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Archive for the ‘Dental Health’ Category
You’ve been there… with a colleague or friend, talking, and you couldn’t concentrate on what they were saying because their breath could kill a moose! Or, worse… maybe it’s you! You’re not sure. Those sudden steps backwards, averting of the face, premature ending of a conversation could all be signs of mouth malodor.
Bad breath (halitosis) is most often caused by poor oral hygiene, periodontal (gum) disease, dry mouth from colds or medications, food stuck between the teeth, and excessive bacterial growth on the tongue. The main source of oral malodor is usually bacteria getting stuck in the grooves of the tongue. Volatile compounds are the chief perpetrators.
But there is hope. When a chemical called chlorine dioxide is contained in a mouth rinse, it neutralizes these sulphur compounds. Mouth rinses (commercially known as chlosys) and toothpaste containing these sulphur-neutralizing compounds are available in our office. The neutralizing effect of these rinses lasts for eight hours. In contrast, commercially available mouth rinses have been proven to have no significant effect on oral malodor. If you suspect that friends or colleagues have halitosis, please refer them to our office for an evaluation.
Osteoporosis and Osteonecrosis: An Update on Biophosphates
by Mark N. Jacobson, DDS
Biophosphates are a class of medication often prescribed for patients who are diagnosed with osteoporosis, the loss of bone strength and density, and also those on chemotherapy. Popular biophosphate brand names include Avedia, Zometa or Fosamax. Before taking these medications, however, patients should understand the “side-effect risk” of developing osteonecrosis of the jaw.
Osteonecrosis is a condition that often results in permanent and painful destruction of bone in the jaw. Caused by a combination of poor blood supply and impaired bone healing, it is (thus far) resistant to treatment and has become a serious concern of dentists.
For patients with osteoporosis, biophosphates work by inhibiting osteoclasts, the bone cells that dissolve old bone so that the body can build new bone. By slowing down the bone-dissolving osteoclasts, new bone growth is more dense and resistant to fracture. For chemotherapy patients, biophosphates halt the spread of cancer to the bone.
For patients who are contemplating chemotherapy, it is imperative to have a complete dental evaluation before starting therapy. For osteoporosis patients, a dental check-up is advisable to evaluate the health of bones in the jaws. For patients who develop osteonecrosis, the loss of jaw bone can be aggravated by tooth extractions, oral surgery, deep scaling and even dentures rubbing against the jaw.
It is far more effective to prevent osteonecrosis than to try to treat it after bone loss has occurred. In some cases, the most effective treatment is to work with a physician to evaluate an appropriate level of biophosphates or alternatives to biophosophates. Dentists also can give patients who are on biophosphates special treatment. For example, root canals on a hopeless tooth may be preferred to extractions, because removing the tooth start a cascade of jaw bone loss that is difficult to stop.
The latest thinking for patients currently on biophosphates for osteoporosis, is to take a one year “vacation” from taking the medication to allow the body to grow new osteoclasts.
Always let your dentist know if you are taking, or planning to start taking, biophosphates.
Periodontal Disease and Pregnancy Complications
by Mark N. Jacobson, DDS
Any serious medical complications in pregnancy can increase risks to both the mother and fetus. Periodontitis (gum disease) is an infectious condition that affects 23% of women between the ages of 30-54. It can, and should, be treated by a professional before the start of pregnancy or, if necessary, very soon after.
Untreated periodontal disease may increase the risk of unfavorable pregnancy outcomes including preterm deliveries, while also contributing to medical problems that can affect the health of a newborn child after delivery.
A recent joint research study conducted by the University of North Carolina and the University of Alabama documented the link between pregnant mothers with periodontal disease and preterm deliveries. The study concluded that “women with periodontal disease were seven times more likely to deliver low-birth weight babies prematurely.”
Preterm and low-birth weight infants tend to be more susceptible than normal deliveries to impaired lung function and development. They also have a higher risk of developing neurodevelopment problems such as cerebral palsy, blindness, deafness, respiratory problems, behavioral problems, learning problems, cardiovascular disease, diabetes and obesity.
Why does the link between gum disease and preterm deliveries exist? Scientists believe that periodontitis acts as a source of bacteria and inflammatory factors that induce pregnancy complications via the blood. The gums shed bacteria that enters the bloodstream, triggering systematic (whole body) inflammatory responses during pregnancy. Microbiological studies have shown when a fetus is exposed to the mother’s oral bacteria and an inflammatory response occurs, and the risk of preterm delivery rises to about 60%. Also, scientists believe that infectious germs are often passed from mother to child after the birth.
The effective treatment of periodontitis by a qualified dentist focuses on removing bacterial deposits that form in pockets above and below the gumline. The dentist will scale and root plane the gums to help them heal and prevent additional bacterial deposits. In some cases, curettage is done to remove soft tissues within the pockets, making it harder for more bacteria to form.
According to three studies, professional treatment of periodontal disease in infected mothers resulted in a 28% reduction in preterm or low-birth weight deliveries.
And what about “expectant fathers” with gum disease? While clearly there is no danger during pregnancy, it is a good idea for infected fathers to receive treatment before the baby is born, so that there is less risk of germs being passed to the newborn through ordinary handling and contact by either parent.
Why are More and More People Over The Age Of 30 Going to a Periodontist at Least Once a Year?
By Mark N. Jacobson, DDS
Because your periodontist can detect and treat certain gum diseases for which your dentist is not trained. Periodontists are dentists who have extensive training in the diagnosis, treatment and prevention of periodontal disease. They pursue a minimum of two years of specialty training in addition to dental school.
Many people go to a periodontist or are referred to one by their dentist when they notice any of the following symptoms:
- Persistent bad breath;
- Teeth that are spreading or loose;
- Bleeding or tender gums; or
- Pus between the teeth and the gums.
However, you may have gum disease and not have any of these signs. Most people do not experience any pain due to gum disease and then it goes unnoticed. That is why annual periodontal examinations are a good practice.
What is Gum Disease?
Periodontal disease (or gum disease) is the major cause of adult tooth loss, affecting three out of four persons at some time in their life. The main culprit of gum disease is plaque, a colorless, sticky substance that constantly forms on your teeth. If plaque is not removed, toxins destroy the tissue around your tooth, forming “pockets” that attract more plaque. Unless treated, you could eventually lose your teeth.
How is Gum Disease Diagnosed?
With regular visits, your periodontist can detect developing gum disease early, before your gums and the bone around your teeth are irreversibly damaged. A small measuring instrument is gently inserted between the tooth and the gum to measure the depth of your pockets. The depth of the pockets determines the extent of the tooth support damage.
Based on this examination, along with a set of X-rays, your periodontist will discuss a personalized treatment program for your condition.
How is Gum Disease Treated?
In the early stages of gum disease all that may be needed is a scaling and root planning. This simply involves removing plaque and tartar in the pockets around the tooth and smoothing the root surfaces.
However, maybe your case has progressed and surgical treatment is required. With modern techniques and medication, you should feel no discomfort during these procedures.
After surgery, the affected area may be tender or sore. Your periodontist will make sure you have medication to relieve this discomfort. Many patients go back to their normal routine in only a few hours!
Will Gum Disease Return?
While you probably will not need major work in the same area, periodontal diseases are chronic and require constant, careful attention. Periodontal treatment helps control disease and prevents further destruction to the gums and bone, allowing you to keep your teeth.
With an annual visit to your periodontist, and daily brushing and flossing, you can keep gum diseases from becoming more serious or recurring. You don’t have to lose your teeth to periodontal disease.
Tooth-Grinding Wear: Prevention and Repair
By: Mark N. Jacobson, DDS
“I don’t grind my teeth, honest!”
How many times have I heard that comment from a patient? Then, examining the same patient’s mouth, how often do I see yellow dentin between two layers of white enamel – the clear evidence of a “grinder”?
Almost everyone grinds teeth a bit, a tendency that dentists call “bruxism.” But what most patients don’t understand is that grinding isn’t just a behavior – it also has to do with the “bite you were born with.” Some people have an even bite that preserves the enamel and keeps the tooth healthy, while others have a natural bite that doesn’t quite mesh together and, as a result, grinding gradually wears away enamel.
Tooth enamel is the hardest substance in the human body, and yet it can be worn away over time, not by the chewing of food but by rubbing the teeth together. Some patients unknowingly have acid reflux and tooth-grinding in combination with stomach acid can have particularly severe damage.
I tell “grinders” to think of the tooth as a tootsie roll lollypop, with hard enamel on the outside and a softer substance, dentin, on the inside. Once the softer dentin is exposed, the tooth wears away even more rapidly. This can cause the joints to the mandible to become irritated and painful.
Several solutions for tooth-grinding have shown successful results. First, if I suspect that acid reflux is involved, I recommend that the patient consult a gastro-enterologist. Then, I often suggest a mouth guard with a hard outer surface. I have helped patients fit this guard with special planes built in that mimic the shape of the temporomandibular joint. When the jaw moves to the right, left, forward or backward, these planes lift the mandible, keeping teeth from touching and wearing down.
Teeth-grinding is a subconscious habit that can continue during sleep. Because a sleeping patient is not conscious, this grinding can be more damaging to teeth than when awake Therefore, the fitted mouth guard usually should be worn at night. While some patients worry whether the guard will inhibit deep sleep, it usually becomes routine after a couple of nights.
Caution: Athletic mouth guards or any other type of dental guard bought off the store shelf can actually injure the teeth and temporomandibular joints because they lack fitted planes to allow for free movement of these joints. Also, their rubbery grip can loosen the teeth and irritate the joints.
If teeth already have been worn down by grinding, they can be rebuilt so that their natural inclines are restored, and this (along with more awareness of the problem) can protect patients from further grinding damage.
In summary, while many patients worry about grinding, and some have already damaged their teeth because of it, effective treatments exist and can be implemented fairly easily. Nobody needs to go through life with short, stubby teeth with yellow tops. A good dentist can help to prevent or correct this problem, starting as soon as today.
