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.

Citations:

MLA

APA

Teeth grinding during sleep is usually involuntary, and often times an individual suffering from the condition will not know until the symptoms are present or until a dental checkup. Also known medically as bruxism, this condition involves the constant grinding, gnashing or clenching of the teeth. While mild cases may not require treatment, more serious cases can lead to future dental complications if left untreated. Be sure to have regular dental checkups to catch and treat teeth grinding symptoms.

Causes

There are many different reasons why bruxism occurs, and it may be different for everyone. Even doctors today cannot determine the exact cause of teeth grinding. Some of the more universal causes for bruxism include:

• Unresolved anxiety, stress, tension or fear
• Suppressed anger or frustration
• An aggressive, competitive, hyperactive personality
• Abnormal sleep problems or habits
• Misalignment of upper and lower teeth
• Crooked or missing teeth
• In children, response to pain from teething or an earache
• Complications or side effect of other medical diseases, such as Huntington’s disease or Parkinson’s disease
• Side effects of other medication, such as antidepressants

Symptoms

Since teeth grinding often happens during sleep, it is common that a person will not know if he or she is suffering from bruxism until a dentist is consulted. Below are some signs and symptoms that may indicate teeth grinding while sleeping

• Continuous dull headaches
• Sore or painful jaw
• Heightened teeth sensitivity to cold, hot, sweet, or sour foods
• Loose and/or fractured teeth with unknown reasons
• Stress or insomnia
• Earaches (as the jaw bone is close to the ear canal)
• Chronic facial pain
• Damage on the inside of the cheeks or tongue from chewing
• Worn tooth enamel

One guaranteed way is to ask your sleep partner or family members to observe your sleep habits. If they can detect a crunching, grinding or clicking sound during your sleep, you are most likely grinding your teeth. If bruxism is left untreated, your jaw joint and bones may become damaged in the long run due to constant wear and tear. It is also unhealthy for your teeth, as they can fracture or wear down. Untreated teeth grinding can feel extremely uncomfortable and annoying.

  YEARS OF UNTREATED BRUXISM

  RECONSTRUCTIVE DENTISTRY (CROWNS)

Prevention

There are several steps that can be taken to maximize prevention of teeth grinding during sleep:

• Reduce stress: since stress, fear, and anxiety is a common culprit in teeth grinding, stress reduction may help prevent future episodes of bruxism. Try yoga, meditation or talking to a family member for stress management.
• Avoid stimulants at night: stimulants, such as caffeine, alcohol and smoking, may impede the body from properly relaxing. For sensitive individuals, bright lights, television, and computer screens can also be stimulants. Be sure to properly “cool down” an hour before bed by dimming the lights and relaxing to help avoid teeth grinding.
• Visit your dentist regularly: your dentist will be the most effective person to determine whether or not you suffer from bruxism, as he or she can see the wear and tear effects.

Treatment

While most children outgrow bruxism, it can be a nuisance for adult sufferers. There are several ways to relieve teeth grinding:

• Mouth guards: the most common way to relieve teeth grinding is to wear a mouth guard during sleep. Mouth guards can be easily obtained at the local drug store, or your dentist can also fit you with a customized mouth guard for a more comfortable fit.
• Stress relief: if your bruxism is caused by stress, fear or anxiety, you may find relief through stress management therapy. Exercise, meditation, physical therapy, relaxation techniques or professional counseling can be effective methods to help against teeth grinding due to stress.
• Dental work: if the teeth grinding is associated with dental problems, such as crooked or missing teeth, bruxism may be lessened by fixing such problems. Sometimes, tooth crowns, braces or splints may be used to aid reconstructive dental work.
• Biofeedback therapy: if teeth grinding is of a behavioral nature or is habit-based, biofeedback therapy can be helpful. Biofeedback is characterized by a combination of alternative medicine and monitoring procedures that teaches and regulates involuntary responses. Sometimes, machines and equipment can also be used.
• Medication: although not commonly used, sometimes doctors may choose to prescribe muscle relaxants for the patient to take before sleeping. If teeth grinding is a side effect of a prior medication, the doctor may also change the drug therapy to alleviate bruxism.

Sources:

• Mayo Clinic
• PubMed Health
• American Dental Association

New "massage method" quadruples protection against tooth decay

25 March 2012 University of Gothenburg

Do you really want to avoid cavities in your teeth? Try massaging them with a high-fluoride toothpaste after lunch. “Rubbing toothpaste onto your teeth increases the fluoride protection by 400%,” says Anna Nordström, dentist, PhD and researcher at the Sahlgrenska Academy at the University of Gothenburg, Sweden.

Eight years ago a new brand of toothpaste was launched in Sweden with more than three times as much fluoride as standard toothpaste. Available without prescription, it is aimed primarily at those with high caries risk.

  First scientific evaluation

Researchers at the University of Gothenburg’s Sahlgrenska Academy have now performed the first scientific evaluation of the effect of this so called “high-fluoride toothpaste”. The study has resulted in a new method that quadruples the level of protection from fluoride.

  Four times better protection

In the study, 16 volunteers tested a variety of brushing techniques, using either high-fluoride or standard toothpaste, and brushing either two or three times a day.

“The study revealed that those who used a high-fluoride toothpaste three times a day had four times better fluoride protection in the mouth than those who used standard toothpaste twice a day,” says researcher Anna Nordström from the Institute of Odontology at the Sahlgrenska Academy.

  Rub your teeth after lunch

Also tested was a new method developed in collaboration with professor Dowen Birkhed, which involves rubbing toothpaste onto your teeth with a finger.

“This ‘massage’ method proved to be at least as effective as a third brushing in increasing the amount of fluoride in the mouth,” Anna Nordström explains. “Rubbing the front of your teeth with toothpaste can be an easy way of giving your teeth a third “shot” of fluoride during the day, after lunch for example. But this should not replace brushing with a fluoride toothpaste morning and evening – it’s an extra.”

  Daily use is essential

Brushing with fluoride toothpaste has played – and continues to play – a major role in combating tooth decay, and there is strong scientific evidence that daily use of fluoride toothpaste has a pronounced preventive effect.

The study Effect of a third application of toothpaste (1450 and 5000 ppm F), including a “massage” method, on fluoride retention and pH drop in plaque was published in Acta Odontologica Scandinavia.

Link to article: http://www.ncbi.nlm.nih.gov/pubmed/22320714

THE RESEARCHER´S TOP TIPS
• Use toothpaste at least twice a day, after breakfast and before going to bed.
• If necessary, brush a third time or rub on some toothpaste instead.
• If you have problems with cavities, choose a toothpaste with a higher fluoride content.
• Avoid rinsing out the toothpaste with water.

http://www.ncbi.nlm.nih.gov/pubmed/22320714

Full bibliographic information

• Journal: Acta Odontol Scand. 2012 Feb 9. [Epub ahead of print] Title: Effect of a third application of toothpastes (1450 and 5000 ppm F), including a 'massage' method on fluoride retention and pH drop in plaque.
  Authors:Nordström A, Birkhed D.

Canker Sores - What Are Canker Sores?

See a Baby Tooth? See a Dentist

Baby teeth are worth more than just a dollar under the pillow. Providing proper care and oral hygiene during a child's first year of life can mean a lifetime of good oral health.

Traditionally, parents have waited to bring their children to the dentist until primary teeth begin to appear. A 2002 consumer poll by the American Academy of Pediatric Dentistry shows that nearly 70 percent of parents wait until their children are 3 years old before taking them to the dentist. But a dental visit by age 1 – or within six months of the eruption of the first baby tooth – is crucial, says Academy of General Dentistry (AGD) spokesperson Cynthia E. Sherwood, DDS.

Dr. Sherwood says this early visit gives a dentist the opportunity to see potential problems such as early-childhood caries (also known as baby bottle tooth decay); educate the parent on proper oral hygiene for the child; and give the toddler a positive experience in a dental setting. This can do wonders in allaying fears and boosting the child's future attitude toward visiting the dentist, Dr. Sherwood says.

Education is the heart of the age-1 exam. "When we see a toddler, we primarily talk to the parents about growth, development, thumb sucking, bottle and breast feeding, oral hygiene and nutritional issues, use of fluoride and why baby teeth are important," Dr. Sherwood said.

During this first visit, the dentist usually will sit knee-to-knee with the parent, with the child nestled in the parent's lap, and the dentist will ask the parent to demonstrate how she or he brushes the child's teeth. Then, if parent and tot are comfortable, the dentist will turn the child around onto his or her lap, so the dentist can get a good look at the child's teeth and gums. This "pleasant, painless visit" should take no more than 15 minutes, Dr. Sherwood said.

"Sitting knee-to-knee with the parent, playing with the baby and talking with the parent, I can get a very good sense of the child's oral health care, and this position gives us a good opportunity to get a good look at the child's teeth," says Dr. Sherwood. "It's a great experience for everyone involved."

Toddler dos and don'ts:

DO:

• Take your child to the dentist within six months of the eruption of the first baby tooth, definitely by age 1.
• Follow your dentist's advice regarding nutrition, hygiene routine, fluoride and dental-visit schedule.
• Teach your child how to brush around age 3, and brush your teeth with your children to model good technique and spot problems.

DON'T:

• Think baby teeth don't matter "because they'll just fall out anyway."
• Allow children to have continual access to a bottle or "sippy cup" filled with anything other than water.
• Give your children the impression that visiting the dentist is unpleasant.

The Value Of The Mouth

Your mouth is the most useful part of your body

•  Breath, smile, talk
•  Greet, communicate, intimacy

Your mouth is one of the most important parts of your body

•  Eat or drink at least five times/day
•  Critical role nourishing your body

If your mouth is diseased…

•  You can’t enjoy your food
•  You can’t chew properly
•  You can’t digest thoroughly
•  You can’t receive proper nutrition
•  It affects your complete well-being

Therefore, you have a lifelong need for ideal dental health.

Constant wear and tear occurs because you use your mouth all the time.

Dentistry is the only science that can keep you as healthy as a young adult.

At Main Plaza Dental we are passionate about your dental health and take pride in providing you only the best care.

Your dentist prescribes medications for many reasons. While some drugs are formulated to fight oral diseases, others are used to prevent infections after surgical procedures such as tooth extractions and gum surgery. Certain drugs are used prior to dental treatment. These medications are used to help fight infections and also to control existing conditions such as heart murmurs and valve problems. Your dentist will discuss with you what medications you will be taking, when you will take them and why.

What should I find out about my medication?

Ask your dentist what you should look for after you've begun treatment. Ask about common side effects and what you should do if you experience them. Also ask about anything you should not take with the new drug, since the drug may interact with other prescription and over-the-counter medications and with certain foods. Ask your pharmacist any additional questions you did not ask the dentist. If you get a medication that looks different from the one you have been taking, speak up immediately.

When your dentist writes a new prescription, keep a record noting the brand name, generic name, the purpose, the dosage, how many times per day the drug should be taken and for how long. Every prescription dispensed by a pharmacist comes with a patient information sheet describing everything you need to know about the drug. Read the sheet before beginning your prescription, and read it each time before you take the drug. If you take several medications, keep a diary to check your daily intake and note any symptoms.

How do I know if I am experiencing a side effect or an allergic reaction to medication?

Some patients are allergic to certain drugs and can experience side effects that range from mild irritations, such as rashes, to more serious problems, such as breathing difficulties. Fortunately, fewer than 5 percent of allergic reactions are life-threatening. An allergic reaction is the result of an overreaction in your body's immune system, which fights what it perceives to be a foreign substance.

Not all side effects are allergy-related and can occur regardless of your body's disposition toward them. By and large, these side effects are rare and are expected by the drug's manufacturer. Depending on the drug, some side affects may include nausea, drowsiness or headaches. Your dentist may be able to lower the dosage or change the drug's formula to reduce or eliminate these side effects. It is important to discuss side effects with your dentist or pharmacist to determine if you are suffering from an allergic reaction or not. Don't discontinue a medication without talking with your dentist first. This could prolong the healing process.

What should my dentist know about my medical history?

It is important to share with your dentist your medical history and the medications you are taking, especially for serious conditions such as kidney, lung, heart or liver disease. Some dental medications have the potential to interact with other drugs and cause you harm or treatment failure.

Don't assume your dentist knows your medical history. The most common cause of drug -related interactions is the doctor's lack of information about your medical history. Update and review your history every time you see the dentist. In addition to informing your dentist of past prescriptions, tell him or her about any adverse reactions. Include any vitamins, supplements or herbal remedies you take on the list, as well as any diet plans.

What else should I know about my prescription?

When taking any medication prescribed by your dentist it is important to finish it. Many people take prescribed medicine, especially antibiotics, only until they feel better. Dosages are exact and are necessary to fight or prevent infections. By taking medication only until you feel better, all the drug has done is eliminate susceptible microorganisms and left the ones that tend to become drug-resistant. Ask your dentist before you take any non-prescription medications, vitamins, herbal remedies or dietary supplements. If you don't feel well after taking a medication, consult your dentist or pharmacist.

Research has shown that playing a musical instrument can help nourish, cultivate, and increase intelligence in children, but playing a used instrument also can pose a potentially dangerous health risk.

Used woodwind and brass instruments were found to be heavily contaminated with a variety of bacteria and fungi, many of which are associated with minor to serious infectious and allergic diseases, according to a study published in the March/April 2011 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD).

"Many children participate in their school's band ensemble and often the instruments they play are on loan," said R. Thomas Glass, DDS, PhD, lead author of the study. "Most of these instruments have been played by other students, and without the proper sanitation, bacteria and fungi can thrive for weeks and even months after the last use."

A total of 117 different sites, including the mouthpieces, internal chambers, and cases, were tested on 13 previously played instruments of a high school band. Six of the instruments had been played within a week of testing, while seven hadn't been touched in about one month. The instruments produced 442 different bacteria, many of which were species of Staphylococcus,which can cause staph infections. Additionally, 58 molds and 19 yeasts were identified.

"Parents may not realize that the mold in their child's instrument could contribute to the development of asthma," said Dr. Glass.

Additionally, the yeasts on the instruments commonly cause skin infections around the mouth and lips ("red lips").

"Because these instruments come into contact with the mouth, it's no wonder they're a breeding ground for bacteria," said AGD spokesperson Cynthia Sherwood, DDS, FAGD. "As dentists, we see this same growth of bacteria in dentures, athletic mouthguards, and toothbrushes.

Researchers found that many of the bacteria can cause illness in humans and are highly resistant to the antibiotics normally prescribed by general practitioners. This finding makes sterilization of instruments extremely important.

"Instruments should be cleaned after each use to reduce the number of organisms," said Dr. Sherwood. "And cleaning should not be confined to the mouthpiece, since the bacteria invade the entire instrument."

Dentists are able to assess a patient's overall oral health and may recognize symptoms of serious diseases, including diabetes, cancer, and eating disorders, which often manifest as signs and symptoms inside of the mouth.

Diabetes

More than 25 million people in the United States alone suffer from diabetes.

"Because diabetes reduces the body's resistance to infection, the gums are at risk for gingivitis, an inflammation usually caused by the presence of bacteria in plaque," says Academy of General Dentistry (AGD) spokesperson Julie Ann Barna, DMD, MAGD. "Additionally, those with diabetes can experience high incidences of oral fungal infections and persistent bad breath."

Oral Cancer

Oral cancer is one of the most common cancers, with approximately 35,000 new cases reported annually in the United States.

"Indicators of oral cancer may include bleeding sores, lumps, or thick, hard spots, as well as changes in the way teeth fit together," says Dr. Barna.

Oral cancer is sometimes difficult to self-diagnose, so routine dental exams are recommended. A dentist will feel for lumps or irregular tissue changes in your neck, head, cheeks, and oral cavity and thoroughly examine the soft tissues in your mouth, specifically looking for any sores or discolored tissues.

Eating Disorders

"Eating disorders, including anorexia nervosa and bulimia nervosa, can rob the body of much-needed vitamins and minerals," says Dr. Barna. "Without proper nutrition, the gums can lose their healthy pink color and become increasingly soft and tender, bleeding easily."

Disorders that involve excessive vomiting, such as bulimia, can cause discoloration and erosion of the teeth due to constant contact with acid from the stomach. People who have eating disorders also may experience swollen salivary glands, dry mouth, sensitive teeth, and loss of tooth enamel.

Diseases negatively impact your general health, but they also can damage your oral health.  Regularly scheduled dental exams allow dentists to detect or monitor your health.

Tooth decay happens when bacteria in your mouth consume the sugars we eat. When you eat food containing ordinary sugar (sucrose), it gives bacteria on your teeth energy, allowing them to multiply and start making acids that can eat away the enamel on the teeth. This "acid attack" causes tooth decay and cavities to begin to form.

Xylitol is a natural sweetener derived from the fibrous parts of plants. It does not break down like sugar and can help keep a neutral pH level in the mouth. Xylitol also prevents bacteria from sticking to the teeth. This is how it protects the teeth from tooth decay. With Xylitol, the acid attack that would otherwise last for over half an hour is stopped. Most people are not aware of this benefit because such a claim makes xylitol into a drug, crossing a boundary not allowed by the Food and Drug Administration.

Less bacteria, less acid – healthier teeth!

Because the bacteria in the mouth that are causing cavities are unable to digest xylitol, their growth is greatly reduced. The number of acid-producing bacteria may fall as much as 90%. No acid is formed because the pH of saliva and plaque does not fall. After taking xylitol, the bacteria do not stick well on the surface of the teeth and as a result, the amount of plaque decreases.

Repairing damaged enamel

Research has shown that the use of xylitol also helps repair damage to the enamel. Saliva in itself protects the mouth and teeth. Stimulated saliva in particular contains all the components needed to repair early cavities. If sugar is only taken a couple of times a day, the saliva can do the job alone. But most people take sugar so often that the mouth's own defensive tools are not enough.

Saliva that has xylitol is more alkaline than saliva stimulated by other sugar products. After taking xylitol products, the concentration of basic amino acids and ammonia in saliva and plaque may rise, and plaque pH rises as well. When pH is above 7, calcium and phosphate salts in saliva start to move into those parts of enamel that are weak. Therefore, soft, calcium-deficient enamel sites begin to harden again.

While reversing a rising trend of negative health and high health-care costs won't happen overnight, improving your own health can begin sooner than later, and xylitol can have a significant influence on that trend.

All teeth are attached to their socket by the periodontal ligament. When a tooth (or teeth) are hit hard enough—like with a baseball, hockey stick, or the pavement—at just the right angle, the tooth will pop out, like a cork from a bottle. The periodontal ligament will stretch like a rubber band and will split in half; half will stay on the root surface and half stays attached to the socket wall. If these two halves can be kept alive, when the tooth is replanted they will knit back together and a new periodontal ligament will re-form.¹

The half that stays on the socket wall is not a problem to keep alive. It is still attached to its blood supply and is protected by the boney walls of the socket. However, the half that stays on the root surface must be protected from dying at all costs. When a patient calls or shows up in the office with a knocked out tooth, the office must shift into an emergency mode. The patient must be told three things when they call:

Don’t touch the tooth root.

Place the tooth in saline solution like Hank’s Balanced Salt Solution (more about that later).

Place the tooth in a soft-sided container with a tightly fitting top.

How to Prevent Crushing the Tooth

The cells on the tooth root are very delicate and even touching them with fingers can be damaging. Many laypeople panic at the moment of an accident and take actions that appeal to common sense, such as placing the knocked out tooth in a tissue or ice, while in reality these steps can be very damaging to the tooth’s chances of survival. Either of these actions will actually kill the tooth root cells and lower the incidence of success following their re-implantation. Urban legends have sprung up on how to store knocked-out teeth, such as placing them in the mouth between the gum and cheek. This is a treatment that was developed 50 years ago when scientific methods for storing knocked out teeth weren’t available. This may be one of the worst things to do, second only to placing the teeth in a tissue. Here are the problems: First, saliva is filled with bacteria and infects the tooth cells, and second, the tooth may get swallowed. Third, the concentration of saliva is toxic to the cells, and fourth, the patients may accidentally bite the teeth. Ever try and keep a marble in your mouth for even a minute?

Keeping the Cells Nourished

Remember, once it’s out of the socket, the tooth loses its blood supply. A normal cell keeps 15 minutes’ worth of stored nutrients. After 15 minutes, the cell begins to die, and after 60 minutes it will essentially be dead. Dead cells cannot knit back with the cells on the socket wall and the root will slowly be eaten away (resorbed) until, 6 months to 2 years later, it is completely gone.

So the key factor in keeping cells nourished is providing a storage fluid that can replenish the used-up nutrients. There is only one fluid that can do this. It is called Hank’s Balanced Salt Solution (HBSS).² It is a scientific fluid (not a saltwater mix) that provides all of the nutrients and the correct cell pressure to keep cells alive. It is the most commonly used fluid in medical research. Knocked out teeth placed in HBSS can be kept alive for at least 24 hours. Even more importantly, teeth that have been out of the mouth for an hour can have their depleted nutrients completely replenished, restoring the cell to complete functionality if placed in HBSS for 30 minutes prior to re-implantation.

Milk as a Storage Medium

Milk is a good substitute as a storage medium for knocked out teeth when HBSS isn’t available. Milk’s main benefit is that it doesn’t destroy tooth root cells; however, it doesn’t have the ability to re-nourish them, either. Milk was a good storage medium 30 years ago but it has been replaced by far superior techniques, such as Save-A-Tooth.

Saving a Tooth When it Arrives in the Office

The journey from the site of an accident where teeth are knocked out is like Dorothy’s trip on the yellow brick road: anything and everything that could irreversibly damage the teeth can happen: teeth can fall out of glasses, the storage fluid can spill out, the root cells can be crushed during removal from the carrying container. Save-A-Tooth is a six-part system that contains a HBSS and protects the teeth from “cradle to re-implantation.” When teeth arrive in the dental office, they should immediately be transferred to a Save-A-Tooth. This will permit replenishment of the lost nutrients and provide healthy cells that can knit back to the healthy cells on the socket wall. From a scheduling standpoint, Save-A-Tooth is crucial. Without it, time is critical and rules everything that is done. All other patients have to be pushed back, panicky parents can’t be thoroughly counseled about the ramifications of this terrible injury, and terrified kids can’t be calmed down. With a Save-A-Tooth, time is irrelevant. The office has 24 hours in which all of the above can be addressed. Good advice for all of your patients with children is to have a Save-A-Tooth system at home—telling them to have it ahead of time is like a physician telling patients to have an EpiPen on hand at all times when their child has severe allergies because oral Benadryl is not the best line of defense for a bee sting.

The consequences of a knocked-out tooth are serious and can last a lifetime. For a 7-year-old who loses two front teeth, the dental problems are monumental. Because their jaws will be developing and growing until they are 18, they can’t even benefit from such ordinary dental remedies as fixed bridges or implants. These children are condemned to 11 years of continual changing dental remedies such as flippers—which, as we all know, can be uncomfortable and, at times, socially embarrassing—at one of the most socially sensitive times in their life. By being prepared for knocked out teeth, not only can the scheduling craziness associated with their treatment be avoided, but also the chances of making an enormous difference in a child’s life can be greatly increased.

References

1. Krasner P, Rankow H. New philosophy for the treatment of avulsed teeth. Oral Surg Oral Med Oral Pathol. 1995;79:616-623.

2. Blomlof L. Milk and saliva as possible storage media for traumatically exarticulated teeth prior to replantation. Swed Dent J. 1981;Suppl 8.

3. Cvek M, Cleaton-Jones P, Austin J. Effect of topical application of doxycycline on pulp revascularization and periodontal healing in reimplanted monkey incisors. Endodon Dent Traumatol. 1990;6(4):170-176.

Disclosure

Dr. Krasner has received financial compensation from Save-A-Tooth.

About the Author

Paul R. Krasner, DDS
Clinical Associate Professor
Temple University School of Dentistry
Philadelphia, Pennsylvania

Private Practice in Endodontics
Pottstown, Pennsylvania

Short teeth can be a result of attrition from bruxism (grinding) and/or erosion from excessive acidity in your diet.  What can be done about this?  The obvious answer is to make them longer, but how to best accomplish this can get complicated. First a dentist should determine the optimal edge position of the maxillary central teeth. Usually this can be done by having a patient going through a series of lip poses; Lip at rest, lip smiling, and possibly making the sound"eeeeeee". Mock up composite can be added to the edges of the maxillary incisors in order to try out how the incisor edge would look with a slight addition. Photos can be taken of the patient in the various lip poses.

Once the optimum pleasing position of the central incisors is envisioned then the hard part takes place. usually a set of study impressions and a full set of radiographs are taken. Studying these helps a dentist to determine exactly what should be done to achieve the changes needed to lengthen teeth. Usually most central incisors should be about 10 mm long but how to create the additional length that is needed? Treatments needed may involve possible orthodontic treatments (including either teeth extrusion or teeth intrusion}, crown lengthening, opening the bite, porcelain veneers, crowns or simple bonding. Often a combination of these treatments may be needed.

Often, when a patient comes to my office with this or another esthetic problem it can take several visits to determine a proposal for their treatment plan. Commonly, specialists need to be consulted in order to come up with the best treatment plan.

I belong to a study club in which a group of experienced dentists get together every month or so and go over case presentations. Among our members, we have an Orthodontist, Periodontist, Oral Surgeon, Endodontist, Pedodontist, experienced lab technicians and a few general dentists. It is often surprising how many ways we can come up to restore the patient's mouths that are being presented. Most often a number of options have to be explored and the pros and cons of each need to be reviewed before we can come to a consensus for a optimal treatment plan.

Taking good care of your teeth at every stage of life is a good way to avoid painful toothaches, expensive trips to the dentist, and tooth loss in old age. But there is another powerful reason to practice good oral health: It can affect the health of your whole body. Research shows that the bacteria that cause tooth decay and gum disease in your mouth may also play a role in heart disease and stroke. And there is some evidence that tooth loss before age 35 may be a risk factor for Alzheimer’s disease. (1)

The Mouth/Body Connection What does brushing and flossing have to do with the rest of your body? Your mouth is the gateway to your body—and it’s not a very pristine gateway. It’s filled with bacteria—in fact, there are more bacteria living in your mouth than there are people on earth. (2) Most of these bacteria are harmless, and good oral care plus the body’s immune system can keep the bad bacteria in check. But if you neglect oral health—or if your immune system is weakened—harmful bacteria can multiply. In just one day they can colonize every surface of your mouth and form asticky substance called plaque on the surfaces of your teeth. Over time, acids in the plaque can cause cavities and gum disease. But the bacteria in your mouth can do damage elsewhere, too.

If you have gum disease or cuts in your gums from dental work, oral bacteria can enter your bloodstream and cause infection in your heart or lungs. Oral bacteria may also attach to fatty buildup in your arteries, increasing the chances of stroke or heart attack. Some research suggests that if your mouth is chronically inflamed due to severe gum disease, that inflammation may cause swelling elsewhere in your body, including your arteries. It may also contribute to rheumatoid arthritis. Poor oral health probably won’t give you heart disease or other diseases. But if you already have risk factors for certain diseases, it can increase your chances of getting them. (1, 2)

Beyond Brushing The rate of tooth decay in the U.S. has actually improved over the last 30 years due to advances in oral health care. But there is still a long way to go. Tooth decay is the most common chronic disease among kids and teenagers, and most adults show signs of gum disease. (3) The good news: There’s a lot you can do to improve your oral health—and by extension, support your overall health. The minimum is to brush and floss twice a day. Follow these additional tips and do your mouth—and your body—a favor.

1. Brush up on brushing (and flossing). Research shows that the average person spends about one minute brushing their teeth. In the process, they remove about 60% of the plaque. By investing a little more time and not much effort, you can do better. Aim for two minutes of brushing time. Brush the tooth surfaces nearest your tongue first, since they are more at risk for decay and you tend to brush best when you first start. Use a soft-bristled brush and fluoride toothpaste, and replace your toothbrush when the bristles look worn (about every 3-4 months). If you want to do an even better job, consider using a powered toothbrush. It does a better job of reaching the areas between your teeth, where the risk of decay is greatest. Careful flossing can remove some of this interdental plaque, but you can get even better results by using a small, interdental brush and toothpaste to scrub the inner surfaces of your teeth. (4, 5)

2. Rinse. Consider using an antimicrobial mouth rinse. Your teeth make up only about 20% of the surface area in your mouth. But harmful bacteria live in the other 80%, too—on your tongue, gums, and other tissues, and in your saliva. Antimicrobial mouth rinse kills bacteria that are not on your teeth, but could easily move there. It also prevents and reduces plaque on tooth surfaces that are hard to reach with a brush or floss. (6)

3. Eat a healthy diet and limit snacks. If you eat five fiber-rich fruits and vegetables a day, it not only benefits your overall health, it also stimulates saliva flow in your mouth, and that helps remineralize tooth surfaces where decay is just beginning. Avoid snacks that are packed with sugar or starches. (3)

4. Avoid tobacco and limit your intake of alcohol. Smokers have a four times greater risk of developing gum disease than non-smokers. And tobacco use in any form—including smokeless tobacco—increases the risk of gum disease and oral and throat cancers. Heavy use of alcohol also increases your risk of oral and throat cancers, and the risk gets even higher when you use alcohol and tobacco together. (3)

Focus on Kids Research shows that exposure to plaque over a person’s lifetime may be the key risk factor in dental diseases. (7) Helping your children develop good oral health habits early on will pay dividends for the rest of their lives. Talk to your dentist about the best way to protect your child’s teeth and ask about dental sealants that can protect young teeth from decay. Encourage your kids to eat healthy snacks. And be aware of hidden dangers in their diet. For instance, sour candies may seem like a good choice because they contain less sugar than sweet candies. But in fact, their high acid content is very damaging to teeth. Sports drinks are also loaded with acid, but the danger doesn’t stop there: Studies show that prolonged exposure to these drinks softens a child’s dental tissue and tooth enamel. If your child consumes these candies or beverages, it’s best to rinse with water soon after, and wait 45 minutes before brushing, since abrasive toothpaste can further erode the softened enamel. (8)

Learn more about maintaining your health and well-being:

TheVisualMD.com: The 9 Vi­sual Rules of Wellness

References

1. Mayo Clinic

2. TheVisualMD.com

3. Centers for Disease Control and Prevention

4. Claydon N. Current concepts in toothbrushing and interdental cleaning. Periodontology 2000. 2008;48:10-22.

5. Yost KG, Mallatt ME, Liebman J. Interproximal gingivitis and plaque reduction by four interdental products. J Clin Dent. 2006;17:79-83.

6. Gurenlian JR, The role of dental plaque biofilm in oral health. J Dent Hyg. 2007; (suppl):4-12.

7. Boyens JV, Poulton R, Broadbent JM, et al. Dental plaque and oral health during the first 32 years of life. J Am Dent Assoc.2011;142:415-426.

8. American Dental Hygienists’ Association

Deepak Chopra, M.D.

Streptococcus Mutans

As reported in the Journal of Clinical Microbiology.

A team of scientists from Boston has confirmed that the bacterium Streptococcus mutans is a primary culprit in early childhood caries (EEC) cavities on the first set of teeth, and has identified a new species of bacterium, Scardovia wiggsiae, which they suspect is also a major contributor.

Here is the abstract of the original paper.

Cultivable anaerobic microbiota of severe early childhood caries.

Tanner AC, Mathney JM, Kent RL, Chalmers NI, Hughes CV, Loo CY, Pradhan N, Kanasi E, Hwang J, Dahlan MA, Papadopolou E, Dewhirst FE.

Source

The Forsyth Institute, 245 First Street, Cambridge, MA 02142. annetanner@forsyth.org.

Abstract

Severe early childhood caries (ECC), while strongly associated with Streptococcus mutans using selective detection (culture, PCR), has also been associated with a widely diverse microbiota using molecular cloning approaches. The aim of this study was to evaluate the microbiota of severe ECC using anaerobic culture. The microbial composition of dental plaque from 42 severe ECC children was compared with that of 40 caries-free children. Bacterial samples were cultured anaerobically on blood and acid (pH 5) agars. Isolates were purified, and partial sequences for the 16S rRNA gene were obtained from 5,608 isolates. Sequence-based analysis of the 16S rRNA isolate libraries from blood and acid agars of severe ECC and caries-free children had >90% population coverage, with greater diversity occurring in the blood isolate library. Isolate sequences were compared with taxon sequences in the Human Oral Microbiome Database (HOMD), and 198 HOMD taxa were identified, including 45 previously uncultivated taxa, 29 extended HOMD taxa, and 45 potential novel groups. The major species associated with severe ECC included Streptococcus mutans, Scardovia wiggsiae, Veillonella parvula, Streptococcus cristatus, and Actinomyces gerensceriae. S. wiggsiae was significantly associated with severe ECC children in the presence and absence of S. mutans detection. We conclude that anaerobic culture detected as wide a diversity of species in ECC as that observed using cloning approaches. Culture coupled with 16S rRNA identification identified over 74 isolates for human oral taxa without previously cultivated representatives. The major caries-associated species were S. mutans and S. wiggsiae, the latter of which is a candidate as a newly recognized caries pathogen.

Now, there is a need to develop strategies to combat these additional bacteria besides regular dental care and various mouth rinses (chlorhexidine, Povodine iodine and fluoride). There has also been the hope of the development of an anti-caries vaccine but research continues.

By Dr. Gregory Cole, DDS

Posted by Dr. Jared W. Hemmert, DDS

A dental implant is an artificial tooth root that a periodontist places into your jaw to hold a replacement tooth or bridge. Dental implants are an ideal option for people in good general oral health who have lost a tooth or teeth due to periodontal disease, an injury, or some other reason.

While high-tech in nature, dental implants are actually more tooth-saving than traditional bridgework, since implants do not rely on neighboring teeth for support.

Dental implants are so natural-looking and feeling, you may forget you ever lost a tooth.You know that your confidence about your teeth affects how you feel about yourself, both personally and professionally. Perhaps you hide your smile because of spaces from missing teeth. Maybe your dentures don't feel secure. Perhaps you have difficulty chewing. If you are missing one or more teeth and would like to smile, speak and eat again with comfort and confidence, there is good news! Dental implants are teeth that can look and feel just like your own! Under proper conditions, such as placement by a periodontist and diligent patient maintenance, implants can last a lifetime. Long-term studies continue to show improving success rates for implants.

What Dental Implants Can Do?

• Replace one or more teeth without affecting bordering teeth.
• Support a bridge and eliminate the need for a removable partial denture.
• Provide support for a denture, making it more secure and comfortable.

by Jared W. Hemmert, D.D.S.

Technology today is changing our everyday lives. Many people, however, aren't aware that technology also is impacting dentistry in new and exciting ways. Cutting-edge innovations in dental instruments are requiring less time in the dental chair, causing less discomfort and creating satisfying results. One breakthrough instrument, called CEREC®, allows dentists to quickly restore damaged teeth with natural-colored ceramic fillings, saving patients time and inconvenience.

What is CEREC?
CEREC is an acronym for Chairside Economical Restoration of Esthetic Ceramics. Translated, it means that a dentist can economically restore damaged teeth in a single appointment using a high-quality ceramic material that matches the natural color of other teeth.

How does the instrument work?
CEREC uses CAD/CAM (Computer Aided Design/Computer Aided Manufacturing) technology, incorporating a camera, computer and milling machine in one instrument. The dentist uses a special camera to take an accurate picture of the damaged tooth. This optical impression is transferred and displayed on a color computer screen, where the dentist uses CAD technology to design the restoration. Then CAM takes over and automatically creates the restoration while the patient waits. Finally, the dentist bonds the new restoration to the surface of the old tooth. The whole process takes about one hour.

What does this innovation mean for a patient?
A tooth-colored restoration means no more silver fillings discoloring smiles. The filling is natural-looking, compatible with tissue in the mouth, anti-abrasive and plaque-resistant. Dentists no longer need to create temporaries or take impressions and send them to a lab. Because of this, the traditional second visit has been eliminated. CEREC has two decades of clinical research and documentation to support the technology. The restorations have been proven precise, safe and effective.

How can I find out if this is an option for me?
Call our office at 801-794-9684. We will be happy to answer your questions on this new technology.

As we move forward with our blog, we hope to promote dental awareness as a vital part of your healthy lifestyle. Here you will find a variety of articles and topics including dental news, advancements in dental technology and treatment, practical dental health advice and updates from Dr. Jared Hemmert and his staff.

We hope you find our blog to be helpful, engaging and informational to ensure your best dental health. As always, feel free to contact us with any dental questions or concerns.

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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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

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.

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.