Spring Lake Dental Group

Importance of Primary Dentition

Author: Dr. Alison V. Berger, DMD, FAGD

Did you know that primary teeth, commonly known as baby teeth, are a great indicator of the future dental health of your childs permanent dentition?  Unfortunately, I hear a lot of parents telling me: “Oh, it’s just a baby tooth.”  It is not just a baby tooth.

Our children’s primary dentition consists of 20 teeth and these are the predecessors of 20 out of the 32 permanent teeth. That means that when your child loses that baby tooth, there is a permanent tooth following right behind it. Therefore, the health of that baby tooth, for the most part, will determine how healthy the permanent tooth following it will be. For example, if we have a deep cavity on a baby tooth that is not promptly treated and reaches the nerve of the tooth, it can potentially lead to an infection.  This infection can spread to the point of causing swelling, fever and pain, which are systemic manifestations that can be life threatening if left untreated. At a more localized level, the infection can cause damage to the developing tooth that is succeeding it, and show defects on the structure of it. 

Also, space distribution among the primary teeth is a big indicator of the space availability for the permanent teeth. Baby teeth are narrower than the adult tooth. When we see nice even spaces between primary teeth, it gives us a better chance of having permanent teeth to come in with proper alignment and positioning. Whereas, having tight contacts and crowding in the primary dentition, will be a huge indicator of crowding in the permanent dentition, which leads to the need of orthodontic treatment (braces) in order to achieve proper function and alignment.  

We encourage you to bring your children in for a dental evaluation as early as 1 year of age. At this time, we can walk hand in hand with you, to help you and guide you through your child’s dental growth and development.  Here at Spring Lake Dental Group we will be looking forward to seeing you and your family, and meeting your dental needs.

Antibiotic Stewardship

As part of our continuing education efforts within the practice, our most recent topic was antibiotic stewardship. This topic refers to the appropriate use of systemic antibiotics in the treatment of dental infections and prophylaxis. The overuse of antibiotics carries the risk of allergic reaction, anaphylaxis and the development of resistant bacteria that may harm the patient in any future infections.

We also use antibiotics in the role of premedication in one of two specific situations; prevention of bacterial cardiac (heart) endocarditis and orthopedic joint replacement. Both of these conditions are complex and have many variables in deciding as to when there is appropriate use in their indications. But recent literature has come out that may affect the recommendations that you hear from your dentist, cardiologist or orthopedic surgeon. In the January 2023 edition of the Journal of the American Dental Association, there is an investigation titled, “Quantifying the risk of prosthetic joint infections after invasive dental procedures and the effect of antibiotic prophylaxis”. The conclusions of the authors (Thornhill, M.H. et. al.) was that there was no significant association between invasive dental procedures and late periprosthetic joint infections and that there was no effect of antibiotic prophylaxis coverage of invasive dental procedures in the reduction of late periprosthetic joint infections. The practical implication here is that in the absence of benefit, the continued use of antibiotic prophylaxis poses an unnecessary risk to patients from adverse drug reactions and to society from the potential of antibiotic prophylaxis to promote development of antibiotic resistance. Dental antibiotic prophylaxis use to prevent joint infection should, therefore, cease.

At Spring Lake Dental Group, we pride ourselves on being lifelong students. This is a complex issue and deserves a serious conversation. We are always available to you to have that discussion. But prudent use of antibiotics is going to be a topic that will impact all of society and we would like to think that our use is evidenced based with appropriate follow up. Come in and let’s have that discussion.

New Year, New You?

Author: Dr. Sarah Mischo, DMD

Dr. Andrew from {PRACTICE_NAME}Well, it’s that time of year yet again when we are well into January and may or may not still be following our New Year’s resolutions. Almost everyone has made a resolution of wanting to eat healthier, exercise more, see friends more frequently, etc. etc, but how many of you can say you are still following the resolutions you put in place for yourself? On January 1st, I heard an interesting news segment and read an insightful article that discussed New Year’s resolutions. According to these sources, almost half of all Americans decide to participate in the age-old tradition of making yearly resolutions, but according to Dr. John Norcross, a psychology professor at the University of Scranton who conducted studies back in the 80’s, only 40% of Americans followed their New Year’s resolution for at least six months.

What should your New Year’s resolution include to set you up for success? Your goal should be a SMART goal. “SMART” stands for specific, measurable, achievable, relevant, and time-bound. Here is an example of how to turn a non-specific goal into a ‘SMART’ goal:

Goal: “I’m going to take better care of my teeth.” An example of revising this to a SMART goal would be “I’m going to floss my teeth nightly before bed at least 6 days a week for the next six months”

Specific: Rather than focusing on a broad topic, it focuses on a specific behavior that you have direct control over.

Measurable: Rather than a subjective statement like “taking better care”, you can check off on your calendar that you actually flossed 6 out of the 7 days a week.

Achievable: Nobody is perfect, and resolving to do something every single day is probably unrealistic. Plus, if you set your goal too high and fall short early, you may be tempted to give up on the goal completely. Maybe you don’t floss at all right now, instead of starting out trying to floss 6 days a week, maybe start with 2 days and go from there.

Relevant: Consider the “why” behind your goal. For example if you floss this will improve your oral hygiene and hopefully keep you coming into the office for routine dental cleanings. Time-bound: This is a point where you can reassess your goal and see if there have been any improvements. If you come to the office twice a year for cleanings, you could use your cleaning appointment to reassess and see if what you have been working towards at home has paid off with better overall hygiene.

I hope you all are still on track with whatever resolutions you decided to make for yourself, and I hope that one of your resolutions is to stay on schedule with your hygiene visits at Spring Lake Dental Group!

Article Sources:

https://www.wsj.com/articles/resolutions-new-years-research-advice-11672863827 https://www.goodmorningamerica.com/living/story/experts-share-advice-making-new-years-resol utions-start-94364502

Polypharmacy

Author: Kimberly N. Powell, DDS, MS, FAGD

What is this? In a recent article on Colgate Oral Health Network, polypharmacy refers to the use of multiple medications, with the most accepted definition referring to a count of five or more medications. As stated in the article, the prevalence of polypharmacy was higher among individuals at least 65 years-of-age. Per the article, polypharmacy-related issues include adverse drug effects, drug-drug interactions, drug-disease interactions, reduced health-related quality of life, disability and hospitalizations. It is important as dental healthcare providers that all medications including over the counter ones are listed in the medical history as we are introducing yet another drug into the patients system when anesthetic is needed for scaling and root planing, fillings, crown preparations, extractions, etc.  

 Polypharmacy can cause dry mouth/xerostomia and was found to increase the likelihood of xerostomia by 38% for individuals taking between 4 and 6 medications, and doubled and more than tripled the likelihood, respectively, for individuals taking 7 to 10 or eleven or more medications. Why is this important? Dry mouth increases the risk of dental caries and dental erosion and this erosion can cause exposure of dentin and tooth sensitivity. Saliva helps to clear the mouth of debris and dilute the environment so its not so acidic. An acidic environment in the oral cavity can wear away tooth structure. The reduction in saliva also decreases the content of calcium, phosphate, fluoride ions in the oral cavity thus decreasing the protective effects it affords and demineralization of enamel can occur and remineralization of enamel reduced. Demineralization is the lost of minerals like calcium and phosphate in enamel and remineralization occurs when those minerals fill in the weakened enamel. Some medications that can cause dry mouth include proton pump inhibitors (Omeprazole), benzodiazepines (Valium), skeletal muscle relaxants (Flexeril), opioids (Codeine), anti-depressants.  

After identifying patients with polypharmacy-induced dry mouth, some treatment options include more frequent recare visits with the hygienist, in-office fluoride applications, prescribing toothpaste with more fluoride, and consultations with the patients medical provider to reduce or substitute medications. We would not advocate any patient not taking their medication as prescribed by their medical provider but we do advocate having a conversation with their provider that could improve their systemic and oral health.

Local Anesthetics

Numbing!  This is a frightening thought for a lot of our patients. But, what a difference it has made in the last century for the dental field. Local anesthetic was successfully introduced in the dental field in 1943 when lidocaine formulation was stabilized. Since then, we administer local anesthetic on a daily basis for routine dental procedures. There are two main families of local anesthetic: amides and esthers. Nowadays, the most prevalent one are the amides, which have shown decreased adverse reactions, such as allergies.  Some formulations of local anesthetics include epinephrine (adrenaline) as a vasoconstrictor.  This serves as a conjunctive additive to increase the effectiveness of the administration and duration of the anesthetic solution within the tissue. Scientific advancements have provided a great array of options available to dental professionals in order to achieve profound anesthesia with minimal doses.
As with any chemical introduced into the body, safety precautions have to always be taken, specially for medically compromised patients. Caution is always followed for patients who suffer from hypertension, diabetes, glaucoma, kidney and liver dysfunction, and pregnancy, among others.  Also, uncontrolled infections can be very challenging to anesthetize due to the acidic environment of the tissue, which may require a buffered formulation of the local anesthetic.
All these details may sound very technical, but I hope it helps you see how intricate our bodies are, and how amazing scientific advancements are to allow us to provide our patients with the best care possible.

Do-It-Yourself Dentistry

Author: Dr. David Dickerhoff, DDS, MAGD, FOCOI

According to Becker’s Dental review (1/3, Portalatin), “Dentists are warning against a new wave of TikTok videos showing people using do-it-yourself methods to solve dental issues to avoid visiting the dentist”, the Miami Herald reported on January 2nd. Some of the viral “videos include making at-home veneers, removing braces with a spoon and filling gaps with dental filling.” The article reports that “several TikTok users who used these hacks have also said that they regret using the methods, including one woman who ended up visiting the dentist to treat pain after she tried to straighten her teeth with a nail file.” We all are familiar with how popular social media has become, but reflect on the fact that these posting are not refereed, and an ounce of common sense must be applied to all recommendations you receive on this medium. Nuf said?

Dimensions of Dental Hygiene (12/29, Machado) reported, “The National defense Authorization Act of 2023 will require between two and four dental plan options for active military and National Guard members and their families beginning January 1st, 2026.”  Previously, “the military dental coverage offered only one plan.”  According to the article, “The new options must include one standard plan, covering preventive, restorative, and specialty care, and a premium option that would include higher coverage than the standard plan.”

We at Spring Lake Dental Group, see where this is going and how it will impact our military service members and their families. Philosophically, we at SLDG, have always wanted to accept military insurance and hope that our elected officials negotiate and reasonable rate for our military members as well as a fair level of compensation for care providers. But as this is still years in the offing, the point that I would like to make is about the relationship that you cultivate between you and your health care provider. Understanding your needs and the choices you have concerning those needs will be paramount in understanding which option you should choose. The business of dentistry and the contract you have with an insurance carrier should not come between you and your care provider. At Spring Lake Dental Group, we relish in our patient education time! We welcome questions and we wish all of our patients were well informed enough to make an educated decision. Once made, that is when we feel we do our best job in providing outstanding care in a safe and respectful environment. Nuf said?

Every Patient Is Special

Author: Kimberly N. Powell, DDS, MS, FAGD

An article in General Dentistry titled Understanding Special Needs in Dental Practice starts with the statement, Every patient is special, and each deserves the greatest care we can deliver.  The statement is very true, but the emphasis is on a population whose needs can range from anxiety to a significant physical, systemic, and/or developmental challenge. Patients who are identified with special needs may require significant modifications to treatment planning and delivery. It has been documented that individuals with special needs have a significant disadvantage in obtaining hygiene services and have worse hygiene than their non-affected counterparts. For this population, emphasis on home care is very important as treatment successes will depend heavily on the oral healthcare provided outside the office. First we must identify who provides oral home care for the patient. If it is the patient, oral health education must be communicated in a way that the patient comprehends it. If the caregiver or family member provides this care, oral health instructions should be given to them and demonstrated correctly. The dental team must communicate to the caregiver the need to report any changes in the patients general health, oral health, or other related physical or behavioral changes. When it comes to treatment planning, it is important to determine if the patient in the chair has the capacity to understand and follow planned treatment and if the patient is able to participate in dental treatment with or without support such as physical and/or pharmacologic (medications). Scheduling of appointments has to be considered also.  Patients with diabetes may need  appointments early in the day. Some patients with special needs may need longer appointments to address challenges to their care which isnt encountered in their non-affected counterparts.  The article closes with a clear directive, It should be routine to have a team meeting to discuss a prospective visit from a patient with special needs so that everyone is prepared for any challenges that arise. At SLDG, it is routine and we prepare!

 *Information in this blog article was obtained from General Dentistry, July/August 2022, vol 70, number 4, Larry N. Williams, DDS, MPH

All I Want for Christmas Is a New Toothbrush?

Author: Dr. Sarah Mischo, DMD

Dr. Andrew from {PRACTICE_NAME}Did you receive a gift card for the holidays, but aren’t sure what to spend it on? Are you thinking about treating yourself to a new toothbrush? No, I’m not joking, and if you’ve recently walked down the oral hygiene aisle at Target, Walmart, or any other department store you may have been overwhelmed by the sheer number of toothbrush options that are available. So what is the best type of toothbrush to invest in?

I get this question from patients all the time, and the answer is both simpler (and slightly more complicated) than you might expect. The most important piece of home oral hygiene is remembering to do it, and even the fanciest toothbrush won’t help improve and maintain your smile if you aren’t using it regularly. But for those of you who have mastered the habit of brushing and flossing regularly, there are some important difference in toothbrush types that you may want to know about. 

Powered toothbrushes have been available since the 1940’s, and electric toothbrush technology has made some big strides in that time. In general, modern powered/electric toothbrushes have been shown in repeated studies to remove more plaque, reduce rates of gingivitis, and reduce the gingival (gum) bleeding than standard manual toothbrushes. That said, while toothbrush companies spend a great deal on advertising to convince you that their particular powered toothbrush is the best in the business, there is little quality evidence to suggest that one particular brand or model of electric toothbrush performs significantly better than any other. 

Now that you have the right toothbrush, here are some tips that you can use while brushing your teeth. Hold the toothbrush at a 45 degree angle and make sure that you are brushing along the gumline. The gumline is where plaque is most likely to accumulate. If plaque remains on tooth structure for long periods of time this can lead to cavities forming. Don’t forget to get the toothbrush back by the molars on the cheek and tongue sides–these are the spots that are often forgotten. One last step to aid you in brushing your teeth is to set your timer. A lot of the electric toothbrushes today have apps you can download on your phone that will time the length of brushing. You should be brushing your teeth twice a day for two minutes each time. 

So the next time you are in the office feel free to talk to your dental hygienist or dentist about different toothbrush options or some quick pointers on your technique! 

Protect The Teeth

Christmas season is my favorite time of the year. We get to laugh, enjoy our family and gather at the dinner table with lots of comfort food. Also, it’s the best time to bake all those yummy desserts and cookies. My family and I love all the chocolate and cookies we make, but I always have to remind them, as well as my patients, that we need to have moderation and clean those pearly whites after enjoying our desserts. The oral environment can be a very hostile environment and the frequency of exposure to the sugars in our diet increases the risks of dental decay. One of the most common areas to find decay is on the chewing surface (occlusal surface) of our teeth due to the increased surface area created by the grooves and fissures present as normal anatomy of the tooth. Most posterior teeth, premolars and molars, have very pronounced grooves, that if left with food and sugar debris sitting on it, will be the perfect environment to house the dangerous cavity promoting bacteria. Also, most of these crevices are too small, making it almost impossible for the toothbrush bristles to clean the plaque accumulated in it.  This is when you will hear us recommending dental sealants as a preventative way to save those areas from decaying. A dental sealant is a safe and non-invasive way to prevent cavities from forming in this occlusal surface. It does not require numbness, it is a very quick and painless procedure. A single sealant will take an average of 1 minute to be done.  It consists of chemically preparing the enamel of a clean tooth, placing a dental bonding agent followed by the sealant material, and light curing it. This is all there is to it. Throughout the years sealants have proved to be an extremely effective way to decrease the rate of dental decay. From our dental family to yours, we wish you a Merry Christmas and a Happy New Year, and let’s protect those pretty teeth!

Stay Healthy

Author: Dr. David Dickerhoff, DDS, MAGD, FOCOI

USA Today reported Pfizer and its partner BioTech “have shown that their new COVID-19 booster does what they hoped it would, with the same safety and side effect profile as earlier shots”. In a study released on Friday, “the pair found that adults mounted a strong immune response to the new “bivalent booster” which is targeted to both the original virus and the BA.4 and BA.5 variants.” The New York Times reported the two companies, “said that one month after getting the new booster, clinical trial participants over 55 had antibody levels that were about four times as high as those who received the original booster’. Also, “Pfizer said that the updated shot increased antibodies nearly tenfold for younger adults and 13-fold for older ones compared with antibody levels before receiving the shot. It’s flu season and I recommend getting your yearly influenza immunization at your earliest opportunity. Don’t do these immunizations at the same time as it might be hard to distinguish a bad reaction if they are delivered simultaneously.

If you haven’t updated your pneumococcal pneumonia immunization, ask your pharmacist if they have the new Prevnar-20 vaccine. It helps protect against 20 strains of the bacteria that cause pneumococcal pneumonia. Once again, choose a separate date to get each of these immunizations. Veteran’s Day is November 11th each year and once again, our practice observed this holiday by closing the dental practice. We consider it a honor to be able to care for our active duty military, retirees and their families. On this day annually, we will be taking a moment to honor their service and the sacrifices they have made for our country.