Acid Erosion
What is acid erosion?
Many of the foods and drinks we consume contain acid, which can temporarily soften the hard enamel surface of your teeth.  Over time the enamel is dissolved and eventually becomes thinner.  Brushing after consuming acidic foods or drink will wear away the softened enamel faster.  This wearing of enamel caused by acid in our diet is called acid erosion.

What causes acid erosion?
Food and Drink:  Studies have shown that acidic drinks such as citrus-based and other juices, soft drinks, sports drinks, herbal teas and wine, fruit and chewable vitamin C tablets are likely to exacerbate dental erosion.  It is important to note that caffeinated beverages and alcohol, especially wines, are also dehydrating as well as acidic and can lead to dry mouth this therefore increases the risk of acid erosion.
Reflux: Reflux is a common cause of tooth erosion, as your teeth are attacked by the acid in the reflux.  Reflux may also be a side effect of pregnancy, your diet and is also caused by some medications.
Chronic vomiting: Chronic vomiting conditions can severely erode your teeth causing loss of dental enamel, yellowing of teeth, and may also increase chips and fractures of the enamel as it becomes thinner.
Dry Mouth: Saliva helps to neutralise the acid in your mouth, insufficient saliva will allow acid to damage your teeth more quickly.

What are some of the signs of acid erosion?
Teeth may develop a yellowish appearance as enamel becomes thinner and the yellower dentine shows through. You might notice a rounded look on the surface and edges of the teeth.

In the later stages, teeth may appear slightly transparent near the biting edges, and small cracks may be visible at the edges of the teeth.

Thinning enamel may also be a cause of sensitivity.  As dentine becomes exposed through loss of enamel, an occasional slight twinge may be felt when consuming hot, cold, sweet or acidic (e.g. wine or juice) foods and drinks.  Sensitivity usually means that the erosion is active and therefore needs to be treated.

Keys to preventing acid erosion:
Enjoying food and drinks is part of living a balanced life, and it isn’t necessary to cut out these drinks or foods all together.  Instead there are some key things that people can do to ensure they are maintaining good oral health while enjoying their choice of food and beverages.

• Avoid holding or ‘swishing’ soft drinks or sport drinks around the mouth as this increases the likelihood of dental decay and enamel erosion.
• Use a straw where possible as this minimises exposure of the beverage to teeth.
• Never brush your teeth immediately after consuming acidic food or drink.  Wash your mouth with water, and wait approximately 1 hour before brushing.
• Drink fluoridated tap water as much as possible.  Try to follow the consumption of acidulated drinks with a glass of water as it helps wash the sugars and acids from these beverages away.
• Make sure that you maintain a routine of brushing with fluoride toothpaste at least twice a day after meals, clean in between your teeth and visiting Michael Adams’ practice regularly.

Sports and Energy Drinks Responsible for Irreversible Damage to Teeth

A recent study published in the May/June 2012 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry, found that an alarming increase in the consumption of sports and energy drinks, especially among adolescents, is causing irreversible damage to teeth -- specifically, the high acidity levels in the drinks erode tooth enamel, the glossy outer layer of the tooth."Young adults consume these drinks assuming that they will improve their sports performance and energy levels and that they are 'better' for them than soda," says Poonam Jain, BDS, MS, MPH, lead author of the study. "Most of these patients are shocked to learn that these drinks are essentially bathing their teeth with acid."

Researchers examined the acidity levels in 13 sports drinks and nine energy drinks. They found that the acidity levels can vary between brands of beverages and flavors of the same brand. To test the effect of the acidity levels, the researchers immersed samples of human tooth enamel in each beverage for 15 minutes, followed by immersion in artificial saliva for two hours. This cycle was repeated four times a day for five days, and the samples were stored in fresh artificial saliva at all other times.

"This type of testing simulates the same exposure that a large proportion of American teens and young adults are subjecting their teeth to on a regular basis when they drink one of these beverages every few hours," says Dr. Jain.

The researchers found that damage to enamel was evident after only five days of exposure to sports or energy drinks, although energy drinks showed a significantly greater potential to damage teeth than sports drinks. In fact, the authors found that energy drinks caused twice as much damage to teeth as sports drinks.

With a reported 30 to 50 percent of U.S. teens consuming energy drinks, and as many as 62 percent consuming at least one sports drink per day, it is important to educate parents and young adults about the downside of these drinks. Damage caused to tooth enamel is irreversible, and without the protection of enamel, teeth become overly sensitive, prone to cavities, and more likely to decay.

"Teens regularly come into my office with these types of symptoms, but they don't know why," says AGD spokesperson Jennifer Bone, DDS, MAGD. "We review their diet and snacking habits and then we discuss their consumption of these beverages. They don't realize that something as seemingly harmless as a sports or energy drink can do a lot of damage to their teeth."

Dr. Bone recommends that her patients minimize their intake of sports and energy drinks. She also advises them to chew sugar-free gum or rinse the mouth with water following consumption of the drinks. "Both tactics increase saliva flow, which naturally helps to return the acidity levels in the mouth to normal," she says.

Also, patients should wait at least an hour to brush their teeth after consuming sports and energy drinks. Otherwise, says Dr. Bone, they will be spreading acid onto the tooth surfaces, increasing the erosive action.

Dentists: Doctors of Oral Health ( From the American Dental Association)

Introduction

Most Americans today enjoy excellent oral health and are keeping their natural teeth throughout their lives. But this is not the case for everyone. Cavities are still the most prevalent chronic disease of childhood. Further, about 100 million Americans did not see a dentist in 2007, even though regular dental examinations and good oral hygiene can prevent most dental disease.

Too many people mistakenly believe that they need to see a dentist only if they are in pain or think something is wrong, but they're missing the bigger picture. A dental visit means being examined by a doctor of oral health capable of diagnosing and treating conditions that can range from routine to extremely complex.

The American Dental Association believes that a better understanding of the intensive academic and clinical education that dentists undergo, their role in delivering oral health care and, most important, the degree to which dental disease is almost entirely preventable is essential to ensuring that more Americans enjoy the lifelong benefits of good oral health.

A Team Approach

The team approach to dentistry promotes continuity of care that is comprehensive, convenient, cost effective and efficient. Members of the team include dental assistants, lab technicians and dental hygienists. Leading the team is the dentist, a doctor specializing in oral health who has earned either a Doctor of Dental Medicine (DMD) degree or a Doctor of Dental Surgery (DDS) degree, which are essentially the same.

The Dentist's Role

Dentists are doctors who specialize in oral health. Their responsibilities include:

Diagnosing oral diseases. Promoting oral health and disease prevention. Creating treatment plans to maintain or restore the oral health of their patients. Interpreting x-rays and diagnostic tests. Ensuring the safe administration of anesthetics. Monitoring growth and development of the teeth and jaws. Performing surgical procedures on the teeth, bone and soft tissues of the oral cavity. Managing oral trauma and other emergency situations.

Dentists' oversight of the clinical team is critical to ensuring safe and effective oral care. Even seemingly routine procedures such as tooth extractions, preparing and placing fillings or administering anesthetics carry potential risks of complications such as infection, temporary or even permanent nerve damage, prolonged bleeding, hematomas and pain.

As doctors of oral health, dentists must be able to diagnose and treat a range of conditions and know how to deal with complications—some of which are potentially life-threatening.

More than Just Teeth and Gums

Dentists' areas of care include not only their patients' teeth and gums but also the muscles of the head, neck and jaw, the tongue, salivary glands, the nervous system of the head and neck and other areas. During a comprehensive exam, dentists examine the teeth and gums, but they also look for lumps, swellings, discolorations, ulcerations—any abnormality. When appropriate, they perform procedures such as biopsies, diagnostic tests for chronic or infectious diseases, salivary gland function, and screening tests for oral cancer.

In addition, dentists can spot early warning signs in the mouth that may indicate disease elsewhere in the body. Dentists' training also enables them to recognize situations that warrant referring patients for care by dental specialists or physicians.

Education and Clinical Training

The level of education and clinical training required to earn a dental degree, and the high academic standards of dental schools, are on par with those of medical schools and are essential to preparing dentists for the safe and effective practice of modern oral health care.

Most dental students have earned Bachelor of Science degrees or their equivalent, and all have passed rigorous admission examinations.

The curricula during the first two years of dental and medical schools are essentially the same—students must complete such biomedical science courses as anatomy, biochemistry, physiology, microbiology, immunology and pathology. During the second two years, dental students' coursework focuses on clinical practice—diagnosing and treating oral diseases. After earning their undergraduate and dental degrees (eight years for most) many dentists continue their education and training. Some go on to achieve certification in one of nine recognized dental specialties.

Upon completing their training, dentists must pass both a rigorous national written examination and a state or regional clinical licensing exam in order to practice. As a condition of licensure, they must meet continuing education requirements for the remainder of their careers, to keep them up-to-date on the latest scientific and clinical developments.

Why Oral Health Matters

Numerous recent scientific studies indicate associations between oral health and a variety of general health conditions—including diabetes and heart disease. In response, the World Health Organization has integrated oral health into its chronic disease prevention efforts "as the risks to health are linked."

The American Dental Association recommends that dental visits begin no later than a child's first birthday to establish a "dental home." Dentists can provide guidance to children and parents, deliver preventive oral health services, and diagnose and treat dental disease in its earliest stages. This ongoing dental care will help both children and adults maintain optimal oral health throughout their lifetimes.

Dentists' areas of care include not only their patients' teeth and gums but also the muscles of the head, neck and jaw, the tongue, salivary glands, the nervous system of the head and neck and other areas.

Improving the Nation's Oral Health

Despite all we know about the importance of oral health to overall health, to people's self-esteem and to their employability, state and federal policies continually sell dental care short.

Most states spend 2 percent or less of their Medicaid budgets on dental services. Only 16 states offered substantive coverage for adult Medicaid enrollees in 2007. An estimated 164 million work hours are lost each year due to oral disease.

The American Dental Association is committed to improving the nation's oral health through public education and through legislative advocacy to strengthen funding for dental services provided through public health programs.

Together, we can work to improve America's oral health and give all of us something to smile about.

* Many but not all dentists complete a 4-year college degree before entering dental school; some enter dental school after 3 years.
** Many dental public health specialists also complete a two-year Master's degree in public health.
*** Many oral and maxillofacial surgeons obtain medical (M.D.) degrees in conjunction with their programs.

* Many but not all dentists complete a 4-year college degree before entering dental school; some enter dental school after 3 years

ANOTHER REMINDER TO HAVE A HEALTHY MOUTH

Oral bacteria that escape into the bloodstream are able to cause blood clots and trigger life-threatening endocarditis. Further research could lead to new drugs to tackle infective heart disease, say scientists presenting their work at the Society for General Microbiology's Spring Conference in Dublin.

Streptococcus gordonii is a normal inhabitant of the mouth and contributes to plaque that forms on the surface of teeth. If these bacteria enter into the blood stream through bleeding gums they can start to wreak havoc by masquerading as human proteins.

Researchers from the Royal College of Surgeons in Ireland (RCSI) and the University of Bristol have discovered that S. gordonii is able to produce a molecule on its surface that lets it mimic the human protein fibrinogen - a blood-clotting factor. This activates the platelets, causing them to clump inside blood vessels. These unwanted blood clots encase the bacteria, protecting them from the immune system and from antibiotics that might be used to treat infection. Platelet clumping can lead to growths on the heart valves (endocarditis), or inflammation of blood vessels that can block the blood supply to the heart or brain.

Dr Helen Petersen who is presenting the work said that better understanding of the relationship between bacteria and platelets could ultimately lead to new treatments for infective endocarditis. "In the development of infective endocarditis, a crucial step is the bacteria sticking to the heart valve and then activating platelets to form a clot. We are now looking at the mechanism behind this sequence of events in the hope that we can develop new drugs which are needed to prevent blood clots and also infective endocarditis," she said.

Infective endocarditis is treated with surgery or by strong antibiotics - which is becoming more difficult with growing antibiotic resistance. "About 30% of people with infective endocarditis die and most will require surgery for replacement of the infected heart valve with a metal or animal valve," said Dr Petersen. "Our team has now identified the critical components of the S. gordonii molecule that mimics fibrinogen, so we are getting closer to being able to design new compounds to inhibit it. This would prevent the stimulation of unwanted blood clots," said Dr Steve Kerrigan from the RCSI.

The team are also looking more widely at other dental plaque bacteria that may have similar effects to S. gordonii. "We are also trying to determine how widespread this phenomenon is by studying other bacteria related to S. gordonii. What our work clearly shows is how important it is to keep your mouth healthy through regular brushing and flossing, to keep these bacteria in check," stressed Dr Petersen.

References:
Society for General Microbiology

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What Is Gum Disease (Periodontitis)?

Periodontitis means "inflammation around the tooth" - it is a serious gum infection that damages the soft tissue and bone that supports the tooth. All periodontal diseases, including periodontitis, are infections which affect the periodontium. The periodontium are the tissues around a tooth, tissues that support the tooth. With periodontitis, the alveolar bone around the teeth is slowly and progressively lost. Microorganisms, such as bacteria, stick to the surface of the tooth and multiply - an overactive immune system reacts with inflammation.

Untreated periodontitis will eventually result in tooth loss, and may increase the risk of stroke, heart attack and other health problems. Bacterial plaque, a sticky, colorless membrane that develops over the surface of teeth, is the most common cause of periodontal disease.

In dentistry, periodontics deals with the prevention, diagnosis and treatment of diseases involving the gums and structures which support teeth. There are eight dental specialties, of which periodontics is one. If you want dental implants, you see a periodontist.

In most cases, periodontitis is preventable. It is usually caused by poor dental hygiene.

Periodontitis is:

1. Inflammation of the periodontium.

2. A chronic inflammatory disease of the periodontium occurring in response to bacterial plaque on the adjacent teeth; characterized by gingivitis, destruction of the alveolar bone and periodontal ligament, apical migration of the epithelial attachment resulting in the formation of periodontal pockets, and ultimately loosening and exfoliation of the teeth.

What is the difference between periodontitis and gingivitis?

Gingivitis occurs before periodontitis. Gingivitis usually refers to gum inflammation while periodontitis refers to gum disease and the destruction of tissue and/or bone. Initially, with gingivitis, bacteria plaque accumulates on the surface of the tooth, causing the gums to go red and inflamed; teeth may bleed when brushing them. Even though the gums are irritated and bothersome, the teeth are not loose. There is no irreversible damage to bone or surrounding tissue.

Untreated gingivitis can progress to periodontitis. With periodontitis, the gum and bone pulls away from the teeth, forming large pockets. Debris collects in the spaces between the gums and teeth, and infect the area. The patient's immune system attacks bacteria as the plaque spreads below the gum line. Bone and connective tissue that hold the tooth start to break down - this is caused by toxins produced by the bacteria. Teeth become loose and can fall out.

Put simply, Periodontitis involves irreversible changes to the supporting structures of the teeth, while gingivitis does not.

What are the signs and symptoms of periodontitis

A symptom is something we feel and describe to the doctor, while a sign is something others, including the doctor can see. For example, pain is a symptom while redness or inflammation is a sign.

Periodontitis signs and symptoms can include:

• Inflamed (swollen) gums, gum swelling recurs
• Gums are bright red, sometimes purple
• Gums hurt when touched
• Gums recede, making teeth look longer
• Extra spaces appear between the teeth
• Pus may appear between the teeth and gums
• Bleeding when brushing teeth
• Bleeding when flossing
• Metallic taste in the mouth
• Halitosis (bad breath)
• Loose teeth
• The patient's "bite" feels different because the teeth do not fit the same

What are the causes of periodontitis?

• Dental plaque forms on teeth - this is a pale-yellow biofilm that develops naturally on teeth. If is formed by bacteria that try to attach themselves to the tooth's smooth surface.
• Brushing teeth gets rid of plaque, but it soon builds up; within a day or so.
• If it is not removed, within two or three days it hardens into tartar. Tartar is much harder to remove than plaque. Another name for tartar is calculus. Getting rid of tartar requires a professional - you cannot do it yourself.
• Plaque can gradually and progressively damage teeth and surrounding tissue. At first, the patient may develop gingivitis - inflammation of the gum around the base of the teeth.
• Persistent gingivitis can result in pockets developing between the teeth and gums. These pockets fill up with bacteria.
• Bacterial toxins and our immune system's response to infection start destroying the bone and connective tissue that hold teeth in place. Eventually the teeth start becoming loose, and can even fall out.

What are the risk factors for periodontitis?

A risk factor is something that increases the risk of developing a condition or disease. For example, obesity is a risk factor for diabetes type 2 - this means that obese people have a higher chance of developing diabetes. The following risk factors are linked to a higher risk of periodontitis:

• Smoking - regular smokers are much more likely to develop gum problems. Smoking also undermines the efficacy of treatments.
• Hormonal changes in females - puberty, pregnancy, and the menopause are moments in life when a female's hormones undergo changes. Such changes raise the risk of developing gum diseases.
• Diabetes - patients who live with diabetes have a much higher incidence of gum disease than other individuals of the same age
• AIDS - people with AIDS have more gum diseases
• Cancer - cancer, and some cancer treatments can make gum diseases more of a problem
• Some drugs - some medications that reduce saliva are linked to gum disease risk.
• Genetics - some people are more genetically susceptible to gum diseases

Diagnosing periodontitis

A qualified dentist should find it fairly straightforward to diagnose periodontitis. The dentist will ask the patient questions regarding symptoms and carry out an examination of his/her mouth.

The dentist will examine the patient's mouth using a periodontal probe - a thin, silver stick-like object with a bend at one end. The probe is inserted next to the tooth, under the gum line. If the tooth is healthy, the probe should not slide far below the gum line. In cases of periodontitis, the probe will reach deeper under the gum line.


Two types of periodontal probes. 1. Michigan O Probe (left). 2. Naber's Probe (right)

The dentist may order an X-ray to see what condition the jaw bone and teeth are in.

What are the treatment options for periodontitis?

The main aim of the periodontist, dentist or dental hygienist, when treating periodontitis, is to clean out bacteria from the pockets around the teeth and prevent further destruction of bone and tissue.

For best treatment results, the patient must maintain good oral hygiene and care. This involves brushing teeth at least twice a day and flossing once per day. If there is enough space between the teeth, an interdental brush (Proxi-brush) is recommended. Soft-picks can be used when the space between the teeth is smaller. Patients with arthritis, and others with dexterity problems may find that using an electric toothbrush is better for a thorough clean.

It is important that the patient understands that periodontitis is a chronic (long-term) inflammatory disease - this means oral hygiene must be maintained for life. This will also involve regular visits to a dentist or dental hygienist.

Initial treatment

It is important to remove plaque and calculus (tartar) to restore periodontal health.

The healthcare professional will use clean (non-surgically) below the gumline. This procedure is called scaling and debridement. Sometimes an ultrasonic device may be used. In the past Root Planing was used (the cemental layer was removed, as well as calculus).

Medications

• Prescription antimicrobial mouthrinse - for example chlorhexidine. It controls bacteria when treating gum disease, as well as after surgery. Patients use it like they would a regular mouthwash.
• Antiseptic "chip" - this is a small piece of gelatin which is filled with chlorhexidine. It controls bacteria and reduces periodontal pocket size. This medication is placed in the pockets after root planing. The medication is slowly resealed over time.
• Antibiotic powder/gel (ARESTIN^®) - a gel that contains minocycline hydrochloride, an antibiotic. This medication controls bacteria and shrinks periodontal pockets. It is placed in the pockets after scaling and root planing. It is a slow-release medication.
• Antibiotic microspheres - miniscule particles containing minocycline, an antibiotic. Also used to control bacteria and reduce periodontal pocket size. They are placed into pockets after scaling and root planing. A slow-release medication.
• Enzyme suppressant - keeps destructive enzymes in check with a low-dose of doxycycline. Some enzymes can break down gum tissue, this medication holds back the body's enzyme response. Taken orally as a pill, and is used with scaling and root planing.
• Oral antibiotics - either in capsule or tablet form and are taken orally. They are used short-term for the treatment of acute or locally persistent periodontal infection.

Advanced periodontitis

If good oral hygiene and non-surgical treatments are not enough, the following surgical interventions may be required:

• Flap surgery - the healthcare professional performs flap surgery to remove calculus in deep pockets, or to reduce the pocket so that keeping it clean is easier. The gums are lifted back and the tarter is removed. The gums are then sutured back into place so they fit closely to the tooth. After surgery, the gums will heal and high tightly around the tooth. In some cases the teeth may eventually seem longer than they used to.
• Bone and tissue grafts - this procedure helps regenerate bone or gum tissue that has been destroyed. With bone grafting, new natural or synthetic bone is placed where bone was lost, promoting bone growth.
  
  In a procedure called guided tissue regeneration, a small piece of mesh-like material is inseted between the gum tissue and bone. This stops the gum from growing into bone space, giving the bone and connective tissue a chance to regrow.
  
  The dentist may also use special proteins (growth factors) that help the body regrow bone naturally.
  
  The dental professional may suggest a soft tissue graft - tissue taken from another part of the mouth, or synthetic material is used to cover exposed tooth roots.

Experts say it is not possible to predict how successful these procedures are - each case is different. Treatment results also depend on how advanced the disease is, how well the patient adheres to a good oral hygiene program, as well as other factors, such as smoking status.

What are the complications of periodontitis?

The most common complication from periodontitis is the loss of teeth. However, patients with periodontitis are also at a higher risk of having respiratory problems, stroke, coronary artery disease, and low birth weight babies.

Pregnant women with bacterial infections that cause moderate-to-severe periodontal disease have a higher risk of having a premature baby.

Periodontitis can make it harder for patients with diabetes to control blood sugar.

Prevention

The best way to prevent periodontitis is to follow a program of good oral hygiene, one that you begin early and practice consistently throughout life. That means brushing your teeth at least twice daily — in the morning and before going to bed — and flossing at least once a day. Better yet, brush after every meal or snack or as your dentist recommends. A complete cleaning with a toothbrush and floss should take three to five minutes. Flossing before you brush allows you to clean away the loosened food particles and bacteria.

Also, see your dentist or dental hygienist regularly for cleanings, usually every six to 12 months. If you have risk factors that increase your chance of developing periodontitis, you may need professional tooth cleaning more often.

References:
Sources: National Health Service (NHS), UK. National Institutes of Health (NIH), USA. University of Maryland Medical Center. Medical News Today archives.

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