PatientsonBloodThinnersRequirePrecautionsBeforeandDuringOralSurgery

The proliferation of drugs to treat all manner of diseases and conditions has heightened concerns not only about general side effects, but also how a particular drug may affect treatments for other conditions. There are indications, for example, that drugs classified as blood thinners could cause complications for patients undergoing oral surgery.

Blood thinners like Warfarin are typically prescribed to patients with artificial heart valves or who are at significant risk for stroke, heart attack, or the formation of clots that could potentially damage the heart and lungs. The drug reduces the coagulation (clotting) mechanism in blood; aspirin taken regularly should also be considered a blood thinner.

As with any invasive procedure, blood thinners can complicate oral surgery. Blood doesn’t clot normally and so bleeding during a procedure is more difficult to stop. This doesn’t necessarily mean the surgery can’t be performed. For one thing, many oral procedures like tooth removal involve little trauma to tissues and bleeding in the hands of a careful and experienced surgeon. The surgeon can also use hemostatic agents during surgery that will stabilize blood clotting, as well as suturing the incision in such a way as to reduce bleeding from surface capillaries. In the case of a tooth extraction, a bone graft placed within the empty socket not only reduces bone loss from a missing tooth, but can also enhance bleeding control.

In consultation with your medical doctor, it’s also possible to temporarily stop or reduce your medication dosage in anticipation of a pending oral surgery. While it may not be safe to stop the drug altogether, a reduced dosage can ease the anti-coagulant effect and reduce any complications from bleeding that might occur during the surgery. You can then resume normal dosage soon after the procedure.

During your pre-op examination, it’s important to let your surgeon know about any drugs you are currently taking, including over-the-counter drugs like aspirin. The oral surgeon will then be able to take the necessary steps, including working with your medical doctor, to ensure your surgical procedure is safe and uneventful.

If you would like more information on oral surgery precautions while taking blood thinners and other medication, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Oral Surgery & Blood Thinners.”

By Pendleton Dental Care
March 03, 2014
Category: Dental Procedures
ChristieBrinkleysTipsonToothWhitening

Christie Brinkley's world-famous smile has graced the covers of countless magazines for over 30 years. In fact, in her own words from an interview with Dear Doctor magazine, the supermodel said, “I think my smile was really my passport to success in the modeling industry.” And while most of her smile's appeal comes naturally, Christie does give it a boost with good oral hygiene, regular dental checkups and tooth whitening. As Christie says, “When it comes to teeth, keep it as natural as possible. Do not go overboard on whitening. You want your teeth to compliment your face…your friends should not be required to wear sunglasses when you smile!”

Aside from some potential minor side effects such as tooth sensitivity, whitening teeth through bleaching is a relatively inexpensive way to brighten your smile conservatively and successfully. There are three common methods, as described below:

  • An external or vital approach where “vital” (living) teeth are bleached through direct contact to the tooth's surface.
  • An internal or non-vital approach where the tooth is whitened from the inside during a root canal treatment.
  • A combination approach in which both internal and external bleaching techniques are used.

But what causes teeth to become discolored?

Tooth discoloration can be caused by a traumatic blow to your teeth resulting in nerve tissue (pulp) death. However, there can be many other causes: consuming or using products that stain the teeth such as coffee, tea, cola, tobacco products and red wine, to name just a few. Aging is another factor, as it results in changes in the mineral structure of the tooth as the enamel, the outermost layer, loses its beautiful and youthful translucency. Other causes include exposure to high levels of fluoride; tetracycline, an antibiotic, administered during childhood; inherited developmental disorders and jaundice in childhood; and tooth decay.

The good news is that we routinely brighten smiles through tooth whitening. To learn more about brightening your smile, continue reading the Dear Doctor magazine article “Teeth Whitening.” Or if you are ready to have your teeth professionally whitened, contact us today to schedule an appointment so that we can conduct a thorough examination and discuss your whitening treatment options. And if you want to read the entire feature article on Christie Brinkley, continue reading “The Secret Behind Christie Brinkley's Supermodel Smile.”

By Pendleton Dental Care
February 21, 2014
Category: Oral Health
Tags: oral health  
PreservingYourTeethsEnamelCouldPreserveYourTeeth

Teeth are composed of layers of different types of tissue. The main inner layers — the pulp and dentin — help the teeth respond and adapt to external forces. But they’re vulnerable to decay and quite sensitive to environmental extremes. They are protected from all these by a coating of enamel, made of the hardest material found in the human body.

But while enamel is strong, it’s not invincible — it can soften and dissolve (de-mineralize) if the mouth environment becomes too acidic. While de-mineralization occurs normally whenever the mouth becomes too acidic after eating or drinking, saliva helps neutralize the acid (buffering); in fact, saliva can restore to the enamel some of the calcium and other minerals it has lost (a process called re-mineralization).

If the acidic level remains too high for too long it can overwhelm saliva’s buffering ability and cause permanent mineral loss to the enamel. This erosion leaves teeth more susceptible to decay and disease and could lead to tooth loss. With this in mind, here’s some ways you can help preserve your enamel:

  • Wait about thirty to sixty minutes after eating or drinking to brush your teeth. Counterintuitive as this may sound, it takes about thirty minutes for saliva to restore a normal pH level and re-mineralize the enamel. If you brush within this window of time, you could brush away some of the softened minerals from the enamel.
  • Only brush twice a day. Over-brushing causes undue enamel wear, as well as contributing to receding gums.
  • Take advantage of less acidic or mineral-rich beverages. Drink milk or water most of the time, rather than juices, sodas or sports drinks. The calcium in milk or as an additive to acidic beverages aids in buffering and re-mineralization.
  • Use a straw for acidic beverages. With a straw your teeth avoid direct contact with most of the beverage’s acid, a key factor in de-mineralization.
  • Avoid eating just before bed. Saliva flow decreases significantly when we sleep. If you eat right before bed, there may be less saliva available for buffering and re-mineralization.

Following these tips, along with effective oral hygiene, will go a long way in protecting your teeth’s enamel coating — and preserving your teeth in the long run.

If you would like more information on enamel erosion and how to prevent it, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “6 Tips to Help Prevent the Erosion of Tooth Enamel.”

By Pendleton Dental Care
January 23, 2014
Category: Dental Procedures
PadmaLakshmisSmileARecipeforBeauty

Before she began hosting the long-running TV competition Top Chef, Padma Lakshmi was a well-known model and successful cookbook author. (Appropriately, she is said to have been “discovered” by a modeling agent while sitting in a café in Madrid.) Yet the Indian-born beauty's striking look — at once exotic and familiar — doesn't come from any cookie-cutter mold.

So when Lakshmi had cosmetic work done on her teeth, early in her career, her dentist didn't use a cookie-cutter approach either: Instead, her smile was carefully designed, using small amounts of bonding material to brighten her teeth and to bring their shape and spacing into harmony with her facial features.

Dentistry by Design
What exactly is smile design — and what could it do for you? Essentially, it's the process of evaluating your smile in concert with the appearance of your entire face, and visualizing the changes — some dramatic and some subtle — that will make it really shine. Some aspects we consider include the face's shape, the proportion or “balance” of facial features, the complexion, eye and lip color and form, and the overall dimensions of the smile.

Based on dental aesthetics and clinical experience, we will probably have a number of suggestions to make on how you can improve your smile. Your input will also be very important; while some individuals prefer perfectly even teeth and a sparkling “Hollywood white” smile, others are looking for a result that's more in keeping with a “natural” look: slight irregularities in tooth shape, spacing, and even color.

There's no right or wrong answer here: Having a “perfect” smile means what's perfect for you, so it's very important for dentists and patients to communicate openly during the smile design process. But sometimes, words alone just aren't enough to convey the subtle dimensions of beauty.

The Trial Smile
Fortunately, it's now possible to preview your “perfect” smile using a number of different techniques. Advances in computer imaging make this the first step in previewing your new smile — you can see the changes before a single tooth is touched! Still, many people find that having a more concrete picture is helpful. The next step is to make a 3-D mock-up the proposed dental work on an actual model of your mouth. That way, you can see a physical representation of the final results — and even turn it around and hold it in your hands.

There's still one more way to really experience the difference cosmetic treatments can make without committing to a permanent change: the provisional restoration. Here, tooth-colored bonding material and other techniques are used to actually create the new smile — temporarily. This gives you time to “live with it,” and see if the proposed changes work for you. If everything goes well with the provisional work, the permanent restoration is guaranteed to please.

So if you want holiday treats, get out the cookie cutter — but if you're looking for a smile that's uniquely yours, and one that enhances your own individual appearance… call our office and ask about a smile design consultation. You can learn more in the Dear Doctor magazine articles “Great Expectations — Perceptions in Smile Design” and “Beautiful Smiles by Design.”

By Pendleton Dental Care
January 08, 2014
Category: Dental Procedures
Tags: braces   orthodontics  
ExtraCareisRequiredWhenTreatingTeenagersWithLostTeeth

Permanent tooth loss at any age greatly affects long-term oral health. But because their jaw and facial structures are still developing, it’s particularly consequential for adolescents. Add to that any planned orthodontic treatment, and a little extra care is warranted when a teenager loses a tooth.

The biggest concern is potential bone loss caused by the missing tooth. Because the mouth structures are still developing, bone loss can be especially problematic for any future restorations of missing teeth. One of the best ways to slow or stop bone loss is to surgically insert bone-grafting material at the time of an extraction. Bone grafts act as scaffolds that the body builds natural bone upon; eventually the natural bone completely replaces the graft material.

When it comes to the matter of orthodontics, the treatment plan will be to either close the space so that future tooth replacement isn’t necessary or maintain the space for future tooth replacement. If the choice is the latter, the orthodontist will maintain enough space during installation of the braces for future replacement. In the meantime, the orthodontist can install temporary, color-matched tooth replacements within the braces to cover the gap. After the braces have been removed, artificial crowns may also be incorporated into the retainers for a more natural appearance until receiving a permanent replacement.

The best choice for that permanent replacement is a dental implant, a “stand-alone” system that encourages bone maintenance and doesn’t interfere or impact adjacent teeth. The only real question for adolescents is when to install the implants.

The mouth’s structural development doesn’t conclude until early adulthood: in males around ages 20, and in females typically a year or so earlier. Your dentist will evaluate your adolescent’s growth and development to determine if he or she is ahead or behind the growth curve. Natural teeth grow and develop along with the corresponding bone growth, but implants are artificial devices that don’t “grow” with the natural bone. It’s important, therefore, to postpone an implant installation until the jaw structure has fully developed — if done too early, the implant crown’s length won’t appear to be proportionally right (especially in relation to natural teeth) as the jaw continues to grow.

If you would like more information on dental implants for teenagers, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dental Implants for Teenagers.”





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