Monthly Archives: May 2012

Links Between Dental Disease and General Health Are Increasing

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Twenty-five years ago we were taught in Dental School that there was some nebulous connection between oral and general health. The “Focus Theory” of disease alluded to the presence of bacteria in the mouth which could become the cause of infection in other parts of the body. No specific examples of such disease were described. Since then, several important studies have shown that indeed there is a direct link between dental and general disease – Respiratory and Heart Disease, Premature Births and Diabetes.

Researchers have found that people with gum disease are nearly twice as likely to develop heart disease. Specifically, coronary artery disease in which the walls of the blood vessels around the heart are thickened due to the buildup of fatty proteins. Blood clots in these arteries can obstruct blood flow, and, thereby, restrict the amount of nutrients and oxygen required for normal heart function. In patients with periodontal disease, bacteria from the mouth enter the bloodstream, attach to the fatty plaques, and contribute to clot formation which can cause heart attacks.

Gum disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require preventive antibiotics prior to dental procedures. Last year the American Heart Association revised the guidelines for this premedication announcing that “…the risks of taking prophylactic antibiotics for certain procedures outweigh the benefits.” Taking these antibiotics is not necessary for most people, and “might create more harm than good.” Please call or email our office if you would like clarification in your case.

Next, mouth infections including gum disease are associated with an increased risk of respiratory disease including pneumonia. It is thought that such diseases are acquired through the inhaling of fine droplets from the mouth and throat into the lungs. These droplets contain germs which can multiply in the lungs and cause damage. These infections are more frequent in patients with chronic obstructive pulmonary disease (COPD) which is common amongst long-term smokers.

In another mouth-body connection, pregnant women who have oral disease are up to seven times more likely to have babies prematurely and with low birth weight. Apparently oral disease triggers increased levels of biological fluids which induce labor. And, in women whose periodontal condition worsens during pregnancy the risk of having a premature baby is even higher.

Finally, people with diabetes have known for many years that they are more prone to advancing periodontal disease than is the general population. More recent research suggests that the relationship between these maladies goes both ways. Gum disease may, in fact, make it more difficult for diabetics to control their blood sugar, placing such patients at risk for complications.

In most cases, patients are unaware that they have any gum disease as they experience no pain, and cannot see any signs of infection. A common early indicator is the presence of blood after a patient brushes or flosses. Sometimes, such patients report being concerned with bad breath or a bad taste in their mouths. In any case, if you have any concerns about the link between your dental and general health, please call us @ 908.359.6655 or email us @ info@DesignsForDentalHealth.com

NOTE: Originally posted August 21st, 2008

Is Tooth Wear Normal?

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Most people think that it is. If teeth do wear away, they do so very slowly; so, a typical dental patient does not even realize that he or she may have as much as twenty to fifty percent attrition. Patients with such wear rarely feel pain, are still able to eat well, and are simply unaware that a problem exists.

In fact, tooth wear is not normal, but is one of the three classic signs of an unstable bite. Dentists regularly see older folks whose teeth exhibit almost no wear. These folks have healthy bites, no destructive oral habits, and avoid foods and beverages which contribute to wear. Dentists also frequently see teenagers and twenty-somethings whose teeth exhibit wear that one would expect to see in a senior citizen. The causes of such wear run the gamut. I recently saw a 26-year-old who exhibited at least thirty percent wear on four of his front teeth. In this case, the cause was very straightforward – a tongue bar (piercing) with which he developed a habit of playing with his teeth. Simply removing the bar helped to slow his wear problem, but did not solve or reverse his attrition. Repairs are required to avoid additional wear due to the exposure of the softer layers of his teeth – but more on this later.

A more common cause of tooth enamel erosion is the presence of acid which softens exposed tooth surfaces. Sources of acid include stomach digestive fluids which enter the mouth because of chronic acid reflux through the esophagus, eating disorders like bulimia, or frequent ingestion of acidic foods like soda or citric fruit juices. Patients often do not realize that they have a potentially life-threatening problem with acid reflux (GERD). Such patients may develop severe ulcers on their esophagus and may begin to notice chronic heartburn. But, fortunately, the appearance of a specific type of tooth erosion indicates this condition, and our routine examinations will uncover it.

What is the most common cause of tooth wear? Occlusion – or really malocclusion – as I alluded to in our previous blog. Teeth that meet prematurely (before all the others) will respond by wearing down, getting loose, or moving out of position. Sometimes, teeth just do not have a “home” place to meet opposing teeth, and during the chewing movement such teeth must withstand destructive forces. Similarly, patients frequently exhibit extensive wear on teeth which oppose old crowns and bridgework. Most such dental work is made of porcelain, which is much harder than natural teeth. If the bite is not quite right in these cases, the natural teeth lose the battle of which tooth is in the way. Still other people have a habit of grinding or clenching their teeth. And, if such patients have any irregularities in their occlusion, aggressive tooth wear is a quite common consequence.

I could ramble on about the myriad of causes of tooth wear, but let us get to the crux of the matter. A tooth is composed of three basic layers. The outer layer, which is visible above the gum, is called enamel. Enamel is the hardest substance in your body and is the beautiful, white, outermost, non-sensitive layer. Just under the enamel is dentin. Dentin is yellowish in color, and much softer (some sources say seven times softer) than enamel. This layer can sometimes be sensitive if exposed. The innermost layer is called pulp. Pulp contains nerves, blood vessels and soft tissue. If the enamel wears away enough to expose dentin, the wear process will speed up because the dentin is so soft. Since dentin supports enamel, as dentin wears away, the enamel eventually begins to chip leaving a ragged appearance to the edges of the teeth. And, by the time a patient realizes that his or her teeth have worn down enough to warrant some repair, a more invasive, expensive and time-consuming service will have become necessary. In advanced cases of tooth wear, the only solution is full mouth rehabilitation if the patient chooses to save his or her teeth. Finally, as tooth wear advances, the jaws can get closer and closer together. As this occurs, the chin and nose get closer together as well, causing an aged appearance of the face. Earlier is definitely better when it comes to addressing occlusal wear problems.

If you have any concerns or questions about tooth wear, please feel free to call us to discuss your problem (908.359.6655) or you may email @ info@DesignsForDentalHealth.com. Finally, if you have any suggestions for future blog subjects, we would appreciate hearing from you.

NOTE: Originally posted on June 10th, 2008

Occlusion – The Most Mysterious Oral Affliction

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Occlusion is the single most fascinating subject pertaining to dentistry. Like dental decay and gum disease, malocclusion leads to premature tooth loss and a myriad of other dental maladies. In the simplest terms, occlusion is how the teeth meet. But, there is an entire system of nerves, muscles, bones and joints which all must work in a balanced and unstressed manner to provide a comfortable and stable bite.

If this system is not in sync, there are a host of signs and symptoms which may be displayed. From the dentist’s point of view, the three major signs of malocclusion (or bite problem) are:

1. Tooth wear
2. Loose teeth and
3. Teeth that have moved out of position

For the patient, there are several symptoms which may be experienced due to malocclusion:

• Headaches (often migraines are misdiagnosed bite problems)
• Neck and shoulder pain
• Facial pain
• Clicking or popping sounds when chewing or opening/closing
• Stuffy ears and ringing in the ears (tinnitus)
• Dizziness
• Tingling fingers
• Sleeplessness
• Difficulty chewing

Temporomandibular Joint Dysfunction (TMD) is a term which encompasses a combination of the signs and symptoms listed above. You may envision a screen door with hinges which are out of whack. To close the door completely, it must always be given an extra strong push. After some time, this forcing the door shut eventually takes its toll on the stressed hinges, and they either break or become so worn out that the door will not close completely no matter how much force is applied. Similarly, in the mouth, if the system is not aligned properly, the muscles have to work overtime to get the teeth to meet. When these muscles fatigue they begin to hurt. And, in the worst case, the jaw joints suffer damage due to their chronically being forced into a compromised position. Patients with TMD are often helped by using orthotics which reposition their jaw into its relaxed muscle position. When the muscles are freed to function normally, pain ceases very rapidly. Even chronic pain sufferers can feel relief in as little as one day.

Many patients display tooth wear to one degree or another. The wearing process is a slow one and patients are often not aware of the problem until it is quite advanced. Earlier is better when addressing wear issues, as there is more tooth to work with and a better long-term prognosis for successfully restoring the teeth.

Equally common are patients whose teeth have moved out of position and are both unesthetic and unstable as a result. We frequently see adults who had worn braces as a child, but their teeth have shifted back to their original position to one degree or another. Crowded lower front teeth which seems to be get worse with time is another common complaint. Such tooth position problems can be reversed using orthodontics, and Invisalign has been a wonderful adjunct treatment for such cases. Invisalign offers a more esthetic alternative to regular braces and can be removed for easier home care. The type of tooth movements which can be accomplished with invisalign is limited however.

There will be more on tooth wear and tooth position problems in the next blog article. If you have any questions or concerns about your occlusion, please feel free to call our office at 908.359.6655 for answers. Or, you may send email to info@DesignsForDentalHealth.com.

NOTE: Originally posted April 24th, 2008

The Basics Of Avoiding Gum Disease

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Gum Disease has historically been a major cause of premature tooth loss. The incidence of this infection is very high worldwide, and is considered to afflict more than seventy-five percent of Americans to some extent. The good news is that gum disease, or periodontitis, is a preventable problem. Like dental decay, it is caused by bacteria which produce acid as a byproduct of the carbohydrates that they ingest. This acid irritates the gums and erodes the bone holding the teeth. So, in the simplest terms, if the bacteria are eliminated, no gum disease can develop. At the end of this article, you will learn how simple it is to diagnose this condition, and exactly what to do about it.

There are three basic stages of periodontal disease. The initial stage is called Gingivitis which simply means inflammation of the gums. This inflammation is easily recognizable because you will see or taste blood after brushing or flossing. In addition, the gums usually look a bit red and swollen in effected areas. Such inflammation is easily reversed with a visit to the hygienist and proper home care. What the hygienist does is inspect the gums for signs of inflammation and the build-up of tartar (called calculus, which is simply calcified plaque). She then thoroughly cleans the effected areas and polishes the teeth. Usually, this procedure will eliminate the bleeding and redness until the bacteria reorganize and recreate their inflammatory products. Patients who have regular professional cleanings in conjunction with proper brushing and flossing rarely develop more serious stages of this disease. Our job as dental professionals is to help you, our patient, avoid progressing beyond this initial stage of gum inflammation.

If the gum disease were permitted to progress to stage two, it would be more accurate, then, to call it “bone disease.” At this stage, the bacteria have progressed past the gums and are now into the bone. Most patients still experience no discomfort at this stage, but the attachment of the teeth is certainly compromised now. The loss of bone is now visible on the x-rays, and inflammmed gum pockets are deeper than three millimeters. A patient may notice that his or her gums are receding or pulling away from the teeth. And, you may consider that since the gums are attached to the teeth and to bone, then for recession to have occurred, the bone must have receded first. At this stage, more aggressive gum therapy is necessary to stop the further progression of periodontal disease. Usually deep cleanings and personalized home care plans are utilized.

In stage three of Periodontal Disease, the teeth have lost more than half of their attachment to the gums and bone. Patients at this stage of gum disease will experience more obvious inflammation (swelling and bleeding) as well as the loosening of the teeth. In more severe cases, the loss of teeth has or will occur. We have actually seen patients who have lost teeth during normal chewing as a result of this advanced bone infection. Such patients will require the help of a gum specialist, or periodontist, if they wish to save their teeth.

Now let us get to the heart of the matter – the inside secret, the bottom line. During your regular examination and cleaning appointments, we will measure the depth of the gum pockets around your teeth. If any are greater than three millimeters AND they are bleeding they must be treated. End of story. Untreated pockets WILL get worse, and the deeper the pocket, the more virulent are the bacteria which live there. As with nearly all oral conditions, prevention is the key.

Fortunately, today we have many modalities for treating this disease. We use ultrasonic scalers to comfortably remove the toxic deposits around the teeth. We use a wonderful product called Arrestin to deliver antibiotic directly into infected pockets. We even have a laser which can be used to remove infected tissue and sterilize pockets. And, finally, there are various adjuncts like fluoride, ClosysII toothpaste and rinse, and special cleaning aids which all assist in keeping gum tissues healthy.

If you have any questions or concerns about your periodontal health, please feel free to call our office at 908.359.6655 for answers. Or, you may send email to info@DesignsForDentalHealth.com.

NOTE: Originally posted on January 31st, 2008

Mercury Amalgam Fillings Banned

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In 2008, the American Dental Association, (ADA), announced that the use of mercury-silver, or amalgam, dental fillings has been banned in Sweden, Denmark and Norway. There has been much discussion about the health and environmental risks of mercury fillings in the United States as well as Europe for some time. This new broader ban was instituted because mercury is considered in those countries to be a dangerous environmental toxin as well as a potential health risk.

However, in the USA the use of mercury in dental fillings is still approved by the government and the ADA. It is only in recent years that most American insurance companies have approved payment for alternatives to mercury amalgam fillings. It is considered unethical for a dentist to advise a patient to have mercury fillings removed for health reasons. However, any patient may choose to have their existing amalgams replaced with an alternative material if they so desire.

From a dental point of view, amalgam fillings are inferior to their alternatives for various reasons. Just like a mercury thermometer, as they are exposed to heat, amalgam fillings expand. And with cold, they contract. The problem is that they expand contract at a slightly greater rate than the tooth structure which surrounds them. After years of hot and cold cycling, small cracks develop in the teeth. Eventually, these cracks propagate and the teeth fracture. Then, a larger and more complicated restoration is required to repair the damage. In addition, unlike the alternative materials used to repair teeth which are bonded into place, amalgams do nothing to hold the remaining tooth together. And, from a cosmetic point of view, silver fillings cause the teeth to appear grayish. Such discoloration often increases over time. Although ethically, I am not permitted to recommend removal of amalgams for strictly health issues, I decided over fifteen years ago to stop using mercury-containing fillings. My patients’ experience with the alternative materials has been excellent in terms of longevity of service, comfort, and appearance.

There are two main amalgam alternatives. For fillings which are less than one-third the width of the tooth, composite restorations are wonderful. They are relatively inexpensive, bonded into the tooth for strength, and match the tooth color. Larger restorations are best replaced with porcelain inlays or onlays. These, too, are bonded to the surrounding tooth structure and match in color. They are very strong and can be used to conservatively restore teeth which, in the past, required crowns or caps.

If you have any concerns or questions about such filings, please feel free to call our office at 908.359.6655 for more information. Or, you may send email to info@DesignsForDentalHealth.com.

NOTE: Originally posted on January 10th, 2008

How to Never Have Another Cavity!

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Preventing Cavities and Dental Decay

Dental decay seems to be the main concern of patients when they come into our office for an examination. Fortunately, the incidence of decay (how frequently it is seen) has decreased very significantly in the last fifty years owing mainly to the availability of fluoride in drinking water which makes teeth harder and, therefore, more resistant to decay.

For a cavity to develop, there are three variables which must be present. The secret to never again having dental decay is to eliminate at least one of these. Theoretically, the prevention is not difficult.

First, plaque must be present on the teeth. Plaque is a nearly invisible deposit of sticky goo (for lack of a better word) which is LOADED with bacteria. It is this plaque which we try to remove each day by tooth brushing and flossing. The purpose of the brush is to loosen the plaque from the exposed parts of each tooth so that it can be rinsed out. Floss does the same thing between the teeth where the brush cannot reach.

Everyone in our office agrees that an electric brush is FAR more effective than any manual brush at removing plaque. We have tried many brushes, most recently the new Sonicaire brand. I had tried this brand in the past and could not get used to the way it tickled my palate. The company has addressed this issue, and I now love this brush. We have never before seen an instrument perform so well! We highly recommend it, and can provide one for you at significant savings under the retail price.

Second, food must be available for the bacteria. They love certain carbohydrates which they ingest. Then, the little devils produce acid as a by-product of this ingestion. It is this acid which causes cavities. And what foods result in the most damage? Sugar in all its forms – soda, gum, sports drinks, candy, raisins, fruit roll-ups, etc. There are other contributing substances, but in my experience, SUGAR IS THE ENEMY!

I recently was visited by one of my favorite patients. She has a history of developing serious cavities very quickly. She had always attributed the decay to some hereditary flaw, but on further discussion she admitted to sucking life savers frequently every day at work to keep her breath fresh. She also uses sugar in her coffee and drinks several cups per day. It is likely that these habits are contributing to her dental problem if not causing them. So, if you think that you have too many cavities, perhaps an inventory of your dietary intake may shed some light on the problem. It is interesting that in the last few years, a new syndrome of rapidly advancing decay has developed among people who ingest sports drinks frequently…

Time is the third variable in the dental cavity equation. People will only develop decay if the plaque and food are allowed to remain on the teeth for extended periods. So, if you brush thoroughly and remove all the plaque, no decay will develop. Similarly, if you eat a candy bar, but quickly remove the bits that stick in your mouth, you will not have a cavity. We were taught in dental school that it takes the bacteria about twenty minutes to turn sugar into acid in high enough concentration to cause problems. So, perhaps eating junk food before bed without brushing is not a good idea. Similarly, sugary foods that are also sticky remain in the mouth a long time, and, so, are the worst for causing decay.

To summarize:

Bacterial Plaque + Sugary Foods + Time = Cavities

Eliminate any one of these variables, and you will never have a cavity again!

If you have questions or comments, please feel free to call our office at 908.359.6655. Or you may send email to info@DesignsForDentalHealth.com.

P.S. Thanks to new technology, we are better able to locate cavities and judge their severity. We now employ the Diagnodent Laser Cavity Detection Aid. It looks like some day, the dental “pick” will be a thing of the past…

NOTE: Originally posted November 26th, 2007

How to Avoid the Pain, Inconvenience and Expense of Dental Disease

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There are really only four ways to lose teeth prematurely, and only four pathways to develop dental disease. This article is the first of in a series which will hopefully provide information and insight to help you, our patients, avoid the pain, inconvenience and expense of dental disease. And, more importantly, give you the tools necessary to keep your teeth healthy for life!

Now, this first installment will provide an overview of the causes of dental disease. It is these various “etiologies” which frequently develop unrecognized or worse, unmanaged. But, to be managed, the REAL cause of a patient’s problem must first be recognized or uncovered. Since we are dealing with the human body, and not a machine, you can imagine how complicated discovering the real cause of a patient’s problem might be.

For example, a patient comes to the office complaining of pain in an upper back tooth especially when she bites on it or drinks anything cold. Seems pretty straightforward, and the “typical” patient believes that she probably has a cavity. Maybe so, but more often not. This patient may have a cracked tooth, the most frustrating kind of tooth problem to uncover — more on this in a future article. Or, maybe the bite is off, or the patient has a sinus problem, etc., etc.

What is the point? A very thorough examination of every new patient is absolutely essential. A quick five-minute look-see at the end of your cleaning just will not provide adequate information to get a true picture of what is happening in any patient’s mouth. And, existing patients are encouraged to have a comprehensive examination every five years or whenever a new problem is suspected.

So, the four ways people can lose teeth prematurely?

Trauma — injuries to the teeth or jaws or head.

Cavities — bacteria burrowing into the teeth and making progressively bigger holes.

Gum Disease — bacteria working their way into and destroying the bone which holds the teeth.

Bad Bite — teeth which do not meet in a healthy and/or comfortable way respond by becoming worn, loose or out-of-position. Bad bites are also the most common cause of TMD (head, neck and facial pain).

Please feel welcome to call our office at 908.359.6655 if you have specific questions with which you need help. I look forward to providing useful and timely information to you via this, my first attempt at blogging. Please let me know if you have any comments or suggestions for future topics. You may send email to info@DesignsForDentalHealth.com.

NOTE: Originally posted on October 29th, 2007