Posts for category: Oral Health
Around 20 million people—mostly women after menopause—take medication to slow the progress of osteoporosis, a debilitating disease that weakens bones. But although effective, some osteoporosis drugs could pose dental issues related to the jawbones.
Osteoporosis causes the natural spaces that lie between the mineral content of bone to grow larger over time. This makes the bone weaker and unable to withstand forces it once could, which significantly increases the risk of fracture. A number of drugs have been developed over time that stop or slow this disease process.
Two of the most prominent osteoporosis drugs are alendronate, known also by its trade name Fosamax, and denosumab or Prolia. While originating from different drug families, alendronate and denosumab work in a similar way by destroying specialized bone cells called osteoclasts that break down worn out bone and help dissolve it. By reducing the number of these cells, more of the older bone that would have been phased out lasts longer.
In actuality this only offers a short-term benefit in controlling osteoporosis. The older bone isn’t renewed but only preserved, and will eventually become fragile and more prone to fracture. After several years the tide turns negatively for the bone’s overall health. It’s also possible, although rare, that the bone simply dies in a condition called osteonecrosis.
The jawbones are especially susceptible to osteonecrosis. Forces generated by chewing normally help stimulate jawbone growth, but the medications in question can inhibit that stimulus. As a result the jawbone can diminish and weaken, making eventual tooth loss a real possibility.
Osteonecrosis is most often triggered by trauma or invasive dental procedures like tooth extractions or oral surgery. For this reason if you’re taking either alendronate and denosumab and are about to undergo a dental procedure other than routine cleaning, filling or crown-work, you should speak to your physician about suspending your medication temporarily. Dentists often recommend a suspension of three to nine months before the procedure and three months afterward.
Some research indicates this won’t worsen your osteoporosis symptoms, especially if you substitute another treatment or fortify your skeletal system with calcium and vitamin D supplements. But taking this temporary measure could help protect your teeth in the long run.
If you would like more information on the effect of osteoporosis treatment 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 “Osteoporosis Drugs & Dental Treatment.”
We’re all familiar with “naughty” and “nice” lists for food: “nice” items are beneficial or at least harmless; on the other hand, those on the “naughty” list are not and should be avoided. And processed sugar has had top billing on many people’s “naughty” list for some time now.
And for good reason: it’s linked to many physical ills including obesity, diabetes and heart disease. As a favorite food for oral bacteria that cause dental disease, sugar can also increase your risk for tooth decay or periodontal (gum) disease.
Most people agree that reducing sugar in their diet is a great idea health-wise. But there’s one small problem: a great many of us like sugar—a lot. No matter how hard we try, it’s just plain difficult to avoid. Thanks perhaps to our ancient ancestors, we’re hard-wired to crave it.
But necessity is the mother of invention, which is why we’ve seen the development over the past half century of artificial sweeteners, alternatives to sugar that promise to satisfy people’s “sweet tooth” without the harmful health effects. When it comes to dental health, these substitute sweeteners won’t contribute to bacterial growth and thus can lower disease risk.
But are they safe? Yes, according to the U.S. Food and Drug Administration (FDA). The agency has approved six types of artificial sweeteners for human consumption: acesulfame K, saccharin, aspartame, neotame, sucralose and rebaudioside A. According to the FDA any adverse effects caused by artificial sweeteners are limited to rare conditions like phenylketonuria, which prevents those with the disease from safely digesting aspartame.
So, unless you have such a condition, you can safely substitute whatever artificial sweetener you prefer for sugar. And if dental health is a particular concern, you might consider including xylitol. This alcohol-based sweetener may further deter tooth decay—bacteria can’t digest it, so their population numbers in the mouth may actually decrease. You’ll find xylitol used as a sweetener primarily in gums, candies and mints.
Reducing sugar consumption, couple with daily oral hygiene and regular dental visits, will certainly lower your risk of costly dental problems. Using a substitute sweetener might just help you do that.
If you would like more information on sweetener alternatives, 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 “Artificial Sweeteners.”
Teeth-replacing dental implants not only look life-like, they’re made to last. For one thing, the metals and dental materials used in them are impervious to bacterial infection.
But that doesn’t mean implants are impervious to failure. Implants depend on the bone and other natural mouth structures for support. If the bone becomes weakened due to disease, the implant could become unstable and ultimately fail.
Peri-implantitis, the condition that can lead to this kind of failure, is a major concern for implant longevity. It’s a type of periodontal (gum) disease triggered by plaque, a thin film of food particles that can build up quickly in the absence of adequate brushing and flossing. The gum tissues around the implant become infected and inflamed.
If the infection isn’t properly treated with renewed oral hygiene and clinical plaque removal, it could spread below the gum line and begin to damage the underlying gum tissues and bone. This could destroy the all-important connection between the titanium implant post and the bone. The implant could eventually loosen and become completely detached from the bone.
The key is early intervention before the bone becomes damaged. Besides plaque removal we may also need to apply antibiotics in some form to control the growth of disease-causing bacteria. If the disease has fairly advanced we may also need to consider surgical repair to strengthen the attachment between implant and bone.
You can help to avoid peri-implantitis altogether by practicing consistent daily brushing and flossing around all your teeth including the implant, and seeing your dentist at least twice a year for cleanings and checkups. And by all means see your dentist if you notice any signs of gum swelling, redness or bleeding. Staying on top of your gum health will help not only the natural tissues and remaining teeth in your mouth, it will help preserve your implants for decades to come.
Athletes in contact sports are at significant risk for traumatic injury to their teeth and mouth. It’s estimated 600,000 emergency room visits each year involve a sports-related dental injury.
Athletic mouthguards have become the premier safeguard against sports-related oral injuries. First worn by professional boxers in the 1920s, mouthguards are now required for use by various sports associations and leagues — from amateur youth to professional — for a number of sports. The National Collegiate Athletic Association (NCAA), for example, requires their use during play for hockey, lacrosse, field hockey and football. The American Dental Association recommends mouthguards for 29 sports or exercise activities.
But do mouthguards actually prevent injury? To answer that question in a scientific manner, the Journal of Sports Medicine published an evidence-based report in 2007 on mouthguard effectiveness for preventing or reducing the severity of oral-facial injuries and concussions. While the report objectively analyzed many of the problems and issues associated with mouthguards (like materials, design and durability), it concluded the risk of an oral-facial injury was nearly two times greater without the wearing of a mouthguard.
That being said, most dentists and other professionals in sports safety would advise not all mouthguards are alike. The stock, “off the shelf” mouthguard found in many retail stores with limited size offerings is the least expensive, but also least protective, of mouthguard types. Mouth-formed or “boil-and-bite” protectors, which are softened in boiling water and then bit down on by the player to form the fit, are better than the stock version — however, they often don’t cover all of the player’s back teeth.
The best option is a custom-designed guard made by a dentist for the individual patient. Although relatively expensive (costs range in the hundreds, compared with $25 or less for a stock guard), they provide the highest recognized level of mouth protection.
The bottom line: a mouthguard is a must-wear part of any uniform for any sport that involves contact or high velocity objects of play. If you or a family member is a contact sport athlete, it’s essential you protect your teeth and mouth with a custom-fit, high quality mouthguard.
If you would like more information on mouthguards, 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 “Athletic Mouthguards.”
What makes a beautiful smile? The teeth, of course: bright, evenly shaped and precisely aligned with each other. But your teeth can be as perfect as can be and your smile will still appear unattractive.
The reason? Your gums show more than they should when you smile.
What's considered a gummy smile is largely a matter of perception that can vary from person to person. As a rule of thumb, though, we consider a smile “gummy” if four millimeters (mm) or more of the gums show.
Fortunately, we can minimize the gums' prominence and make your smile more attractive. But what methods we use will depend on why your gums stand out. And it's not always because of the gums themselves.
It could be your teeth didn't erupt normally during dental development. Mature crown (the visible part of the tooth) length is normally about 10 mm with a width about 75-85% of that. But an abnormal eruption could result in teeth that appear too short, which can make the gums stand out more. We can correct this with a surgical procedure called crown lengthening in which we remove excess gum tissue and, if necessary, reshape the underlying bone to expose more of the tooth crown.
Another potential cause is how far your upper lip rises when you smile. Normally the lip rises only enough to reveal about 4 mm of teeth. In some cases, though, it may rise too high and show more of the gums. We can modify lip movement in a number of ways, including Botox injections to temporarily paralyze the lip. A more permanent solution is a lip stabilization procedure. It sounds bad, but it's a fairly simple procedure to surgically reposition the muscle attachments to restrict movement.
Your gummy smile may also result from an upper jaw too long for your facial structure. We can correct this with orthognathic (“ortho” – straighten, “gnathos” – jaw) surgery. During the procedure the surgeon permanently positions the jaw further up in the skull; this will reduce the amount of teeth and gums displayed when you smile.
Discovering the true cause of your gummy smile will determine how we treat it. After a complete oral examination, we can then discuss your options to transform your smile into a more attractive one.
If you would like more information on treating gummy smiles and other cosmetic problems, 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 “Gummy Smiles.”