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Author: Service Lifter

Osteoporosis & Oral Health

Osteoporosis is a condition that weakens bones and makes them more prone to fracture. Estimated to affect about 10 million Americans at present, it causes some 2 million fractures each year — and as our population ages, these numbers are expected to increase. Osteoporosis can affect any part of the body — including the jawbone that supports the teeth.

This may be of particular concern if you are considering certain dental procedures — for example, getting dental implants to replace missing teeth. Implants are today’s gold standard for tooth replacement, because they look and function so much like real teeth. But their success depends on a process known as osseointegration, by which they fuse to living bone in the jaw. For this to occur, that bone must be relatively healthy; yet osteoporosis — and certain medications used to treat it — may affect your oral health.

Bone: An Ever-Changing Tissue

The living bone tissue in the body isn’t like the dry, white skeleton you may have seen in a doctor’s office or on TV. It is constantly being remodeled by two natural processes: resorption, in which the body removes and breaks down old, damaged bone; and bone formation, where the removed material is replaced by new, healthy bone. In an ideal situation, both processes happen at an equal rate; osteoporosis, however, tips the balance toward resorption, weakening the bone structure.

A class of drugs called bisphosphonates (whose brand names include Fosamax, Boniva, Reclast and Prolia) can inhibit resorption and help bring the two processes back into balance. But for reasons that aren’t fully understood, these medications sometimes have a different effect on the bones of the jaw. In rare cases, long-term bisphosphonate users experience osteonecrosis of the jaw (ONJ), a condition in which isolated areas of jawbone lose their vitality and die. If you are a candidate for oral surgery, tooth extraction or implant placement, it’s important to consider the possible effect of bisphosphonate use before you have this type of procedure.

Taking Medication

Over 90 percent of the people who suffer from bisphosphonate-associated ONJ received high doses of the medication intravenously — often for cancer treatment. Only a small percentage of those who take the drug orally are likely to develop this condition. So generally speaking, if you have osteoporosis or are at high risk of bone fractures, the benefit of taking these medications far outweighs the risk.

But if you are about to begin therapy with high doses of bisphosphonates, it’s ideal to have a dental exam and resolve any oral disease before beginning the medication. Likewise, while you’re receiving the medication, it’s best to avoid invasive dental treatments if possible. However, since untreated oral disease may cause serious health problems, be sure to discuss the situation with all members of your medical team before making treatment decisions.

Most people who take oral bisphosphonates for osteoporosis won’t have to postpone or avoid dental procedures, because they have little risk of developing ONJ. In the case of dental implant placement, the decision to proceed is made on an individual basis, after a thorough examination of the quality and quantity of tooth-supporting bone in the jaw. The presence of osteoporosis may influence the type of implants used, and the amount of healing time needed to complete the osseointegration process.

No matter what dental procedures you are considering, it is vital to keep us informed about any medical conditions you have, and any drugs you may be taking — both prescription and non-prescription.

Preventing Osteoporosis

There are several ways you can help prevent osteoporosis. For a start, make sure you’re getting enough calcium and vitamin D. It also helps to decrease your caffeine and alcohol intake, and quit smoking. Weight-bearing exercise — physical activities that force you to work against gravity, like walking, jogging or weight training — can bring a host of benefits. And don’t forget your regular visits to the dental office. Your dental professionals don’t just help you to maintain good oral health — we encourage you to keep up your overall health as well.

Cracked Teeth

Tooth Bonding - Step by Step.Firmly anchored in your jaw and protected by an outer coating of tough enamel, your teeth are remarkably strong — yet it’s still possible for them to chip, crack, or even break. In fact, there is some evidence that today, our teeth are developing cracks at a record rate. This may be due to the fact that people are living longer (giving teeth more time to accumulate damage), or that our stress levels are increasing (which may cause teeth clenching and grinding).

Biting on hard objects, receiving a blow to the mouth, or having large cavities (or old amalgam fillings) that weaken the tooth’s structure are also common causes of tooth fractures. But no matter of the cause, there are a number of symptoms that indicate a tooth may be cracked, and several treatments we can offer, depending on the severity of the injury.

Small chips on the edges or cusps of teeth often cause no symptoms, and can be treated by cosmetic bonding or other methods. Deeply fractured teeth, on the other hand, may be a serious problem. The sooner they are treated, the more likely it is that the affected tooth can be saved. Let’s take a look closer look at the types of fractures teeth can develop, and the symptoms they may produce.

Minor Cracks (craze lines)
These tiny fissures in the outer enamel of the tooth often cause few or no symptoms; in fact, most don’t require treatment. If you are having tooth pain, however, these cracks will need to be evaluated and possibly treated. That’s because without a careful examination, there is no way to know for sure whether these cracks go into only the enamel, or if they penetrate into the dentin (inner body) of the tooth. While the tiniest craze lines don’t show up on X-rays, they can often be detected by feel (using a small instrument called an explorer), by having you close down on a “bite stick,” or by using special dye stains or high-magnification instruments.

Vertical Cracks
Cracked tooth.This type of crack often starts at the chewing surface and extends toward the roots — but may it also begin in the root and continue toward the crown. Either way, it doesn’t completely separate the tooth into two parts. Depending on the extent of the fracture, you may feel only minor discomfort that occurs in response to temperature changes (with hot or cold beverages, for example); or, it may produce sharp pain when you chew. In any case, you shouldn’t ignore the symptoms, because cracked teeth require dental treatment quickly to keep them from progressing further. If the cracks continue to progress, tooth extraction may become necessary.

Deep Fractures or Split Teeth
When serious fractures occur, you’ll know it: The distinct parts of the tooth can be separated from each other, and tooth’s pulp is often inflamed and painful. This condition requires immediate treatment, and it’s rarely possible to save the affected tooth.

Treatment for Cracked Teeth
What treatment is best for a cracked tooth depends on the extent and the severity of the damage. If a small crack is detected early enough, it’s often possible to seal the fissure with restorative materials. For larger cracks that involve the pulp of the tooth, root canal treatment is generally required. Afterward, the visible structure of the tooth may be restored with a crown or “cap.” Sometimes, additional procedures may be recommended to try and save the tooth. In the most severe cases, however, the tooth will need to be extracted.

The preferred treatment for cracked teeth is — you guessed it — prevention! Wearing proper protective equipment (including a custom-fitted mouthguard) when playing sports, and staying alert to dangerous situations (like distracted or impaired driving) can help keep you safe. So can regular dental checkups, where your teeth are examined carefully for early signs of a problem. However, if you experience any symptoms that could indicate a cracked tooth, don’t wait: The sooner it’s treated, the better the chance that we can save it.

Interdental Cleaning Devices

Almost everyone understands the importance of regular brushing and flossing to their oral health. You’ve heard it many times before, at office visits and checkups: Proper oral hygiene is your first line of defense against tooth decay and gum disease. Yet, while most of us brush regularly, many people don’t floss as often as they should… or at all!

Why not? Sometimes, it’s because we don’t have the manual dexterity to handle the floss, or because braces or partial dentures get in the way; or, perhaps we just never got in the habit. Yet proper cleaning of the interdental areas (the small spaces between teeth) is crucial — and here’s why:

Consistent brushing with fluoride toothpaste has been proven effective at removing dental plaque from the tooth’s surfaces and making them more resistant to decay. But regular toothbrushes simply can’t get into the small gaps between teeth, or the tiny crevices where teeth meet gums. Unfortunately for our oral health, that’s exactly where tooth decay and gum disease starts — and that’s where the tools called “interdental cleaners” can help.

There are several different types of interdental cleaners available, including special brushes and irrigation devices (commonly called “water picks”). None of them, by themselves, are a substitute for brushing and flossing. However, as part of a regular program of oral hygiene, they can be effective at fighting plaque and reducing the incidence of tooth decay and gum disease.

The Interdental Brush

Interdental brush.This specially designed toothbrush (sometimes called an interproximal brush or proxabrush) can be successfully utilized to clean the small gaps between teeth, as well as the gums and the areas around braces, wires, or other dental appliances. Because it has a handle not unlike a standard toothbrush, many people with limited dexterity find it easy to use. Plus, numerous clinical studies have demonstrated its effectiveness at reducing plaque and controlling gingivitis (gum inflammation).

The cleaning surface of an interdental brush is similar in shape to a small, conical pipe cleaner. Its short bristles radiate from a thin central wire, which is small enough to pass through a very tight space. The brushes are available with both coated and uncoated wire, and come in different widths to accommodate an individual’s particular dental anatomy. When needed, they can also be used to apply antibacterial or desensitizing agents to certain areas of the teeth or gums.

Oral Irrigation Devices

Available to consumers for over 50 years, these devices (sometimes known as water jets or water picks) can also play a role in interdental hygiene. While their popularity has gone up and down over the decades, many studies have shown that they provide a safe and effective method of diluting the acids produced by plaque. Irrigation devices typically use pulsed or steady jets of pressurized water to remove food particles from the hard-to-clean interdental spaces, as well as in some subgingival (below the gum line) pockets.

Proper brushing and flossing is still generally considered the gold standard of at-home oral hygiene. But if you have trouble flossing regularly — or if you’re at increased risk for developing dental or periodontal disease — then using these interdental cleaners might be right for you.

Mouthguards for Children

Kids who take part in athletic activities — whether they’re playing on organized sports teams, bicycling, or just kicking a ball around — gain a host of well-documented health benefits. Yet inevitably, along with all the fun, the sense of achievement, and the character-building features of athletics, the possibility of injury exists. Does this mean your kids shouldn’t play sports? Of course not! But it makes sense to learn about the risks involved, and to take appropriate precautions.

How prevalent are sports-related dental injuries? In 2012, the National Youth Sports Safety Foundation forecast that more than 3 million teeth would be knocked out in youth sporting events that year! Among all the dental injuries we treat in children, it is estimated that over 25% are sports-related, and the majority of these involve the top front teeth.

Besides the immediate trauma, sports-related injuries can result in time lost from school and work, and substantial cost — up to $20,000 over a lifetime to treat a missing permanent tooth. Yet there’s a simple and relatively inexpensive way to reduce the chance of dental injury in children: A properly-fitted, comfortable mouthguard, worn whenever playing sports where the possibility of orofacial injury exists.

Use the Right Equipment

Athletic mouthguards.

You wouldn’t let your child play football without a helmet and protective padding, right? Yet it might surprise you to know that kids playing basketball are 15 times more likely to sustain injuries to the mouth or face than football players! Mandatory mouthguards are one reason for that: More American kids wear mouth protection for football than any other sport, which has resulted in a dramatic drop in injuries.

Mouthguards are required in only four school-based sports: football, ice hockey, lacrosse, and field hockey. Yet basketball and baseball are associated with the largest number of dental injuries. Other sports for which the American Dental Association (ADA) recommends wearing a mouthguard include bicycling, soccer, skateboarding, wrestling and volleyball. Do mouthguards work? The ADA estimates that athletes who don’t wear mouthguards are 60 times more likely to suffer dental injury than those who do.

What Type of Mouthguard Is Best?

The best mouthguard for your child is the one he or she actually wears, both at practice and on game day. There are several different types of mouthguards on the market, which generally fall into three categories:

  • An “off-the-shelf” mouthguard. Available at many sporting goods stores, this type comes in a limited range of sizes, and varies widely in quality. The least expensive option, it offers a minimal level of protection that’s probably better than nothing. It generally must be clenched in the mouth, which can make wearing it uncomfortable and cause trouble breathing and speaking.
  • The “boil and bite” mouthguard. These are designed to be immersed in hot water, and then formed in the mouth using finger, tongue and bite pressure. When they can be made to fit adequately, they generally offer better protection than the first type—but they may still be uncomfortable, and usually fail to offer full coverage of the teeth.
  • A custom-made mouthguard. This is a piece of quality sports equipment that is custom fabricated for your child’s mouth. How? Molds or impressions of your child’s teeth will be made and then tough, resilient, high quality materials are perfectly fitted to that impression. This type of mouthguard offers your child maximum protection and a superior level of comfort — and its cost is quite reasonable.

At the present time, when top-quality sports equipment for kids can run in the hundreds of dollars, it makes more sense than ever to invest in the proven protection of a professionally made, custom-fitted mouthguard.

Cosmetic Gum Surgery

Before and After Cosmetic Gum SurgeryThere are many elements that make up an ideal smile; bright, healthy-looking teeth immediately come to mind. But the gum tissue that surrounds and supports those teeth also plays a big role in how appealing your smile will look.

There are various cosmetic issues involving gum (gingival) tissue. For example, your smile may look “gummy” — meaning you seem to display too much gum tissue when you smile, or your teeth appear too short. Sometimes it’s the opposite problem — your teeth appear too long because your gum tissue has receded (pulled back), exposing tooth-root surfaces that were covered at one time. Or, you may have an uneven gum line, meaning gum tissue covers some of your teeth more than others. All of these cosmetic gum problems can be successfully treated with cosmetic procedures performed in the dental office.

Cosmetic Gum Problems

Excess Tissue. A gummy smile can be caused by excessive gum tissue covering more enamel surface of a tooth’s crown (upper portion) than normal. If that is the case, a procedure known as “crown lengthening” can be performed, in which gum tissue (and sometimes a small amount of bone tissue) is removed to expose more tooth surface.

Receding Gums. Sometimes your gums can shrink down (recede), exposing a portion of your tooth roots. This causes a cosmetic problem because root surfaces, which have no enamel covering, tend to appear more yellow than the crowns of your teeth. Also, exposed roots can be more sensitive to cold or touch, and can be at greater risk of decay. There are various gum-grafting procedures that can cover exposed roots, all of which involve moving gingival (gum) tissue from one site in the mouth to another. For example, roots can be covered with tissue from the roof of your mouth, which is of the same type; or adjacent (nearby) tissue can be moved over to cover an exposed root. Sometimes laboratory-processed tissue from another donor can even be used. All of these options can be discussed with you in more detail.

Uneven Gum Line. If you have an uneven gum line where some teeth are covered by more tissue than others, it is often possible to recontour (reshape) the tissue for a very pleasing effect. This can be done conventionally with a surgical scalpel or with newer dental laser technology. The advantage of a laser is that it seals the tissue as it sculpts it, making the procedure more comfortable and requiring a shorter healing time.

What to Expect

All cosmetic gum surgery can be performed at the dental office — and it usually requires only a local anesthetic (numbing shot). In fact, for laser surgery you may need only a topical anesthetic applied in gel form. If you would like a deeper level of relaxation, you can have oral or possibly even an IV sedative; but if this is required, you will need a ride home. Laser surgery leaves no open wounds and causes minimal, if any, discomfort, though the anatomy of the area may preclude laser use. An examination is required to determine whether conventional or laser treatment is in your best interests.

Grafts may take longer to heal, particularly if tissue is taken from the roof of your mouth. If that’s the case, you will have two sites that need to heal: the donor site from which the tissue was taken, and the recipient site where the tissue was attached. Both of these sites will require stitches, usually of the dissolving type. You will need to eat a softer diet and avoid chewing on that side of your mouth for a few days. Though full healing may take a few weeks, you will be able to resume your normal activities the very next day. Whichever kind of cosmetic gum surgery you may need, the procedures are routine and predictable — and they can do wonders for your smile!

Early Orthodontic Treatment

You probably know that it’s never too late to begin orthodontic treatment — but when it comes to your youngster’s teeth, did you know that earlier may be better than later? According to the American Association of Orthodontists, kids should have an initial orthodontic screening at age 7. What makes early evaluation — and potentially, early treatment — so important?

There are several ways that kids can benefit from an orthodontic evaluation at an early age. But it’s important to recognize that early evaluation isn’t necessarily followed by early treatment; in most cases, if orthodontic work is needed, your child’s growth patterns are simply monitored until it’s time for treatment to begin. This creates an opportunity to get the best results in the most efficient way, and to help prevent future problems.

Although every child’s development is different, in most kids the first adult molars have typically started to emerge by around age six. At this point it is possible to evaluate the basic alignment of the teeth, from front to back and side to side. It may also be possible at this point to determine whether there is adequate room in the mouth for all of the permanent teeth — and, if not, to take action.

When Earlier Treatment Is Better

Treatment for common orthodontic problems typically begins around age 9-14, when all of the baby teeth are gone and many of the permanent ones are in place. But there are some conditions that are much easier to treat if they’re caught at an early age, when a child’s natural growth processes are going full speed ahead.

Crossbite.One is severe crossbite, a condition where the upper teeth close inside the lower teeth. To treat this problem, a device called a palatal expander can be used, which gradually and painlessly widens the upper jaw; it’s especially effective when the jaw itself hasn’t fully developed. If one waits too long, a more complicated treatment — or even oral surgery — might be required to correct the problem.

Crowding.Another condition that may benefit from early treatment is severe crowding. This occurs when the jaws are too small to accommodate all of the permanent teeth. Either palatal expansion or tooth extraction may be recommended at this point, to help the adult teeth erupt (emerge from below the gums) properly. Even if braces are required later, the treatment time will likely be shorter and less complicated.

Protruding teeth.Early intervention may also be helpful in resolving several other problems. Protruding teeth, especially in front, can be prone to chipping and fractures; they may also lead to problems with a child’s self-image. A severe underbite, caused by the lower jaw growing much larger than the upper jaw, can result in serious bite problems. Orthodontic appliances, including braces and headgear, can be successfully used to correct these problems at this stage, when the child’s development is in full swing, thereby increasing the chances that surgery can be avoided.

Correcting Bad Habits

Dangers of Thumb Sucking.

At one time or another, anyone may pick up a bad habit. But there are some situations where a youngster’s parafunctional (detrimental to health) habits can actually influence the development and function of his or her teeth, jaws and mouth. Some examples of these are persistent thumb sucking, tongue thrusting and mouth breathing.

The sucking reflex is natural in early childhood; it usually disappears between ages 2 and 4. But if it persists much later, the pressure of the digit on the front teeth and the upper jaw can actually cause the teeth to move apart and the jaws to change shape. This can lead to the orthodontic problem called “open bite,” and may impair speech. An open bite can also be caused by the force of the tongue pushing forward against the teeth (tongue thrusting).

Mouth breathing — an abnormal breathing pattern in which the mouth always remains open, passing air directly to the lungs — is related to alterations in the muscular function of the tongue and face. It may cause the upper and lower jaw to grow abnormally, which can lead to serious orthodontic problems. Although mouth breathing may start from a physical difficulty, it can become a habitual action that’s hard to break.

Various orthodontic treatments are available to help correct these parafunctional habits — and the sooner they’re taken care of, the less damage they may cause. But these potential problems aren’t always easy to recognize. That’s one more reason why you should schedule an early orthodontic screening for your child.

Eating Disorders & Oral Health

Millions of people in the United States, particularly teenage girls and young women, suffer from health-threatening eating disorders, and dentists are often the first to spot the signs. Why? The repeated, self-induced vomiting that characterizes bulimia nervosa has a pronounced effect on teeth. Anorexia nervosa (self-starvation) can also have some noticeable effects on oral health.

More than 90% of those with bulimia experience tooth erosion. This is caused by acid from the stomach, which can dissolve the enamel when it comes in contact with teeth during vomiting. Teeth that have lost enamel can appear worn, chip easily, and become sensitive to hot and/or cold. Of course, acid erosion can also affect people who drink a lot of soda, sports drinks and energy drinks — even the diet varieties. But acid erosion in bulimics has a particular pattern: It is evident on the upper front teeth, particularly on the tongue side and biting edges. The bottom teeth, on the other hand, tend to be protected by the tongue when a person throws up.

Once enamel is lost, it can’t grow back. But the damage can be repaired with various restorative techniques including veneers and/or crowns. The best treatment will be determined by how extensive the damage is, which in turn depends on how frequently the person has engaged in binge-purge behavior.

To protect teeth in the short term, it is important not to brush them immediately after vomiting as this can scrape off more of the softened enamel. It is better to rinse with water to which a little baking soda has been added, which neutralizes the acid. Even a plain water rinse is helpful. Sometimes a sodium fluoride mouthrinse is recommended to strengthen the enamel and reduce its loss.

Erosion is not the only sign of an eating disorder that a dentist or hygienist may notice. In severe cases the salivary glands can become enlarged, causing the sides of the face under the ears to look puffy. Also, the throat, back of the tongue and roof of the mouth can appear reddened or otherwise traumatized from the use of fingers or other objects to induce gagging. Soft tissues of the mouth can also be damaged by acid.

Only about 20% of anorexics experience tooth erosion, but there are other signs that may become apparent in the dental office. Nutrition and hygiene suffer in general, which in turn can mean more tooth decay and gum disease. There is also considerable overlap between anorexia and bulimia.

If you are struggling with an eating disorder or believe that a loved one is, please let your healthcare professionals know. We will make sure you get the help you need for healthy teeth and a healthy life. You can also visit the National Eating Disorders Association for some helpful information.

Geographic Tongue

Geographic tongue is characterized by harmless lesions, or patches, that can suddenly materialize on the tongue’s top surface. The condition gets its name from the physical appearance of the lesions, which resemble smooth, red islands, possibly rimmed with white. Their smoothness comes from the absence of the tiny bumps or “papillae” that normally cover the entire surface of the tongue. These variations in color and texture give the whole tongue a map-like appearance.

The pattern on the tongue can change daily as the lesions appear to move or migrate, healing in one spot only to reappear in another. That’s why the medical term for this condition is benign migratory glossitis. It’s scary looking, but does not compromise a person’s health.

Discomfort from the condition can sometimes be relieved with over-the-counter pain relievers; mouthrinses containing anesthetics, antihistamines, or steroids; and by avoiding certain irritants such as tobacco, alcohol, and foods that are spicy, salty or acidic.

No one knows exactly what causes geographic tongue. Some factors that may play a role include vitamin B deficiency, irritation from alcohol or spicy foods, and genetics.

This condition can be diagnosed simply by examining your tongue; laboratory tests are usually not necessary. Geographic tongue normally resolves on its own, but a dental professional should be consulted if you notice any changes in your tongue’s appearance.

Pregnancy, Hormones & Oral Health

You probably know that many physical and emotional changes you will experience during pregnancy result from an increase in the levels of certain hormones — the chemicals that regulate many important processes in the body. But what you may not realize is that these hormonal variations can affect your oral health — and usually not for the better. In fact, surges in the female hormones estrogen and progesterone can dilate (expand) the tiny blood vessels in your gums, increasing blood flow. This makes gums more sensitive to the bacteria (and associated toxins) found in the sticky dental plaque that accumulates on teeth every day.

Pregnant women commonly notice that their gums may become red and swollen, and even bleed when they floss or brush their teeth, a condition known as “pregnancy gingivitis.” Similar gum inflammation can result from taking birth control pills that contain a type of synthetic progesterone, or even from the normal hormonal fluctuations of the menstrual cycle.

Another, less common effect of pregnancy hormones on the gums is an overgrowth of gum tissue or small, berry-colored lumps at the gum line or between teeth. These growths are called “pregnancy tumors,” though they are completely benign.

All of the above conditions usually clear up within a few months after giving birth. Still, if you experience gum inflammation, it’s a sign that you need to take extra conscientious care of your teeth and gums during pregnancy.

Why It Matters

Pregnancy hormones don’t cause gingivitis by themselves — the irritants in plaque need to be present first. So if you experience the signs and symptoms mentioned above, you’ll want to redouble your oral hygiene efforts, both for your sake and your baby’s. Untreated gingivitis can progress to a more serious form of gum disease called periodontitis — a bacterial infection that attacks not just the gums but also the tooth-supporting bone beneath. It can eventually cause bone loss, loose teeth and even tooth loss. Some research has even indicated a link between periodontal (gum) diseases and other serious health conditions, such as cardiovascular disease and diabetes.

Pregnant women should also be aware that studies have suggested a link between periodontal (gum) disease and preterm delivery. Although the exact mechanism by which this happens is unclear, evidence suggests that the bacteria in dental plaque can reach the placenta and trigger inflammatory responses. This causes substances to be released into the bloodstream that may in turn start labor prematurely. Preeclampsia, a form of high blood pressure specific to pregnancy, may also be associated with periodontal disease.

What You Can Do

  • Eat right. Even if pregnancy cravings are driving you to seek out sugar, try to go easy on the sweets. While they offer you and your developing baby virtually nothing in the way of nutrients, they’re the favorite food of disease-causing oral bacteria. If you find you can’t resist sweets, try to eat them only at mealtimes and make sure to brush your teeth afterwards.
  • Stick to a good oral hygiene routine. Make sure to floss every day and to brush your teeth at least twice per day. If morning (or afternoon or evening) sickness is a problem, don’t brush immediately after throwing up. That’s because the enamel on your teeth, which has been temporarily softened by the acid coming up from your stomach, can now be easily removed. Instead, rinse with a teaspoon of baking soda dissolved in a cup of water (or even plain water) to neutralize the acid. Wait a full hour before brushing your teeth.
  • Have a dental cleaning and exam. Not only are professional cleanings safe during pregnancy, they’re highly recommended. So if you haven’t been to the dentist in a while, now is a great time to make an appointment. And don’t forget to share the happy news! You teeth can certainly be cleaned and examined — but for other non-emergency dental procedures, it’s probably best to wait.

Blood Thinners & Dental Procedures

Millions of people regularly take anticoagulant or antiplatelet medications (sometimes called “blood thinners”) to help prevent heart attack and stroke, and to manage a variety of medical conditions including cardiac arrhythmia and stent placement. While these drugs have proven, life-saving benefits, they can also cause side effects such as increased bleeding. So it may be a cause for concern if you’re taking one of them and you need to have a dental procedure.

Anticoagulants are among the more widely used pharmaceuticals today, particularly for heart patients. Some common prescription anticoagulants include heparin, warfarin (Coumadin and generics), clopidogrel (Plavix) and dabigatran etexilate (Pradaxa). Regular aspirin and NSAIDS (like Advil) also have anticoagulant properties. The purpose of anticoagulant medications is to keep the blood from clotting (clumping together) as readily as it normally does; this reduces the chance of a clot forming inside a blood vessel, which could lead to a stroke or heart attack.

If you are taking one or more of these medications, it will take longer for any type of bleeding to stop. For some dental or surgical procedures, that’s a factor that must be considered. The most important thing you should do is inform your dentist right away if you are taking any kind of anticoagulant or antiplatelet medication — especially if you have just started taking it. The name and dosage of your medication will be noted in your records, and your cardiologist (or other specialist) will be consulted if necessary, to determine what’s best for you.

Having Dental Work with Blood Thinners

While each patient is different, there are some generally accepted guidelines for having dental work while taking anticoagulant medications. If the drug is being taken on a temporary basis (after knee replacement, for example) then the safest choice might be to put off non-essential dental procedures. However, in many cases it’s entirely possible to have needed work done while taking anticoagulants. In each situation, the risk of increased bleeding must be balanced against the chance that going off the medication could cause more serious problems.

A number of studies have shown that for many common dental procedures — cleanings, fillings and restorations, for example — it’s safer to continue taking anticoagulant medications than to stop, even temporarily. That’s because it is generally possible to control bleeding with local measures (such as biting down on gauze), using hemostatic devices and minimally invasive surgical techniques. Scheduling dental work for early in the day and allowing plenty of time for rest afterwards also provides an opportunity to control any bleeding that does occur.

More Complex Procedures

In some cases, more extensive dental procedures such as tooth extraction or implant placement may be recommended for people taking anticoagulants. As always, the potential risks and benefits of stopping the anticoagulant medication must be carefully weighed. To help in the decision-making process, one or more diagnostic blood tests, such as prothrombin time (PT) or International Normalized Ratio (INR), may be ordered. Then a judgment can be made, based on the test results and on clinical experience.

While it’s extremely rare for common dental procedures to cause potentially life-threatening complications, it makes sense to take as few chances as possible. That’s why you should tell us about any medications you may be taking, including herbs and vitamins. While taking anticoagulants doesn’t prevent you from having dental work, it’s important to share information about your medications so you can get the best results from your treatment.