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Posts for: December, 2015


Office cleanings and other minor procedures are a routine part of regular dental care. For some people, though, a routine visit could put them at slight risk for a serious illness.

The reason for this concern is a condition known as bacteremia. This occurs when bacteria, in this case from the mouth and conceivably during an office cleaning or other routine dental procedure, enters the bloodstream. Although for most people this isn’t a great issue, there’s been concern that bacteremia could further compromise the health of patients with or susceptible to other conditions like endocarditis (heart inflammation), prosthetic joints or compromised immune systems.

This concern grew out of a number of studies in the early 20th Century that seemed to show a link between dental bacteremia and infective endocarditis. At about mid-century it became a common practice to administer antibiotics before dental work (usually 2 grams of amoxicillin or an equivalent about an hour before) to high risk patients as a way of protecting them against infection. The practice later expanded to other health issues, including many heart conditions.

Beginning in 2007, however, guidelines developed jointly by the American Heart Association and the American Dental Association reduced the number of conditions recommended for antibiotic therapy. Based on these guidelines, we now recommend pre-procedure antibiotics if you have a history of infective endocarditis, artificial heart valves, certain repaired congenital heart defects, or heart transplant that develops a subsequent heart valve problem. Patients with prosthetic joints or immune system problems are no longer under the guidelines, but may still undergo antibiotic therapy if believed necessary by their individual physician.

If you have a condition that could qualify for antibiotic therapy, please be sure to discuss it with both your dentist and physician. We’ll work together to ensure any dental work you undergo won’t have an adverse effect on the rest of your health.

If you would like more information on antibiotic therapy and dental care, 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 “Antibiotics for Dental Visits.”


A few days before the Oscars, Vanity Fair magazine asked Academy Awards host Neil Patrick Harris to name his most treasured possession. Was it his Tony award statuette for best leading actor in a musical? His star on the Hollywood Walk of Fame? The stethoscope he wore while playing teenaged doctor Doogie Howser on TV? No, as it turns out, the 41-year-old actor’s most treasured possession is… his wisdom teeth. Yes, you read that correctly. “Oddly, I still have my four wisdom teeth,” Harris said. “I refuse to let them go or I’ll lose my wise parts.”

How odd is it for a 41-year-old to have wisdom teeth? Actually, not that odd at all. While it is true that wisdom teeth are often removed, there’s no one-size-fits-all approach to this. It all depends on whether they are causing problems now, or are likely to cause problems in the future.

The trouble wisdom teeth cause is related to the fact that they are the last molars to come in, and that molars are large in size. By the time wisdom teeth appear between the ages of 17 and 21, there often is not enough room for them in the jaw. Sometimes it’s because you may have inherited a jaw size that’s too small for your tooth size; and generally speaking, the size of the human jaw has evolved to become smaller over time.

If room is lacking, the adjacent molar (that came in earlier) can interfere with the path of eruption — causing the wisdom tooth to come in at an odd angle. The wisdom tooth can hit up against that other tooth, possibly causing pain or damaging the adjacent tooth. This is known as “impaction.” Sometimes the wisdom tooth breaks only partway through the gum tissue, leaving a space beneath the gum line that’s almost impossible to clean, causing infection. A serious oral infection can jeopardize the survival of teeth, and even spread to other parts of the body.

If a wisdom tooth is impacted, will you know it? Not necessarily. A tooth can be impacted without causing pain. But we can see the position of your wisdom teeth on a dental x-ray and help you make an informed decision as to whether they should stay or go. If removal is the best course of action, rest assured that this procedure is completely routine and that your comfort and safety is our highest priority. If there is no great risk to keeping them, as Neil Patrick Harris has done, we can simply continue to monitor their condition at your regular dental checkups. It will be particularly important to make sure you are reaching those teeth with your brush and floss, and that you keep to your schedule of regular professional cleanings at the dental office. All healthy teeth are indeed worth treasuring.

If you would like more information about wisdom teeth, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Wisdom Teeth” and “Removing Wisdom Teeth.”

By George L. Landress, D.D.S., M.A.G.D.
December 14, 2015
Category: Dental Procedures
Tags: crowns   bridges  

Crowns or bridges offer an ideal solution when a tooth is damaged or missing. These permanent prosthetic devices not only provide crowns and bridgescosmetic benefits; they also preserve your ability to bite and chew normally. George L. Landress, D.D.S., M.A.G.D., your dentist in Danbury, explains how these devices can help you.

What are crowns and bridges?

Crowns fit over a tooth, strengthening it or changing its appearance. Bridges are used to replace a missing tooth or teeth. A bridge consists of at least three connected crowns. Two of the crowns fit over teeth on either side of the missing tooth and anchor a third crown, called a pontic, in place. Crowns and bridges are made of durable materials that can handle the wear and tear involved in chewing and biting, such as porcelain, resin, porcelain-fused-to-metal, ceramic and gold.

Why do I need a crown?

Bridges aren't the only option if you're interested in replacing a missing tooth. A crown can also be used to replace a tooth if it's attached to a dental implant. Other possible reasons that you might need a crown include:

  • To protect a damaged or cracked tooth from breaking
  • To repair a broken tooth
  • To cover teeth that are discolored, too short or misshapen
  • To strengthen a tooth weakened by a large filling

How do I receive a bridge or crown?

The preparation process is similar for both bridges and crowns. Your dentist will make an impression of the tooth or teeth that will be covered by a crown or bridge and file them slightly to accommodate the thickness of the crown or bridge. He'll also create a temporary crown or crowns in his office, which you'll wear until your crown or bridge is ready. Because it will take a little time for your permanent crown or bridge to be created in a dental laboratory, you'll wear the temporary crowns for a week or two.

When your dentist receives the crown or bridge, you'll return to his office. He'll check the fit of the bridge or crown and make any adjustments before cementing it on to your tooth or teeth.

Think a bridge or crown is the right choice for you? Call George L. Landress, D.D.S., M.A.G.D., your dentist in Danbury, at (203) 743-7608 and schedule an appointment. Why not improve your smile with one of these cosmetic options?