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Examination, Scale and Clean

In addition to daily brushing and flossing, visiting the Dentist every six months for a regular examination and clean, is important for maintaining good oral health and hygiene, and for early detection of any dental problems.

A scale and clean involves the removal of tartar (calculus) from the tooth surfaces by special dental instruments. Plaque, a soft, sticky film containing bacteria which builds up on teeth, can be removed by normal brushing. However, if plaque is not removed, it hardens to become tartar, and if left untreated, it will damage healthy teeth and gums, and can cause tooth decay, gum disease, supporting bone loss leading ultimately to tooth loss.

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Regular dental checkups

Going to the dentist regularly helps in several ways. For a start, you get to know the dentist, the staff and the routine. But, most importantly, you catch problems early when they are simple and easy to treat.

That means there’s less likelihood of having to have a major and possibly more uncomfortable procedure.

You also develop a trusting relationship with your dentist, and hear about new advances that will improve the health of your teeth and your experience at the dentist.

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Fissure Sealants

Teeth which contain deep grooves that cannot be reached by the fine bristles of a toothbrush are susceptible to plaque (bacteria) building up in the groove and causing decay. To prevent this, is a protective tooth coloured resin coating, known as a fissure sealant, is placed in the groove of the tooth to stop decay from forming.

Fissure sealants are ‘plastic’ colourless protective liquids, which are painted onto the biting surfaces of the back teeth. They are then hardened by the application of a concentrated beam of ultraviolet light. They are permanent and remain in place for many years.

Fissure sealants have been used in Dentistry for many decades and provide a very effective means of preventing tooth decay. They are usually placed in the adult molar teeth soon after they present themselves in the mouth. The first molar teeth come through at about six years of age and are fissure sealed soon thereafter. The second molar teeth present at twelve years of age and are subsequently fissure sealed. Other teeth can also be fissure sealed, especially in cases where tooth decay is likely to occur rapidly.

Often, one finds adult molar teeth in children which have suffered from a small amount of decay. It is now possible to use painless and drill-free techniques such as special pastes or air-abrasion devices to disinfect and remove this decay and fissure seal the tooth. This prevents the tooth from developing a ‘full blown’ cavity and thus, needing more unpleasant treatment at a later date.

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Antibiotic Prophylaxis

Antibiotic prophylaxis guidelines exist for two groups of patients: those with heart conditions that may predispose them to infective endocarditis, and patients who have total joint replacements, who may be at risk for developing hematogenous infections at the site of the prosthetic.

For decades, the Australian Heart Association (AHA) recommended that patients with certain heart conditions take antibiotics shortly before dental treatment. This was done with the belief that antibiotics would prevent infective endocarditis (IE), previously referred to as bacterial endocarditis. The AHA’s latest guidelines were published in its scientific journal, Circulation, in April 2007 and there is good news: the AHA recommends that most of these patients no longer need short-term antibiotics as a preventive measure before their dental treatment.

The Australian Dental Association participated in the development of the new guidelines and has approved those portions relevant to dentistry. The guidelines were also endorsed by the Infectious Diseases Society of Australia and by the Pediatric Infectious Diseases Society.

The guidelines are based on a growing body of scientific evidence that shows the risks of taking preventive antibiotics outweigh the benefits for most patients. The risks include adverse reactions to antibiotics that range from mild to potentially severe and, in very rare cases, death. Inappropriate use of antibiotics can also lead to the development of drug-resistant bacteria.

Scientists also found no compelling evidence that taking antibiotics prior to a dental procedure prevents IE in patients who are at risk of developing a heart infection. Their hearts are already often exposed to bacteria from the mouth, which can enter their bloodstream during basic daily activities such as brushing or flossing. The new guidelines are based on a comprehensive review of published studies that suggests IE is more likely to occur as a result of these everyday activities than from a dental procedure.

The guidelines say patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with:

• mitral valve prolapse
• rheumatic heart disease
• bicuspid valve disease
• calcified aortic stenosis
• congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.
The new guidelines are aimed at patients who would have the greatest danger of a bad outcome if they developed a heart infection.

Preventive antibiotics prior to a dental procedure are advised for patients with:

1. artificial heart valves
2. a history of infective endocarditis
3. certain specific, serious congenital (present from birth) heart conditions, including
- unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits
- a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure
- any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device
4. a cardiac transplant that develops a problem in a heart valve.
The new recommendations apply to many dental procedures, including teeth cleaning and extractions. Patients with congenital heart disease can have complicated circumstances. They should check with their cardiologist if there is any question at all as to the category that best fits their needs.

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