Posts for: August, 2021
In a little over a century, antibiotics have changed the face of healthcare. We no longer fear cholera, strep throat or even a small cut as our forebears did a hundred years ago. Antibiotics are also an essential weapon against infection in dental situations.
But evidence is mounting that we're overusing these miracle drugs. Besides continued growth in antibiotic prescriptions, sometimes to preempt a possible infection rather than treat an existing one, food producers are increasingly adding them to animal feed and other products as a preventive measure.
The problem with expanding our uses of antibiotics is the ability of targeted microorganisms to develop defenses against our most common drugs. Some may even mutate into a kind of "super bug" like Methicillin-resistant Staphylococcus aureus (MRSA), which no longer responds to a particular antibiotic.
As older antibiotics become less effective, we must develop newer drugs to overcome the strengthened defenses of targeted microorganisms. But this takes time—meanwhile, as antibiotic options dwindle, more than 2 million people each year encounter an antibiotic-resistant infection that results in around 20,000 deaths according to the Centers for Disease Control (CDC).
But there are hopeful signs that the world is now rising to meet the threat of antibiotic resistance. For example, support is growing within the U.S., Canada and the EU to ban the use of antibiotics in animal feed except for treating actual infections.
Many healthcare organizations are also exploring ways to reduce unnecessary antibiotic prescriptions. One way is to make better use of testing, especially to identify the precise bacteria causing an infection so that it can be targeted with a specific antibiotic that will best respond to it.
We're also seeing modifications in the use of antibiotics as a preventive measure. For example, people with certain conditions like congenital heart problems or joint prosthetics have routinely received antibiotics before dental procedures to preempt infection. In recent years that list of conditions has been trimmed substantially.
The move toward a more conservative use of antibiotics will have an impact on healthcare, including dentistry. But whatever the changes, dentists and other health professionals will continue to place their patient's health at the forefront.
If you would like more information on the use of antibiotics in dentistry, 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 “Antibiotics: Use and Abuse.”
The worst outcome of periodontal (gum) disease is tooth loss—but it isn't the only form of misery you might suffer. One of the more troublesome results associated with gum disease is gum recession.
Normal gum tissue covers teeth from just above the visible crown to the roots, providing protection against bacteria and oral acid similar to the enamel on the crown. But advanced gum disease can weaken these tissues, causing them to pull away or recede from the teeth.
Not only can this diminish your smile appearance, but the exposed areas are more susceptible to further disease and painful sensitivity. And it certainly can accelerate tooth loss.
But there are some things we can do to reduce the harm caused by gum recession. If we're able to diagnose and treat a gum infection early while the gums have only mildly receded, the tissues could stabilize and not get worse.
The chances for natural regrowth are unlikely, especially the more extensive the recession. In such cases, the gums may need some assistance via plastic periodontal surgery. Surgeons reconstruct gum tissues by grafting like tissues to the area of recession. These grafts serve as a scaffold for new tissues to gradually grow upon.
There are two general types of grafting procedures. One is called free gingival grafting. The surgeon completely removes a thin layer of skin from elsewhere in the mouth (such as the palate), then shapes and attaches it to the recession site. Both the donor and recession sites heal at approximately the same rate, usually within 14-21 days. This procedure replaces missing gum tissue, but doesn't cover exposed tooth roots to any great extent.
In cases of root exposure, dentists usually prefer another type of procedure, known as connective tissue grafting. The donor tissue is usually taken again from the palate, but the design of the surgery is different. A flap of tissue at the recipient site is opened so that after the connective tissue from the palate is placed at the recipient site to cover the exposed roots, the flap of tissue covers the graft to provide blood circulation to the graft as it heals.
Both kinds of procedures, particularly the latter, require detailed precision by a skilled and experienced surgeon. Although they can successfully reverse gum recession, it's much better to avoid a gum infection in the first place with daily oral hygiene and regular dental care.
If you would like more information on treating gum recession, 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 “Periodontal Plastic Surgery.”
If you've decided on a dental implant to replace a missing tooth, you've made a great choice. Implants are a big favorite of both dentists and patients, not only for their life-likeness, but also their durability. Studies show that more than 95% of implants survive after ten years.
As you may know, single tooth implants are composed of two main parts: a metal post (usually titanium) imbedded in the jawbone; and a life-like crown affixed to the end of the post. But what you may not know is that there are two ways to attach the crown—either with screws or with dental cement.
Neither way is superior to the other—both have their own set of advantages and disadvantages. A cemented crown, for instance, usually looks more like a natural tooth than a screw-retained crown (more about that later) and dentists have more flexibility in making them look natural.
But cemented crowns require an additional piece of hardware called an abutment to better match it with the implant, something unnecessary with a screw-retained crown. Some people can also experience a reaction to the cement resulting in inflammation or even bone loss. And once installed, removing the crown later for repair or replacement is much more difficult than with a screw-retained crown.
Besides attaching directly to the implant, screw-retained crowns don't require cement and are more easily attached and removed. But the screw-hole can pose some aesthetic problems: Although it can be filled with a tooth-colored filling, the tooth's appearance isn't as ideal as a cemented crown.
So, which one is best for you? That will depend on the type and location of teeth being replaced, as well as your dentist's preferences. For instance, a more attractive cemented crown may be better for a visible front tooth, while a screw-retained crown might be a good choice for a back premolar or molar where appearance isn't as big a factor.
In the end, it's likely your dentist will discuss the pros and cons for each method as it pertains to your individual case. Whichever way your crown attaches, the end result will still be a life-like tooth that could last you for years to come.
If you would like more information on 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 “How Crowns Attach to Implants.”