Questions and Answers

Have you ever heard the numbers 3,4,3 while your hygienist is cleaning your teeth? How about larger numbers like 5, 6, or 7? How about hearing those numbers and your hygienist says you need a deep cleaning after you just had a cleaning?

I can understand why it this can be a bit confusing. Knowing a bit of dental background and dental anatomy can help to make it easier to understand.
Every tooth sits in a socket that is made with bone, ligament fibers, nerves, blood vessels, and gum tissue. The tooth has a very sophisticated connection to your jaw, and its is important for keeping the tooth for life.

As we eat food, bacteria develop on the surface of our teeth and gums. It is often called plaque. If bacteria are left on the tooth surface long enough, they can also become calcified and hardened, creating a barnacle of infection around your tooth. The tooth-gum connection is very sensitive to any bacteria invasion. When plaque starts to form, our body starts to mount a response by sending inflammatory agents to fight the bacteria. Unfortunately, our tooth-gum connection is very sensitive to this bacteria invasion, and inflammatory agents that are directed to the area. If plaque and calculus are left untreated, the inflammatory agents start to breakdown the tooth-gum connection. It is our body’s attempt to move the healthy tissue away from the growing infection. This means that our bone and gum attachment shrinks away from the crown of the tooth, resulting in reduced tooth attachment. As this process continues, we start to notice symptoms such as loosening teeth, teeth crowding, un-aesthetic dark triangles, bleeding, bad breath, and pain. This disease process is called periodontal disease.

The good news is there are ways to prevent this breakdown. There are simple preventative measures such as daily brushing, flossing, and regular hygiene appointments with your skilled hygienist. With the use of brushes, floss, and scalers we are removing the plaque film to stop this inflammatory process. In many cases, if not removed often and thoroughly, plaque and calculus will cause a “pocket” to form. Your gums and bone begin to slowly detach from your tooth and recede due to the plaque and calculus. Plaque and calculus will continue to grow in the pockets, deep down where your floss and brush simply cannot reach.

This is where the deep cleaning comes into play. Your hygienist needs to devote a specific time to work these troubled areas to clean the calculus and plaque. With complete removal of the bacteria we can see healing of the tissue, and reforming of a healthier tooth connection. By spending more time on these specific sites, we can help to protect the precious attachment from further loss.

The purpose of prescribing antibiotics prior to specific dental procedures is usually limited to a select group of patients. An antibiotic may be pre- scribed to reduce bacteria that could be introduced into the blood stream, and to help prevent the possibility of bacteria from colonizing on an artificial joint, heart valve, or congenital heart defect.

Since my graduation from dental school and ten years of practice, I have seen two revisions for the guidelines on taking antibiotics prior to dental
procedures. There are two main categories of patients where this recommendation was previously and may currently may still be made.

The first group of individuals are those who have undergone a total joint replacement such as knees or hip replacements. After a systematic review, piloted by The American Academy of Orthopedic Surgeons and the American Dental Association, a conclusion was made that most individuals in this group are no longer required to take the pre-medication of antibiotics. There was a lack of evidence that the antibiotics prevented colonization of the replaced joint. There are also concerns regarding increasing side effects associated with antibiotics. There are still a select few individuals that have had joint replacements, and due to extended health circumstances, still require an antibiotic pre-medication.

The second group of individuals requiring antibiotic pre-medication are those with ill-repaired congenital heart defects, heart valve replacement, or a history of infective endocarditis. The American Heart Association recommends that these individuals still use an antibiotic regiment the day dental procedures are performed.

Patients who have any total joint replacements or congenital heart issues should bring these conditions to the dentist’s attention at their first exam appointment, so a discussion can be made about whether or not a pre- medication is relevant. There are many times in my practice that I will also recommend a discussion with the orthopedic surgeon or cardiologist if necessary. Once a mutual decision is made by all practitioners and the patient, and if deemed necessary, then typically a single one-time dose of antibiotics is taken 1 hour prior to the dental appointment.

Patients and friends of our practice wonder why their dental insurance does not cover 100% of their treatment, or in some cases the entire treatment at all. Dental insurance is a valuable part of our health benefits, but its purpose over time has become a tool to lessen the cost of dental treatments.

Unlike medical insurance, dental insurance plans are designed to prevent
the dire and catastrophic dental situations through ongoing prevention. Routine exams, hygiene appointments, radiographs and fluoride treatments are more likely to be covered at a higher percentage as compared to restorative treatments such as composite fillings, crowns, root canals, and implants. Insurance plans tend to reduce their percentage of coverage on major procedures quite routinely, or will not cover the procedure entirely. Unfortunately, this notion of coverage, leaves individuals mistaking their insurance plan’s “covered procedures” as what would be the best treatment choice for their oral health.

At our office we provide careful examinations and build a treatment plan that is custom to your needs and interests. This plan is built with your dental goals and an ideal oral health model in mind. Once we form this plan together, we will work with your insurance company to help you receive the maximum benefits that you can annually, so your insurance does work for you.

There are great advantages to living by the rule of prevention. Typically seeing a dentist for regular routine exams can prevent greater future costs, time in the dental chair, and pain. Fortunately, preventative services are well covered by many dental plans. I think taking advantage of the preventative services your insurance plan offers will save you money in the future, and keep you smiling longer.

I have many parents ask me at what age should they bring their child in for their first check-up? The American Pediatric Dental Association recom- mends a child should start seeing a dentist by their first birthday.

There are many solid reasons why I believe in starting this habit at such a young age. First and foremost, is establishing the feeling that the dental office is a familiar and comfortable place, and building a trustful relation- ship while someone is young. In the dental office, there are many new sights, sounds, and smells, and it is important children experience these firsts in a relaxed and fun way. At our office we strive to make this process as fun as can be, while also educating you on all the dental dos and don’ts that will keep your child’s smile healthy and beautiful.

By starting the habit of routine check-ups at an early age, we are also teaching your child that a healthy mouth is an important part of a healthy body. We will always help to motivate and encourage this process from the first infant exam through adolescence to adulthood.

Should your child ever be in need of further dental treatments, we have al- ready fostered a great relationship, which allows us to treat your child with much less associated anxiety. I also believe that I can find cavities when they are smaller and easier to treat, if a child is seen earlier and often.

I recommend I see your child once every six months for a cleaning and check-up starting at the age of one. With this important good early start, I promise to build a foundation of trust and security, and to give you and your child the building blocks needed for a healthy smile for life.