Explaining a Cavity Diagnosis

When the dentist examines your teeth and finds decay you may hear some designations that mean nothing to you but seem a little frightening. The dentist may refer to a number of surfaces. These are like directions on a compass, and indicate where the decay is present. Occlusal indicates the top, or biting surface of a molar. Incisal is the same surface for an anterior tooth. Mesial and distal indicates the sides of the teeth in both the anterior and posterior. Lingual is the back of any tooth surface, while buccal represents the face of the posterior teeth. For an anterior tooth this is the facial surface. Another important fact to note is that once you cross the midline of your mouth , which is between the front teeth, mesial and distal reverse. So a MBD on tooth number 2  would be a three surface filling starting on one side and going across the face of the tooth to the back side. An IL on tooth number 8 would be the biting surface and back of the tooth. Knowing these surface indicators will make it less stressful when you hear them called out.

Periodontal Disease Factoid

Plaque only contributes to 20% of the risk for developing periodontal disease. While plaque is present for periodontal disease to develop, it also depends heavily upon the relationship between the host, environment, and bacterial population.

Impact of Medications on the Oral Cavity

Unfortunately your recently prescribed medication may be affecting more than the condition for which it was prescribed. Here are a few conditions to be aware of when beginning a new medication. Drug induced xerotomia or dry mouth is the most common complaint involved with a medication, and it increases with dosage or number of medications. It can be addressed with salivary replacements and fluoride supplements. Aphthous ulcers may be a side effect of some medications, and based upon the severity can be treated with over the counter medications. Gingival hyperplasia can result from anticonvulsants, calcium channel blockers, and immune suppressing drugs. This can be alleviated to a degree with exceptional home care. Taste alteration is complaint for over 200 medications, and unfortunately  can result in patients over indulging in salt or sweetener to combat. Nonsteroidal anti-inflammatory drugs and antihypertensive agents  can produce a delayed hypersensitivity reaction of lichen planus. Finally, mucositis can be the result of radiation and chemotherapy treatment for which “Magic mouthwash” is very effective. Any side effects resulting from medication should be discussed with your dentist and physician.

Oral Biofilm

Biofilm is formed when bacteria develop complex communities. These communities can mature if they are not disrupted into more destructive bacteria. Biofilm exposed to excess carbohydrates produces a Gram positive carbohydrate fermenting bacteria. These bacteria contribute to demineralization and ultimately caries. Gram negative anaerobic bacteria dominated biofilm accumulated sub and supragingivally contribute to gingivitis and periodontitis Disruption may be achieved mechanically and chemically. Mechanical disruption is performed by physically removing plaque by brushing or flossing. Chemical disruption is achieved with oral rinses.

Third Molar Extractions Factoid

Generally four third molars will begin to erupt between the ages of 17 and 25. Evaluation of third molars is done at this time with a panoramic radiograph. Extractions are sometimes performed for orthodontic treatment or orthognathic surgery as part of the treatment process. Other conditions which warrant extraction of impacted third molars are periodontal conditions, cysts, pericoronitis, and carious lesions. In most cases these teeth are asymptomatic at the time of extraction, and are being pulled to prevent future problems. These can be predicted by the position of the teeth on the panoramic radiograph.

Therapeutic Use of Botox

Many patients are shocked to hear that their dentist is now trained in administering Botox. While Botox is most commonly known for its use in fighting the aging process, it is also an important tool in dealing with dental related muscle hyperactivity. Traditional appliance therapy and bite adjustments are the most common tools for dealing with  conditions like bruxism, temporomandibular joint disfunction, clenching, hypersalivation and masseteric hypertrophy. Botox inhibits the release of the neurotransmitter acetylcholine which causes muscle contraction. This is very beneficial for parafunctional habits as an injection of Botox directly into the temporal and masseter muscles can help relieve the pain and muscle tension of these conditions. In cases of hypersalivation the Botox is injected directly into the parotid and submandibular glands to significantly reduce salivary flow. If you suffer from any of these conditions it recommended that you discuss the option of Botox injections as part of your treatment with your dentist.


New Thresholds for High Blood Pressure

A recent move by the American Heart Association and the American College of Cardiology has increased the number of American adults with what is considered high blood pressure to 46 percent of the population. Hypertension or high blood pressure damages blood vessels and contributes to clogged arteries puts patients at significant risk for heart attack, stroke, and other serious medical conditions. The previous threshold was 140/90. The higher number measured the force the blood puts on the artery walls when the heart contracts, while the lower number measures the same force between beats. Now the threshold will be 130/80 to increase awareness of risk factors. Regular exercise, smoking cessation, and healthy eating habits are all essential to lowering blood pressure.

Hidden Dangers of Halloween Candy

As the Halloween season rolls around there is more to be scared of than ghosts. The really frightening thing is the candy bowl. We all know how hard it is to keep from packing on the pounds during the holidays, but your teeth also need to fear the season. Dipping into the candy bowl keeps your teeth bathed in sugar, increasing the risk of decay. Sticky candies like Starburst or Gummy bears leave a residue in the grooves of the biting surface that further contribute to decay. Finally, nuts and crunchy fillings can potentially damage dental work like fillings or crowns. These dangers should be enough to deter you from taking that second or third trip to the candy bowl.

Link Between Periodontal Disease and Women’s Cancer

While men are more prone to develop periodontal disease than women the CDC estimates that almost 40% of adult women in the U. S. have gum disease. Recently increased breast cancer risk and periodontal disease have been shown to be linked.  A recent study done by the State University of New York at Buffalo was conducted to determine if gum disease is associated with any other types of cancer. The study, conducted on women aged 54-86 showed that periodontal disease increased the risk of developing any type of cancer by 14%. The most commonly associated cancer was esophageal cancer, but there was also lung cancer, gallbladder cancer, melanoma (skin cancer), and breast cancer. While these findings are concerning it is still too early to completely understand the underlying correlation. More research will be required to develop this connection.

Impacted Wisdom Teeth

Impacted wisdom teeth are third molars that are trapped partially erupted or completely beneath the gums. Symptoms of impacted wisdom teeth are pain, swelling, bleeding, or bad breath. If any of these occur it may be time to go to the dentist to evaluated them.  To properly evaluate wisdom teeth your dentist will need to take a panorex x-ray to evaluate the number and placement of the third molars, and then refer you to an oral surgeon for the extraction surgery. If wisdom teeth are not removed there are a number of possible dental complications that may occur. First, is the risk of developing a periodontal infection if a tooth is only partially erupted. Food debris and plaque will still be able to migrate below the gum, but will be trapped and cause bacterial infection to occur. This can result in expensive periodontal therapy. Secondly, is the risk of damage to the second molar if the top of a third molar is trapped against it. Finally, there is the risk that the erupting third molars will cause the shifting of teeth and ruin the occlusion. The oral surgeon will first review your x-rays and give you the recommended treatment plan. You will then return to have the teeth extracted under sedation. A few days of recovery and a later appointment to remove your stitches and then everything is back to normal.