Posts for category: Oral Health
After months or even years of radiation or chemotherapy, the words "cancer-free" is music to your ears. Your joy and relief, though, may be tempered by the toll these treatments can take on the rest of your body—including your mouth.
Both of these treatments can destroy healthy tissue along with targeted cancer cells. If the focus has been on the head and neck regions, they could damage the salivary glands to the point that they won't produce adequate saliva flow.
A lack of saliva can have a detrimental effect on your oral health. Saliva buffers and helps lower oral acid levels that soften and erode enamel and increase the likelihood of tooth decay. Saliva also supplies antibodies that fight disease-causing bacteria. Otherwise, bacteria—and the risk for disease—can rapidly grow.
If these or other scenarios occur, you may experience dental damage, even tooth loss. Fortunately, we can restore an injured smile in various ways, including dentures, bridges or dental implants. But we should also attempt to limit the potential damage by taking steps to prevent dental disease during cancer treatment.
The most important of these is to brush and floss daily. Everyone should practice these hygiene tasks to remove disease-causing dental plaque, regardless of their health status. But because some natural disease-fighting mechanisms in the mouth may be disrupted during either radiation or chemotherapy, it's even more important if you're a cancer patient.
It's equally important to maintain as much as possible regular dental visits during cancer treatment. Dental cleanings provided during these visits remove any residual plaque and tartar (hardened plaque), which further lowers your disease risk.
Your dentist can better monitor your overall dental condition during frequent visits and provide as much treatment as you can tolerate. They can also enhance your protection against disease by prescribing antibacterial mouthrinses, fluoride applications or products to boost saliva production.
Some teeth and gum problems may be unavoidable; in that case, you may need post-treatment dental care to restore your oral health as needed. But caring as much for your dental health as you're able during cancer treatment could help you realize a better outcome.
There's still much about the underlying nature of chronic jaw joint dysfunction we have yet to unravel. Treating these conditions known as temporomandibular joint disorders (TMDs) may therefore require some experimentation to find what works for each individual patient.
Most TMD therapies are relatively conservative: eating softer foods, taking anti-inflammatory pain relievers or undergoing physical therapy. There have been some surgical techniques tried to relieve jaw pain and dysfunction, but these have so far had mixed results.
Recently, the use of the drug Botox has been promoted for relieving jaw pain, albeit temporarily. Botox contains tiny amounts of botulinum toxin type A, a poisonous substance derived from the bacterium Clostridium botulinum, which can cause muscle paralysis. It's mainly used to cosmetically smooth out small wrinkles around facial features.
Because of these properties, some physicians have proposed Botox for TMD treatment to paralyze the muscles around the jaw to reduce pain and discomfort. While the treatment sounds intriguing, there are a number of reasons to be wary of it if you have TMD.
To begin with, the claims for Botox's success in relieving jaw pain have been mainly anecdotal. On the other hand, findings from randomized, double-blind trials have yet to show any solid evidence that Botox can produce these pain-relieving effects.
But even if it lived up to the claims of TMD pain relief, the effect would eventually fade in a few weeks or months, requiring the patient to repeat the injections. It's possible with multiple Botox injections that the body will develop antibodies to fight the botulinum toxin, causing the treatment to be less effective with subsequent injections.
Of even greater concern are the potential side effects of Botox TMD treatment, ranging from headaches and soreness at the injection site to more serious muscle atrophy and possible facial deformity from repeated injections. There's also evidence for decreased bone density in the jaw, which could have far-reaching consequences for someone with TMD.
The best approach still seems to lie in the more conservative therapies that treat TMD similar to other joint disorders. Finding the right combination of therapies that most benefit you will help you better manage your symptoms.
If you would like more information on treatments for TMD, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Botox Treatment for TMJ Pain.”
Parents will do just about anything to relieve their children's discomfort when they're in pain. When a toddler is suffering through a teething episode, it's tempting to turn to a topical numbing ointment to soothe their gums.
But there can be a hidden danger for kids if you use certain over-the-counter products used by adults for gum or teeth pain. Many of these topical ointments contain a pain reliever called benzocaine. While it's relatively safe for adults, benzocaine can be hazardous for infants and young children.
Studies have found that benzocaine contributes to a disease called methemoglobinemia, in which a protein in the blood called methemoglobin increases to abnormal levels. Too much of this protein inhibits the transport of oxygen throughout the body. For young children, this can cause shortness of breath, fatigue and dizziness. In extreme cases, it could lead to seizures, coma or even death.
Parents are urged to avoid using any product containing benzocaine to ease gum or teething pain in children. Instead, the American Academy of Pediatric Dentistry recommends providing a child a chilled (not frozen) teething ring, pacifier or a damp clean cloth to chew on. The chewing action helps relieve gum swelling pressure and the cold will help numb the pain. Massaging the gums with a clean finger may also help.
If the pain persists, parents should consult a doctor or pharmacist about giving their child pain medication. Drugs like ibuprofen or acetaminophen (never aspirin) administered in the proper dosage for a child's age can help ease teething discomfort. Medications should always be given orally—you should never rub substances like aspirin or alcohol directly on the gums, which can further irritate already inflamed tissues.
Teething episodes come and go during a child's early dental development—they are like storms that swell and abate before they finally pass. Except when accompanied by fever or diarrhea, there's no need for concern. Your main goal is to help ease their discomfort as much—and as safely—as possible.
Forty years have passed since the first reported case of Acquired Immune Deficiency Syndrome (AIDS), and it and the human immunodeficiency virus (HIV) that causes it are still with us. About 1.2 million Americans are currently infected with HIV, with 50,000 new cases diagnosed each year.
The emergence of antiretroviral drugs, though, has made it possible for many with HIV to live normal lives. Even so, the virus can still have a profound effect on health, including the teeth and gums. Because of its effect on the immune system, HIV+ patients are at greater risk for a number of oral conditions, like a fungal infection called candidiasis ("thrush").
Another common problem is chronic dry mouth (xerostomia), caused by a lack of saliva production. Not only does this create an unpleasant mouth feel, but the absence of saliva also increases the risk for tooth decay and periodontal (gum) disease.
The latter can be a serious malady among HIV patients, particularly a severe form of gum disease known as Necrotizing Ulcerative Periodontitis (NUP). With NUP, the gums develop ulcerations and an unpleasant odor arising from dead gum tissue.
Besides plaque removal (a regular part of gum disease treatment), NUP may also require antibiotics, antibacterial mouthrinses and pain management. NUP may also be a sign that the immune system has taken a turn for the worse, which could indicate a transition to the AIDS disease. Dentists often refer patients with NUP to a primary care provider for further diagnosis and treatment.
Besides daily brushing and flossing, regular dental cleanings are a necessary part of a HIV+ patient's health maintenance. These visits are also important for monitoring dental health, which, as previously noted, could provide early signs that the infection may be entering a new disease stage.
It's also important for HIV+ patients to see their dentist at the first sign of inflamed, red or bleeding gums, mouth lesions or loose teeth. Early treatment, especially of emerging gum disease, can prevent more serious problems from developing later.
Living with HIV-AIDS isn't easy. But proper health management, including for the teeth and gums, can help make life as normal as possible.
If you would like more information on dental care and HIV-AIDS, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “HIV-AIDS & Oral Health.”
Your gums don't just attractively frame your teeth—they protect them as well. If they shrink back (recede) from their normal covering, portions of the teeth could become exposed to bacteria and other hazards.
Unlike the visible crown, which is protected by enamel, the tooth root depends largely on the gums as a shield against bacteria and other hazards. When the gums recede, it exposes the roots and makes them more susceptible to disease or trauma. It may also cause sensitivity to hot and cold foods as the now exposed dentin gets the full brunt of temperature and pressure sensations once muffled by the gums.
There are actually a number of causes for gum recession. In rare cases, a tooth may not have erupted normally within its bony housing, which inhibits the gums from covering it fully. Thinner gum tissues, passed down genetically, are also more susceptible to recession. And a person can even damage their gums and cause them to recede if they brush too aggressively.
The most common cause, though, is advanced periodontal (gum) disease. This bacterial infection arises from dental plaque, a thin biofilm that accumulates on tooth surfaces, usually because of poor hygiene practices. As the infection and resulting inflammation in the gums worsens, they lose their attachment to teeth resulting in a number of harmful outcomes that include recession.
The first step then in treating gum recession is to treat the underlying problem as much as possible. In the case of gum disease, effective treatment could stop mild to moderate recession and sometimes reverse it. For more extensive recession, a patient may need gum grafting surgery to help regenerate lost gum tissue.
You can help prevent gum disease, and thus lower your risk for recession, with daily brushing and flossing to remove bacterial plaque. Likewise, see your dentist at least twice a year for dental cleanings to remove any residual plaque and tartar (hardened plaque).
You should also visit your dentist promptly if you notice swollen or bleeding gums, or more of your teeth surfaces showing. The earlier your dentist diagnoses and begins treatment for gum recession, the better your chances for a healthy and more attractive outcome.
If you would like more information on maintaining good gum health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Gum Recession.”