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.”
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.”
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.”
Local anesthesia has emerged over the last half century as one of the most effective tools in dentistry. Its use has literally revolutionized pain control and led to a new description of care known as comfortable dentistry.
The term “local” indicates that the numbing agent is applied only to the area affected by the procedure to temporarily block nerve sensation while the patient remains conscious. Some topical anesthetics are applied to the surface of the lining tissues of the mouth with a cotton swab, adhesive patch or spray to immediately numb the area. While topical anesthetics are sometimes used to increase comfort during teeth cleaning, they’re most often used to block the feeling of the needle prick of an injectable “local” anesthetic. Injectable “local” anesthetics provide a deeper numbing of the teeth, gums and bones.
Along with other calming or sedative techniques, local anesthesia is especially helpful in lowering a patient’s anxiety and stress levels during treatment. It’s a necessity during treatments like decay removal, deep root cleaning, fillings, tooth extractions or gum surgery because the nerve-rich tissues of the mouth are especially sensitive to pain. There are some treatments, however, that don’t call for anesthesia such as enamel removal or shaping (unless the more sensitive dentin below the enamel layers has been exposed).
One common complaint about local anesthesia is the lingering numbness a patient may continue to feel even a few hours after their visit. This inconvenience can be reduced by using different types of anesthetics, and there are now agents that can be applied after a procedure to reverse the effects of an anesthetic.
Local anesthesia benefits both you the patient and your dental professional — you’re more comfortable and less stressful during your visit, and your dentist or hygienist can work more effectively knowing you’re at ease. A pain-free, anxiety-free treatment atmosphere contributes greatly to your long-term dental health.
If you would like more information on the use and benefits of local anesthesia for dental procedures, 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 “Local Anesthesia for Pain-Free Dentistry.”
Oral cancer is not as uncommon as people think. In 2008 an estimated 34,000 cancers of the mouth and throat were diagnosed. In order to minimize your risk of developing oral cancer, be aware of habits that increase your risk.
Early signs of oral cancer can mimic harmless sores that occur in the mouth such as canker sores, minor infections, or irritations that occur from biting or eating certain foods. Cancers in the lip area can easily be mistaken for harmless sores.
It is important to have regular oral examinations to detect signs of oral cancer. Although 90 percent of oral cancers occur in people who are over 40, it is becoming more prevalent in younger people, particularly those who adopt risky behaviors: smoking, drinking and oral sex.
It is important not to let a suspicious sore go unchecked. If detected and treated early, while a lesion or growth is small, survival rates can exceed 80 percent. Contact us today to schedule an appointment to discuss your questions about oral cancer. You can also learn more by reading the Dear Doctor magazine article “Oral Cancer.”