Maybe you’re thinking: “Wow, Doc! We’re being a little dramatic here, aren’t we?” Well, read on.
No doubt, this title will elicit a few snickers and maybe even the occasional one-liner like “No, but I know someone whose breath could kill!” Nevertheless, the possibly shocking truth is that yes, bleeding gums can kill you.
As a practicing dentist, I see all levels of home care. There are patients who practice excellent hygiene and have firm, pink and healthy gums or teeth without cavities. Then there are those who probably wouldn’t recognize a toothbrush if it poked them in the eye and whose mouths have so much plaque it looks like they just finished eating cottage cheese.
The bottom line is – where along this spectrum do you fall – and what can it mean for your overall health?
As I write this, I recall a question posed to me by one of my patients just yesterday. He told me that one of his “lady friends” had recently passed away. According to his story, he had seen her a few weeks ago and then noticed she wasn’t around very much. When he asked about her, he learned she had died as a result of complications following a dental abscess. His question “is that possible?” reflected an incredulity that is typical when it comes to the effects of oral health on the body.
Again, my answer was “yes, it’s possible.” Severe sepsis, which is basically a systemic inflammatory response to infection, can lead to organ failure and death. His friend was forty-two years old.
Obviously, this is an extreme example of infection traveling from one site and affecting the entire organism, but there are more subtle examples that are no less significant. Take bleeding gums. There are probably few people who haven’t experienced this phenomenon at some point or another in their lifetimes. If you are a hypochondriac, you probably should stop reading right now. If, on the other hand, you are just interested in knowing what significant step you can take to reduce your risk for heart attack or stroke, read on.
If I were to speculate, I think that many physicians and dentists probably still don’t think of tooth-related infections as systemic risk factors. The science behind this concept, however, is clear. In fact, a number of studies have been completed which clearly show the following:
Tooth-related infection can cause death
Infection equates to heart attack and stroke
Periodontal diseases are a portal for systemic inflammation and disease
If you have a periodontal infection you are going to have elevated C-reactive proteins, and C-reactive proteins are four times more predictive of cardiovascular complications than cholesterol
References for these studies will be made available on my website. But that represents a relatively small sampling of the articles which conclude red gums represent a disease process unto itself. This observation is the critical point.
If red gums represent inflammation and infection, then bleeding gums are definitely not something you should ignore. Even if you are not worried about your health, you may be surprised to know that many clinicians believe that aging is caused by systemic inflammation. There are a few studies supporting this theory as well, but the point is simple: don’t ignore your oral health. You might even look younger if you take care of your teeth! One of the simplest ways to reduce inflammation is to control the bacteria in your mouth. Start by brushing after meals and flossing every day. Eat a proper diet rich in vitamins and minerals. Get enough rest. Exercise, and reduce stress.
Also, don’t forget to visit your dentist regularly. Because so many dental conditions are symptom-free in their early stages, patients can be hit hard by neglect. The perception of “no pain, no problems” is often misleading when it comes to dental problems. Couple this with the fact that in tough economic times, people tend to put off what they perceive as optional or unpleasant, and you can have a formula for disaster – financial, or otherwise….
Dry mouth, also called xerostomia, is a common oral health problem. Unfortunately, for some patients it becomes a “silent” condition that often goes undiagnosed and untreated. While there are many potential reasons for this condition, one of the most frequent contributing factors is the use of medications. Over four hundred commonly prescribed drugs list dry mouth as a potential side effect.
While this condition is fairly common in the general population, the prevalence increases with age. This is likely because many older adults take medications for one or a number of co-existing medical conditions.
Though some people may consider dry mouth an inconsequential medical or dental concern, it can be a troublesome symptom also associated with systemic diseases and health conditions. Things that most people take for granted, such as being able to chew their food – or even to taste it – result in a reduced quality of life for the patient with xerostomia.
Negative effects of dry mouth can include:
• Increased dental decay
• Oral infections
• Cracks and fissures in the tissues of the mouth
• Denture sores and ulcerations
• A decreased willingness or ability to speak easily
Keep in mind that almost everyone has experienced dry mouth at some time in their lives. Dehydration following excessive perspiration, diarrhea, or alcohol consumption are experiences many people have experienced at one time or another. These situations are generally transient and easily identified. It should be noted here that not only alcohol consumption, but simply rinsing with alcohol-containing mouthwashes can result in a dry mouth. Many patients hold these rinses in their mouths for much longer than the recommended 30 second period. This can produce a type of tissue burn called sloughing; however, even regular use can cause a drying effect for many individuals.
If, however, you find any of the following problems to be daily events, you should raise the issue with your dentist or physician:
• Do you consistently need to sip liquids to help you to swallow your food?
• Does your mouth feel dry whenever you eat?
• Do you have any difficulty swallowing?
• Does the amount of saliva in your mouth seem to be much less than you remember, or do you not notice the difference?
There are several simple things your health practitioner can do to evaluate your condition. A medical history will also provide clues. For example, certain conditions such as diabetes, cancer treatments, and Sjögren’s syndrome have also been connected with dry mouth. (Sjögren’s syndrome is a chronic autoimmune disease in which a person’s white blood cells attack their moisture-producing glands.)
Keep in mind that dry mouth symptoms may not appear until saliva production has been reduced to approximately half the normal flow.
While it is always best to identify the source of the problem to seek a long-term resolution, sometimes it is necessary to provide symptomatic relief. A number of products have been developed that can help the dry-mouth patient who so often has extra sensitive mouth tissues. These include stimulation products such as chewing gums, specially formulated toothpastes and mouthwashes that are free of irritating ingredients, and moisturizing gels or sprays.
The important thing is that you do not ignore dry mouth symptoms if they exist. Talk to your dentist or doctor. Day-to-day symptoms and their complications can be managed. If you and your doctor correctly identify the source, perhaps those problems can even be eliminated over time. The simple pleasures of life – eating comfortably, tasting an enjoyable meal, laughing freely – shouldn’t be just a memory.
Not long ago, I heard something from a patient that really surprised me. Now, that in itself is significant, because after practicing dentistry in Philadelphia for over 20 years, I thought I had just about heard it all. This patient, who up until recently had a great record of regular follow-up visits for cleanings and check-ups had been missing in action for about a year and a half. After we caught up with her and found out what was behind her unusual lapse in dental care, I learned that, among other things, she had been listening to a friend who had asked her: “Why do you want to go to the dentist? He’ll just find things that are wrong with you. And it’s so expensive.”
Quite apart from the fact that this patient usually left her checkup without a need for any additional treatment, I thought to myself “With friends like that, who needs enemies?”
Well, here’s one to chew on: Let your oral health go and sure it may be expensive. That is, if you choose to get back into shape. Maybe even really expensive.
But, take care of yourself and – unless you have a serious accident – it’s very unlikely.
Statistically, I have found that patients who keep up with their bi-annual visits, have far less treatment that needs to be done. At times, an old filling or two may require replacement, but usually not a lot beyond that. That’s just normal wear and tear.
People who grind or clench their teeth often experience a higher need for dental work due to added stresses on their teeth, but we have solutions for this too.
All-in-all, having regular check-ups keeps the bulk of your hard-earned money in your pocket and not mine. Think about it. It’s just common sense.
Chances are that you have met someone with a dental implant and didn’t even know it. Completely natural looking, they have saved countless beautiful smiles. Dental implants are on the leading edge of technology and use special biomaterials – and they can be placed in only one or two office visits!
You may be a candidate for dental implants. In our office, we coordinate treatment with a periodontist who handles the first step of the procedure.
Implants are basically artificial tooth roots which anchor to surrounding bone and to which replacement teeth are attached.
The periodontist handles the first part of the procedure, which is placing the tooth root. Once that step is completed, I complete the second step which involves making the replacement tooth.
Permanent replacement teeth can be made translucent like natural enamel and are framed by your natural gum tissue.
Implants are long-lasting and reliable – and actually, quite cost effective. The cost to replace a single tooth with an implant is comparable to making a dental bridge. But, unless you’re 125 years old, most bridges will have to be replaced after several years. (Five to fifteen is the national average.) Implant crowns can last considerably longer because there is no natural tooth structure beneath them that can decay and if the crown comes loose, it is usually just a matter of re-cementing the crown.
Implants can replace one tooth, rebuild an entire jaw of missing teeth, or be used to secure dentures.
Essential oils have many benefits, from curing athlete’s foot or controlling fungal infections, to helping with gingivitis. The article below discusses tea tree oil — also known as melaleuca oil. Many patients in our office have benefited from the essential oils present in two products available for purchase in our office: Tooth and Gums Tonic and Tooth and Gums Paste. Used properly, natural remedies can be of great benefit, without many of the side effects associated with traditional cures.
Natural Ways to Keep Your Teeth and Gums Healthy
By Kathy Jenkins
Whether you’re trying to cure a toothache, make your teeth whiter or prevent gum disease, there are many natural remedies that can be helpful in between visits to the dentist. Eating right, and brushing and flossing your teeth are certainly important, but there are numerous other methods available that can give your oral health a boost. Among these are herbs, oils, and the like. We will be giving you a few examples you may choose to follow that can give your oral hygiene a positive boost.
Going to the dentist is something that most of us would like to avoid. But if your teeth hurt right now, that is exactly where you should go. One such instance is if you have an abscessed tooth. This is a potentially serious condition where your tooth gets infected, and this can spread to other parts of your body. There are many symptoms that can be associated with this circumstance, including a bitter taste in your mouth and a swollen neck or jaw. Antibiotics from your dentist will usually help to control or get rid of the infection. Typically, your doctor will also prescribe pain medication for any discomfort you are feeling. An emergency room may be your best bet for getting relief from an abscessed tooth, especially if you are lacking dental insurance or the funds to cover your bill.
Natural antibiotics exist, and tea tree oil is considered one of them. Because it has powerful healing properties doesn’t mean you can take it without following directions, and if it says not to take it internally, you shouldn’t. If you need a good toothpaste or mouthwash, you should consider tea tree oil. It can also be useful in controlling gingivitis. Rinse your mouth with a small amount in a glass of water, because it can be too strong undiluted. If you are looking for the safest way to use tea tree oil then get a mouthwash or toothpaste which already contains it, or some other commercially prepared product. This works really well for giving you fresher breath as well as help to prevent gum disease. A product with tea tree oil in it can be harmful if you swallow it, so use caution when rinsing and be careful not to administer it to children that might be prone to swallowing rather than rinsing and spitting.
There may be a dentist in your area who favors holistic techniques. Consult with them about natural ways to care for your teeth and gums. You may be surprised how many dentists can be found that have this orientation. Holistic dentists went to the same kind of dental schools as anyone else, but they focus on natural and holistic techniques and substances. If you need to have any filling done, a holistic dentist would never use a filling that’s mercury based. When you have this kind of dentist, you will always have someone to consult when it comes to natural ways to keep your mouth healthy. In some cases, you may have to travel a little further to find a good holistic dentist, depending on where you live. Our overall health is greatly affected by our mouth because it is often the first place where infections and toxins are likely to be found. If you can maintain clean teeth and gums, and you eat the right foods, you will be less likely to have many cavities. Hopefully the above will give you some orientation to alternative options, but keep in mind that it’s also necessary to get regular dental checkups.
Kathy Jenkins gives suggestion about your teeth as well as how to handle Angular Cheilitis (cracking at the corners of your mouth.) She also has a link to book I have not reviewed concerning the subject. Many cases of angular cheilitis can be resolved, however, by supplementing with vitamins B12, vitamin C, and zinc. An over-the-counter antibiotic cream may also help. Some cases of angular cheilitis are caused by ill-fitting dentures. This can only be remedied by having a new set of dentures made that fit properly. If you are interested in the book Kathy Jenkins references, you can find it here: Angular Cheilitis.
Here is an interesting article about sleep apnea solutions. Our office provides an extensive complement of night-time apnea and snoring solutions. Ask us about aveoTSD — the latest simple, inexpensive, and noninvasive anti-snoring medical device.
By Brent Arends
Is there room for two gold standards in the world of sleep? In 2011, most sleep physicians still put CPAP in the gold category, with oral appliances taking the second-place silver slot. If Sheri Katz, DDS, has her way, that hierarchy may someday be a bit more nuanced—perhaps with CPAP at 18 karats and oral appliances at 14.
CPAP has the benefit of time and the respect that goes with it. Among patients, however, oral appliances frequently carry a significant preference advantage. “Given the option, about 70% of patients choose oral appliances,” says Katz, president of the American Academy of Dental Sleep Medicine (AADSM), Darien, Ill. “Oral appliances are noninvasive, convenient, discreet, easy to travel with, and it’s a therapy that works. Dentists who are interested in participating in this field must take the correct training and know the proper protocols. We need more dentists to do this, but only as many as we can properly train and accredit.”
As a sleep apnea sufferer and oral appliance user herself, Katz believes wholeheartedly in the efficacy of dental sleep medicine. Despite evidence and consumer preference, she knows respect in the medical community is built on positive experiences. “Satisfaction depends on patients working with qualified dentists,” stresses Katz. “Sleep physicians and other referring specialists are going to be disappointed if they send [a patient] to just anyone, and the patient is not titrated properly or brought through a proper protocol. By the same token, we can be disappointed by blindly putting everyone on CPAP. If we work together and build relationships, we can form effective teams.”
AADSM membership is growing quickly every year, and the Dental Sleep Medicine Facility Accreditation Program, launched earlier this year, figures to make it easier to find qualified dentists. “How can the public, referrers, and third-party payors—including Medicare—identify who is well trained in the field?” asks Katz. “Every dentist can make an impression and probably get some sort of device inside a patient’s mouth. But should they be doing this if they do not have the proper training? The answer is no.”
Katz hopes that AADSM facility accreditation will serve as a seal of approval to guide entities beyond mere state licenses. “State licensure has really been more of a tax revenue source, and not successful in identifying who is really competent,” she says. “The facility accreditation process demands that we demonstrate our knowledge through a policies and procedures manual. Facility accreditation requires certain levels of education, so many hours in the field, and eventually a board certification, which we offer.”
DIFFERENT DECADES, DIFFERENT ATTITUDES
When Katz began practicing dentistry in 1978, CPAP had not yet been invented. Restorative dentistry ruled dental school curriculums from coast to coast, with only occasional showings from the so-called “fringe” disciplines of orofacial pain and TMJ.
Steven Scherr, DDS, graduated from dental school just 3 years after Katz began practicing, and he had “never heard of sleep apnea” up to that point. A little more than a decade ago, that all changed when a physician asked him to make an oral appliance. “I hardly knew what sleep apnea was,” admits Scherr, owner of the Sleep Disordered Breathing and Facial Pain Centers of Maryland, Pikesville, Md. “I figured I would try anything once, and it worked out. The patient was thrilled. She had tremendous success, and felt much better. The referring physician sent more patients, and his partner sent even more. Within 2 years, 50% of all my patients were referred for treatment of sleep-related breathing disorders.”
Scherr’s growing stable of referring clinicians represents an overall awareness in the medical community that mirrors a massive push in the consumer media. Initially skeptical physicians have taken the time to read the research, and converts are now embracing the idea that CPAP is not the only viable treatment for sleep apnea.
The American Academy of Sleep Medicine (AASM) opened the door by publishing practice parameters in 2006. The report concluded that oral appliances are indicated for use in patients with mild to moderate sleep apnea.
Don A. Pantino, DDS, agrees that medical understanding has taken “a huge jump” in oral appliance acceptance, and he predicts that will only grow. “In 2006, we looked at the new data and oral appliances were doing well,” says Pantino, who owns a private dental practice in Islip, NY. “As a matter of fact, they should be offered as a first-line therapy for mild and moderate patients. Patients should be educated and given a choice. The conventional wisdom is still that CPAP is more effective for severe patients. However, if that does not work, it is OK to try an oral appliance or combination therapy.”
With the research question partially answered, concerns shifted to insurance companies that largely would not pay. As of January 2011, however, a custom fabricated mandibular advancement oral appliance used to treat OSA is covered if certain criteria are met, according to a new local coverage determination. “CMS officials did not make that decision lightly,” says Scherr. “In this economic age, medical directors would much rather not introduce a new therapy that they must pay for. But they also did an extensive literature review, and they felt the literature strongly supported the use of oral appliances for the treatment of sleep apnea.”
Recognizing the growing importance of dental sleep medicine, officials at Tufts University, Boston, ultimately installed a formal dental sleep medicine curriculum—a move in line with the university’s past accomplishments within the nonrestorative realms. Pantino, an adjunct professor at Tufts, points out that as recently as 1999, sleep garnered about 2 hours of instruction during a 4-year medical school stint—a time frame he views as absurd in light of the fact that humans spend one third of their lives sleeping.
Even in 2011, promoting sleep at the dental school level is necessary. With this in mind, Pantino has used his role as president of the American Board of Dental Sleep Medicine (ABDSM) to help develop a digital PowerPoint presentation to introduce the academy and explain the importance of a sleep curriculum.
Beginning in March 2011, students have an opportunity to learn through accompanying modular lessons in the classroom setting or online. Call it an educational initiative or even a marketing tool, but it is all part of an ambitious goal to convince 100% of dental schools to develop formal dental sleep medicine programs.
Pantino believes a greater focus in the academic setting will naturally lead to a cultural shift among dentists who, at the very least, should be actively checking for signs of sleep apnea within every patient. “Every patient who snores or suffers from hypertension, diabetes, depression, and obvious anatomical landmarks should be considered,” says Pantino. “As medicine goes toward a more holistic approach and we screen for more things, oral appliances make perfect sense. So many patients are going to be diagnosed, and CPAP can be noisy, painful, and not ideal for everyone. When oral appliances are properly applied, with the right adjustments, and administered to the proper patients, they can have a remarkable benefit.”
And given enough time and evidence, that old gold standard may gradually change. “In general, it takes 15 to 20 years to get new advances through the system, and then another 5 to 10 for insurance companies to catch up and pay for them,” adds Pantino. “The gold standard is usually the first thing out there. I make it clear to my patients that I really want them to try the CPAP, and if it works, that is wonderful. I am not here to sell patients appliances. I am here to make sure they get the best therapy that is going to work for them.”
“Doc, I think I have a cavity. Every time I drink some soda, my tooth hurts.”
Experience tells me it’s certainly possible, so I’ll naturally take a look – but quite often, I already know that what is causing the discomfort is an entirely different issue. Patients are often surprised when I explain that while I understand this area hurts, it’s not a cavity.
Hot, cold, air, or sweets – the triggers can be different for different people – but the effect is the same: dental pain. For some, it can be mild or tingly. For still others, it can be excruciating and intense. And yet, this can occur without decay.
So what’s going on? Often, it has to do with changes to the tooth enamel. This protective outer layer of your tooth is both the hardest substance in your body and it acts as an insulator to the inner and more sensitive dentin layer, as well as the pulp. Hard as it is, enamel is still subject to changes that can have consequences for your comfort and tooth function.
So what causes enamel to become damaged or thinned?
In a word – life. But here are a few practices or habits that tend to accelerate changes:
— Dietary factors such as acidic drinks (sodas, fruit juices, wine) and foods — Teeth clenching and grinding — Dehydration of teeth caused by a dry mouth condition (medications or insufficient water intake) — Digestive problems such as acid reflux — Damaging habits (using your teeth in ways you shouldn’t, such as opening things with them) — Improper brushing (overly aggressive or excessively abrasive)
The result of thinned enamel – also referred to as enamel erosion – is sensitivity. Gum recession can also produce a similar result because this exposes the root surface, which is not covered by enamel. Nevertheless, the result is comparable. The teeth hurt.
Yet another popular activity – tooth whitening – can lead to sensitivity due to the cleansing activity of peroxides that are used to remove stain and debris within and between the complexes of enamel rods (the basic unit of tooth enamel). It also removes something called smear plugs (debris in the dentin tubules), and this increases the conductivity of fluid that exists in the tooth’s inner layer, the dentin. When the fluid backs up – once again, you experience pain.
In many cases, desensitizing toothpastes can help. The active ingredient is typically potassium nitrate. It usually takes several weeks of continued use to experience relief. If this does not resolve your symptoms, your dentist may be able to administer a desensitizer that provides instant relief. Any persistent pain should be evaluated by a dental professional in order to prevent more serious and expensive problems.
Dr. Richard Walicki is a dentist practicing general and cosmetic dentistry. While we hope you find the information contained herein interesting and useful, this blog is for informational purposes and is not intended to diagnose any oral disease. Dental conditions should be evaluated by your dental health professional or a qualified specialist.
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