Tooth and Mouth signs of Celiac Disease

Gluten-free diets have become a nutrition fad and gluten-free products abound, but for people with celiac disease being gluten-free is a necessity.  Diet is the only treatment for this autoimmune disease and eating even the tiniest amount of gluten, a protein found in wheat, barley and rye, can cause severe illness.  If left untreated it severely damages the intestines. 

Celiac disease, which seems to be on the rise, affects about 1% of the population and is diagnosed with blood tests and biopsy.  But celiac disease is tricky because the classic symptoms, diarrhea and weight loss, are not present in everyone with the disease leading some physicians to feel it is underdiagnosed.  Some people present with constipation and bloating, others with vitamin deficiencies since the destruction of the intestines leads to poor absorption of nutrients, and some have no symptoms at all.  But there are some other classic signs of the disease and they show up in the mouth.

Children with celiac disease are often found to have poorly formed or missing enamel on the teeth resulting in cavities.  If they are diagnosed before the age of 7 and treated with gluten-free diet, the adult teeth are unaffected.  If not, the disease will also affect the enamel of the permanent teeth.  Over 80% of children with celiac disease have been found to have enamel defects of the teeth.

Adults with untreated or undiagnosed celiac disease also have problems with weak enamel, cavities and bleeding gums.  In addition they may have higher incidence of advanced periodontal disease similar to people with other types of systemic inflammatory diseases like diabetes.  Some people with celiac will develop glossitis, an inflammation of the tongue caused by vitamin deficiency, and about 40% of people with the disease have recurring ulcers of the mouth. 

Because the symptoms of celiac disease, both in the mouth and the rest of the body, are similar to other conditions, a full medical history and further testing is necessary.  But for the person with a family history as well as medical and dental problems similar to celiac, the answer to mysterious symptoms may start in the dental chair.

For more information on celiac disease please visit:   www.celiac.nih.gov/articlearchives.aspx

This blog is not intended to treat or diagnose any dental or medical condition.  Please visit your doctor or dentist if you have any medical or dental concerns.

Diabetes and Your Mouth

Do you have diabetes?  Do you know your A1C?  Do you know that having diabetes can harm your gums and your teeth?  Not only can diabetes contribute to gum disease and cavities, having gum disease can make diabetes worse. 

An A1C test determines the average amount of sugar in your blood.  In general, consistent results of 5.7 to 6.5 are considered pre-diabetic and 6.5 and over is considered diabetic.  A level of 7 and above is considered uncontrolled. 

Diabetes is an inflammatory disease that affects the whole body and also has an effect on the mouth.  There are many signs of diabetes in the mouth.  Out of control blood glucose levels exaggerate the body’s response to germs that are present in plaque.  This results in inflamed, swollen gums and gum disease may progress very quickly in diabetics.  Germs in the mouth also use sugar as fuel so high blood sugar levels may lead to an increased incidence of cavities.  Dry mouth caused by medications or dehydration can contribute to cavities as well.  Diabetes may also cause thrush, a yeast infection in the mouth.   

The relationship between diabetes and gum disease is very well established.  It is so important to take excellent care of the teeth and gums if you have been diagnosed with diabetes.  If inflammation in the gums is not treated it can be very difficult to control blood glucose levels.  Brushing and flossing as well as regular dental hygiene visits are essential.  Treating other signs of the disease such as dry mouth is also necessary to prevent cavities.  If you have diabetes it is imperative to discuss any oral symptoms with your doctor, dentist and dental hygienist.

To learn more about diabetes, including symptoms and risk factors, visit the American Diabetes Association website where you can take their diabetes risk quiz:

http://www.diabetes.org/are-you-at-risk/diabetes-risk-test/?loc=atrisk-slabnav

(Like their website says “It takes only 60 seconds and it could save your life!”)

This information is not intended to treat or diagnose any medical or dental condition.  Please see your doctor or dentist for treatment.  You'll feel better and stop worrying!  

The Gums, Part II (If you Ignore Your Teeth, They'll Go Away)

My last post addressed gingivitis, the reversible form of gum disease.  Gingivitis is reversible because although the gums are infected with germs and are bleeding and swollen, removal of the plaque with good brushing and flossing, as well as regular dental hygiene visits, can restore the gums to health.

Periodontitis, the irreversible form of gum disease, means that the bacterial infection of the gums has now spread to the supporting structures of the tooth.  These supporting tissues are the ligaments and bone that hold the teeth in the mouth.  In its most severe form periodontitis causes the teeth to become loose and fall out.

There are several things that contribute to periodontitis.  A person may have a family history of the disease, have other health issues such as diabetes, or take medications that affect the mouth.  Smoking is a also a huge factor in periodontitis and tooth loss.  (A special note for smokers: the gums of smokers may not bleed.  Blood and oxygen are being sent by the body elsewhere, like the lungs, brain and heart, to compensate for the damage being caused by smoking and nicotine also constricts the blood vessels.  Smoking is very devastating to the teeth and smokers have higher and more severe incidence of periodontal disease and more tooth loss than nonsmokers.)

Periodontitis occurs because plaque germs have been able to get below the gum line and harden.  The gums pull away from the teeth, forming a pocket.  This makes it even more difficult to keep the teeth clean.  The deeper the pocket, the harder it is for a toothbrush or floss to reach the bacteria hiding in the pocket.  When the pocket is deep enough, and this is just millimeters in measurement, it become impossible to remove the bacteria with ordinary brushing or flossing.  In this pocket the bacteria explode in number and type.  The plaque hardens, forming in layers on the teeth.  The body, in its effort to fight the bacteria off, begins an assault that will eventually destroy the connective tissues - ligaments and bone.  If this process continues unchecked eventually the gums recede, the teeth loosen and then they fall out.  The insidious part of all this is that, often, periodontitis is completely painless, but there are signs to look for:

- Lack of personal daily oral hygiene (brushing and flossing are not happening)
- Bleeding gums
- Swollen, "puffy" looking gums
- Bright red or purple colored gums
- Persistent bad breath
- Receded gums
- Sensitive teeth
- Teeth seem to have "shifted"
- Loose teeth
- Gums may be sensitive or hurt when touched but are otherwise painless
- Pockets around the teeth greater than 3 millimeters (as measured by a hygienist or dentist)
- Tooth abscess, pus

Once the ligaments and bone are destroyed, they are gone.  However, with proper treatment the condition of the gums and teeth can be maintained and further tooth loss prevented.  This may involve scaling and root planing ("deep cleaning") to remove deposit below the gum line, medications applied topically or given orally, and even surgery.

If you have any of the signs of gum disease get to a dental professional right away and find out what you can do to restore or maintain the health of your mouth.  If you haven't been brushing and flossing start today, now.  Your teeth will thank you by sticking around.

Photo courtesy of Photobucket.com

Please see your dental or medical professional for treatment.  This blog is not intended to diagnose or treat any disease or condition.

The Gums, Part I

Dental hygienists are all about the teeth.  We stress the importance of a beautiful smile and keeping the teeth healthy and clean.  But the gums are equally important.  Gums help keep the teeth in the mouth, attaching them by ligaments to the upper and lower jaw.  In order for the mouth to be truly healthy both the teeth and the gums need to be healthy.  Bleeding gums indicate a diseased state.  In this post I'll address gingivitis, the reversible form of gum disease. 

Gingivitis is an inflammation of the gums and means that there is bacteria (in the form of plaque or hardened plaque - also called tartar or calculus) that is not being removed properly.  The gums will bleed and appear soft, spongy and red. 

It is important to remember that bleeding gums are not normal yet there are many people who just accept it.  There isn't any other part of the body, that if it bled, would not cause alarm.  Just imagine: You are in the shower, you start to wash your arm and as you touch it with your washcloth, it begins to bleed.  You wouldn't think 'maybe I'm washing my arm too hard' or 'oh, that again?' - you'd get yourself to the doctor and say 'Hey! My arm is bleeding here - HELLOOOO."  Bleeding gums are a sign of disease and infection.  Puffy, bleeding gums mean that there is plaque bacteria present and your body is trying to fight it off. 

Flossing everyday is a great way to reduce that bacteria and keep your gums in tip top shape.  It cleans in between the teeth where a toothbrush can't reach and helps to strengthen the gums.  Only brushing and not flossing is like washing your face and hair but never washing your ears - you're not getting the whole job done.  If your gums are bleeding when you floss, don't let it discourage you.  Many people stop flossing because their gums bleed but this is the exact opposite of what they should do.  Continue to floss daily, using proper technique, and the bleeding will eventually stop.  

Brushing also keeps the gums healthy.  Brushing the teeth at the gumline and sweeping away the plaque also keeps bacteria in check.  (Please see my post on proper brushing technique.)  Rinses, like Listerine, can also help reduce plaque levels but still are no substitute for flossing.  If you floss regularly and properly you will greatly improve the health of your gums and your teeth.  For a great video on flossing, please view the following from the Colgate website  http://www.colgate.com/app/CP/US/EN/OC/Information/Video-Library/How-to-Floss.cvsp

Taking care of your gums will help you keep your teeth and mouth healthy throughout your life.

(Next post: The Gums, Part II - Periodontitis)

This blog is not intended to replace dental or medical care nor treat or diagnose any condition.

Your Dental Horoscope: Converts, Obesessors and Casuals.

People come in all shapes and sizes, and with all kinds of habits.  Nobody is perfect.  When it comes to caring for their teeth, my patients run the gamut from "I brush five times a day and floss after every meal," to "Floss? What's floss?"

Some people are "Converts."  I'm one myself.  Converts had dental issues as a child or adult.  They may have worn braces.  They definitely have fillings and/or crowns and perhaps have had a root canal or two.  They know how many shots of anesthetic it takes to get them numb.  They don't want to go through that anymore.  They don't want to spend the money on it.  They've realized that toothbrushes, toothpaste and floss are much less expensive than fillings and caps, and prefer to spend their cash on outrageous items like food, clothing and rent.  They see the value in maintaining what they've got.  They take it as a personal failure if they get a cavity and may become depressed.  A "Dental Horoscope" for the Convert would be as follows: You are a practical, conscientious person.  You value your time and the time of others so you make an extra effort to get the job done.  You count every dollar and every blessing.  You are cheap.

Then there are the "Obsessors."  (It's a nicer term than fanatic, don't you think?)  Obsessors love their teeth.  They own several electric toothbrushes with a variety of features.  They typically have had little or no dental work.  If they have a filling, they remember exactly when they got it and why: "I told Aunt Zelda to NOT send me those cookies.  Then Hurricane Wanda hit.  We had no water and drank only soda for three days."  They now have an emergency kit with three days supply of water in their home and their car.  Obsessors will call a week before their dental hygiene appointment to confirm.  Obsessors have taken great care of their teeth their whole lives.  Maybe too great.  They have areas of gum recession and enamel wear that may cause them to need fillings or gum surgery.  Intervention and compliance are necessary.  They must be taught brushing techniques, like using the non-dominant hand with a soft (SOFT) brush, so that they don't brush their gums and teeth right out of their mouths.  They must be reminded that they are brushing teeth, not grout.  Their horoscope would read something like this: You are a precise and organized person.  You believe there is a place for everything and everything in its place.  If everyone just did what you said, life would be perfect. Your life, that is.  You will make a note in the comments section challenging my usage of the word obesessor as a noun and not as a verb with the direct object.

Finally, there are the "Casuals".  "Hey," I might say to one of these folks, "how'd you break that front tooth?"  They might answer, "My front tooth is broken?"  Casuals take a long pause before answering the question, "How often do you floss?" A really long pause.  But most Casuals are exceedingly honest.  They won't lie about their dental hygiene routine because they don't have one.  And they know that as soon as you look in their mouths you'll know it, too.  With the right encouragement, Casuals can become Converts or even Obsessors.  For the dental professional this could be accomplished using words such as periodontal disease, bone loss and severely bleeding gums.  Their spouses or significant others may also inspire change using phrases like, "Your breath stinks," or "I wouldn't kiss you with a ten foot pole."  Here is the horoscope for the Casuals:  You are honest, forthright and open.  You believe that others should be honest and forthright and open, too.  Unless they are giving you bad news.  Then you don't mind engaging in some good, old-fashioned denial.

Are you a Convert, Obsessor, or Casual, or are you somewhere in between? 

Wishing you good health, Yvonne

This blog is for entertainment purposes only and is not intended to treat, diagnose or cure any condition or illness.

Oil Pulling - Fab or Fad?

Oil pulling is an method of oral cleansing that has its origins in Ayurveda, a 3,000 year old Indian medical system.  Ayurvedic medicine is steeped in tradition and has at its core a belief in herbal and natural ingredients, diet, nutrition, and exercise, as well as the interrelationship of a person's health, environment, and the universe.

There has been a lot of interest recently regarding oil pulling and the benefit of oils in general.  Oil pulling is said to cleanse toxins from the mouth, teeth and gums, cure toothaches, freshen breath and whiten teeth.  The traditional method of oil pulling involves swishing sesame seed oil over, between and around the teeth and tongue for 10 to 20 minutes or more. It is important to not gargle with or swallow the oil.  The oil is spit out when it becomes thin and white in color.  Coconut oil and grape seed oil, due to their anti-bacterial properties, have also become popular for oil pulling.  Other oils can be used but are not considered to have the same health benefits.  Oil pulling is anecdotally lauded as beneficial and some small research studies have yielded positive results for it's antibacterial properties similar to conventional rinses like chlorhexidine.

Essential oils such as those used in Listerine mouthwash - eucalyptol, menthol, methyl salicylate, and thymol - have been well established through research and use as beneficial and antiseptic.  Listerine was the first antiseptic used in medical procedures and is named after Sir Joseph Lister, who introduced the first hygiene procedures in surgery, like hand washing and sterilizing instruments, during the 1860s.  It seems, then, that oils have their place in both medical and oral health history.

So what's the problem with oil pulling? After all, it uses natural ingredients that are relatively inexpensive and is an established practice of an ancient Indian medical system.  Here's the problem: to benefit from oil pulling's anti-bacterial properties it must be done for 10 to 15 minutes - minimum. Twenty minutes is thought to be optimal.  Consider the fact that many people often find it difficult to brush for the recommend two minutes, two times a day!

In order to try oil pulling for myself, I used an oil I had on hand (olive) and could not continue past three minutes.  Nothing about the experience made me want to become proficient at it and I'm pretty open to new methods of oral hygiene.  Sesame seed oil, the oil traditionally used, has a much stronger taste so I doubt I'd be any more successful using that.  I also think that swishing with any non-sweetened liquid, even water, for twenty minutes, would have some cleansing benefits.  Hopefully, more research will be done on this interesting practice.

So, with all due respect to those who successfully perform this practice as part of their health regimen, oil pulling is not for everyone.  Successfully adopting it into a daily dental hygiene routine does not seem practical or more beneficial as compared with other methods of hygiene.  Oil pulling will most likely prove to be a passing health and beauty fad, except for the most tenacious of people already dedicated to the practice.

Have you tried oil pulling?  I invite your comments or questions.

This blog is for entertainment purposes only.  It is not intended to treat or diagnose any condition or illness.  Please visit your doctor or dentist if you have medical or dental concerns.

Toothpaste

I get lots of questions from patients about toothpaste.  The most common questions are about which toothpaste to use and which toothpaste I use.

Unless you have a specific dental condition, such as tooth sensitivity, or a condition for which you need a prescription strength toothpaste, I don't recommend any particular brand or kind.  Personally, I use the cheapest brand on sale that has sodium fluoride in it.  However, to treat my intermittent tooth sensitivity, I use a toothpaste that contains potassium nitrate.  (These toothpastes may be labeled "sensitive" or "sensitivity."  Check the "Drug Facts" label on the box for the active ingredients.)  In the office I use a professional formula to pre-treat patients who have tooth sensitivity.  These products work by blocking pores in the dentin portion of your tooth where sensitivity can occur due to receding gums or worn enamel.*  (Sensitivity may also be due to cavities or build up of tartar (also called hardened plaque or calculus) in which case toothpaste won't help.)

Another question I get is about whitening toothpaste.  Unless a toothpaste contains hydrogen peroxide or carbamide peroxide, ingredients that actually bleach the teeth, any whitening effect is more likely from consistently brushing your teeth.  Only the active ingredient supplies the desired effect of the product.  Some toothpastes contain triclosan or stannous fluoride, for example.  These have anti-bacterial properties that may help with gingivitis.  There are also many "inactive" ingredients in toothpaste that contribute to the abrasiveness, smoothness or taste of the product.  Sodium bicarbonate, also known as baking soda, and silicates are stain removers found in toothpastes.

"Re-enamelizing" or "re-mineralizing" is a question of interest as well.  Once enamel is gone it's gone.  However, fluoride can bind with minerals in the tooth structure to form a protective layer on the surface of the tooth.  This is the basis of the claim that toothpaste prevents "de-mineralization" of the teeth or encourages "re-mineralization," and the reason that fluoride "strengthens" teeth.  Fluoride also has anti-bacterial properties and so may help to reduce germ levels which contribute to the formation of acid.

How about the abrasiveness of toothpaste?  Can toothpaste itself damage the teeth?  I recently found some data regarding the RDA or Radioactive Dentin Abrasion of toothpaste, also referred to as "Relative" Dentin Abrasion.  This is how abrasiveness of toothpaste is rated in a lab setting and must be in a certain range to be approved by the Food and Drug Administration (FDA) and get the seal of the American Dental Association (ADA).  Unfortunately, while there are some online charts that cite these numbers for toothpastes, I can't verify the year or original source of the information.  (If I do, I'll post it.)  Some toothpaste is definitely more abrasive than others.  What I recommend is calling the manufacturer directly and asking them for the RDA, or abrasiveness rating, of the product.  This is sometimes considered to be a "trade secret."  They may just give you a range.

Whatever type of toothpaste you use, what is most important is the mechanical removal of plaque from your teeth.  This means that you should be gently brushing at least two times a day for two minutes using a SOFT toothbrush with a small amount of toothpaste.  The goal is to remove plaque, which is a colony of germs attached to your teeth, before it hardens.  Just like hand washing, toothbrushing must be done thoroughly to ensure the removal of the germs.  Regular brushing of the teeth is more important than the type of toothpaste you use.  Just take care to be gentle.

If the bristles on your toothbrush are smashed after using it two times you are brushing too hard!  If you are an "agressive toothbrusher" an electric toothbrush is probably NOT for you.

If you are are only brushing for 30 seconds you are not brushing long enough.

If you are using so much toothpaste that it only takes you a week to go through the entire tube, you are using too much.

When you brush your teeth, you should also be brushing your gums, another reason to be gentle.

For a great description and illustration of how to properly brush (from the American Dental Hygienists' Association website) go to:
http://www.adha.org/resources-docs/7221_Proper_Brushing.pdf

Please use the comment section if you have any questions or comments or if you'd like to share the name of your favorite toothpaste!

*You should discuss gum recession, enamel wear and tooth sensitivity with your dental hygienist or dentist. 

This information is not intended to treat or diagnose any dental or medical condition.  Please contact your medical or dental professional for treatment and information.

Pick a loser

As a follow up to my last post regarding e-cigarettes I'd like to share another issue about tobacco.  I was catching up on episodes of The Daily Show with Jon Stewart and watched an excellent piece on tobacco farming and child labor laws.  This shocking situation has also been reported on by the BBC, NPR, various local news stations and is being monitored by Human Rights Watch.  Apparently children as young as 12 can legally work on farms.  There is NO minimum age on small farms.  Children are working ridiculously long hours in unsafe conditions and without personal protective equipment.  They are being sickened and poisoned by contact with the tobacco leaves and pesticides.  Yet under pressure from big agriculture in 2012, the Labor Department withdrew a proposal to more strictly regulate the age and conditions of child farm laborers.  The tobacco companies response to child laborers?  Well, they are certainly "concerned."  (Yep, that's pretty much it.)  It is sickening to know that children are working under terrible conditions, using dangerous equipment and being exposed to harmful chemicals.  It is even more disgusting that this occurs in an industry that grows a toxic product that destroys people's health and causes cancer while making billions of dollars in profit in the process. And, of course, the US government gets it share through taxes.  So what if a few kids get harmed?  After all, they get the benefit of helping their families make money and learning the value of hard work.  That's the farmers' perspective.  Well, whatever helps you sleep at night.  But I think that in an industry that makes this much money in a country where we claim we are so concerned about human rights, more can be done to protect these kids.  What do you think?

For a great summary of the HRW report and excellent video, (the boys featured are remarkable,) view the following BBC report:  http://www.bbc.com/news/magazine-27350412

Up in Vape

Recently, on a beautiful day in Seaside Heights, I sat on a boardwalk bench waiting for my son and his friends and doing some people watching.  As I observed the variety of swimsuits, sundresses, piercings and tattoos adorning the bodies of early summer beach goers, (including a teen wearing a horse head mask,) activity at one particular store caught my eye.  It was a smoke shop selling e-cigs and other smoking paraphernalia.  What struck me was the number of young people, mostly in groups, stopping to purchase and browse.  The attraction of teens and young people to smoking is nothing new, of course, and as I age the range of people I consider to be “young” increases.  It is a fact, however, that there is still so much unknown about the effect of e-cigarettes and vaping on health.  E-cigs even eliminate the fear of “getting caught” because there is no smoke involved.  High school kids will vape in school, even in class.  Opportunities to “smoke” continue to grow, regardless of our lack of understanding of the long term consequences.  For adults who currently smoke and are considering quitting, e-cigs may be a viable “lower risk” alternative.   However, despite claims that e-cigs are safer than regular cigarettes and can help people quit there is little research yet to support this.  And more and more products are being developed all the time that stress lifestyle benefits over health benefits.  RJ Reynolds aims to make e-products that deliver a “satisfying” experience to smokers.  Philip Morris is developing a product that uses tobacco to deliver a tobacco flavor nicotine vapor claiming “reduced” risk.  There was a time when “light” cigarettes were marketed as such until it was found that these claims were untrue or murky at best.  And, if you are old enough to remember, there was a time when doctors were used to advertise the health benefits of cigarettes.  These new products contribute to the illusion that starting this kind of a habit is not at all harmful when this is far from true.  Smoking flavored tobacco using a hookah is also very much in vogue.  In the past year there has been a 21% increase in high school students who do this.  This is another practice where there is a huge misconception that it is safer than traditional cigarettes, just like it was once assumed that chewing tobacco was safer.  Finally, let’s look at the players in this industry.  These products are largely unregulated and there is a lot of money to be made.  E-cigarettes and vapor delivery systems have gained a lot of popularity with the public for a variety of reasons including the legalization of pot for medicinal and non-medicinal use in some states.  But don’t think for one minute that these companies are concerned about anything other than how to relieve you of your money.  They have a long history of just blowing smoke.

This information is not intended to treat or diagnose any dental or medical condition or illness.  Please visit your medical or dental health professional if you need medical or dental treatment.

Sources: http://www.ama-assn.org, http://www.rjrvapor.com, http://www.nydailynews.com/new-york/malboro-man-peril-article-1.1369911, www.adha.org, www.cdc.gov

No Numbing Gel for Babies

Teething is a normal part of development.  Baby teeth start to erupt between 5-7 months of age and continue to come in until the child is about three years old.  Babies may seem fussy, cry, and chew on their hands.  A cold cloth or teething ring for baby to chew on or massaging the gums with a clean finger are the best ways to treat discomfort.  (Fever during teething is coincidental and use of products with acetaminophen should be used according to directions to avoid overdose in an infant.)  While parents may be distressed that their child is in pain, numbing gels are never recommended to treat teething pain.  Over the counter products can do more harm than good and can cause a rare but potentially fatal condition called methemoglobinemia in which the oxygen level of the blood drops.  Parents should also never use left over adult prescriptions to treat teething pain in babies. 

For more information about the products in question and to read the FDA's warning, please go to:
http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm385817.htm 

Now a word about the use of numbing gels for adults.  Pain in the mouth that is so severe you find yourself applying numbing gel is not normal.  Cavities or infections in the mouth do not get better, they only get worse.  At best numbing gel will only temporarily alleviate pain and then you may find yourself in a more painful or potentially dangerous situation.  If your teeth or a tooth hurts, see a dentist! 

This information is not intended to diagnose or treat any disease or condition.  Please visit your medical or dental professional for treatment.

Bad Breath and Sniffing out Lung Cancer

I have patients who are diligent about brushing and use mouthwash yet complain of bad breath.  There are several causes of bad breath but I usually address flossing habits first.  Flossing gets in between the teeth where the toothbrush can't reach.  Plaque, which is made of germs, live and grow all over the mouth.  Not flossing is like taking a shower and washing your face but not washing your hair or your ears - you're not doing the whole job.  Plaque stinks and unfortunately there is no other way to effectively get the plaque out from between the teeth.  Even new electronic devices, which are like mini water-picks, still recommend flossing in their instructions.  There simply is no substitute.  When investigating reasons for bad breath, other things to look at are medications, tooth alignment, mouth breathing and other health considerations.  Some medications can cause dry mouth, a common side effect of certain meds, which can lead to bad breath.  Supplements like fish oil or garlic, foods like onions or other odiferous foods can also cause it.  Tooth alignment can cause the mouth not to fully close, leading to drying of the mouth tissues and again, bad breath.  Mouth breathing at night or snoring, sometimes a sign of a serious health issue like sleep apnea, can also cause this problem as can life style habits, like smoking and drinking.  Bad breath certainly can be troublesome so it is best to discuss the issue frankly with your medical or dental professional especially since chronic bad breath may indicate underlying health problems.  It was also reported recently that the breath in general may even reveal other important information about a person's health.  At a conference of the American Society for Clinical Oncology new research revealed some amazing results.  Researchers reported that they have developed a machine using nanotechnology that can "smell" the breath of patients with lung cancer and other lung ailments.  Simply by breathing into a tube subtle changes in the body chemistry of the person are detected.  While this technology is still being tested the initial results seem promising.  (Please see the original article at http://www.livescience.com/46108-breath-test-lung-cancer.html ) Perhaps someday your doctor, dentist, or dental hygienist will be able to administer a simple breath test that can save your life or the life of your loved one.  That sure smells sweet.
This information is not intended to treat or diagnose any dental or medical problem or illness.  Please visit your medical or dental health professional if you need medical or dental treatment!

For Brighter Smiles

There is nothing like being with friends to make me feel like a million bucks.  Friday night it was at a formal, lavish affair to celebrate our town's anniversary and honor community members who make it a great place to live.  It was a little daunting to walk by myself into this throng of people dressed to the nines, laughing, talking and drinking.  Making my way through the crowd I saw my friends across the room and social anxiety faded to relief!  These are the friends I have made since moving to town twenty years ago.  (Where has the time gone!?)  Some of them I have known for more than a decade and others met more recently but all are cherished.  One who knows my kids well and whom we affectionately called "Crossing Guard Lady" for years.  We now paint sets together for our community theater show and I so appreciate her common sense and no nonsense advice.  Another who simply cracks me up with her wit and uncommon humor.  She's that person who makes you feel like you're in 4th grade again.  And several more friends each of whom evoke such wonderful memories and have a special spot in my heart.  It makes me feel so blessed.  On Saturday, it was by contrast a very informal affair - girls night out at a friend's home.  Just pull up a chair and grab a glass of wine or a beer.  We know each other so well that when we see each other it's almost as if the conversation picks up where it left off.  These are the women I have known since I was a teen and who know where the bodies are buried!  (What happens in the Poconos stays in the Poconos.)  We've gotten in trouble together, had a blast together, and celebrated the specials times in each other's lives together.  We joke and laugh so hard it's hard to breathe.  We talk about our lives, jobs, families, various gynecological and medical procedures, and everything else we can think of to talk about.  We can say anything to each other and we do.  I find that so amazing.  I can't imagine my life without these people in it.  So driving home today, I was smiling.  I was ear to ear grinning just thinking about this weekend, the many past weekends and days, and more I hope to come.  Nothing makes my smile brighter than my friends.

Drugs and Dry Mouth (The Top Five Prescription Drugs)

Dry mouth (also called xerostomia,) can be very uncomfortable.  Your entire mouth including the lips, tongue and throat can become very dry if saliva production decreases.  Having dry mouth can making eating uncomfortable or painful and can cause bad breath.  It can lead to higher levels of plaque, tooth decay, and dentures that are ill-fitting.  It may even cause an outbreak of thrush, a yeast infection that can occur in the mouth.  Unfortunately, dry mouth is a common side effect of many medications.  While saliva levels can return to normal if a medication is discontinued, this is not an option for many people.  If a medication needs to be taken for a long period of time or permanently, dry mouth must be managed to maintain the health of the mouth and teeth.  The mouth, after all, is meant to be a wet place!  Dry mouth symptoms can be managed by sipping water frequently, chewing sugarless gum or sucking on sugarless candies, using lip balms and with products like Biotene.  Biotene is sold in drug stores without a prescription as a rinse, spray or gel.  It acts by lubricating the mouth and holding in moisture.  (For more information see http://m.biotene.com/) There are also store brands available.  Since saliva production decreases during sleep, using this kind of product before going to bed may be very helpful.  It is also very important to continue to brush and floss regularly if you have dry mouth.  Below lists the five most commonly prescribed drugs. ( http://www.drugs.com/stats/top100/sales ) 

Three of them - Abilify, Nexium, and Advair Diskus - can cause dry mouth.

1-      Abilify (aripiprazole) – treats depression. 

2-      Nexium (esomeprazole) – treats GERD (gastroesophageal reflux disease) and reduces stomach acid.

3-      Humira (adalimumab) – treats rheumatoid arthritis, osteoarthritis, psoriasis; also may be used to treat Crohn’s disease and ulcerative colitis.

4-      Crestor (rosuvastatin) – lowers “bad” cholesterol

5-      Advair Diskus (fluticasone & salmeterol) – for treatment of asthma and COPD.  

Dry mouth can interfere with your quality of life and the health of your mouth so speak with your doctor, dentist, dental hygienist or other health professional about ways to manage it.

This information is not intended to treat or diagnose any dental or medical problem or illness.  Please visit your medical or dental health professional if you need medical or dental treatment!

Sweet Dreams Are Made of Teeth (apologies to Annie Lennox)

Have you ever dreamed about your teeth?  Dreams about your teeth or dreams that your teeth are falling out are surprisingly common.  You might not be surprised that I see teeth in my dreams, however, I had dreams about teeth long before becoming a dental hygienist.

So what do dreams about teeth mean?  Dream analysis has been around for a long time.  From Joseph’s prophetic dreams in the bible to the surreal dream paintings of Salvador Dali̒, dreams tantalize and fascinate people. Freud proposed that a person’s dreams hold deeper meaning that can be interpreted only by analyzing its details using (his) psychoanalytic methods.  In Freud’s “The Interpretation of Dreams” he illustrates this method using his own dreams.  He describes a dream about a patient he treated who was also his good friend.  Her treatment was not as successful as he would have hoped.  In the dream Freud attempts to give his friend an oral exam, which she resists and he imagines she must have false teeth!  After exploring all the details of his dream, Freud concludes his dream uncovers a desire to gain back the respect of a person who is very important to him.  Freud believed that all dreams are the “(disguised) fulfilment of a (suppressed, repressed) wish.”(1) 

Modern pop culture puts dream analysis squarely in the realm of entertainment like horoscopes or psychic readings.  Websites abound that make suggestions as to why we dream about particular subjects.  Although studies have been conducted to explore what happens to the brain while dreaming, there is little scientific basis to dream analysis.  It is very subjective.  It would be difficult to pinpoint what any dream means to any given person without understanding that person’s perspective, history and environment.  The physiology and anatomy of the brain, like any other organ, may not vary much from person to person but the experiences of each individual can vary greatly and will influence the brain's performance and reactions.   The structure and function of the heart is the same in all, but the heart of an athlete will be much more prepared to run a marathon than the heart of a person who smokes two packs a day.  So it is difficult to say what causes teeth dreams or what the meaning of teeth dreams would be to different individuals.  Still, dreaming about the teeth is a very common occurrence.  (Perhaps not so surprising if we consider that (almost) everyone has them!)  Analysis of teeth dreams offer a variety of interpretations including issues of self-esteem, concern about money, death, fear of death or loss of a loved one, and even lying and deception.

In the dental profession, it is generally accepted that the health of the teeth and self-esteem are linked.  There are thousands of advertisements and sites from cosmetic dentists to implant dentists and orthodontists touting various procedures as a way to improve the way we look and feel about ourselves.  A recent study in the U.K. revealed that tooth loss might affect the way people feel about themselves both socially and psychologically.  Some of the people in the study reported staying home because of the condition of their teeth and compared tooth loss to the loss of a limb.(2)  An Italian study confirmed that having misaligned teeth could affect the “psychosocial well-being” of adolescents.(3)

If the condition of the teeth is a contributing factor to how attractive a person feels, then teeth are an important element of self-esteem.  But this depends on individuals and the importance they place on their teeth, as well as cultural and other factors.  Dentists and dental hygienists know that some patients value their dental health much more highly than others.  So the reasons that people dream about their teeth must be as varied as people themselves!  And how could a dream about the teeth falling out or rotting be the fulfillment of any kind of wish as Freud proposed? Teeth dreams, generally, are pretty disturbing.  Perhaps the horror of the dream forces the person to realize that he or she wishes to do, wants to do, or should be doing something different.  Or maybe it’s just guilt over eating that last piece of chocolate cake!

I welcome your comments and thoughts!

(1) The Interpretation of Dreams, Sigmund Freud (1913) Third Edition, translated by A.A. Brill.  New York: The Macmillan Company, 1913.  New York: Bartleby.com, 2010

(2) Rousseau, N., Steele, J., May, C. and Exley, C. (2014), ‘Your whole life is lived through your teeth’: biographical disruption and experiences of tooth loss and replacement. Sociology of Health & Illness, 36: 462–476. doi: 10.1111/1467-9566.12080
(3) Perillo L, Esposito M, Caprioglio A, Attanasio S, Santini AC, Carotenuto M.Orthodontic treatment need for adolescents in the Campania region: the malocclusion impact on self-concept. Patient Prefer Adherence. 2014 Mar 19;8:353-9. doi: 10.2147/PPA.S58971. eCollection 2014. PubMed PMID: 24672229; PubMed Central PMCID: PMC3964173

This information is not intended to treat or diagnose any dental or medical condition.  If you have a medical or dental concern, please seek treatment from a medical or dental professional. 

Less is more for healthy teeth

When it comes to nutrition for a healthy mouth, less is more.  Generally, the less ingredients something has, the healthier it is for you.  A package of cheese crackers, for example, contains: enriched flour, riboflavin, cheddar cheese, soybean oil, salt, corn syrup, baking soda, yeast, and soy lecithin (and this is a shortened list,) whereas an apple has one ingredient.  A banana is a banana, lettuce is lettuce, and nuts are nuts – well, you get the idea!  This rule doesn’t always apply, however, as orange juice has only one ingredient but contains lots of sugar (22 grams per serving.)  You’re better off just having the orange at about 9 grams of sugar per serving.  Less is also more when it comes to how frequently we eat sugary snacks or drinks as well as how long we take to eat them, too.  It is better to have dessert right after a meal or sweet drinks with a meal.  Constant snacking and sipping doesn’t allow the pH of the mouth to return to normal as fast as it could, putting one at greater risk for cavities.  So substitute in those “one ingredient” snacks and have snacks or beverages with meals for better tooth health.

My next post explores a surprisingly common phenomenon: Dreams about teeth!

This information is not intended to diagnose or treat any dental or medical condition.  If you need dental or medical attention please visit a dental or medical professional!

Sugar - just say "no"

In February the California State Senate introduced the "Sugar-Sweetened Beverages Safety Warning Act," the first legislation of its kind in the United States.  The bill calls for warning labels on beverages containing more than 75 calories per 12 ounce serving which read: "Drinking beverages with added sugar(s) contributes to obesity, diabetes and tooth decay."  Research has shown that the effects of sugar on the body are so dramatic and potentially damaging that the warning was suggested to inform consumers of the danger.  No matter where you come down on legislating about the ill effects of sugar, the dental profession has known for a long time that sugar is very harmful to the teeth, especially if you aren't brushing and flossing properly or regularly.  Plaque, a biofilm which forms on the teeth, is full of germs that love to eat sugar.  The germs form acid as a byproduct which sits on your teeth and can cause cavities.  In addition, taking a long time to drink a sugary beverage by sipping it over a long period of time prevents your mouth from returning to normal, neutral pH levels.  (Sorry all you latte, cappuccino and frappuccino lovers!)  So the next time you reach for that sugary drink, give some thought to the health of your teeth as well as the health of your body!  Here are some "rules" you can follow and, although I can't enforce them legislatively, I hope you'll consider them helpful: Drink water whenever, juice just once, milk with meals, and soda - skip it.

Have a great day and don't forget to brush your teeth 2 times a day for two minutes and floss each day.

This information is not intended to diagnose or treat any dental or medical condition.  If you need dental or medical attention please visit a dental or medical professional!