(972) 727-5001 720 East Main Street, Suite A
Allen, TX 75002

Patient Information

Aggressive Oral Prevention Measures For Patients With High Decay Risk

Some patients experience a higher incidence of decay than others. Below are some things that can help lower the chances of decay in high-risk patients.

  • Use of prescription strength fluoride toothpaste 2-3 times per day. Brush 2 min. Floss with paste still in mouth if possible. Spit excess and do not rinse. Can use alone or alternate with regular toothpaste (which is more abrasive) if desired. Refrain eating/drinking for at least 30 minutes after using prescription toothpaste.
  • Daily use of xylitol products (candies, gum, etc.). These can also help stimulate saliva activity. Granular xylitol is also recommended to be used in place of sugar or artificial sweetener. Xylitol is a sugar substitute proven to reduce decay risk. It can be found in gums such as Trident and Spry.
  • Nightly use of fluoride trays (if recommended by dentist). Place several drops of prescription fluoride gel in trays and evenly disperse. Place over the teeth and wipe excess. Leave in place for 15-30 min. Remove trays, spit excess, and place trays in mouth over night if possible.
  • Use of Peridex 0.12% Rinse (or generic) 1 time per day for 2 weeks, stop for 3 months, and continue the same regime.
  • Use of saliva substitutes, such as Biotene products as needed for dry mouth, if dry mouth is suspected to be the cause of increased decay.

Aggressive Oral Prevention Measures For Patients Receiving Head/Neck Radiation

Radiation to the head and neck can cause dry mouth. Having a dry mouth can increase the risk of decay because saliva helps to naturally fight decay and rinse bacteria from teeth. Below are recommendations to protect teeth from decay during radiation treatment.

  • Use of prescription strength fluoride toothpaste 2-3 times per day. Brush 2 min. Floss with paste still in mouth if possible. Spit excess and do not rinse. Can use alone or alternate with regular toothpaste (which is more abrasive) if desired. Refrain eating/drinking for at least 30 minutes after using prescription toothpaste.
  • Daily use of xylitol products (candies, gum, etc.). These can also help stimulate saliva activity. Granular xylitol is also recommended to be used in place of sugar or artificial sweetener. Xylitol is a sugar substitute proven to reduce decay risk. It can be found in gums such as Trident and Spry.
  • Nightly use of fluoride trays (if recommended by dentist). Place several drops of prescription fluoride gel in trays and evenly disperse. Place over the teeth and wipe excess. Leave in place for 15-30 min. Remove trays, spit excess, and place trays in mouth over night if possible.
  • Use of Peridex 0.12% Rinse (or generic) 1 time per day for 2 weeks, stop for 3 months, and continue the same regime.
  • Use of saliva substitutes, such as Biotene products as needed for dry mouth, if dry mouth is suspected to be the cause of increased decay.
  • 3-4 month cleanings and recall schedule, unless otherwise specified.

Dental Emergencies

There are a number of simple precautions you can take to avoid accident and injury to your teeth. One way to reduce the chances of damage to your teeth, lips, cheek and tongue is to wear a mouthguard when participating in sports or recreational activities that may pose a risk. Avoid chewing ice, popcorn kernels and hard candy, all of which can crack a tooth. Cut tape and open packages using scissors rather than your teeth.

Accidents do happen, and knowing what to do when one occurs can mean the difference between saving and losing a tooth.

We try to reserve time in our daily schedules for emergency patients. If you have an emergency, call the office and provide as much detail as possible about your condition. If it is after-hours, and you are a patient-of-record, your call will be forwarded to an emergency number. Remember, pain is a signal that something is wrong—a problem that will not disappear even if the pain subsides. If you're concerned about seeing the dentist because you have limited or no dental insurance, ask your dentist if the practice offers a convenient outside monthly payment plan. If the answer is yes, you can submit an application online and usually get an immediate credit decision, and the emergency care you need.

Tips for Dealing with Dental Emergencies

Swelling

Advanced tooth decay can lead to infections in teeth that spread to the surrounding bone. If the infection becomes trapped in the bone and cannot escape, pus and pressure builds up. This can cause extreme pain and can also sometimes lead to a life-threatening situation. Lower tooth/jaw infections have the ability to swell large enough to impinge on your airway or to allow bacteria to spread into the body. Upper tooth/jaw infections have the ability to swell and enter spaces in your head that lead to the brain, allowing the bacteria to spread and cause a brain infection. Swelling in the mouth is not something to be ignored. Call the office for an appointment as soon as you notice swelling. Early treatment of the infection is crucial.

Bitten Lip or Tongue

Clean the area gently with a cloth and apply cold compresses to reduce any swelling. If the bleeding doesn't stop, go to a hospital emergency room immediately.

Broken Tooth

Rinse your mouth with warm water to clean the area. Use cold compresses on the area to keep any swelling down. Call the office immediately.

Cracked Tooth

If you suspect you have a cracked tooth, call the office for an appointment to determine the extent of the crack and discuss treatment options. Depending on the size and location of the crack, treatment may vary from bonding to root canal treatment. A severely cracked tooth may need extraction.

Jaw-Possibly Broken

Apply cold compresses to control swelling. Go to your dentist or a hospital emergency department immediately. Baylor Hospital in downtown Dallas is a long drive from Allen, but they usually staff an oral surgeon in the Emergency Room there. Not all emergency rooms have an oral surgeon on staff. The Baylor ER is a good recommendation for after-hours emergencies involving a possible broken jaw. Call first to verify an oral surgeon will be there.

Knocked Out Tooth

Hold the tooth by the crown, not the root, and rinse off the root of the tooth in water if it's dirty. If it's not dirty, you do not need to rinse it. Do not scrub it or remove any attached tissue fragments. If possible, gently insert and hold the tooth in its socket. If that isn't possible, put the tooth in a cup of milk and get to the dentist as quickly as possible. Take the tooth with you to the dentist. If no milk is available, keep the tooth inside your mouth, holding it carefully in your cheek with saliva around it, taking care not to accidentally swallow it.

Tooth Knocked Loose

Call the office immediately. The loose tooth/teeth may need to be splinted to other teeth for stabilization while they heal.

Objects Caught Between Teeth

Try to gently remove the object with dental floss; avoid cutting the gums. Never use a sharp instrument to remove any object that is stuck between your teeth. If you can't dislodge the object using dental floss, contact the office.

Toothache

Rinse your mouth with warm water to clean it out. Gently use dental floss or an interdental cleaner to ensure that there is no food or other debris caught between the teeth. Never put aspirin or any other painkiller against the gums near the aching tooth because it may burn the gum tissue. If the pain persists, contact the office.

Average Tooth Eruption and Shedding Ages

Guidelines For Antibiotic Pre-medication

There are various reasons why some patients require antibiotics prior to receiving dental treatment, including (1) people with certain heart conditions, (2) people with total joint replacements, and (3) people who have compromised immune systems due to medications such as chemotherapy or conditions such as HIV. Each of these situations are discussed in more detail below, in 3 separate sections, along with helpful links with more information.

From the American Dental Association & the American Heart Association Regarding Antibiotic Pre-Medication

With input from the ADA, the American Heart Association released the current recommendations for the prevention of Infective Endocarditis, IE, in 2008.

The current recommendations advise pre-medication for a smaller group of patients than previous versions. This change was based on a review of scientific evidence, which showed that the risk of adverse reactions to antibiotics outweigh the benefits of prophylaxis for most patients. Concern about the development of drug-resistant bacteria also was a factor.

Also, the data are mixed as to whether prophylactic antibiotics taken prior to a dental procedure prevent IE.

The recommendations note that people who are at risk for IE are regularly exposed to oral flora during basic daily activities such as brushing or flossing, suggesting that IE is more likely to occur as a result of these everyday activities than from a dental procedure.

The current recommendations advise use of preventive antibiotics prior to certain dental procedures only for patients with:

  • artificial heart valves
  • a history of infective endocarditis
  • a cardiac transplant that develops a heart valve problem
  • the following congenital (present from birth) heart conditions:*
  • 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

* Patients should check with their cardiologist if there is any question as to whether they fall into one of these categories.

Patients who took prophylactic antibiotics in the past but no longer need them include those with:

  • mitral valve prolapse
  • rheumatic heart disease
  • bicuspid valve disease
  • calcified aortic stenosis
  • congenital (present from birth) heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy

Dental Procedures

Prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of the teeth, or perforation of the oral mucosa.

Additional Considerations About Antibiotic Prphylaxis

Sometimes patients forget to premedicate prior to their appointments. The recommendation is that the antibiotic be given before the procedure. This is important because it allows the antibiotic to reach adequate blood levels. However, the recommendations to prevent infective endocarditis state:

"If the dosage of antibiotic is inadvertently not administered before the procedure, the dosage may be administered up to two hours after the procedure."

Another concern that dentists have expressed involves patients who require prophylaxis but are already taking antibiotics for another condition. In these cases, the recommendations for infective endocarditis recommend that the dentist select an antibiotic from a different class than the one the patient is already taking. For example, if the patient is taking amoxicillin, the dentist should select clindamycin, azithromycin or clarithromycin for prophylaxis.

Visit The American Heart Association for more information about their dental recommendations.

From the American Academy of Orthopaedic Surgeons (AAOS) Regarding Joint Replacements

Given the potential adverse outcomes and cost of treating an infected joint replacement, the AAOS recommends that clinicians consider antibiotic prophylaxis for joint replacement patients with one or more of the following risk factors prior to any invasive procedure that may cause bacteremia.

  • Patients at Potential Increased Risk of Hematogenous Total Joint Infection
  • All patients with prosthetic joint replacement
  • Immunocompromised/immunosuppressed patients
  • Inflammatory arthropathies (e.g.: rheumatoid arthritis, systemic lupus erythematosus)
  • Drug-induced immunosuppression
  • Radiation-induced immunosuppression
  • Patients with co-morbidities (e.g.: diabetes, obesity, HIV, smoking)
  • Previous prosthetic joint infections
  • Malnourishment
  • Hemophilia
  • HIV infection
  • Insulin-dependent (Type 1) diabetes
  • Malignancy
  • Megaprostheses

Dental Recommendation: 2 grams of Cephalexin, Cephradine, or Amoxicillin 1 hour prior to dental appointment.

Occasionally, a patient with a joint prosthesis may present to a given clinician with a recommendation from his/her orthopaedic surgeon that is not consistent with these recommendations. This could be due to lack of familiarity with the recommendations or to special considerations about the patient's medical condition which are not known to either the clinician or orthopaedic surgeon. In this situation, the clinician is encouraged to consult with the orthopaedic surgeon to determine if there are any special considerations that might affect the clinician's decision on whether or not to pre-medicate, and may wish to share a copy of these recommendations with the physician, if appropriate. After this consultation, the clinician may decide to follow the orthopaedic surgeon's recommendation, or, if in the clinician's professional judgment, antibiotic prophylaxis is not indicated, may decide to proceed without antibiotic prophylaxis.

Visit the AAOS website and more information.

Pre-Medication in Patients Who Have Compromised Immunity

Patients with a compromised immune system may not be able to tolerate a transient bacteremia following invasive dental procedures. These non-cardiac and non-joint-related factors can place a patient with compromised immunity at risk for distant-site infection from a dental procedure. This category includes, but is not limited to, patients with the following medical conditions:

Immunosuppresion secondary to:

  • human immunodeficiency virus (HIV)
  • severe combined immunodeficiency (SCIDS)
  • neutropenia
  • cancer chemotherapy
  • hematopoietic stem cell or solid organ transplantation
  • Head and neck radiotherapy
  • Autoimmune disease (eg, juvenile arthritis, systemic lupus erythematosus)
  • Sickle cell anemia;
  • Asplenism or status post splenectomy
  • Chronic steroid usage
  • Diabetes
  • Bisphosphenate therapy (in some cases)

If you feel you may need pre-medication due to any reason, but are unsure, provide our dental office with contact information for your medical doctor(s) so that we may consult with them. Medical/Dental consultations take time, so please give us as much advance notice as possible to prevent any delays in your dental appointment.

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