Posts for: January, 2020
When we refer to periodontal (gum) disease, we’re actually talking about a family of progressive, infectious diseases that attack the gums and other tissues attached to the teeth. Caused primarily by bacterial plaque left on tooth surfaces from inefficient oral hygiene, gum disease can ultimately lead to tooth loss.
There’s only one way to stop the infection and restore health to diseased tissues — remove all of the offending plaque and calculus (hardened plaque deposits) possible from tooth and gum surfaces, including below the gum line at the roots. The basic tools for this task are specialized hand instruments called scalers or ultrasonic equipment that vibrates plaque loose. A series of cleaning sessions using these tools could stop the infection and promote healing if followed with a consistent, efficient daily hygiene habit.
There are times, however, when the infection has progressed so deeply below the gum line or into the tissues that it requires other procedures to remove the plaque and infected tissue. One such situation is the formation of an abscess within the gum tissues, a pus-filled sac that has developed in response to infection. After administering local anesthesia, the abscess must be treated to remove the cause and allow the infectious fluid to drain. The area is then thoroughly flushed with saline or an antibacterial solution.
The gum tissues are not completely attached to the tooth surface for a small distance creating a space. These spaces are called periodontal pockets when they are inflamed and continue to deepen as the disease progresses. These inflamed and sometimes pus-filled pockets form when tissues damaged by the infection detach from the teeth. If the pockets are located near the gum line, it may be possible to clean out the infectious material using scaling techniques. If, however, they’re located four or more millimeters below the gum line a technique known as root planing may be needed, where plaque and calculus are shaved or “planed” from the root surface. As the disease progresses and the pockets deepen, it may also be necessary for surgical intervention to gain access to the tooth roots.
To stop gum disease and promote soft tissue healing, we should use any or all treatment tools at our disposal to reach even the most difficult places for removing plaque and calculus. The end result — a saved tooth — is well worth the effort.
If you would like more information on treating periodontal disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Treating Difficult Areas of Periodontal Disease.”
Eating disorders cause more than psychological harm. The binge-purge cycle of bulimia or the self-starvation patterns of anorexia can also injure the physical body, especially the mouth.
For example, nine in ten people with bulimia will experience tooth enamel erosion from stomach acid entering the mouth from induced vomiting. Although purging is less frequent with anorexic patients, one in five will also develop erosion.
An eating disorder isn't the only reason for enamel erosion: you can have high acid levels from over-consuming sodas, energy drinks or certain foods, or not properly brushing and flossing every day. But erosion related to an eating disorder does produce a distinct pattern in the teeth. When a person vomits, the tongue moves forward and presses against the bottom teeth, which somewhat shields them from acid contact. This can create less erosion in the lower front teeth than in others.
Eating disorders can cause other oral effects. Stomach acid contact can eventually burn and damage the mouth's soft tissues. The salivary glands may become enlarged and cause puffiness along the sides of the face. The use of fingers or other objects to induce gagging can injure and redden the back of the throat, the tongue and other soft tissues.
It's important to stop or at least slow the damage as soon as possible. To do so requires both a short– and long-term strategy. In the short-term, we want to neutralize mouth acid as soon as possible after it enters the mouth, especially after purging. Rather than brushing, it's better to rinse out the mouth with water or with a little added baking soda to neutralize the acid. This will at least help reduce the potential damage to enamel.
In the long-term, though, we need to address the disorder itself for the sake of both the person's overall well-being and their oral health. You can speak with us or your family physician about options for counseling and therapy to overcome an eating disorder. You may also find it helpful to visit the website for the National Eating Disorders Association (nationaleatingdisorders.org) for information and a referral network.
If you would like more information on how eating disorders can affect health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Bulimia, Anorexia & Oral Health.”
There’s been a growing awareness about the effects of gluten, a protein found in grains like wheat, rye and sometimes oats, on certain people. An estimated 1 in 133 Americans have Celiac Disease (CD), a gluten-related disorder that causes the body’s immune system to work against itself. And if you have CD, you could eventually face dental problems like enamel pitting and erosion.
When a person with CD consumes gluten, their immune system mistakenly identifies the protein as malicious and attacks it. The attack occurs in the membranes that line the digestive system, which in the process destroys cilia, tiny hair-like structures that aid in food absorption. This disrupts the body’s normal absorption of nutrients, which can lead to a number of systemic conditions including intestinal cancer.
Because of the lack of nutrients, your teeth’s enamel may develop defects. You may begin to see dull spots or pitting, or chalky grooves in its normally shiny surface: this is a sign you’ve lost surface enamel crystals (decalcification). You may also be more susceptible to outbreaks of aphthous ulcers (canker sores).
Because symptoms can be misdiagnosed or go unnoticed, it may be years before you know you have CD. You can, however, get a definitive diagnosis through a blood test for gluten antibodies, which is then confirmed with a biopsy of a tissue specimen from the intestine.
While there’s ongoing research for CD-related medication, there’s currently only one recognized treatment for it — remove gluten from your diet. This is much harder than it sounds, and requires knowing what you can and can’t eat, along with strict monitoring of food package labeling. Thankfully, the world is becoming better educated in this respect as more food manufacturers are clearly labeling products containing gluten and restaurants are providing gluten-free menu options.
Once you have dietary controls in place, your dental issues can be treated as any other person, with one exception: none of the products used in treatment like polishing paste or fluoride gels should contain gluten, and must be verified before using.
CD is a serious condition that could even become life-threatening. Knowing you or someone in your family has it will help you protect both your overall health and your teeth.
If you would like more information on the gluten’s effect on dental health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Gluten & Dental Problems.”