Dr Hardeep Bhatta & Dr Allen Friesen
Suite 205 - 1465 Salisbury Ave
Port Coquitlam, BC V3B6J3
The proliferation of drugs to treat all manner of diseases and conditions has heightened concerns not only about general side effects, but also how a particular drug may affect treatments for other conditions. There are indications, for example, that drugs classified as blood thinners could cause complications for patients undergoing oral surgery.
Blood thinners like Warfarin are typically prescribed to patients with artificial heart valves or who are at significant risk for stroke, heart attack, or the formation of clots that could potentially damage the heart and lungs. The drug reduces the coagulation (clotting) mechanism in blood; aspirin taken regularly should also be considered a blood thinner.
As with any invasive procedure, blood thinners can complicate oral surgery. Blood doesn’t clot normally and so bleeding during a procedure is more difficult to stop. This doesn’t necessarily mean the surgery can’t be performed. For one thing, many oral procedures like tooth removal involve little trauma to tissues and bleeding in the hands of a careful and experienced surgeon. The surgeon can also use hemostatic agents during surgery that will stabilize blood clotting, as well as suturing the incision in such a way as to reduce bleeding from surface capillaries. In the case of a tooth extraction, a bone graft placed within the empty socket not only reduces bone loss from a missing tooth, but can also enhance bleeding control.
In consultation with your medical doctor, it’s also possible to temporarily stop or reduce your medication dosage in anticipation of a pending oral surgery. While it may not be safe to stop the drug altogether, a reduced dosage can ease the anti-coagulant effect and reduce any complications from bleeding that might occur during the surgery. You can then resume normal dosage soon after the procedure.
During your pre-op examination, it’s important to let your surgeon know about any drugs you are currently taking, including over-the-counter drugs like aspirin. The oral surgeon will then be able to take the necessary steps, including working with your medical doctor, to ensure your surgical procedure is safe and uneventful.
If you would like more information on oral surgery precautions while taking blood thinners and other medication, 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 Surgery & Blood Thinners.”
When a natural tooth can’t be preserved, it is important to have it replaced as soon as possible. Presently, there are two excellent tooth-replacement systems in wide use: traditional bridgework and high-tech dental implants. What’s the difference between the two methods?
Essentially, it comes down to how the replacement tooth is secured in the mouth. In the dental implant system, a natural looking prosthetic tooth is solidly anchored in place by a screw-like titanium implant. This is inserted directly into the bone of the jaw in a minor surgical procedure, and over a short period of time (usually 6 – 12 weeks) its titanium metal structure will actually become fused with the living bone.
With bridgework, however, the support for the prosthetic tooth (or teeth) comes from the healthy teeth adjacent to it. These teeth must be prepared (shaped) by carefully removing some of the outer tooth material (enamel and some dentin), which enables them to be fitted with coverings called crowns or caps. Crowns are often used on their own, to restore teeth that are missing too much of their structure to be treated effectively with standard fillings. But the bridgework system goes one step further.
Instead of making individual crowns for each tooth, a dental lab will fabricate a bridge — a single unit consisting of crowns for the prepared teeth, plus complete prosthetics to replace the missing tooth (or teeth). A three-unit bridge, for example, consists of one complete prosthetic tooth to replace the one that’s missing, plus two crowns for the adjacent “abutment” teeth. It’s possible to have larger bridges as well: For example, a six-unit bridge might consist of two complete prosthetic teeth in the center, with two crowns for abutment teeth on each end, all linked together in one piece.
While bridgework has been used effectively for decades, it is now being gradually supplanted by dental implants. Implants don’t require the removal of healthy tooth material from abutment teeth, and they don’t place extra stress on those teeth; plus, they generally last much longer than natural tooth bridges. However, the dental bridge remains a viable alternative for tooth replacement in many circumstances.
If you have certain health conditions, your medical doctor may prescribe an antibiotic for you to take prior to a dental visit. The reason why is a story that dates back to the mid-20th Century.
In the early part of the last century, a theory became popular that bacteria in the mouth could migrate to other parts of the body and cause systemic illness or disease. During the 1930s and 1940s evidence arose that indicated a connection between dental procedures that caused bleeding and two serious health conditions: bacteremia (the presence of bacteria in the bloodstream) and infective endocartitis. The latter is the inflammation of inner tissues of the heart (including the valves) caused by infectious agents, most notably bacteria. It became common then to prescribe antibiotics to patients susceptible to these conditions as a preventive measure. Later, patients with prosthetic joints or poor immune systems were added for this kind of treatment.
For many years, the American Heart Association (AHA) recommended pre-visit antibiotic treatment for a wide array of heart patients. After several years of research that indicated the treatment wasn't necessary for most people and might even be detrimental, they updated their guidelines in 2007 and reduced their recommendation list to just a few conditions. They now recommend the antibiotic treatment for patients with artificial heart valves, a history of infective endocartitis, heart transplant recipients with valve problems, and certain congenital (inherited) heart conditions.
If you have a condition that calls for a pre-visit antibiotic treatment, all the providers involved with your care will need to communicate. Your medical doctor will most likely prescribe two grams of amoxicillin (or a similar antibiotic if you are allergic to amoxicillin) that you would take an hour before the dental procedure. We in turn would communicate with your medical doctor concerning the dental procedures you're scheduled to undergo (including regular cleanings), in case your doctor would like to make adjustments in your medication.
Your health and well-being is of utmost importance to all your healthcare providers, medical and dental. Working together, we can ensure the dental procedures you need for oral health won't have an adverse impact your general health.
If you would like more information on antibiotic treatment before a dental visit, 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 for Dental Visits.”
There are only a few teeth that are known by nicknames. The big, late-blooming third molars (“wisdom teeth”) are one set; another set is the sharply-pointed canines, also called the “eyeteeth”. These two sets of teeth have something else in common: They can both suffer from the failure to develop in the proper place. Impacted wisdom teeth are a well known problem; impacted canines, however, are an issue that’s seen less frequently — but can often be effectively treated without extraction (removal).
What does the term “impacted” mean? In dental terminology, it indicates a tooth that is growing in a position where it can’t erupt (grow in to the bite) properly. This sometimes happens in cases where the bite is “crowded” — that is, where there isn’t enough space in the jaw for all of the teeth to develop properly. An impacted tooth remains “buried” to some extent in the tissues of the gums and jaw. It may eventually cause various problems with the roots of neighboring teeth, or even form a cyst (fluid-filled sac). That’s why treatment of impacted teeth is so important.
Impacted third molars (wisdom teeth) are generally removed (extracted), and are rarely missed. Canines, however, are located near the front of the mouth, forming an important component of an aesthetically pleasing smile. Therefore, whenever possible, it’s preferable to bring these teeth into good alignment with the rest of the smile rather than remove them. How is this done?
The process begins with a series of radiographic images (x-rays or CT scans) that show the exact positions of the affected teeth. Next, a minor surgical procedure, performed under local anesthesia, is used to expose the crowns (surfaces) of the impacted teeth. Then, a bracket is bonded to the surface of the tooth, which can be attached to orthodontic appliances. These appliances will, in time, move the tooth into a better position.
Impacted canines can be a serious problem — but the good news is that, with the proper treatment, it’s often possible to bring them into alignment with the rest of your smile. If you would like more information about treating impacted canine teeth, call our office for a consultation. You can learn more in the Dear Doctor magazine article “Exposing Impacted Canines.”
When most people think of orthodontic treatment, they may think of braces worn during the teenage years. But there are some types of malocclusions (bad bites) that may benefit from intervention much earlier than adolescence. A cross-bite is one example.
A cross-bite occurs when the front teeth of the lower arch bite in front of the upper teeth rather than behind them. The condition can have an adverse effect on any of the six front teeth of either arch. This type of malocclusion can develop quite early in childhood.
Orthodontists have developed a two-phase treatment for a cross-bite, with the possibility that the first phase may be all that’s needed. If your child has a cross-bite, your orthodontist may first recommend he or she wear a specially-designed retainer for a few months. The retainer could stop and correct an existing problem before it becomes worse, or it could prevent a deeper problem from developing in the first place. The retainer could also help guide jawbone development during these formative years, even as early as age 7, for children at risk.
Even if this first phase doesn’t fully correct the cross-bite and the second phase (most likely braces or a similar orthodontic device) becomes necessary, it could still help to make the second phase easier and less costly. On the other hand, if orthodontic treatment is postponed until adolescence when the mouth structures are more fully formed it may become quite difficult or even impossible to correct the problems that have developed.
As a result, early intervention for this or similar orthodontic conditions is the most efficient strategy, even when later treatment is necessary. As part of your child’s regular dental care (which should begin ideally around their first birthday), we can advise you on any need for an orthodontic evaluation based on our observations. An orthodontist can then best advise whether waiting until later for treatment is best, or whether intervention now could lessen problems later.
If you would like more information on preventative orthodontics, 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 “Preventative & Cost Saving Orthodontics.”
Do you have gum disease? According to the U.S. Centers for Disease Control, about half of the adults in America have a mild, moderate or severe form of this disease. But if you’re 65 or older, your chance of having it goes up to 70 percent! Periodontal (gum) disease is sometimes called a “silent malady” because major symptoms may not appear until it has reached an advanced stage. How can you recognize the early warning signs? Here are some clues to look for:
Gum disease is a widespread problem — but it’s also very treatable. If you would like more information, call our office to arrange a consultation. You can learn more in the Dear Doctor magazine articles “Warning Signs of Periodontal (Gum) Disease” and “Understanding Gum (Periodontal) Disease.”
Sports are an important element in human society — besides providing enjoyment they also build discipline, teamwork and character.
But sports activities, especially for children and teenagers, also carry the risk of physical injury — and your teeth and mouth aren’t immune. About 22,000 mouth injuries occur annually in individuals under the age of 18. As the degree of contact within the sport rises, so does the risk of dental injuries.
To reduce this risk, it’s important to adopt a comprehensive approach to dental injuries, beginning with protection. For any sport that involves a ball, stick, puck or physical contact with another player, athletes should incorporate two pieces of equipment to fully protect against mouth injury: headgear and a mouthguard. Both help to evenly distribute the forces generated during an impact and thus reduce the chance or severity of injury.
The design of headgear will depend on other factors involving a particular sport. Mouthguards are more singular in their purpose, and so what works in one sport should work in another. While there are a number of types like stock or “boil and bite,” the highest level of protection is a custom-fitted mouthguard created by a dentist to specifically fit the individual’s bite. Although more costly than other options, it can better reduce the chances of an even more costly mouth injury.
Because we can only reduce the risk of injury but never eliminate it, protection is only part of the approach. Individuals, parents and sports officials should have plans in place for treating dental injuries should they occur. Depending on the level of trauma, individuals should have access to a dentist as soon as possible. It’s also important to know what to do when specific injuries occur, whether they require an immediate, urgent or less urgent response. The Dear Doctor magazine article, “The Field Guide to Dental Injuries” is an excellent primer on dental injury treatment.
Sports can have a positive effect on physical, emotional and social development. Adopting a well-rounded approach to dental injury prevention and treatment will help keep the focus on those benefits.
If you would like more information on protection and treatment from sports-related dental injuries, 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 “An Introduction to Sports Injuries & Dentistry.”
Teeth are composed of layers of different types of tissue. The main inner layers — the pulp and dentin — help the teeth respond and adapt to external forces. But they’re vulnerable to decay and quite sensitive to environmental extremes. They are protected from all these by a coating of enamel, made of the hardest material found in the human body.
But while enamel is strong, it’s not invincible — it can soften and dissolve (de-mineralize) if the mouth environment becomes too acidic. While de-mineralization occurs normally whenever the mouth becomes too acidic after eating or drinking, saliva helps neutralize the acid (buffering); in fact, saliva can restore to the enamel some of the calcium and other minerals it has lost (a process called re-mineralization).
If the acidic level remains too high for too long it can overwhelm saliva’s buffering ability and cause permanent mineral loss to the enamel. This erosion leaves teeth more susceptible to decay and disease and could lead to tooth loss. With this in mind, here’s some ways you can help preserve your enamel:
Following these tips, along with effective oral hygiene, will go a long way in protecting your teeth’s enamel coating — and preserving your teeth in the long run.
If you would like more information on enamel erosion and how to prevent it, 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 “6 Tips to Help Prevent the Erosion of Tooth Enamel.”
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