Everyone knows that physical activity has innumerable benefits, such as improving your muscle mass, reducing your risk of heart disease, strengthening your bone density, etc. But when people think of physical exercise improving their bodies, they aren’t typically thinking of it improving their oral health.
However, one article that was published last spring says that exercise can reduce gum disease and reduce the link to other secondary illnesses that affect the oral cavity:
Regular Exercise Prevents Gum Disease
A study published in the Journal of Dentistry in 2005 found that regular exercise can help lower the risk of contracting periodontitis, or gum disease. After studying the relationship between gum disease and physical activity, the report concluded that exercising regularly is associated with lower risk of developing gum disease. In fact, the people who regularly worked out and had never smoked were 54% less likely to have periodontitis compared to those who reported no regular physical activity. A National Health and Nutrition Examination Survey also found that even partially active people (exercising 3 times or less per week) were 33% less likely to have periodontitis than those who do not exercise.
Correlation between BMI and Oral Health
Maintaining a healthy BMI (body mass index) is actually very beneficial for your oral health. Health issues associated with obesity like hypertension and diabetes are known for contributing to poor oral health. In fact, a study in The Journal of Periodontology from the University of Florida conducted a study to find the affect that weight has on dental health. Researchers looked at BMI, body fat percentage, and oxygen consumption to assess how healthy each participant was. According to the study “Individuals who maintained normal weight, engaged in the recommended level of exercise, and had a high-quality diet were 40% less likely to have periodontitis compared to individuals who maintained none of these health-enhancing behaviors.”
Since the aim of dentistry is to focus on preventative methods before resorting to restorative options, it’s in your best interest to add exercise to other good habits like daily brushing and flossing. For other preventative treatments that can help, check out lagunavistadental.com/services/preventive-dentistry/.
Not only is exercise beneficial to patients’ oral health, but it is beneficial to dentists and their practices. Dental student Jeffrey Asano says that dentists should make exercise a priority since it can help you relieve the stresses of the profession while in school and at your future practice. Furthermore, he says that some of his exercises have actually improved his skill set:
For me, backpacking is a great avenue to escape the stresses of dental school. It offers a moment of peace to reflect in nature, which can significantly improve your mental health as well as provide a means for physical exercise. Since nearly everyone can walk, backpacking is an accessible activity for many people. Hiking trails for beginners are as short as one mile and those seeking a challenge can tackle trails as long as 20 miles. No matter the length of the trail, backpackers from all physical fitness levels are welcome to move at their own pace. The best part of backpacking is that it offers so many ways to feel accomplished. For some, enjoying the journey is more satisfying than reaching the destination. However, my favorite aspect is finding hidden gems along the trail, such as a waterfall or a famous bouldering location.
While backpacking hiking trails is my way of relaxing, bouldering is my way to improve strength. Bouldering is a great alternative to those who find going to the gym too repetitive. Plus, building your grip strength through climbing has benefits that can be applied to practicing dentistry. Improving finger strength can help steady your hands for deep cleanings, applying rubber dams, holding a handpiece or even torquing implants. For those who enjoy the social aspect of hobbies, bouldering has a close-knit community that encourages camaraderie and mutual support for other climbers . . .
Although these kinds of exercise benefits may seem minute in comparison to others, they can really add up in the long run. Dental practitioners will be better equipped to deal with the stresses and physical activity required at work, and patients will have better chances of only needing preventative services.
Trying to figure out a dental emergency can be a bit tricky–if you’re in pain, then you obviously would want to get in ASAP, right? However, the best course of action is to call your dentist first so they can figure out just how bad the situation is. For instance, if your pain can be soothed with oral analgesics, then you most likely can wait. Teeth, crowns, inlays, onlays, and other restorations that have been knocked out often warrant a visit.
But what about a chipped a tooth? Is the problem just cosmetic or is there functional damage as well? While you may think that figuring out the severity of a chipped tooth is difficult, believe it or not, it can be difficult for practitioners as well!
The Daily Grind reiterates how important it is to call dentists first to assess the situation, since the term “chipped tooth” can cover a wide range of issues:
I know this is something you hear all the time: “I chipped a tooth.” This can mean so many things, especially if it is coming from a nondentist.
“I chipped a tooth” in the posterior can be a chip off the marginal ridge next to a class II restoration that you did five years ago. And if you saw this, you might just say, “It is fine,” or you might just smooth it off. Or a broken tooth in the posterior could mean the ling cusp of tooth No. 12 just broke to the gumline and below.
The question that usually comes up at our office is: How do we schedule patients who call and say, “I chipped a tooth.”
I am a doctor who does not like to schedule a “come in and we will see” visit. I know how difficult it can be for people to take time off of work or get a babysitter just so I can tell them, “Yep, you have a chipped tooth, and we can see you in three weeks to take care of this.”
Sometimes I schedule 50 minutes for a chip on the anterior that you couldn’t see with a microscope, or I might schedule 20 minutes for a “chip” when, actually, a child fell off his bike and “chipped” the heck out of teeth Nos. 8 and 9, to the point where the nerves were hanging out.
Because I refuse to do a “look-and-see” appointment, about a year ago, we bought a smartphone for the office. First, we bought it to be able to send text messages to people to confirm their appointments. We all know that calling someone at home and leaving a message on their voicemail is about as effective as sending a smoke signal (but we tried for 10 years). And nearly everyone has a smartphone these days, and everyone sends text messages (except for Grandma Nel, who we still just call). Now that we have this designated smartphone, we just ask people to send us a photo of the tooth via text message.
Hopefully more and more dentists implement this smartphone picture idea. Although a poorly lit picture off your phone isn’t the most ideal diagnosis tool, it is a start and can weed out non-emergencies.
When you do get to see your dentist for a chipped tooth, you may want to ask him or her about visiting a radiologist. According to one Chinese study, it may be beneficial to visit a radiologist as well as your dentist, since their imaging equipment may be more thorough when checking for potential chips and cracks that aren’t immediately apparent:
When it comes to examining images of a tooth and identifying a crack, should you use periapical radiography or cone-beam CT (CBCT)? Also, who is better trained to identify these cracks on images, an endodontist or a radiologist?
Researchers from China noted that cracks in teeth present practitioners with a challenge in designing a treatment plan. Using both periapical radiography (PR) and CBCT, they investigated the best imaging method to identify these cracks while also comparing the performance of different practitioners (PLOS One, January 4, 2017).
“In clinical practice, it is a huge challenge for endodontists to know the depth of a crack in a cracked tooth,” the authors wrote . . .Early enamel cracks have no obvious symptoms and may not be visible on examination. Yet they can lead to patients coming to your office because of pulpitis, periapical periodontitis, or even root fracture. As creating an appropriate treatment plan and assessing the long-term prognosis for these teeth can be difficult, there’s a need to understand the best way to diagnose this condition . . .
“Within the limitations of this study, on an artificial simulation model of cracked teeth for early diagnosis, we recommend that it would be better for a cracked tooth to be diagnosed by a radiologist with CBCT than PR,” the authors concluded.
If you aren’t sure what constitutes an emergency or how to take care of a chipped tooth, you can find more information at lagunavistadental.com/services/general-dentistry/emergency-dentist/.
The fear of heights, public speaking, and spiders are all pretty common. And how about the fear of the dentist? Colgate.com says that as much as 15% of U.S. patients suffer from this type of anxiety–to put that in perspective, that’s well over 20 million people!
Thankfully dentists do understand this problem and that’s why sedation dentistry has really helped many people. A recent blog post goes over what sedation is and how it can help?
Sedation dentistry is very safe for children, but like with any procedure, there are potential side effects. You understandably may not want to consider this option for your child, so what can you do?
First off, if you have a fear of the dentist yourself, it’s best not to talk about it in front of your son or daughter so they don’t pick up the fear themselves. You can also decrease their anxiety by reading children’s books about dentists. Instead of just telling them to not be afraid, these books will have illustrations and a story showing how positive this experience can be. Also, you may want to go in with your son or daughter during the appointment and sit by them if they are very afraid.
Drbicuspid.com editor Lori Roniger posted a study that showed that dentists who said reassuring phrases also were able to improve dental anxiety and seem more empathetic to caregivers:
What Can You Say to Reassure Pediatric Patients?
Practitioners who provide more positive reinforcement and reassurance when speaking with pediatric patients were perceived by caregivers to be more patient-centered and empathetic, according to a new study conducted in Hong Kong.
In addition, the inclusion of caregivers in conversation, such as the clinician mentioning the parent or caregiver present, was a key factor in producing a quality clinical experience, the study authors reported in PLOS One (January 3, 2017).
“Unlike the conversations focusing on the treatment procedures, those offering positive reinforcement and reassurance appeared to the caregivers that the clinicians were providing more patient-centered care and showing more concern to the patients, thereby creating more clinician-patient interaction,” wrote Hai Ming Wong, PhD, DDS, and colleagues at the University of Hong Kong. “Engaging patient-centered care can help clinicians build stronger clinician-patient relationships for productive engagement in preventive care.”
Dr. Wong is a clinical associate professor of pediatric dentistry at the university. Researchers from disciplines such as dental public health, psychology, and education at the university participated in the study.
Saying ‘mommy’ is helpful
The authors noted that good communication has been found to result in improved patient cooperation, self-care skills, and treatment plan adherence, as well as better treatment outcomes and a lower likelihood of dental anxiety. However, good communication may not be sufficient to achieve these results, with other active ingredients likely embedded within good communication underpinning those effects, they explained.
If you want to learn more about pediatric dentistry and how to help your child get over their fears, take a look at lagunavistadental.com/services/general-dentistry/pediatric/
For the third year in a row, dental professionals topped the U.S. News & World Report’s annual list ranking the best jobs of the year, according to ADA News.
Dentists, which ranked No. 2 in 2016’s list, took the No. 1 spot in 2017. It last held the top spot in 2015. Orthodontists, which ranked No. 1 last year, is this year’s fifth best occupation; oral and maxillofacial surgeons rounded up the top 10 with a tie for No. 9.
Occupations are ranked based on U.S. News’ calculated overall score, which combines several components into a single weighted average score between zero and 10. These components are: 10-year growth volume; 10-year growth percentage; median salary; job prospects; employment rate; stress level; and work-life balance.
Dentists scored an overall score of 8.2; orthodontists, 8.1; and oral and maxillofacial surgeon, 7.7.
“The Bureau of Labor Statistics predicts employment growth of 18 percent between 2014 and 2024, with 23,300 new openings,” according to the U.S. News & World Report. “A comfortable salary, low unemployment rate and agreeable work-life balance boost dentist to a top position on our list of best jobs.”
The magazine also reports that orthodontists and oral and maxillofacial surgeons are expected to grow by 18 percent from 2014 to 2024, with about 1,500 new job openings for orthodontists and 1,200 new jobs for oral and maxillofacial surgeons.
Not only are thousands of job opportunities opening up, but denticle.com says that of all the health professionals Americans want to see more of, dentists–once again–come out on top.
On the flip-side, dental school is very competitive, and along with finishing your bachelor’s degree, you’ll need to pass the Dental Admissions Test (DAT) and complete four or more years of schooling before you can start practicing.
Could you go to school for something else? You may want to look into dental therapy according to drbicuspid.com:
>Americans overwhelmingly support the concept of dental therapists, according to the results of a recent phone survey. Interviewers asked thousands of registered U.S. voters if they would like a new type of midlevel provider similar to a nurse practitioner, and 80% of respondents said yes . . .
Critics are concerned that dental therapists will not provide the same standard of care as a dentist. They also tend to be skeptical that therapists can increase access to dental care or reduce costs.
Meanwhile, proponents of midlevel providers point to evidence that dental therapists effectively reduce untreated caries, not only in the few U.S. states that have approved their use but also abroad. In addition, support for midlevel providers appears to be gaining momentum.
Although there is some natural skepticism about the roles of dental therapists, these professionals are trained to clean teeth, apply sealants, and administer anesthetic. Many of these therapists perform pediatric dental treatments under the supervision of a dentist, while others have a dual license as a hygienist/therapist.
This career option is flexible, less competitive, and helpful in areas where low-income children need affordable dental care. If you aren’t sure which career path you should take, you’ll want to learn more about the education requirements different dental specialties, like pediatric dentistry. You can learn more at lagunavistadental.com/services/general-dentistry/pediatric/
Discover Magazine released an intriguing article a few years back about the great benefits of mouth wash. According to researchers, Streptococcus mutans is the bacterial culprit when it comes to our cavities. But during a small clinical study, they found that mouthwash was able to pretty much wipe this bacteria away so that healthy bacteria could take its place and thrive. This study was very small, so 0f course, further research will be needed before we know exactly how long these kinds of results last.
But mouthwash’s benefits don’t seem to stop there. According to a recent article at drbicuspid.com, there have actually been studies testing the effect of mouthwash on sexually-transmitted infections:
Rinsing with the antiseptic mouthwash Listerine for one minute can significantly reduce the prevalence of gonorrhea-causing bacteria, according to a new study. Now, researchers want to know whether Listerine can also help prevent the spread of sexually transmitted infections (STIs).
“If Listerine has an inhibitory effect against N. gonorrhoeae in the pharynx, it could be a cheap, easy to use, and potentially effective intervention for gonorrhea prevention and control,” wrote the authors, led by Eric Chow, MPH, PhD. Chow is a senior research fellow at the Melbourne Sexual Health Clinic . . .
In addition to their clinical trial, the researchers performed an in vitro study in which they tested the effect of Cool Mint Listerine and Total Care Listerine on N. gonorrhoeaecolonies. They also found that both types of Listerine significantly slowed bacterial growth after just one minute.
“The two studies presented here are the first to demonstrate Listerine can inhibit the growth of N. gonorrhoeae in vitro and in a clinical study and raise the potential that it may be useful as a control measure,” Chow and colleagues wrote.
While people may use mouthwash for small things–like bad breath or whitening–it’s pretty cool that an inexpensive over-the-counter product has the possibility of reducing cavity- and STI-causing bacteria.
Despite these benefits, you may be surprised to hear that there are detractors. In fact, one of these opponents is actually a dentist (Dr. Alvin Danenberg):
Yes, I tell them antibacterial mouthwash kills bacteria. Yes, bacteria can cause gum disease. Yes, you should want healthy gums.
But you know that bacteria serve many purposes in the mouth, when the good bacteria balance out the bad kinds. Healthy gums are dependent on a healthy balance of bacteria. One underrated bacterial benefit is to allow a specific pathway of digestion to occur that is critical for health.
When bacteria are killed indiscriminately, both harmful and good bacteria are killed, and the mouth’s delicate balance of bacteria goes awry. This means that tooth decay and gum disease may be more likely to occur.
To address their concerns, I talk with my patients about the benefits of mouth bacteria and the unique role they play in the chemical pathway of certain foods. Specifically, the chemical pathway of “nitrate-to-nitrite-to-nitric oxide” is dependent on specific anaerobic bacteria in the mouth . . .
So I tell my patients, if you kill the bacteria in your mouth and on your tongue with antiseptic mouthwash, salivary nitrates wouldn’t be converted into nitrites. With less nitrites in your system, you would produce less beneficial nitric oxide.
While mouthwash does have benefits, Dr. Danenberg does make some sound points. After all, whenever you take an antibiotic, your doctor will usually tell you to take a probiotic so your gut flora isn’t unbalanced. If mouthwash is able to kill good bacteria, what’s stopping bad bacteria from thriving again?
If you aren’t sure how often you should use mouthwash, it’s just best to ask your dentist at your next dental cleaning. He or she may say it’s okay, or you may be offered alternatives. Take a look at lagunavistadental.com/services/preventive-dentistry/
Sixty percent of the adult population in the U.S. will have gastroesophageal reflux disease (GERD) symptoms that could last a year (some adults will experience GERD on a weekly basis). What does GERD do exactly? You probably are already familiar with the common symptoms of heartburn and nausea, but GERD can also cause excess stomach acids to rise back up in the esophagus and mouth, which can cause tooth decay.
While just about anyone can experience GERD, seniors are at a higher risk–especially seniors over the age of 65 who are taking medications with side effects that affect the GI tract.
If a senior is having difficulty with GERD, then he or she should take the previous tips to heart. After all, if someone already has erosion from stomach acids, adding acidic beverages and foods isn’t a great idea.
While some people may be lax about their oral health care, it can be a great boon to those GERD. For instance, fluoride treatments can strengthen enamel and prevent it from softening from stomach acids. You can learn more about these kinds of treatments at lagunavistadental.com/services/preventive-dentistry/fluoride-treatments/
Besides fluoride treatment, dental expert John Flucke says that oral discs can greatly help:
Study Shows OraCoat® XyliMelts® Oral Adhering Discs Effectively Treat Acid Reflux
Gastro-esophageal reflux disease (GERD), more commonly known as acid reflux, describes a chronic digestive condition in which an accumulation of stomach acid in the esophagus creates symptoms. Acid reflux affects about 30 percent of the population on a weekly basis and is known to contribute to or cause a number of medical and dental problems including heartburn, sore throat, laryngitis, cough, halitosis, and tooth decay. The condition is also associated with sleep disturbance and can have a negative effect on nighttime comfort and overall quality of life.
The study aimed to prove if XyliMelts, recently rated by a Clinicians Report® survey as the most effective remedy for alleviating dry mouth† could produce similar results in treating patients suffering from acid reflux, which is often managed by prescribed and over-the-counter medications that prevent excessive acid production . . .
XyliMelts are formulated from all-natural ingredients commonly used in foods. As tests prove that salivary stimulants can decrease the perception of nighttime dry mouth, tests also suggest increased saliva can diminish nighttime reflux . . . Test results displayed that both the disc and gel reduced the taste of reflux, heartburn sensation, morning hoarseness, perceived reflux severity, and the number of antacids taken during the night.
And since these XyliMelts are made from all-natural ingredients used in food, that makes it more likely that they won’t have any reactions with medications that seniors may be taking already. You can talk with your dentist for more information about these kinds of remedies.
One of the wonderful perks of getting older is increased risk for many health issues. For instance, as you age, certain kinds of cancer are more common–especially oral cancer:
Oral cancer is the sixth most common cancer, accounting for 30,000 newly diagnosed cases each year – and 8,000 deaths. If not diagnosed and treated in its early stages, oral cancer can spread, leading to chronic pain, loss of function, facial and oral disfigurement and even death.
Who gets oral cancer?
Anyone can get oral cancer. Heavy drinkers and people who smoke or use other tobacco products are at higher risk. Though it is most common in people over age 50, new research indicates that younger people may be developing oral cancers related to human papillomavirus (HPV).
Early detection can save
The good news? The earlier oral cancer is detected and treated, the better the survival rate – which is just one of the many reasons you should visit your dentist regularly. Twice-yearly dental checkups are typically covered with no or a low deductible under most Delta Dental plans.
As part of the exam, your dentist will check for oral cancer indicators, including feeling for lumps or irregular tissue in your mouth, head and neck. A biopsy will be recommended if anything seems concerning or out of the ordinary.
If it isn’t treated this cancer can cause pain, the loss of salivary function, and the need for tissue removal, which can cause disfigurement. But Delta Dental says that if patients get checked often for early signs by their dentists, then oral cancer can be stopped in its tracks.
So what’s the issue? Not enough seniors actually have dental care that would help them discover and stop cancer:
A new study published in the December edition of Health Affairs analyzed access to dental care for Medicare beneficiaries, and the findings don’t look good. Only about 10% of older U.S. adults have dental insurance, and, of those who do, they still pay half of all their dental costs out of pocket.
The researchers looked at Medicare data to see how seniors with different income levels and types of insurance access dental care. They attributed the overall lack of coverage and high percentage of out-of-pocket spending to larger policy trends, including the exclusion of dental care in Medicare and the changing of insurance benefits for retirees.
“Despite the wealth of evidence that oral health is related to physical health, Medicare explicitly excludes dental care from coverage, leaving beneficiaries at risk for tooth decay and periodontal disease and exposed to high out-of-pocket spending,”
“Until dental care is appropriately considered to be part of one’s medical care, and financially covered as such, poor oral health will continue to be the ‘silent epidemic’ that impedes improving the quality of life for older adults.”
Clearly there needs to be a change in the general attitude concerning the need for care. Everyone can do their part to make dental care more viable for seniors.
If seniors cannot afford a plan, they need to do everything in their power to still get adequate care, such as looking at payment plans, seeking out low-cost care at dental schools, applying for government aid, maintaining good oral care at home, and so on. If you are senior, you should make oral cancer check-ups a natural part of your to-do list. You can find more information about oral cancer screenings at lagunavistadental.com/services/preventive-dentistry/oral-cancer/
Even though the Food & Drug Administration has given their blessing to dental amalgam, their site still warns the general public about elemental mercury and the damage it can do to the body. They say that mercury vapor can possibly bioaccumlate, or slowly build-up in your kidneys or brain–although no studies have shown any negative effects so far.
But even though amalgam fillings have been used for over a century in the dentistry profession, the possible downsides of mercury should be food for thought. One dentist, a Dr. Tom Colpitts from Tulsa, even says that he’s changed his mind over the years about their usage:
Because mercury is a neurotoxin and since you can’t just dispose of it easily into water supplies, Dr. Colpitts says that it’s worth patients time to weigh the pros and cons.
The good news is that many offices, like Laguna Vista Dental, just offers composite dental fillings, which you can learn more about here: lagunavistadental.com/services/general-dentistry/dental-fillings/
The great thing about composite fillings is that they are very aesthetically pleasing as well as safe. The only downside of composite fillings is their tendency to wear down more quickly compared to other fillings. However, Drbicuspid.com released an article recently that outlines some of the most common causes for wear:
Reasons for Composite Failure Have Changed
Since resin composites were introduced, there has been an ongoing challenge to improve their clinical performance, particularly for use in posterior teeth,” the authors wrote. “This has seen the introduction of hybrid, packable, nanofilled, low-shrinkage, and bulk-fill composites, but still the clinical effectiveness of posterior composite is questioned by many.”
Dr. Alvanforoush is a doctoral student from the Melbourne Dental School at the University of Melbourne.
Reasons for failure
Direct resin composite restorations are becoming more popular, as patients prefer tooth-colored restorations because they offer a superior aesthetic appearance, and patients want to avoid the placement of new amalgam in their mouths. The study authors noted that substantial advancements and changes in composite materials and adhesive systems have taken place over the last 20 years, but no systemic literature review has assessed the clinical performance of posterior composite restoration . . .
The authors concluded that comparing the reasons for failure over the last two decades had revealed an important shift as secondary caries, postoperative sensitivity, and wear were reduced as failure factors in contrast with the increased role of tooth fracture, restoration fracture, and endodontic treatment as reasons for failure.
“The greater level of fracture may relate to the increase in size of restorations now being placed; however, more detailed data are needed,” they wrote. Read the full article here . . .
Again, the top reasons for failure included things like tooth fracturing and the presence of secondary caries. While fracturing can sometimes occur due to traumatic accidents, it can also occur in minute amounts due to bruxism (teeth grinding). And since bruxism and secondary caries are both preventable (mouth guards and good oral hygiene), you can make composite fillings more viable with a little extra care.
And perhaps, one day patients won’t even need fillings. According to another study presented at Drbicuspid.com, researchers believe they can restore tiny caries with a drug+collagen sponge that can regenerate dentine:
Study Offers New Treatment for Larger Caries
January 9, 2017 — Soon you might be treating your patient’s caries with a collagen sponge filled with a drug — first tested to treat Alzheimer’s patients — that stimulates the natural ability of teeth to restore dentine.
A study published January 9 in Scientific Reports by researchers in the U.K. documented a new method of stimulating the renewal of living stem cells in tooth pulp. While still needing human clinical trials, this approach may allow large cavities to be repaired without the use of cement or fillings.
“The simplicity of our approach makes it ideal as a clinical dental product for the natural treatment of large cavities, by providing both pulp protection and restoring dentine,” stated lead study author Paul Sharpe, PhD, in a press release. “In addition, using a drug that has already been tested in clinical trials for Alzheimer’s disease provides a real opportunity to get this dental treatment quickly into clinics.”
Sharpe is the head of the craniofacial development and stem cell biology division at the King’s College London Dental Institute . . .
After removing caries decay, a tooth’s soft inner pulp is exposed, and a natural dentine repair process begins. This process uses a form of stem cells in the patient’s mouth that becomes new cells. These cells release a form of reparative dentine, according to the study authors. Read the full here . . .
Although this kind of restoration still has many kinks to work out, the fact that the study authors are eager to get this kind of treatment into clinics ASAP is exciting.
In the meantime, if patients focus on preventative dentistry measures, they can have long-lasting composite fillings and avoid amalgam altogether.
If you’ve had headaches, jaw pain, neck pain, and fatigue lately, you may want to get checked out by your dentist. According to Delta Dental, about 15% of U.S. adults suffer from a TMJ/TMD issue. Dr. Alvin Danenberg says that he believes that that number is significantly higher due to his years of experience. And if you aren’t sure what’s causing your pain, Dr. Danenberg has some ideas:
8 possible causes of your patient’s jaw pain
As a periodontist, I frequently treat temporomandibular joint (TMJ) pain or temporomandibular disorders (TMDs). Many of the causes of this type of jaw pain also can damage the jawbone around the roots of teeth.
In my experience, between 60% and 70% of adults have experienced some symptoms of TMD. Their most frequent complaint is pain either in the jaw joint or the jaw muscles. Patients often experience discomfort when opening their jaw, along with popping and cracking sounds in the jaw joints when opening and closing. Some patients also experience buzzing or ringing sounds in their ears.
TMDs are multifactorial, and their sources may be difficult to identify. I initially focus on the following eight related causes for TMDs:
- Trauma (such as a car accident) involving the jaw joint, which could damage the joint structures
- Clenching and grinding the teeth
- Teeth that have been improperly restored or are out of alignment
- Poor nutrition and unhealthy digestion, which could cause chronic inflammation and affect all joints in the body, such as in patients with rheumatoid arthritis
- Emotional stress, such as illustrated by a study by Lei and colleagues in Cranio (April 28, 2016).
- Lack of sleep
- Excessive estrogen, although studies vary
- Infection in the joint
Many factors affect jaw pain. The more obvious causes should be explored first. If grinding habits or bite problems exist, these must be corrected. Stress reduction, restorative sleep, and good nutrition to provide proper hormone balance must be implemented to reduce TMD symptoms. If symptoms persist, other treatment options should be considered to make the patient comfortable. Read full article here . . .
Although this article points out many possible explanations for your jaw pain–some of which you may have even suspected, it does forget one: mouth breathing. That may surprise you, since such a habit seems rather innocuous.
However, chronic mouth breathing can start all the way back to when you were a child. obviously the correct way to breathe is through your nose, but if you have enlarged tonsils, allergies, or other issues that make it difficult to breathe through your nose, then mouth breathing will naturally occur.
For mouth breathers, the the lower jaw comes down, as well as the tongue. During normal breathing, the tongue rests on the soft palate and balances the pressure of the cheek muscles. But when the tongue is always lowered, there is nothing to counterbalance the cheeks, which can press in and make the maxilla narrower.
Since the jaws change, this often causes a chain reaction where the lower jaw is pushed back and TMJ is the result. You can see a clear explanation of this phenomenon in the following video:
So if you think that mouth breathing is the cause of your issues, you may be wondering what you can do to fix it. First, you will want to get set up with either day-time appliances (for severe cases) or a night-time appliance–similar to a mouth guard, that will relieve some of the pressure.
Just being aware of your mouth breathing may help, since you will be able to self-correct and breathe through your nose. If this is too difficult, you may need surgery (to remove adenoids or tonsils), or you may need to visit a doctor to fix a deviated septum.
Besides reducing your symptoms, are there any oral appliances that could re-align the jaw? Dr. Donald Tanenbaum says the jury is still out:
Can Mouth Guards Cure TMJ?
How about oral appliances to re-align the jaw? This concept of jaw re-alignment to address a TMJ problem remains controversial. To date there is no science to support the concept that a poor bite or mal-aligned jaw is responsible for the emergence of TMJ symptoms. At most a bad bite or mal-aligned jaw may be a risk factor but with no more weight than other risk factors such as; female gender, gum chewing, clenching, night grinding, or stress. As long as there remain millions of people with bad bites and asymmetric jaws without symptoms this concept has to be viewed with skepticism. In addition, if an appliance were to be made to re-align the jaw, it would require the patient to bite or rest on it when in the mouth to hold the jaw in the ‘better’ position. This action of course would violate the principle that the jaws should hang at rest during the day. Clearly this option must be chosen with great care. Read more here . . .
However, if your upper jaw has been narrowed over time due to this issue, you may be wanted to fix it anyway with orthodontic treatment. An expander can be used to widen the jaw, and braces can be used to correct overbites that are commonly seen in mouth breathers.
Even though realigning the jaw to correct the problem is looked at with some skepticism, it can help you in your efforts to correct mouth breathing, fix both cosmetic and functional issues, and possibly reduce TMJ due to disc slipping.
Trying to get your young children to have good oral hygiene may be a losing battle. After all, many young kids are picky eaters, and would rather have dessert than the nutritious meal you labored over. And in an attempt to avoid fluorosis–or tooth discoloration–parents may be unsure of how much toothpaste is appropriate to help keep their kids’ teeth clean.
A recent article by Lori Roniger explores these oral health challenges with kids from Utah. Although the recommendations in the article were for Utah families, they’re very applicable to any parent:
We know oral health diseases are largely preventable, yet we are moving in the wrong direction,” noted Shaheen Hossain, PhD, the primary author of the report, in a statement. “Along with increasing the access to needed services, we still need to educate parents on the importance of oral hygiene, nutritious diets with fewer sugary beverages, and getting routine dental care . . .
They recommended several strategies to improve the oral health of children in Utah:
- Increasing access to dental insurance and care
- Enhancing the public’s understanding of the importance of oral health and its benefits to overall health and quality of life
- Improving coverage by educating families about Children’s Health Insurance Program (CHIP), Medicaid, and other dental insurance
- Expanding access to community water fluoridation
- Expanding school-based caries prevention activities, such as fluoride varnish and sealant programs in elementary schools
- Providing better incentives and reimbursements to dental practitioners who see low-income people
- Focus on closing the dental care access gap by increasing awareness of existing community resources
As you can see, one of the recommendations is a school-based sealant program. But even if your child doesn’t have this kind of program, you can still look into it since it is a common pediatric dentistry service. If you’ve never heard of sealants before, they are plastic coatings that the dentist paints on to the grooves of the enamel. They can be applied in under a half an hour, and they create a barrier that can help your child stave off cavities.
Delta Dental goes into more details as to why sealants are a great idea:
Cavities are the most common chronic disease among children and that untreated decay affects 19.5% of 2- to 5-year-olds and 22.9% of 6- to 19-year-olds.
Luckily there are sealants, which can reduce childhood tooth decay by more than 70%. A dental sealant is a thin, plastic coating that prevents food and bacteria from getting stuck in the grooves and pits of molars and premolars.
It’s recommended children get sealants once they get their permanent teeth. Here are 3 reasons why:
1. Extra Protection
Children are just learning about dental hygiene and may not be properly removing food and plaque from every nook and cranny. Sealants will provide extra protection during these cavity-prone years.
2. Easy and Painless
If your child gets nervous at the dentist, rest assured that sealants are a painless and quick procedure. There are no needles and no drills, and the whole process takes 15 minutes on average.
3. Long Lasting
Sealants can last for up to 10 years! Make sure to periodically check in with your dentist to ensure that your child’s sealants are still intact and don’t have any chips or cracks.
No parent wants to spend money on extraneous procedures, but this truly is a needed one since cavities are so prevalent in children and since it can reduce decay by more than 70%! While fillings can certainly be used to repair cavities, they aren’t as strong as the original enamel structures.
Plus, fillings and other restorative dentistry isn’t as ideal as preventative dentistry options like sealants. So be sure to talk with your dentist about this option and how to make it work within your family’s budget.
It’s no wonder that Americans have been highly concerned about water safety for the past few years. After the debacle in Flint, Michigan, people are understandably fearful about what goes into their water. Because the city of Flint didn’t take care, many residents were exposed to serious issues because of lead poisoning, such as mental impairments.
Besides lead poisoning, there are many other problems that people should be aware of, such as
- Sanitary sewer overflows: This happens when sewage leaks out of the system before getting to a treatment center
- Contaminated groundwater from the agricultural sector (e.g. pesticides)
Researchers are still uncertain of all the ramifications of farming contaminants. In fact, Medline Plus shared an article recently about how the pesticides used in farming were actually altering oral bacteria:
Pesticide exposure may change the makeup of bacteria in the mouths of farm workers, a new study finds.
Researchers at the University of Washington analyzed swabs taken from the mouths of 65 adult farm workers and 52 adults who didn’t work on farms. All lived in Washington’s Yakima Valley.
The farm workers had higher blood levels of pesticides, and greater changes in their mouth bacteria than non-farm workers, the study found.
The most significant finding was in farm workers who had the organophosphate pesticide Azinphos-methyl in their blood.
In this group, researchers found significantly reduced quantities of seven common groups of oral bacteria. Among those was Streptococcus, which first author Ian Stanaway called “one of the most common normal microbiota in the mouth.” He’s a doctoral candidate in environmental toxicology.
Stanaway noted that previous studies have found that “changes in species and strains of Streptococcus have been associated with changes in oral health.”
The changes noted in this new study persisted into the winter, long after the growing season when pesticide use is highest, the researchers said.
The study doesn’t establish a direct cause-and-effect relationship, however.
The results were published recently in the journal Applied and Environmental Microbiology.
With this discovery, “the challenge becomes, what does this mean? We don’t know,” principal investigator Elaine Faustman said in a journal news release. Faustman is a professor in the university’s Department of Environmental and Occupational Health Sciences.
“We depend on the microbiome for many metabolic processes,” she said . . .
Now you are probably thinking, wait, Streptococcus is associated with illness, right? So shouldn’t reduced strains be a good thing? It’s true that streptococcal pharyngitis–commonly known as strep throat–and other strains are responsible for infections, but there are streptococcal species that aren’t harmful and are actually a normal part of the oral cavity. These are a part of the microbiota, or the microorganisms that share body space according to biologist Joshua Lederberg.
So if chemicals in the water can cause changes in the oral cavity, what else are people worried about? Believe it or not, the answer is fluoride! This is surprising since water fluoridation has been given the okay by the Center for Disease Control (CDC), the World Health Organization, the American Dental Association (ADA), and the like.
In fact, some people are so worried that Drbiscupidcom. says a Fluoridation Society has cropped up to combat fears:
Johnny Johnson Jr., DMD, president of the newly formed American Fluoridation Society (AFS) got into the fluoridation fight when local officials in his community of Pinellas County, FL, voted in 2011 to discontinue water fluoridation, citing concern that residents might be ingesting too much fluoride . . .
“I thought she was kidding, but she was serious,” he recounted. “I explained there’s been no literature that found any connection whatsoever between water fluoridation and cancer, and I sent her information. She was blown away by the research and said she had definitely been misled.”
In another incident, a public health student told him there was “lots of debate about toxins and arsenic in fluoride.” Dr. Johnson replied: “There’s no debate; the science is crystal clear.”
. . . The main thing that healthcare professionals can do is be aware of what’s going on in their communities regarding water fluoridation, Dr. Johnson advised. Letters to newspapers and noticing what people are saying about the issue are tip-off’s about efforts against community water fluoridation.
According to the CDC, the only issue that excess fluoride has caused over the years is fluorosis, or cosmetic issue where teeth become discolored. And if you look at different clinical studies, communities that add fluoride often see less cavities in their residents.
If you are worried about fluoride, you can talk to your dentist about the issue. Some people actually opt out of fluoridated water, but still glean the benefits of topical fluoride since it isn’t ingested.
Could a Germ Link Gum Disease, Rheumatoid Arthritis?
Rheumatoid arthritis is a chronic form of arthritis linked to an overactive immune system. It can affect a variety of body systems, not just the joints. The disease affects roughly 1.5 million U.S. adults, according to the U.S. Centers for Disease Control and Prevention.
For more than a century, scientists have noticed that people with this inflammatory disease are more likely than others to suffer from gum disease, Andrade noted.
Researchers began to suspect a common factor was triggering both diseases.
In recent years, investigators have found signs that rheumatoid arthritis patients with fewer teeth — possibly as a result of gum disease — have more severe cases. Researchers have also reported that people with gum disease are twice as likely to have rheumatoid arthritis, the study authors said.
But the explanation for the connection wasn’t clear.
For the new study, Andrade’s team examined almost 200 samples from the gums of people with rheumatoid arthritis. The researchers looked for evidence of a type of bacteria, called A. actinomycetemcomitans, that’s linked to gum disease.
Signs of infection were detected in almost half of the rheumatoid arthritis patients compared to just 11 percent of another group of people without gum disease or rheumatoid arthritis.
This finding raises the possibility that the germ could cause both gum disease and rheumatoid arthritis, the study authors suggested.
According to Andrade, the bacterium may afflict the gums and then cause swelling in the joints as a kind of side effect.
Researchers have also wondered about the reverse — whether gum disease could be a side effect of rheumatoid arthritis. A study published in Current Oral Health Reports raised the question of whether the gums might be, in effect, another affected “joint.” Read full article here . . .
Of course, many of these studies already know that gum disease can be tied with other illnesses. The main question now is which came first: the chicken or the egg? Does gum disease cause these diseases, or do other illnesses make people prone to gum disease?
Some studies have already made claims that the gum disease comes first and is the main contributor to the development of other diseases. For instance, the Dental Tribune says that many researchers believe that treating periodontal disease can slow the progression of Alzheimer’s.
Again, according to drbicuspid.com, the correlation is obviously present for many diseases–like heart disease–but scientists are still trying to figure out just how they affect one another. But chronic inflammation seems to be the main problem:
Is gum disease a key risk factor for heart disease?
December 13, 2016 — Research has demonstrated a connection between periodontal disease and coronary heart disease (CHD), but the nature of the relationship remains to be determined. To help under this association, researchers have developed a model to illustrate the possible links between periodontal disease and the pathogenesis, hallmarks, and biomarkers of CHD.
While a correlation between periodontal disease and coronary heart disease is well-documented, and there is evidence that periodontal disease is associated with a higher risk of CHD, it remains unclear whether this correlation is due to a causal relationship or a shared underlying disorder, such as inflammation. The researchers sought to deepen understanding about this connection and determine the likely method of action for a possible causal relationship between them. This is important since 30% of the U.S. population has moderate periodontitis, the authors wrote. Read full article here . . .
So back to flossing . . . that’s probably the easiest way to start preventing inflammation from gum disease. Since gum disease is tied to heart disease, arthritis, Alzheimer’s, and so on, patients may want to take their dentist’s recommendations more seriously.
Lastly, along with flossing, an anti-inflammatory diet (full of veggies, fruits, fiber) can also help to delay the effects of gum disease. With the new year just around the corner, perhaps improving gum health can be added to any health-related resolutions.
Have you heard of the documentary Fed Up? The film talks about how thirty years ago, the U.S. government failed to notice the role sugar played in dietary guidelines and in people’s health. Since people wanted “low fat” options that still tasted good, fat was removed and replaced with sugar; and processed foods thrived.
So are Americans obsessed with sugar now? According to The Washington Post, we most certainly are and eat more sugar than any other country. The average American has over 125 grams of sugar each day, which–according to the Post–is about three cans of coke.
While diabetes and obesity are the main health issues that can arise from sugar addictions, oral health issues are also a problem. Some local governments have even tried to stymie issues with sugar taxes according to asdablog.com:
How do sugar taxes work?
Sugar taxes raise the price of SSBs. The local government then collects that money to put toward public services, infrastructure improvements and other city costs. A city with a $0.01 sugar tax will see the price of a two-liter bottle of soda increase by about $0.68 and a six-pack of canned soda increase by $0.72. These taxes do not usually apply to milk, 100% juice, baby formula, alcohol or medical beverages.
Do sugar taxes affect health?
A 2016 study published in The BMJ found that following the implementation of a 2014 SSB tax in Mexico, purchases of taxed beverages decreased while purchases of un-taxed beverages increased. A 2016 study published in the Journal of Dental Research also indicated that SSB taxation could reduce caries rates and dental treatment costs. Furthermore, a 2015 study in the Journal of Dental Research notes that while dentistry has focused on increasing oral hygiene and prevention services, recent findings suggest that efforts to decreasing sugar intake to reduce caries should also be increased.
What can dental students do about sugar taxes?
If you live in or attend school in an area with sugar taxes, you can talk to your patients about what they mean. Patients often need help feeling motivated to take action towards improving their oral health and dietary habits. Talking with patients about how they can save money and improve their oral health by drinking tap water instead of soda is a great motivating factor! Informing patients about the true cost of soda may be just the push they need to break their soda-drinking habit.
Of course, not everyone may be happy about these increased taxes. After all, how much do you want the government getting involved in your day-to-day choices? On the flipside, this article was geared towards dental students and how they can help–not force–people adjust their habits in moderation.
Again this is a tricky issue. Most people know that a habit like smoking is detrimental to their oral health, and they may be open to quitting. But if you get in the way of someone’s dietary choices, they may be telling you that you’ve crossed a line. Everyone needs to eat, and unfortunately many sugary items are more affordable.
To encourage change, dentists should be more up-front with how sugar can contribute to cavities and the need for dental fillings. Although a recent article at 123dentist.com addresses those wanting whiter teeth, the content outlines just how much soda and other sugary items contribute to tooth decay:
Fruit juices, especially berry or citrus fruit juices, are full acids and sugars. This is a dangerous combination for teeth as the acids break down the outer layer of teeth, exposing the vulnerable dentin, and sugars offer a breeding ground for bacteria which can attack the inner part of the tooth and cause cavities. The yellowing effect can come from both a buildup of bacteria, plaque and tartar and the exposed inner layer of teeth. If you’re looking for hydration, water is the best and healthiest way to quench your thirst.
Any beverage with carbonation is acidic. This is because the bubbles of carbonation are actually carbon dioxide and when you drink it, the gas goes through a chemical reaction in your mouth which turns it into an acid. This acid, again, is very harmful to tooth enamel as it weakens it, makes the tooth more vulnerable, and exposes its yellow inner layers. Pops and carbonated juices with sugar are especially destructive as the sugar promotes the growth of bacteria as well as exposing your teeth to acids. Favour non-carbonated drinks as you enjoy your holiday season and you won’t have to worry about yellowing teeth in the new year.
Because people generally don’t like to be forced to make a change (in the case of some sugar taxes), being sure to offer alternatives may be a better long-term option. Alternatives like seltzers, low-fat milk, unsweetened tea with honey, etc. are all good options. And even though 123dentist.com article says that carbonated drinks and fruit juices are sugary and can cause decay, that doesn’t mean you have to completely cut them out. Everything in moderation, right?
With the advent of Obamacare in 2010, more and more people were expected to sign up for affordable healthcare. While many people have benefited from this subsidized healthcare, not as many people signed up as were expected to.
The Fiscal Times looked at different demographics, and unsurprisingly, those with low incomes are often waiving health insurance due to deductibles and premiums that are too high.
And even if those in dire straits do end up getting a healthcare package, they may end up opting out of dentistry benefits. One Medline Plus article has more on this topic:
Many Americans Skip the Dentist Due to Cost
Americans are more likely to skip needed dental care because of cost than any other type of health care, researchers report.
Working-age adults are particularly vulnerable, the study found. Some 13 percent reported forgoing dental care because of cost. That’s nearly double the proportion of seniors and triple the percentage of children for whom cost poses a barrier to dental care, the study showed.
Cost was the main impediment to dental care even for adults with private insurance. “It seems like medical insurance is doing a better job at protecting consumers from financial hardship than dental insurance,” said study author Marko Vujicic. Typically, private dental insurance includes annual maximum benefit limits and significant “coinsurance” — the patient’s share of costs on covered services, Vujicic explained. He is chief economist and vice president of the American Dental Association’s (ADA) Health Policy Institute in Chicago.
. . . Evelyn Ireland, executive director of the National Association of Dental Plans, agreed with the report that avoiding dental care can affect overall health. Fortunately, the percentage of the population citing cost as a reason for not getting dental services has declined steadily since 2010, Ireland said. And in 2014, it was the lowest since 2003, she added.
Colin Bradley is vice president of business development at Winston Benefits Inc., a company that helps employers administer dental benefits. He said employers who offer private dental plans must emphasize the value of those benefits, including preventive services often provided at no out-of-pocket cost. Read full article here . . .
No one wants to make generalizations, but it is sometimes easy for patients to isolate their dental health from other bodily concerns even though oral issues can definitely impact overall health. Although the Medline Plus article makes a point that problems with cost have steadily declined, efforts should still be made to keep it that way. For instance, the article did say that educating the general public about the benefits of preventative dentistry should be top priority.
Along with increased educational resources, a study presented at drbicuspid.com illustrates that early intervention with children can also eliminate cost issues:
Study: School-based sealant programs save money
Programs that provide dental sealant to children at schools are cost-effective and prevent the need for many fillings, according to a new study published in the December issue of Health Affairs.
The results, which were published in Health Affairs, provide useful information for comparing school-based sealant programs with other alternatives. These programs typically provide sealants at little or no cost to children attending schools with a large population of low-income families who do not receive regular dental care.
“Increasing sealant prevalence among low-income children could save society money and decrease toothaches and their sequelae,” the study authors wrote (Health Affairs, December 2016, Vol. 35:12, pp. 2233-2240).
The authors noted that 27% of low-income children in the U.S. have untreated cavities by adolescence. However, sealants are used in only 38% of lower-income children compared with 47% of those from higher-income families. School-based sealant programs have been shown to increase the number of students receiving sealants and prevent cavities.
The Community Preventive Services Task Force, an independent panel of public health experts, has recommended school-based sealant programs since 2002. Nonetheless, in 2013 only 15 states had such programs in more than half of schools serving low-income populations, defined as those in which most students participated in the free and reduced-cost meal program. Read the full article here . . .
If children have better health from these sealant programs, then they won’t have to see the dentist for a host of issues down the line. Early prevention equals better health; better health means less dentist visits; and less dentist visits means more money in the bank.
It’s honestly too bad that only 15 states have implemented such sealant programs. While these children would still need to see the dentist for an annual visit, their parents wouldn’t need to pay exorbitant amounts of money for fillings, extractions, or even prostheses. Hopefully there will be changes in the future that emphasize the importance of affordable dental care.
Bruxism, or teeth grinding, can be difficult to spot if you aren’t an expert. After all, unless your teeth are overly sensitive or you get headaches, there’s no way to really tell how worn your enamel is unless you’re a dentist. And to make things more difficult, proteethguard.com says that daytime bruxism is quite uncommon–90% of teeth grinders do it while they sleep!
To top it off, Theresa Pablos, an editor at drbicuspid.com, recently posted an article that discusses how tooth wear can sometimes be difficult to spot–even for the experts!
Tooth wear screening tools fall short, new study finds
Which tooth wear evaluation tool works best? None, according to a new study. Researchers found that the four most common systems to categorize erosion all fall short of the requirements needed to be universally used in dental practice and research.
A team of international researchers realized that no universally applicable evaluation tool exists. Therefore, they set out to determine whether one of the existing systems could be used universally or if dental researchers need to create a new tool.
“It was this study’s first aim to perform an in-depth analysis of the characteristics of four commonly used tooth wear evaluation systems to determine if … [these systems show] characteristics of a hypothetical, broadly applicable evaluation system,” wrote the study authors, led by Peter Wetselaar, DDS, an assistant professor at the University of Amsterdam and Vrije Universiteit Amsterdam (BMC Oral Health, November 3, 2016) . . .
More people are aging with their natural dentition, and erosion is becoming an increasingly common problem seen in the dental office. However, while there are universal systems to diagnose and monitor caries and periodontal disease, a similar tool does not exist for tooth wear.
Keep in mind that this study is basically testing the effectiveness of a universal tool. There are definitely tools that can spot your tooth wear, but they have to be used in combination with other tools. This study was looking for a tool that met all four criteria set by researchers, such as ease of use.
Because bruxism can sometimes be difficult to spot for patients and–and sometimes for dentists who don’t use a wide array of tools–what can you do? One of the best ways to reduce tooth wear is to assess and change any risk factors. For example, you may know that certain foods–like soda, candies, or acidic fruits–can spur on tooth decay and exacerbate the wear from bruxism; but, did you know that alcohol consumption and smoking are risk factors as well?
Alcohol, cigarettes are risk factors for bruxism
December 14, 2016 — When patients report smoking cigarettes or frequently drinking alcohol, you probably automatically think of their increased risk for caries and periodontal disease. However, you may want to also check for bruxism during your exam.
A new study found those who smoke cigarettes and binge drink have an increased risk for sleep bruxism. The study authors hope dentists will use their findings to screen at-risk patients for the condition, which can lead to tooth wear and fractures, periodontal disease, and headaches.
“Because results of our [systematic review] indicated that there is some available evidence of the possible association between [sleep bruxism] and alcohol, caffeine, and tobacco, dentists should be aware of this possibility during the first dental appointment,” wrote lead study author Eduardo Bertazzo-Silveira, DDS, and colleagues (Journal of the American Dental Association, November 2016, Vol. 147:11, pp. 859-866).
Dr. Richard H. Nagelberg, a dentist in Philadelphia, published a satirical article recently on dentistryiq.com, which amusingly chided dentists for “guesswork” in regards to diagnosing periodontal disease. Although Nagelberg’s article asks a lot of rhetorical questions to get his fellow peers thinking, one salient point he does make is that patients should be thinking about this issue too.
The majority of patients may not know just how serious periodontal disease is. After all, one could arguably say that the average patient goes into their dentist’s office with concerns about cavities and doesn’t think too much about their gums.
As Dr. Nagelberg points out, patients probably don’t know that bacteria that causes periodontal disease can be identified pretty quickly during a check-up, and then antibiotics could easily be prescribed. Since the dentistry profession is supposed to help patients prevent issues, why would those who’ve already been diagnosed with periodontal disease need a bacterial ID more than those who could still mitigate the problem?
In another article by Nagelberg, he encourages dentists to take the the extra step with patients who don’t already have periodontal disease:
The hallmark of prevention is to identify risk factors for disease and then to manage those risk factors before the disease, condition, or event occurs. This is why there is so much information available regarding the risk factors for cardiovascular disease. Periodontal disease is no exception. Identify the biggest risk factor for periodontal disease—namely, the specific bacteria a patient harbors in his or her mouth—and then manage it with an antimicrobial protocol before periodontal disease rears its ugly head.
Patients who have a strong family history of periodontal disease would be an ideal place to start. Since you can reasonably predict that these individuals have some level of elevated risk for periodontal disease, why not find out which oral bacteria they have? And the same for patients with gingivitis who have not yet progressed to periodontitis. If the test shows very few bacteria at low levels, we can conclude that, at this time, the patient is not at risk for the development of periodontal disease, and vice versa. This just makes sense.
While Dr. Nagelberg has some good points, why stop with patients who have a family history of the disease? Honestly, shouldn’t everyone be concerned with the ramifications of this disease? Besides the obvious negative effects to the gums and jaw bones, there have been so many studies concerning how periodontal disease is correlated to other major issues–like heart disease:
Although some patients may be familiar with the heart disease correlation, it doesn’t stop there. The Dental Tribune released a sobering article about how periodontal disease also has a correlation to Alzheimer’s:
Recent studies provide increasing evidence that untreated periodontal inflammation is linked to cognitive decline and Alzheimer’s disease, and that treating periodontitis may reduce or delay risk of this disease. About one out of every nine Americans have some form of Alzheimer’s disease, according to the Alzheimer’s Society. It is the worst type of dementia, involving the most cognitive decline and memory loss.
Research has already found Porphyromonas gingivalis (P. gingivalis) in brains of Alzheimer’s patients. P. gingivalis is a bacterium associated with chronic periodontitis. Researchers propose that when these bacteria reach the brain, an immune response is stimulated in the brain to release proteins that kill the bacteria, but also cause broader destruction . . .
A study by professor Stjohn Crean and Dr. Sim Singhrao at the University of Central Lancashire (UCLan) School of Medicine and Dentistry in England involved the examination of brain tissue samples of 10 deceased people with Alzheimer’s and 10 people without it.
It was found that bacteria found in chronic periodontal disease were present in the brains of four of the 10 people with Alzheimer’s but in none of the 10 without it. Researchers theorized that chronic periodontal disease bacteria, P. gingivalis, enter the bloodstream and brain, prompting an immune system response, which over time is thought to contribute to cognitive decline and Alzheimer’s disease.
Because there are so many issues linked to periodontal disease, dentist should focus on bacterial identification so patients can avoid SRP, pocket irrigation, and the like. And patients not only should be diligent about flossing, but they shouldn’t hesitate to speak up if they want their dentist to check for periodontal disease-causing bacteria.
If you think back to your previous dental visits, can you remember the professional who interacted with you the most? There’s a good chance it was your dental hygienist. After all, hygienists do a lot of the heavy lifting during dental exams and cleanings. They perform fluoride treatments, place sealants, screen for oral cancer, help with fillings, check for decay, update medical history, and so on.
Despite their training and important role of helping you maintain your oral health, hygienists can often be overlooked. In fact, hygienist Candice Feagle wrote an opinion piece in October that outlines this common issue:
I am certain that every hygienist has heard the phrase, “Oh, you’re just a hygienist.” I recently attended a function, and someone I was introduced to uttered the dreaded phrase. The “just” hit me in the chest as if I was wearing a shirt with a bull’s-eye on it. Everyone around us continued to engage in their conversations, and I noticed I was the only person in the room that actually reacted to the “just.”
Yes, I am just a hygienist:.
- Yes, I just review the patient’s medical history with them verbally because sometimes when patients are nervous they forget to write valuable medical information down on forms.
- Yes, I just talk to my patient for 45 minutes while I am “cleaning teeth” in order to help them feel comfortable and more importantly assess their stress level while gaining insight into their overall health.
- Yes, I just perform oral cancer screenings, periodontal charting, decay assessments, oral hygiene assessments, sealant placements, fluoride treatments, detailed explanations regarding dental treatments, and deal with any other overall health concerns they may have, often referring them back to their physician.
- Yes, I just sterilize the operatory, equipment, and dental instruments according to state regulations to ensure the health and safety of my patients and myself.
- Yes, I just obtained my bachelor’s degree in allied dental health, completed continuing education requirements, maintained my local anesthesia license, maintained my dental hygiene license, maintained my nitrous oxide administration credits, and continue to research dental technology to ensure that my patients are receiving the best dental hygiene care possible.
. . . I know the varied abilities and diverse opportunities being a hygienist represents. Still, I’ve chosen to fully embrace the phrase, “you’re just a hygienist.” Why? I do so to follow the brilliant and humble example of the Dalai Lama who once said, “I describe myself as a simple Buddhist monk. No more, no less.” My fellow hygienists, I hope you are proud to be just hygienists!
It is rather surprising that Ms. Feagle would have to justify her value. Then again, so many jobs in the medical field can have thankless moments and difficult situations to navigate despite job security. For instance, according to Salary.com, nurses have exhaustingly long hours and less-than fun duties, like changing bedpans. Yet nurses are very much underpaid for all that they do.
Even medical professionals in the upper echelons of the pay scale have their struggles. For instance in Dr. Maggie Kozel’s book The Color of the Atmosphere: One Doctor’s Journey in and out of Medicine, she explores that delicate balance of trying to help patients while being stressed by insurance regulations and liability.
Despite Ms. Feagle’s experiences with others, hygienists truly are vital to patients’ health. For instance, one New England hygienist says that she and her fellow hygienists are often the first people that sees signs of oral trauma and disease. She also says that the job is fast-paced and you have to be ready to assist many other co-workers on the fly:
Thankfully, the Dental Tribune says that because of their education and skills, hygienists should be allowed to contribute more to the field as oral health care becomes more accessible:
“Through dental hygiene diagnoses, dental hygienists educate patients on behaviors that minimize risks of oral infections, help detect risk factors for infectious diseases and cancers of the head and neck,” said ADHA president Betty Kabel, RDH, BS. “This elevates the role of the dental hygienist within the overall health care system, as we seek to expand the access to oral care. It’s important to utilize the dental hygiene diagnoses regularly and consistently to ensure optimal care for our patients.”
While dental hygienists’ rigorous education prepares them to provide preventive and therapeutic oral health services, the profession’s scope of practice varies from state to state. ADHA emphasizes that it is important for dental hygienists to fully utilize their education to provide oral health care services that fall within their scope . . .
You can read more about the changing roles of hygienists at the American Dental Hygienists’ Association (ADHA) website. The association is concerned with this profession’s value, since “confusion still exists on how to implement it into daily practice.”
Want to look real good for your Christmas card photo this year? This is the perfect time to go in for tooth whitening. After all, between Halloween, Thanksgiving, and Christmas festivities, you may have guzzled beer, wine, and mulled cider–all of which stain teeth. And even though seasonal sugary sweets don’t cause discoloration, bacteria in your mouth can eat those sugars and enamel, thus exposing yellow dentin.
You probably have seen how popular teeth whitening is, but may wonder just how safe it is. Dental expert Michelle McPhail says that it is one of the safest, and quickest cosmetic procedures. However, it is not recommended for young children or pregnant women.
Besides limiting those groups, pretty much any other person who is otherwise healthy can usually get this procedure. And even the side effects are minimal, with soft tissue irritation and tooth sensitivity being the main issues. So what’s the catch? According to a study at drbicuspid.com, researchers found that this procedure could cause more inflammation and pulp (center of your tooth) damage.
Researchers from Brazil wanted to know if the chemicals involved would damage the dental pulp of patients. Their study in the Journal of Applied Oral Science investigated using both in-office and at-home bleaching processes.
“Tooth bleaching is a technique of choice to obtain a harmonious smile, but bleaching agents may damage the dental pulp,” the authors wrote (J Appl Oral Sci, September-October 2016, Vol. 24:5, pp. 509-517).
Teeth bleaching is generally considered a conservative and effective technique, but the pulp’s inflammatory response should be better understood before a bleaching technique is used clinically, the researchers noted. They measured inflammatory events and cells involved in the human pulp response to at-home and in-office bleaching.
The researchers found that in-office bleaching with 38% hydrogen peroxide had “more intense inflammation, higher macrophages migration, and greater pulp damage” than the carbamide peroxide group. They noted, however, that these techniques did not induce migration of mast cells and actually increased the number of blood vessels.
But keep in mind that this study also found that in-office bleaching with hydrogen peroxide caused more inflammation. If you want to avoid any side effects, you could ask your dentist about carbamide peroxide instead, which is a low-dose whitener that can be used at home.
If you are worried that a take-home system won’t get you the results you want, you may want to consider an Opalescence system. It does use a stronger hydrogen peroxide gel, but it also contains potassium nitrate which reduces sensitivity.
While these take-home options can certainly mitigate issues from stronger whitening systems, one has to wonder if an increase in side effects is due to patients’ addictions to whitening! In fact, Prevention.com had an interesting article about how some people develop a body dysmorphic disorder and end up overbleaching because they are never satisfied with results:
Unfortunately, many people don’t stop when they should. “Ten years ago, people weren’t even aware of bleaching,” says Irwin Smigel, DDS, president of the American Society for Dental Aesthetics. “Now every dentist I know has had to cut off at least one patient because of overbleaching. People come in with great, great pain, and I can see immediately from the color of their teeth and the irritation along the gums that they’ve been bleaching and bleaching.”
The urge to keep whitening may spring from the fact that teeth stubbornly refuse to maintain their same sparkling brightness for long. “Once you stop with the bleach, it regresses—your teeth start returning to their original color,” says Smigel. “Very few people are happy with the color once it starts regressing, so they’ll do teeth whitening again and again.” Dental laboratories are working to keep pace by creating new caps, fillings, and crowns in ever-brighter shades.
For some individuals, the pursuit of blindingly white teeth can become a true obsession. “There’s anorexia nervosa among certain people who desperately want to be thin, and there’s also a similar syndrome for people whose teeth are never white enough,” says John W. Siegal, DDS, a New York City dentist. This can go so far as to be classified as a form of body dysmorphic disorder (BDD)—a distorted view of one’s features that becomes so consuming that it interrupts daily functioning and requires psychiatric treatment—says Katharine A. Phillips, MD, a professor of psychiatry at Brown Medical School.
So while the study by Brazilian researchers may shed some light on side effects, the Prevention article may have some perspective that needs to be taken into account. Perhaps side effects can be reduced greatly if patients know that these results will fade and that they will have to wait until their dentist gives the go-ahead before they whiten again.
Like many patients you are probably tired of going to the dentist and hearing the questions:”Are you brushing thoroughly?” and “Are you flossing every day?” Even if you are adamant about your brushing and flossing, it can be annoying to hear that you have a cavity or that your gums are inflamed. You probably look forward to a routine check-up where you find that you have a clean bill of health!
While some people are predisposed to oral issues due to genetics or secondary conditions, there is something you can do to nail your next dental exam and cleaning: focus on your diet.
For instance, the site 123dentist.com recently shared a blog post on which foods could amp up your gum health. Take a look:
Want healthier gums? Eat more of these foods.
Vegetables like kale and spinach are filled to the brim with mouth-healthy vitamins and minerals. Specifically, they hold vitamin C, which boosts the production of red blood cells and reduces inflammation. Both these benefits battle against irritation and gum disease. Leafy greens require more chewing, thanks to their high fibre content, which is good for gums because the chewing action creates more saliva. This helps to flush out food particles, bacteria, and plaque that may be sticking to your teeth near the gum line. Revamp your diet with power-packed greens by creating salads with them, adding them as a cooked side dish to main meals, and putting them in soups and sandwiches.
Celery, carrots, and apples
Foods that are very crunchy are excellent at scraping away stuck on food and plaque. The hard bits of foods like celery, carrots, and apples get in between teeth and into tooth crevices and can help keep your mouth fresh between brushings. Crunchy fruits and vegetables also happen to be high in fibre, which, again, means they take longer to chew and generate more saliva. Saliva is great for flushing the mouth of bacteria near the gum line. Simply add these foods to your daily diet as snacks to help get rid of food particles between meals. Read the entire food list . . .
It’s not news that fruits and veggies are good for you. But this kind of information is often used when talking about weight loss rather than oral health. However, the oral benefits from 123dentist.com’s blog post are also backed up in a separate dentistry video by Dr. Gordon Wilson:
He advises individuals to stock up on foods that have beta carotene, folic acid, antioxidants, and vitamins A, B, C, and E, since these can accelerate bone regeneration and prevent plaque from sticking to your gums.
Adding these kinds of foods shouldn’t be hard. There are so many good recipes online these days that even the worst cook in the world can find something simple, healthy, and tasty to make! The problem, however, may not be in incorporating good things into your diet, but cutting things out. For example, ilikemyteeth.org talks about the politics of soda companies and how finding good water to drink can be a struggle–even in the U.S.:
Bottled Water or Tap? Considerations for your Choice
Most health advocates promote drinking water over sugar sweetened beverages. Many urge tap water over bottled water. That’s the best way to benefit from the prevention provided by the fluoride that is added to community water systems serving about 75% of us. (Most bottled water does not contain the optimal level of fluoride to protect teeth.)
As a result of the lead crisis in Flint, Michigan and the fight to protect the safety of the water at Standing Rock, there is growing awareness of long-ignored water issues around the country, from basic water safety to something we now know as water poverty. The U.S. still has some of the safest drinking water on the planet, but eroding trust means that we are at risk of drinking less of it . . .
And then there is this. Soda companies invest millions of dollars in campaigns to defeat soda taxes that are designed to discourage people from buying and consuming sugar sweetened beverages. (They have also funded successful efforts to influence health organizations.) These taxes are being imposed more widely to help abate the dramatic increase we are experiencing in obesity and Type 2 diabetes, especially among children. The rates of these diseases are highest in the very populations that the industry targets most – low income neighborhoods and racial and ethnic minorities . . .
So is bottled water a bad choice, the villain? There are lots of reasons why it isn’t as good at tap water for most of us. However, for people who are substituting water for soda, or people who whose water is decidedly unsafe, or people who are exploring whether or not to trust what comes from the tap, bottled water is a compromise that we live with until everyone’s right to healthful water is guaranteed. Read full article here . . .
When it comes down to it, even if bottled water doesn’t have the fluoride benefits of tap water, it is significantly better than drinking pop. If you can cut down on your soft drinks, you should be seeing improvements at your dental check-ups. One way to ease into this transition is by getting your fix from club soda. Again, it’s not as good as drinking from the tap, but it’s a step in the right direction. Keep your good brushing and flossing habits up, but see if some diet changes do the trick.
It can be frustrating being a smoker who needs certain medical procedures but is continually turned away because smoking is a contraindication. However, you may be surprised to hear that smoking isn’t necessarily a contraindication for dental implants. According to a video by Dr. Anjali Amarnath, as long as smokers quit their habit for a short time after their surgery, they have a fairly good success rate. Take a look:
In the past, however, smoking was certainly a contraindication. It’s only because of the combined efforts of patients, dentists, and advanced technology that it’s now possible for successful dental implants. Because implants are more successful than they were before, it may be tempting for patients to continue their habit and flout their doctor’s instructions. This is a sure-fire way to ruin your chances of success. So you may be wondering why is smoking so bad anyway–why would stopping it for only a short while help? The site 123dentist.com has the answer:
Why is smoking bad for your oral health?
Decreased levels of oxygen in the blood leads to a weakened immune system and leaves your mouth vulnerable to infection. This means that bacteria found in your mouth can more easily build-up and infiltrate your gums. The bacteria can quickly destroy gum flesh, causing it to recede and become loose and unhealthy. The gums help to anchor teeth in place, so when their health is compromised teeth can become loose and potentially fall out. When gum disease progresses it can affect the bones and surrounding flesh, causing them to break down, too. Studies have shown that those who smoke are two times more likely to contract gum disease than those who don’t.
Because dental implants only work for those with strong gums and bones, smokers can’t afford to mess around after surgery. Even stopping for a week or two can help give your gums a breather to heal properly and take the implants. Doctors understand that kicking the habit is difficult–they are only asking patients to quit temporarily. However, an upcoming surgery could be a motivator to kick the habit altogether. For instance, 123dentist.com also says that quitting intermittently or covering up the issue with “band-aid methods,” like stronger toothpaste, isn’t going to fix long-term issues:
There are toothpastes and mouthwashes available on the market produced specifically for those who use tobacco products, however they are not nearly as effective at treating oral issues brought on by smoking as getting rid of the habit is. These products are generally more harsh and abrasive in an attempt to target destructive bacteria but they have no effect in restoring enamel, reversing tooth rot, root rot, gum rot, or preventing any kind of cancer. Read more here . . .
It’s an understatement to say that quitting smoking is daunting. But quitting is not impossible. Drbicuspid.com has some encouraging news about adults being able to quit:
CDC: Fewer U.S. adults smoke now than in 2005
The news is mostly positive, as the percentage of U.S. adults who smoke cigarettes declined from 20.9% in 2005 to 15.1% in 2015, and the proportion of those identified as daily smokers declined from 16.9% to 11.4%, according to lead author Ahmed Jamal, MBBS, and colleagues in Morbidity and Mortality Weekly Report (November 11, 2016, Vol. 65:44, pp. 1205-1211).
“The [U.S.] Surgeon General has concluded that the burden of death and disease from tobacco use in the United States is overwhelmingly caused by cigarettes and other combusted tobacco products,” the authors wrote . . . Adults in the following categories also were more likely to smoke:
- Adults living below the poverty level
- Adults enrolled in Medicaid or who are uninsured
- Adults who have a disability or limitation
“. . . Proven population-based interventions, including tobacco price increases, comprehensive smoke-free laws, antitobacco mass media campaigns, and barrier-free access to tobacco cessation counseling and medications, are critical to reducing cigarette smoking and smoking-related disease and death among U.S. adults,” the authors concluded. Read the full article here . . .
As you can see, the numbers don’t lie: people can kick this habit. While it is ultimately up to the patient to decide if he or she wants to quit, these results show that a good support system is invaluable to lifestyle changes. And because the data shows that those struggling with their finances may smoke more, it’s important for dentists to consider manageable payment plans so their patients can pursue implants.
Since Medicaid doesn’t cover implants, patients may be disheartened by their options. But dentists should be upfront about extractions and dentures–which are usually covered by Medicaid–that way patients know they have temporary options while they explore financing for permanent implants down the line.