Treating Medically Complex Patients with Dental Infections

A refresher on some of the conditions, pharmaceutical treatments, and host defenses that can complicate treatment:

Part 1- Determine the severity of the infection e.g. How is the patient feeling? How quickly did the infection start? Is there any trismus, dyspnea, dysphagia, malaise? If the infection arose quickly and/or shows signs listed above, the infection may be severe and immediate action or referral to an Oral Surgeon may be required.

Part 2- Determine Patient’s host Defense Mechanisms: There are many different metabolic diseases or dysfunctions that can contribute to more severe infections e.g. Uncontrolled diabetes type I or II, End Stage Renal Disease, Severe Alcoholism, and malnutrition. There are also Immune System-Suppressing Diseases that can lower white cell functioning and allow infections to spread faster e.g. HIV/AIDS, Leukemias and Lymphomas or other congenital or acquired immunologic diseases.

Part 3- Is the patient taking any Pharmaceuticals that decrease host defenses to infections? Certain drugs can lower white cell counts to low levels, with this the host defenses are severely compromised potentially allowing infections to run rampant. Patients commonly receive immunosuppressive drugs for things like 1. organ transplants, 2. cancer chemotherapeutics, and 3. autoimmune diseases. These drugs commonly fall under the the categories of Cyclosporine, Corticosteroids, Tacrolimus, and Azathioprine. Some of these drugs can affect the patient for years after ending therapy.

Summary:

Quick and efficient action for patients presenting with any of the conditions listed above are important. Reminder that if the patient has difficulty breathing, swallowing, opening, elevated temperature, severe malaise, need for General Anesthesia, or compromised host defenses, it may be time to refer to your neighborly Oral Surgeon.

Pharmaceutical Refresh: Other common names for drugs listed above for attention.

  1. Cyclosporine: Sandimmune, Neoral, Gengraf
  2. Tacrolimus: Envarsus XR, Astagraf XL, Protopic
  3. Azathioprine: Azasan

Reference:

Hupp, J. R., III, E. E., & Tucker, M. R. (2019). Contemporary Oral and maxillofacial surgery. Elsevier. 

The Author of this post does not assume any liability for any injury and/or damage to persons or property as a matter of products liability, malpractice, negligence, or otherwise, or from any use or operation of any methods, instructions or ideas contained. The foregoing parties will not be liable for any direct, special, indirect, incidental, consequential, or punitive damages as a result of the reader’s use of this information.

So You Lost Your Tooth

You’re putting up the Christmas tree after Thanksgiving (hopefully) and, while carefully placing ornaments, you turn around to be greeted by your kid swinging a branch. You look down to reveal your front tooth in your hand and you’ve quickly realized what has happened – you just lost your tooth! Quick – let’s review what to do.

Ranting lost tooth spectacled man GIF on GIFER - by Kazigis

Don’t Panic

Your tooth may be okay. Look at the tooth to reveal if it’s whole or if parts have fractured off – try and keep all of the pieces if so. If you find that the tooth is dirty (if you are on a baseball field, for instance) your first instance may be to wash it off. If you’ve made it this far – this is important – so pay attention! Do NOT rinse the tooth off excessively. Just like the bones in your body, your teeth are attached to the bone in your jaw with ligaments. If you wash off the tooth aggressively, the fibers that still remain on your tooth will not have a chance to re-attach to the bone. If the tooth has large debris, a gentle wash with milk, saline, or saliva will suffice. The next step? Stick that tooth back in there, baby! Pick the tooth up by the crown, NOT the root, and attempt to place it back in the socket. Grab something to bite on such as a rolled-up kleenex or piece of cotton and place moderate pressure on the tooth. We are attempting reimplantation, and it may save your tooth!

Lost Tooth GIFs | Tenor

What Is Reimplantation?

Reimplantation is a procedure that dentists and oral surgeons utilize in order to save a tooth or even move a tooth to another site (wisdom teeth may be reimplanted in spaces where other molars are lacking). It’s important to understand that this technique is ONLY for permanent teeth, and shouldn’t be bothered with primary/ baby teeth as it may damage the permanent tooth beneath it. Reimplantation isn’t perfect and depends on several factors. These factors include – ‘the extra-alveolar time until reimplantation, storage medium, handling, and periodontal ligament condition of the avulsed tooth as well as the patient’s general health¹.’ With that being said, let’s focus on the studies provided by the International Association of Dental Traumatology.

The International What?

A recent study has shown that the chances of a long-term survival of an avulsed tooth (a tooth that has come out) has a higher chance of long-term survival by following the International Association of Dental Traumatology Guidelines². We’ve already discussed the basics of what to do, but let’s outline them.

  1. Remain calm
  2. Pick the tooth up by the crown, not the root
    1. If the tooth is dirty, rinse with milk, saline, or your own saliva (gently)
  3. Place the tooth immediately back in the jaw
  4. Once in its position, bite on gauze, a handkerchief, or a napkin and hold it in place
  5. Go see your dentist³

If you’re unsure if the tooth is whole and do not want to replace the tooth, your best option is to store the tooth in a medium that is available to you. The best medium is the one you have available. If you have it nearby, though, milk is greater than saliva, and saliva is greater than saline. A study found that teeth stored in milk decreased the rate of loss of avulsed teeth by greater than 50%⁴. Although saline is the worst out of the choices, leaving the tooth air-dry is detrimental to the prognosis of the tooth. In fact, after a tooth has dried out for 30 minutes, most of the ligament cells surrounding the tooth have died.

funny cow :P | Cows funny, Funny, Cow

So What Next?

Treatment of an avulsed tooth after it has been re-implanted (or lack thereof) varies depending on the type of tooth and the conditions it has withstood. Your dentist should know the following steps after an accident has occurred. With that being said, let’s review some of the possibilities:

  • You may require a flexible splint to hold the tooth in
  • You may require a root canal two weeks after the trauma occurred (this depends on age)
  • Systemic antibiotics may be administered
  • You may be given an antibiotic rinse such as chlorhexidine
  • You may have a follow-up appointment routinely to observe the teeth

To Summarize:

  • A tooth that has fallen out hasn’t lost all hope!
  • If a tooth is clean and has fallen out, stick it back in (if not soak it in milk)
  • Follow up with your dentist and call their emergency line as soon as possible
  • You may need a root canal after the tooth has stabilized

References:

¹Gonçalves, P., Ionta, F. Q., Rios, D., Oliveira, D., Couto-Filho, C., & Honório, H. M. (2018). Reimplantation of an avulsed mature permanent tooth after 6 days: a 1-year follow-up. General dentistry66(4), 71–75.

²Wang G, Wang C, Qin M. A retrospective study of survival of 197 replanted permanent teeth in children.

³Fouad AF, Abbott PV, Tsilingaridis G, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol 2020;36(4):331-342. https://doi.org/10.1111/edt.12573. 

⁴Coste, S. C., Silva, E., Santos, L., Barbato Ferreira, D. A., Côrtes, M., Colosimo, E. A., & Bastos, J. V. (2020). Survival of Replanted Permanent Teeth after Traumatic Avulsion. Journal of endodontics46(3), 370–375. https://doi.org/10.1016/j.joen.2019.11.013

Liability Statement:

The medical advice given in this blog should only be utilized by a medical professional who has received a medical degree. I am not responsible for the medical advice given in this blog and each case should be reviewed extensively with sources outside my blog. This blog is for education purposes only and is not meant as a substitute for an academic institution.

What to do for SDF Stains?

If you have ever handled Silver Diamine Fluoride in the dental office you have probably stained something, or a lot of things… chairs, countertops, instruments, and the list goes on.

The Best way to get rid of SDF stains? – Prevention. Now with that being said we can take all of the precautions in the world, but accidents still seem to happen with this stuff.

We are currently using Riva Star from SDI Limited out of Australia. This product has a second liquid application step of Potassium Iodide which helps to reduce staining on the tooth surface and gingival tissues. It also helps to prevent any staining if immediately applied to the skin after accidental SDF exposure.

On hard surfaces, we have found stain removal success with Toilet Bowl Bleach e.g. Clorox Clinical Bleaching Gel. We like to use this product as it has more of a gelatinous form and will not run off of the counter or tray tops.

For Clothing: currently we have not found a solution and you just might be out of luck….

Do Not Wipe this stuff without first applying bleach, or without using something similar to a CaviWipe so that the liquid is not just smooshed around.

Summary:

Prevention of Soft Tissue Stains: Immediately apply Riva Star Step 2 Potassium Iodide on tissue and allow to sit for 30 seconds. Then rinse off with water and dry. Multiple applications may be required.

Removal of Stains from Hard Surfaces: Place Gel Bleach directly on stain as soon as possible. Lay a 2×2 or whatever size piece of cotton over the Gel and allow to sit for 30 minutes to an hour, then wipe off with water. More problematic stains may need multiple applications or longer application periods with scrubbing after the application of the bleach.

Let’s Talk Fluoride

I have a patient at least once a week tell me they don’t use fluoridated toothpaste, and I promptly ask them to divulge why. Let’s talk about why dentists recommend the use of fluoride and why I believe you should use it, too.

What Is Fluoride?

The CDC states the following about fluoride – ‘Fluoride is a mineral that occurs naturally and is released from rocks into the soil, water, and air. Almost all water contains some fluoride, but usually not enough to prevent tooth decay¹.’

The CDC is right – fluoride is just about everywhere in low concentrations, including seawater and freshwater and even in the layers of our atmosphere. There’s fluoride in almost all of the foods we consume, including most notably in tea and in fish. Black tea, for instance, has about 3ppm fluoride found in it². The ‘Halo’ effect of fluoride is a phenomenon that refers to the spread of fluoride in communities that have fluoridated water and also plays a large role in the fluoride we receive – this same water is bottled or used to water crops which increases our consumption of fluoride.

Funny Gifs : toothpaste GIF - VSGIF.com

So How Does Fluoride Work?

‘Fluoride reduces the incidence of dental caries (cavities) and slows or reverses the progress of existing lesions.’ But how does it do it?

Fluoride is an antibacterial. It increases the acidity of the bacterial cytoplasm and disrupts their metabolism³. Along with its antimicrobial action, fluoride helps remineralize our teeth. As acids produced by bacteria interact with our teeth, minerals are leached from the surface. Fluoride present during this time ‘grabs’ on to those minerals, and places them back onto our teeth⁴. There aren’t a lot of materials out available today (though more are being studied) that produce the same remineralization action that fluoride presents, and it’s why we, as dentists, recommend fluoride so readily.

The point above about fluoride’s ability to remineralize is why it is so important to use and why other toothpastes just aren’t doing the same for you. If any patient I see has ‘starter cavities’ (also known as incipient lesions), extra strength fluoride toothpaste is my go-to treatment protocol.

Flouride - Pediatric Dentist
This is a great little diagram representing how fluoride works (thank you tooth town pediatric dentistry)

Is Fluoride Safe?

Yes! At the right concentrations. That isn’t to say fluoride is harmless, though, and this is where a lot of ‘fluoride non-believers’ get apprehensive. Let’s take a look at some studies.

Studies have shown adverse effects of systemic over-consumption of fluoride resulting in negative performance on cognitive tests⁵. This literature review was conducted on fluoride exposure and intellectual disability for children in early development that was conducted in 2012. How does that affect those who use fluoridated toothpaste? It doesn’t – you shouldn’t be ingesting the toothpaste and if you’re reading this you most likely aren’t in early development. It IS important for children though, who may accidentally ingest their toothpaste. That’s why it’s important to use small amounts of children’s toothpaste – let’s take a look at the current recommendations:

‘Using no more than a smear or rice-size amount of fluoridated toothpaste for children less than three years of age may decrease risk of fluorosis. Using no more than a pea-size amount of fluoridated toothpaste is appropriate for children aged three to six (see Figure)⁵.’

Smear size vs. Pea Size

On the other side of the argument, there are various articles stating that the efficacy and safety of fluoride is largely established (using reasonable proportions) – one literature review states – ‘Supported by more than half a century of research, the benefits of fluoride toothpastes are firmly established⁶.’ Another study goes on to claim ‘Epidemiological studies of fluoridation programmes have confirmed their safety and their effectiveness in controlling dental caries.⁷’

I truly believe it’s O.K. to want to lessen fluoride intake in children for precautionary measures – simply reduce the amount you place on your toothbrush (use the guidelines and picture above!). Quitting completely, though, currently is not supported by the literature. With that in mind, let’s talk about one common complication of fluoride that relies entirely on over-fluoridation of children’s teeth and what we can do to prevent it.

I Hear It Can Stain My Child’s Teeth?

If you’re reading intently, you may notice a line above that mentions fluorosis. Fluorosis isn’t dangerous, but it is unsightly. Fluorosis is a condition that was once known to be called ‘mottled enamel,’ and appears as darkened or chalky spots most notably around the anterior teeth. The spots represent areas of heightened enamel proteins that are deposited due to the over-intake of fluoride. These areas are actually cavity-resistant, but the trade-off isn’t worth the appearance⁸. To reduce the chance of this occurring in children, it’s important to keep the fluoride intake low (by using the guidelines above, once again).

So What’s The Bottom Line?

I start out with fluoride discussions by saying I’m a personal liberty believer – I don’t think anyone needs to be told what to do and can make decisions based off their research themself. That being said, I only recommend treatment to my patients based on if I’d perform it on myself or my family members. That’s why I recommend fluoridated toothpaste to every one of my patients, and even some stronger toothpastes for others. With the information and research available currently on fluoride, I encourage you to read peer-reviewed articles or some of the ones I’ve posted on this blog. Message me on social media if you’d like to #TalkFluoride.

Sponge Bob Thumbs Up GIF - Sponge Bob Thumbs Up Ok - Discover & Share GIFs

To Summarize:

  • Fluoride is everywhere, if you think you aren’t ingesting it, you are
  • Fluoride doesn’t just act as an antimicrobial, it actually replaces minerals on your teeth
  • It’s good for your teeth!
  • It’s safe! There aren’t enough studies linking it to adverse effects yet
  • If you are worried about fluoride, just make sure you are using the right amount. This is important for children
  • Fluorosis is well documented but NOT dangerous, use the right amount of toothpaste
  • You’re right to ask questions about what you put into your body, feel free to ask me anything about fluoride
  • I DO recommend fluoridated toothpaste!

References:

¹CDC. (2019, March 8). About fluoride. Centers for Disease Control and Prevention. Retrieved November 19, 2021, from https://www.cdc.gov/fluoridation/faqs/about-fluoride.html. 

²Kanduti, D., Sterbenk, P., & Artnik, B. (2016). FLUORIDE: A REVIEW OF USE AND EFFECTS ON HEALTH. Materia socio-medica28(2), 133–137. https://doi.org/10.5455/msm.2016.28.133-137

³Aoun, A., Darwiche, F., Al Hayek, S., & Doumit, J. (2018). The Fluoride Debate: The Pros and Cons of Fluoridation. Preventive nutrition and food science23(3), 171–180. https://doi.org/10.3746/pnf.2018.23.3.171

⁴Buzalaf MAR, Pessan JP, Honório HM, Ten Cate JM. Mechanisms of action of fluoride for caries control. Monogr Oral Sci. 2011;22:97-114. doi: 10.1159/000325151. Epub 2011 Jun 23. PMID: 21701194.

⁵AAPD. (2018). Fluoride Therapy. AAPD. Retrieved November 22, 2021, from https://www.aapd.org/media/Policies_Guidelines/BP_FluorideTherapy.pdf.

⁶Marinho, V. C., Higgins, J. P., Sheiham, A., & Logan, S. (2003). Fluoride toothpastes for preventing dental caries in children and adolescents. The Cochrane database of systematic reviews2003(1), CD002278. https://doi.org/10.1002/14651858.CD002278

⁷O’Mullane, D. M., Baez, R. J., Jones, S., Lennon, M. A., Petersen, P. E., Rugg-Gunn, A. J., Whelton, H., & Whitford, G. M. (2016). Fluoride and Oral Health. Community dental health33(2), 69–99.  

⁸Chi, A., Neville, B., Damm, D., Allen, C. (052015). Oral and Maxillofacial Pathology, 4th Edition. [VitalSource Bookshelf 10.0.1]. Retrieved from vbk://9781455770526

Brian Laundrie’s Remains Confirmed via Dental Records: What was needed?

Forensic Odontology, aka Forensic Dentistry is “the area of dentistry concerned with the correct management, examination, evaluation, and presentation of dental evidence in criminal or civil legal proceedings in the interest of justice.”1

What Would a Forensic Dentist Need to Help Determine the Identity of Human Remains?

First, an antemortem dental record of the deceased is required. The dental record, a legal document, may contain a list of the fillings, restorations, cavities, health history, dental models, x-rays, and treatment plans amongst other things.

Most States mandate that dental offices keep these records of previous patient for 7-10 years and Federal legislation states pediatric patient records must be held onto up to the age of 18-21 depending on the jurisdiction.1

What is Needed for to Make a Positive Identification with Dental Records?

“Sufficient uniqueness among the comparable items in the antemortem and postmortem databases, and no major differences observed.” This can be accomplished with the front teeth of the skull compared to photographs, previous radiographs, dental implant placements, patterns on the roof of the mouth, radiographic outline of the sinuses, and some specific procedures completed by dentists1.

With that information the Forensic Odontologist can help the Medical Examiner or Coroner determine the body postmortem.

Why Did They Need A Forensic Odontologist?

This part is more speculation on my part, but Laundrie’s body was found in a very warm and humid environment. That combined with potential Florida wildlife can speed up decomposition faster than in other environments2. Because of the quicker decomposition, dental analysis may have been a better option in this case.

  1. Neville, B. W., Damm, D. D., Allen, C. M., & Chi, A. C. (2016). Oral and maxillofacial pathology. Elsevier. 
  2. https://biorecovery.com/how-does-environment-affect-body-decomposition/

The Author of this post does not assume any liability for any injury and/or damage to persons or property as a matter of products liability, malpractice, negligence, or otherwise, or from any use or operation of any methods, instructions or ideas contained. The foregoing parties will not be liable for any direct, special, indirect, incidental, consequential, or punitive damages as a result of the reader’s use of this information

A Little Dental History: Ancient Egypt

Remember learning about all of the Pyramids and Pharaohs of ancient Egypt? Unsurprisingly Egyptians from ~3000b.c. to ~300bc also had teeth, and those teeth also had the same issues we deal today.

Courtesy of ©Egyptian Museum, Cairo

You may have seen images similar to the bridgework completed above making note that Egyptians may have been skilled in dentistry. That is apparently not the case after a little more digging.

There has only been a total of three bridges similar to the one above excavated out of tombs. And it appears that they were never really in function, only put in place postmortem for deliverance into the afterlife1.

Extensive research has been conducted as to whether or not the skilled craftsmen/women of Egypt filled cavities, similar to how dentists do today. But even though Egyptians had access to gold and other potential filling materials, no fillings have ever been documented1.

Speaking of filling cavities, one of the papyrus’ found in Egypt does describe that they thought small tooth worms caused cavities. Not quite worms, but that’s close enough to the bacterial cause of cavities we know of today2.

After much debate it seems as though the Egyptians, for all of their technological advances, did not do much dentistry other than pastes and simple mouthwashes. So it appears those poor souls lived through some pain. But they did give us some pretty sweet Pyramids.

  1. Forshaw, R. The practice of dentistry in ancient Egypt. Br Dent J 206, 481–486 (2009). https://doi.org/10.1038/sj.bdj.2009.355
  2. Caminos R A . Late Egyptian miscellanies. Brown Egyptological Studies, 1. London: Oxford University Press, 1954.

Sensitive After a Filling?

‘Well it didn’t start hurting until you started messing with it!’

We get this as dental professionals a lot. And we understand. Let’s talk about why post-operative sensitivity can happen and why it (usually) isn’t something to worry about.

What Is Post-Operative Sensitivity?

A study in 2013 decided to determine what different types of variables contributed to post-operative sensitivity. In their article, they defined sensitivity to be ‘pain in a tooth associated with mastication or with sensitivity to hot, cold, and sweet stimuli that occurs 1 week or more after restoration¹.’

What Causes Post-Operative Sensitivity?

When a filling restoration is performed on a tooth, a surgery is being conducted. The tooth’s decay is being excavated using a high-speed handpiece (drill) that causes heat and friction to occur on the tooth. Many times, this causes an inflammation of the inner layer of the tooth (pulp) known as pulpitis. Often, this resolves without worry or further adjustment. Other forms of post-operative hypersensitivity are due to hyper-occlusion. When the tooth is filled back up, the filling may be too high. Biting on this filling that is too high is like hitting a bruise, and results in pain. Lastly, post-operative sensitivity because the filling material may have gaps in it, which could be due operator error. There’s always the chance the filling can go wrong during the procedure, resulting in a pulp exposure that would illicit pain – but this only occurs rarely and the dentist will tell you during the procedure if this had occurred, so no need to worry about that here.

In the study discussed earlier, 30% of the teeth that were treated for fillings had post-operative sensitivity, and 18% had the sensitivity last more than 4 weeks. The study also found that 10% of those who had the fillings did not have sensitivity before the filling¹.

Should I Be Worried?

You shouldn’t be worried if you exhibit sensitivity to cold/hot, sweets, or even clenching after you have had a filling. You aren’t alone when it comes to sensitivity, and studies show that the only significant factor for not having sensitivity is if you are an older individual (sorry, youngins). Other studies are inconclusive on whether or not the type of filling and size increases or decreases the chance for sensitivity. If sensitivity does arise, wait at least two weeks to see if the sensitivity lessens. A quick call to your dentist after may be necessary to adjust or redo the filling, if necessary.

Teeth GIF

To Summarize:

  • Sensitivity after fillings is common
  • Post-op pain could be from a variety of reasons, usually because the bite is too high
  • You may be more sensitive after the procedure than before it
  • You shouldn’t be worried about post-op sensitivity, though a quick visit back to your dentist might be necessary

References:

¹ Berkowitz, G., Spielman, H., Matthews, A., Vena, D., Craig, R., Curro, F., & Thompson, V. (2013). Postoperative hypersensitivity and its relationship to preparation variables in Class I resin-based composite restorations: findings from the practitioners engaged in applied research and learning (PEARL) Network. Part 1. Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995)34(3), e44–e52.

Liability Statement:

The medical advice given in this blog should only be utilized by a medical professional who has received a medical degree. I am not responsible for the medical advice given in this blog and each case should be reviewed extensively with sources outside my blog. This blog is for education purposes only and is not meant as a substitute for an academic institution.

Dental Calculus and National Geographic?

Andrew Curry from National Geographic has published a history article1 from 2019 highlighting the role Dental Calculus is playing in deciphering the mysteries of the histories. Reading through the article we learn that scientists, archaeologists, paleogeneticists, microscopists, and chemists, are studying dental plaque found on teeth from skeletal remains. The Nat Geo article is a summary from Science Advances2.

What Can the Calculus Tell Us?

The researchers call it fossilized plaque, but calculus is able to trap all sorts of things including bacterial DNA, minerals, and information on the typical diet of the skeleton.

Of interest, this article highlights that the researchers found a rare mineral, lazurite, in the dental calculus of a woman from around 1100 A.D. This is impressive as it appears that this blue mineral was used by medieval artists and scribes–a profession thought to only be held by men of the time.

photography by: Christina Warinner2

What Does this Mean for Us?

If you have an issue with future aliens or scientists digging through your teeth to learn what you ate, drank, or put in your mouth–Then you better be brushing and keeping your teeth clean so they can’t study your dental calculus.

  1. Curry, A. (2019, January 10). Precious jewels in teeth reveal medieval woman artist. National Geographic. Retrieved October 6, 2021, from https://www.nationalgeographic.co.uk/history-and-civilisation/2019/01/precious-jewels-teeth-reveal-medieval-woman-artist?utm_source=Facebook&utm_medium=Social&utm_campaign=JARVIS&fbclid=IwAR3VRD0g8WlXNE7ODunrbCfdlT9fckfLmlrDiwCh-OdNM4iwFJtMnDvRb40. 
  2. Radini, A., Tromp, M., Beach, A., Tong, E., Speller, C., McCormick, M., Dudgeon, J. V., Collins, M. J., Rühli, F., Kröger, R., & Warinner, C. (2019). Medieval women’s early involvement in manuscript production suggested by lapis lazuli identification in dental calculus. Science advances5(1), eaau7126. https://doi.org/10.1126/sciadv.aau7126

American Heart Association Updated Prevention of Infective Endocarditis Guide

The American Heart Association has updated their recommendations regarding Antibiotic Prophylaxis for Infective Endocarditis. No changes have been made regarding which dental procedures need prophylactic coverage.

Current Dental Procedures Requiring Antibiotic Prophylaxis:

  1. Manipulation of the gingival tissues– Any type of Dental Cleanings, gum surgeries, and even deeper fillings that approximate the gum tissue
  2. Manipulation of the periapical region of teeth– Root canals, tooth extractions, and associated treatments
  3. Perforation of the oral mucosa–not including injecting dental anesthetics through non-infected tissue.

Conditions/Diseases that Required Antibiotic Prophylaxis:

  • Prosthetic cardiac valves, including transcatheter-implanted prostheses and homografts
  • Prosthetic material used for cardiac valve repair, such as annuloplasty rings, chords or clips
  • Previous Infective Endocarditis
  • Unrepaired cyanotic congenital heart defect (CHD) or repaired CHD, with residual shunts or valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or prosthetic device
  • Cardiac transplant with valve regurgitation due to a structurally abnormal valve

Updated Antibiotic Prophylactic Regimens:

*Clindamycin is no longer recommended for antibiotic prophylaxis for a dental procedure*

*Single Dose of Antibiotics 30-60 minutes before procedure from the list below*

  1. No Penicillin Allergy:
    • 2g of Amoxicillin for adults or 50mg/kg for children.
  2. Allergic to Penicillin:
    • 2g of Cephalexin for adults or 50mg/kg for children or;
    • 500mg of Azithromycin/Clarithromycin or 15mg/kg for children or;
    • 100mg of Doxycycline for adults
  3. Unable to take Oral Medication:
    • 2g of Ampicillin for adults or 50mg/kg for children IM/IV or;
    • 1g of Cefazolin/Ceftriaxone or 50mg/kg for children IM/IV.
  4. Allergic to Amoxicillin and Unable to take Oral medications:
    • 1g of Cefazolin/Ceftriaxone or 50mg/kg for children IM/IV.

Review these Recommendations and again note that Clindamycin has been removed as a recommended Antibiotic for IE prophylaxis1,2.

References:

  1. Prevention of Viridans Group Streptococcal Infective Endocarditis: A Scientific Statement From the American Heart Association. Circulation. 2021;143:e•••–e•••. Accessible at https://www.ahajournals.org/doi/10.1161/CIR.0000000000000969
  2. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143:e72-e227. Accessible at https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923

The Author of this post does not assume any liability for any injury and/or damage to persons or property as a matter of products liability, malpractice, negligence, or otherwise, or from any use or operation of any methods, instructions or ideas contained. The foregoing parties will not be liable for any direct, special, indirect, incidental, consequential, or punitive damages as a result of the reader’s use of this information.

MTN DEW and teeth

A true American Icon.

While many find this vague, citrus-y tasting drink a necessity to everyday life, consuming it may be causing irreparable harm to teeth. A few of the contents and chemical aspects of MTN Dew combine to make it especially harsh on teeth.

First off, we already know that sugar helps feed bacteria that help to degrade our teeth. As you may have read in our previous posts, bacteria in our mouth thrive off of sugar. After we consume the sugar, so do they. The by-product of the bacteria eating the sugar is acid which slowly demineralizes our teeth forming a cavity1.

Next on the list of negatives for MTN Dew is the low pH. Similarly to how the acid that bacteria in our mouth produce a low pH, MTN Dew has a pH around 3.222. It has been well established that the outer enamel that protects our teeth demineralizes around a pH of 5.52. So every time a sip is taken from that green bottle, or whichever color MTN Dew you prefer, demineralization is happening.

Last, but not least and probably not the end of the list, MTN Dew contains Citric Acid. As the name suggests, what do you think it does? Fairly straight forward here–it has an erosive effect on teeth, lowers the pH and again, causes demineralization of tooth structure3.

Summary:

This is not a “You Cannot Drink MTN Dew” Post, as this information applies to pretty much all soda. This is a take note of how much soda you are drinking and adjust accordingly. Nothing wrong with a little MTN Dew in moderation. But the less soda you drink, the better for your teeth.

  1. Von der Fehr, F. R., Löe, H., & Theilade, E. (1970). Experimental caries in man. Caries research4(2), 131–148. https://doi.org/10.1159/000259635
  2. Reddy, A., Norris, D. F., Momeni, S. S., Waldo, B., & Ruby, J. D. (2016). The pH of beverages in the United States. Journal of the American Dental Association (1939)147(4), 255–263. https://doi.org/10.1016/j.adaj.2015.10.019
  3. Fuller, J. L., & Johnson, W. W. (1977). Citric acid consumption and the human dentition. Journal of the American Dental Association (1939)95(1), 80–84. https://doi.org/10.14219/jada.archive.1977.0551

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