Good News for those who have to take Antibiotic Pre-Medication before Dental Visits:Research indicates that certain patients may no longer have to take antibiotics prior to Dental Treatment. (Warning: Please confirm with your health care provider before stopping any medication regiment.)
Quote from the American Dental Association Website:
For decades, the American Heart Association (AHA) recommended that patients with certain heart conditions take antibiotics shortly before dental treatment. This was done with the belief that antibiotics would prevent infective endocarditis (IE), previously referred to as bacterial endocarditis. The AHAís latest guidelines were published in its scientific journal, Circulation, in April 2007 and there is good news: the AHA recommends that most of these patients no longer need short-term antibiotics as a preventive measure before their dental treatment.
The American Dental Association participated in the development of the new guidelines and has approved those portions relevant to dentistry. The guidelines were also endorsed by the Infectious Diseases Society of America and by the Pediatric Infectious Diseases Society.
The guidelines are based on a growing body of scientific evidence that shows the risks of taking preventive antibiotics outweigh the benefits for most patients. The risks include adverse reactions to antibiotics that range from mild to potentially severe and, in very rare cases, death. Inappropriate use of antibiotics can also lead to the development of drug-resistant bacteria.
Scientists also found no compelling evidence that taking antibiotics prior to a dental procedure prevents IE in patients who are at risk of developing a heart infection. Their hearts are already often exposed to bacteria from the mouth, which can enter their bloodstream during basic daily activities such as brushing or flossing. The new guidelines are based on a comprehensive review of published studies that suggests IE is more likely to occur as a result of these everyday activities than from a dental procedure.
The guidelines say patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with:
mitral valve prolapse
rheumatic heart disease
bicuspid valve disease
calcified aortic stenosis
congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.
The new guidelines are aimed at patients who would have the greatest danger of a bad outcome if they developed a heart infection.
Preventive antibiotics prior to a dental procedure are advised for patients with:
artificial heart valves
a history of infective endocarditis
certain specific, serious congenital (present from birth) heart conditions, including
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
a cardiac transplant that develops a problem in a heart valve.
The new recommendations apply to many dental procedures, including teeth cleaning and extractions. Patients with congenital heart disease can have complicated circumstances. They should check with their cardiologist if there is any question at all as to the category that best fits their needs.
The full report is available to download below, along with supporting charts. If you have any questions about these guidelines, please feel free to contact the ADA Division of Science by calling 312-440-2878. ADA members may use the Associationís toll-free number and ask for x2878.
Topic Posted 4/19/07
Chronic Periodontal Disease can Lead to Heart Disease
Periodontal disease and fibrinogen levels
GREIFSWALD, GERMANY. Periodontal disease is the major cause of tooth loss in middle-aged and elderly people. It involves chronic inflammation of the gums and a gradual loss of tooth attachment. The presence and extent of periodontal disease is measured with a tool that probes the accessible depth of the pockets surrounding the teeth. German researchers now report a distinct association between the number of periodontal pockets deeper than 4 mm and the blood plasma level of fibrinogen. High fibrinogen levels have been associated with an increased risk of heart disease and stroke.
The study involved 1276 men and 1462 women between the ages of 20 and 59 years. A total of 685 participants had fibrinogen levels above 325 mg/dL (3.25 grams/L) and were thus at increased risk for cardiovascular disease. Participants with 15 or more deep periodontal pockets were found to be 88% more likely to have a fibrinogen level above 325 mg/dL than were those with less than 15 deep (greater than or equal to 4 mm) pockets even after adjusting for other known factors influencing fibrinogen levels. Chronic gastritis (inflammation of the stomach lining), especially if combined with alcohol consumption, was a strong predictor of high fibrinogen levels as was chronic bronchitis, high LDL cholesterol levels, and the use of general medications. The use of aspirin, on the other hand, was associated with lower fibrinogen levels. Schwahn, C, et al. Periodontal disease, but not edentulism, is independently associated with increased plasma fibrinogen levels. Thrombosis and Haemostasis. Vol. 92, August 2004, pp. 244-52
Editor's comment: A high intake of vitamin D and topical application of coenzyme Q10 to the gums have both been associated with a reduced risk for periodontal disease. Elevated fibrinogen levels can be reduced by increasing daily water intake, by fish oil supplementation or by supplementing with relatively large doses of niacin (1500 mg twice daily).
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We now offer CEREC Metal Free Crowns and Inlays/Onlays that can far out perform traditional methods of crown fabrication. What use to take 2 to 3 weeks and 2 or more visits can now take about an hour from start to finish. A traditional crown requires an impression and then a model is poured leading up to a 13 stage process, each of which could add 13 more levels of error into the fabication.
With CEREC Crowns the impression is taken with a Digital camera and then the crown is designed in a Computer Automated Design (CAD) program. When the design is complete the computer sends a wireless signal to an in house Computer Automated Milling (CAM) unit.
The Milling Unit is basically a robot that fabricates the crown for you by milling very high resolution cuts using medical grade diamond burs into a special porcelain block. If there is an error it can occur only twice; that is when designing or milling the crown. But in 10 minutes the correction can be made rather than waiting for several days to send your crown to the lab and have it return back again.
See the official CEREC website below for more info.
Click here to learn more about CEREC Inlays, Onlays, and Crowns
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