Gum Disease, Inflammation, and Your Health

All of our body’s organ systems are interconnected. What happens in one system can and often does affect other systems. One prominent and currently emphasized interrelationship is the one between periodontal (gum) disease and cardiovascular disease. And in particular, it is inflammation which is the common link between these two conditions.

Inflammation by itself is not a bad thing. Acute inflammation is the body’s normal response to injury and infection. This type of inflammation is experienced as redness, pain and swelling. Immediately after an injury, there is a biochemical reaction which improves blood flow to the affected area. Nerve and other cells send out signals to recruit white blood cells which help fight foreign bodies. This acute inflammation is absolutely necessary for normal good health.

There is another kind of inflammation which is our main concern in this article. That is chronic inflammation which is also known as low–grade or systemic inflammation. This inflammation is long–lasting and examples include autoimmune disorders like rheumatoid arthritis and lupus. In these cases the body mistakenly initiates an inflammatory response even though there is no actual infection or injury to be fought. Other examples of chronic inflammation include inflammatory bowel diseases like ulcerative colitis and Crohn’s disease.

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Chronic “hidden” inflammation occurs throughout the body when something engages the immune system. This engagement varies from person to person but may include repeated or prolonged infection, smoking and gum disease. Obesity also makes one prone to inflammation as fat cells turn out inflammatory proteins called cytokines. Most people don’t know that they are inflamed. There is a test which measures the inflammatory marker called the C–reactive protein but it is not used routinely to determine increased risk of associated diseases. The important point is that inflammation is the primary cause for most of our serious chronic diseases including cardiovascular disease, diabetes, cerebrovascular disease, rheumatoid arthritis, and Alzheimer’s disease to name but a few.

As far as the connection between gum disease and cardiovascular disease, research indicates that heart disease, clogged arteries, stroke and bacterial endocarditis may all be linked to oral health. Researchers believe that gum–disease–producing bacteria enter the bloodstream and make their way to the heart. And just as these bacteria create chronic inflammation and damage of the gums and bone around the teeth, the same bacteria can cause a similar response in the blood vessels. Inflammation can begin and accelerate the build-up of plaques with in blood vessels – called atherosclerosis or hardening of the arteries. These plaques decrease the flow of blood to both the heart and the brain, and if such a plaque breaks free can result in a heart attack or stroke.

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What can you do? Roughly 75% of adults have some form of gum disease and 30 % have moderate to advanced periodontitis. Those with more advanced gum disease are much more likely to develop associated inflammation-related heart disease or stroke or the other inflammation-related illnesses. Having a thorough periodontal examination and following up with necessary gum disease periodontal therapy is the best first step. Avoid the obvious creators of inflammation which have been proven to be unhealthy. Prime examples are smoking and heavy drinking of alcohol.

There are many who advocate an “anti-inflammatory” diet. Many of the recommended foods would be typical of Mediterranean cuisine and certainly represent good nutrition. Such a diet would include:

• Generous amounts of fruits and vegetables

• Using healthy fats like olive oil

• Eating small portions of nuts

• Drinking red wine in moderation

• Eating fish regularly

• Limiting or eliminating red meat

If you would like more information about inflammation, gum disease and your health, please feel free to contact us by telephone at 908.359.6655 or via our website at www.DesignsForDentalHealth.com

Healthcare Versus Sickcare and the Mouth–Body Connection

Our current healthcare system should more aptly be named “ sick care.” It seems to me that the times are changing and we are at the beginning of a new kind of healthcare which might be called “Integrative Medicine.”

Integrative Medicine focuses on health and wellness rather than just the treatment of disease. Such “healthcare” is dependent on a different relationship between doctors and patients – including dentists. Patients are not just seen when treatment for illness is required. But, this kind of doctoring involves a closer relationship with each patient to determine the specifics of his or her current condition, risk factors, concerns, medical history, family history, nutrition, etc. In this way, the “whole person” is evaluated and using “alternative” medicine as well as traditional “evidence–based” medicine, appropriate personalized care can be provided. Wellness, rather than disease, is emphasized. Prevention rather than just treatment for illness is provided. Wellness and healing are the primary goals.

Did you know that a healthy mouth can add 7.5 years to your life?

From our dental perspective, you may notice some changes in the emphasis of our treatment. We’ll want to stay current with your overall health, the medicines which you are using and your goals for your desired level of well-being.

We hope provide you with adequate information so that you may better understand the interconnectedness of you your “oral” health and your “body” health. Such a relationship is referred to as the oral–systemic connection and explains the relationship between oral–dental health and various body systems’ health issues including:

  •         Heart disease
  •         Diabetes
  •          Pregnancy and childbirth issues
  •         Obstructive sleep apnea
  •         Oral cancer
  •         Inflammatory disease
  •          Nutrition and the ability to chew
  •         Chronic disease
  •         Emotional health and confidence
  •          Etc.

It is our intention to write a series of blog articles about the different connections between diseases of the various body systems and oral health. We will also ask your help by keeping us apprised of your current health and all medicines including non-–prescription supplements which you are taking. We will also, with your permission, keep your primary health professional abreast of your dental condition so that your overall wellness can better be served.

We will offer newer options for your care in our office including DNA testing to better determine your risks of developing chronic oral diseases which research has proven can have detrimental effects on your overall health. It is our goal to help you achieve a higher and more informed level of oral health that has been the norm during the first three decades of my practice of dentistry.

Feel free to ask us about anything “new” which you notice during your upcoming visits. We welcome your comments and thoughts on the subject. Feel free to call us at 908-359-6655 or via our website www.DesignsForDentalHealth.com for questions and additional information. 

Oil Pulling – A Dentist’s View

I first heard about oil pulling several years ago when one of my more “holistic” patients asked about it. Recently, the subject has been raised with increasing frequency. “Oil pulling” is an ancient Indian folk remedy in which oil is used as a kind of mouthwash. This technique is touted to improve oral health as well as provide many incredible detoxification benefits.

What is oil pulling and how does it work?

A tablespoon of oil is placed in the mouth and is swished around the teeth for twenty minutes. During this swishing process, bacteria that are present on the teeth and soft tissues of the mouth become trapped in the oil. Certain bacteria like Streptococcus Mutans cause gingivitis and dental decay, and eliminating them certainly leads to improved oral health. After the twenty minutes, the oil is expectorated (spit out) into the trash, not the sink or the toilet so as to avoid causing a clog.

Various different oils are recommended. The original technique apparently called for sesame oil, but more recently there seems to be a trend toward using coconut and sometimes sunflower oil. It is very important that the oil not be swallowed as all the collected bacteria could lead to systemic illness if ingested. Some people recommend performing this technique every day, while others suggest that four to five times a week is adequate.

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So what are the professed benefits of oil pulling?

This technique acts as an antibacterial and antiviral system, and so detoxifies the mouth and indirectly the entire body. The potential benefits of this treatment include:

  • Whiter teeth
  • Healthier teeth and gums
  • Improvement of acne, eczema, psoriasis and other skin conditions
  • Clearing sinuses and helping allergy sufferers
  • Eliminating halitosis
  • Helping with general pain issues
  • And many more

Is there any truth to all of these claims?

As a matter of fact, there is reason to believe that this technique does provide detoxification benefits. This is one of a number of methods which can be used to clean the mouth so thoroughly that the body is better able to heal itself. Apparently there is a study which was published in 2008 in which oil pulling using sesame oil resulted in a significant reduction in Streptococcus Mutans after two weeks. However, this technique was not as effective as chlorhexidine mouthwash which is commonly recommended by dentists and periodontists to control gum inflammation. In addition, a serious limitation of this technique is that the oil only travels about one millimeter deep into the gums around the teeth, and the more damaging infections are more than three millimeters deep. This technique should not be used by people with active gum disease.

The most interesting thing about this technique is that it highlights the fact that as our oral health improves, so does our general health. Everything in the body is connected. So that improvement in the sinuses, the throat, the cardiovascular system, the skin and various other body systems is a very positive byproduct. When the mouth is healthier, the level of inflammation in the body is reduced, the body is better able then to heal, and we feel better and look better.

Oil pulling may be considered as an alternative to an excellent oral homecare regimen. Such a regimen would include brushing for two minutes twice each day and especially before bed, flossing between the teeth regularly, and perhaps using a WaterPik with an antimicrobial agent on a regular basis as well. Ideally people should have their dentist or hygienist recommend an oral care system specifically designed for him or her. In addition, nowadays we even have a DNA test which can determine specifically which bacteria are present in each patient’s mouth, and if they have the specific marker which might make them more susceptible to periodontal disease.

If you have any questions about oil pulling or would like information about developing a homecare regimen for yourself, please feel free to contact us by telephone at 908.359.6655 or via our website at www.DesignsForDentalHealth.com

All-on-4®, A Dental Miracle

All–on–4® is the name for a technique used in the total rehabilitation of patients who have lost or will soon lose all of their teeth in one or both arches. This system was developed in the 1990s through studies which were funded by Nobel Biocare which has been a corporate leader in the implant industry since the early 1980s.

The All-on-4® treatment concept is a miracle because patients arrive at their dentist’s office in the morning with either no teeth or teeth which cannot be saved in one or both arches.  At that appointment, the implant surgeon (usually a periodontist or oral surgeon), the prosthetic dentist (in this case, me) and a lab technician work collaboratively.  A few hours later the patient leaves the office with a complete set of teeth which are not removable, which function well and which look amazing.

In addition, no grafting is required before placing the implants with this system. Therefore, most patients who have been told that they are not good candidates for implants because of a lack of bone, or large sinuses, or other anatomical circumstances are perfect candidates for the All–on–4® procedure.

There is no grafting, and no lengthy healing time required. Four implants are placed in each treated jaw. This procedure takes advantage of the dense bone which is available in the front of both the top and bottom jaws and places two implants there. Two more implants are placed in the back of the jaws and at an angle to both avoid sensitive anatomic areas as well as to take advantage of available dense bone there. Permanently fixed bridges can then be secured to these four implants immediately because of the solid primary stability which is gained by these strategically placed implants.

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The full dental bridge which is attached to these implants is not removable, has no coverage of the palate, and can be used immediately to eat a complete diet without restriction. After four to six months, a final fixed prosthesis is placed over the implants once total healing is assured.

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The advantages of All–on–4® are many:

1. Get implants in one day with minimal surgery.

2. Entire procedure completed in one location and one day.

3. Avoid the expense and healing time of bone grafting.

4. Have fixed, not removable teeth.

5. Have a complete new set of teeth which look and feel natural – Smile Again!

6. Have the ability to again eat all the foods that you desire.

If you have any questions about the All–on–4® procedure or if you know someone who would benefit from it, please contact us at 908.359.6655 or via our website at www.designsfordentalhealth.com

Your Shimbashi Number And Your Bite

I am writing this article in honor of Dr. Henry “Hank” Shimbashi, a practicing dentist and researcher from Edmonton, Alberta who passed away this week. Dr. Shimbashi was a very influential friend of comprehensive restorative dentists and his research is used every day in offices like mine where problems with the bite and TMJ’s are treated.

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As a result of his research, the Shimbashi number was established to indicate an ideal relationship between the upper and lower jaws. When there is an optimal position of the lower jaw relative to the upper jaw, the muscles which are connected to them will also be at their optimal length and can function ideally.

If the relationship between the upper and lower jaws is altered, one or more of the many muscles of the head, neck and face may be overworked causing them to go into spasm — i.e., be painful. This can happen if the lower jaw is too close to or far from the upper jaw, too far forward or back, or shifted in any direction relative to the upper jaw.

Dr. Shimbashi’s research measured muscle activity in over 500 patients. He found that there was an ideal vertical dimension at which the jaw muscles functioned at their maximum potential. In addition, at this ideal position, patients had no symptoms of muscle pain. This vertical dimension was found to be universally applicable in all age groups and all races.

This simple number which we use is the measurement from the gum line of the upper front tooth to the gum line of the lower front tooth. Dr. Shimbashi found this ideal distance to be approximately 19 mm plus or minus one mm (about three quarters of an inch) when a patient bites.  In our office, we often see patients with bite problems whose Shimbashi number is significantly less than ideal  measuring as little as 10 mm or even less. In such patients, the lower front teeth are often nearly completely covered by the upper teeth. Such patients are much more likely to develop tooth and pain problems resulting from their bad bites.

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So what is your Shimbashi number?  If you have any questions about your bite as a result of this article, please feel free to call our office at 908.359.6655 or via our website at www.DesignsForDentalHealth.com

Is It Really A Migraine??

Last week in the course of a routine examination, I asked a standard question of our young woman patient: “Do you have any problem with headaches?” She replied that she does have “migraines”. So I asked a few relevant questions about the headaches, and as is often the case, this patient’s answers led me to believe that her headaches are, in fact, not migraines.

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In our office, we often treat patients with head and neck pain who have been diagnosed by their doctors as having temporomandibular joint dysfunction. Oftentimes, such patients visit their doctors because they assume that the headaches from which they suffer must be migraines.

What are the typical signs and symptoms of a migraine headache? A typical migraine may last several hours to as many as three days. The pain is moderate to severe, pulsating, and usually on one side of the head. Typical associated signs of migraines include nausea and/or vomiting, as well as sensitivity to light and noise. Many migraine patients describe an “aura” just before the migraine begins. Auras are exhibited as a change in vision or hearing. Episodic migraines occur fewer than fifteen times per month with only some of these headaches being actual migraines. Such headaches occurring more than fifteen days per month with pain lasting four hours or more over a three-month period are considered to be “chronic migraines”.

Migraines may be triggered by various factors, and three out of four migraine sufferers describe specific triggers. Common examples of these triggers are physical exertion, stress, hormonal changes, weather changes, and others.

Tension headaches are the most common primary headaches. Such headaches may be misdiagnosed as migraines and vice versa.

Cluster headaches are severe attacks of pain on one side of the head lasting between fifteen minutes and three hours. These headaches may occur every other day or as often as eight times each day. Cluster headaches may be associated with facial sweating, restlessness, agitation or nasal congestion.

Other types of headaches include those brought on by exertion or coughing.  They may be described as feeling like stabbing pain or other equally unpleasant feelings.

If you or someone that you know suffers from headaches, we can generally help determine whether or not migraine headache is a proper diagnosis. The determination is made based upon the patient’s history and description of the pain as well as a screening examination to rule out the possibility of TMJ-type pain. We even have a computerized evaluation system to diagnose which muscle or muscles may be causing the problem. Patients often find it hard to believe that their headaches may be related to their jaw joints or their bite. The truth is, the connection between head and neck pain and the muscles involved in moving the jaw as well as those holding the head erect are commonly the source of such pain.

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If you have a question about headaches or would like additional information please feel free to contact us via our website www.DesignsForDentalHealth.com or by calling our office at 908.359.6655.

Cracked Tooth Syndrome – What You Need To Know

We have had several patients recently who have had problems related to cracked teeth. The symptoms of which these patients complain can be difficult for both the patient and the dentist.  Both can become frustrated because the underlying cause of symptoms is frequently difficult to pinpoint.  Often, patients will complain about pain which is caused by biting pressure and sometimes temperature.  It is frustrating for both parties because the described symptoms are often difficult to duplicate in the dental office.  It’s kind of like bringing your car to the dealer with a specific problem which suddenly vanishes as soon as you arrive at the dealership.

Cracked teeth generally occur for two reasons.  First, silver or amalgam fillings expand and contract as we consume hot and cold foods and beverages. The expansion and contraction of the filling is slightly greater than the tooth itself.  So, after years of such cycling in temperature-associated expansion and contraction, cracks frequently develop in the teeth.  Second, cracks may occur while chewing foods.  Commonly patients will describe a sharp pain in a tooth while they had been chewing, and the tooth will remain sensitive to biting pressure and/or temperature.

Cracked teeth are addressed in stages depending upon symptoms.  First, a bonded filling may be placed in an attempt to prevent the cracks from propagating further.  Depending on the depth and severity of the crack, an onlay or crown may be necessary to prevent the tooth from breaking.  An onlay covers any thin walls of the tooth which may be at risk for fracture and is considered a conservative, aesthetic and long-term restoration.  If the tooth has an extensive existing restoration or a more severe crack, then a crown which covers the entire tooth will be required to prevent the tooth from breaking.

In either case, the problem needs to be addressed as quickly as possible to prevent the crack from propagating further into the tooth leading to more severe dental problems.  For example, if the crack reaches the pulp of the tooth, then root canal therapy will be required as well.  The most severe complication would be the vertical tooth fracture which includes the root thereby making the tooth non-restorable.  In such cases removal of the tooth and replacement in some fashion will be required.

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The important points to remember are as follows:

1. Determine the exact source of discomfort first

2. Address the symptoms as quickly as possible

3. Begin with the most conservative treatment and progress as needed to eliminate all symptoms

Such teeth need to be followed on a regular basis to ensure that damage to the pulp has not occurred.  Appropriate x-rays at routine intervals will be helpful for this.  Keeping your dentist apprised of precise symptoms will also go a long way to help in diagnosis.

If you have any questions about cracked tooth syndrome please do not hesitate to contact our office by calling 908.359.6655 or on the web at www.DesignsForDentalHealth.com

Dr. Nadler Lectures at SMC

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This past Thursday evening, I had the pleasure of speaking to the Diabetes Support Group at the Somerset Medical Center.  The title of the talk was “Diabetes in Dentistry –What You Need To Know.”  Two themes were emphasized during the hour-long lecture.

First, all systems and organs in the body are connected.  And, in this case, diabetics are at risk for more severe periodontal infections than the general population.  In addition, uncontrolled periodontal disease actually aggravates the diabetes as well as the reverse.

Second, it’s all about prevention.   Those with diabetes often have xerostomia or “dry mouth.“  So, not only do diabetics have a compromised ability to fight infections, butdry mouth also contributes to an increased risk of decay and gum disease.  As a result, cavities and gum disease can progress rather quickly in these patients.  And, by the time a person realizes that a problem exists, the issue is often quite advanced and requires more aggressive, costly and involved treatment to be addressed.  Prevention through regularly scheduled care  as well as proper home care is the best way to avoid such major problems. 

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The entire lecture as well as the questions and answers segment that followed was videotaped.  It will be on the hospital television channel as well as online at www.somervilletv.com under “Live TV.”

If you have any questions about diabetes and dentistry, it will be my pleasure to answer them.   I can be reached in the office @ 908.359.6655 or online at www.DesignsForDentalHealth.com  

 

A Healthy Smile Is No Luxury

Teeth Need Not Change with Age!

Healthy AgingA healthy mouth helps to promote general health and wellness through all stages of life.  According to everydayhealth.com, “research shows that people with good dental health are less likely to develop diabetes and heart disease or have strokes”.  So, maintaining a healthy mouth throughout life is a wonderful habit to develop for the sake of preserving your teeth, your smile, and your overall well-being!

The basics of dental care – brushing, flossing, regular check-ups and cleanings, and eating right – are the same as in all other stages of life. However, there are certain oral health concerns that are more common in seniors.  Knowing these can help you know what to watch for as years come and go.

 

Tooth Decay:  Bacteria-filled plaque builds up quickly on your tooth enamel, the hard protective covering on your teeth.  The acid that these bacteria produce causes tooth decay.  As we get older, cavities are more likely to develop around old fillings and crowns as well as on exposed root surfaces.

Gum Disease:  Gum disease or periodontal disease, occurs when plaque accumulates and spreads beneath the gum line.  Again, the bacteria in plaque which work their way onto and under the gumline causes inflamed, bleeding gums and eventually bone loss.  Once the attachment of the teeth is compromised, repair can be either very difficult or impossible.  In its most severe form, gum disease results in the loss of teeth.

Root Caries:  Root caries is decay on the roots of your teeth.  If the gums recede and the soft root surface of the tooth is exposed, such decay is very common.  This surface is more susceptible to decay than tooth enamel and is more commonly seen as we enter our retirement years.

Dry Mouth:  Dry mouth is also called xerostomia.  It often occurs as a side effect of medication or other health problems and treatments, including cancer treatments like radiation therapy.  Menopausal and post-menopausal women also often produce less saliva.  The reduction of saliva leads an increased risk of tooth decay and gum disease because the buffers in saliva which neutralize bacterial acids are no longer present.

Oral Cancer:  There are about 35,000 cases of mouth, throat and tongue cancer diagnosed every year according to the American Cancer Society.  Most are over the age of 40, with an average diagnosis age of 62.  Two of the most common contributors to oral cancer are tobacco in any form and alcohol.  Enough said!  Regular exams which include oral cancer screenings can be life savers.

Denture Problems:  Denture wearers need regular care too.  If dentures become loose or fit poorly, mouth sores develop making chewing very difficult and potentially causing excessive loss of bone.  Dentures must also be properly maintained so that bacterial colonies do not form on their surfaces.

Be sure to ask your dental professionals for assistance in caring for your dentures.

 

The steps to maintaining oral health throughout  life change very little.

  • Brush and floss regularly to eliminate plaque.
  • Have regular dental check-ups and cleanings.
  • Eat nutritious foods and put a limit on “Junk”.
  • Don’t smoke or chew tobacco, and if you do, take the steps to quit.
  • Drink alcohol in moderation.
  • If you have dentures, be sure to give them proper care.

These few simple steps lay a solid foundation for excellent oral health and help you to maintain a smile to last a lifetime!

LINKS AND RESOURCES

VIDEO: Adults Over 60

Health Aging: Oral Health

Adult dental health: aging healthfully

Oral Health Concerns for People Over 60

What Are You Afraid Of? –The Scariest Dental Procedures Explained

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Image courtesy of Gregory Szarkiewicz / FreeDigitalPhotos.net

According to reports and our experiences, nearly half of all adults dread going to the dentist. From root canals to TMD to the smallest filling, many adults are afraid of the dental procedures they need to maintain or improve their oral health. Many even avoid going to the dentist altogether because of these fears. Check out this slideshow put together by Everydayhealth.com that explains some of the procedures that people find the most frightening. A little education can go a long way to allay patients’ fears about dentistry!

SLIDESHOW: THE SCARIEST DENTAL PROCEDURES EXPLAINED