Dry Mouth (Xerostomia)

If you suffer from dry mouth, you are not alone.  Millions of Americans suffer from xerostomia, or the subjective perception of dry mouth. 

Causes include medications (including those used to treat depression, anxiety, allergies, high blood pressure, asthma, muscle relaxants, sedatives), systemic diseases (Sjogren's, rheumatoid arthritis, lupus, scleroderma), radiation therapy, dehydration, mouth-breathing habits, smoking, and chewing tobacco. 

Symptoms of xerostomia include the obvious dry, sticky feeling in the mouth and throat, but can also include difficulty eating and swallowing or wearing dentures, as well as changes in taste or burning/tingling sensations in the mouth.  People suffering from dry mouth often have sores in the mouth, a dry tongue, and cracks on the corners of the mouth.  There is an increased risk of susceptibility to oral candida, as well as decalcification of enamel, acid erosion, and gingival inflammation. 

So what can you do if you suffer from dry mouth?

Because xerostomia can cause substantial oral problems, it is best to talk with your dentist or hygienist as soon as you notice symptoms of a dry mouth.  Early recognition allows us to personalize a treatment protocol for you.  A dry mouth increases the risk for tooth decay, periodontal disease, and candida (yeast) infections.  For this reason, we must make an extra effort to protect the teeth and oral tissues.  We may prescribe oral rinses, fluoride trays, or saliva-stimulating medications.  We can instruct on the proper tools and techniques for home care.  Patients with dry mouth will want to avoid alcohol, caffeine, acidic beverages, or products that may irritate oral tissues (including whitening products).  A humidifier at home can often help, and in some cases, the physician can prescribe an alternative medication with less drying side-effects. 

If you have questions about xerostomia or believe you are suffering from it and would like to speak with a dentist, please visit our website www.kalamazoodds.com and use the "Contact Us" page to schedule an appointment. 

Canker Sore Relief

 

Are you one of the millions of Americans who suffers from recurrent apthous ulcerations (i.e. canker sores)?  If so, we've compiled some information you may find helpful.  

Canker sores are one of the most common oral pathoses.  The prevalence in the general population has been reported to vary from 5% to 66%.  Canker sores are triggered by a variety of causative agents, and there appear to be different triggers for different people.   The following have all been reported to be responsible for canker sores: 

• allergies
• genetic predisposition
• nutritional deficiencies
• hematologic abnormalities
• hormonal influences
• infectious agents
• trauma
• stress
• systemic disorders (such as celiac disease, cyclic neutropenia, reiter's disease, behcet's syndrome)

Although no single agent is responsible for triggering canker sores, the damage it causes on the oral mucosa is a T-cell mediated immunologic reaction.

As if one variation of canker sores wasn't more than enough, there are actually three.  They are Minor, Major, and Herpetiform. 

Minor apthous ulcerations represent the form found in up to 80% of those affected.  Patients with minor apthous ulcerations have the fewest recurrences and the lesions exhibit the shortest duration.  The canker sores are typically 3-10mm in diameter and heal without scarring in 7-14 days.  Anywhere from 1 to 5 lesions may be present during each episode.  The most commonly involved sites are the buccal and labial mucosa (inside the cheek and lip), the underside of the tongue, floor of the mouth, and soft palate.  Females are more affected than males.

Major apthous ulcerations occur in about 10% of those affected.  They are larger (1-3 cm) and have the longest duration per episode (2-6 weeks).  They may cause scarring.  Any oral surface may be affected, but the labial mucosa, soft palate, and tonsillar area are most common sites. 

Herpetiform apthous ulcerations have the greatest number of lesions and the most frequent recurrences.  The lesions are small (1-3 mm in diameter), but there may be clusters of up to 100 in a single recurrence.  The ulcerations heal within 7-10 days but the recurrences are often closely spaced. 

So what can you do about these little sores that bring a lot of pain?  If you suffer from frequent recurrences, it is important that your medical history is reviewed for any signs and symptoms of a system disorder that may be associated with canker-like ulcerations.  Unfortunately, there is no medicine that will eliminate a canker sore on the spot.  For minor sores, a topical therapy can be provided to minimize the discomfort for the 7-14 days they take to heal. Major apthous ulcerations are more resistant to therapy and often warrant a more potent corticosteroid.  Laser ablation has been proposed, as it may shorten the duration of the sore and decrease symptoms.  It is often of limited practical benefit, however, since patients cannot return with each canker sore recurrence. 

If you suffer from frequent canker sores and would like to be evaluated by a dentist, feel free to contact us via our website www.kalamazoodds.com  

April is Oral Cancer Awareness Month

 

April is Oral Cancer Awareness Month.  We have compiled some important facts and figures about oral cancer that we hope you will find useful.  But let us start with a recent article published in the March 2013 Consumer Reports Magazine that we do not find useful.  The article is titled, “Save your Life: Cancer Screening is Oversold.  Know the Tests to Get—and Those to Skip.”  Quotes from the article include:

• “screening tests can sometimes do more harm than good.”
• many practitioners are “overselling cancer tests”
•  
• “oral cancer screening is one of the several medical tests that are overrecommended and unnecessary for all but high-risk patients.”
• “most people shouldn’t waste their time on most diagnostic tests, including chairside visual screenings for oral cancer"
•  
• “Most people don’t need the test unless they are at high risk, because the cancer is relatively uncommon.”

 

There are several problems with this in terms of oral cancer screenings.  Let's address each in turn:

• “screening tests can sometimes do more harm than good.”  The reality is that there is no harm whatsoever in an oral cancer screening. 
• many practitioners are “overselling cancer tests”  Oral cancer screenings are often free, or included in the cost of a typical dental exam.
•  
• “oral cancer screening is one of the several medical tests that are overrecommended and unnecessary for all but high-risk patients.”  The reality is that we no longer know who the "high-risk" patients are.  Historically, smokers and heavy alcohol drinkers were our "high-risk" patients. Today, the fastest growing segment of the oral cancer population are young, healthy, non-smokers.  This is due to the skyrocketing increase in HPV-related cancer (see below for HPV facts)
• “most people shouldn’t waste their time on most diagnostic tests, including chairside visual screenings for oral cancer"  You are already sitting in the dental chair having an exam.  An oral cancer screening is not a separate appointment.
•  
• “Most people don’t need the test unless they are at high risk, because the cancer is relatively uncommon.”  Again, we no longer know who our "high-risk" patients are.  As far as being "relatively uncommon," the fact is that one person every hour of every day will die from oral cancer. 

 



 

Keep reading for oral cancer facts:

 



Prevalence

According to the National Cancer Institute, an estimated 42, 000 new cases of cancer in the oral cavity and pharynx will be diagnosed in 2013. 

Oral cancer will claim 8000 deaths in 2013.

 

Risk Factors

Alcohol and tobacco (using them in combination results in 15 times the risk of using one or the other)

Exposure to the human papilloma virus version 16 (HPV 16), which is now the leading cause of oral cancer in the U.S.

An estimated 25% of cancer patients have no known risk factors

Almost twice as many men as women will be affected by oral cancer

Historically, oral cancer has been a disease of those over 40, but the fastest growing segment of the oral cancer population is young, healthy, non-smokers due to the connection with HPV

Prolonged exposure to sun or tanning beds increases the risk for lip cancer

Users of smokeless tobacco face a 40% greater risk of oral cancer than non-users

 

 Possible Signs and Symptoms

Sore on the lip or in the mouth that doesn’t heal

Lump or thickening on the lip or gums or in the mouth

White or red patch on the lips, tongue, gums, tonsils, or lining of the mouth

Bleeding, pain, or numbness on the lip or in the mouth

Change in voice

Loose teeth, dentures that no longer fit

Trouble chewing or swallowing, or a feeling that there’s a lump in the throat

Persistent hoarseness or sore throat

HPV

HPV is the fasted growing sexually transmitted infection

At least 50% of sexually active people will acquire HPV at some point in their lives

99% of those with HPV infections clear the virus through the normal immune response with little or no apparent symptoms (1% will develop cancer)

HPV-oropharyngeal cancer has been tied with oral sex, but the virus (when active) may be passed on with kissing

HPV has accounted for a 225% increase in oropharyngeal cancer since 1988

HPV-16, the same strain that is responsible for the majority of cervical cancer, is responsible for up to 95% of orphayngeal cancer. 

By 2020, HPV-related oropharyngeal cancer will outnumber HPV-related cervical cancer.

 

Early Detection

See your dentist for an oral examination at least annually

The earlier the detection, the greater the likelihood of a cure

Here's the reality of an oral cancer screening: It is not invasive. It is visual and tactile only. It is painless. It is free. You are already in the dental chair. The awkward few minutes of allowing us to look in the back of your throat, feel under your tongue, and examine your cheeks and tongue are out of our belief that early detection DOES save lives. 

 
 

For more information on our oral cancer exam, please click here

For information on the Velscope, one of the adjunctive diagnosic tools our office uses in oral cancer screenings, please click here

 

During the month of April, we are offering free oral cancer screenings.  Please contact us if you would like to schedule an exam.

 

 

If you would like to learn more about oral cancer, please check out mouthhealthy.org, the ADA's consumer website. 

 

 

 

 

Teeth Whitening

Your smile is often the first thing people notice about you!  One of the easiest ways to improve your smile is through whitening.  Below are some of the most frequently asked questions we receive about whitening. 

 

Q: Am I a candidate for bleaching?

A: A proper dental exam is the first step in deciding whether or not you are a candidate for whitening.  We need to determine the cause of discoloration before we can decide whether bleaching will help.  There are several causes for discoloration (abscessed or nonvital teeth, decay) for which bleaching may mask the problem, but not resolve it. 

Q: What are the different whitening options?

 A: There are 3 options: in-office (Zoom!) whitening, at-home bleaching (with custom made plastic trays), and over-the-counter products.  The concentration of bleaching solution, duration of treatment, and cost vary with each option. 

Q: If my teeth become sensitive during treatment, what can I do?

A: Sensitivity is a common side-effect of bleaching.  We suggest reducing the frequency of bleaching (every other day instead of every day).  We also have desensitizing pastes/gels that can be placed into the bleaching try to help reduce sensitivity.

Q: How long will it take and how long do the results last?

A: While everyone’s results vary depending on frequency of use, many people see maximum results with at-home whitening (using custom trays) in about 2 weeks.  No bleaching method can whiten permanently, but results last from 6 months to 2 years, at which time touch-up applications are indicated. Keeping up with regular oral hygiene, avoiding tobacco and beverages that stain (coffee, soda, tea, red wine) can help make bleaching effects last as long as possible.

Q: I have a lot of gum recession and exposed roots.  Can I still bleach?

A: Exposed tooth roots do not bleach, so if you have root exposure that is visible when you smile, the results won’t be ideal.  There are other cosmetic options which we can talk with you about.  

Q: What if I have porcelain crowns or composite fillings on my front teeth?

A: Composites and porcelain restorations will remain the same color.  If you wish to bleach, you have to consider what it will look like if your natural teeth bleach but your restorations do not.  Talk with us to discuss options for your particular case.

If you are interested in learning more about the whitening options we provide, please visit us at www.kalamazoodds.com. 

Pediatric Dental Health

February is National Children’s Dental Health Month! We want our youngest patients to have a lifetime of good oral health and encourage you to bring your child in for a visit.  Below are some Frequently Asked Questions about pediatric dental health.

 

When Should Children Have Their First Dental Visit?

The American Academy of Pediatric Dentistry (AAPD) suggests that parents should make an initial “well-baby” appointment approximately six months after the emergence of the first tooth, or no later than the child’s first birthday.

Although this may seem surprisingly early, the incidence of infant and toddler tooth decay has been rising in recent years.  Tooth decay and early cavities can be exceptionally painful if they are not treated  immediately, and can also set the scene for poor oral health in later childhood.

What potential dental problems can babies experience?

A baby is at risk for tooth decay as soon as the first tooth emerges, and especially so if one of the parents is high-risk.  During the first visit, we try to help parents implement a preventative strategy to protect the teeth from harm, and also demonstrate how infant teeth should be brushed and flossed.

In particular, infants who drink breast milk, juice, baby formula, soda, or sweetened water from a baby bottle or sippy cup are at high-risk for early childhood caries (cavities).  To counteract this threat, we discourage parents from filling cups with sugary fluids, dipping pacifiers in honey, and transmitting oral bacteria to the child via shared spoons and/or cleaning pacifiers in their own mouths.

How can I care for my infant’s gums and teeth?

Many parents do not realize that cavity-causing bacteria can be transmitted from the mother or father to the child.  This transmission happens via the sharing of eating utensils and the “cleaning” of pacifiers in the parent’s mouth.  Parents should also adhere to the following guidelines to enhance infant oral health:

•Brush – Using a soft-bristled toothbrush and a tiny sliver of ADA approved non-fluoridated toothpaste (for children under two), gently brush the teeth twice each day.  For infants without teeth, wipe the gums with a damp cloth after every feeding.  This reduces oral bacteria and minimizes the risk of early cavities.

•Floss – As soon as two adjacent teeth appear in the infant’s mouth, cavities can form between the teeth.  Ask us about strategies for flossing your child’s teeth.

•Pacifier use – Pacifiers are a soothing tool for infants.  Be sure not to dip pacifiers in honey or any other sweet liquid.  Prolonged pacifier use, as well as thumb-sucking can be detrimental in older toddlers and young children.

•Use drinking glasses – Baby bottles and sippy cups are largely responsible for infant and toddler tooth decay.  Both permit a small amount of liquid to repeatedly enter the mouth.  Consequently, sugary liquid (milk, soda, juice, formula, breast milk or sweetened water) is constantly swilling around in the infant’s mouth, fostering bacterial growth and expediting tooth decay.  Only offer water in sippy cups, and discontinue their use after the infant’s first birthday.

•Visit the dentist – Around the age of one, the infant should visit a dentist for a “well baby” appointment.  The dentist will examine tooth and jaw development, and provide strategies for future oral care.

When will my child get her first tooth?

The eruption of primary teeth (also known as deciduous or baby teeth) follows a similar developmental timeline for most children.  A full set of primary teeth begins to grow beneath the gums during the fourth month of pregnancy. For this reason, a nourishing prenatal diet is of paramount importance to the infant’s teeth, gums, and bones.

Generally, the first primary tooth breaks through the gums between the ages of six months and one year.  By the age of three years old most children have a “full” set of twenty primary teeth. 

My child has a cavity in a baby tooth.  Can’t we just pull it since it will fall out eventually anyway?

Although primary teeth are deciduous, they facilitate speech production, proper jaw development, good chewing habits - and the proper spacing and alignment of adult teeth.  Caring properly for primary teeth helps defend against painful tooth decay, premature tooth loss, malnutrition, and childhood periodontal disease.

In what order do baby teeth erupt?

 

 I’m pregnant.  Should I be seeing a dentist?

Pregnancy is an exciting time. It is also a crucially important time for the unborn child’s oral and overall health.  The “perinatal” period begins approximately 20-28 weeks into the pregnancy, and ends 1-4 weeks after the infant is born.  With so much to do to prepare for the new arrival, a dental checkup is often the last thing on an expectant mother’s mind.

Research shows, however, that there are links between maternal periodontal disease (gum disease) and premature babies, babies with low birth weight, maternal preeclampsia, and gestational diabetes.  It is of paramount importance therefore, for mothers to maintain excellent oral health throughout the entire pregnancy.

Maternal cariogenic (cavity-causing) bacteria is linked with a wide range of adverse outcomes for infants and young children.  For this reason, the American Academy of Pediatric Dentistry (AAPD) advises expectant mothers to get dental checkups and counseling regularly, for the purposes of prevention, intervention, and treatment.

 

We hope you have found this information helpful.  If you are an expectant mother or have young children, we would encourage you to call us if you have additional questions or would like to schedule an appointment (269) 344-8988.   Our website also provides additional information on pediatric health, including questions pertaining to pacifiers and thumb sucking, as well as sedation dentistry for children. 

http://www.kalamazoodds.com/procedures/pediatric-dentistry/

Toothpaste Too Abrasive?

Each and every toothpaste has a granular component that is added to aid in the removal of plaque and bacteria.  The primary issue and problem with the granular additive, along with the mechanism of the toothbrush bristles, is that over a period of time it can lead to a "notch-like" defect at the gum line.  These gum line defects occur at the junction where the protective enamel layer stops and the root surface begins.  The areas can be sensitive to thermal (temperature) changes, especially cold, as well as sweets.  Eventually, composite (white filling) material may be required to cover and protect these areas once the defects have occurred.

The latest research and literature supports the fact that the number one cause of these gum line defects is due to the abrasiveness of toothpastes.  The most destructive of the toothpastes are the ones that have whitening components in them as well as some that contain baking soda and tartar control properties.  Any toothpaste that has an abrasive level of 150 (RDA value) or below, we consider as being "safe" to use such as Crest regular or Colgate regular.  Others that are above the 150 abrasive level, we regard as being too abrasive.

We have compiled a current list of many of the commonly used toothpaste on the market today and their granular levels.  Ask us when you are in next for a copy to insure that what you are using at home is not too abrasive.

Canker Sore Relief

Canker sores (apthous ulcers) occur in approximately 20% of the population.  They are usually located under and/or on the tip of the tongue, inside the cheeks or lips or along the gum tissue.  These ulcers can vary in degree of painfulness and usually heal uneventfully in seven to ten days.  Occasionally, some may have a prolonged healing time.  The exact cause of canker sores is not known.  However, the following factors or conditions are probable causes associated with the development of the oral ulcers.  Stress, vitamin deficiencies, medications, diseases (celiac, Crohn's and lupus), trauma, food allergies and toothpaste containing sodium lauryl sulfate.

If you are someone who frequently suffers from canker sores, we have several over the counter topical medications or prescription medications as well as a nutritional recommendations available in relieving the outbreak stage, making eating and talking more comfortable.  We also suggest checking with us if you have unusually large or painful canker sores that do not seem to heal.

As there is no definitive cure for canker sores, we are confident in giving you recommendations which are based on the individual patient needs and the severity of the ulceration.  Feel free to consult one of us at your next visit or contact us regarding treatment options on canker sores.  Our goal is to keep you comfortable and provide you with the most up to date information on products and nutritional recommendations.

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