Category Archives for "Dental Education Library"

Could These Common Diseases Be Contributing to Tooth Decay?

No part of the body functions truly independently, and your teeth are no exception. Your mouth is a window to the rest of your body and will often show warning signs if there is something bigger going on. If you’ve ever wondered why we ask so many questions about your medical history and lifestyle, it is because we are trying to understand the entire picture, along with what your mouth and oral health are telling us. There are many more things that can contribute to tooth decay rather than just poor oral hygiene. In fact, common diseases such as diabetes, autoimmune conditions, and eating disorders are examples of some systemic disease that do in fact impact the health of our teeth. As your Mississauga family dentist, we feel that it is important for you to be educated on the oral-systemic links in order to achieve optimal oral health. Common systemic conditions are:

  1. Diabetes
    Diabetes is perhaps the most significant cause and effect relationship with tooth decay. Whether you have type I or type II diabetes, your body’s blood sugar level is elevated because of lowered insulin levels. This impacts many parts of your body and the mouth as well. One of the most common symptoms of diabetes is dry mouth. Beyond making your mouth feel more comfortable, saliva acts as your mouth’s natural cleansing system, and protects your teeth against the bacteria that cause tooth decay. Lack of salivary flow makes your teeth more vulnerable and more prone to developing cavities.

    As the tooth decay continues to build up, the risk for gum disease also increases due to the continual buildup of bacteria in your mouth. In fact, about a quarter of all people diagnosed with diabetes also develop gum disease. To further complicate this situation, gum disease can cause blood sugar levels to rise, which can in turn, increase the severity of the diabetes. It is a vicious cycle that needs to be addressed as soon as symptoms begin to develop.

  2. Autoimmune Conditions
    Autoimmune conditions are a family of diseases that involve the body attacking parts of itself. This can include everything from major organ systems such as kidneys, to smaller systems such as salivary glands. Many of these diseases have an impact on the mouth, but the one that is most directly tied to oral health is Sjögeren’s syndrome. Sjögeren’s syndrome reduces the amount of saliva the mouth produces, which has the same effects we described earlier with diabetes. With extreme cases, patients may not even produce saliva at all.

    People with Sjögeren’s are advised to make more frequent visits to the dentist in order to monitor and keep watch of any tooth decay as a result from the decreased saliva flow. There are also several over the counter products that can be used in order to manage the symptoms and increase salivary flow. Products including xylitol – a natural saliva stimulant – will be quite beneficial to those experiencing dry mouth.

  3. Anorexia and Bulimia
    Both anorexia and bulimia are severe eating disorders in which a person has an extreme fear of becoming overweight, and either eat less or regurgitate food as a result. Both conditions have implications on the teeth because the body is not receiving the proper amount of minerals, vitamins, proteins and other nutrients that are needed in maintaining good oral health and preventing tooth decay. A person who is bulimic may binge eat and then vomit, which allows the acid that is breaking down the food to eat away at the tooth enamel. Overtime, the acid will weaken the tooth structure, making it more prone to getting cavities.

Avoid Tooth Decay with Total Body Care

These are just a few of the more common diseases that contribute to tooth decay. The connection between your mouth and body are not always apparent, which is why it is important to share your medical history with your dentist. Our team at Credit River Dental Centre will work with you in order to develop a treatment plan that integrates your mouth with the rest of your body for a full-body approach. To learn more speak to your dental team at Credit River Dental Centre or book your appointment today at (905) 278-4297 and take control of your oral health!

The Mouth is the Source to Your Body

You get to your dental appointment a few minutes early and just when you’re about to sit down, you’re asked by your friendly dental patient coordinator to fill out what looks like a 10 page booklet of questions about your previous dental history and medical history. As you flip through the pages, you wonder to yourself-wow, why is your dental professional asking so many questions?

After a few minutes or so upon completing your so called medical/dental history booklet, you’re then brought into the room. Yes, the room where your comprehensive oral examination will take place. As you sit patiently looking up at the television screen, the dentist comes in to greet you and explains what will happen within the next hour of your examination and what we hope to achieve as we gather all of this information about you.

“So let’s start by taking your blood pressure,” he begins. At this moment, like most, you start to question why, as your blood pressure is suddenly recorded a little higher than what’s considered normal. Your arm’s quite a distance from your teeth. What does this have to do with my mouth? The flood gate of questions begins.

Your dental professional then asks you, “Do you know what your blood pressure normally is?” “When was the last time you had a physical?” or “Any family history of heart disease?” You start getting a little concerned and answer as best you can. So yes, why do we take blood pressure, need your medical history and ask the questions that we do? Knowing information such as this is important in understanding how your body will react to treatments that may be done. It helps your dental professional to understand if there are any underlying conditions that may also affect the outcome of treatment and also if there is a potential for any condition or medication to contra-indicate it.

Have you ever heard the term “Prevention is Worth a Pound of Cure?” We take this very seriously in our practice. This is often where dentistry and medicine are different.

After we collect the necessary baseline information, your dentist will then design a customized treatment plan for you. This will entail the frequency of hygiene appointments which is based on your periodontal evaluation and current medical condition, restore any decayed teeth and discuss preventative measures to be taken for this, and also an evaluation of any potential risks for conditions such as sleep apnea, teeth grinding (bruxism), oral cancer, etc.

Dentistry is very focused on prevention. How many times does your medical doctor ask you when you last visited your dentist? Or better yet, how often do you visit your dental professional? Does the head, neck and mouth magically not connect to the rest of the body? Or are they just not informed about the importance of Oral Health to the overall health of the body?

Lately, more attention has been paid to the Oral-Systemic Link.

When inflammation exists in the mouth, experts have equated this to having a wound the size of your hand.

If you had a wound the size of your hand, would you not have it treated or be just a tad bit concerned? Inflammation is inflammation regardless of where it is in our bodies and it is important that both medical and dental professionals recognize this. What’s unfortunate about periodontal disease is that damage can progress without any pain and oftentimes when discomfort occurs, it is beyond repair.

Dentistry has changed over the years. Prevention is key in maintaining balance not only in our bodies but in our mouths as well. You could very well take care of your body; feed it healthy food, exercise, take supplements, and more but if your oral care is not up to par and there is a presence of even the slightest bleeding upon flossing or brushing, this is a clean indication that inflammation may be present. A cleaning isn’t just a cleaning when you see your dental hygienist regularly. It entails so much more but the most important part of your hygiene appointment is reducing the amount of bacterial contamination in the mouth which will reduce the inflammation.

To learn more speak to your dental team at Credit River Dental Centre or book your appointment today at (905) 278-4297 and take control of your oral health!

Conquering Canker Sores

If you’ve ever had a canker sore, you would understand how irritating these little spots in your mouth can get. Here at Credit River Dental Centre, we often have patients ask us what they can do to prevent and treat their canker sores. As your Mississauga family dentist, we’ve put together some basic information and tips in order to help you overcome the discomfort that canker sores cause.

What exactly are canker sores?

Canker sores are small ulcers that develop inside the tissues of your mouth. Canker sores are typically white or gray and oval-shaped ulcers, with a red-edged border. They are commonly located on the soft tissues and at the base of the gums. Although canker sores are benign and are not contagious, they can be quite painful and awfully annoying. These ulcers can be quite sensitive and can make it difficult to do daily tasks such as eating, drinking and talking.

What causes canker sores?

  1. Injury/Stress
    • One of the most common causes of canker sores is injury. Brushing too hard, biting your gums, harsh mouthwashes or eating something hard are some things that may cause these tiny ulcerations to appear. Certain people are also more sensitive with toothpastes that contain sodium lauryl sulfate (SLS), which can also lead to the development of these sores.
  2. Acidic Foods
    • Highly acidic foods, such as fruit, can irritate the tissues or worsen the condition of canker sores.
  3. Vitamin Deficiency
    • Children are more susceptible to getting canker sores because their bodies are consistently growing and demand for more vitamins. Doctors suspect that a vitamin B-12 deficiency can contribute to the cause of canker sores.
  4. Weak Immune System/Chronic Illness
    • Individuals with weakened immune systems are more susceptible to getting canker sores. A weaker immune system cannot repair ulcers as quickly as a healthy immune system. Individuals with Celiac disease or Crohn’s disease are also more prone to getting canker sores.

How to get rid of them

Thankfully, canker sores do go away on their own within one or two weeks. The best thing you can do is to keep your mouth healthy. This means keeping up with your oral care regime, including brushing twice and flossing daily. It may be tempting to avoid brushing in the area due to discomfort, however it is important to remove the plaque, bacteria, and food debris in order to aid healing. You should also avoid eating highly acidic and/or spicy foods, as they can cause irritate the tissues.

Over the counter mouthwashes and ointments are also available in order to soothe the area. Gingigel by Oral Science is a product that we highly recommend for those with canker sores or gum inflammation. It relieves pain and contains hyaluronic acid – a natural substance found in the connective tissues of the body. Hyaluronic acid helps to stimulate the production of new healthy tissue and promote tissue regeneration, allowing the sore to heal at a faster rate.

If you are noticing large sores, have sores that do not go away after three weeks, or are experiencing severe pain associated with your mouth, we encourage you to visit us at Credit River Dental Centre to have us examine the lesion to ensure that it is indeed a canker sore.

Tooth or False? 5 Fun Facts You May Not Know!

Being your top choice Mississauga dental team, we love to share important information and advice when it comes to great oral health. Dental health is a serious matter to ensure proper oral health, but who said it can’t be fun? Check out some of these fun facts that will make you smile!

  1. Tooth enamel is the second strongest compound in the world after diamonds! This makes it the strongest substance in your entire body. Tooth enamel consists of mainly calcium and phosphate mineral crystals, which makes it stronger than even your bones. It is made up of 96% minerals and makes it one of the only few parts of your body that can’t fix itself, therefore maintaining healthy oral care is crucial to keep your all natural diamond smile nice and strong!

  2. On average, a person produces about 2 to 4 pints of saliva a day. That equates to approximately 25,000 quarts in a lifetime! Saliva keeps your mouth hydrated, prevents bacteria from reproducing and causing cavities and bad breath. Saliva also contains a chemical called opiorphin that is six times more potent than morphine! According to a team of French researchers from Pasteur Institute in Paris, France , a study that included isolating opiorphin and injecting them into rats found that the chemical was so effective that the rats needed six times the amount of morphine to render the same effects! Unfortunately not everyone has an adequate amount of saliva and if you don’t it can be detrimental to your oral health. If you have any concerns about your saliva production speak with your dental professional at your next dental visit.

  3. The jaw consists of the most powerful muscle in the body based on weight called the masseter. In conjunction to all the jaw muscles working together, the jaw can actually close the teeth with a brute force up to 55 pounds on the incisors or up to 200 pounds on the molars! Talk about a powerhouse mouth! We also know that with great power, comes great responsibility! If you know or suspect you grind your teeth, bringing it up at your next visit would be a good idea as a night guard may be advised. Teeth grinders often have stronger jaw muscles, so you want to make sure you still protect those pearly whites! When grinding or bruxism is a concern, your dental profession can help prevent further trauma or possibly damage to your teeth. Make sure to mention this at your next dental visit.

  4. Patients who are expectant mothers have a high risk of delivering premature and low birth weight babies if there is a presence of Periodontal Disease. With the rise of hormones, morning sickness, and diet choices during pregnancy, your oral health is more susceptible to infection, disease and inflammation if proper oral hygiene care isn’t practiced. Be sure to let us know prior to treatment if you are pregnant so we can assure both you and baby are safe!

  5. Scheduling regular dental hygiene appointments can help prevent heart attacks! We all know that keeping your teeth and gums clean helps steer clear of cavities and gum disease, so it’s important to have your hygiene treatments done regularly to help avoid exacerbating conditions such as heart disease and diabetes. When was your last hygiene appointment? As your Mississauga Dental Team we strive to ensure that your optimal oral health is our primary goal.

Call us today at (905) 278-4297 and we’d be more than happy to book an appointment for you!

Carbonated Water…What you should know.

When we drink acidic drinks, like sodas, fruit juices, or (mildly) acidic bubbly waters, the minerals in our teeth dissolve in a process called demineralization. Saliva pH is between approximately 5.5-6.5, depending on the phosphate and calcium ions in your body. The more ions in your spit, the lower the critical pH, or in other words, the more acid your teeth can withstand before demineralizing. The pH of most bubbly waters might be below the critical pH for most mouths, but the claims that these waters are ‘extremely acidic’ are completely false. The pH of Gatorade is about 3, of orange juice is about 3-4 and of Coke is 2.4. If the pH to stay above is ~6 (tap water is ~7), then drinking your daily Perrier warm, or even better warm and flat would be best. That is not how most people enjoy their Perrier however so the best thing to do is to rinse your mouth afterwards with some tap water.

While sparkling water is far better for your teeth than sugary drinks, be sure to drink plenty of regular, fluoridated water as well. Water with fluoride naturally helps fight cavities and helps to wash away cavity-causing bacteria. It also helps to keep your mouth from becoming dry which can also increase the risk of cavities.

Not all sparkling waters are created equally, however. Citrus-flavored waters often have higher acid levels that can increase the risk of damage to your enamel. Plan to enjoy these in one sitting or with your meals. This way, you aren’t sipping it throughout the day and exposing your teeth over and over again to the slightly higher level of acid it contains.

Although sparkling water doesn't contain sugar, it is carbonated. It's the carbonation of sparkling water that has some people worried. A few studies have been performed in order to examine the acidity of various drinks, including sparkling water. One, published in the Journal of the American Dental Association, measured the pH of nearly 400 beverages. The drinks included a mix of sweetened sodas, sports drinks, juices, teas and sparkling waters. It was found that while a majority of sports drinks were rated as "extremely erosive,", certain sparkling waters ranked as "minimally erosive."

Ada McVean at McGill University conducted a similar study testing the pH of nine different brands of sparkling water. She tested the drinks at refrigerator temperature and room temperature, as well as in carbonated form and decarbonated form. In all of her tests, the waters had a pH above 4.0 meaning “minimally erosive”. The pH went up when the waters were at room temperature and when they were decarbonated, suggesting that sparkling water is more erosive in the form in which you're most likely to drink it (cold and bubbly).

So, is sparkling water bad for your teeth? 

The short story here is that sparkling water is much less erosive than many other beverages. To keep your teeth as healthy as possible, the American Dental Association recommends swapping sugary beverages for sparkling water, but not replacing regular, fluoridated water with sparkling water. Skip the Pepsi and quench the craving with some S. Pellegrino, your teeth will thank you, and your blood sugar will too.

Marijuana Use and Your Oral Health

On October 17th, 2018, the Government of Canada had introduced the legalization of recreational marijuana use in Canada. As the use of marijuana becomes more common, we will continue to see it’s possible side effects. As your Mississauga family dentist and as a part of our commitment to our patients, we feel that it is important to discuss and educate you on effects of cannabis on your oral health.

Now you may be thinking, How can marijuana affect my oral health ? According to several studies, chronic marijuana use can lead to higher incidences of cavities, oral cancer, periodontal disease, and gingivitis. Marijuana users tend to have more plaque deposits, cavities, and a higher chance of developing oral cancer, oral candidiasis, and other oral infections.

Here are some of the oral health effects that we think you should all be aware of :

  • Dry Mouth (Xerostomia) 
    • Since saliva acts as the mouth’s natural cleansing system, it is important for one to maintain their salivary flow. Saliva contains antibacterial agents that wash away acids, food debris, and bacteria to protect your teeth from getting cavities or erosion.
    • Cannabis is known to reduce saliva production, which can lead to dry mouth. This makes one more susceptible to getting cavities, tooth sensitivity, and bad breath.
  • Periodontal Disease and Gingivitis
    • Periodontal disease is an infection of the supporting system for your teeth and is actually one of the most common chronic diseases in adults.
    • The inflammation caused by the smoke inhalation can damage the bone and connective tissue attachments of teeth over time, which could then lead to tooth loss.
  • Cavities
    • People often get the “munchies” after Cannabis use. This is because it contains THC which stimulates your appetite which lead frequent snacking. Snacking combined with more plaque and less saliva is the perfect environment for one to develop a lot of cavities in a short period of time. This may also cause existing fillings, crowns and other restorative work to fail.​​
  • Cannabis Stomatitis
    • As a result smoking, high temperatures are introduced into the mouth. Overtime, this repeated exposure results in damage to the lining of the mouth also known as Cannibis Stomatitis.
    • This often results in chronic inflammation of the soft tissues including the tongue, cheeks, palate and lips – one or a combination of these make you more susceptible to developing oral cancer.
  • Other Effects During Dental Treatment
    • Smoke inhalation can cause increased bleeding and a higher risk of developing infections, such as dry socket, after surgery.
    • Cannabis can alter the effects of any prescribed medication and anaesthesia needed for your procedure.
    • Most local anaesthetics contain epinephrine. Smoking marijuana can cause a reaction to the epinephrine, resulting in an increased blood pressure and/or heart rate, which could lead to further serious complications.

What You Can Do

  • Make sure to brush, floss, and rinse daily with an alcohol-free mouth wash
  • Make sure sugary foods and drinks to a minimum
  • Make sure that have frequent dental exams and oral cancer screenings
  • Maintaining health of the gums is also very important so make sure to have regular dental hygiene appointments to reduce and prevent inflammation and gum disease
  • To reduce the risk of developing cavities, make sure you receive a topical fluoride varnish to act as a protective layer for your teeth
  • Asking your hygienist about how you can manage dry mouth
  • Discuss how you can improve your homecare regimen with your dental professional

As your Mississauga Dentist, your oral health is our top priority. Our goal is to ensure that we are able to provide you with the information needed in order to educate you on achieving your optimal oral health. If you have any further questions, you can contact our team at Credit River Dental Centre at 905-278-4297.

Give the Gift of Oral Health!

It’s that time of the season again! You hear the sleigh bells jingling, ring ting tingling too! And while Jolly Old St. Nick is preparing gifts for everyone, you too can give the perfect gift of oral health!

As your Mississauga Dentist, we want to ensure that we can equip you and your family with the best dental technology available to use at home.

With the holiday season upon us, it can get pretty overwhelming when deciding what gifts to get everyone. Whether it’s that nice sweater that grandma mentioned, or the newest video game your nephew’s been going on and on about, that shopping list can get pretty detailed. So, what can you give that can be universal, yet still add a personal touch? Consider an electric toothbrush!

Nothing says happy than a big, bright, and clean smile. An electric toothbrush not only cleans better, but has multiple benefits when compared to the manual toothbrush. A decent electric toothbrush can rotate up to 1000 times in a minute. Not even Popeye can brush that quickly with those muscle arms! Along with its brushing power, electric toothbrushes provide an array of features that are beneficial to your brushing needs.

Pressure sensors are a great tool built into some electric toothbrushes. These sensors are great for signalling when you’re applying too much pressure or brushing too hard.

Timers are great when you don’t know if you’re brushing long enough. Electric toothbrushes like the Oral B Genius have timers for each quadrant of your mouth, so you don’t have to worry about not spending enough time on each part of your mouth.

Digital reminders are great for letting you know when it’s time to replace your brush head. You want to make sure your toothbrush is always properly equipped with an effective brush!

Limited Mobility friendly is another great feature of electric toothbrushes. People who suffer from issues such as carpel tunnel, arthritis, and even developmental disabilities can still maintain great oral health with the help of an electric toothbrush.

Orthodontic recommended makes electric toothbrushes a favourite amongst orthodontic patients. A study from the Department of Paedodontics, Humboldt University in Berlin, Germany found that those who had braces found it easier to brush and clean with an electric toothbrush.

Fun for kids which means children will look forward to brushing regularly. Not only does it make it fun, but it’s also engaging. It also gives peace of mind knowing you’re able to clean the mouth better especially with they’re trying to chomp down on the toothbrush.

Safe for gums is another added benefit of using an electric toothbrush. If used properly, it should not cause any harm to the gums or the tooth enamel.

Although it may not seem like the “traditional” holiday gift, rest assured that an electric toothbrush is not only a thoughtful, but extremely beneficial to the lucky recipient. Because who wouldn’t want the gift of an extraordinary smile!

Should You Brush or Floss First?

What is the meaning of life? What is the key to happiness? Should I brush first or should I floss first? These are just some of the age old questions that have baffled society for centuries. A recent report published by the American Academy of Periodontology (AAP) may have the answer!

Their study included 25 participants who were asked to brush their teeth first, then use dental floss to clean the spaces between their teeth (brush-floss). In a second phase, the same group was asked to use floss, then brush their teeth (floss-brush). Researchers found that the amount of plaque between the teeth and in the mouth overall was significantly reduced when participants were asked to floss first then brush!

As flossing loosens bacteria and debris from between your teeth, brushing afterwards (when the mouth is rinsed with water) further clears the mouth of these particles. Plaque bacteria are the primary culprit behind the development of periodontal disease, an inflammatory condition that occurs when bacteria accumulate below the gum line. Periodontal disease can lead to swelling, irritation, gum recession, and tooth loss if left untreated.

“Patients often ask which step should come first in their daily oral hygiene routine,” says Steven R. Daniel, DDS, president of the AAP. “While this study finds that flossing before brushing may result in the reduction of plaque, it’s important for everyone to remember to do both every day to maintain the health of their smiles.”

The study also found that fluoride, a mineral that aids in the prevention of cavities and tooth decay, remained in the mouth at higher levels when participants flossed before brushing. Study subjects used a fluoride toothpaste during both phases of the investigation.

“As with choosing the right type of toothbrush and interdental cleaner, patients should also consult with their dentists on whether a fluoride toothpaste is best for them,” Dr. Daniel says.

The AAP recommends flossing regularly, brushing twice a day, and undergoing yearly comprehensive periodontal evaluations for the prevention of periodontal disease, which is treatable and often reversible with proper and timely care.

So there you have it. You now know the answer to one of life’s most intriguing mysteries.

What you didn’t know about Bottled Water!!!

Health Canada has stated that the quality standards of tap and bottled water are "similar."

See this link regarding Why Canadians are---or aren't drinking bottled water (from the Globe & Mail).

In this article they state that "A federal agency regulates what is and isn't considered acceptable in public tap water, then gives the job of monitoring their flow to municipalities. In Toronto, water is tested every six hours to confirm the absence of harmful bacteria.  No government body is in charge of testing bottled water, which is classified as food and subject to the Food and Drugs Act. Processing plants are inspected annually by the Canadian Food Inspection Agency and any additional testing is voluntary."

If you do choose to go the bottled water route, it is important to note that not all bottled water is equal as they vary on the pH scale which determines their level of acidity and alkalinity.  The ideal pH of water for human consumption is a pH of 7.0.  Tap water in Ontario ranges from a pH of 6.5 to 8.0.  See figure 1 below for the varying pHs of bottled water.  Photo credit: dataverse.

The Benefits of Fluoridated Water and why Tap Water is the Ideal Choice

There is often a stigma that tap water is 'bad' because it has an element called fluoride in it. In reality, it is actually better for you than most bottled water because the fluoride in it meets the recommended levels.

With all things considered, it's important to know that bottled water companies usually filter out almost all of the fluoride element.  Fluoride shouldn't be feared as it is a natural occurring element that is found in food, soil and water.  Dentally it has been proven to strengthen tooth enamel and decrease one's risk for cavities.  Ontario has a fluoridated water program, meaning that there is a regulated amount of fluoride in our city's water. The fluoridated water program is recognized by many organizations such as Centers for disease control and prevention, Health Canada and the American and Canadian dental associations. 

The fluoride concentration in our water supply is constantly monitored and measured.  Fluoride in concentrations of  0.7 ppm (parts per million) in tap water is considered ideal for human consumption in that it does not cause any adverse affects to anyone of any age. For any more information about the Fluoridated Water Program please visit Safe Drinking Water Foundation.

With this information we hope that you enjoy the warm days yet to come and appreciate the perks of our fluoridated water system without worrying about it being 'bad' for you while you keep yourself hydrated.  The benefits of tap water outweigh those of bottled water.  Know your options so you can make the best decision for you and your family!

To Take or Not To Take…The Controversy Over Taking Antibiotics Prior to Dental Treatment

Updated Antibiotic Prophylaxis Guidelines Prior to Dental Treatment

Infective Endocarditis

In 2007 the American Heart Association’s (AHA) established its latest guidelines for antibiotic prophylaxis prior to dental procedures to prevent infective endocarditis. The guidelines were changed as a growing body of scientific evidence has shown that the risks of taking preventive antibiotics outweigh the benefits for most patients. These risks include adverse reactions to antibiotics ranging from mild to potentially severe and the development of drug-resistant bacteria.

The AHA guidelines emphasize the importance of achieving and maintaining excellent oral health and practising daily oral hygiene. For most patients, taking preventive antibiotics before a dental visit is not indicated. The guidelines state that prophylactic antibiotics, which were routinely administered to certain patients in the past, are no longer needed for patients with:

  • mitral valve prolapse
  • rheumatic heart disease
  • bicuspid valve disease
  • calcified aortic stenosis
  • congenital heart conditions such as ventricular septal defect, atrial septal defect and
  • hypertrophic cardiomyopathy.

Only patients at greatest risk of developing infective endocarditis, an infection of the heart’s inner lining or the heart valves should receive short term preventive antibiotics before common, routine dental procedures.

People who should take antibiotics include those with:

1.prosthetic cardiac valve or prosthetic material used for cardiac valve repair

2.a history of infective endocarditis

3.certain specific, serious congenital (present from birth) heart conditions, including:

  • unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits
  • a completely repaired congenital heart defect with prosthetic material or device,
  • whether placed by surgery or by catheter intervention, during the first six months after the procedure
  • any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device

4.a cardiac transplant that develops a problem in a heart valve

Antibiotic prophylaxis is recommended for patients with the above conditions who undergo any dental procedure that involves manipulation of gingival tissues or the periapical region of a tooth and for those procedures that perforate the oral mucosa. The following procedures and events do not need prophylaxis:

  • routine anesthetic through noninfected tissue
  • dental radiographs
  • placement of removable prosthodontic or orthodontic appliances adjustment
  • of orthodontic appliances
  • placement of orthodontic brackets
  • shedding of deciduous teeth
  • bleeding from trauma to the lips or mucosa

Joint Replacement

The Canadian Orthopedic Association (COA), the Canadian Dental Association (CDA) and the Association of Medical Microbiology and Infectious Disease (AMMI) Canada provide the following guidance in regards to the management of dental patients with orthopedic devices:

  1. Patients should not be exposed to the adverse effects of antibiotics when there is no evidence that such prophylaxis is of any benefit.
  2. Routine antibiotic prophylaxis is not indicated for dental patients with total joint replacements, nor for patients with orthopedic pins, plates and screws.
  3. Patients should be in optimal oral health prior to having total joint replacement and should maintain good oral hygiene and oral health following surgery. Orofacial infections in all patients, including those with total joint prostheses, should be treated to eliminate the source of infection and prevent its spread.

From time to time we do see patients whose Orthopedic Surgeons still insist that the patients take an antibiotic prior to dental treatment in some cases for 2 years after surgery and in some cases for the rest of the patient’s life. In light of these new guidelines, it is therefore recommended that the Orthopedic Surgeon prescribe the course of antibiotics for the patient in these cases. If you have any questions regarding any of the above information, please feel free to call us!

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