Are you afraid of the dentist?

Fighting Dental Fear

Fear that affects one’s ability to seek or receive dental treatment has real consequences. Ignoring gingivitis, gum disease characterized by bleeding, puffy gums, can cause it to progress to periodontitis, advanced gum disease characterized by bone loss in the jaw and loose teeth. Cavities left untreated only get bigger. A sore in the mouth that does not heal may be a sign of oral cancer and ignoring it can be deadly. Neglecting the teeth during pregnancy can result in low birth weight.

Avoiding dental treatment also has financial consequences. A small cavity that could have been treated with fluoride or a filling may end up needing more extensive treatment like a root canal, crown, or other expensive restoration. These treatments also require multiple visits leading to more time off from work. A restored tooth is more likely to need future treatment versus a natural tooth.

Dental fear that prevents a person from getting treatment is recognized as a debilitating phobia called odontophobia. Fear of the dentist or of dental treatment may be related to a person’s tolerance for pain and is often an issue for people who have suffered from abuse. Estimates on the number of people affected by true dental phobia varies widely from 9% to over 30%, however, most people can testify to the fact that going to the dentist for treatment is no walk in the park. 

Dental Fear. (image:ym)

There are a variety of things that may cause dental fear. Some patients may be ashamed that they have waited so long to see the dentist. Aside from being afraid that something is seriously wrong, they fear “the lecture” they may get for not taking care of their teeth. 

Pain is a also common fear. While dentistry has come a long way, it still involves the administration of anesthetic with needles or other methods that can be scary for some people. 

Bad childhood experiences with dental treatment are a cause of fear, too.  People with dental fear have also cited feelings of loss of control during treatment and a general discomfort with the sights, sounds and even smells of a dental office. Some people feel uncomfortable with treatment because they have a strong gag reflex or report feeling like they may choke during dental procedures. 

Whatever the reason, dental fear is real and can be troubling for people. Still, dental treatment and regular dental check ups are absolutely necessary for health.

There are a number of ways to try to cope with dental fear:

Ask questions and discuss your fears with the dentist or dental hygienist. It’s not necessary to reveal your innermost secrets but being upfront about your dental fear will help guide them with your treatment. For example, if you fear the sight of needles, the tray can be covered or they can adjust their approach to keep the needle out of the line of your sight.

Find a dentist and dental hygienist you like and whose staff make you feel comfortable and welcome. 

A dental office’s environment is important. An environment suited to your personality can help you deal with the anxiety you feel when visiting the dentist. Perhaps you favor a soothing environment with soft music or prefer an office with lots of stimuli, like televisions mounted on the ceiling for patient viewing.

Set the mood with music.  Listening to music on headphones during treatment can be very helpful for people who are sensitive to noise.

Wearing sunglasses or goggles while receiving treatment can help with harsh lights.

It is important to set your appointment when you are least likely to be stressed. If rushing to an appointment after a day at work stresses you out, consider making early morning or weekend appointments instead. Dental office staff should be willing to work with you and help keep you on track for your appointments.

Resist the urge to cancel. It is important to keep your appointments since delaying treatment or not going for regular dental hygiene visits is only likely to worsen your dental issue.

Stress reducing methods like guided relaxation techniques and biofeedback, or other professional help like counseling or hypnosis, may help reduce anxiety in the dental setting as well. 

Do you have dental fear? Answer TRUE or FALSE to the questions below:

I hate going to the dentist

I had a bad childhood experience at the dental office

I don’t trust what my dental hygienist tells me

I don’t trust what my dentist tells me

I hate having my teeth cleaned

I frequently cancel appointments for no reason

If you answered TRUE to most of these questions you may have dental anxiety. Think about the reasons you don’t like to or want to go to the dentist and ways you can cope with them. If you are avoiding treatment because of your fear talk to your doctor or dentist to get the help you need.

One of the best ways to deal with dental issues is to not have them in the first place! It is worth the small effort it takes to brush and floss every day.

Sources: http://jada.ada.org/article/S0002-8177(16)30966-7/fulltext; Milgrom, P., Weinstein, P., Heaton, L.J. Treating Fearful Dental Patients: A Patient Management Handbook. 3rd ed. Dental Behavioral Resources.Com, Seattle, WA; 2009; http://www.dentalfearcentral.org/; https://www.health.harvard.edu/blog/dental-fear-our-readers-suggest-coping-techniques-20100825327; 1. Moore R, Birn H. [Phenomenon of dental fear] Tandlaegebladet. 1990;94:34–41. [PubMed]

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

Gum Disease and Cancer in Women

If you could reduce your risk of getting cancer by brushing and flossing, would you do it? 

There are two types of gum disease: Gingivitis and Periodontal Disease. Both of these mean that the gums are infected with germs and there is inflammation in the mouth.

Gingivitis is the “reversible” type of gum disease. It is characterized by bleeding, puffy gums and it’s the type commonly discussed on toothpaste commercials. Gingivitis can be reversed with regular brushing and flossing in addition to eating a healthy diet.

Periodontal Disease is an advanced form of gum disease and is what happens over time if you ignore gingivitis. In people with Periodontal Disease, germs in the mouth have increased in amount and changed in type. In an effort to get rid of the germs, the body’s immune system responds by destroying the tiny connective tissues that keep the teeth attached to the gums and by destroying bone levels in the jaw. Periodontal disease is “irreversible” yet it can be controlled with proper treatment. 

People are often unclear about whether they have gum disease yet over 50% of adults have some form of it.

If you have Periodontal Disease, your dentist or dental hygienist may have discussed with you the “pockets” in your gums and recommended “deep” cleanings. You may have been told that you have “receding” gums or you may feel like your teeth have “shifted.”  These simple terms are used to help people understand their gum health, however, Periodontal Disease is a complex and serious condition. It is important to manage periodontal disease before further destruction to the mouth, like tooth loss, occurs.

Avoiding Periodontal Disease may also help to guard against common cancers in women. 

A recent long-term study that followed over 65,000 women revealed that there is an association between certain cancers and Periodontal Disease. The association to esophageal cancer was strongest but it was also evident in cancers of the lung, gallbladder, breast, and skin. Overall, women with Periodontal Disease were 14% more likely to get cancer than women without Periodon

Gum disease, cancer & women yml

tal Disease; 20% more likely for women who are current or former smokers.

For more information on this study, go to: http://www.reuters.com/article/us-health-cancer-gum-disease-idUSKBN1AH4SN

Also: http://www.medscape.com/viewarticle/883628 

Sources: Reuters.com & Medscape; original source article:  bit.ly/2w2vmvi Cancer Epidemiology, Biomarkers and Prevention, published online August 1, 2017

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

The Great American Smokeout, November 17, 2016

During the Great American Smokeout, held on the third Thursday of each November, the American Cancer Society asks smokers to quit even if just for one day. After 20 minutes of not smoking, heart rate and blood pressure decrease; after 12 hours, carbon monoxide levels in the blood drop. The longer a person stays smoke-free the more health benefits are gained.

image from cancer.org

Smoking also affects the mouth and teeth in very serious ways. 

Smoking increases risk for:

• oral cancer (cancer of the mouth)
• esophageal cancer (cancer of the throat)
• periodontal disease (gum disease that leads to bone loss)
• cavities
• tooth loss
• black hairy tongue (Google an image of it)
• dry mouth
• bad breath

Diseases caused by smoking and second hand smoke are preventable. Quitting, if only for one day, is the first step to better health.

For more information about The Great American Smokeout and how to quit smoking, visit:

http://www.cancer.org/healthy/stayawayfromtobacco/greatamericansmokeout/

cdc.gov, ada.org, cancer.org. This blog is not intended to diagnose or treat any condition. If you need medical or dental treatment, seek help from your doctor or dentist. If you smoke, QUIT!

Lung Cancer and Gum Disease

A new report released in June finds an increased risk of lung cancer in people with gum disease. The report, which analyzed previous studies, found that even after adjusting other lung cancer risk factors like smoking, drinking alcohol, and diabetes, there was still this increased risk.The risk was higher still in women with periodontal disease than in men. 

Health mouth, healthy body (Artwork: YM)

So what is periodontal disease? There are two types: gingivitis and periodontitis. Gingivitis is early gum disease and is reversible. These are puffy, bleeding gums that can be healed with regular flossing and brushing. The second type of gum disease, periodontitis, means that the disease had gone into other structures of the gums, like the ligaments that help hold the teeth to the bone. In advanced periodontitis, teeth may be loose due to bone loss and the gums may be receding. This type of gum disease can not be reversed but can be managed. Daily brushing and flossing combined with regular dental visits and gum therapy can stop the condition from worsening. There is no pain with most gum disease and some people with gum disease may feel like their teeth have "shifted." Often, they have not been going for their regular check-ups and cleanings every six months. 

Up to one-half of Americans over the age of 30 have some form of gum disease. Periodontal disease is 2.5 times more common than diabetes, yet people tend to neglect their teeth without really thinking about how it can affect the rest of the body. 

Given that lung cancer death is the number one cancer death in the U.S., this newly discovered risk is yet another reason to take good care of your teeth. Just think about it: two minutes of brushing two times a day may decrease your risk of dying from lung cancer. Isn't that worth it?

For more on this report visit: https://www.perio.org/consumer/gum-disease-lung-cancer-risk

This blog is not intended to treat or diagnose any condition. If you are worried about your health, go visit your doctor or dentist. Please take care of yourself!

Be a Quitter

The Great American Smokeout

Cigarette smoking kills over 500,000 Americans each year including deaths due to second-hand smoke. Illness due to smoking results in hundreds of billions of dollars in medical costs. (cdc.gov)

Every third Thursday each November, the American Cancer Society asks smokers to quit, even if it's for just one day (cancer.org). After 20 minutes of not smoking, heart rate and blood pressure decrease; after 12 hours, carbon monoxide levels in the blood

Quit Smoking Today
Photo: Y. Mikalopas

drop. The longer a person stays smoke free the more health benefits are gained.

In addition to being devastating to the entire body, smoking affects the mouth and teeth in very significant ways. Smokers may find that their gums don't bleed, ordinarily a sign of health. However, smokers actually have a higher incidence of both periodontal disease and tooth loss than non-smokers. The gums aren't bleeding because the blood vessels are constricted and oxygen is needed more urgently by the lungs and heart. 

Smoking also increases risk for the following conditions in the mouth:

• oral cancer 
• esophageal cancer
• periodontal/gum disease
• cavities
• tooth loss
• black hairy tongue (if you've never seen it, Google it)
• dry mouth
• bad breath

Diseases caused by smoking and second hand smoke are preventable. Quitting, if only for one day, is the first step to better health.

sources: Ann Periodontol. 1998 Jul;3(1):88-101., cdc.gov, ada.org, cancer.org. This blog is not intended to diagnose or treat any condition. If you need medical or dental treatment, seek help from your doctor or dentist. If you smoke, QUIT!

Your Heart in Your Mouth

"My heart was in my mouth" is an expression I have always loved and a friend of mine used to use it all the time.  At 14 years old she already had a job working in a local bodega, (that's the Brooklyn version of a convenience store only smaller and selling more beer and cigarettes than anything else,) and I thought she was super-sophisticated.  She certainly met a lot of colorful characters and nary a shift went by that something nerve-wracking hadn't happened along the bustling avenue where she worked.

The phrase came to mind the other day as I was reading an article on dental treatment of patients with heart disease.  It is so important that patients with cardiovascular disease inform their dentists and dental hygienists of any changes in their heart health or medications.  Certain procedures, such as valve replacement or stent placement, may require premedication or even delay non-emergency treatment.  Medications for heart disease, ranging from high blood pressure meds to blood thinners also have effects on the mouth such as increased bleeding or dry mouth. Patients who have had strokes may find it difficult to brush or floss due to loss or decrease of function on the affected side of the body and need to adjust their dental home care routine accordingly.

Although people with gum disease do have a higher incidence of heart disease even after accounting for other factors like diabetes or risky health habits like smoking and drinking, no definite cause and effect relationship between the two has been proven.  More research is being done to figure out this relationship and determine if treating gum disease can help to improve heart health in cardiovascular patients or even help to avoid heart problems in the first place.  Until that determination is made, however, it just makes sense to recommend that people with heart disease take excellent care of their teeth and gums.  Tooth decay and gum disease are completely preventable with good daily oral hygiene which reduces inflammation in the mouth as well as the rest of the body.

Brushing at least two times a day for two minutes and flossing every day keeps your mouth healthy, may keep your heart healthy, and will probably keep you from feeling like your heart is in your mouth at your next dental hygiene visit.

This information is not intended to treat or diagnose any condition.  If you have a dental or medical problem or concern PLEASE see your dentist or doctor!  

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.

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.