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Posts for category: Oral Health

By Bruce A. Leonard, DDS
February 12, 2022
Category: Oral Health
Tags: gum disease  
DentistsSometimesUseAdditionalWeaponsintheFightAgainstGumDisease

The term periodontal disease refers to bacterial infections that target the gums. These infections typically start as inflammatory responses to dental plaque, a bacterial biofilm collecting on tooth surfaces, especially around the gum line.

Early on, we can often stop the infection and minimize damage by removing accumulations of dental plaque and tartar (hardened plaque), which tend to fuel the disease. This process, known as debridement, effectively "starves" the infection and allows the gums and other infected tissues to heal.

But if gum disease is anything, it's stubborn: An infection can continue to advance rapidly. As it does, it weakens gum attachment and causes bone loss, both of which could eventually cause tooth loss.

When it reaches this state, advanced gum disease can turn into a long-term siege of keeping the infection at bay and trying to limit bone loss. To stay ahead of it, we may turn to additional treatments besides debridement, especially for difficult-to-treat areas around the roots.

Mouthrinses. Dentists often prescribe antimicrobial agents to patients with advanced gum disease to help further control bacterial plaque buildup. The most common of these is chlorhexidine, typically in a 0.12% solution mouthrinse. Chlorhexidine is quite effective in controlling bacteria, but prolonged use can lead to tooth staining.

Topical antibiotics. Dentists may also apply antibiotic treatments, usually tetracycline, directly to affected areas. Topical applications like these are often more effective in penetrating hard-to-reach areas than manual cleaning tools. Dentists must be selective, though, in using this tool, because long-term application could disrupt "good" oral bacteria along with the bad.

Other medications. In addition to antibiotics, dentists may also use other drug treatments like chlorhexidine chips or doxycycline gel that continues to deliver effects over a long period. These "sustained release" medications continue to suppress bacteria, and are often used in conjunction with mechanical cleaning to reduce inflammation.

These additional tools can improve the overall treatment outcomes for advanced gum disease. But they must be used prudently and only in those cases where the benefits of better gum health outweigh the risks.

If you would like more information on preventing and treating gum disease, 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 “Treating Difficult Areas of Periodontal Disease.”

By Bruce A. Leonard, DDS
February 02, 2022
Category: Oral Health
Tags: gum disease  
GumDiseaseAroundtheToothRootsCanBeDifficulttoAccessandTreat

Periodontal (gum) disease may begin superficially, but it can eventually work its way deeper below the gums to become a threat to the teeth and the underlying bone. The tooth roots are especially vulnerable to the disease with long-lasting implications to the tooth's survival.

An infection usually begins with dental plaque, a thin biofilm on tooth surfaces that harbor the bacteria that cause gum disease. The infection may eventually reach an area around the tooth roots called a furcation, where the roots branch off from the main tooth body. If the disease gains a foothold in a furcation, it could seriously erode the infected bone structure.

This often occurs in stages, commonly classified as early, moderate or advanced ("through and through"). In the first stage, the infected area exposes a slight groove in the tooth, but no significant structural loss. The next stage shows bone loss of at least two millimeters. In the most advanced stage, the bone loss now extends all the way beneath the tooth from one side to the other.

As with any situation caused by gum disease, it's best to catch a furcation involvement early and initiate treatment. As with any case of gum disease, the objective is to remove accumulated plaque and tartar (hardened plaque), which both fuel the infection. With plaque removed, the periodontal tissues can begin to heal and possibly regenerate.

It can be hard to achieve these outcomes because furcations are difficult to access. Although we may be able to clean the roots with tools like scalers (curettes) or ultrasonic equipment, we might still need to surgically access the area to completely remove the infection.

Initial treatment of furcations is often only the beginning. Someone with this level of gum disease usually needs continuous, heightened dental care and maintenance to prevent reinfection, often by an experienced hygienist working in consultation with a periodontist (gum specialist). It's also common to surgically alter the tissues around a furcation to make them easier to inspect and clean.

The best scenario, of course, is to avoid an infection altogether, or at least diagnose it before it becomes this advanced. The best way to stay gum (and tooth) healthy is to be sure you brush and floss every day, and see your dentist for cleanings and checkups at least twice a year.

If you would like more information on treating furcations, 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 “What are Furcations?

By Bruce A. Leonard, DDS
January 13, 2022
Category: Oral Health
Tags: tooth decay  
AddressTheseRiskFactorstoPreventToothDecay

Put teeth in contact with acid from oral bacteria and you've created the conditions for tooth decay. Also known as caries, tooth decay is the most common human disease on the planet, responsible for destroying countless teeth.

We fortunately have effective treatments for arresting decay and minimizing its damage. But it's a far better strategy to prevent it in the first place—a strategy well within your reach if you and your dentist can reduce your individual risk factors for the disease.

Of these risk factors, there's one in particular we can't control—the genes we inherit from our parents. Researchers estimate up to 50 possible genes can influence whether or not a person develops cavities. Fortunately, though, most think the overall genetic influence has minimal impact on a person's oral health.

And although there's not much about your genetic makeup regarding cavity development that you can change, there are other factors you can definitely do something about. Here are 3 of the most important that deserve your attention if you want to prevent tooth decay.

Dental plaque. The main trigger for tooth decay and other dental diseases is a thin film of food particles on tooth surfaces called dental plaque, the main food source for the bacteria that cause disease. You can reduce this risk by removing plaque daily with brushing and flossing, along with a professional cleaning every six months.

Saliva. This essential bodily fluid helps prevent tooth decay by neutralizing acid. Problems can arise, though, if you have insufficient saliva. If you suffer from "dry mouth," you can improve saliva flow by talking to your dentist or doctor about changing medications, drinking more water or using saliva enhancement products.

Diet. Bacteria feed mainly on sugar and other refined carbohydrates. So, the more sweets, pastries and processed foods you eat, the more bacterial growth you can expect to occur. By changing your diet to more whole foods like fresh vegetables, protein and dairy, you may be able to reduce bacterial growth and your risk for decay.

Tooth decay always happens for a reason. By addressing these and other controllable risk factors, you may be able to stop decay from forming.

If you would like more information on preventing and treating tooth decay, 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 “What Everyone Should Know About Tooth Decay.”

By Bruce A. Leonard, DDS
December 24, 2021
Category: Oral Health
Tags: dry mouth  
TakeStepstoStopChronicDryMouthandAvoidDentalDisease

We all experience that unpleasant "cotton-mouth" feeling now and again. But what if it happens all the time? Chronic dry mouth is more than unpleasant—it could be a medical condition that threatens your oral health.

Chronic dry mouth is a sign you don't have enough saliva present. That's a problem because we need saliva to keep our teeth and gums healthy by neutralizing the oral acid that erodes tooth enamel. Saliva also supplies antibodies to fight infection.

A saliva deficiency could be the result of lifestyle habits like drinking alcohol or smoking, metabolic diseases or treatments like chemotherapy or radiation. More commonly, though, it's a side effect from a medication you're taking.

Given the heightened risk it causes to your teeth and gums, what can you do to alleviate chronic dry mouth?

Review your medications. If you're taking prescribed medications, talk with your pharmacist or doctor about possible oral side effects associated with any of them. If so, it may be possible to switch to an alternative medication without the dry mouth side effect.

Don't use tobacco. Regardless of whether you smoke, dip or chew, tobacco use can interfere with saliva production. Kicking the habit not only improves saliva flow, it may further reduce your risk for oral diseases, especially oral cancer.

Drink more water. Saliva is mainly composed of water—so, be sure your body has plenty of it to facilitate saliva production. It's a good idea to sip extra water throughout the day, and especially before and after you take medication.

Practice oral hygiene. As a general rule, brushing and flossing every day is pivotal in preventing dental disease—but it's especially important with dry mouth. Be sure, then, to brush twice and floss once every day. You should also see your dentist at least every six months for dental cleanings and checkups.

Chronic dry mouth could be setting you up for future dental disease. But taking steps to alleviate it while practicing daily dental care could help you avoid that unhappy outcome.

If you would like more information on alleviating chronic dry mouth, 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 “10 Tips for Dealing With Dry Mouth.”

By Bruce A. Leonard, DDS
December 04, 2021
Category: Oral Health
Tags: oral health   osteoporosis  
SomeOsteoporosisTreatmentsCouldImpactDentalCare

Millions of Americans live with osteoporosis, a degenerative bone disease that can turn a minor fall into a potential bone fracture. Literally meaning "porous bone," osteoporosis causes the natural marrow spaces in bone tissue to progressively grow larger and weaken the remaining bone.

Many osteoporosis patients take medication to slow the disease's process. But due to the dynamic nature of bone, some of these drugs can have unintended consequences—consequences that could affect dental care.

As living tissue, bone is literally "coming and going." Certain cells called osteoblasts continuously produce new bone, while others called osteoclasts remove older tissue to make way for the new. Drugs like bisphosphonates and RANKL inhibitors interrupt this process by destroying some of the osteoclasts.

As a result, more of the older bone remains past its normal lifespan, helping the bone overall to retain strength. But ongoing research is beginning to hint that this may only be a short-term gain. The older, longer lasting bone is more fragile than newer bone, and tends to become more brittle and prone to fracture the longer a patient takes the drug. This tissue can also die but still remain intact, a condition known as osteonecrosis.

The femur (the large upper leg bone) and the jawbone are the bones of the body most susceptible to osteonecrosis. Dentists are most concerned when this happens in the latter: Its occurrence could lead to complications during invasive procedures like oral surgery or implant placement.

Because of this possibility, you should keep your dentist informed regarding any treatments you're undergoing for osteoporosis, especially when planning upcoming dental procedures like oral surgery or implant placement. You might be able to lower your risk by taking a "drug holiday," coming off of certain medications for about three months before your dental work.

As always, you shouldn't stop medication without your doctor's guidance. But research has shown drug holidays of short duration won't worsen your osteoporosis. If you're already showing signs of osteonecrosis in the jaw, a short absence from your prescription along with antiseptic mouthrinses and heightened oral hygiene could help reverse it.

Fortunately, the risk for dental complications related to osteoporosis medication remains low. And, by working closely with both your dentist and your physician, you can ensure it stays that way.

If you would like more information on osteoporosis and your dental care, 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 “Osteoporosis Drugs & Dental Treatment.”