FAQs and Useful Tips
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Why do some people have to take antibiotics before dental treatment?
People with artificial heart valves and some types of artificial joints may require antibiotics before dental work. Artificial heart valves are the highest risk; bacteria can get into the bloodstream (bacteremia) during the procedure, travel to the heart, and stick to the valves. The bacteria multiply into large colonies and destroy the valves, and/or seed throughout the rest of the body. For more information see, for example,
Not all dental work creates significant bacteremia, but for higher risk procedures, which includes dental cleanings, antibiotics are recommended, usually taken one hour prior to the dental appointment. Artificial joints can develop a similar problem, and an infection could require replacement of the joint. Until recently, even most heart murmurs (leaky valves) were also covered with antibiotics. The most recent guidelines are that heart murmurs do not require antibiotics unless the patient has had a history of bacterial endocarditic--that is, a heart infection. If you have previously taken antibiotics before all dental visits, you should ask us before your appointment to see if you are in one of the groups that should still take them. In 2009, the joint doctors further muddied the waters by issuing two sets of conflicting recommencations, following an informal conference held in a hotel bar (so goes the story, at any rate). You will need to check with your orthopedic surgeon to see which set of rules he or she believes. In 2012, the surgeons are holding a conference, and have promised to sort this out with just one set of recommendations at that time. I'm trying to finagle an invite to this conference so I can get a preview of the new rules -- that, and it's being held at a very nice resort with excellent free food and drinks.
Is there any way to avoid taking these antibiotics? I don’t like taking pills ...
Unfortunately, you can't just say "I'll accept the risk of heart damage, what do you want me to sign?" To go ahead with treatment under those circumstances would be malpractice for the dentist, and his or her insurance wouldn't cover it if something went amiss. Regarding artificial joints, it's a single dose, so look on the bright side--as recently as the 1990‘s, most orthopedic surgeons were prescribing a week of antibiotics for all dental treatment (yikes!) The rules get reviewed every several years, and if enough of you folks with artificial hips die from taking antibiotics, they might change the recommendations away from taking the drugs ☺.
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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. The Sonicare is probably the most popular, and although the sonic waves don’t magically kill all the bacteria, the vibrating motion does a good job of removing plaque. It’s especially good for those with arthritis, and the brush beeps every 30 seconds to pace you through the four quadrants of your mouth--very few people will brush the recommended two full minutes without this reminder. There are now several versions--make sure you get one of the newer ones with the improved brush heads. Older models the brushes are getting hard to find, so a bargain won’t be in the long run, as the brushes need to be replaced every 3 months or so. The fancier models have two speeds, an ultraviolet brush sterilizer, and other gimmicks which really aren’t worth the money in my opinion, but if Sonicare will give me a kickback, I’ll be happy to recommend the most expensive model. There are several sizes of heads available--get the smallest one, so you can get the brush back behind your molars. Sonicare now makes a kids version as well.
Oral B makes the Braun electric brush, which has some advantages over the Sonicare. For starters, they only make a small head, and the vibrations are slightly faster. The replacement brushes are generally a bit cheaper, which can add up over the years. Like the Sonicare, there is a beep every 30 seconds, and it comes in several varieties, including one with a wireless monitor so you can watch the seconds tick down. Clearly, some engineer had too much time on his hands when that was designed.
Both the Sonicare and the Braun have detachable heads, the idea being you can use one handle/motor for the whole family. We don’t advise this, there’s too much dribble-back, and it’s a little too much like sharing a toothbrush. Besides, the motors eventually wear out, and you will need to buy a new one twice as often if you’re using it twice as much. There are a couple of models that come with two brush handles and one charger, and that’s fine, there’s very little contamination potential with the induction charger.
There is mounting evidence that manual brushing with improper technique or too much force causes considerable damage to teeth. Seriously, if God had intended us to brush out teeth manually, we'd have a brush on the end of our index finger. It may not be a coincidence that as more and more people are becoming interested in whiter teeth, we're seeing more and more tooth damage that looks suspiciously like it was caused by excessive brushing. People with stomach acid reflux (heartburn, GERD) are at even more resik for combination acid/brushing damage. Our current feeling is that every adult should probably use one of the above electric brushes, not because it gets the teeth cleaner but because it's less likely to cause damage. (We also own stock in Sonicare and Oral B, but that's got nothing to do with it ... Just kidding)
