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Royal Dental Blog

Blood Thinners and Dental Treatments

July 4, 2019

Filed under: Uncategorized — dallasroyaldental @ 8:33 pm

Many dental patients are taking “blood thinner” medications for various medical conditions to prevent the formation of potentially harmful blood clots [e.g: stroke, heart attack, deep vein thrombosis (DVT) or pulmonary embolism (PE)]. However, these medications interfere with the body’s normal clotting mechanism to stop blood flow at a site of tissue injury, which is of concern to dentists for procedures that cause bleeding.

There are two main pathways by which the body normally forms a blood clot. The first involves small blood cells called platelets which clump together at the wound to form a plug which slows the flow of blood through the vessel and forms a matrix. The next phase is coagulation when proteins in the blood interact with each other to fill in the spaces between the platelets, stabilize the clot, and make it more solid until bleeding stops.

Antiplatelet medication [i.e: aspirin, Ticlid (ticlopidine), and Plavix (clopidogrel)] target the first phase of clot formation by preventing platelets from sticking to each other and to the blood vessel walls.  Aspirin does this by creating permanent changes in the platelets which last throughout the lifetime of the platelet (7-10 days) which can only be reversed as the body produces new platelets that have not been exposed to the medication.

Anticoagulant medications [i.e: Coumadin (warfarin)] inhibit the second phase of clotting by blocking production or the function of proteins that stabilize the clot (anticoagulation). For warfarin,  it takes several days after the starting of medication to reach full anticoagulation effect,  and several days after the medication is stopped for the anticoagulation to stop.  In addition many foods and other medications can affect warfarin by either increasing or decreasing activity, therefore the physician needs to frequently monitor (with blood test – See Box to right) for too little or too much anticoagulation activity. There are newer anticoagulants such as Pradaxa (dabigatran), Xarelto (rivaroxaban) and Eliquis (apixaban), which do not need as much time as warfarin to reach full anticoagulation effect, and also to stop that effect when discontinued.  However, their anticoagulation activity cannot be monitored as easily as warfarin.  Lovenox (enoxaparin) is used to prevent PE and DVT, and is given through self-injection.

Some Dental Procedures
Associated with Bleeding
Dental prophylaxis (teeth cleaning)
Scaling and root planning (deep teeth cleaning)
Periodontal (gum) surgery
Tooth extractions
Dental implant placement

Preparations for dental procedure

Most of the time bleeding from dental procedures is not difficult to control and stop, even in patients who are taking blood thinners. However, both the effect of these medicines on clotting and the potential for bleeding from dental procedures varies between each patient. Therefore, for each procedure and patient, the risk of bleeding from the dental procedure must be weighed against the risk of harmful blood clot formation from altering the dose or discontinuing the medication.

The INR is shorthand for “International Normalized Ratio.” It is the primary method that health care providers use to measure the degree of anticoagulation for taking Coumadin (warfarin). For most medical conditions, the expected range for anticoagulation as measured by the INR is 2.0 – 3.5. An  INR of 2.0 roughly means that a person taking this drug takes twice as long to clot than a normal individual.

Your dentist will want you to provide a thorough and complete medical history. Factors that he/she may ask you to provide include: all medical conditions (e.g: heart disease, irregular heartbeat, stroke, liver disease, kidney disease, history of blood clots); all current medications; name of your physician; purpose of antiplatelet and/or anticoagulation therapy medications; anticipated time that you will be on these medications; the results of any monitoring of the effects of these agents (blood test results); and any problems that you have had with your medicines. Your dentist may run some tests before your treatment and consult with your physician before doing the dental procedure. They may do the dental procedure in one of 3 ways: 1) continue taking the medications as normal; 2) change the dose or type of medications or; 3) stop the medication before the procedure.  Furthermore, precautions may be made before, during and after the dental procedure to reduce the risk of significant oral bleeding. Do not discontinue or alter your medications without the advice of your physician and dentist.




Gum Disease in East Dallas May Be Linked to Alzheimer’s Disease

June 26, 2019

Filed under: Uncategorized — tntadmin @ 7:36 pm

elderly couple smiling

Did you know that the most common dental problem in the world is gum disease? About 50 percent of American adults will contract it at some point. While the condition by itself is awful, it can actually cause other health problems. Most recently, it has been suggested to be linked to Alzheimer’s Disease. Since June is Alzheimer’s and Brain Awareness Month, now is a perfect time to examine the connection between Alzheimer’s and gum disease in East Dallas.


Invisalign vs. Smile Direct Club

June 23, 2019

Filed under: Uncategorized — Tags: , , — dallasroyaldental @ 4:20 pm

Invisalign as the brand name is a producer of clear aligners, and they have come a long way since their introduction about fifteen years ago. Recently, however, their patent expired, and other companies such as Smile Direct Club are now able to manufacture clear aligners. Some companies are also offering these treatments directly to patients and eliminate the higher cost, need of an attending dentist or an orthodontist, and of course the convenience of not dealing with dental benefit carriers.

However, there is a catch; aligning teeth is a treatment, and does require evaluation by a dentist or an orthodontist. If a patient has multiple caries or gum disease with bone loss, the outcome of by-passing a dentist could result in far more expensive and costly complications. Not to mention that teeth movements and progress needs constant monitoring by your dentist to make sure your treatment is on the right track.

It is always highly recommended to see your dentist and have a comprehensive oral evaluation to eliminate these complications.  Remember alignment of your teeth is a TREATMENT and should be carefully planned and monitored by a fully experienced provider. The advantage of Invisalign is that your experienced provider is carefully planning and constantly monitoring your progress to get the best result.

Why Do I Need a Crown?

June 16, 2019

Filed under: Uncategorized — Tags: , , , , , — dallasroyaldental @ 10:24 pm

Teeth are subject to heavy tear and wear as the result of strong forces of occlusion (bite), which can cause fractures on teeth, especially teeth with decay, large fillings, and basically with compromised natural structure.

Parafunctional habits such as heavy bruxing or clenching and chewing ice can also cause significant damage to our dentition. These traumas may cause microfractures starting on enamel often time with no significant symptoms. Gradually these fractures may become larger and get deeper close to the nerve of the tooth in which case symptoms of pain with chewing and cold sensitivity will ensue.

Fractured teeth are tricky. The Fracture itself may not be found on xrays or clinically, however with some simple examinations the diagnosis of fractured tooth can be made.

The treatment of fractured teeth varies from restoring teeth first with full coverage crown, and in severe cases root canal treatment and even extraction may be indicated.

Normally, a full coverage crown is recommended for the following:


-fractured tooth not extending to the root

-a tooth with large or gross carious lesion

-a root canal treated tooth (to prevent fracture)

-a tooth with existing large restoration (filling), compromising the natural structure (preventive measure)

-severely worn teeth

-a full mouth rehabilitation



There is a different between a “chipped” tooth and a “fractured” tooth. Often time a chipped tooth, such as chipped incisal teeth, can be conservatively treated with composite resin restorations (bondings), whereas, in fractured teeth the treatment is more involved and simply placing a filling will not fix the problem.

Summer Heat, Dehydration, and Bad Breath!

June 10, 2019

Filed under: Uncategorized — dallasroyaldental @ 4:11 pm





If you’re experiencing bad breath, you will be relieved to hear that there are several simple steps you can take to help alleviate your symptoms. However, it is worth knowing what might be behind your bad breath in the first place.

Bad breath is usually caused by bacteria which gather in the mouth to break down the particles of food that are left over from when we eat. This causes unpleasant smells to form in the mouth, which causes the breath to smell bad.1 Good oral hygiene and a healthy balanced diet are the first steps you should take towards tackling bad breath. However, did you know that dehydration is also a cause bad breath?

Saliva’s role in breath odor

Dehydration is a major cause of bad breath. In a healthy mouth, the saliva keeps your mouth moist and less hospitable to the bad bacteria that are attracted to the decomposing cells and food particles. It also helps maintain the pH levels in your mouth.

When you’re producing a normal amount of saliva, you’re swallowing often which washes away bacteria and dead cells that accumulate on the tongue, gums and cheeks. Saliva also neutralizes acids and prevents plaque from forming on the surface of your teeth.

When you’re dehydrated, your production of saliva decreases and you’re missing out on its antibacterial action.

This is also why we wake up with ‘morning breath’, because your mouth slows down its production of saliva overnight leaving bacteria to breed.

A dry mouth could be caused by a number of factors including medication, not getting enough fluids, or a health condition. Certain antihistamines and antidepressants can cause a dry mouth in some people. Also, breathing through your mouth can lead to a dry mouth. This is why some people experience bad breath after playing sports, as they are breathing rapidly through their mouths causing it to dry out.

The good news is that you can easily help protect yourself against dehydration and a dry mouth by drinking plenty of water, ensuring your diet is healthy and you are not over-consuming caffeine, salt or alcohol as these can all dehydrate the body. The daily recommendation is 6-8 glasses of water, and remember that you can also get your fluids through foods such as fruits, vegetables and legumes.

Metals in Dentistry

June 5, 2019

Filed under: Uncategorized — dallasroyaldental @ 1:29 am

Gold used to be the standard of care in dentistry. Amalgam restorations, better known as the silver fillings, used to be the only option when it came to have your cavities filled. However, materials used in dentistry have changed and improved significantly. In fact, the old silver fillings are almost phasing out of many practices due to patients’ safety and also environmental concerns.

Today, when it comes to material of choice, patients have the options of selecting composite resin fillings, better known as tooth-colored fillings, and porcelain crowns, inlays, onlays, and veneers. These materials have improved significantly to almost match the natural strength and longevity of enamel without compromising the wellbeing of patients.

Whether you need a simple filling or a full coverage crown your dentist is able to custom match the restoration with your existing dentition.

Another advantage of these materials is the minimal requirement to prepare a tooth. For instance, due to their physical characteristics, porcelain laminate veneers can be fabricated as thin as 0.3 mm without compromising the material strength. This minimal tooth reduction eliminates post-operative sensitivity classically associated the aggressive reduction of teeth in order to gain enough room and fabricated thick restoration to withstand strong forces of bite.

There, however, indication in which metal is still used. Gold restorations have proved superb longevity over years of function. The compromise, however, is the esthetics. Porcelain fused to metal (PFM) is also another material of choice where a layer of porcelain is baked over a metal core. In my opinion PFM crowns are excellent but not for front teeth due to their lack of natural translucency, yet could be an excellent choice for posterior teeth specially in cases where severe bruxism is a concern.

Is Pumpkin Bad for Your Teeth? Your Dentist in East Dallas Weighs in

September 18, 2018

Filed under: Uncategorized — dallasroyaldental @ 2:44 am

three orange pumpkins side by side

As we head into fall, one of the fruits people love to eat is the pumpkin. The variations are almost endless, ranging from pumpkin spice latte to pie, and oh, the childhood memories you have related to this storied seasonal fruit. As you continue reading, though, your dentist in East Dallas discusses the pumpkin to reveal whether it’s good or bad for your oral and overall healthy. By applying what you learn, you’ll prevent unwanted dental problems while still being able to enjoy this wonderous fall delight!


Bleeding Gums and Diet

July 3, 2018

Filed under: Uncategorized — dallasroyaldental @ 6:23 pm

bleeding gum tissue around a tooth

We live in a time where people are becoming more and more conscious and careful regarding their diet and maintaining a healthy lifestyle. From different training programs to many, many different diets, we’re always looking for new ways to lose weight and look great. Why? Because we care. Being physically fit gives us a sense of wellbeing and increases our self-esteem. People who are committed to a training program to lose weight and become physically fit usually become more successful and proactive in completing other tasks.

Is there any side effects to any of these diet programs? Not if it is recommended by your physician or designed by a nutritionist based on your physical characteristics and personal goals. However, I do have some concerns as a dentist that I’d like to share with you today.


4 Steps to Choose the Right Cosmetic Dentist

June 23, 2018

Smiling woman in dental chair talking to cosmetic dentistMost general dentists will offer cosmetic dentistry services, and so far, the American Dental Association, has not recognized cosmetic dentistry as its own specialty. So, how do you find a good cosmetic dentist? Don’t trust just any dentist to create a flawless smile. Keep reading this post to learn more about what to look for when choosing the right cosmetic dentist to create your picture-perfect smile.

How to Have a Fast, Convenient Dental Appointment

June 5, 2018

Filed under: Uncategorized — dallasroyaldental @ 9:54 pm

Your busy schedule does not always permit you to spend much time in the dentist’s waiting room or chair. But, you realize the importance of having routine dental care to keep your dental health in check. The good news is that although you can’t actually control the dentist’s schedule, there is a lot you can do at your end to speed up the process. Plus, the smoother your participation goes, the easier it will make the dentist’s and hygienist’s job. Keep reading for some tips on saving time at the dentist’s office.