- joint premeds 2015Antibiotics Premedication
- Washington Dental / Delta Dental Insurance Questions
- Electric Toothbrushes
- Breastfeeding and Dentistry
- Which toothpaste to use?
- Recycling your toothbrush?
Many of our patients have to take antibiotics prior to dental appointments. Mostly this is for people with artificial heart valves, or a history of bacterial endocarditis (SBE). In both these cases, bacteria in the blood can lodge on the heart valve and grow into pathologic clumps, which can seed through the rest of the body. If you Google “bacterial endocarditis” you’ll find more than you ever wanted to know about it. We don’t premed for heart murmurs any more, something that was required until fairly recently. Interestingly, Britain quit premedicating all heart patients a few years ago. They did not see any increase in SBE as a result, indicating that either premeds don’t help, or that there isn’t a risk from dental treatment after all. There haven’t been any good studies showing higher rates of SBE associated with dental treatment in this country, so it’s probably the latter.
For joint replacement, antibiotic premedication is more controversial. Recommendations were all over the map until 1997, at which point they were reduced and standardized somewhat. Then in 2009 the orthopedic surgeons muddied the waters severely, with the result that most dentists threw up their hands and just premedicated everyone. Over the next several years, the American Dental Association (ADA) made half-hearted attempts to clarify the situation, and finally came out with a statement of DO NOT take premeds for prosthetic joints. We still recommend premeds for immunocompromised people (diabetes, chemo, certain other conditions), but if you’re 65 or less and in good health, no. The ADA position is that, based on the science, dentists should not be prescribing premeds for joint replacements. If your orthopod wants to ignore the science, that’s fine, and he or she should do the prescribing. Here’s a detailed summary of the history of joint premeds, as of October, 2015: joint premeds 2015
Not all dental work creates significant bacteremia, but high risk procedures include cleanings, certain fillings, crowns, and extractions. To minimize antibiotic use, if you need premeds and require some kind of urgent treatment—broken tooth, lost filling, etc.—do not take antibiotics for the evaluation appointment–there’s no point exposing yourself to antibiotics if all we’re going to do is take X-rays and run tests.
In June, 2011, our office withdrew from the Delta Dental Insurance network. We are now a Delta Dental provider again, but only for the “Premier” plan not the PPO. There are several Delta PP insurance plans that do not cover ANY costs for out-of-network dentists. Most, however, cover at a lower level for non-PPO dentists.
Toothbrush recommendations—while we don’t specifically recommend any one type of electric brush, or sell them in our office, we do have some preferences. Most popular is the Sonicare brush. Advertising claims aside, the sonic waves don’t do anything magical to the bacteria, but the vibrating motion does a good job of removing bacterial plaque. There are now a mind-boggling number of versions of this brush, with options such as a UV sterilizer, USB-port charging, multiple cleaning cycles, and gold-plated charging stations. The brushes for the Sonicare are fairly expensive, and need replacing every 3 months. Unfortunately with the plethora of models out there, it’s hard to tell you which one to buy. None of them are bad, but some of them you’re paying a premium for stuff you don’t need. One advantage to this brush is that we give out replacement brush heads at cleaning appointments, instead of a manual brush–but only if you have the right model. Ask for a look at our brushes before you buy a Sonicare to be sure you’re getting our style.
Another option is the Braun Oral B electric brush. The brush head is smaller, and the vibrating motion is slightly faster than the Sonicare. Most models beep every 30 seconds, and notify you when you’ve gone 2 minutes. They splatter and dribble more than the Sonicare, and are perhaps best used in the shower. The brushes are less expensive than Sonicare brushes, and there are some specialty shapes for cleaning orthodontic appliances and wires. Braun also makes a smaller, cheaper, spiffed-up brush for kids.
There are some ultrasonic (as opposed to sonic) brushes on the market, but they didn’t seem to work very well when I tried them. That, and all the neighborhood dogs gathered around my house and howled when I used it. We don’t recommend them at this time, although the idea is good—ultrasonic waves can kill bacteria, unlike sonic waves. There are also a number of cheaper copies of the Braun brush—they may work just fine, I haven’t tried them.
All the brushes mentioned have removable heads, so that each member of the family can have their own brush and share the motor section. We don’t recommend this—there’s too much dribble-back effect. You wouldn’t share toothbrush handles with someone, and the motor is just a glorified handle.
The American Dental Association recently (August 2015) published a nice web page about dental aspects of breastfeeding. I don’t know how long they will maintain the page, but it’s a good resource as long as they keep it posted. Here’s the link: breastfeeding
When choosing a toothpaste, less is usually better. That is, we do not recommend the Extra Whitening, Breath Freshening, Calculus Zapping, Gum Healing, and Politically Correcting versions of toothpaste. I hate to name names, but good old fashioned Crest is fine, the kind with no additives at all except fluoride. It’s also cheap. Colgate makes a similar low-tech paste that’s fine, and I’m sure there are others–Lord knows there’s an entire rack of the stuff at pharmacies. The additives tend to make some people’s teeth sensitive
For people with sensitive teeth, Sensodyne and Crest both make desensitizing toothpastes. The label says not to use more than two weeks, but in fact they’re safe for long term use. Once again, try for a version that has nothing in it but fluoride and the desensitizer; additional additives will only decrease the effectiveness. If you have chronic sensitive teeth, it’s usually a sign of acid exposure, be it dietary or stomach acid reflux. Ask us about this at your next appointment, as we can often see signs of acid damage.
There’s one brand of toothpaste out there that we recommend specifically against. I can’t mention it here, for fear of having my office firebombed, but it’s expensive and available only at fine health food stores. Hint: Ralph’s of Arkansas isn’t it.
Finally, there is solid new data to indicate you shouldn’t use any toothpaste at all. You can clean your teeth just as well with a good electric brush and water only. This should be followed with a fluoride rinse, such as Act. I don’t know of many people following this regimen, but it has the least potential to damage the enamel and still prevents cavities with the fluoride rinse. Ask us for details.