SECTION I General Dentistry
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:
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.
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.
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.
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.
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.
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.
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.)
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.
(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.)
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!