Tuesday, December 19, 2017

Thumb Sucking and Soothers......

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Thumb sucking and soother use can make a baby feel secure and happy.  Since the habit is relaxing it may induce sleep.
The habit that persists past the eruption of teeth can cause problems with the proper growth of the mouth and tooth alignment.
The example above shows an anterior open bite due to thumb sucking or soother use.
In some cases orthodontic correction might be required due to this habit.

Saturday, November 4, 2017

8 Things You Should Know About Wisdom Teeth

1. They used to serve a very important purpose.

Some scientists believe that human ancestors required more grinding functionality of their teeth for proper nutrition because their diet consisted of mostly raw and unprocessed foods. Having these four additional teeth or “third molars” allowed for optimal nourishment.

2. Third molars exhibit more variation than any other tooth in the mouth.

Nearly one fifth of the population is missing one or more third molar. In addition, their anatomy is widely variable among patients. Some have one large root and some have tw or three sprawled roots. The age at which third molars emerge into the oral cavity also varies tremendously, with the average being between 17 and 21 years of age. However, it is not uncommon to see third molars erupt earlier or much later than this.

3. Most third molars are recommended for removal.

Occasionally, patients have enough space in their mouth for the third molars to grow in and can maintain them throughout their lifetime. However, these teeth are often difficult to access and clean, which leaves them more susceptible to decay or periodontal disease. Over time, these conditions could impact the otherwise healthy neighboring second molars.

4. Often they do not erupt in alignment with adjacent teeth.

Due to the fact that most patients do not have adequate space in their jaws for complete eruption of the third molars, they can be found in many different orientations. Some are situated horizontally and some angularly. Some are fully covered by bone and/or soft tissues – or “impacted” – and some are just partially covered. Rarely, an impacted third molar may be situated so close to a nerve or sinus cavity that your dentist may opt to monitor rather than remove it.

5. Problems associated with third molars may not cause symptoms.

There seems to be a misconception that if the third molars don’t cause discomfort, they don’t need to be evaluated. However, even if they are impacted, or retained within bone and/or soft tissue, problems can arise such as tumor or cyst formation around the tooth. Such problems can cause destruction of bone, healthy teeth, or other tissues, making the treatment more complicated. By frequent monitoring of the development of the third molars, treatment can be more predictable and conservative.

6. Your dentist will evaluate you to create an individualized treatment plan.

Your dentist will take into account your age, medical history, orientation of the teeth, and proximity of the teeth to structures such as nerves, sinus cavity, and second molars when determining if and when you are a candidate for third molar removal. Most often, a panoramic radiograph will be taken to visualize the third molars and surrounding structures.

7. Timing is very important.

Your dentist will monitor the development of the third molars to determine the ideal time for extraction. The early stage of root development – before these teeth are fully formed – is the optimal time for removal. Once the teeth are ready for removal and it has been determined that removal is the recommended course of action, don’t delay treatment. The healing process is much faster and less eventful in young, healthy patients. Individuals older than 25 may experience a more difficult or prolonged recovery and have an increased risk of complications.

8. Sedation may or may not be right for you.

In addition to local anesthetic to prevent pain during the removal procedure, you and your dentist will determine whether any form of sedation is recommended to control anxiety. Sedation options may include nitrous oxide (“laughing gas”), oral sedation, or intravenous sedation. Patients may drive themselves home after the procedure with nitrous oxide but not with any other form of sedation. Many patients undergo third molar removal with some form of sedation, but not everyone is a candidate. Your provider will create an individualized plan to ensure your comfort and safety.
Your dentist will be able to answer questions you may have, and let you know what to expect. Our goal is to make you feel as informed and comfortable as possible in order to make each dental experience a positive one.

Tuesday, October 10, 2017

Some Important Information About X-rays

Did you know it would take approximately 10000 dental x-rays to reach your annual maximum dose of radiation?

- Each time you fly from coast to coast you receive 4 millirems of backround radiation.....the equivalent of four panoramic x-rays.

- There is backround radiation from things like concrete buildings, roads and even the sun...just standing around you receive more than 3 bitewing x-rays worth of radiation every day.

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Saturday, August 19, 2017

Wednesday, August 9, 2017

Newest State Of The Art Sterilization

We realize the importance of having state of the art technology when it comes to sterilization.  With that in mind we have upgraded our sterilization station to reflect that.  Feel confident, as always, that we are on the cutting edge with our technology at the office of Dr. Jordan Pettigrew.


Thursday, August 3, 2017

Kids Are Consuming 5 Times More Sugar Than They Should: An Interesting Article From The Globe And Mail

Last week, I gave my kids each a can of Coke and two sugar cubes for breakfast. I’ve been serving this to them regularly, although in my defence I didn’t know it.
The meal I’ve been putting on the kitchen table looks like a tableau straight out of a breakfast commercial: Nutella on toast, a bowl of Frosted Flakes, a glass of orange juice. But the combined amount of sugar is a revolting, parental-guilt-inducing 47 grams, the same amount you’d get from washing down a pair of sugar cubes with a Coke.
Of course, you might say, a sugary cereal and chocolate smeared on bread, what was I thinking? But the juice was the worst offender, by a wide margin – and it was 100-per-cent O.J., not from concentrate.
You may have thought, given the marketing, that juice is an “all-natural” part of a healthy breakfast, that it is just as good as, or not much worse than, actual fruit. You would be wrong. Last month, the American Academy of Pediatrics released new guidelines that all but ordered parents to swat juice boxes out of their kids’ hands, stat.
We all want to feed our kids good foods, and to keep their sugar intake under control. But what hope does a parent have when juice jacks your kids up on nearly as much sugar as pop?
Dangerously sweet
The American Heart Association, the Heart and Stroke Foundation, Diabetes Canada and the Childhood Obesity Foundation, among others, have all joined the World Health Organization in calling on parents to reduce their children’s sugar consumption.
“The evidence is extremely clear that excess sugar is harmful to you,” says Dr. Tom Warshawski, chair of the Vancouver-based Childhood Obesity Foundation. “Bottom line, almost everyone is eating unhealthy levels of sugar.”
According to data from the most recent Canadian Community Health Survey, kids consume 33 teaspoons of sugar a day, far above the World Health Organization’s recommendation that sugars ideally make up 5 per cent but no more than 10 per cent of a person’s daily calories.
The health consequences are troubling, to say the least, including an increased likelihood of everything from high blood pressure or heart disease to type-2 diabetes, sleep apnea and depression, as well as bone and joint problems. Obesity rates for children in Canada between the ages of 2 and 17 have tripled in the last 30 years, according to Statistics Canada.
Gulping down 33 teaspoons of sugar a day isn’t a direct route to any one of these conditions, but certainly gets kids pointed in the wrong direction.
The lure of liquid sugars
Keep in mind that a single glass of apple juice contains the same amount of sugar as four or five apples do, without any of the fibre. “Have an orange for breakfast, don’t drink orange juice,” Warshawski advises.
The American Academy of Pediatrics agrees. In its strongest language yet on the subject, the organization declared that fruit juice has absolutely no essential role in healthy diets. “Essential means something you need to have. You simply don’t need fruit juice in your diet,” says Dr. Steven Abrams, chair of the AAP’s committee on nutrition.
And while fruit juice is most easy for parents to mistake for a smart choice, other drinkable sugars are also big problems: Don’t be fooled into thinking that “vitamin-enhanced” energy drinks, sports drinks, flavoured waters or drinkable yogurts are ever a better choice than water or milk.
What else to watch out for
Sugar is in almost every part of a child’s diet, even in foods marketed as healthy choices, not just juice. “It’s not as simple as having kids avoid candy. Most of our kids’ sugar comes from places that we don’t necessarily associate it with,” says Dr. David Hammond, an associate professor in the school of public health and health systems at the University of Waterloo in Ontario.
In a study published earlier this year, Hammond found that 66 per cent of packaged food contains added sugars. It turns up almost everywhere: in baby food, granola bars, yogurt and so on. Given this ubiquity, it can be difficult for parents to navigate sugar in such a way that they keep their kids’ diet below recommended levels.
The study also found that added sugar was labelled in more than two dozen different ways, making a trip to the grocery store even more confusing. “This is not helping consumers,” Hammond says. “We need to simplify this information.”
Doing so would help parents make informed choices, which would likely mean reducing the amount of sugar children eat.
Why this is happening
It doesn’t help matters that when kids aren’t eating sugary foods they are being bombarded by ads for sweet treats.
Kids in Canada between the ages of 2 and 11 are exposed to more than 25 million food and drink ads each year – most of them for junk food – on the 10 most popular websites for children in that age category, according to a study commissioned by the Heart and Stroke Foundation. It was led by Monique Potvin Kent, an assistant professor in the school of public health at the University of Ottawa.
“We haven’t set things up too easy for parents,” Potvin Kent says. “We’ve kind of let food and beverage companies determine what our food environment is.” She’d like to see restrictions placed on marketing to children and teens online in order to limit their exposure to junk food and other sugary items.
“In my view, it’s essential,” she says.
What should I do?
The recommendation is that kids consume at most six teaspoons or fewer of sugar a day, not 33. “No.1, avoid sugary drinks. That is the simplest way to get unnecessary sugars out of your diet,” Warshawski says. As well, eat fresh, whole foods rather than packaged foods as much as possible, and stay away from added sugar whenever you can.
Be aware, too, that there is little to no difference between fructose, dextrose, honey, maple syrup, agave sugar or any other similar sweeteners. All of them cause a spike in blood sugar that is unhealthy. “There’s no evidence it’s any healthier for you than plain old table sugar,” Warshawski says. Whatever sugar you prefer, prioritize moderation, he says.
And yes, while parents should “minimize the treats,” Warshawski also says focusing on cakes, chips or chocolate bars often means missing the more insidious items that children consume daily, especially what you’re pouring in their cups, because sugary drinks are the single largest source of added sugar in a child’s diet. “Nothing is as bad as sugary drinks, quite frankly,” he says.
So, this morning I gave my kids each a bowl of oatmeal and a banana. My daughter asked for Nutella on toast, but she didn’t balk when I told her that from now on it’s a treat she can only have on the weekend.
Then, I poured her a glass of water. She drank it without complaint.

Thursday, July 20, 2017

Keep An Eye On Your Tongue!

What Your Tongue Can Tell You About Your Health

Reasons why you should ‘watch’ your tongue

woman sticking out her tongue
For clues about problems in your mouth, stick out your tongue and look in the mirror. A healthy tongue should be pink and covered with small nodules (papillae). Any deviation from your tongue’s normal appearance, or any pain, may be cause for concern.

If your tongue has a white coating or white spots

A white tongue, or white spots on your tongue, could be an indication of:
  • Oral thrush: a yeast infection that develops inside the mouth. It appears as white patches that are often the consistency of cottage cheese. Oral thrush is most commonly seen in infants and the elderly, especially denture wearers, or in people with weakened immune systems. People with diabetes and those who are taking inhaled steroids for asthma or lung disease can also get it. Oral thrush is more likely to occur after you’ve taken antibiotics.
  • Leukoplakia: a condition in which the cells in the mouth grow excessively, which leads to white patches on the tongue and inside the mouth.  Leukoplakia can develop when the tongue has been irritated.  It’s often seen in people who use tobacco products. Leukoplakia can be a precursor to cancer, but isn’t inherently dangerous by itself. If you see what you think could be leukoplakia, contact your dentist for an evaluation.
  • Oral lichen planus: a network of raised white lines on your tongue that look similar to lace.  We don’t always know what causes this condition, but it usually resolves on its own.

If your tongue is red

A red tongue could be a sign of:
  • Vitamin deficiency: “Folic acid and vitamin B-12 deficiencies may cause your tongue to take on a reddish appearance,” Dr. Allan says.
  • Geographic tongue: This condition causes a map-like pattern of reddish spots to develop on the surface of your tongue. “These patches can have a white border around them, and their location on your tongue may shift over time,” says Dr. Allan. “Geographic tongue is usually harmless.”
  • Scarlet fever: an infection that causes the tongue to have a strawberry-like (red and bumpy) appearance. “If you have a high fever and a red tongue, you need to see your family doctor,” Dr. Allan says. “Antibiotics are necessary to treat scarlet fever.”
  • Kawasaki disease: a condition that can also cause the tongue to have a strawberry-like appearance. It is seen in children under the age of 5 and is accompanied by a high fever. “Kawasaki syndrome is a serious condition that demands immediate medical evaluation,” says Dr. Allan.

If your tongue is black and hairy

Much like hair, the papillae on your tongue grow throughout your lifetime. In some people, they become excessively long, which makes them more likely to harbor bacteria.
 When these bacteria grow, they may look dark or black, and the overgrown papillae can appear hair-like.  Fortunately, this condition is not common and is typically not serious. It’s most likely to occur in people who don’t practice good dental hygiene.
He says people with diabetes, taking antibiotics or receiving chemotherapy may also develop a black hairy tongue.

If your tongue is sore or bumpy

Painful bumps on your tongue can be due to:
  • Trauma: Accidentally biting your tongue or scalding it on something straight out of the oven can result in a sore tongue until the damage heals.  Grinding or clenching your teeth can also irritate the sides of your tongue and cause it to become painful.
  • Smoking: Smoking irritates your tongue, which can cause soreness.
  • Canker sores: mouth ulcers. Many people develop canker sores on the tongue at one time or another.  The cause is unknown, but stress is believed to be a factor.  Canker sores normally heal without treatment within a week or two.
  • Oral cancer:  A lump or sore on your tongue that doesn’t go away within two weeks could be an indication of oral cancer.  Keep in mind that many oral cancers don’t hurt in the early stages, so don’t assume a lack of pain means nothing is wrong.

Watch your tongue!

 Everyone should check their tongue on a daily basis when they brush their teeth and tongue.  Any discoloration, lumps, sores or pain should be monitored and evaluated by a medical professional if they don’t go away within two weeks

Tuesday, June 20, 2017

Please Read This Article......Routine Dental Checkup Could Save Your Life!

SALT LAKE CITY — Rebecca Ward never dreamed a routine dental cleaning would lead to a life-saving surgery.
Her hygienist noticed a canker sore on her tongue and asked her if it had been there very long. Ward wasn't sure how long the sore had been there and didn't think much of it.
Her dentist sent her to an oral surgeon and although she thought that might have been an exaggerated move, she obliged.
The results were a shock.
"They called me the night before the appointment and said, 'We just wanted to make sure you have someone coming with you,'" Ward recalled.
She had oral cancer.
Dr. Jason Hunt, an otolaryngologist with the Huntsman Cancer Institute, said it's not uncommon for people to miss the signs of oral cancer.
"They start out as white lesions that are slightly raised but they're not painful initially and the patient doesn't think much of it. They think, 'Oh, maybe I bit my tongue or bit my cheek,'" Hunt said.
Ward didn't have any of the risk factors.
"No smoking, no drinking," she said. "I actually did an internship with the Utah Tobacco Quit Line."
Hunt said that's not unusual. The cancer institute has a lot of patients who go in with really no risk factors and still develop oral cavity cancer. Often times it's in the middle age, female population, he said.
Hunt recommends if you have a change inside your mouth that persists for more than two to three weeks, have it checked and possibly biopsied. When caught early, oral cancer can be removed without chemotherapy or radiation and with little effect on speech and swallowing. A large, later-stage lesion can require removal of parts of the tongue and mouth, and even the jaw.
Doctors removed Ward's tumor and took skin and fat from her arm to reconstruct her tongue.
"You would never know," Ward said. "People think I have a large piece of gum in my mouth."
Ward is grateful she didn't lose her voice, and now she uses it to warn others.
Some dentists routinely do oral cavity searches to look for lesions, but not all. Doctors recommend asking for one at your next cleaning. The best advice is to be your own advocate and push for something to be done if a sore isn't healing.

Tuesday, June 6, 2017

Some Interesting Information On Antibiotic Prophylaxis

Antibiotic prophylaxis remains a controversial topic in the dental community, even though new guidelines have been released in recent years. Are you familiar with them? This article is an effective summary of the most important highlights the dental professional needs to know for joint replacement, infective endocarditis, stents, and coronary bypass surgery.


My inbox gets a lot of these questions:
“Are you sure about the information about prophylactic antibiotics for joint replacement therapy?”
“What is the most recent guideline about antibiotic prophylaxis for joint replacement? I heard that the recommendations changed.”
“I thought that the patient had to take antibiotics for 2 years or life?”
Considering that over one million Americans have a hip or knee replaced each year, (1) this topic of premedication needs clarification.
You will find your answer very shortly. But let’s start from the top. What is antibiotic prophylaxis? Antibiotic prophylaxis refers to medication which is given in preparation for an operation or other treatment. During some dental treatments, bacteria from the mouth enter the bloodstream. In most people, the immune system kills these bacteria. But in some patients, bacteria from the mouth can travel through the bloodstream and cause an infection somewhere else in the body. Antibiotic prophylaxis may offer these patients extra protection.
This article is an effective summary of the most important highlights the dental professional needs to know for joint replacement, infective endocarditis, stents, and coronary bypass

Joint replacement


Joint replacement is accomplished by removing a damaged joint and putting in a new one. A joint is where two or more bones come together, like the knee, hip, and shoulder. Sometimes, the surgeon will not remove the whole joint, but will only replace or fix the damaged parts. Joint replacement is becoming more common. Up until 2012, antibiotics were recommended for two years after surgery or for a lifetime.


In patients with a history of complications associated with their joint replacement surgery who are undergoing dental procedures that include gingival manipulation or mucosal incision, prophylactic antibiotics should only be considered after consultation with the patient and orthopedic surgeon. (2)
The 2015 ADA clinical practice guideline states that "In general, for patients with prosthetic joint implants, prophylactic antibiotics are NOT recommended prior to dental procedures to prevent prosthetic joint infection.” (3)


In 2012 and 2014, a series of scientific recommendations and systematic reviews found little evidence that dental procedures are associated with prosthetic joint implant infections. (Side note: systematic review refers to the summary of carefully designed healthcare studies and is considered to be evidence of high level.) Other factors such as the potential harms of antibiotics including risk for anaphylaxis, antibiotic resistance, and opportunistic infections such as Clostridium difficile were included in creating the new recommendation.

Supporting resources

Antibiotic dosage and schedule (4)

  • For patients not allergic to penicillin: cephalexin, cephradine, or amoxicillin 2 grams orally 1 hour prior to dental procedure.
  • For patients allergic to penicillin: clindamycin 600 mg orally 1 hour prior to dental procedure.

Infective endocarditis                                                               Infective endocarditis is defined as an inflammation  of the endocardial surface of the heart. Endocarditis generally occurs when bacteria or other germs from another part of the body enter and spread through the bloodstream and attach to damaged areas in the heart. If left untreated, endocarditis can damage or destroy the heart valves and can lead to life-threatening complications.


Prophylactic antibiotics are recommended for patients undergoing dental procedures that involve manipulation of gingival tissue or the periapical region of the teeth, or perforation of the oral mucosa and have the following conditions:
  • “A prosthetic heart valve or who have had a heart valve repaired with prosthetic material.
  • A history of endocarditis.
  • A heart transplant with abnormal heart valve function.
  • Certain congenital heart defects including:
    • Cyanotic congenital heart disease (birth defects with oxygen levels lower than normal) that has not been fully repaired, including children who have had a surgical shunt and conduits.
    • A congenital heart defect that's been completely repaired with prosthetic material or a device for the first six months after the repair procedure.
    • Repaired congenital heart disease with residual defects, such as persisting leaks or abnormal flow at or adjacent to a prosthetic patch or prosthetic device.”5

Numerous scientific evidence concluded that the risk of adverse reactions to antibiotics generally outweighs the benefits of prophylaxis for many patients who would have been considered eligible for prophylaxis in previous guidelines. Concern about the development of drug-resistant bacteria also was a factor for the simplified guidelines.

The 2014 ADA/ACC (American College of Cardiology) guidelines add that optimal oral health is maintained through regular professional dental care and the use of appropriate dental products, such as manual, powered, and ultrasonic toothbrushes; dental floss; and other plaque-removal devices. (6)

Supporting resources

Antibiotic dosage and schedule (7)

  • 1 hour before the procedure to allows the antibiotic to reach adequate blood levels. However, if the dosage of antibiotic is inadvertently not administered before the procedure, the dosage may be administered up to 2 hours after the procedure.
  • Patients not allergic to penicillin: oral amoxicillin 2g (50 mg/kg for children)
  • Patients allergic to penicillin or ampicillin: oral cephalexin 2g (50 mg/kg for children) or clindamycin 600 mg (20 mg/kg for children)



A stent is a tiny wire mesh tube that helps keep the coronary arteries open, which in turn reduces the chance of a heart attack. It is placed with the use of a balloon catheter that expands and locks the wire mesh. The stent is left permanently.


Antibiotic prophylaxis for dental procedures is NOT recommended for patients with coronary artery stents. (7)


Primary prophylaxis for stent placement is not routinely advocated because the overall infection risk is extremely low. In addition, dental, respiratory, gastrointestinal, or genitourinary procedures have not been implicated as causes of bacteremia that have accounted for stent infections. (8)

Supporting resources

Coronary artery bypass

Coronary bypass surgery is a surgical procedure that diverts the flow of blood around a section of a blocked or partially blocked artery in the heart by creating a new pathway to the heart. During a coronary bypass surgery, a healthy blood vessel is taken from the leg, arm, or chest and connected to the other arteries in the heart so that blood bypasses the diseased or blocked area.


Antibiotic prophylaxis for dental procedures is NOT needed in persons who have undergone a coronary artery bypass surgery. (7)


There is no evidence that coronary artery bypass graft surgery is associated with a long-term risk for infection. (7)

Supporting resources

I would like to conclude this summary by emphasizing the need to utilize the evidence supporting the guidelines. I purposely left the details and background information to create a concise article that can effectively provide answers. If you find colleagues and patients who doubt your decisions, be ready to provide scientific proof that can back your professional judgments. Antibiotic prophylaxis guidelines for joint replacements seem to be especially controversial. So, share this article and print out copies for your dental office. Evidence-based decision making protects you, the dental professional and patient.
1. Joint Replacement Surgery: Health Information Basics for You and Your Family. National Institute of Health website. https://www.niams.nih.gov/health_info/joint_replacement/. Accessed May 16, 2017.
2. Antibiotic Prophylaxis Prior to Dental Procedures. American Dental Association website. http://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis. Updated March 17, 2017. Accessed May 16, 2017.
3. Sollecito TP, Abt E, Lockhart PB, et al. The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints: Evidence-based clinical practice guideline for dental practitioners - a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc. 2015; 146(1):11-16 e8.
4. Quinn RH, Murray JN, Pezold R, Sevarino KS. The American Academy of Orthopaedic Surgeons Appropriate Use Criteria for the Management of Patients with Orthopaedic Implants Undergoing Dental Procedures. J Bone Joint Surg Am. 2017; 99(2):161-63.
5. Infective endocarditis. American Heart Association. http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/TheImpactofCongenitalHeartDefects/Infective-Endocarditis_UCM_307108_Article.jsp#.WRT169Lyv6Q. Accessed May 16, 2017.
6. Nishimura RA, Otto CM, Bonow RO, et al.  2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(23):e521-643.
7. Wilson W, Taubert KA, Gewitz M, et al. Prevention of Infective Endocarditis. Guidelines from the American Heart Association. Circulation. 2007;116:1736-1754. doi: 10.1161/CIRCULATIONAHA.106.183095.
8. Baddour LM, Bettmann MA, Bolger AF, et al. Nonvalvular cardiovascular device-related infections. Circulation. 2003;108(16):2015-31