kiss somebody with a dragon mouth, my God, it's the worst experience ever as an actor to try to act like you enjoy it!"

And even if you're not on stage, it's no fun to kiss someone whose oral hygiene isn't what it should be. So what's the best way to step up your game? Here's how Vivica does it:

“I visit my dentist every three months and get my teeth cleaned, I floss, I brush, I just spent two hundred bucks on an electronic toothbrush — I'm into dental hygiene for sure.”

Well, we might add that you don't need to spend tons of money on a toothbrush — after all, it's not the brush that keeps your mouth healthy, but the hand that holds it. And not everyone needs to come in as often every three months. But her tips are generally right on.

For proper at-home oral care, nothing beats brushing twice a day for two minutes each time, and flossing once a day. Brushing removes the sticky, bacteria-laden plaque that clings to your teeth and causes tooth decay and gum disease — not to mention malodorous breath. Don't forget to brush your tongue as well — it can also harbor those bad-breath bacteria.

While brushing is effective, it can't reach the tiny spaces in between teeth and under gums where plaque bacteria can hide. But floss can: That's what makes it so important to getting your mouth really clean.

Finally, regular professional checkups and cleanings are an essential part of good oral hygiene. Why? Because even the most dutiful brushing and flossing can't remove the hardened coating called tartar that eventually forms on tooth surfaces. Only a trained health care provider with the right dental tools can! And when you come in for a routine office visit, you'll also get a thorough checkup that can detect tooth decay, gum disease, and other threats to your oral health.

Bad breath isn't just a turn-off for kissing — It can indicate a possible problem in your mouth. So listen to what award-winning kisser Vivica Fox says: Paying attention to your oral hygiene can really pay off! For more information, contact us or schedule an appointment for a consultation. You can read the entire interview with Vivica A. Fox in Dear Doctor's latest issue.

By Dr. Malenius
September 19, 2018
Category: Oral Health
Tags: teething  
EaseYourChildsTeethingDiscomfortwiththeseTips

Although it’s a natural part of dental development, teething is no picnic for your baby. This process in which each of their twenty primary teeth gradually erupt through the gums usually begins around their sixth to ninth month and may not end until around age three.

These periodic tooth eruptions can cause your baby to bite, gnaw, drool or rub their ears. Teething can also disrupt sleeping patterns, decrease appetite and cause gum swelling and pain that can turn your otherwise happy baby into an unhappy one.

Managing these teething episodes is one of the most common topics parents bring up with their dentists. Since teething is supposed to happen, there’s no need for medical intervention unless the child is also experiencing diarrhea, rashes, fever or prolonged irritability associated with teething episodes. In most cases, the best you can do is to make your child more comfortable. Here are a few things to help you do just that.

Provide cold items for gnawing. Rubber teething rings, wet wash cloths or pacifiers that have been chilled can give your child something to gnaw on and ease the pressure of sore gums while the chilled temperatures help numb pain. Be sure, though, that the items aren’t frozen because extremely cold temperatures can burn the skin.

Gum massage. You can massage your child’s gums with one of your fingers during a teething episode to counteract the throbbing pressure coming from the erupting tooth. Just be sure your finger is clean and don’t use any numbing agents unless advised by your dentist or pediatrician.

OTC medication. You can ease mild to moderate teething pain with over-the-counter pain relievers like acetaminophen or ibuprofen in dosages appropriate for your child’s age. But don’t apply rubbing alcohol to the gums or massage in any pain reliever—both practices can burn the skin. And, as mentioned before, only apply numbing agents like Benzocaine with the advice and supervision of a healthcare professional.

Besides these practices, be sure to keep up regular dental checkups to monitor the teething process and ensure all is going normally. And remember: though it may seem harrowing at times, the teething process won’t last forever.

If you would like more information on easing the effects of teething, 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 “Teething Troubles: How to Help Keep Your Baby Comfortable.”

LookAfterYourTeethDuringCancerTreatmenttoAvoidDentalDisease

Cancer treatment can be an all-out battle with intense side effects for your entire body. One particular area that can suffer is your mouth.

Chemotherapy and radiation target and destroy cancer cells, which can lead to non-cancerous cells caught in the crossfire and also destroyed. The salivary glands in the mouth are prone to such damage, which could greatly impact your ability to ward off dental disease.

Saliva, what salivary glands produce, plays a major role in oral health. The bodily fluid disseminates antibodies throughout the mouth that fight disease-causing bacteria. It also neutralizes acid, which can erode tooth enamel, and helps restore lost minerals to the enamel.

If the salivary glands become damaged, however, they may produce less saliva and create a condition called xerostomia or “dry mouth.” This is a common occurrence for cancer patients, which can rob them of saliva’s benefits and make them more susceptible to tooth decay or periodontal (gum) disease. The end result could be tooth loss.

There are things you and your dentist can do to prevent this. First, have a complete dental checkup before undergoing cancer treatment. If at all possible have any necessary dental work undertaken (with adequate recovery time afterward) before beginning chemo or radiation. Your dentist and oncologist (cancer specialist) may need to coordinate any planned dental work.

You should also practice daily oral hygiene with brushing and flossing, along with keeping up your regular dental cleanings. This will prevent the buildup on teeth of bacterial plaque, which in turn will reduce your chances for dental disease. Your dentist may also prescribe antibacterial as well as fluoride mouth rinses to help limit the growth of oral bacteria.

To minimize dry mouth, increase your water consumption as much as possible. You may also use saliva boosters like xylitol, an alcohol-based sweetener found in many gums or mints that promotes salivation (it also deters oral bacterial growth).

And don’t forget to maintain a healthy diet, which will not only benefit your stamina during cancer treatment but can also help you maintain better dental health. Providing good care for your mouth during this trying time will help ensure your teeth and gums stay as healthy as possible.

If you would like more information on oral care, 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 “Oral Health During Cancer Treatment.”

EarlyInterventioncanCorrectAbnormalUpperJawandPalateGrowth

Poor bites, also known as “malocclusions,” can have a dramatic impact on mouth function and appearance. Moving teeth to better positions will solve most of these bite problems — but not all.

A case in point is a malformed maxilla, the skeletal structure formed by the union of the upper jaw and the roof of the mouth (the palate). If the rear portion of the maxilla develops too narrowly, the back teeth will bite abnormally inside the lower teeth while the front teeth bite normally, creating what’s known as a crossbite. People with this kind of malocclusion often shift their lower jaw to one side to bite down completely.

This can be corrected without too much intervention if the problem is diagnosed while the person is young. This is because the maxilla is actually formed from two bones that don’t completely fuse together in the center of the palate until just after puberty. An orthodontic appliance known as a palatal expander takes advantage of this slight gap. The metal appliance is placed along the narrowed portion of the palate in the rear of the mouth: four metal “arms,” two on each side, attach to the inside of the back teeth with a tension device between them that extends the arms outward to put pressure against the teeth.

Every day the patient or a parent uses a special key to turn the tension device and cause it to expand slightly, placing additional outward pressure on the jaw. This will widen the gap in the center of the palate and new bone will grow to fill in the increased space. Over time this will cause the rear portion of maxilla to widen.

While effective, a palatal expander may not work in every case, and it must be done before the two bones fuse permanently. When it can be used, though, it’s a proven treatment that can restore proper bite function, as well as improve your child’s smile.

If you would like more information on palatal expanders to correct certain bite problems, 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 “Palatal Expanders.”

WhyemBigBangTheoryemActressMayimBialikCouldntHaveBraces

Mayim Bialik has spent a good part of her life in front of TV cameras: first as the child star of the hit comedy series Blossom, and more recently as Sheldon Cooper’s love interest — a nerdy neuroscientist — on The Big Bang Theory. (In between, she actually earned a PhD in neuroscience from UCLA…but that’s another story.) As a child, Bialik had a serious overbite — but with all her time on camera, braces were just not an option.

“I never had braces,” she recently told Dear Doctor – Dentistry & Oral Health magazine. “I was on TV at the time, and there weren’t a lot of creative solutions for kids who were on TV.” Instead, her orthodontist managed to straighten her teeth using retainers and headgear worn only at night.

Today, there are several virtually invisible options available to fix orthodontic issues — and you don’t have to be a child star to take advantage of them. In fact, both children and adults can benefit from these unobtrusive appliances.

Tooth colored braces are just like traditional metal braces, with one big difference: The brackets attached to teeth are made from a ceramic material that blends in with the natural color of teeth. All that’s visible is the thin archwire that runs horizontally across the teeth — and from a distance it’s hard to notice. Celebs like Tom Cruise and Faith Hill opted for this type of appliance.

Clear aligners are custom-made plastic trays that fit over the teeth. Each one, worn for about two weeks, moves the teeth just a bit; after several months, you’ll see a big change for the better in your smile. Best of all, clear aligners are virtually impossible to notice while you’re wearing them — which you’ll need to do for 22 hours each day. But you can remove them to eat, or for special occasions. Zac Efron and Katherine Heigl, among others, chose to wear clear aligners.

Lingual braces really are invisible. That’s because they go behind your teeth (on the tongue side), where they can’t be seen; otherwise they are similar to traditional metal braces. Lingual braces are placed on teeth differently, and wearing them often takes some getting used to at first. But those trade-offs are worth it for plenty of people. Which celebs wore lingual braces? Rumor has it that the list includes some top models, a well-known pop singer, and at least one British royal.

So what’s the best way to straighten your teeth and keep the orthodontic appliances unnoticeable? Just ask us! We’d be happy to help you choose the option that’s just right for you. You’ll get an individualized evaluation, a solution that fits your lifestyle — and a great-looking smile!

For more information about hard-to-see (or truly invisible) orthodontics, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Orthodontics for the Older Adult” and “Clear Aligners for Teenagers.”

VeneersmayOfferaLessInvasiveWaytoTransformYourSmile

If your smile is, to put it mildly, “unattractive,” you may think only extensive and expensive dental work can change it. But depending on your teeth’s actual condition, you might be able to obtain a new smile with a less-invasive option: porcelain veneers.

As their name implies, veneers are thin layers of dental porcelain bonded to the front of teeth to cover imperfections. They’re custom designed and manufactured by a dental technician to match the natural color, shape and size of the teeth they’re covering and to blend with neighboring teeth.

Veneers are quite effective for heavily stained, chipped or moderately misaligned teeth that are otherwise healthy. They can even be used to address slight gaps between teeth and restore worn teeth to make them appear larger and more youthful.

Overall, they’re less invasive than other dental restorations. That said, though, most veneers will still require some alteration of the affected teeth. This is because although quite thin they can still appear bulky after they’re bonded to the teeth. We can minimize this by removing a small amount of a tooth’s outer enamel. While this alteration is modest compared to other restorations, it’s nonetheless permanent– your teeth will require some form of restoration from then on.

Veneers also require special consideration while biting. You’ll need to exercise care and avoid biting hard items like candies (or using your teeth as tools) or the veneer could break. Similarly if you have a teeth grinding habit, you may want to consider having a custom guard created that you wear at night to prevent solid contact between your teeth. The excessive force generated while grinding or clenching teeth could also shatter veneers.

Veneers may not be the answer in all cosmetic dental situations, such as extensive disfigurements or bite problems. To know for sure if your particular dental condition could benefit, see your dentist for a complete dental examination and discuss whether obtaining veneers is a viable option for you. If so, you may be able to gain a much more attractive smile from this less invasive but no less effective option.

If you would like more information on porcelain veneers and other dental restorations, 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 “Porcelain Veneers: Strength & Beauty as Never Before.”





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