Category Archives for "Dental Education Library"

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!

Why A Cleaning Isn’t Just A Cleaning: 5 Things About Your Dental Hygiene Visit You May Not Know About

The week of April 7th to 13th is Dental Hygiene Week! Registered Dental Hygienists in the province of Ontario are required to complete a dental hygiene program by an accredited school specifically designed to train Dental Hygienists. Programs are often at least 18 months to 2 years in length. In the province of Ontario, Dental Hygienists are considered Oral Health Professionals and once we obtain a Self-Initiation License, we are able to practice independently. With this being said, there are many responsibilities and duties that fall under our scope of practice.

Often times, patients are unaware of what exactly a hygienist does. You probably often refer to your hygiene therapy treatments as “just a cleaning” but it is so much more than that.

Based on a thorough assessment of your “gum” condition, your hygienist performs various procedures to ensure your gum health is being maintained. Aside from it just being all about the “gums,” your dental hygienist also notes any abnormalities or suspicious areas that may require further attention.

So why is a cleaning, not really just a cleaning? A lot of people think when they’re sitting in their hygienist’s chair is that they are ‘just having their teeth cleaned’. There is so much more going on.

Your Medical History
When you visit your hygienist, we update your medical history at every appointment. Why you ask? Quite often, patients do not see how much their medical history impacts their oral health. Medical history and family history identify any risks or potential risks in order to help you maintain optimal oral health. For example, if you are taking medications for blood pressure, diabetes or high cholesterol you are at risk for dry mouth. Dry mouth can create issues with the development of decay and loss of taste among other symptoms.

2. Intra-Oral and Extra-Oral Assessment, Homecare Assessment
When we “take a look” we’re not just looking for areas that look suspicious on your teeth. We’re checking for any lumps or bumps in the head and neck area, any discoloration not just in your oral tissues but also changes in a moles and anything that can warrant a concern. This assessment allows us to determine if further screening is needed especially when it may pertain to oral cancer.

When we look at your teeth we assess for things such as plaque build-up which helps us determine if the home care regimen needs improvement. Based on this information we will decide which homecare recommendations or suggestions will aid in a more effective home care regimen. After all, you only visit your hygienist every few months, what you do between your appointments will heavily impact the longevity and health of your teeth and gums.

3. The Periodontal Assessment
The periodontal assessment is critical in determining the response of the tissues/gums to the previous scaling (cleaning) appointments. The color and appearance of the tissues are noted as well as changes from the previous appointment.
No one likes to be poked and prodded but in order to determine areas of concerns, we have to periodically assess your gum health by measuring your pocket depth, recession, mobility of your teeth, and other variables to aid us in determining the health of the supporting structures of your teeth. A full examination is not done at each appointment but those deeper areas are often measured to assess for stability or progression of disease patients are most likely unaware of.

4. Collaboration with Other Health Care Professionals
When the cause of declining gingival health cannot be determined or unexplained abnormalities are found in the mouth, there is often a need to refer to or work with other health care professionals. This isn’t defined only as professionals in the dental field but others such as a medical doctor, or specialist, diabetic educator, nutritionist, etc. that relate specifically to the findings. The goal a hygienist always has in mind is helping guide patients to optimal overall health and in doing so, it may require collaboration with other health care professionals.

5. The Scaling or “Cleaning”
Lastly, the scaling is properly termed in the hygienist field as “debridement.” This is what every patient recognizes as their cleaning. This often entails the use of an ultrasonic cleaning device that pulsates water in combination with the use of hand instruments. After the scaling or removal of bacteria, calculus and debris, adjunctive therapies may be recommended based on the assessment of the tissues from one appointment to the next. Whether it be more frequent scaling visits, a full periodontal assessment or additional hygiene therapy the goal is to improve the tissues if they are still in an inflammatory state.

So when you think about all that’s done during your appointment, you can see that a cleaning isn’t just a cleaning but includes a variety of assessments that all tie in to maintaining your Optimal Oral Health!

If you have any further questions or concerns, don’t hesitate to contact us and ask your Dental Hygienist about what she/he can do to help you improve your Overall Oral Health!

My Invisalign Journey

Is straightening your teeth something you've always wanted to do but never got done because you "never have the time" or "didn't have enough money to do it right there and then", or were just simply on the fence about it? That was me when it came to straightening my two tilted front teeth!!!

I'd like to share my journey with you because I know that some have always wanted straighter teeth but never came around to doing it eventually deciding to settle with a smile you're not fully content with.  I hope my story inspires you to make a decision that will lead you to a more satisfied smile that can affect not only your level of confidence but also your ability to keep your teeth cleaner.

Growing up, I had always dreamed about having straighter teeth. My two front teeth were tilted inwards toward one another and it made me so self-conscious about smiling. I did have orthodontic work when I was 9 years old but it was mostly to adjust an under bite (when the bottom teeth overlap the top teeth). Having a severe under bite was the main concern that needed to be addressed at the time and second was to straighten out my teeth which unfortunately didn't happen. We all know life happens, and after my under bite was corrected my parents simply couldn't afford another full orthodontic treatment (as my sister was also doing full orthodontic treatment). So, that was the end of orthodontic treatment for me...I thought.

I survived high school and college with the teeth I have but was never truly content with my smile. I worked minimum wage jobs as a cashier with little benefits, and I always inquired at my dental visits how I can get straighter teeth...but with my minimum wage salary I still could not afford it. There was always something that pushed that one goal further and further away from me. Like buying a new car, or not wanting braces during my sister's wedding, or saving money to go on a trip with my friends.  There was always something. And there probably always will be because it isn't cheap but at the same time, it was well worth the investment. You can always buy that designer purse, have the latest cell phone, wear nice clothes, have nice shoes and not realize that it's Your Smile that's your best accessory!

As I finally found a career that suited me in the oral healthcare field naturally, I not only realized that having straighter teeth is aesthetically pleasing, but rather important for function. Also, having everything straight makes it much easier to  maintain your oral homecare which in return adds to the longevity of your teeth. That's when I knew I could not prolong this anymore. When I found out I wouldn't even need the traditional brackets and wires, I was ecstatic! I could do this without anyone really knowing while still enjoying the foods I love, and not having the hassle of learning a new brushing technique! I needed to have this treatment!!!  So I did it, I jumped right into it and I told myself I would make it work. Even if it means I couldn't eat out as often as I'd like or have to wait a month or two more to get my hair done. I was going to make it work and I did. It was the best money I have ever spent on myself.  Now, after just only 9 months of full Invisalign treatment I am finally 100% happy with my smile. 

Adjunctive Therapy to your Regular Hygiene Appointment

Are you one of those patients who sees their hygienist regularly every 3 or 4 months?  Do you have an immaculate dental homecare routine and follow each and every recommendation made to you by your dentist and dental hygienist BUT still have issues with inflammation and bleeding?  If this is you, you may benefit from Professional Oral Irrigation.

Oral or pocket irrigation is a procedure that is done on patients that have deep periodontal pockets of 5 mm or more.  A patient’s gum pocket is determined when periodontal charting is done.  This is generally performed during a professional dental cleaning or during a comprehensive oral examination. The dentist and/or your hygienist will also check for any gum inflammation as well as bleeding.  If bleeding and inflammation are present, this is a sign of gum disease.

When the term "irrigation" is done, your dental hygienist places an antimicrobial agent such as Chlorhexidine into the diseased pocket.  This results in flushing out of the bacteria, particles and toxins from below the gum line.  Chlorhexinde is used to help reduce infections as well as control plaque and periodontal spaces between your gums and teeth.

With a combination of daily oral hygiene and professional maintenance care, the chances of keeping your natural teeth increases while the chances of serious health problems that are associated with periodontal disease decrease.

For more information about oral irrigation please contact us!

Top 5 things You’re Missing When You Are Missing Teeth

  1. Healthy teeth.

A missing tooth can cause the teeth around the space to shift and in turn open up larger spaces between teeth and expose the roots of otherwise healthy teeth. This provides more areas for food and bacteria to hide, making cleaning and hygiene more difficult. This of course can lead to tooth decay and gum disease.

  1. Your jaw bone. Literally.

As soon as a tooth is removed your jaw bone under goes changes in order to remodel the bone around the extraction site. During the first year after the extraction is when most of the bone loss occurs in both height and width as the bone is no longer needed to support a tooth.  

Having large holes in your gums gives bacteria a place to live, causing plaque to develop. That bacteria spreads to the other areas of the mouth and cavities form. That is why if a person is missing one tooth, they eventually need a partial or complete set of dentures or dental implants in the long run.

Your lips and cheeks lose their support which can give someone a more aged appearance.

  1. Your ability to chew well and break down your food properly.

Missing even one tooth can change the way you chew your food. The opposite tooth becomes useless (like one hand clapping) which will impact the way your food is broken down. Food that is not broken down as well can cause issues such as choking and acid reflux.

  1. The ability to speak properly.

If your teeth are missing, you may have difficulty pronouncing certain words. Your tongue, lips and front teeth help in forming speech sounds properly.  By replacing missing teeth, making that all important speech would become a much easier endeavour!

  1. A confident smile.

Quite often when people are missing a tooth, especially a tooth in the front of their mouth, they tend to get self-conscious about their smile.  Just think about how much you love to socialize, not just in person with family and friends, but maybe with that stranger you’ve been dying to meet or even just taking that perfect selfie! Being self conscious about your smile can have a negative impact on your confidence and may even prevent some people from socializing as often.

If you have a missing tooth, or a few of them, contact Credit River Dental Centre today and see what we can do for you to prevent your teeth from further damage and give you back your smile!

Don’t Sugar Coat it! The truth about Diabetes and your Oral Health

Diabetes has been and will continue to be a growing concern in Canada.  It is estimated that approximately 11 millions Canadians are living with diabetes or prediabetes and these numbers are expected to rise to 13 million in the next couple of years and that approximately 1.5 million Canadians are living with undiagnosed diabetes.

Signs and Symptoms (from the Diabetes Canada website) include

  • Unusual thirst
  • Frequent urination
  • Weight change (gain or loss)
  • Extreme fatigue or lack of energy
  • Blurred vision
  • Frequent or recurring infections
  • Cuts and bruises that are slow to heal
  • Tingling or numbness in the hands or feet
  • Trouble getting or maintaining an erection

You may wonder why your dental professional is interested in knowing that you have this condition.  Simply put, the relationship between what exists in your mouth and in your body are connected.  As in the eyes are the mirror to the soul, the mouth is the reflection of your health and vice versa.  Where this affects patients who have diabetes is in the importance of minimizing inflammation.  The body doesn’t recognize that gingivitis (gingival/gum inflammation) is inflammation in the mouth.  What it does recognize is that there is a presence of inflammation in the body.  When gum disease is present in the mouth and is not controlled, the body recognizes this as a chronic inflammatory state.  This can be detrimental and can contribute to uncontrolled diabetes.

So how can your dental professional help you?  Informing your dental professional that you have diabetes or suspect you may have diabetes or have family history of diabetes will help us determine what course of action to take to ensure your risk is minimized.  If needed we will collaborate with other professionals working with you towards improving your diabetes status.

Creating a plan to reduce inflammation in the mouth can be done by

  1. Improving homecare which will reduce plaque (soft deposits) which triggers the inflammatory process. Pay particular attention to cleaning between your teeth as this accounts for 40% of the tooth surfaces and the areas most often neglected.
  2. Visiting your hygienist regularly to remove hard and soft deposits that can increase the progression of gum disease.  Based on your hygienist’s assessment, frequency of dental hygiene visits will depend on your current gum condition.
  3. Improving food choices to decrease plaque production and avoid ones that will cause a spike in blood glucose levels.

Being a dental professional is all about improving your oral health and doing what we can to ensure overall health.  In order to do so it is important for us to look at all aspects of your health and lifestyle.

Together, we can improve your overall health and your quality of life!

By Sue Ellen Umali-Lee

When should you start bringing your infant to the dentist?

Your bouncing baby has been sleeping and eating for months now: don't forget the importance of of cleaning their mouths.

Many parents ask when they should bring their young children in to the dentist. The first answer is as soon as possible, we love the little ones. Bringing your child in at an early age will also help connect the visit with a positive environment and help to avoid future dentist anxiety.

We would like to see your children before their first birthday, and especially important within six months of their first tooth erupting. These first early stages are essential for early warning signs and preventing future problems. Once a child's teeth have started to erupt, conditions such as early stages of gum disease, baby bottle tooth decay, and teething related problems can be detected and treated.

A baby's gums and mouth can be cleaned using an infant toothbrush that slides onto your finger. Do not use toothpaste; water is fine for cleaning a baby's mouth. Toothpaste can be added in a pea sized amount when your child is old enough to understand not to swallow the paste. Even then we advise to not use fluoride toothpaste until your child is around two years old.

Having your child comfortable with dental visits and treating potential conditions before they become problems will give you and your child reason to smile. 

Give our office a call to book your child's first appointment. We look forward to seeing you!

For more information please go to the following links:

Don’t Let Tooth Sensitivity Affect Your Quality of Life!

Over half of the population is living with undiagnosed dentinal hypersensitivity or tooth sensitivity.  Do you know if you are at risk or if you may have this common condition?

Dentinal hypersensitivity is a short, sharp pain in one or more teeth that results from the exposure of dentin (second layer of tooth structure).

These various factors put you at risk:

  • xerostomia (dry mouth)
  • improper brushing (abrasion) and tooth wear lesions (attrition)
  • having uncontrolled gum (periodontal) disease
  • home tooth whitening
  • tooth erosion resulting from diet or acid reflux
  • abfraction which results from teeth grinding (bruxism)

This common condition can be treated.  It is not normal to feel any form of tooth sensitivity especially while eating foods you enjoy or even just breathing in the cold Canadian air.

If you experience dentin hypersensitivity, there are ways for you to help alleviate the symptoms.  You can do this by

  • ensuring that your diet is not high in acid
  • if you suspect that you may have acid reflux, visit your medical professional for an assessment
  • modify your brushing techniques by applying less pressure on brushing and using a soft bristled toothbrush
  • have a proper assessment done by your dental professional to make the appropriate recommendations

There are many products that can be applied by your dental professional to alleviate the discomfort but to successfully manage ongoing discomfort your dental professional will work with you to determine the cause of your tooth sensitivity, what can be done in office to alleviate discomfort and what recommendations can be made for you to continue management at home.

Don’t Let Tooth Sensitivity be a Pain!

Your toothbrush

Your toothbrush is your toothbrush - don't share it. If you use an electric toothbrush get separate brushing heads for each user.

Unless your dentist suggests otherwise, choose a brush with soft bristles. There are many shaped toothbrush heads and bodies: select one that fits your mouth and is easy to handle, ensuring you can reach behind your back molars.

A toothbrush should be changed about every three months, and whenever you see that the bristles are starting to fray and bend. We also recommend replacing your toothbrush after you have a cold or other virus.

Taking the time to care for your teeth and mouth will benefit your overall health and be well worth the effort. If you would like a demonstration of proper brushing techniques, please ask us during your next visit.

Mouth Cancer Action Month

It's hard to believe that fall is almost over and winter is coming. While there's a bit more time before the snow hits, you shouldn't forget to bundle up to avoid getting caught off guard by the sudden change in temperature. The last thing you want is to get sick during the last few weeks of fall fun!

Although there are many fun events that are happening during the fall season, please note that November is also Mouth Cancer Action Month. The disease can affect the lips, tongue, cheeks, throat and other parts of the head and neck area.  

Our team here at Credit River Dental Centre would like to remind you the importance of oral cancer screening. Dr. Lee and our hygienists recommend that you see us for your complete oral examination every 2-3 years to detect signs of decay or disease. An early detection can save you from a number of different conditions such as oral cancer.

If we haven’t seen us for your complete oral examination, please call our office to set up an appointment.

For more information about Mouth Cancer Action Month please go to