My Blog

Posts for: October, 2018

By Scott A. Allegretti, DDS Provincetown Dental Arts
October 26, 2018
Category: Dental Procedures
Tags: dental implants  
WhatYouShouldKnowAboutAntibioticTherapyBeforeImplantSurgery

Placing a dental implant within the jawbone requires a surgical procedure. For most people it’s a relatively minor affair, but for some with certain health conditions it might be otherwise. Because of their condition they might have an increased risk for a bacterial infection afterward that could interfere with the implant’s integration with the bone and lead to possible failure.

To lower this risk, dentists for many years have routinely prescribed an antibiotic for patients considered at high-risk for infection to take before their implant surgery. But there’s been a lively debate among health practitioners about the true necessity for this practice and whether it’s worth the possible side effects that can accompany taking antibiotics.

While the practice still continues, current guidelines now recommend it for fewer health conditions. The American Dental Association (ADA) together with the American Heart Association (AHA) now recommend antibiotics only for surgical patients who have prosthetic heart valves, a history of infective endocarditis, a heart transplant or certain congenital heart conditions.

But patients with prosthetic joint replacements, who were once included in the recommendation for pre-surgical antibiotics, are no longer in that category. Even so, some orthopedic surgeons continue to recommend it for their joint replacement patients out of concern that a post-surgical infection could adversely affect their replaced joints.

But while these areas of disagreement about pre-surgical antibiotics still continue, a consensus may be emerging about a possible “sweet spot” in administering the therapy. Evidence from recent studies indicates just a small dose of antibiotics administered an hour before surgery may be sufficient to reduce the risk of infection-related implant failure with only minimal risk of side effects from the drug.

Because pre-surgical antibiotic therapy can be a complicated matter, it’s best that you discuss with both the physician caring for your health condition and your dentist about whether you should undergo this option to reduce the infection risk with your own implant surgery. Still, if all the factors surrounding your health indicate it, this antibiotic therapy might help you avoid losing an implant to infection.

If you would like more information on antibiotics before implant surgery, 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 “Implants & Antibiotics: Lowering Risk of Implant Failure.”


By Scott A. Allegretti, DDS Provincetown Dental Arts
October 16, 2018
Category: Oral Health
IncreaseYourImplantsSuccessChancesbyKeepingYourGumsHealthy

If you’ve just received a dental implant restoration, congratulations! This proven smile-changer is not only life-like, it’s also durable: more than 95% of implants survive at least 10 years. But beware: periodontal (gum) disease could derail that longevity.

Gum disease is triggered by dental plaque, a thin film of bacteria and food particles that builds up on teeth. Left untreated the infection weakens gum attachment to teeth and causes supporting bone loss, eventually leading to possible tooth loss. Something similar holds true for an implant: although the implant itself can’t be affected by disease, the gums and bone that support it can. And just as a tooth can be lost, so can an implant.

Gum disease affecting an implant is called peri-implantitis (“peri”–around; implant “itis”–inflammation). Usually beginning with the surface tissues, the infection can advance (quite rapidly) below the gum line to eventually weaken the bone in which the implant has become integrated (a process known as osseointegration). As the bone deteriorates, the implant loses the secure hold created through osseointegration and may eventually give way.

As in other cases of gum disease, the sooner we detect peri-implantitis the better our chances of preserving the implant. That’s why at the first signs of a gum infection—swollen, reddened or bleeding gums—you should contact us at once for an appointment.

If you indeed have peri-implantitis, we’ll manually identify and remove all plaque and calculus (tartar) fueling the infection, which might also require surgical access to deeper plaque deposits. We may also need to decontaminate microscopic ridges found on the implant surface. These are typically added by the implant manufacturer to boost osseointegration, but in the face of a gum infection they can become havens for disease-causing bacteria to grow and hide.

Of course, the best way to treat peri-implantitis is to attempt to prevent it through daily brushing and flossing, and at least twice a year (or more, if we recommend it) dental visits for thorough cleanings and checkups. Keeping its supporting tissues disease-free will boost your implant’s chances for a long and useful life.

If you would like more information on caring for your dental implants, 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 “Gum Disease can Cause Dental Implant Failure.”


By Scott A. Allegretti, DDS Provincetown Dental Arts
October 06, 2018
Category: Oral Health
Tags: oral hygiene  
HowEffectiveisYourOralHygieneFindOutwithaPlaqueDisclosingAgent

Brushing and flossing every day are important for preventing dental disease. The object is to remove as much bacterial plaque, the thin biofilm most responsible for disease, from your teeth and gums as possible.

But how do you know your hygiene efforts are that effective? You can of course do the “tongue test” รข?? feel your teeth with your tongue after brushing and flossing and see if they feel smooth and “squeaky” clean. We can also give you a “report card” at your regular cleaning appointment. There is, however, a more precise way you can find out at home by using a plaque disclosing agent.

A plaque disclosing agent is a formulation that when applied to the teeth will temporarily dye any bacterial plaque present a distinct color. While dental hygienists occasionally apply them, they’re also available over the counter for use at home. They’re usually found in a solution, tablet or swab form in various flavors.

To use the product you first brush and floss, then swish the disclosing liquid around in your mouth for about 30 seconds before spitting it out (or chew the tablet or apply the swab as directed). The agent will react with any remaining plaque and dye it a bright color. There are even two-tone agents available that can differentiate between old and new plaque and dye them different colors.

Examining your teeth in a mirror will give you a good idea where you need to concentrate your attention when brushing and flossing. If, for example, you see dyed plaque more along the gum line and less in other places, then that’s where you should focus your hygiene efforts.

While the dye will eventually wear off on its own, you should take the opportunity to brush and floss again to remove any remaining dyed plaque. Not only does this provide a more thorough cleaning at that moment, you’ll also get a better sense of how “thoroughness” feels for future brushing and flossing.

It’s always good to know how well you’re doing with your dental hygiene efforts. A plaque disclosing agent can give you just the right feedback to help you improve.

If you would like more information on proper oral hygiene habits, 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 “Plaque Disclosing Agents.”