31: General Dentistry

SECTION I General Dentistry

PROPHYLACTIC ANTIBIOTICS FOR PREMEDICATION

Patient Name: ________________________ Date: ______________

Reasons for antibiotic premedication are:

image To prevent infective endocarditis
image To prevent infection in a total joint replacement
image To protect persons who are immunocompromised

These conditions might occur following any treatment or activity that causes bacteria to enter the bloodstream (bacteremia). Therefore it is recommended that persons undergoing dental or dental hygiene procedures that cause bacteremia, and who also are at high risk for complication from endocarditis, receive antibiotic premedication before professional care. For that reason, if you have been diagnosed as having any of the following conditions, you will need to be premedicated before invasive dental or dental hygiene treatment:

image Prosthetic heart valve or prosthetic material used for cardiac valve repair including bioprosthetic and homograft valves
image Replacement joints such as hips or knees received within the past 2 years
image Congenital heart disease (CHD)

image Unrepaired cyanotic CHD, including palliative shunts and conduits
image Repaired CHD with residual defects at the site of or adjacent to the site of a prosthetic patch or prosthetic device (which inhibits endotheliazation)
image Completely repaired CHD with prosthetic material or device during the first 6 months after the procedure
image Previous infective endocarditis
image Intravascular access devices (for chemotherapy, hemodialysis, hyperalimentation)
image Cerebrospinal fluid shunts
image Heart transplant with valvulopathy

Before we can begin treatment in some cases, we must consult with your physician to determine which premedication is recommended for your specific condition. When it has been determined that you need to be premedicated before dental procedures, we will ask you before each dental appointment whether you have taken the premedication.

When your physician, surgeon, or cardiologist determines that it is best for you to be premedicated before certain dental procedures, you must take the premedication. Your physician may prescribe an antibiotic different from those listed in the following table.

If you have not taken the medication as prescribed, we will not be able to perform any dental treatment. There are no exceptions. The result could be a serious illness with a prolonged hospital stay.

Regimens for a Dental Procedure (Single Dose 30 to 60 Minutes before Procedure)

image

If you have any questions about prophylactic antibiotics for premedication, please feel free to ask us.

Specific Recommendations: ______________________________

STAYING WELL: HOW TO KEEP YOUR MOUTH HEALTHY

Patient Name: ________________________ Date: ______________

Congratulations! You have completed all dental treatment necessary up to this point. If you follow the listed suggestions, you will have the best chance of maintaining that optimum oral health for the longest time. If you are unsure about any aspect of what you should be doing, please ask us for further instruction.

image Brush, floss, and use recommended dental cleaning aids correctly, at least once each day.
image Brushing and flossing cleans only about 20% of the mouth. To reach the other 80%, we recommend that you rinse twice daily for 30 seconds with an ADA-accepted antimicrobial mouth rinse. If you experience dry mouth symptoms, we recommend that you: _______________________
image Given your unique oral care needs, we also recommend the following oral care products and/or devices for your use:_______________________
image Come to the office for recare hygiene appointments at the specific intervals we recommend. This is very important. Every mouth is different. Based on the number of dental restorations you have, the number and alignment of your teeth, your apparent ability at this time to keep your teeth clean, and your medical history, we recommend that the interval be no longer than ____ months. With this interval, there is the best opportunity to prevent gum disease or correct problems found early when they are small, easier, and less expensive to treat.
image Each time you come in for procedural dental hygiene care, make your next hygiene recare appointment before you leave the office. But please try to remember when you are due for an appointment. No matter how attractive we make our reminder cards, they seem to have a habit of getting mixed up in junk mail and being discarded without being noticed.
image If you have followed our advice, you should receive years of successful service from your teeth. Natural teeth and restorative materials are subjected to great stress on a daily basis. Please do not put things in your mouth that do not belong there. This will tremendously shorten the effective life span of your teeth and restorations.
image Do not chew on ice or frozen candy bars, bite on hard candy, or keep hard candy or breath mints in your mouth on a routine basis. Any sugary food that you keep in your mouth for a long time (as it dissolves) can easily and quickly cause tooth decay. You can use sugar-free candy and mints that contain xylitol.
image If you smoke, stop. Remember that smoking has a negative effect on your gum tissue and on your general health.
image Smoking and drinking coffee, tea, and cola beverages will have a tendency to stain or darken your teeth over time. This can be reversed with your regular recare dental hygiene and, if necessary, noninvasive tooth whitening procedures.
image If you are having your dental treatment scheduled for time or financial reasons, please continue at the time we have discussed.
image If you have had a protective mouth guard made (to protect your teeth and new restorations or reduce the effects of a bruxing or grinding habit), please wear it as instructed.

We have used the most appropriate diagnostic and treatment knowledge, procedures, and materials available for your treatment. Teeth and restorations can break from excessive force or trauma. If you take care of your car, it will last longer than if you never change the oil, fluids, and so on, and it will cost you much less to keep in operation. Your teeth and gums need regular maintenance care, too. No individual treatment you received costs as much as your car, but with adequate care you probably will have your restorations longer than your car.

Thank you for giving us the opportunity to serve you, and we hope to see you soon.

Specific Recommendations: ______________________________

HOW TO BRUSH! HOW TO FLOSS!

Patient Name: ________________________ Date: ______________

An old humorous expression says, “You don’t have to brush all your teeth every day. Only the ones you want to keep!” And while we laugh at these words, the message could not be more correct. To maintain good oral health, teeth must be thoroughly cleaned each and every day. One good method of brushing is called the modified Bass technique. It is quite effective. We can instruct you on how to brush properly. It is certainly easier to see it done than to read and imagine. But this will help you get started.

Use a multitufted, soft, nylon-bristled toothbrush. Hard-bristled toothbrushes can easily damage your teeth and gums. Soft-bristled toothbrushes last about 3 months before they need to be replaced. When the toothbrush bristles become worn, they will not give you the best possible performance. Medium- and hard-bristled brushes will last longer, but almost everyone brushes too hard to use these brushes. If you use medium- and hard-bristled brushes or brush improperly with any toothbrush, you can cause permanent damage to your gum tissue, causing it to wear away. This can also wear notches into the tooth itself, exposing the dentin. In both cases, severe tooth sensitivity could develop.

THE MODIFIED BASS METHOD

image The bristles of the brush should be angled toward the area where the tooth meets the gum, approximately a 45-degree angle.
image The bristles of the brush should be able to gently slide under the gum tissue. Gently move the brush back and forth so that there is a vibrating motion, not a scrubbing motion. The brush head should be able to cover and clean about two teeth at a time.
image Brush each area for about 10 seconds, then roll the bristles to the biting surface. Move the brush head so that it overlaps a small portion of the tooth just brushed and the next teeth. Repeat until all teeth have been brushed.

Brush all teeth. Start on the cheek side of the back teeth, at one corner of your mouth, brushing as you move across to the opposite corner. Then switch to the inside (tongue or palate side), and again brush from one corner to the other. Brush both upper and lower teeth using the vibrating back-and-forth motion.

Some areas will require you to switch the brush to a different angle such as the inside (tongue and palate side) of the top and bottom front teeth. Using the tip or small end of the brush will help clean around this curved area. Use the same type of vibrating motion with the brush, moving up and down against the tooth.

If you see blood on your toothbrush, try to clean the gum area more thoroughly for several days until the bleeding stops. If you continue to see bleeding, contact your dental hygienist.

Brushing the biting surfaces of the teeth is easy. Place the bristles on the biting surface of the teeth into the grooves, and brush back and forth. Be sure to brush the biting surfaces of left side and right side, upper and lower teeth.

The tooth surfaces should feel smooth and free of any furlike coatings when your tongue is rubbed over them. Lastly, brush the tongue gently from back to front to remove any coating that has accumulated. You will find that your food will taste better too when your tongue is kept clean.

image

The Bass toothbrushing method. A, Proper intrasulcular position of brush in the mouth aims the filaments toward and into the gingival sulcus. B, Diagram shows the ideal placement with slight subgingival penetration of the filament tips. C, Place toothbrush so that filaments are angled approximately 45 degrees from the long axis of the tooth. D, Start at the most distal tooth in the arch and use a vibrating, back-and-forth motion to brush.

(B and D, From Newman MG, Takei HH, Klokkevold PR, Carranza FA, eds: Carranza’s clinical periodontology, ed 10, St Louis, 2006, Saunders.)

USE OF DENTAL FLOSS

Start with a 14- to 16-inch piece of floss. Any type of floss is okay to use. Most people find nonshredding floss, which is thinner, easiest to use.

image Lightly wrap the floss around the forefingers of each hand until there is a length of about 1 to 11⁄2 inches available between the fingers. Don’t wrap it so tightly that you cut off circulation and your fingers turn blue!
image Using your thumbs and forefingers, position the floss over the spot where two teeth meet.
image With a gentle buffing motion, back and forth, move the floss between the teeth and slide it first under the gum around one of the teeth in a U shape.
image Move the floss up and down a few times, then reverse the U and floss the other tooth. The floss needs to get under the gum.
image Then remove the floss and place it between the next two teeth. Holding the floss taut between your fingers will give you more control, and flossing will be easier. If you see blood on the floss, try to clean the gum area more thoroughly for several days until the bleeding stops. If you continue to see bleeding, contact your dental hygienist.
image Note that some people benefit from other types of interdental cleaning aids such as interdental brushes and sponges, wooden piks, and end-tufted brushes. Ask your dental hygienist if these oral care devices are appropriate for you.
image Remember, brushing and flossing cleans only about 20% of the mouth. To reach the other 80%, we recommend that you rinse twice daily for 30 seconds with an ADA-accepted antimicrobial mouth rinse.

When you are able to perform these daily procedures effectively, you will significantly reduce your risk of gum disease and decay and the associated expenses of treatment. There are other flossing aids available if you have problems using your hands. Let us know about these problems. Power toothbrushes can also be used. Again, talk to us about these devices. Keeping your teeth healthy for the rest of your life can be accomplished—one day at a time.

image

Use of interdental plaque control devices. A, Dental floss. B, Interdental brush. C, End-tuft brush.

image
image

A, Dental floss. B, Dental tape.

(A, from Perry DA, Beemsterboer PL: Periodontology for the dental hygienist, St Louis, 2007, Saunders. B, from Newman MG, Takei HH, Klokkevold PR, Carranza FA: Carranza’s clinical periodontology, ed 10, St Louis, 2006, Saunders.)

If you have any questions about how to brush or floss, please feel free to ask us.

Specific Recommendations: ______________________________

ENERGY DRINK ALERT

Patient Name: ________________________ Date: ______________

We have recently noticed a developing and serious tooth decay problem in some of our patients. What we are seeing is tooth decay that progresses much more quickly than usual. This decay is seen on root surfaces and around the margins of restorations (fillings) and crowns (caps) where the tooth and restorative material meet. In some individuals these restorations were placed only a short time ago. From discussion with the patients who exhibit this extreme and unusual type of decay, there seem to be common factors (e.g., they drink diet beverages, soda, sports drinks, energy drinks, and bottled iced tea). Their brushing and flossing habits appear to be adequate. They are taking no special medication. All seem to be concerned with their weight.

Years ago this type of decay was seen in patients who kept candy, mints, or other edible breath fresheners in their mouths for hours, causing tooth decay. Although other factors may be the actual or contributing causes of this problem, the only currently detected causes are the beverages—soda and artificially sweetened bottled iced tea.

Sugar in food and drink feeds the bacteria present in dental plaque, allowing the bacteria to produce lactic acid. The lactic acid breaks down the minerals in the tooth enamel, which causes white spot lesions and cavities. Although diet drinks are sugar-free, they are also very acidic. This acid also breaks down the minerals in the tooth enamel, causing cavities. By the time the saliva dilutes these acids enough to bring the mouth back to its proper pH balance, new or additional decay may already be in progress. Frequently, before the mouth reaches its proper pH balance, the patient is already uncapping another bottle or can of that drink!

Suggestions for the reduction or elimination of this type of decay include:

image Reduction or cessation of the drinking of these drinks and substituting plain water
image Rinsing your mouth with water as soon as possib/>

Related posts:

  1. 10: Dental Hygiene Care Plan and Evaluation
  2. 18: Acute Gingival and Periodontal Conditions, Lesions of Endodontic Origin, and Avulsed Teeth
  3. 6: Assessment of the Dentition
  4. 38: Medical Emergencies
  5. 44: Clients with Special Needs
  6. 5: Extraoral and Intraoral Clinical Assessment

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Jan 1, 2015 | Posted by in Dental Hygiene | Comments Off on 31: General Dentistry

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