SERVICE WITH A SMILE
By maintaining good oral-health practices at home and scheduling regular office visits, most patients can avoid many common dental problems. Daily brushing and flossing, and the application of sealants, can help youngsters avoid tooth decay. Adults can avert their most common problem, gum disease, with regular professional care. In cases where tooth loss, breakage, or misalignment does occur, the dentist is expert in a variety of advanced restoration and replacement techniques. In addition, there are a number of cosmetic procedures, including tooth whitening, veneers, and bonding, that effectively remedy chipped, discolored, and gapped teeth. The more patients know about dental health, the better their smiles. In the weeks and months ahead, this column will address all aspects of dental care.
P.S. Flossing is every bit as important as daily brushing in fighting plaque buildup and tooth decay.
DON’T HOLD YOUR BREATH
No one likes bad breath, which is good reason to schedule regular dental cleanings and examinations. These provide opportunities for the dentist and hygienist to check for gum disease, which can cause bad breath. At the same time, it’s important to note that a number of medical conditions can also be responsible. Dry mouth, sinus infections, bronchitis, respiratory infections, and gastrointestinal disorders should also be mentioned to the dental professional who’s trying to identify the source of bad breath. Also bear in mind that more serious conditions (such as diabetes, some cancers, and kidney and liver failure) can produce chemicals that lead to bad breath. If any of these are suspected, a referral to a specialist will be provided.
P.S. Along with brushing and flossing, tongue-scraping helps prevent bad breath.
Despite the fact that local anesthetics block the pain associated with any dental procedure, some patients would rather suffer the agony of a toothache than sit in the dentist’s chair. Fortunately, the dentist can help fearful patients overcome their anxiety by treating them with one of a wide range of sedation options. The most minimal of these is nitrous oxide (“laughing gas”), which is inhaled through a mask over the nose and leaves the patient relaxed and awake. Oral sedation, which can range from minimal to moderate (depending on the dosage), involves simply taking a pill (Halcion) about an hour before the procedure. The patient remains awake but drowsy. Drugs can also be administered intravenously for more immediate effect.
P.S. Nitrous oxide has been in use in dentistry as an anesthesia since late 1844.
REDUCING ATHLETES’ CONCUSSION RISK
Everyone from young soccer players to professional football players is vulnerable to concussions, which has become an issue of great concern. One way that parents can reduce their children’s risk of experiencing a sports-related concussion is to have them outfitted with custom-made, properly fitted mouth guards that dentists provide. According to a study of more than 400 high school football players, those wearing store-bought, over-the-counter mouth guards were more than twice as likely to suffer mild traumatic brain injuries (MTBIs)/concussions than those wearing custom-fit mouth guards. Previous research has speculated that mouth guards can reduce concussion risk by helping absorb shock, stabilize the head and neck, and limit movement caused by a direct hit to the jaw.
P.S. Because custom-made mouth guards are more comfortable than over-the-counter versions, athletes are more likely to wear them than take them out and chew on them.
NIGHTTIME MOUTH-BREATHING DANGER
If you wake up with a dry mouth, you may be breathing through your mouth while you sleep. If so, you should know that nighttime mouth-breathing has been linked with an increased risk of dental erosion and tooth decay. The problem is that breathing through your mouth dries up saliva, which plays a vital role in preserving dental health. As saliva levels drop, the oral environment becomes increasingly acidic, which leads to loss of tooth enamel through erosion (the direct effect of acid without the influence of bacteria) and tooth decay (the effect of bacteria breaking down foods to produce acid). Mouth-breathing and dry mouth should be brought to the attention of your dentist, who can recommend treatment.
P.S. Researchers found that pH levels (a measure of acidity/alkalinity) of mouth-breathers dropped to 3.6, which is well below the 5.5 threshold at which tooth enamel begins to break down.
As a consequence of looking at images that they have taken of themselves with cell phones, some people are scheduling appointments with their dentists for cosmetic work. This self-perceived problem stems from the fact that “selfies” are taken at close distance, which produces a distorted image of their teeth. As a result, the front top teeth appear to be overly large, making them look “horsey.” This problem of “dental dysmorphia” is often compounded when the light of an unflattering flash emphasizes the prominence of the front teeth. The good news is that dentists are quick to point out that it is proper and natural for the front top teeth to be a little more dominant than teeth on either side.
P.S. In cases where teeth are overly large, tipped, or have uneven edges, the dentist can “contour” their shapes by selectively removing enamel.
ESOPHAGEAL CANCER LINKED TO GUM DISEASE
Cancer is not one disease. It is, instead, a group of diseases with a variety of different causes and treatments. As researchers delve into the many possible causative factors, they uncover information that may seem unlikely and surprising. One such discovery recently came to light when researchers found that a bacterium (Porphyromonas gingivalis) that contributes to gum disease was present in nearly two-thirds (61 percent) of the cancerous tissue samples taken from patients with esophageal cancer. This type of cancer begins in the tube that moves food from the throat into the stomach. It is difficult to diagnose in its early stages, and usually progresses rapidly. The hope is that treating gum disease may help prevent its occurrence.
P.S. If it is proven that P. gingivalis actually causes esophageal cancer, a dental exam may become a screening tool for the disease.
FIXING UNDERSIZED TEETH
When a permanent second tooth on either side of the upper front teeth does not fully develop, the small, pointed, cone-shaped incisor is referred to as a “peg lateral incisor.” Because these underdeveloped teeth seriously detract from the attractiveness of a smile, correction is needed. In some cases, the dentist may elect to augment a pegged tooth with bonding material. While this option is relatively quick and inexpensive, the composite material used for bonding does not have the luster of natural enamel. It is also likely to become dull and more prone to staining over time. Porcelain veneers, however, may be more expensive and take longer to complete, but they look much more natural and last a great deal longer.
P.S. Some patients with peg lateral incisors have parents with the same condition.
LIFELONG CARE FOR DENTAL RESTORATIONS
Whether dental restorations such as crowns, bridges, and veneers are supported by natural teeth or implants, they require lifelong care. Newly revised guidelines recommend that patients with dental restorations visit their dentists at least every six months so that the dentist and/or hygienist can clean, adjust, repair, or replace their restorations. The dental team can also advise patients with dental restorations about home maintenance. Dental restorations made of composite materials, metal alloys, porcelain, plastic, and other manmade materials collect dental “plaque” (the sticky bacterial film that constantly forms on the teeth) that must be removed with daily brushing and flossing. Otherwise, these colonies of germs will harden into tartar, compromise restorations, and threaten gum and bone health.
P.S. Tartar is calcified (hardened) plaque that can only be removed by sharp tools in the dentist’s office.
LEARNING THE ROPES
There are numerous kinds of floss from which to choose in order to meet your flossing needs. While unwaxed floss is best for closely spaced teeth, waxed floss is more resistant to breaking but more difficult to use in tight spaces. For cleaning between teeth that are loosely spaced, dental tape (waxed or unwaxed) is a good choice because it is broader and flatter than traditional floss. Yarn-like “super floss” is stiff enough to be threaded through implants, bridges, and other dental restorations. If you have difficulty holding floss and/or fitting your fingers into your mouth, try using the Y-shaped plastic tool known as a floss holder, which holds a length of floss between two prongs.
P.S. In addition to dental floss, small spiral brushes known as “interproximal brushes” clean gaps between teeth and around prosthetic restorations. “Irrigation devices” send pulsating streams of water between teeth to flush out debris.
SUGAR-FREE DRINKS DAMAGE TEETH, TOO
While many people believe that sugar-free beverages do not pose a danger to teeth, the fact is sugar-free drinks and confections can be as damaging as their sugary counterparts. It is important to know that, whether or not a drink contains sugar, it is the acid in those drinks that does the damage. Sugar is linked with tooth decay because it creates plaque on the tooth enamel that bacteria digest and convert to acid, which etches away at enamel to cause decay. With this in mind, even with the sugar removed, drinks containing acid will also erode tooth enamel. According to a recent study, the majority of soft drinks and sports drinks cause measurable loss of tooth enamel.
P.S. When drinking soft drinks and sports beverages, look for acidic additives such as “citric acid” and “phosphoric acid” on their label of ingredients.
ADVANCED SLEEP APNEA TREATMENT
Nighttime snoring is not only annoying, but it may also be indicative of a far more serious problem. “Sleep apnea” is a common sleep disorder characterized by pauses in breathing, snorting and choking noises, and instances of shallow breathing. “Obstructive” sleep apnea occurs when muscles at the back of the throat (which support the soft palate, the uvula, the tonsils, the side walls of the throat, and the tongue) relax to the point where the airway narrows/closes when breathing in. To treat this form of sleep apnea, the dentist can make a “mandibular advancement device,” which works by moving the jaw forward and increasing the size of the airway, thereby reducing the air resistance that causes snoring and sleep apnea.
P.S. Recent research suggests that mandibular advancement devices are effective at reducing blood pressure in patients with hypertension.
THE X FACTOR
If you are concerned about exposure to radiation from dental x-rays, you should know that a routine exam, which includes four bitewing x-rays, is equivalent to less than one day of natural background radiation or a short plane trip (1-2 hours). By properly shielding patients’ bodies while taking x-rays, the radiation exposure is even lower. New patients are encouraged to get posterior “bitewings,” which include molars and premolars, plus more extensive x-rays, such as panoramic (which create a single image of the entire mouth including upper and lower jaws) or periapical (which highlight two to three teeth at a time, from root to crown). After that, patients at low risk for decay can get bitewings every 24 to 36 months.
P.S. Digital x-rays involve even (significantly) less radiation exposure than film x-rays.
WHITE DONE RIGHT!
An American Academy of Cosmetic Dentistry survey indicates that 99.7% of adults believe that a smile is an important social asset, which helps explain why tooth whitening is one of the most popular cosmetic dental procedures. Professional tooth whitening is particularly effective because dentists are permitted to use hydrogen peroxide at the 6% legal limit. Because the chemical agents used to whiten teeth are so tightly regulated, the whitening power of over-the-counter products is restricted. Professional tooth whitening is also conducted under carefully controlled conditions. While the dentist uses custom trays to deliver whitening agents, over-the-counter trays are often so ill-fitting that gums become irritated and damaged. For this and other reasons, professional tooth whitening is the way to go.
P.S. With today’s dentist-supervised systems, even patients with sensitive teeth can undergo tooth whitening treatment.
One of the finer points of a root canal procedure involves protecting patients from bacterial infection with the use of a “dental dam.” This involves placing a soft latex or silicone shield over the patient’s teeth and holding it in place with a clamp so that only the affected tooth pokes through an opening in the shield. This procedure, recommended by the American Association of Endodontists (root canal specialists), prevents the patient’s saliva from getting into the tooth and contaminating the root canal with bacteria. It also protects the patient’s mouth from the strong disinfectants that are used to clean the root canal. With the dam in place, patients can still breathe through their mouths and noses, yawn, swallow, and cough.
P.S. Research shows that the success rate of root canal treatment is higher if a dental dam is used.
CLEAN TEETH, CLEAR MIND
Older patients have more to gain by visiting the dentist for regular checkups than simply maintaining healthy teeth and gums. As researchers continue to explore the notion that oral health and many diseases may share a common inflammatory pathway, new evidence has emerged that links oral health with cognitive well-being. While this research is in its nascent stage, it is an important area of study. About 36% of people in this country over the age of 70 are living with some degree of cognitive decline. The likelihood and severity of cognitive decline tend to increase with age. Concurrently, a higher rate of oral disease has been observed among seniors suffering from cognitive impairments. Improved oral health may improve their outlook.
P.S. Many people with dementia are often unable to properly maintain their oral health as their overall health declines, which could alert dentists and hygienists of the early stages of dementia.
THE THIN VENEER OF RESPECTABILITY
If your front teeth are severely discolored, misshapen, chipped, cracked, or otherwise imperfect, you may be interested to know that their appearance can be dramatically improved with the application of “porcelain veneers.” These ultra-thin porcelain shells are an excellent alternative to crowns in many situations that require a more conservative approach to changing a tooth’s color, size, or shape. A three-step treatment plan, which includes planning, preparing, and bonding the veneers in place, provides results that are unsurpassed in their cosmetic beauty and longevity. Porcelain veneers more closely approximate the look of natural teeth in terms of color, luster, and luminosity than any other material. Their outstanding strength and abrasion resistance ensures that they will last many years.
P.S. Porcelain veneers are an excellent choice for reducing gaps between front teeth.
TREATING GUM RECESSION
The term “gum recession” refers to the process in which the margin of gingival (gum) tissue surrounding each tooth pulls back or wears away. As a result, “pockets” (gaps) develop around teeth that can trap the bacteria that threaten tooth and bone health. At the very least, anything more than mild recession of the gingiva results in greater tooth-root sensitivity to hot and cold, as well as an unsightly appearance. To remedy these functional and cosmetic problems, a gingival graft may be sutured in place around the tooth to replenish any deficiency. The graft consists of a thin piece of tissue taken from the roof of the mouth or from adjacent gums. The results are both permanent and highly effective.
P.S. Aside from gum disease, gum recession can be caused by overly aggressive brushing, hormonal changes, smoking, grinding teeth, or a misaligned bite.
THE DIABETES FACTOR
Diabetes has been associated with numerous wide-ranging health risks, and tooth loss may be one of them. When researchers reviewed data collected from more than 37,000 adults aged 25 years and older, they found that diabetics lost their teeth at twice the rate of non-diabetics. In addition, the study revealed that people with periodontal (gum) disease were more likely to have diabetes than people with healthy gums. While researchers could not pinpoint a specific causal link between diabetes and tooth loss, they emphasized that their findings were consistent with other chronic diseases (such as heart disease, respiratory disease, and cognitive disease) that are also associated with poor oral health. Regular dental visits are as important as exams by other doctors.
P.S. Previous studies have found that people with diabetes are less likely to floss and brush as often as people without diabetes. They are also more likely to skip annual dental exams.
SMOKING CHANGES ORAL ENVIRONMENT
According to the Centers for Disease Control and Prevention, there are 16 million people living in this country with a smoking-related illness. Because more than three-quarters of cases of oral cancer are thought to be linked to smoking, researchers sought to find out why. There are approximately 600 species of bacteria in the human mouth. One study (all participants were age 50 and older) focused on comparing the oral bacteria of smokers with those of non-smokers. It was found that the oral environment of smokers was very different from that of non-smokers and ex-smokers. Levels of 150 species of oral bacteria were significantly higher in smokers, including ten percent more species of Streptococcus, which is known to promote tooth decay.
P.S. According to the research mentioned above, it takes approximately ten years for oral bacteria to return to normal levels after a smoker quits.
Inflammation has been likened to fire in that it is a smoldering process that has the potential to injure tissues, joints, and blood vessels. “Acute inflammation” helps the body deal with injury and disease by introducing white blood cells that surround the injured or diseased area and fight off invaders that might cause infection. This explains why cuts and bruises lead to redness, heat, and swelling around tissues and joints. On the other hand, when “chronic inflammation” sets in, white blood cells flood the problem and end up attacking healthy tissues and organs nearby. With this in mind, it is important to treat the inflammation associated with gum disease because it can lead to tooth loss and problems elsewhere.
P.S. Inflammation can travel all over the body, which is why chronic gum disease can contribute to heart disease and other health issues.
It is estimated that one-third of Americans over 65 have either dentures or some other type of prosthetic replacement tooth. Although dentures provide patients with a functionally and cosmetically acceptable way to replace teeth at a reasonable cost, they do have a drawback. Because our jawbones tend to shrink as we age, even well-fitting removable dentures tend to become loose. One way to address this problem is with the use of a dental implant (or implants). Because titanium implants are surgically embedded in the jawbone, where they eventually fuse with the surrounding bone, they provide a solid point of attachment for bridges or crowns. This means that replacement teeth will remain firmly in place, providing a newfound sense of security.
P.S. The number of implants necessary for a full-arch, fixed bridge varies depending on the patient’s specific anatomy, the opposing teeth, the type of bridge desired, and the number of teeth that need to be replaced with the prosthesis.
Because “plaque” is constantly growing in the mouth, it is important to brush and floss teeth to prevent it from building up on tooth surfaces and hardening into “tartar.” Plaque is a sticky bacteria-laden film that forms continuously around teeth and gums and can cause real problems if it is not removed within 24 hours. Bacteria in plaque do their damage when they convert sugars and starches from food into enamel-dissolving acid and toxins that inflame the gums and cause them to pull away from teeth. As a result, tooth root surfaces become exposed, leaving them susceptible to cavity formation. When plaque is allowed to accumulate, it hardens into tartar, which requires professional treatment to remove with specialized scraping instruments.
P.S. While plaque is nearly colorless, tartar (also known as “calculus”) is characterized by tooth discoloration and staining.
BE HAPPIER WITH YOUR SMILE
By some estimates, one in four adults avoids smiling because he or she is embarrassed about the appearance of his or her teeth. As a result, these self-conscious individuals are more likely to withdraw from social and work situations, in which case, they are less likely to meet the person (or get the job) of their dreams. Fortunately, cosmetic dentistry provides a chance to overcome problems such as discolored, chipped, or widely spaced teeth. Through the use of cosmetic whitening, tooth-colored fillings, dental bonding, porcelain laminate veneers, custom tooth crowns, and other tooth-enhancing techniques, the dentist can make any smile more attractive. If your smile is undermining your confidence, you owe it to yourself to schedule a consultation.
P.S. If you have crooked, overlapping, or chipped teeth, the dentist can use a technique called “tooth sculpting” to reshape and contour tooth enamel.
Sugar and carbohydrates are not the only things we ingest that have the potential to damage teeth. Many of us also eat foods and drink beverages that contain acids that contribute to “dental erosion.” This underappreciated problem, which affects as many as 20% of the population, begins with softening (demineralization) of the enamel and underlying dentin, which results in diminished tooth structure. Dental erosion can also result from brushing too forcefully, tooth-grinding, and medications taken by older patients that reduce saliva flow. To prevent dental erosion from occurring, patients are urged to consume fewer acidic beverages, limit consumption of citrus fruits, and use toothbrushes with soft bristles. They should also try to at least rinse teeth after eating.
P.S. By chewing sugarless gum, you can increase the flow of saliva, which helps to mineralize teeth.
IN-OFFICE TOOTH WHITENING
If you are wondering whether professional in-office tooth whitening offers any advantages over the tooth-whitening available in a pharmacy, you can begin with efficacy. While tooth-whitening systems developed for home treatment are restricted to using low-dose whitening agents, in-office whitening procedures are conducted under the careful supervision of dental professionals, who use high-concentration whitening gels to “power whiten” teeth in a single session. During this time, the dentist will either apply a protective gel to your gums or a rubber shield that protects your gums from irritation. At the same time, a special light or laser might be used to enhance the action of the whitening agent. No other tooth-whitening method is as quick or effective.
P.S. In-office tooth-whitening procedures offer the best whitening gels and techniques for avoiding tooth-sensitivity issues.
BRIDGING THE GAP
When one or more missing teeth must be replaced, the dentist will likely recommend a “bridge.” This prosthetic device is made of artificial teeth that are fused to a metal frame. This is held in place on either side by virtue of attachment to implants or healthy teeth that are outfitted with crowns. The anchoring teeth are called “abutments,” while the replacement crowns between them are known as “pontics,” which can be made of gold, alloys, porcelain, or a combination of materials. In some cases, a “Maryland bridge” may be used to replace a single tooth. This type of bridge attaches to teeth on either side with metal strips that are bonded to the back of adjacent teeth.
P.S. An alternative to the Maryland bridge is an Encore bridge, which is made entirely of tooth-colored materials.
SEALANTS PREVENT CAVITIES
One of the most effective ways of preventing cavities from forming in the teeth of young children is to coat the chewing surfaces of permanent back teeth (molars and premolars) with a plastic coating that protects them from decay. Research shows that “dental sealants” are quick, easy, and painless to apply and could prevent up to 80 percent of cavities in school-aged children. Yet, a recent report from the CDC indicates that about 60 percent of school children ages 6-11 years do not get dental sealants. To help bridge this gap, parents are urged to inquire about this very worthwhile treatment for their children. It is far more cost-effective to prevent cavities than to fill them.
P.S. Research shows that dental sealants prevent 80 percent of cavities for two years after application and continue to protect against 50 percent of cavities for up to four years after placement.
CARING FOR DENTURES
While dentures are not subject to decay, they do accumulate plaque, tartar, and stains. With this in mind, it is important to care for dentures much the same way natural teeth are cared for (except dentures are cleaned outside the mouth). This entails brushing dentures with a non-abrasive cleanser at least once a day. They should then be soaked in a mild soaking solution and thoroughly rinsed in water before being placed back in the mouth. Dentures should never be soaked in products containing bleach or placed in boiling water, which can cause them to deform. It should also be pointed out that a little dental adhesive goes a long way. Only two to three pea-sized dollops are needed.
P.S. Denture wearers should take a break from wearing dentures to minimize gum irritation.
Receding gums, known as “gingival recession,” is a common condition that occurs when the gum tissue that normally surrounds the tooth pulls back and exposes the tooth root. If the recession goes untreated and becomes severe, there is increased risk that the exposed tooth root will become decayed and/or infected. If gum recession is caused by physical wear of the gums by vigorous brushing or the use of a toothbrush with hard bristles, the dentist will recommend a softer brush and better brushing technique. If gum disease is at the root of the problem, the dentist will work to remove built-up plaque and tartar accumulations. Tooth-colored composite resins may also be recommended to cover exposed root surfaces.
P.S. Age is a leading risk factor for gum recession, with 88 percent of people over the age of 65 having receding gums in at least one tooth.
MEDICATED DENTAL IMPLANT
The future of dental implants may include those with a built-in reservoir that contains slow-release drugs, which will eliminate “bacterial biofilms” that may lead to infection. These implants, which are currently in the research phase, are made of porous composite material through which the drugs can gradually diffuse from the reservoir to the outside of the implant. Biofilms are aggregates of bacteria in a slime-enclosed mass, which are very difficult to treat. When bacterial biofilms become chronic, they are extremely resistant to antibiotics. Researchers have found that by filling the reservoirs in the medicated dental implants with chlorhexidine (a powerful antimicrobial found in mouthwashes), they were able to stop Streptococcus mutans and halt the formation of biofilms.
P.S. Streptococcus mutans is a common oral bacterium that attacks teeth.
SPOTTING SIGNS OF DISEASE
A thorough dental examination may reveal more than signs of tooth decay and gum disease; the dentist is in a unique position to spot signs of other diseases, as well. For instance, signs of mouth dryness may be indicative of diabetes. While patients may not realize that their reduced saliva production is an issue until it decreases by half, the dentist may see signs of dry mouth much earlier. Diabetes also increases vulnerability to oral infections that create swelling around the teeth, in the gums, and in other areas of the mouth. In addition, the dentist may notice fungal infections (such as thrush, which produces white patches in the mouth) that may be evidence of diabetes.
P.S. Aside from diabetes, the dentist may see signs of Crohn’s disease, heart disease, cancer, and rheumatoid arthritis while conducting a dental exam.
THE IMPORTANCE OF TREATING A TOOTH INFECTION
When chewing or tapping on a tooth causes it to feel tender, it may be a sign of “apical periodontitis,” inflammation at the root’s tip that is most often caused by tooth decay. To relieve the pain and treat the underlying infection, patients undergo “root canal” (or “endodontic”) treatment, during which the inflamed or infected pulp is removed and the inside of the tooth is carefully cleaned and disinfected. It is then filled and sealed with a rubber-like material (gutta-percha). After that, the tooth is restored with a crown or filling. This treatment addresses the localized infection and inflammation, but new research reveals that it may also reduce the risk of coronary artery disease, thereby benefitting the heart as well.
P.S. According to Finnish researchers, patients with untreated apical periodontitis were found to be 2.7 times more likely to have acute coronary syndrome than patients with no infection.
TOOTH INFECTIONS LINKED TO HEART DISEASE
Regular dental checkups and conscientious oral care at home can pay big overall health dividends. The latest evidence of these benefits comes from a study’s finding that “acute coronary syndrome” (sudden blockage in the blood supply to the heart) is 2.7 times more likely among those with infections at the tip of a tooth root, even if there are no evident symptoms. Dental examinations of people suffering from acute coronary syndrome (with symptoms of shortness of breath, chest pain, dizziness, and nausea) revealed that over half (58 percent) suffered from inflammatory lesions at a tooth’s root tip, called “apical periodontitis.” An estimated one person in four suffers from at least one tooth infection, with cavities as the most common cause.
P.S. Apical periodontitis is caused by bacterial invasion of the pulp of the tooth, which may be detected on dental x-rays.
CHEW YOUR FOOD
Most mothers have told their children not to gobble down their food and eat it more slowly. As it turns out, this piece of advice is as wise as almost every other bit of guidance that mothers give their children. Chewing food completely (try ten times per bite) not only helps with digestion and nutrient absorption, but it may also help protect against infection. Researchers recently found that chewing food (known as “mastication”) can stimulate the release of “T helper 17” (Th17) cells in the mouth, which fight off harmful bacteria. However, too many Th17 cells can be counterproductive to the health of the gums. Researchers hope to find a healthy balance that might someday lead to reduced infection.
P.S. Because it takes approximately 20-25 minutes for the hormones in your body to reach your brain to tell you that you are full, eating slowly helps prevent overeating.
For patients with minor dental irregularities, “dental contouring” or “reshaping” provides a relatively easy remedy. This cosmetic procedure involves removing small amounts of enamel to minimize or alleviate imperfections. For instance, chipped or fractured areas can be smoothed out, and specific angles or edges can be rounded or squared. Tooth reshaping can also be undertaken to alter the shape, length, contour, or position of a tooth and its relationship to adjacent teeth to improve the look of a smile. The technique can also be used to reshape overlapped teeth, as well as to minimize the appearance of crowding. Dental contouring may even be used to correct developmental imperfections and abnormalities such as pitting and grooves in the enamel.
P.S. Tooth reshaping does not usually require an anesthetic and often provides instant results.
ZEROING IN ON XEROSTOMIA
It is important to properly diagnose the cause of “xerostomia” (dry mouth) in order to treat it properly. While many older adults incorrectly assume that xerostomia is a natural part of aging, it is more likely to be a side effect of the 400 or so medications that can affect the salivary glands, including antihistamines, decongestants, antidepressants, diuretics and other hypertension medications, drugs used to treat Parkinson’s disease, chemotherapy drugs, and medication used to treat dementia. Additionally, dry mouth may be caused by radiation to the head and neck; nerve damage affecting the salivary glands; and conditions such as the autoimmune disorder Sjögren’s syndrome, diabetes, and HIV/AIDS. For chronic xerostomia, a prescription-strength fluoride gel may be needed to protect teeth.
P.S. If left untreated, xerostomia can lead to speech and eating difficulties, halitosis (bad breath), an increase in the number of dental cavities (saliva helps prevent tooth decay), and infections in the mouth (such as thrush).
DETECTING ORAL CANCER
Last year, approximately 48,000 new cases of oral and throat cancer were diagnosed in the United States. Because dental checkups involve a close look at oral tissues, dentists are often the first to spot oral cancer, which may first appear as red or white patches or sores that do not heal on the tongue, insides of the cheeks, floor of the mouth, hard and soft palates, and elsewhere in the mouth and throat. It is crucial these signs be detected early with regular dental checkups and oral monitoring. Otherwise, mouth and throat cancers tend to be diagnosed when the disease is more advanced, leading to a five-year survival rate of only 63%. Symptoms should be brought to the dentist’s attention.
P.S. Symptoms of oral cancer include loose teeth for no apparent reason, a painful tongue, a lump or thickening of the skin or lining of the mouth, a sensation that something is stuck in the throat, and persistent swelling.
SIPPY CUPS, FRUIT JUICE, AND DENTAL EROSION
The American Academy of Pediatrics’ (AAP) revised guidelines on children’s fruit juice consumption calls for a halt to fruit juice for babies under one year of age. While parents might assume that a drink containing “100 percent fruit juice” is healthy, the AAP warns that the drink provides “no nutritional benefit.” And although such drinks may contain some vitamins and minerals, they may also contain up to two teaspoons of sugar per 100-milliliter serving and high amounts of acid that contribute to dental erosion. The AAP recommends no more than 4 ounces of fruit juice for toddlers aged 1-3 years. The use of sippy cups is also discouraged because they allow juice to pool around teeth for prolonged periods.
P.S. Babies should not be allowed to go to sleep with a bottle containing milk or formula since this habit can lead to “baby bottle tooth decay.”
DENTAL CARE CUTS PNEUMONIA RISK
There has been a lot of accumulating evidence that good oral care helps preserve health in other parts of the body. For instance, there is research showing a link between dental care and critically ill patients. Most recently, this link has been expanded to include the general population, as data from a national survey suggests that people who never undergo regular dental checkups have nearly twice the risk of getting bacterial pneumonia as those who visit their dentists twice a year. The fact is that there is a direct connection between the mouth and lungs through which bacteria can be breathed in. This study confirms the need to include dental checkups as part of a comprehensive approach to wellness.
P.S. “Aspiration pneumonia” is the term used to describe a lung infection that occurs after food, liquid, or vomit is inhaled into the lungs.
The term “toothbrush abrasion” refers to brushing one’s teeth so vigorously that tooth enamel becomes damaged and gums recede. This overly energetic brushing leads to thinning enamel and exposed roots that become overly sensitive to hot and cold foods and drink. Avoiding this potential problem begins with selecting a toothbrush with soft bristles that flex enough to get into the gum margin without hurting delicate gum tissue. It should also be pointed out that cavity-causing plaque is a soft, loose film that can be removed from tooth surfaces without hard scrubbing. With this in mind, care should be taken not to scrub one’s teeth as if scrubbing a grouted tile surface. Teeth should be brushed with a gentle up-and-down motion.
P.S. If your toothbrush looks frayed after only a few weeks of use, it is likely a sign that you are brushing your teeth too forcefully.
Once the average American adult has reached age 50, he or she has lost 12 permanent teeth to decay, injury, or gum disease. It is important that these missing teeth be replaced so that the bite will not be altered and the jawbone will not weaken. In order to address all these potential adverse consequences of tooth loss, it is important to restore full function to the mouth and jaws. To this end, a dental implant is the preferred option for replacing a single lost tooth. When screwed into place in the jaw, a titanium implant acts as a replacement for the tooth root to which a porcelain crown can subsequently be attached. Implants look and feel natural.
P.S. Missing teeth can compromise overall health by decreasing biting and chewing ability and limiting nutrient intake from food.
THE HOLE TRUTH
It is important to distinguish between caries, the Latin word for decay, and a cavity, which is the hole that occurs if the caries has destroyed the tooth enamel and penetrated the tooth’s dentin. Caries may first appear as a white or brown spot on tooth enamel. It is an indication that bacterial acids have begun to dissolve calcium and phosphate in the tooth enamel (demineralization). If it is detected early enough, it is possible to remineralize the enamel and stop decay by cleaning the teeth thoroughly, applying topical fluorides, and removing plaque. Otherwise, once a cavity forms, remineralization cannot fill it up. Left untreated, a cavity will continue to grow until it destroys the entire crown of the tooth.
P.S. Dentin is the bone-like tissue that makes up the largest portion of the tooth.
CATCH-22 FOR DIABETICS
Diabetics have every reason to keep their blood sugar under control with medication and healthy habits. One potential complication they face is an increased prevalence of gum disease because they are generally more susceptible to bacterial infection and have a decreased ability to fight invasive bacteria. Complicating the situation even further is emerging research showing that not only are people with diabetes more susceptible to serious gum disease, but serious gum disease may have the potential to affect blood glucose and contribute to the progression of diabetes. To put it simply, the relationship between diabetes and gum disease is a two-way street. Diabetics must be diligent about their brushing and flossing habits, as well as controlling their blood sugar levels.
P.S. Due to their higher susceptibility to serious gum disease, diabetics face a higher risk of bone loss (in the jaws) and subsequent tooth loss.
Ordinarily, a person produces between 0.75 and 1.5 liters of saliva daily, with peak production occurring during meals and the least amount of saliva being produced during sleep. However, it sometimes happens that people produce too much saliva, a condition known as “hypersalivation.” As a result, saliva can spill over the bottom lip (drooling). This condition can be constant or intermittent, temporary or chronic. Causes may range from sinus infections, morning sickness, and poisonous spider bites to excess saliva production, compromised swallowing ability, and difficulty keeping the mouth closed. False teeth, oral ulcers, an enlarged tongue, or poor tongue mobility may also play a role. The goal of diagnosing hypersalivation is to pinpoint the cause and recommend the best treatment.
P.S. Difficulty swallowing or clearing saliva from the mouth may also be associated with underlying conditions such as Down syndrome, autism, stroke, and Parkinson’s disease.
THE DRILL ALTERNATIVE
When told that there is an alternative to the traditional drill used for removing tooth decay, some might think that it involves a laser. While there are lasers that can perform some dental tasks, something as old as “air abrasion” can be utilized to remove smaller pockets of tooth decay painlessly and without local anesthetic. “Kinetic abrasion technology” is the term used to describe a decay-removal technique that is somewhat akin to sandblasting on a far smaller and gentler scale. It involves bombarding the decayed area with a high-speed stream of micro-fine particles that virtually blasts away decay safely and silently, without heat, pressure, or anesthetic. The dentist then simply fills the cavity with amalgam or tooth-colored resin.
P.S. The air abrasion method requires wearing protective glasses during the procedure, and a rubber dam may be applied inside the mouth and around the tooth area being treated to serve as a particle barrier.
AVOID SHARING SALIVA WITH BABIES
While babies are born without the germs that cause tooth decay, they can get them from their parents. Research shows that, in effect, babies can “catch” caries (tooth decay) from their parents. More correctly, when mothers and fathers have high levels of the bacteria that cause cavities (Streptococcus mutans), the bacteria can be transferred to their toddlers through mouth-to-mouth kissing or sharing of utensils. Once these bacteria establish themselves in babies’ mouths, the incidence of cavities becomes more likely. If parents are concerned about the transmission of bacteria to their babies, they can ask for a dental caries test, which measures the concentration of these bacteria in the mouth. In the meantime, saliva transmission should be avoided.
P.S. The most critical period for decay formation is within the first few months of eruption of teeth, when the enamel is still soft and development is finishing.
One primary reason that Hollywood actors and other celebrities have such nice white smiles is that their teeth have been treated with veneers. These thin shells of tooth-colored porcelain or composite are bonded to the outer surfaces of selected teeth to cover stains, discoloring, chips, and other tooth irregularities. In order to accept the veneers, the dentist must first prepare teeth by removing and minimally reshaping a slight portion of their outer layer of enamel. An even less-invasive procedure involves the use of “ultra-thin” veneers that are so thin that they require no (or little) enamel removal beforehand. Because ultra-thin veneers are so thin, they might not mask tooth discoloration in all cases. The dentist can help you decide.
P.S. The thickness of an ultra-thin veneer is comparable to a contact lens.
BAD BREATH AND BEYOND
The smell of a person’s breath can be indicative of a number of health conditions. For instance, breath that smells like “acetone” (nail polish remover) may be a sign that a diabetic is not managing his or her blood sugar well. In such cases, the body does not receive enough insulin to break down glucose in the blood. When the body cannot get its energy from sugar, it switches to burning fat for fuel instead. The process of breaking down fat to use as energy releases by-products called “ketones,” including acetone. If ketone levels rise too high, the blood can become acidic and affect how other organs in the body function. Recognizing ketone breath may help avert a serious problem.
P.S. Breath analysis may help identify “prediabetes” when diabetes is in its early stage.
CAN ASPIRIN REVERSE TOOTH DECAY?
A recent finding by scientists may help to further bolster aspirin’s reputation as a “wonder drug” with multiple potential benefits. While aspirin (acetylsalicylic acid) has been used for many years as a painkiller, new research suggests that it may also reverse the effects of tooth decay. According to initial research, aspirin has been found to have the ability to stimulate stem cells in teeth, thereby enhancing tooth regeneration. While teeth are able to produce a thin layer of “dentin” (the layer beneath the enamel), it is not enough to repair a large cavity. If researchers can find ways to develop treatments using aspirin that help teeth repair themselves, fillings may become a thing of the past.
P.S. Today’s tooth-colored composite resins used to fill cavities not only look better than amalgam (silver) fillings, but they are far less resistant to shrinkage.
It is estimated that between 30 and 40 million U.S. children and adults grind their teeth at night. Not only does the grinding sound associated with “nocturnal bruxism” awaken and alarm sleepers in the same room as the tooth-grinder, but it can also cause wear and tear on the teeth and damage bone and gums. This rhythmic activity of the jawbone forcing contact between dental surfaces has also been linked to headaches, joint discomfort, muscle aches, and premature tooth loss. Many people are unaware they have a problem with tooth grinding until a sleep partner points out the fact. This should prompt a visit to the dentist, who can prescribe a mouth guard to protect the grinder’s teeth.
P.S. Aside from being a symptom of stress and anxiety, bruxism can be the result of the body’s reaction when the teeth do not line up or come together properly (malocclusion).
If you have stained or discolored teeth, you might want to try a fast and effective professional tooth-whitening procedure that can make your teeth up to eight shades lighter. This technique makes use of advanced LED light-activated technology to enhance the action of bleaching materials on teeth. One of the advantages of this new tooth-whitening technique is the speed at which it can be accomplished. (Treatments typically take an hour.) This is made possible by the fact that light activates the tooth-whitening agent to work more quickly. Severe discoloration, such as that associated with tetracycline stains, may require more than one treatment. Yellow and brown teeth respond better to treatment than gray teeth, which lighten but do not whiten.
P.S. Veneers, caps, crowns, and false teeth cannot be whitened.
It has recently been noted that a popular cocktail can erode tooth enamel and give rise to cavities. The Aperol Spritz is an Italian-inspired cocktail that combines Prosecco (a less-expensive alternative to Champagne) and Aperol (an Italian aperitif composed of bitter orange, rhubarb, and other ingredients). As it turns out, drinking too much of this popular cocktail exposes teeth to the residual sugars and acids that sufficiently eat away at enamel to cause what has come to be known as the “prosecco smile.” Of course, there is nothing new in all this, in that dentists and health professionals have long advised against drinking carbonated beverages, which get their fizz from the release of carbon dioxide, which dissolves into carbonic acid.
P.S. With respect to consuming acidic and sugary foods and drinks, moderation is key. It also helps to rinse with water after consuming foods that pose a danger to tooth enamel.
“Wisdom” teeth, the third and final set of molars that usually erupt between ages 17 and 21, are located at the farthest corners of the upper and lower dental arches. They derive their popular name from the notion that they erupt when we are more mature. Because there is often no space left for them to occupy, they can become misaligned or impacted. If they do not come in straight, it can be very difficult to floss between the wisdom teeth and the molars next to them. Even worse, misaligned wisdom teeth can damage neighboring teeth, and impacted teeth can lead to the formation of a cyst. For these reasons, misaligned and impacted wisdom teeth should be surgically removed.
P.S. Wisdom teeth that remain in the mouth should be regularly monitored for changes and potential problems.
MATERIAL DIFFERENCES IN IMPLANTS
While titanium has been the traditional material of choice for dental implants, patients also have the option of a non-metal tooth-root replacement. Like its titanium counterpart, a “zirconia” dental implant is biocompatible, enabling it to be embedded in the jawbone, with which it bonds directly through a process known as “osseointegration.” Unlike a titanium dental implant, which consists of the implant and the “abutment” (to which the prosthetic tooth is attached), a zirconia dental implant is of one piece (combining the implant and the abutment). Zirconia itself is a crystal material that is best known for its likeness to diamond. While both implant materials are biocompatible, FDA approved, and considered safe, zirconia is for those who prefer a non-metal material.
P.S. Because a titanium dental implant comes in two pieces, it allows for more control over a few elements of the entire tooth-replacement process than a one-piece zirconia implant does.
GUARD AGAINST FACIAL INJURY
Along with sports eyewear, helmets, and face masks, the American Dental Association strongly advises athletes to wear mouth guards that protect against facial injuries. At the very least, the “boil and bite” mouth guards available at pharmacies, which are made out of thermoplastic resins that can be shaped by the tongue and fingers, offer some degree of protection. Stock “fitted” mouth guards are ready-made mouth protectors available at sports stores. Because they cannot be adjusted, wearers may experience breathing difficulties that discourage their use. Finally, the dentist can provide custom-fitted mouth guards that are fitted to the wearer’s unique dental anatomy. These high-quality devices offer superior fit and comfort, based on thickness, height, and other wearer preferences.
P.S. While mouth guards are typically worn over the upper teeth, if you wear a fixed dental appliance on your lower jaw, the dentist can make a mouth guard for the lower teeth as well.
When a tooth is too damaged to accept a filling but not damaged enough to require a crown, dental “onlays” and “inlays” present excellent options. These types of dental restorations, which are also referred to as “indirect fillings,” are used to repair teeth’s damaged chewing surfaces. In cases where there is no damage to the tooth’s cusps, an inlay will be placed between the cusps. If one or more cusps are fractured, an onlay will be used to restore the damaged cusps. Requiring the removal of more tooth material than a filling, but much less material than a crown, onlays and inlays are more durable than fillings and less expensive than crowns.
P.S. Dental inlays and onlays may be constructed of gold, tooth-colored composite resin, or porcelain.
Among the many changes that women go through during pregnancy is the development of swollen gums that may be sore and vulnerable to bleeding. This form of gum inflammation, known as “pregnancy gingivitis,” is prompted by hormonal changes that lead to increased blood flow to the gums, making them swollen, sensitive, and irritated. It should also be noted that hormonal changes during pregnancy also slow the body’s response to bacteria that cause gum infections. As a result, bacteria-laden plaque is more apt to accumulate on teeth, causing them to be more susceptible to gum disease. With all this in mind, pregnant women should schedule regular visits to the dentist to preclude potential gum problems.
P.S. The severity of pregnancy gingivitis usually increases during the second trimester of pregnancy.
E-CIGARETTES AS HARMFUL AS TOBACCO
Not only can cigarette smoking lead to yellow and brown stains on teeth, but smokers are also more likely to produce bacterial plaque that leads to gum disease. And because smoking prevents oxygen from entering the blood stream, infected gums heal more slowly, resulting in inflammation and the likelihood of tooth loss worsening. While some may believe that e-cigarettes are a safer alternative to conventional cigarettes, new research shows that vaping subjects the oral environment to chemicals that pose as much of a health risk as cigarettes, if not more. E-cigarette liquids contain nicotine and other chemicals that damage cells in the mouth to the point where e-smokers are at a higher risk for gum disease, tooth loss, and cancer.
P.S. According to the study mentioned above, e-cigarette flavoring appears to exacerbate the cell damage caused by e-cigarette vapor, with menthol-flavored vapor posing the most harm.
REVERSING TOOTH DECAY
One of the many reasons to have your teeth checked regularly for signs of tooth decay is that, when detected early, the tooth decay process can be reversed. Teeth “demineralize” as a result of bacteria in the sticky film that coats teeth (plaque) using sugars found in food and drinks to create acids that eat away at enamel. Conversely, there are minerals in saliva (such as calcium and phosphate) plus fluoride from toothpaste, water, and other sources that help enamel “remineralize” (repair itself by replacing minerals lost during an “acid attack”). As this battle between demineralization and remineralization constantly rages, it is important to give remineralization the upper hand by brushing and flossing regularly and getting needed fluoride and minerals.
P.S. If needed, topical fluorides can help strengthen existing teeth and make them more resistant to decay.
BETTER SOONER THAN LATER
No one should ever put off necessary dental procedures due to financial concerns. A recent survey of 2,000 Americans reveals that half of those polled postponed a necessary procedure or diagnostic test because they were apprehensive of the bill. Unfortunately, this misplaced concern often backfires when the postponement leads to a worsened condition that requires emergency treatment that costs far more. As the old adage has it, “An ounce of prevention is worth a pound of cure.” If the hygienist or dentist spots early signs of tooth decay, it may be possible to reverse the process with fluoride treatment and anti-bacterial rinses. If not, it is less expensive to fill a small cavity than to get a crown.
HINT: Patients may want to inquire about payment plans that will help them get the treatment they need.
YOUR CHANCE TO GET EVEN
The first thing that someone notices about you is your smile. At a glance, people can tell whether your teeth are discolored, positioned correctly, and evenly aligned. Tooth shape is an underlying factor when it comes to tooth alignment. Teeth that are positioned correctly can still look crooked if they are severely out of shape. Because teeth wear down at different rates, they can be different lengths. Chipped teeth can also make teeth look jagged and uneven. Fortunately, these and other problems can be corrected with a simple cosmetic procedure known as “enameloplasty” (or “tooth reshaping”). By gently removing some of the tooth enamel, the dentist can fix minor imperfections and contour teeth to your satisfaction.
P.S. Cosmetic contouring, which includes polishing, generally takes less than a half hour.
It can be somewhat alarming to find “hair” growing on your tongue. “Hairy tongue,” the term used to describe the growth of small, dark projections (filiform papillae) that give the tongue a furry appearance, develops due to defective shedding of the tongue’s covering tissue. Fortunately, this condition, which occurs in as much as 13 percent of the population, is temporary and harmless. The tongue is normally covered with conically shaped filiform papillae that are approximately one millimeter long. Due to lack of stimulation or abrasion to the top of the tongue, a buildup of keratin (protein), bacteria, yeast, and other debris can create a hair-like mesh. Good oral hygiene, including the use of a tongue scraper, helps resolve the issue.
P.S. Patients with hairy tongue may complain of a gagging or tickling sensation in the soft palate (roof) of the mouth during swallowing. Bad breath or abnormal taste may also result.
EASY DOES IT!
In an effort to keep their teeth clean and white, some people exert excessive pressure on their toothbrushes and/or use overly abrasive toothpastes and powders. This does more harm than good. The fact is that plaque (sticky bacterial film) is soft enough that minimal pressure on the brush, along with the detergents and mild abrasives in most toothpastes are all that is needed to remove it. Brushing harder does not help achieve a deeper clean, may cause sensitive gum tissue to recede, and can even erode tooth enamel. Proper brushing merely requires holding a soft-bristled at a 45-degree angle to the gum-line and using short, gentle strokes to clean one section of teeth at a time.
P.S. If you notice that you are brushing your teeth too hard, try moving the brush in a small, circular motion, rather than brushing back and forth.
DENTURES OR DENTAL IMPLANTS?
For decades, dentures have been the standard replacement for missing teeth. Modern denture technology has improved to the point where custom-fit dentures, made of various materials, can look and feel exactly like natural teeth. However, times are changing, and both patients and dentists have come to view dental implants as their first choice for tooth replacement. Although implants may cost more initially, they can last a lifetime and don’t have to be removed to be refitted or cleaned. Indistinguishable from natural teeth, dental implants also will not slip or move, which provides patients with more confidence when talking and eating. Once fully healed, dental implants allow for a normal diet and routine without any special considerations.
P.S. Patients who smoke, have diabetes, or experience jawbone shrinkage, may not be candidates for dental implants.
One type of pain that dental patients find most concerning involves the “temporomandibular joints,” which act as hinges between the temporal bone of the skull and the lower jaw (mandible). Among the most complex joints in the body, these joints not only hinge open and closed, but they also slide forward and backward, allowing us to chew, talk, and yawn. When problems, called “temporomandibular dysfunction” (TMD), arise in these joints or their surrounding muscles and ligaments, radiating pain and limited jaw movement often result. The dentist can diagnose and treat jaw pain and TMD that are caused by missing teeth; jaw clenching; tooth grinding (bruxism); poor bite (malocclusion); or bad habits (nail biting, pencil chewing, etc.).
P.S. TMD caused by tooth grinding can sometimes be relieved with a custom-fitted mouth splint that is worn while sleeping.
MEDICATION-INDUCED DRY MOUTH
Not only can the condition known as “dry mouth” (xerostomia) arise because of certain health conditions (diabetes, stroke, thrush, etc.), but it may also be a side effect of some prescription and over-the-counter medications. In fact, there are up to four hundred medications that can contribute to dry mouth. These drugs include antihistamines, decongestants, painkillers, muscle relaxants, tranquilizers, diuretics, antidepressants, and drugs that treat high blood pressure, Parkinson’s disease, and incontinence. Anti-seizure medications, immunosuppressant drugs, and channel calcium blockers may also cause “gingival overgrowth” (enlarged gum tissue). It is important to identify any medication that causes dry mouth and adjust the dosage or replace it with another drug before it leads to severe tooth decay and gum disease.
P.S. Thirty percent of all tooth decay in older adults is caused by dry mouth, according to the Oral Cancer Foundation.
A HISTORY OF PREVENTIVE DENTAL CARE
Current oral home-care practices date back thousands of years, as evidenced by the fact that toothpicks from 3,000 BC were found in present-day Iraq. In 355 BC, Hippocrates was the first to recommend cleaning teeth with a dentifrice powder. One thousand years later, Arabian surgeon, Albucasis, was the first to write about tartar formation. He also designed a set of 14 tooth scrapers (which preceded today’s scalers). In 1819, Levi Spear Parmly recommended cleaning teeth with waxed silk (the precursor to dental floss). Then, in 1845, the American Journal of Dental Science prescribed cleaning the teeth with floss silk two or three times per day, which is the first known reference to preventive dental hygiene in an American journal.
P.S. In 1882, Willoughby D. Miller determined microorganisms cause dental decay and carries.
The gap that can occur between any two teeth, known as a “diastema,” most commonly appears between the upper front teeth. This gap may result due to a mismatch between small teeth (inherited from one parent) and large jaw bones (inherited from another). Otherwise, a diastema between the upper front teeth may be caused by an oversized labial “frenum” (the band of tissue that connects the upper lip to the gums between the upper front teeth). When an overly extended frenum causes the tooth separation, a “frenectomy” may be recommended to alleviate the force exerted by the tissue. Subsequently, the gap may close on its own, or the dentist may be able to close the gap with bonding or veneers.
P.S. Gaps between teeth that are caused by gum disease or an incorrect swallowing reflex (tongue thrusting) will grow larger over time.
CONGENITALLY MISSING TEETH
When teeth are missing as a result of failing to develop at birth, it is referred to as hypodontia. The most common congenitally missing teeth are the wisdom teeth (25-35 percent), followed by the permanent upper lateral incisors (two percent), and the second premolars (three percent). The problem this condition poses is that it removes a tooth from the dental arch that normally keeps adjacent teeth in their proper places. For instance, when the upper lateral incisors are missing, the canine (cuspid or “eye”) teeth are apt to move toward the central incisors to fill the gap. In order to identify and deal effectively with such dental abnormalities, it is important to have regular dental checkups.
P.S. Congenitally missing teeth is a condition that tends to appear within families and also may be influenced by environmental factors.
MINDFUL APPROACH TO ORAL CARE
Not only do regular tooth-brushing and flossing lead to healthier teeth and gums, as well as fresher breath, they may also help stave off serious illness. New research revealed DNA evidence that bacteria found in the mouth can move to the brain and may cause Alzheimer’s disease. It has been found that the gum disease bacterium known as Porphyromonas gingivalis (P. gingivalis) produces a protein that destroys brain cells, leading to memory loss and, possibly, Alzheimer’s disease. After studying 53 Alzheimer’s patients, researchers found that 96 percent tested positive for this bacteria. Until a drug is developed that can stop this process, those with a family history of Alzheimer’s, in particular, are encouraged to maintain proper oral care practices.
P.S. Researchers have uncovered common oral pathogens in 79 percent of the cerebral blood clot samples taken from 75 stroke patients.
TAKING A HARD LINE ON SOFT DRINKS
By now, most of us realize that sugary soft drinks (including soda, fruit juices, highly sweetened coffees, and other sources of liquid sugar) are linked to weight gain, obesity, insulin resistance (a primary feature of metabolic syndrome), type 2 diabetes, the possibility of an increased risk for heart disease, and a higher risk of cancer. These potential adverse health consequences of excessive sugary liquid consumption stand alongside the well-known fact that sugary soda not only provides easily digestible energy for the bacteria that cause tooth decay, but it also contains phosphoric and carbonic acids that make teeth vulnerable to decay. With all this in mind, it is best to get children used to drinking non-sugary liquids as early as infancy.
P.S. “Baby bottle tooth decay” occurs as a result of leaving sweetened liquids, including milk, formula, and fruit juice, to cling to an infant’s teeth during sleep when saliva flow decreases.
ORAL HEALTH TIED TO ATHLETIC PERFORMANCE
Whether you are a professional or amateur athlete, regular dental visits may help you perform better and enjoy your sport more. According to the FDI World Dental Federation, not only can oral injury and trauma inhibit athletic performance, but sports-related stress can also lead to dehydration, dry mouth, and teeth-grinding. Additionally, athletes should note that energy beverages and certain foods and supplements contain added sugars and acidic ingredients. These can cause tooth decay and increase the risk of gum disease and tooth erosion. Moreover, the experience of dental emergencies such as a gum abscess, infected tooth, or wisdom tooth eruption prior to a competition, can impair performance or even prevent the athlete from participating at all.
P.S. Because athletes are also at an increased risk for oral and dental trauma and injuries when practicing contact and combat sports, the FDI recommends wearing a custom-made mouth guard.
When a patient has enough natural bone, an “immediate load” dental implant may allow for placement of a temporary tooth directly after the natural tooth has been extracted. This technique was developed in response to patients’ desire for quicker treatment than one would receive with traditional tooth implantation, which can take many months and multiple office visits to complete. Immediate placement and loading of a single implant are made possible with the use of an implant with a tapered body, designed to promote high stability while the implant is integrated into the surrounding tissue and bone. These implants are not for everyone, including those who smoke, grind their teeth, have an autoimmune disease, hygiene issues, or a chronic disease.
P.S. An “immediate load” dental implant known as the “All-On-4” lower denture is actually comprised of four implants that are placed in the jaw bone to give support for an entire denture.
When treating small areas of tooth decay that form on the outer surfaces of teeth (and certain other procedures), “air abrasion” provides an alternative to the traditional high-speed rotary drill. This technique involves directing a hand-held instrument that uses compressed air to propel a fine stream of particles (silica, aluminum oxide, or a baking soda mixture) onto the surface of the tooth. As the particles of decay are removed by the abrasive action of the propelled particles, everything is suctioned away through a thin tube. This air-abrasion technique produces less heat, vibration, and noise than a drill, which some patients find comforting. Air abrasion also reduces the need for anesthesia and leaves more of the healthy tooth material in place.
P.S. An air-abrasion device may also be used to prepare teeth for a number of cosmetic and restorative procedures, including the application of veneers.
As part of a comprehensive examination of the oral cavity, the dentist or hygienist will carefully inspect the patient’s tongue for irregularities. Among the most common is “geographic tongue,” an inflammatory condition that produces white and red patches on the upper surface of the tongue. This condition, which usually resolves spontaneously, derives its name from the fact that the tongue’s surface takes on the appearance of a map. The specific cause is unknown, but stress, allergies, diabetes, and hormones may contribute to its development. While treatment is not necessary, topical steroids, antifungal medications, and other drugs may help to control flares. Geographic tongue may be accompanied by “fissured tongue,” which presents with small grooves (fissures) on the tongue’s upper surface.
P.S. As people age, fissured tongue occurs more often and produces a harmless but prominent fissure down the center of the tongue that requires good oral hygiene to remove debris.
If a baby tooth were to be lost prematurely, a parent may find little sense in becoming too concerned, “because it was going to fall out anyway.” However, the fault with this line of thinking rests with the possibility that adjacent baby teeth may move in to fill the gap left by the lost baby tooth, thereby blocking the emergence of the permanent tooth lying beneath it. Conversely, a baby tooth that takes too long to fall out may cause the corresponding permanent tooth to come in crooked. With these potential outcomes in mind, parents should have their children’s baby teeth checked regularly to ensure that they will not negatively affect the alignment of future permanent teeth.
P.S. If a baby tooth is lost too early, aside from causing serious crowding problems for the developing adult teeth, the loss can negatively impact the child’s jaw muscle and bone development.
TREATING SUBSTANCE ABUSE WITH DENTAL CARE
As scientists increasingly delve into the subject of how oral health is linked to overall well-being, they are coming up with some very interesting findings. The latest of these involves a link between good oral care and better treatment outcomes for those suffering from substance abuse. Researchers found that, when comprehensive oral care was part of a more holistic approach to substance abuse treatment, those who had their major oral health problems addressed by a dental professional stayed in treatment approximately twice as long and had a more than 80 percent increase in completing their treatment program. Those receiving comprehensive dental care realized substantial improvements in employment and drug abstinence, as well as a dramatic decrease in homelessness.
P.S. The study mentioned above shows that improved dental health leads to improved self-esteem, which contributes to a desire for self-improvement.
ADULTS GET CAVITIES TOO!
Older adults may think they are no longer at risk for getting cavities because they no longer eat sweets with the abandon of young children. However, the risk of developing tooth decay begins to rise with the onset of middle age. In part, this has to do with receding gums, which leave vulnerable roots exposed. There is also the increased potential for old amalgam (silver-colored) fillings to shrink or fracture, thereby allowing bacteria to seep down into old cavities to start decay anew. Furthermore, many older people experience reduced saliva production, a condition aptly called “dry mouth,” which reduces the ability to stave off tooth decay. For all these reasons, older adults should remain vigilant against decay.
P.S. Adult patients may want to ask their dentist about fluoride gels or sealant application to stave off tooth decay.
TEETH AS WHITE AS SNOW?
Teeth-whitening procedures are popular among people who want to get rid of stains that prevent teeth from looking their whitest. By removing discolorations caused by coffee, tea, tobacco, wine, etc., the dentist can make patients’ teeth between two to nine shades lighter. The final results depend on each person’s natural tooth color, which is largely dependent on the color of the tooth pulp. The “pulp” (or “pulp chamber”) is the soft area within the center of the tooth that contains the nerve, blood vessels, and connective tissue. It is darker and less transparent than enamel. For this reason, teeth-whitening cannot get teeth “as white as snow.” However, even a change of two to three shades makes a noticeable difference.
P.S. When you see celebrities with snow-white teeth, you are most likely looking at veneers that can be made as white as desired.
Beyond the strong recommendation that everyone brush and floss their teeth at least twice daily, as well as after every time they eat, there are some other tips that people can follow to reduce their risk of developing tooth decay and gum inflammation. For parents who want to find out for themselves how well their children are caring for their teeth and gums, there are “disclosing tablets” available at pharmacies. These chewable tablets make “plaque” (the bacteria-laden film that coats teeth with decay-causing bacteria) visible by using a coloring agent to temporarily stain the areas where plaque remains. Disclosing tablets enable parents to identify how and where children can improve their brushing technique.
P.S. Teeth are more vulnerable to enamel-eating acids while we sleep because we produce less saliva. Therefore, it is best to spit out toothpaste (not rinse) after nighttime brushing, to allow fluoride to remain on teeth to do its work.
A TOTAL KNOCKOUT
While more than five million children’s and adult’s teeth are knocked out annually due to injury or accident, it is possible to replant these teeth if you know what to do. The first tooth-saving step is to quickly pick up the knocked-out (“avulsed”) tooth by the crown (chewing surface), not the root. Gently rinse it off under a stream of tap water. Do not scrub or use soap or chemicals. Then, place the tooth back in its socket, gently holding it by the crown. Slowly push it into place and hold it there. While it is possible to save a tooth that has been outside the mouth for an hour or more, it is best to contact a dentist immediately.
P.S. If it is not possible to reposition a knocked-out tooth in its socket, place it is a glass of water or milk and immediately call the dentist.
Patients were once regularly advised to have “impacted” wisdom teeth extracted to prevent future problems, but we now know that this may not be necessary. While it is certainly true that impacted (stuck beneath the gums) wisdom teeth can develop infections or cause damage to neighboring teeth, one study found that, after age 30, no more than 12% of impacted wisdom teeth ever cause problems. In these cases, dentists can usually detect a problem early enough to remove the tooth, before damage occurs. The study also calculated that only 1% of those with impacted wisdom teeth would benefit from a preventive extraction. Decisions regarding extraction of asymptomatic impacted wisdom teeth should be based on clear evidence and the dentist’s experience.
P.S. Wisdom teeth (third molars) can be impacted in many different angles, with some even growing in sideways.
NO REASON TO GO WITHOUT
“Edentulism” is the absence or complete loss of all of a person’s natural “dentition” (teeth). While tooth loss had long been considered a natural part of the aging process, advances in oral care and treatment have led to the understanding that tooth loss need not be inevitable. By 1996, only one percent of 25-to 34-year-olds were edentulous, compared to 44 percent of those aged 75 or over. It has been estimated that by 2024, only ten percent of Americans age 65 to 74 will be edentulous, compared to nearly 28 percent in 1988 to 1991. Until tooth loss is eradicated, patients should take comfort in knowing that current technologies involving dentures, dental implants, and other prosthetic options are readily available.
P.S. Consequences of missing teeth include significant nutritional changes, obesity, diabetes, coronary artery disease, and some forms of cancer.
YOUR SMILE BECOMES YOU
It is worth mentioning that many people do not have perfect “Hollywood” smiles, but they do have smiles with features that make them immediately recognizable and lovable. For example, one well-known French dentist employs a technique known as “micro-rotations” to create smiles of “harmonious asymmetry.” In order to give their face a more youthful appearance, adult patients may decide to have their lateral incisors rotated slightly instead of having their four front teeth aligned in a perfect row. If you want to see an example of harmonious asymmetry, look at Keira Knightley’s natural smile. Once you see her smile, you will likely agree that she would not be herself without this endearing “imperfection.”
P.S. The French dentist mentioned above, Didier Fillion, helped Kate Middleton achieve the smile she desired prior to her wedding to Prince William.
BAD BREATH AND GUM DISEASE
At the first sign of bad breath (halitosis), most people brush their teeth and reach for the mouthwash. While these measures may treat bad breath caused by odorous foods, they are not enough to cure bad breath that is caused by gum disease. Along with bleeding and swollen gums, persistent bad breath (and/or a “bad taste in the mouth”) is an early sign of periodontal (gum) disease caused by accumulated plaque on tooth surfaces. When the bacteria in plaque remain on teeth and produce toxins that irritate gum tissue, the stage is set for potentially serious problems associated with advanced gum disease (periodontitis). Bad breath may signal the need for a check-up.
P.S. Other dental causes of bad breath include poorly fitting dental appliances, yeast infections of the mouth, and dental caries (cavities).
If you feel a temporary sharp and sudden pain when eating or drinking certain substances (sweet, acidic, spicy, or variable temperature), you are experiencing “tooth sensitivity.” While switching to de-sensitizing toothpaste may help to alleviate the pain, it will not alleviate the cause of the pain. Healthy teeth rely on enamel to protect the softer underlying layer of “dentin,” while tooth roots are protected by gums. However, if the enamel is damaged, or if the gum line has receded, the dentin becomes exposed. Dentin is connected to the nerve that triggers pain in sensitive teeth, so it is important to treat cavities, cracked teeth, gum recession, and enamel and root erosion, which can all cause dentin to be exposed.
P.S. Tooth sensitivity, which affects at least 40 million U.S. adults, can happen to anyone.
Most people are surprised to learn that the oral cavity typically contains over 70 different types of bacteria, some of which are harmless. Others, however, can contribute to dental decay and periodontal (gum) disease. When a “dental abscess” occurs, the buildup of pus that forms inside the teeth or gums is usually the result of a bacterial infection. In cases where tooth decay creates openings in the tooth that can lead all the way to the softer layer of tissue under the enamel called “dentine,” bacteria penetrate the soft inner pulp of the tooth, which becomes infected. Otherwise, bacterial buildup in the periodontal pocket surrounding teeth may lead to a “periodontal (gum) abscess.” Severe pain usually needs immediate treatment.
P.S. An abscess of the soft pulp of the tooth is treated with a root canal, while periodontal abscesses are drained and the periodontal pocket cleaned.
IF CAVEMEN DIDN’T BRUSH, WHY DO WE?
If the ancient Egyptians and Babylonians were the first to brush their teeth, how did preceding generations manage to go without doing so? Well, to begin with, our oldest ancestors didn’t consume processed foods. Instead, they ate natural, nutrient-rich, fibrous foods that helped keep their teeth clean, strong, and resistant to cavities and oral infections. By contrast, not only do many of us eat processed, sugary foods and drink highly acidic beverages, but some people also smoke, which has been linked to oral cancer. Modern men and women also tend to live about three times longer (or more) than our early counterparts. With all this in mind, we must do all we can to preserve our teeth.
P.S. Because our ancestors were generally more active than we, they burned the calories that they consumed and tended to avoid routines that can lead to acid reflux and consequent tooth demineralization.
Parents should understand that, while their children may eventually lose their “primary” teeth, the so-called “baby” teeth should not be considered disposable and unimportant. In fact, a child’s “primary dentition” (first sets of upper and lower teeth) pave the way for the eruption of the permanent adult teeth that replace them. The process of losing all the baby teeth and replacing them with permanent teeth takes about six years, lasting from about age six until the age of twelve. During this period, known as the “mixed dentition” stage, children will display a mix of baby and permanent teeth. Throughout this time, children’s teeth should be checked regularly to ensure that baby teeth remain healthy and permanent teeth erupt properly.
P.S. Children have a set of 20 primary (“baby”) teeth which fall out and are replaced by a set of 32 permanent adult teeth.
Anyone with a tooth that has chipped, cracked, broken, or become stained can take advantage of dental bonding. One of the quickest, easiest, and least expensive of dental procedures, “bonding” makes use of tooth-colored resin to fill gaps, mask discoloration, repair fractures, and make other cosmetic improvements in a single office visit. After the teeth have been etched with a mild acid that maximizes the bond between tooth and resin, the putty-like, tooth-colored resin is applied to the tooth and molded to the desired shape. Then, the resin is “cured” with a special light that hardens the resin in place. Finally, the resin is trimmed and polished. The entire procedure takes 30-60 minutes per tooth.
P.S. Tooth-colored composite resin material can be used in place of traditional amalgam (silver-colored) filling.
“Smashmouth” is a slang term used describe a rough, aggressive style of athletic play. This casual talk is well and good, but when it comes to action, athletes had better wear mouth guards to help prevent contact-related dental injuries. Unfortunately, some athletes are reluctant to do so. According to one study, many college athletes said that they disliked mouth guards, because of poor retention and breathing and speech impairment. However, these problems were largely traced to the use of “boil-and-bite” mouth guards. These inexpensive over-the-counter mouth guards are first boiled and, then, while warm and soft, placed in the mouth to mold to the bite. The custom mouth guards available from dentists are far more comfortable and functional.
P.S. Wearing a protective mouth guard significantly reduces the incidence of a concussion by a blow to the jaw, because the condyle (the protrusion of bone at the jaw joint) is separated from the base of the skull, with the mandible placed in a forward position.
HEALTHIER GUMS, LOWER BLOOD PRESSURE
Recent research links poor oral health to conditions such as cardiovascular disease, obesity, and diabetes. The research concerning the association between gum disease and overall health should be of interest to anyone with high blood pressure. According to analysis of data from the annual U.S. National Health and Nutrition Examination Survey, between 2009 and 2014, people with high blood pressure and gum disease found it more difficult to manage hypertension with medication than those hypertensive patients without gum disease. The more severe the gum disease, the higher the patients’ average systolic blood pressure was found to be. Overall, people with hypertension and periodontal disease were 20% more likely than those without gum disease to have their hypertension controlled with medication.
P.S. Gum disease, which involves chronic inflammation of the tissue around the roots of the teeth, has been linked to higher inflammation throughout the body.
IMPLANTS THAT JUST TOUCH THE SURFACE
Because of bone “resorption” (shrinkage), not all patients have enough bone in their jaws to accept a tooth implant. Normally, an implant is embedded in the jaw, where it will integrate with the surrounding bone, and eventually hold the prosthetic tooth (or teeth) in place. If there is not enough bone underlying the gums to receive the implant, bone may be grafted to the implant site. If grafting is not a feasible option, a “subperiosteal” implant may be used. This type of implant is a metal framework placed beneath the gums where it sits atop the bone, somewhat like a saddle. A subperiosteal implant must be custom-made to fit the contours of an individual’s jaw.
P.S. Small screws may be used to hold a subperiosteal implant in place.
WHAT PREGNANT WOMEN MIGHT EXPECT
Pregnant women should make dental checkups part of their prenatal care regimen. Between 60 and 70 percent of women experience “pregnancy gingivitis”, due to rising progesterone levels. As a result, there is an increase in the flow of blood to gum tissues, making them sensitive, swollen and more likely to bleed when brushing and flossing. Because this condition does not disappear after delivery, gingivitis should be treated by a dentist. In addition, a condition known as “pregnancy granuloma” (sometimes referred to as “pregnancy tumors”) may occur during the second trimester. It is characterized by painless purplish-blue growths that develop between teeth. Some disappear after delivery, while others require surgical removal to prevent a buildup of plaque.
P.S. Pregnancy granulomas, which are not actually tumors, occur in 2% to 10% of pregnant women.
WEAR THE CROWN PROUDLY
When a cavity is too large to be filled or when a tooth is significantly weakened, the dentist is likely to recommend that it be replaced with a “crown” (or “cap”) that takes the place of the visible portion of the tooth that sits above the gum line. Crowns fit over the top of a tooth and protect what is underneath. Once they are cemented in place, they act as a new top for the tooth, while keeping it from breaking apart. Because they are mostly indistinguishable from natural teeth, crowns also restore the appearance of the mouth. They are constructed of very resilient and durable materials, including gold alloys; precious, semiprecious, or nonprecious alloys; porcelain; and composite resins.
P.S. Crowns are also recommended to restore a tooth that has undergone root-canal treatment.
PLAQUE NEVER SLEEPS
The reason it is so important to brush and floss twice daily has everything to do with the nature of the substance that is constantly growing on our teeth. Not to be confused with the fatty substance of the same name that builds up in arteries, “plaque” is a sticky film of bacteria that forms on teeth. You may not see it, but you know it is there when your teeth feel “fuzzy” to the tongue if you skip a brushing. Plaque develops when bacteria feed on sugars and carbohydrates in the foods and liquids we eat and drink. As they do, the bacteria in plaque produces acids that attack tooth enamel, causing cavities and compromising gum health.
P.S. If dental plaque is not removed with a toothbrush and floss, it can harden into “tartar” in as little as two days and is so hard that it can only be removed with professional scraping tools
ANCHORING DENTURES IN PLACE
While complete dentures rely on adhesives to hold them in place over the gums, “overdentures” are anchored to dental implants that are firmly embedded in the underlying bone. Overdentures are more stable than dentures that require adhesives, which leads to improved biting and chewing. In addition, the use of dental implants to hold overdentures in place stimulates the upper and lower jaw bones so that they will not shrink due to bone resorption. This effect helps avoid the “aging look” that may otherwise appear when the lower face takes on a “shrunken” appearance. All these advantages combine to provide a better fit that will both minimize gum sores and require less maintenance.
P.S. Overdentures snap in place onto implants.
DOES CHARCOAL TOOTHPASTE WORK?
The enduring popularity of tooth-whitening is testimony to the fact that it is no mere fad, but an accepted cosmetic procedure and part of routine dental care for many. However, this popularity has led some consumers to try “charcoal toothpaste” based on unsubstantiated claims that it whitens teeth and removes impurities by binding to tooth surface deposits. Unfortunately, while activated charcoal does have toxin-absorbing properties that prove useful in some situations (such as treatment for poisoning), its value as a tooth-whitener is highly doubtful. According to a 2017 analysis of 118 articles that featured a database of 50 charcoal-based toothpastes, researchers found “insufficient scientific evidence to the validate the cosmetic or health benefits or safety claims of marketed charcoal-based dentifrices.”
P.S. The abrasive found in many charcoal-base toothpastes is often much higher than levels found in regular toothpastes. When used regularly, these abrasive products could damage tooth enamel and gums.