Harmful Habits

Over the years I have gotten emergency calls from patients who have accidentally damaged their teeth or mouths.  Unfortunately these patients were often unaware that certain practices can be harmful.  Thus to raise awareness about some of these potentially problematic habits, I decided to describe them below:

• Chewing ice- Some patients have a habit of chewing on ice or ice cubes.  The problem with this is that it can weaken the teeth and cause them to crack or fracture.  Often times a patient will only partially crack their tooth while biting ice.   Later when they eat something soft like a sandwich or chewy like a bagel or bacon, a piece of their tooth will break off.  If the patient is lucky, the tooth can be repaired with a restoration like a filling or a crown.  However in some cases the tooth is not salvagable and may have to be extracted.  People who feel compelled to regularly chew ice may be suffering from Pica which is a form of iron deficiency.  I advise my patients who compulsively chew ice to have their iron levels checked and fight that craving unless they want to have a dental emergency.

• Using teeth as tools- Sometimes patients who call to report they "chipped a tooth" will remorsefully admit that they had been using their teeth as a tool when it broke.  I have heard of patients who open bottles, crack crab legs or nuts, pull tags off clothes and perform various other tasks with their teeth.  These habits may not cause problems initally, but one day a weakened tooth may receive too much pressure and crumble.  My advice is, don't be lazy.  Go and get the appropriate tool for the job because it is cheaper and less painful to replace the tool than it is your teeth!
• Tongue rings-Some years ago, tongue piercing became popular among women and men.  For the sake of brevity, I will not go over the background and history of this practice.  However, the only reason I mention it is because I have observed that many of my patients who had a tongue ring eventually managed to chip or crack their teeth with it.  Most where not aware that this was a potential hazard of having this type of piercing.  Fortunately there are other options available such as soft plastic attachments that can help avoid tooth fracture.  However, the best way to avoid such problems is to remove the tongue ring altogether.
 

• Eating lemons (acidic foods)- There are people who actually enjoy eating lemons (go figure!).  The only problem with this is the prolonged exposure of the teeth to acid.  This can cause erosion of the tooth structure /wear away the enamel.  Teeth can then become sensitive and more susceptible to decay.  Also once the damage has been done, patients are often displeased with the appearance of their teeth and may require veneers or crowns to restore them.  Erosion can also occur with consuming oranges, grapefruits, their fruit juices as well as other acidic foods.  Therefore try to limit eating highly acidic foods and drinks to prevent damage.

• Aspirin burns- Since we are talking about acid in the mouth I thought I should also cover aspirin burns.  Occasionally patients with a severe toothache will decide to place a tablet of aspiring on the gum near the aching tooth to try and numb the pain.  Unfortunately,this often results in an extremely painful ulcer as the acidic aspirin burns a hole in their cheek or gum, worsening their pain.  I always ask these patients if they rub aspirin on their forehead when they get a headache.  They get the picture and hopefully you will too.  Never place any medication designed to be swallowed directly on the delicate cheek or gum tissue!  Take all medicine as directed on the packaging or as prescribed by your doctor.
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  Note the whitish appearance of the aspirin burned cheek

  

The habits listed above are the things I've most commonly observed to cause dental emergencies.  My advice to stay healthy and problem free? Break these habits or avoid them! Happy smiling!

The Dental and Physical Health Connection

Many people have heard the recommendation "See your dentist for a check up every 6 months".  However, this advice comes from an old Crest toothpaste advertisement and is not based on any real scientific evidence.  However, it is still advisable to maintain regular dental examinations and professional cleanings because there have been a lot of recent studies that show a connection between poor oral health and systemic health problems.  The following are a few examples of diseases seen frequently in patients with gum disease:

Gum Disease and Cardiovascular Disease:
Gum Disease or Periodontitis is inflammation of the gum tissue, bones, and ligaments that support the teeth.  It can lead to the destruction of these tissues and eventual loss of teeth, if untreated.  The damage caused by untreated gum disease affects more than just the teeth and gums.  Studies have shown that there is a link to the inflammation of the gums and Cardiovascular Disease.  Patients with cardiovascular disease are at increased risk for heart attack and stroke due to clogged arteries as a result of the disease.  The following article http://perio.org/consumer/perio_cardio.htm speaks about this relationship between gum and heart disease.   It is believed that the dental plaque germs get into the blood stream through the periodontal ligament space around the teeth, cause an inflammation response which over time may result in ccardiovascular disease.  

Gum Disease and Diabetes:

This is a direct quote from the American Academy of Periodontology's website, perio.org.

“Everyone should maintain healthy teeth and gums to avoid periodontal disease, but people with diabetes should pay extra attention,” said Samuel Low, DDS, MS, Associate Dean and professor of periodontology at the University of Florida College of Dentistry, and President of the American Academy of Periodontology (AAP). “Periodontal disease triggers the body’s inflammatory response which can affect insulin sensitivity and ultimately lead to unhealthy blood sugar levels. Establishing routine periodontal care is one way to help keep diabetes under control.” 

It is believed that certain types of infection-fighting white blood cells in patients with diabetes do not work as well.  This allows gum disease causing bacteria to destroy teeth-supporting structures (bone, gums, and ligaments) and helps explain why diabetic patients are more likely to have gum disease than non-diabetic patients. 

Gum Disease and Cancer:

The following is a quote from the e-news letter "Study Suggests Gum Disease Increases Men's Cancer Risk."

"Research published in the June 2008 issue of The Lancet Oncology found that men with a history of gum disease are 14 percent more likely to develop cancer than men with healthy gums. In fact, researchers uncovered that men with periodontal disease may be:

• 49 percent more likely to develop kidney cancer
• 54 percent more likely to develop pancreatic cancer
• 30 percent more likely to develop blood cancers"

As you can see, researchers are finding ties between gum disease and systemic diseases such as cardiovascular disease (which may lead to heart attack and stroke), diabetes, and certain types of cancers.  You should make it a priority to protect your dental health as a strong defense against these and other related health problems.  Good home oral care, regular dental exams, diagnostic dental x-rays, professional cleanings coupled with prompt treatment of any signs of gum disease are essential to protect your health.  Ask your dentist to screen you for signs and symptoms of gum disease at your dental visits and follow home oral care instructions to decrease your risk.   Happy smiling!

Thumbsucking

I am mom of a 2 1/2 year old who has a finger sucking habit.  Therefore I can empathize with the parents of my pediatric patients who suck their thumbs or fingers.  My daughter began her habit in infancy and was very determined to keep it.  I tried to put little cotton mittens over her hands to break the habit but she would just suck on the mittens!  I decided not to fight her on sucking her fingers as a baby and resigned myself to addressing the issue when she was older.

According to the American Academy of Pediatric Dentistry, thumb, finger, and pacifier sucking habits are normal for babies and young children.  It helps soothe children and makes them feel secure.  Children with this habit do it to calm themselves when they are hungry, bored, sleepy, or afraid.  I have even seen ultrasound pictures of infants sucking their fingers in their mother's womb.


18 week ultrasound showing thumb sucking



While many children will stop their thumb, finger or pacifier habit on their own (between the ages of 2 and 4 years), others may continue for several years.

The questions I get from most of my patient's parents are: "Will this habit harm my child's teeth?" "At what age should they stop" and "How do I get my child to stop?"

Q: "Will this habit harm my child's teeth?"

A:  Unfortunately a prolonged habit of sucking fingers or a pacifier can have negative effects.  The pressure or suction from the habit may cause the child's teeth to come in crooked or flare outward.  In some cases, the roof of the mouth may become malformed or narrow.  Children can also have problems with speech such as a lisp or difficulty pronouncing sounds such as "T or "D".  Others may develop a tongue thrust while talking. 

Q:  "At what age should children stop their habit?"

A:  As mentioned earlier, usually if children are able to stop their sucking habit by age 3 or 4 they are not at risk for speech or dental problems.  Children who wait until later to stop may need orthodontic treatment to correct their bite.



Full face photo of child with thumb sucking habit



Intraoral photo of same child with habit



Q:  "How do I get my child to stop?"

A:  Parents and the dentist can help encourage a child to stop their habit by explaining the consequences of sucking their finger, thumb, or pacifier.  If this does not work, the dentist can suggest ways to help change the child's behavior.  My oldest daughter used a pacifier until she was three and then only at bedtime.  I spoke with her several times about how the pacifier was affecting her teeth.  She finally agreed to stop when I bribed her with a new toy in exchange for throwing her pacifiers away.  I will admit, she cried after she realized her pacifier was in the trash can, but when I told her she could have it back if we took the toy back to the store she kept the toy and never looked back.

Some of my patients have had success breaking their habit by using a thumbguard or fingerguard for a few weeks.  According to the thumbguard website;  This flexible plastic device fits over the finger or thumb and "prevents a seal from being created around the thumb with the lips. Without this seal, there is no suction, which is the primary source of pleasure in thumb sucking."  

The American Academy of Pediatric Dentistry also recommends using an ACE bandage for night-time finger sucking habits.  This combined with encouragement and rewards from parents over a period of 6 weeks has been shown to be helpful. 

In rare cases, a child over 5 years old may have a thumb or finger sucking habit due to an emotional problem like anxiety.  These children may need to be evaluated by a physician.  If you or someone you know has a child with a thumb, finger, or pacifier habit, contact your dentist for advice and support. 

Happy Smiling!



Hidden Causes for Cavities

Cavity Basics:
Many people know the most common cause for cavities, also known as tooth decay.  Sugar, candy, sodas, sticky fruit like raisins, fruit snacks, cough drops and other sweets are all well-known cavity causing foods.  Starchy foods like bread, crackers, and chips can also cause cavities because starches are broken down into sugars by digestive enzymes found in saliva. 
Cavities are caused by germs (Streptococcus mutans, Lactobacillus) in the mouth which metabolize sugar from food or drinks and produce acid as a by product.  This acid removes the minerals from the teeth through the process of erosion, causing a hole or cavity in the tooth.  So the basic "cavity equation" is TEETH + SUGAR + GERMS = ACID  -> CAVITY.  Our goal is to keep the teeth, it is difficult to get rid of the germs, therefore the item to eliminate in the cavity equation to prevent cavities is sugar.

Next I will review some lesser known sources of tooth decay, which are as follows:

• Diet soda- Diet soda does not contain sugar, instead it contains artificial sweetners.  Although the sweeteners used in diet sodas generally do not cause cavities; diet soda contains acid as a preservative which erodes teeth.  I like to say that diet soda "skips the middle man," sugar and goes straight to putting acid on the teeth, causing decay.
• Fruit juice- Fruit juice is high in sugars (fructose, sucrose and glucose).  Certain juices such as orange juice and grapefruit juice contain high concentrations of citric acid as well as a lot of sugar and this combination can rapidly cause tooth decay. 
• Sports drinks- Many sports drinks are advertised as being healthy for active people because they "hydrate", replace minerals, and electrolytes lost through perspiration.  However many sports drinks contain sugar and even diet versions contain acid as a preservative which can cause tooth decay.
• Chronic dry mouth (xerostomia)- Dry mouth or xerostomia may be caused by various health conditions, or as a side effect of certain prescription medications.  Decreased saliva flow allows cavity causing bacteria to stick to the teeth longer, affects the pH of the mouth, and can contribute to tooth decay.  Also patients with dry mouth may use hard candy or drink cavity-causing beverages to relieve discomfort from dry mouth.
• Acid reflux (Gastroesophagal Reflux Disease or GERD)- Acid reflux or GERD is a condition that causes stomach acids to escape the stomach and flow up through a patient's esophagus into their mouth.  This may be accompanied by frequent heart burn, and nausea.  The regular flow of acid in the mouth may also erode teeth and cause cavities.
• Asthma inhalers- Please note:  This observation is anecdotal, meaning I have seen increased  occurrence of cavities with some of my patients who use inhalers, however I do not have specific scientific studies to verify this process.  Some theories as to why inhalers may cause cavities are: beta2 agonists, such as salbutamol, and corticosteroids, such as fluticasone propionate, decrease the pH of the dental plaque  (high acidity in the mouth leads to erosion and decay). Beta2-adrenoceptor agonists in inhalers cause decreased saliva secretion by 20 – 35%. The lactobacilli (cavity causing bacteria) count will increase producing more acid by production. The combination of these factors may explain why there can be a higher cavity rate in patients using these types of inhalers.

So, what should you do to avoid these hidden causes of cavities?

• Diet sodas- decrease or eliminate diet soda from your diet.  A healthier beverage choice is water.
• Fruit juice- Better choices to prevent decay are less acidic juices such as 100 % apple, grape, and cranberry juice.  These should be consumed in moderation and can even be diluted with water to decrease the amount of sugar per serving.  I occasionally get creative and mix 2/3 of a cup of no-sodium seltzer water with 1/3 of a cup of one of the less acidic, 100 % fruit juices for a lower sugar "soda".
• Sports drinks- According to the report, “Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate ?"  in the June 2011 issue of Pediatrics ), water is the best drink for routine physical activity.
• Chronic dry mouth/ xerostomia- Consult your physician about your dry mouth symptoms especially if it is a side effect of a presciption medication. Use products specifically formulated to help with dry mouth such as Biotene, or Oasis.  There are toothpastes, mouthrinses and saliva replacement sprays on the market that can give relief.  Avoid oral care products containing alcohol which can cause dry mouth.  Use sugar free candies, gum, or cough drops to stimulate saliva flow.  Sip water frequently through out the day. 
• Acid reflux/ GERD- Consult your physician about controlling this condition.  Reflux can cause other serious health problems as well.
• Asthma inhalers- I would never advise patients to stop using their inhalers. Asthma can be life threatening, as opposed to cavities which are treatable.  Instead, I advise patients who use inhalers to decrease consumption of sugary foods and drinks, brush teeth after meals, and use alcohol free oral care products to prevent dry mouth.

The last and most obvious recommendation is to have regular dental exams so that your dentist can monitor for any new cavities.  I wanted to be sure and talk about these lesser known sources of cavities because I have found that many patients were unaware of them.  Hopefully this information will help people prevent tooth decay.  Happy Smiling!

Care Instructions after a Dental Extraction

Here's another terribly exciting topic:  Care after a dental extraction.
I realize that most patients are a little distracted when I review care instructions after they have had a tooth pulled (extracted).  Patients always nod as though they are listening but they often have a lot of questions for the poor person working the front desk after I walk away.  Therefore, I provide my patients with a written list of dos and don'ts following an extraction.  Post operative instructions are very important; following them can help ensure proper healing of the socket.  After having a tooth pulled, follow these steps:

1. Bite on gauze- be sure to bite tight on the gauze your dentist places over the extraction site.  This applies pressure to the area where the tooth was removed and helps a blood clot to form.  Bite for at least 30 minutes.  If there is still bleeding after 30 minutes, replace the gauze with a new piece.  Fold the gauze in half and then in half again, place over the socket and bite firmly for another 15- 20 minutes. 
2. Swallow saliva- DO NOT SPIT! Swallow your saliva.  There should not be a lot of blood in your mouth following the extraction if you are applying adequate pressure.  If the gauze becomes saturated with saliva, it could cause the area to continue bleeding and not form a good blood clot.
3. Do not spit- This bears repeating.  Spitting can loosen the blood clot from the socket.  If you lose the blood clot you may develop dry socket which hurts worse than a toothache.
4. Do not rinse- Do not rinse your mouth the day of your extraction.  You may rinse gently, the day after your extraction with warm salt water.
5. Do not smoke or drink through a straw- Avoid smoking or sucking through a straw for at least two days following a dental extraction.  The suction can dislodge the blood clot from the socket and lead to painful dry socket.
6. Eat soft, cool foods- Avoid traumatizing the area when eating.  Eat soft foods like mashed potatoes, pasta, soup, rice and the like.  Don't eat crunchy foods like popcorn, potato chips or pretzels.  Do not eat spicy foods, which may cause bleeding.  Chew on the side opposite of the extraction, if possible.  Let food cool to room temperature because heat can cause bleeding.  If food gets in the space where the tooth was, DO NOT dig it out with a tooth pick.  You will probably remove the blood clot which may cause dry socket and pain.
7. Wait for anesthetic to wear off before biting or chewing.  It may take a few hours for the anesthetic to wear off.  Do not chew or bite foods until the numbness has worn off or you may accidentally bite your lip, cheek, or tongue.  A milkshake, smoothie, or protein shake are allowed but no straws!
8. No bubbly drinks- Do not drink soda or beer for a couple days following the extraction.  The carbonation or bubbles can loosen the blood clot, cause dry socket and pain.
9. Avoid alcohol- Avoid drinks containing alcohol or using mouthwash with alcohol because it can dissolve the blood clot.  Wait at least 2 days following an extraction before using these products.
10. No lifting, bending, or strenuous activity the day of your extraction.  This will keep your heart rate up and may cause prolonged bleeding.
11. Brush your teeth to maintain good oral hygiene and promote healing.  Do not brush over the extraction site which may dislodge the blood clot and cause bleeding.
12. Take all recommended or prescribed medication as directed by your dentist.  This will help control pain, fight infection (if prescribed an antibiotic), and promote healing.
13. Call your dentist if you have any unusual symptoms, prolonged bleeding, or pain that is not controlled by recommended medications.

Please notice that I mention how to prevent losing the blood clot from the extraction site several times because dry socket is more painful than a toothache.  It also takes several days to recover from dry socket and may take additional visits to the dentist to treat.  Hopefully following these post operative instructions will help patients avoid this negative outcome.  Happy Smiling!

How to Care for Dentures

How to care for your dentures?  Yeah, I realize that this is not exactly an exciting topic.  However I am surprised by how few patients have been given pointers on how to increase the life and use of their dentures.  So here we go:

• Don't sleep in your dentures.  Just as you remove your socks and shoes at night, you should also remove your dentures.  Your gums and jaw bones need time to rest without pressure on them.  Wearing dentures constantly can lead to fungal infections of the mouth, oral candidiasis.  Also, the constant wear and tear on the gums and jaw bone can speed up bone loss and make dentures fit looser.

• Clean dentures gently.  Using a soft face cloth, liquid hand soap, and cool water, wash your dentures inside and out just as you would a dish.  Gently scrub away all food and dental plaque to prevent stains or odors.  Rinse denture thoroughly and store in a plastic denture case filled with water.  You can add either a teaspoon of white vinegar or bleach to the water to prevent bacterial growth.  Change the water in the denture case daily.  
• For stubborn stains, scrub stained areas with a denture brush and a little baking soda mixed with water.  Do not use the brush every day or over the entire surface of the denture as it will scratch the denture and make it pick up stains and odors quickly.  You may also dissolve effervescent denture cleaning tablets in the water of the denture case to help fight stains as needed.
• Professional Dental cleaning:  You should have a yearly oral exam with your dentist to check for any signs of oral cancer, fungal infections, loose fit, or wear of your denture.  At that visit, ask about having your denture professionally cleaned.  We provide this service free to patients at my office during their regular exam and/ or cleaning.
• Keep Dentures away from pets!  Always store your dentures out of reach from pets.  For what ever reason, dogs especially like to chew up dentures.
• Problems? Call your dentist.  If your denture cracks or you break a tooth off your denture, call your dentist.  DO NOT use super glue! It can melt your denture and ruin it.

So these are the basic steps that can help extend the life and use of your dentures. Happy smiling!