La Jolla, California,
Dr. Charles Briscoe
Table of Contents:
Active Periodontal Therapy (Treatment for Periodontal Disease)
Bruxism
Gingivitis
Home Care
Home Care - Additional Tips
Periodontal Disease
Periodontal Disease and Cardiovascular Disease
Periodontal Disease and Cancer in Men
Periodontal Disease Facts and Reminders
Periodontal Disease and Your General Health
Periodontal Disease and Menopause
Prevention of Periodontal Disease
Risk Factors for Periodontal Disease
Tooth Wear - Attrition, Erosion, and Abrasion
Variables to Periodontal Therapy
Your Cleaning - An Investment in Your Health
Monday 9/15/08
We recently welcomed a new patient who came to see us about upgrading his smile. He had a mouth-full of porcelain crowns and veneers done in the past that he was no longer happy with. My concern, when we saw him, was the bright redness of his gums right around each of his restorations. The margins of the restorations are breaking down, retaining plaque, and causing this gum inflammation. I told him his tissue is the first issue, then we can improve the appearance of his smile. He agreed with my concern, and we scheduled his first hygiene visit this week. I sent him home with the abstracts of several articles relating to periodontal disease in his mouth (the redness, puffiness, and recession of his gums) to his general health. Periodontal disease has been linked to tooth loss, subclinical atherosclerosis, and future stroke. Gum disease, also, may affect the development and course of systemic diseases such as cardiovascular disease, bacterial pneumonia, diabetes mellitus, and low birth weight. Now, he can't get started quick enough!
Tuesday 9/16/08
Following up on yesterday's blog, gum disease also has a link to cancer in men. From the June issue of The Lancet Oncology, men with a history of gum disease are 14% more likely to develop cancer than men with healthy gums. The report states that men with periodontal disease may be 30% more likely to develop blood cancers, 49% more likely to develop kidney cancer, and 54% more likely to develop pancreatic cancer. Gum disease cannot be cured, but certainly can be controlled by daily brushing and flossing, and routine visits for professional cleaning as a minimum.
Wednesday 9/17/08
Cardiovascular disease kills more Americans each year than cancer. Most people are aware that lifestyle choices such as quitting smoking, eating right, and getting enough exercise can lessen one's risk of cardiovascular disease. But, what most may not know, is that by just brushing and flossing their teeth each day, they can also prevent this potentially lethal condition.
Periodontal patients whose bodies show evidence of a reaction to the bacteria associated with periodontitis (gum disease) may have an increased risk of developing cardiovascular disease, according to the Journal of Periodontology (December 2007). Thus, it is important to understand that simple activities like brushing and flossing your teeth everyday, and periodic professional cleanings at the dental office can help lower your risk to cardiovascular disease and other conditions.
Thursday 9/18/08
Postmenopausal women may significantly reduce tooth loss by controlling their periodontal disease, according to a study in the Journal of Periodontology. Keeping one's teeth in their mouth depends upon the integrity of the alveolar bone holding them in the mouth. Periodontal disease is the primary cause of alveolar bone loss and tooth loss in patients over 35. Estrogen deficiency after monopause and consequent loss of bone mineral density have been shown to be associated with an increased rate of tooth loss. These relationships may be explained by an increased severity of periodontal disease in estrogen deficiency. Proper hormone levels and daily brushing and flossing in combination with professional dental cleanings on a regular basis should minimize the potential for tooth loss in postmenopausal women.
Friday 9/19/08
Periodontal Disease (gum inflammation, infection, bone and attachment loss) and Alzheimer's Disease (AD)-
Is there a link? The exact mechanisms responsible for the cause and development of AD have yet to be identified, but inflammation within the brain is believed to play a key role. As reported in Alzheimer's Dement, July 2008, peripheral infection/inflammation may affect the inflammatory state of the central nervous system. Chronic Periodontal Disease is a prevalent peripheral infection that has been associated recently with several systematic diseases (see previous blogs) including AD. These studies suggest that chronic periodontal disease may potentially contribute to the clinical onset and progression of Alheimer's Disease. As chronic periodontal disease is a treatable and controllable infection (not curable), it may well be a readily modifiable risk factor for Alzheimer's Disease. Establishing and maintaining healthy gums now, could lessen your risk of developing this awful disease.
Monday 9/22/08
We talked last week about periodontal disease and its effect on our overall health. Let's take some time to explain what is periodontal disease (PD). Periodontal Disease ranges from simple gum inflammation (gingivitis), to serious disease that results in major damage to the soft tissue and bone that support the teeth (periodontitis). An estimated 75-80% of adults in America have some level of PD (epidemic proportions). Because there is no pain until the condition is at a very advanced stage, most people are not aware they are infected with PD. Our mouths are full of bacteria, which along with mucus and other particles (tissue particles, food particles), constantly form a sticky, colorless "plaque" on our teeth. Brushing and flossing help get rid of plaque which, if not removed, can harden into bacteria-harboring "tartar". The tartar cannot be brushed away. It must be removed by a professional dental cleaning (Thank goodness for dental hygienists!)
Tuesday 9/23/08
Gingivitis is inflammation of the gums caused by the prolonged presence of plaque and tartar on the teeth. The gums become red, puffy and swollen. Gingivitis is a mild form of gum disease that can be reversed with professional dental cleanings by our hygienist and daily brushing and flossing. The gums may bleed during the cleaning and initially when flossing. Gingivitis can be reversed (the inflammation eliminated) because it does not involve bone loss or gum recession.
When the gums are not treated (the person may be brushing but not flossing) the inflammation increases to a point in becomes periodontitis. Here, the plaque builds up below the gums forming pockets. The body's natural immune system creates enzymes that fight the bacterial toxins within the pockets, but mechanical removal of the plaque and tartar are essential. Left untreated, with time the pockets become deeper, bone loss around the teeth occurs, and the gums recede. Sooner or later the teeth become loose.
Wednesday 9/24/08
Periodontal Disease (PD) does not usually show up until people are in their 30s. Certainly the milder form, gingivitis, can occur even in teenagers who don't do much brushing, or who have braces that trap and harbor the plaque and food particles.
Periodontal Disease is a silent disease - it doesn't hurt until it is in an advanced stage. But there are ways to detect it. My favorite is to visit the dentist for check-up and periodontal evaluation. Ways that you may detect it at home are:
* Gums that are red and/or swollen and tender
* Gums that bleed when brushing or flossing
* Spaces opening up between your teeth - as if they were moving
* Loose teeth
* Breath that no longer feels fresh - you constantly want to rinse with a mouthwash
* Gums that have pulled away from the teeth
* Pus between the gums and teeth
* Your bite no longer feels solid - you feel as though your bite has changed
Any or all of these indicate some level of gum inflammation/infection. Don't delay in calling for a dental evaluation, because it won't get better on its own.
Thursday 9/25/08
The risk factors that increase the chance of developing Periodontal Disease (PD) are many. Some of the major ones are:
**Genetics - Some people have a greater genetic predisposition to developing a more aggressive, severe type of Periodontal Disease. People with a family history of tooth loss and dentures should be diligent in their efforts to control PD.
**Tobacco - People that chew or smoke tobacco have a greater chance to develop PD, and the effects are usually greater - deeper gum pockets due to increased amounts of plaque and tartar; more loss of bone and soft tissue that support the teeth.
**Medical Conditions - Systemic (the whole body) diseases such as diabetes, cancer, HIV, blood cell disorders, and AIDS, and the treatment for some of these, can lower one's resistance to infections, making PD more severe.
**Stress - Stress reduces the body's natural defences, including the ability to fight off infection. Thus, when under stress, you have an increased chance of developing PD.
**Medications - An increasing number of drugs (antidepressants, steroids, blood pressure drugs, cancer therapy drugs, some heart medications, some anti-epilepsy drugs) can decrease the saliva flow creating a drier mouth than normal. Saliva has a cleansing and protective effect on the gumsa and teeth. A lack of saliva allows plaque to accumulate on the teeth and gums and cause inflammation and decay.
**Hormonal Changes in Females - Puberty, pregnancy and oral contraceptives change the body's hormone levels. These changes cause the gums to become hypersensitive to the slightest levels of plaque and tartar.
**Ill-fitting Dentistry - Old fillings, crowns, and bridges may harbor more plaque and increase the liklihood of developing periodontal disease.
**Crowded Teeth - The tongue rubbing on the back side of the teeth, and the cheeks and lips rubbing on the front side of the teeth, have a self-cleansing effect on the teeth. When the teeth are crowded and overlapped, this self-cleansing doesn't happen very well, and there is an increased chance of decay and gum problems due to plaque retention.
**Insurance Dependency - People that count on their insurance for all the answers are often the patients with the most problems - gum problems, decay problems, and missing teeth problems. The insurance companies write the rule on whether they will have to pay out some of your premium dollars to help get you healthier. If you need to have your teeth cleaned 4 times a year and your insurance only pays for 2 times a year, it does NOT mean you can only get your teeth cleaned twice a year. DON'T be insurance dependent. In today's market you want to maximize your insurance. But, insurance allowance is a help in covering some of the cost of treatment, not a pay-all.
Friday 9/26/08
Knowing all that we know about Periodontal Disease (PD), how is it that 75-80% of us are affected by it?
Periodontal Disease is a silent disease in that it does not hurt (until advanced stages) and can go undetected in its earliest stage. Too often, people don't go to the dentist regularly and start to build up plaque between their teeth. If the person is not a flosser, the plaque starts to accumulate more and more between their teeth. The once healthy gums, pink and firm around each tooth, now start to become inflammed between the back teeth where the plaque is building up. With gingivitis now established, the bacteria residing in the plaque produce toxins that start to break down the attachment of the gums to the teeth. The body's inflammatory response is to bring increased amounts of blood to those areas to fight off the toxins. The gums become puffy, tender and swollen, and can bleed easily with brushing and flossing (not likely any flossing is occuring in this person).
A cleaning at the dental office at this point could start to turn things around. Flossing and brushing would go a long way toward health. Of course, this person doesn't have any pain, and is unaware of this situation.
Periodontitis sets in as the plaque by-products, the toxins, destroy the tissues that hold the teeth in the bone. The attachment of the gum to the root surfaces start to be destroyed and pockets develop between the gum and the teeth. The gums pull away from the teeth and recede. More plaque is now accumulating below the gum line in these pockets. Some of the plaque on the root surfaces is hardening into tartar. Like the barnacles forming on the piers at the ocean, the tartar is rough and more plaque sticks to the rough surfaces and become hardened. As the disease progresses, bone under the gums that anchors the teeth begins to dissolve away. The person may notice an unpleasant odor coming from their mouth - bad breath. The gums may bleed when brushing. At this point, with less bone anchoring the teeth and less gum tissue covering the roots, the teeth appear longer and are sensitive to cold and are more susceptible to decay.
In advanced periodontitis, the toxins deep in the pockets continue to destroy the periodontal ligaments and bone, causing the teeth to lose more support. Unless treated, the affected teeth become more mobile amd may fall out.
The key, is to not let this all get started. Should you find yourself progressing down the path described above, work hard on brushing and flossing and get into the dental office for evaluation and necessary treatment. You do not have to lose teeth to periodontal disease!
Monday 9/29/08
Prevention of Periodontal Disease (PD) should be a major concern for all of us. In 75-80% of the adults, the concern really should be cleaning up the gums and getting control of the PD (since it can NOT be cured). For today, let's focus more on prevention in the young people and in the 20-25% of adults not affected by PD.
Floss daily, preferably before you go to bed. Then, brush well with a good fluoride toothpaste for approximately two minutes. The flossing will loosen up food and plaque particles that the brush can then help remove. Rinse, swishing the water around. Spit out and repeat. Rinse and swish 2 or 3 times.
Go to the dentist regularly. For some, that means every six months. For others, the need may be more frequently. If you have dental insurance, great! But, it should not be the deciding factor on how often you visit the dental office. Your dentist and/or your hygienist may provide additional ideas on cleaning your mouth at home.
Eat a well balanced diet, which means you need to meet your nutritional needs while not providing any nutrients in excess. Eat items from the following groups: milk and milk products, meat and meat substitutes, fruits and vegetables, and the grains group. Don't use tobacco products in any way, shape, or form.
Tuesday 9/30/08
Prevention of gum disease for the 75-80% of us who have (had) some form of gingivitis or periodontitis really means preventing it from recurring once we have it under control. Regular dental visits, once again, is one of the top things to do. The dental hygienist and dentist can tailor the frequency of visits to the individual person. Also, the more frequently you visit us, the more need for a personalized home care program to meet your specific needs. And, the dental team can give advice on selecting dental products that will work best for each individual. www.ada.org/public/topics/periodontal_diseases.asp
Homecare is a MAJOR factor in controlling gum disease. Morning, midday, and evening. Floss, brush and usually rubbertip. A good fluoride toothpaste should be used as well as a fluoride mouthrinse. Most people in this situation have recession, and fluoride helps protect the root surfaces.
Eat a well balanced diet, and exercise as often as possible. And, once again, stay away from tobacco products.
Wednesday 10/1/08
How do we treat gum disease (periodontal disease)? It depends where you are at with the progression of the disease. A major component of dental health is what we do for ourselves everyday - homecare. Brushing three times a day (after breakfast, midday, and after dinner) and flossing after dinner are the minimum you should be doing to get back to dental health. The other major component is regular dental visits. Cleaning and check-up at least every six months. With early gum disease (gingivitis) this may be enough. Let the dental team clean your mouth up twice a year and you maintain it daily.
Once we slip to a more advanced stage of gum disease, periodontitis, we have receding gums and/or bone loss. Here, the dental team will need to be more agressive in their treatment of you. They will take a complete medical-dental history to identify any underlying or predisposing conditions, and do a complete clinical exam. The dental team will take X-rays, a full set is usually indicated. They will also evaluate the depth of the pockets around each tooth using a calibrated probe.
Most patients at this point will require Active Periodontal Therapy and/or a referral to a gum specialist. We treat most patients here and refer out only the surgical needs. the Active Periodontal Therapy consists of scaling and root planing, debridement, irrigation of the pockets with a medicated rinse, and perhaps placement of antibiotics in specific isolated pockets.
Continued tomorrow......
Thursday 10/2/08
Active Periodontal Therapy ...continued from yesterday.....
Active Periodontal Therapy is similar to the scaling normally done during a routine oral hygiene visit, however, it differs in several significant ways. Infection and the resulting deep pockets exist around your teeth requiring deeper than normal scaling. Since vision is blocked into the tooth structure, small scaling devices (either manual or ultrasonic) will be placed carefully into the pockets and a systematic smoothing of the tooth root surfaces will be performed. Debris that has collected on the tooth surfaces will be removed along with the diseased soft tissue. This procedure (called curettage) requires significant time and expertise. Usually, only one area of your mouth will be done per appointment. The number of the one-hour appointments needed will depend on the severity of your infection. You will be anesthetized for your comfort during these procedures.
Your gum tissue may shrink somewhat as it heals. This is desirable because it reduces the depth of the pockets allowing you to better remove bacteria and debris during your home care. Active Periodontal Therapy is the most conservative way to treat gum disease.
Friday 10/3/08
Six weeks after Active Periodontal Therapy (APT), we have our patients back for re-evaluation. We reprobe every tooth in the mouth, evaluate the tissue tone and texture and take intra-oral photos to show you the results. This is our report card. How well did we do with our clinical treatment, with our homecare instructions to you, and with our emotional appeal and motivatioon to you to save your teeth?
We may have been totally successful, or only partially successful. If we are totally successful and all the pockets have shrunk to 3mm or less, the tissue tone pink and firm, and you are religiously cleaning your mouth, then we celebrate! If we were only partially successful, we need to identify what is going on - or in some cases, what is not happening (i.e. daily) through homecare. We may be able to make some corrections and reconvene in another 6 weeks for re-evaluation, or we may need a referral to a gum specialist for evaluation of one or more sites. Often, the treatment of gum disease is not all or nothing. We may be successful in 60, 70, 80 or even 90% of the areas, and unsuccessful in just a few spots. Those few spots may need treatment by a gum specialist, and often involve surgery.
http://www.nidcr.nih.gov/oralhealth/topics/gumdiseases/periodontalgumdisease.htm
Monday 10/6/08
Periodontal Disease Facts and reminders
1. Plaque forms 20 seconds after eating and 20 minutes after brushing. It hardens into tartar in 24 hours and stays on your teeth.
2. Healthy gums DO NOT BLEED. If you have bleeding gums, pay more attention to your home care instructions. Salt water rinses can help sensitive and swollen gums (1 tsp. salt dissolved into one cup water). If your gums continue to bleed after a thorough home care routine, please contact our office.
3. Experiencing a bad taste or odor is a sign of gum disease/infection.
4. Mouthwashes have no effect on periodontitis. Some mouthwashes can reduce gingivitis.
5. When subgingival plaque reaches a certain threshold level, it produces periodontal disease. Periodontal Disease, therefore, occurs in episodes of activity and quiescenece. That is why daily removal of the bacteria in your mouth is important in reducing your risk of periodontal disease.
Tuesday 10/7/08
Home Care
1. Floss twice a day (morning and night). Wrap the dental floss around your middle finger and guide the floss with your index fingers and/or your thumbs as instructed in a "C" shape and scrap up and down.
2. Brush three times a day (morning, lunch, and bedtime). Hold the toothbrush at a 45 dgree angle toward the gum line and direct the toothbrush under the gums using a small circular stroke. DO NOT RUSH! Spend 3 to 5 minutes brushing. Dry brushing is fine if it is more convenient. Rinse with water and expectorate.
3. Rubber tip one or two times a day. Using the tip of the stimulator, trace around the gum line of the teeth. Place the rubber tip between the teeth from the inside and outside surfaces and use gentle pressure to massage the gum tissue.
4.. Proxabrush one or two times a day if recommended by your dental hygienist. Work the brush between open spaces and around bridgework.
5. If using a water pik, fill the tank with warm water and use medium speed directing the water at the right angle to the long axis of the tooth (never angle the waterjet down into the gum tissue). If you have a heart murmur, heart disease, or an artificial joint, check with your physician before using a water jet device.
6. Use fluoride rinses or desensitizing toothpastes daily if recommended.
Wednesday 10/8/08
Additional Home Care Tips
1. Always brush your tongue or use a tongue scraper daily. Your tongue retains approximately 80% of the bacteria in your mouth.
2. Replace your toothbrush or other home care products if they appear worn out. Toothbrushes should not look flattened or spread out. They should be replaced every six to eight weeks.
3. Toothpastes for sensitive teeth or fluorides are very useful for sensitive root surfaces. Use as directed.
4. Prescription fluoride gels are used to prevent decay, reduce sensitivity and decrease microbial (bacteria) count. After brushing, place gel on a dry toothbrush, proxabrush, or rubber tip and use for one minute, followed by swishing remaining gel for one minute. Do not swallow the fluoride as it may upset your stomach. Fluoride rinses (non-alcohol) you can purchase over the counter such as Act, can also help decrease sensitivity and strengthen teeth. Use one to two times a day. Do not eat or drink for thirty minutes after using.
Thursday 10/9/08
VARIABLES TO PERIODONTAL THERAPY
Variables that may compromise periodontal therapy or have an effect on you may include:
Systemic Health
Nutritional Intake
Ability to Absorb Nutrients
Alcohol
Caffeine
Smoking
Medications or Drugs
Stress Levels
Hormonal Therapy
Trauma from Malocclusion
Faulty Dentistry
Food Impaction
Mouth Breathing
Calculus
Body Chemistry
YOUR CLEANING - AN INVESTMENT IN YOUR HEALTH
Prevention should serve as a lifestyle pattern for total health, not the least of which is dental health. Prevention in dentistry leads to improved long-term oral health and reduced dental costs. It encourages a bright smile, fresh breath, and an overall good feeling of personal security. Prevention is your insurance policy toward a healthier, pain-free, debt free lifestyle.
Our dental hygienists can provide an excellent service to assist you in the maintenance of your overall dental health. Your cooperation with her can serve to increase your knowledge of your present oral condition. When you keep your appointment with your hygienist, the following benefits will result:
* Your hygienist will customize a personal home care and preventive maintenance program for you and inform you of those dental products that are appropriate for your particular needs. You will be instructed in the proper methods of tooth brushing, flossing and adjunctive dental health devices.
* Your entire mouth will be thoroughly and carefully examined for gum disease, growths, lesions, and any abnormalities that would affect your general health.
* Your teeth will be cleaned and polished to remove plaque and tartar both above and below the gum line, eliminating bacteria that lead to cavities, bad breath, and gum disease.
* Fluoride will be applied to teeth to prevent decay (for children), and root sensitivity / root cavities for adults.
* Sealants can be easily applied to the chewing surfaces of children's teeth as a protection against future decay.
For our periodontal maintenance patients, your hygienist will use her specialized cleaning instrument, the Cavitron, to not only remove tartar, but also flush bacteria and debris from the periodontal pockets. She will also irrigate and medicate those same pockets with Chlorohexidine Gluconate.
Dental disease is a silent invader, presenting itself in various forms (puffy, bleeding gums, cavities, oral cancer, and abscesses). Although your mouth may appear to be in good health at this time, stresses, body changes, life changes, medications, illness, and age can tax your immune system. Maintaining regular re-care appointments with your hygienist and follow-ups with Dr. Briscoe offer you the assurance that any problems in regard to your oral care will be addressed immediately.
Taking care of tomorrow's problems today will give you tremendous peace of mind. If you have postponed or missed your last hygiene maintenance appointment, remember: it's not just a cleaning, it's an INVESTMENT in your overall health.
Tuesday 10/14/08
We are saving more teeth these days through gum treatments, root canals, and better patient awareness. As such, with more teeth in patient's mouths than we saw 20 years ago, we are finding more wear on the teeth. The wear is not simply a sign of age, it is an indication of other conditions.
Wear has three causes, and it is important for the dental team to identify which of the three causes has affected your teeth, because the treatments will differ.
The three causes are:
1. Attrition - which is true tooth to tooth grinding.
2. Erosion - which causes tooth wear by demineralizing the tooth structure with acid and demineralized tooth areas getting rubbed away.
3. Abrasion - which is when a person aggressively brushes his or her teeth over a period of time and that abrades portions of the teeth. Another abrasion cause is when older overcontoured porcelain crowns abrade the opposing teeth, wearing them away.
Wednesday 10/15/08
One of the three major causes of tooth wear is attrition. Attrition is caused by tooth to tooth contact. The back teeth become flatter while the front teeth become shorter. In a healthy well-balanced bite the rate of attrition is minimal throughout life. When that rate is dramatically increased, wear will appear on some or all of the teeth.
One of the conditions that accelerate the attrition or wear is bruxism. Bruxism is an involuntary clenching-grinding of the teeth. It is believed to be caused by stress, anxiety, and an imbalance in the biting position of the upper and lower jaws – malocclusion. Bruxism can occur subconsciously during the day or while sleeping.
Moderate to severe attrition of the front teeth can leave a patient with short and unpleasant looking teeth and an aged smile. It is possible to have attrition accompanied by acid erosion and/or abrasion.