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Posts for: October, 2014

By Keith Mellovitz, DDS
October 27, 2014
Category: Dental Procedures
LeaMichelesWiseDentalDecision

Not long ago, Glee star Lea Michele had all of her wisdom teeth removed. This is a very common procedure that people in their twenties, like Michele, often undergo to prevent serious dental problems down the road. The actress found that the procedure really was actually not very difficult to tolerate.

“Feeling all better from my surgery!” she tweeted to fans a few days later. “Back to work tomorrow.”

Why do wisdom teeth so often cause problems? For one thing, they come in years later than the other 28 permanent teeth — usually between the ages of 17 and 25. By that time, there is often no room in the jaw to accommodate them. As man has evolved, the jaws have actually become smaller in size — often creating a lack of space for the wisdom teeth to erupt into proper position. If wisdom teeth become blocked (impacted) by other molars that are already there, infection and damage to neighboring teeth may result.

Sometimes the wisdom teeth themselves cause the problem by growing in at an odd angle. They push against other teeth, often compromising the adjacent tooth's supporting bone. While you would think pain would occur if any of these problems were present, that does not always alert us to a wisdom-tooth problem. It's usually diagnosed with the help of x-rays.

Wisdom tooth extraction is often performed in the dental office using a local anesthetic (numbing shot) to keep you from experiencing any pain, along with conscious sedation to help you relax. The type of anesthesia that's best for you will be determined before the procedure.

After we gently remove the tooth or teeth, you may need to have the site sutured (stitched) to promote healing. You will rest for a short time before going home, and may need to have someone drive you, depending on what type of anesthesia you were given.

Once you get home, you should apply an ice pack on the outside of your cheek for about five minutes on, five minutes off for as many hours as possible to help reduce any postoperative swelling on the first day. Starting on the second day, the warm moist heat of a washcloth placed on the cheek and hot salt water rinses will make you more comfortable. You may want to eat soft foods and brush your teeth very carefully during the recovery period, which lasts only a few days as Lea Michele discovered. Before you know it, you'll be “feeling all better!”

If you have any questions about wisdom teeth, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine article “Wisdom Teeth.”


NewGuidelinesIssuedforAdministeringAntibioticsBeforeaDentalProcedure

One of the possible side effects of dental work is the introduction of oral bacteria into the bloodstream, a condition known as bacteremia. Although not unusual — it can also occur when you eat or brush your teeth — bacteremia could trigger a dangerous infection for some patients.

For many years, we in the dental profession have taken extra precautions with two such categories of patients: those with congenital (“at birth”) heart conditions who are more susceptible to infective endocarditis, a life-threatening infection of the heart lining or heart valves; and patients who’ve undergone joint replacements and are at a higher risk of developing blood-borne infections at the replacement site. It’s been a standard practice for many years to administer antibiotics to patients in these two categories sometime before they undergo a dental procedure as a way of curtailing the effects of any resulting bacteremia.

Recently, however, the guidelines for antibiotic pretreatment for dental work have changed as two major medical associations have revised their recommendations on the procedure. The American Heart Association (AHA) now recommends dentists administer antibiotic pretreatment only to heart patients with a history of endocarditis, artificial valves or repairs with artificial material, heart transplants with abnormal heart valve function and other similar conditions.

Likewise after a series of joint studies with the American Dental Association on infections in dental patients with orthopedic implants, the American Academy of Orthopedic Surgeons no longer recommends pretreatment for artificial joint patients. It’s now left to the dentist and patient to determine whether antibiotics before a procedure is appropriate based on the patient’s medical history. For example, premedication may still be prudent for joint replacement patients with compromised immune systems caused by systemic illnesses like cancer or diabetes.

Although the guidelines have narrowed, it’s still important for you tell us about any heart condition you may have, or if you’ve undergone any type of joint replacement therapy. It’s also advisable for you to discuss with your primary doctor how your condition might be impacted by any proposed or scheduled dental procedure. Our aim is to always minimize any risk to your overall health as we treat your dental needs.

If you would like more information on antibiotic treatment before dental procedures, please contact us or schedule an appointment for a consultation.