Adult Oral Health
Periodontal Disease and Heart Disease Risk
Periodontal disease has been associated with an increased risk of both heart disease and stroke, and recent studies have shown that treatment of severe periodontal disease can reduce markers of inflammation such as C reactive protein, and even reverse some early indicators of pathology in atheroscleosis. Periodontal bacteria have been found in the carotid artery, showing that the bacteria do travel beyond the oral environment. We make treatment or periodontal disease a priority in our office to help our patients maintain good overall health, and we encourage anyone with risk factors for heart disease or stroke to maintain a three month appointment schedule for dental cleanings or periodontal maintenance.
Medications and Dry Mouth
Both aging and medication use often result in a reduced salivary flow. Many medications prescribed have the side effect of dry mouth, and when multiple medications are taken there can be an additive effect with even more salivary problems. The result of this reduced moisture in the mouth can be increased decay, especially at the roots of teeth. We have seen patients develop numerous cavities in a matter of months after a change or increase in medication. We ask about medication use in our medical history updates and encourage patients to tell us if they have symptoms of dry mouth.
To treat this problem, we recommend Biotene Products, an over the counter group of medicines ( rinse, toothpaste, gum) that help moisturize the mouth and help prevent new decay. Fluoride treatments are also an important part of treatment (both in-office and special home care products) as they can strengthen the tooth structure, making teeth more resistant to decay
As was mentioned in the section on dry mouth, cavities at the roots of teeth are common for adults. Root decay may be related to reduced salivary flow, but other factors such as diet can also contribute to this problem. We encourage regular dental exams, fluoride treatments in office and at home to help reduce this problem. Patients who have crowns may have problems at the margins that lead to root decay, so careful examination of integrity of dental work is part of the dental exam.
Oral cancer is on the rise today and has a high rate of mortality, primarily because it tends to be found at a late stage. It is very treatable if found early. We consider oral cancer screening an important part of the dental exam, and in addition to a visual exam, we offer VELscope tissue fluorescence technology, which uses a special light that will highlight abnormal cells as dark spots. We can then follow up with a painless brush biopsy to screen for pathology. People at the highest risk for oral cancer are those who have smoked and/or used alcohol. Existence of the human papilloma virus (HPV) is also a strong risk factor, showing to be related to an increase in development of oral cancer in young adult women. Even without known risk factors, oral cancer can strike, and patients should be aware that at least 25% of cases have no known risk factors. We encourage everyone to consider VELscope examination and screening annually.
In the photographs attached are two views, one of the cancer through the VELscope and the other with visible light. We found this lesion in our office and were highlighted in the Virginia Dental Journal section of oral pathology presented by Dr. John Svirsky oral pathology professor at VCU with cooperation of Dr. Kayes.
Chemotherapy and Radiation therapy
Cancer and chemotherapy can drastically change the oral environment. If a diagnosis of cancer is made and the patient is required to undergo chemotherapy and or radiation, special arrangements must be made at the dental office before this therapy begins. Any questionable teeth must be removed and all dental conditions should be addressed. Jaw osteonecrosis from dental infections after radiation and chemotherapy are serious conditions that must be considered in treatment planning for these special needs.
Worn Out or Broken Teeth
As adults get older, the constant chewing of food, (and other items we shouldn’t chew), takes a toll on teeth. Miniature cracks form in the enamel and progress deeper and deeper into the tooth structure until one day the tooth just falls apart. We notice cracks in teeth all the time and most are like the cracks in an old dinner plate, they are in the superficial layers. Some of the cracks are deeper and are weakening the teeth. When we notice these deeper cracks, especially the horizontal cracks, we recommend that the tooth be crowned before the tooth falls apart at an inconvenient time.
People can develop sensitive teeth for many reasons. Bruxism, root cavities, dietary habits, or use of abrasive toothpastes can all lead to what is known as dentinal sensitivity. Fortunately there are treatments that can alleviate the pain. We can recommend sensitive teeth toothpastes and prescribe fluoride treatments and can perform sealant type treatment at the office.
Bruxism, Tooth Clenching and Grinding
People are under immense stress these days with work, commuting, and juggling family responsibilities. It is no surprise that many people in this area are clenching or grinding their teeth as they internalize their stress. The result of clenching can be headaches, jaw spasms, or generalized facial pain. Grinding can result in worn down teeth that can contribute to a collapsed bite and tooth pain. We prescribe bite guards to be worn at night to help break the clenching/grinding cycle. We have had some patients tell us that their headaches disappeared when they started wearing a bite guard.