Tag Archives: periodontal disease
Let’s look at home whitening kits and why you should avoid them. It shouldn’t come as a surprise that we, as a society, value a good-looking smile. In a recent survey by the American Academy of Cosmetic Dentistry, 99.7 percent agreed that a smile is an important social asset. The flipside of that is that an unattractive smile can be seen as a handicap. And in fact, 74 percent of those surveyed felt an unattractive smile could hurt a person’s chances for career success.
And one of the most common qualities they cited among those with unattractive smiles? “Discolored, yellow, or stained teeth.”
Again, not exactly breaking news. If you’ve spent any time in a CVS, Walmart, or the like over the last few years, you already know how important white teeth are. In that span, home whitening kits have gone from existing on the periphery to taking over entire aisles. Americans are spending more than a billion dollars a year on teeth whitening products.
But, while most home whitening kits are comprised of the same components (strips or trays, bleach), not all teeth staining is the same. If you’ve ever looked closely at your teeth in a mirror, you may have noticed that the discoloration varies subtly. Which could be one reason why, if you’ve ever tried whitening your teeth at home, it had little, if any, effect.
There’s an even greater concern at hand, though: Those kits may actually be destroying your teeth.
What causes the discoloration in the first place?
There are basically two ways your teeth can become discolored: from the outside in and the inside out. The former is the more common and the easier to correct. Coffee, wine, and countless other foods and drinks we consume on a regular basis (chocolate!) leave behind particles that lodge in the teeth’s protective enamel and gradually stain our teeth.
When the staining originates inside the tooth, it’s because the dentin, the bony tissue beneath the enamel, becomes damaged. It can occur as the result of injury, the use of some medications, and bad oral hygiene.
Hard as the enamel is, it’s also thin. Dentin actually makes up most of the tooth’s structure. And it’s already darker than enamel. So, if your enamel wears down—which occurs naturally as we age, though not brushing and flossing enough or consuming too much soda and juice can speed up the process—the dentin can begin to show through.
A blow to the tooth could damage the nerves and tissues at its core, cutting off the blood supply. The nerves and tissues can also become infected as a result of an untreated cavity, which could interfere with the blood supply. In both cases, the tooth could turn gray as the damage worsens.
Tetracycline, a type of antibiotic, can also cause teeth to gray if it’s used during childhood, when teeth are still developing. It can also affect developing babies’ teeth if it’s taken during pregnancy. But that effect is much more widely known today, so doctors generally won’t prescribe it in those cases. There are, however, certain high blood pressure medications and antihistamines that can have the same effect.
In those cases where the discoloration begins within the tooth, not even a professional whitening is going to do much to improve the appearance because there are deeper dental issues at play. The appropriate treatments, while not directly addressing the discoloration, will ultimately improve the tooth’s appearance.
Also worth noting, whitening of any kind is typically not effective on restorations—tooth-colored fillings, dental crowns, porcelain veneers, dental implants. At the very least, using a home whitening kit if you have restorations will result in uneven whitening. (The teeth without restorations will appear lighter than those with them.) But new research is indicating that it may also cause the restorations to break down.
Whitening is also less likely to work if you have other oral health concerns, like tooth decay or periodontal disease. The whitening solutions penetrate any existing decay and the inner areas of the tooth, which can cause a painful sensitivity.
Ineffectiveness is the least of the concerns
For all their popularity, there’s little evidence supporting that home whitening kits do what they say they do. A study published late last year found “low to very low-certainty evidence over short time periods” that home whitening kits were any more effective than a placebo.
But the even-greater cause for concern comes from research that was presented this spring at the annual meeting for the American Society for Biochemistry and Molecular Biology in Orlando. In three new studies, undergrad students working under Kelly Keenan, PhD, an associate professor of chemistry at Stockton University here in New Jersey, found that hydrogen peroxide, the active ingredient in over-the-counter whitening strips can damage dentin, that bony tissue beneath the enamel.
It was already established that hydrogen peroxide can penetrate the enamel and dentin. But Dr. Keenan and her students were able to show that the collagen in the dentin layer—which makes up most of the tooth—decreased after the teeth were treated with whitening strips.
Whitening strips, in other words, are capable of eating away at our teeth.
The safe way to prevent staining
What to do, then? Get in front of it. Even if you’re already experiencing some discoloration, you can prevent it from worsening by following a few basic steps:
- Brush your teeth at least twice a day for two minutes at a time and floss at least once a day. (Check out our oral hygiene primer to make sure you’re doing both correctly.) Flossing’s the only way to clean between teeth and under the gums, which is where most cavities, stains, infections, and other kinds of dental damage begin.
- Try to avoid sugar, starches, and highly acidic foods and drinks as much as possible. If you do partake, brush afterward, but not immediately afterward. Wait about an hour because acid can temporarily soften your enamel.
- And get a professional examination and cleaning twice a year. A hygienist can scrub those hard-to-reach spots. A dentist or periodontist can also treat any issues before they worsen and offer advice tailored to your lifestyle on how to stave off further staining.
If it’s been a while since you’ve seen a dentist, or if you have other dental concerns that need to be treated before addressing your teeth discoloration, contact my office and schedule an appointment. The earlier the intervention, the sooner you can get back to smiling with confidence. and remember to avoid home whitening kits!
For the first time, the standard bearers of the dental field are asking themselves if we’re adequately prepared to meet the needs of transgender and transitioning people. The honest answer in most cases is we are not.
In fact, as the transgender population blooms—one recent estimate put it at 1.4 million people in the United States and around 25 million worldwide, though both are believed to be very conservative—and creates a greater need for health care providers, including dental professionals, who are experienced in managing their care, the social and institutional stigma against transgender people is resulting in discrimination within the health care field.
At least part of the problem can be attributed to ignorance. Little research has been conducted on the oral health implications of transitioning and the barriers to care. At this point, what little we do know about the transgender community is mostly being gleaned from the limited research on the larger LGTBQ community. Not that that should serve as an excuse. If anything, it should further illustrate just how slow we’ve all been to respond to what’s been a prevalent need for quite some time now.
The minority stress theory
One of the few studies focused on the transgender community that does exist was published in late 2017. An anonymous survey among transgender adults was conducted using both a web-based and paper survey. The researchers were attempting to evaluate the level of “dental fear” among transgender people and see if they could spot predictors for it.
“Dental fear” is a term that was coined to describe the anxiety and fear that can be felt in anticipation of or in reaction to dental care. People who have professional dental care regularly generally have fewer oral health problems. But, lots of studies have found that dental fear is one of the most common reasons people don’t maintain that care as they should, along with the cost of dental procedures.
This study found that across the spectrum of transgender identities and biological conditions due to hormonal interventions, the rate of dental fear was higher than at any other point over the last 40 years, though only marginally. “The reason for the slightly higher dental fear may be explained by the minority stress theory,” the researchers wrote.
The minority stress theory posits that when minority groups face chronic levels of increased stress, they develop a negative psychological response to trauma.
The National Transgender Discrimination Survey reports that 19% of people who identify as transgender have experienced refusal of health care, 28% have experienced harassment, and 50% felt a lack of provider knowledge regarding the caring of transgender individuals. Even more, 28% have postponed receiving health care due to fear of discrimination.
That’s the epitome of the minority stress theory.
Those results are riddled with any number of concerns. For one, 40% of transgender individuals have attempted suicide, in part because of that stress, which is roughly nine times the rate of attempted suicide among the US population overall. For our purposes here, let’s home in on why the lack of regular, professional dental care is particularly troubling for someone who is transitioning or transgender. Variations in hormone levels directly affect the oral cavity. So, patients who are undergoing hormone therapies should expect an overly severe inflammatory reaction, which can lead to greater incidences of gingivitis and periodontal disease.
Change on the most basic level
The American Dental Association Commission on Dental Accreditation, in its Accreditation Standards for Dental Education Programs states that “programs must create an environment that ensures an in-depth exchange of ideas and beliefs across gender, racial, ethnic, cultural, and socioeconomic lines” and that “graduates must be competent in managing a diverse patient population and have the interpersonal and communications skills to function successfully in a multicultural work environment.” Despite these statements, education about the care of sexual and gender minority patients has been found to be lacking in predoctoral dental education. The result is a profession of dental providers who may be uncomfortable with the delivery of care specific to transgender patients.
That’s an excerpt from an article titled “Should Dental Care Make a Transition?” that appeared in The Journal of the American Dental Association in February 2018. Where exactly does it leave us? Adrift, that’s where. Are we supposed to wait while curriculums are overhauled? That could take years. And that’s presuming that it’s already begun, which it hasn’t.
For a study that was published earlier this year, oral and maxillofacial surgery residents in accredited training programs across the US were surveyed between July 1, 2017 and January 30, 2018. The results showed that they “had limited exposure to the care of transgender people, but they perceived that such exposure should be an important component of their training.” In other words, medical school and academic hospitals still exist in a bubble.
Institutions are slow to change, even when lives are at stake. So this change is going to need to begin in grassroots fashion, with each one of us consciously meeting our patients where they are, without judgement or preconceptions. It’ll be awkward and mistakes are bound to be made, but that shouldn’t deter us. In a recent survey, transgender and gender-nonconforming people, as well as support networks, said that respectful mistakes are readily corrected with goodwill. Basically, the effort is what matters most—for now.
All of this begins with trust. And, as with every other kind of relationship, that will grow from simply greeting each other with all the respect, kindness, and empathy that should entail. It’s really that simple.
While it’s true that periodontal disease is largely a threat to adults, gingivitis, a mild form of periodontal disease, is often found in kids and teens. In fact, more than half of teens have some form of gum disease, according to a recent estimate.
Which is why it’s important as a parent to be aware of the risk factors and know how to spot the warning signs in your child. Taking your own oral hygiene seriously is also a good idea. It’ll go a long way toward encouraging the same behavior in your kids. We’ll unpack all of that here.
Gum Disease in Kids: Toddlers and bleeding gums
Toddlers’ gums can bleed from brushing for several reasons, but the build-up of plaque is one of the most common. The bacteria in their mouths feasts on the sugar in their foods and forms plaque. In time, that plaque can become tartar and lead to tooth decay and inflamed gums that bleed from brushing.
The problem’s usually easily remedied as long as it’s caught and treated early on. Get into the habit of brushing your toddler’s teeth in the morning and at night, as well as right after any sugary or starchy snacks. (You should help with the brushing until they gain the coordination to do it themselves around seven or eight.) For toddlers two and under, use the equivalent amount of a grain of rice in toothpaste. For those between three and five, keep it to a pea-size amount.
Schedule your toddler’s first dental visit around their second birthday. Most of their teeth will have grown in by then. That first visit will mostly be about familiarizing them with the process, but it’ll also give your dentist an opportunity to spot any less-obvious issues at their onset.
Changing your toddler’s diet will also improve their oral health. You don’t need to avoid juice, candy, pretzels, crackers, and pasta altogether—though, more power to you if you can. Just try to make them occasional treats.
Gum Disease in Kids: Teens and gum disease
Do you remember your teenage years? Some days, most days, it felt like your own body was conspiring against you, right? That’s actually not too far from the truth.
Hormonal changes in teens can put them at risk for periodontal disease. In other words, simply by entering puberty they become more susceptible. During puberty, an increased level of progesterone or estrogen can spur a surge in blood circulation to the gums. In turn, the gums may become more sensitive to irritants, including food particles and plaque, causing them to swell, turn red, and feel tender.
That should subside as your teen gets older as long as they’re following a good oral hygiene regimen. But puberty’s not the only risk factor for developing gum disease. They may inherit the tendency from you and your partner. Braces also make it more difficult to stave off plaque, so cleanings by a dentist may need to be done more frequently than biannually during that period.
And it shouldn’t come as much of a surprise (unless you skipped over the toddler segment) that a poor diet won’t help matters. We’re all pretty well-versed on the evils of sugar by now, but starchy foods, like fries, are trouble, too. They feed the acids that eat away at tooth enamel.
Add some lousy sleep habits and an abundance of stress—it comes from all directions at that age—and it’ll leave your teen more vulnerable to any kind of infection, including gum disease.
If they tell you their gums have been bleeding when they brush or floss, take them seriously and schedule an appointment with their dentist. But chances are, it won’t be that easy. So just try to keep a watchful eye from a safe distance.
You can’t control everything your teen eats any more than you can control what they worry about. Try to make the most of the moments when you do have some influence on them. Stock the fridge and pantry with healthy options. And lead by example.
Gum Disease in Kids: The role model
It may be way more obvious with a toddler than it is with a teen, but you are your child’s leading role model. They’re picking up on so much of what you’re doing—even when they’re pretending like they’re not.
So, if you aren’t already, get into the habit of brushing and flossing at least twice a day. And try to do it in front of your child. Or at least make them aware that you’re doing it.
Just as importantly, take your time doing it. Maybe even bone up on these brushing and flossing tips. Who knows? You could learn something. A lot of us picked up bad habits at an early age because our parents never showed us the right ways. Right the ship with your child.
And schedule regular dental visits and comprehensive periodontal evaluations. Early diagnosis ensures the greatest chance for successful treatment at all ages.
Periodontal disease may help initiate Alzheimer’s disease, according to a new study. Researchers at the University of Illinois at Chicago found that untreated periodontal disease caused inflammation and the degeneration of brain neurons in mice that’s similar to the effects of Alzheimer’s disease in humans.
“Other studies have demonstrated a close association between periodontitis and cognitive impairment, but this is the first study to show that exposure to the periodontal bacteria results in the formation of senile plaques that accelerate the development of neuropathology found in Alzheimer’s patients,” Dr. Keiko Watanabe, one of the study’s authors, told Science Daily.
The mice that were exposed to the bacteria again and again had much higher amounts of a senile plaque that’s found in the brain tissue of Alzheimer’s patients.
What this means is that the bacteria from periodontal disease is not just travelling from the mouth to the brain; it’s also significantly disrupting the brain, to a potentially fatal degree, when it’s left unchecked over a long enough period.
A new common thread
Periodontal disease has already been linked to heart disease, diabetes, and several types of cancer, though the nature of those relationships is just beginning to come into focus. Initially, the catalyst seemed to be the bacteria from periodontal disease. But now it appears that inflammation, the body’s natural response to infection (periodontal disease is an infection) plays a role, too.
Scientists don’t completely understand what causes Alzheimer’s disease in most people, either, though this new study potentially exposes one of the clearest paths yet. There’s thought to be a genetic component in some early-onset cases. Late-onset Alzheimer’s stems from a complicated series of brain changes that occur over decades, according to the National Institute on Aging.
The causes likely include a combination of genetic, environmental, and lifestyle factors. But it’s been difficult to understand how much of an influence each one of those has because their importance can vary from person to person. In other words, there’s not a straightforward cause-and-effect equation. But that may be about to change.
For a while now, there’s been a lot of interest in the factors beyond genetics, like the relationship between cognitive decline and heart disease and diabetes. With this new study, there’s suddenly a common thread: periodontal disease.
What we do know
For all the uncertainty, here’s what we do know about Alzheimer’s disease. Back in 1906, Dr. Alois Alzheimer noticed abnormal clumps (now called amyloid plaques) and tangled bundles of fiber (now called tau or tangles) in the brain tissue of a woman who died of an unusual mental illness. These plaques and tangles are still considered some of the main features of Alzheimer’s disease.
Another is the loss of connections between neurons. Neurons are the body’s broadband. They transmit messages between different parts of the brain and from the brain to muscles and organs. Imagine if all your emails started coming back as undeliverable. In a very basic sense, that’s kind of what having Alzheimer’s is like.
It gets murky from there, but researchers think it’s likely that damage to the brain begins a decade or even more before memory or other cognitive problems become apparent. All the while people feel and appear to be symptom-free. But as more neurons die, more of the brain is affected. What begins as occasional forgetfulness will eventually evolve to an inability to do even the simplest stuff.
Because the onset is still shrouded in mystery, and the rate of progression is different from person to person, Alzheimer’s disease, at this point, is irreversible.
How widespread is it? It’s hard to come up with a concrete count because it’s commonly misdiagnosed and undiagnosed, but the consensus is that about 5.5 million Americans have it. It’s ranked as the sixth-leading cause of death, though it may be closer to the third, behind heart disease and cancer, for older adults, according to the National Institute on Aging.
With our population about to become older than ever before, because of the large amount of aging Baby Boomers, there’s a heightened urgency to understand Alzheimer’s before those numbers begin rising sharply.
Too good to be true?
More positively, a nutritious diet, physical activity, social engagement, and mental stimulation have all been shown to help people stay healthy as they age, and there’s a hope among the scientific community that they may also reduce the risk of cognitive decline and Alzheimer’s. A number of clinical trials are testing those possibilities now.
But what if it turns out to be even easier than that in most cases? What if it comes down to simply preventing and treating periodontal disease? Sound too good to be true? Consider this, then: Right now, half of American adults have periodontal disease, and 70 percent of adults 65 and older have it.
Seems like a minimal investment for a potentially huge reward, right? So, let’s start here. You’ll find a rundown of some of the clearer warning signs for periodontal disease. If you think you may have it, or even if you’re unsure, contact my office and schedule an appointment. I’ll conduct a Comprehensive Periodontal Evaluation.
If you’ve read this far, what’s another hour, especially when it could mean adding years to your life?
More than 80 percent of American adults suffer from periodontal disease caused by plaque build-up, according to one count. Are you one of them?
Plaque hardens within just a few hours of forming on your teeth, and turns into tartar in less than a couple of weeks. That build-up can lead to periodontal disease and tooth loss if it’s left untreated.
No doubt this is far from the first time you’ve heard about plaque. Your dentist probably mentioned it every time she or he reminded you to brush and floss twice a day at the end of your appointments as a kid. But, did you ever really know what it was and why it’s so important to prevent? It’s OK to admit that you didn’t. We’re going to clear that up here and now.
What exactly is plaque?
Let’s start with a basic definition: Plaque is a sticky film that constantly forms on our teeth from leftover food and the saliva in our mouth. It’s loaded with bacteria. The sugars in the food and drinks we consume cause the bacteria to release acids that attack our teeth’s enamel. When the enamel breaks down, that’s how cavities happen.
While that sounds fairly serious, it’s easily remedied. Brush and floss at least a couple times a day and see your dentist every six months for a professional cleaning. Start to break from that habit, however, and that’s when your plaque will harden and turn into tartar. And tartar can lead to gingivitis, an early form of gum disease, and periodontal disease.
Almost all food and drinks cause plaque—which is why it’s so important to brush and floss—but some are especially menacing. These are a few of the most popular offenders:
Yeah, saliva comprises some of that sticky film, but it also washes away food particles. Drinking, however, dries out our mouths, which makes it all that much easier for plaque to form. So, drink lots of water, too. It’ll keep your mouth hydrated and, with any luck, stave off tomorrow morning’s nasty hangover.
I know: We love bread, but it never seems to love us back. As we chew it, our saliva breaks down the starches into sugar. Even more, after enough chewing, that bite of bread has become more like a paste that sticks to the crevices between our teeth. You don’t have to quit bread. Just try to eat less-refined varieties. They have less added sugars, and they don’t break down as easily.
One recent study found that a steady diet of soda could be as damaging to our teeth as using methamphetamine and crack cocaine. Sodas enable plaque to produce even more acid. Compounding the problem, it also dries out your mouth. There’s really no healthier alternative here. Just try to avoid soda altogether.
So, how do I remove plaque?
Once plaque hardens into tartar, the only way to remove it is to see your dentist because your teeth will need to be professionally scraped.
Don’t believe the hype about tartar-control toothpastes. They won’t remove tartar or even halt its progress. Instead, they work by removing plaque from your teeth before it hardens and turns into tartar—which just about any toothpaste is capable of doing.
In fact, brushing your teeth, basic as it may seem, is the most effective measure you can take for not only preventing plaque build-up in the first place but also removing the plaque that’s already started to form. As long as it hasn’t yet hardened into tartar, brushing can eliminate plaque from your teeth in its entirety.
Brushing also removes the loose food particles that contribute to the development of plaque. (Not insignificantly, it also ensures you won’t be delivering another morning presentation with a poppy seed lodged between your two front teeth. It’s hard for all involved to unsee that one.) Just be sure to brush all of your teeth’s surfaces—front, back, top, and bottom. And when you’re done, get in there with a piece of floss. Flossing will flush out the most stubborn particles that are hiding out in the nooks between your teeth.
What if I’ve developed periodontal disease?
Even more startling than the number I led with—80 percent of American adults suffer from periodontal disease caused by plaque build-up—is the likely reality that it’s a conservative estimate. Periodontal disease has been described by one expert as, “one of the most prevalent non-communicable chronic diseases in our population.” So, if you believe you have periodontal disease, you’re far from alone.
Reading this blog post is a good place to begin your treatment. For your next step, contact my office and schedule an appointment. I’ll conduct a Comprehensive Periodontal Evaluation and then tailor a treatment plan that we can begin implementing at your next visit. There’s no need to be self-conscious or embarrassed anymore. But the longer you wait to do something about your periodontal disease, the greater the risk for potential complications.
Why Are My Gums Bleeding?
You’re gazing into the mirror over the bathroom sink, lost in the ritual of your morning routine. Your hands are tugging a piece of floss, tightly strung between your two index fingers, from one side of your mouth to the other. But your mind’s back in bed or already deep in your day—until you notice a spot of blood in the sink.
What just happened? Where did that come from? You look down at the floss. Sure enough, it stained red. Was I doing it too hard? Maybe you feel around your gums with the tip of your tongue and notice an area that feels a little tender.
It’s nothing, right? When I rinse at the end of a cleaning at the dentist, there’s always a little blood. No pain, no gain.
Yes, some occasional bleeding as a result of flossing isn’t usually a problem. But it’s hard to say with total certainty because the flossing may not be the true cause. In fact, bleeding gums are a precursor for a number of larger health issues, some of them fairly serious. We’ll unpack the most common ones here.
Most often, bleeding gums are a sign of gingivitis, a mild form of gum disease. The same bacteria that can cause cavities can also get beneath your gums and cause swelling, irritation, and, eventually, bleeding.
Gingivitis is pretty easy for a dentist or periodontist to spot and treat. But, for as common as it is, it too often goes untreated. And when that happens, gingivitis can progress to periodontal disease, which is much more severe and difficult to treat.
A recent study by the Centers for Disease Control and Prevention discovered that about half of American adults are walking around with periodontal disease. But I brush and floss like I’m supposed to, you’re saying. In some cases, that’s not enough. Some of us just run a greater risk for developing periodontal disease. Men, for example, are more prone to it than women by a pretty wide margin (56 percent vs. 38 percent). And while it’s true that periodontal disease is more common among older adults, don’t be so quick to brush it off if you’re in your twenties or thirties. Basically: There’s no such thing as being too young to get gum disease.
If you suspect you may have gum disease or periodontal disease—click here for a quick rundown of the most obvious symptoms—schedule an exam with me. It’s never too late to treat, but the sooner we can do so, the better.
Stress is a fact of life anymore. But when it starts to feel relentless, stress becomes a different animal that’s capable of causing physiological damage. Essentially, when we’re stressed, our bodies react in much the same way they do in the presence of infection. When that happens in prolonged bouts, that constant state of alert taxes our immune systems and, after long enough, will eventually begin to break them down, making us more susceptible to infection—including gum disease.
If you think you’re doing a decent job of managing your stress, but you’re consistently waking in the morning with a sore jaw, your body may be telling you otherwise. Even if you haven’t spotted any bleeding while you’ve been brushing or flossing, schedule an appointment with me. Clenching and grinding your teeth can put excess strain on both the teeth and the gums and, ultimately, break them down.
Hormonal fluctuations spurred by pregnancy can cause a slew of unusual things to happen to a woman’s body, including bleeding gums. About half of all pregnant women will have what’s referred to as “pregnancy gingivitis” by their second trimester.
The hormonal changes alter the body’s response to the bacteria that causes gum disease. But the symptoms—swollen gums and bleeding during brushing—almost always clear up after pregnancy, according to the American Pregnancy Association. Still, keep up with your biannual dental checkups and oral hygiene regimen to ensure that the problem doesn’t escalate.
If you’re taking blood-thinners, you’ve likely already been warned about the potential for bleeding gums. But few of us are aware that over-the-counter ibuprofen qualifies as one and, hence, carries the same risk.
As a rule of thumb, it’s a good idea to keep your dentist or periodontist abreast of any medications you’re taking, including ibuprofen, even if it’s only for the occasional headache or sore back. That knowledge may alter the course of a treatment they’re planning. And if you think one of those medications may be causing your gums to bleed, they’ll be to tailor your oral hygiene regimen to minimize the effect.
Poor oral hygiene
Speaking of oral hygiene, it’s kind of the elephant in the room.
Occam’s Razor is a philosophy principle that believes the simplest explanation is usually the correct one. Not to understate the significance of any of the aforementioned causes, but they all kind of assume that a basic oral hygiene regimen is in place. If it’s not, there’s really not much need to look any further.
As simply as I can put it: If you’re not brushing your teeth twice a day and flossing at least daily, you’re going to develop gingivitis. And unless you have it treated, it’s going to progress to periodontal disease.
Pay attention to your technique, too. You may think you’re doing yourself a favor by brushing hard or flossing aggressively around your gums, but regularly agitating your gums can also lead to gingivitis. If you have even a hint of doubt about whether you’re doing it right, check out our short oral hygiene primer.
The takeaway: Keep up with your daily oral hygiene regimen and biannual dental checkups. They’re the most effective means to remove the plaque and bacteria that can cause serious irritation and bleeding. And if you’re already experiencing it, for any reason, schedule an appointment with me. I offer a wide variety of treatments to remedy bleeding gums.
Losing a tooth as an adult is one of those scenarios that’ll probably never cross your mind until it happens to you. That realization, whether it occurs abruptly—you unknowingly bite down on a nutshell and crack a molar—or gradually—your periodontal disease progresses to the point that a tooth or two loosens—will come as a rude awakening.
But adult tooth loss is far more common than you may realize. At this very moment, 120 million people in the United States are missing at least one tooth, and more than 36 million have no teeth at all, according to the American College of Prosthodontists. And those numbers are only projected to grow over the next couple of decades as our population gets older. By 2030, it’s estimated that one in five people will be 65 or older.
Aging does put you at a heightened risk of losing a tooth—beyond the normal wear-and-tear, everyone over 35 is generally more susceptible to a host of oral health conditions—but it’s not the only risk factor. In truth, just about anyone could be at risk for adult tooth loss because it could occur in so many different ways. (More on that in a moment.) But there are a few things that could be increasing your risk.
Losing a Tooth as an Adult: Are you at greater risk?
Severe periodontal disease was found to be the leading cause of adult tooth loss in a 2015 study that was published in the Journal of Clinical Periodontology. Right behind it? Heavy smoking. Though the two pretty much go hand-in-hand. Smokers are more likely to produce bacterial plaque, which leads to gum disease, the earliest presentation of periodontal disease. And it tends to worsen faster in smokers than in nonsmokers.
Grinding your teeth is another common cause of adult tooth loss. Over time, the constant clenching can wear your teeth down, damaging the enamel and putting you at greater risk for infection and tooth decay.
Bypassing the dentist also isn’t helping your cause. Those checkups every six months may feel like a nuisance, but that’s when your dentist is able to spot potential trouble while it’s most easily treated and largely reversible.
Losing a Tooth as an Adult: All the ways you can lose a tooth
When most of us are forced to think about losing a tooth, the image that comes to mind is some sort of accident. Minor damage, like a chip, stemming from the likes of a bad bite or a blow to the face, can be repaired, but serious cracks usually require the tooth to be extracted.
On the opposite end of the timing spectrum, gum disease can gradually evolve to periodontal disease, at which point bacteria begins growing under your gum line, and as it grows, it begins to separate the tooth from the gums. The greater that gap, the higher the likelihood that the tooth is going to loosen and eventually either fall out on its own or need to be removed to prevent further damage to the surrounding teeth.
If that sounds too dramatic to ever be you, consider this: About half of American adults age 30 and older have periodontal disease at this very moment, according to the Centers for Disease Control and Prevention. Now that we’ve got your attention, if you’re interested in learning more, check out our four-part blog series on periodontal disease, starting here with How to Tell if You May Have Periodontal Disease.
A cavity left unchecked is also asking for trouble. Caught early—again, a reason to keep those six-month checkups with your dentist—a cavity can be remedied with a filling or a dental crown. However, when it’s left untreated, a cavity can cause decay so extensive that the tooth will need to be extracted.
Losing a Tooth as an Adult: Why you need to restore a missing tooth
A cascade of negative effects begins to occur when you lose even a single tooth as an adult. Almost immediately, you compromise your other teeth and gums because they’ll begin shifting to fill the void, which, eventually, is going to lead to a misaligned bite. In the short term, that’s going to result in some discomfort and premature and uneven wear and tear on the remaining teeth. In the longer term, it could spur more tooth loss.
Also in the long term, the underlying jawbone will begin to deteriorate. It needs constant stimulation, which is easy to come by when you have a mouth full of healthy teeth. Over the course of an average day, they’ll come into contact with each other hundreds of times. The bit of vibration that results is all the stimulation that the bone needs. However, when you lose a tooth, the portion of bone beneath that gap will start to wither from inactivity.
So, remedying your missing tooth (or teeth) is clearly important to your short- and long-term oral health. How, then, should you go about? A dental implant.
An implant replaces the tooth’s root with a titanium post, unlike dentures, the longtime go-to for tooth replacement, which simply sit on top of the gums. Titanium is a biocompatible material, which means that it’ll organically fuse with your jawbone. That has a couple of significant benefits. For one, it creates a stable foundation for your crown or bridge. It’s also going to spur new bone growth. All of that is critical to the longevity of your dental implant and your oral health as a whole. But what’ll matter most to you is that your implant will look and feel natural. After a couple of meals and lots of smiling at mirrors, you’re probably going to forget it’s even there.
It’s time to start smiling more
To learn more about dental implants, schedule a comprehensive periodontal evaluation with Dr. Richard Staller by clicking here. Dr. Staller’s performed more than 8,000 dental implant procedures. It’s time to start smiling more, and Dr. Staller can help you do it.
Do you think you are too young for gum disease? Think again. A study back in 2005 kind of rocked the foundation of the dental world. Gum disease, researchers said, can start much earlier than we thought. And that wasn’t all. It can also begin without any obvious symptoms.
Up to that point, gum disease in teens and young adults wasn’t unheard of, but it was pretty widely assumed that most people were safe from periodontal problems until their mid- to late-thirties.
Researchers followed 254 people in their twenties who had opted to keep all four wisdom teeth, and what they discovered is that 60 percent already had signs of early gum disease around those teeth at the beginning of the study. Two years later, it had worsened in a quarter of them.
The findings put dentists on high alert. Wisdom teeth usually push through the gums between 17 and 25. The decision to extract them if they weren’t causing any pain or damaging other teeth was constantly debated because there weren’t any studies that proved it accomplished much of anything. But, suddenly, there was a reason to.
“People assume that if you don’t have any symptoms [of gum disease], you’re okay,” the study’s lead researcher, Raymond P. White Jr., told The Washington Post at the time. “What we’re saying is that’s not necessarily the case.”
Who’s at risk?
Of course, keeping or extracting your wisdom teeth isn’t the only decision you’ll make that will affect your gums’ health. In fact, there are a number of casual choices you make every day that carry the potential to either nurture or undermine your gums, like that Red Bull you gulped down between classes this morning. Or those M&Ms you snacked on before practice.
It shouldn’t be a huge surprise that diet plays a huge role. Your dentist probably told you during your first check-up (and every one since) that sugar is bad for your teeth. But that’s just scratching the surface. (No pun intended.) Starchy foods, like, gasp, fries, also feed the acids that eat into your tooth enamel.
And too much of the wrong food combined with too little sleep is a recipe for stress, which makes you more vulnerable to infection, and gum disease is an infection.
There are threats that are out of your control, too. Some of you are just more likely to develop gum disease because your parents are the same way, and you inherited the tendency from them. Girls have a higher risk of gum disease than guys. Increases in female sex hormones during puberty can make girls’ gums more sensitive to irritation. You may have already noticed that your gums tend to bleed a little in the days before your period.
But, maybe the most significant influence on your gums’ health is something that’s totally within your control: smoking. If you smoke or chew tobacco, you’re more likely to have plaque and tartar buildup and to show signs of advanced gum disease, according to the American Dental Association.
What’s at stake?
Maybe you’re wondering, If I can’t even tell that I have gum disease, why should it matter that I get it treated right away?
This would be a good time to explain what exactly gum disease is. Gum disease, or gingivitis, is the mildest form of periodontal disease. Basically, your gums become irritated very easily. If you spot some blood on more than a handful of occasions while brushing your teeth, that’s a good indication that you should make an appointment with your dentist.
The most important takeaway here: gum disease is reversible with professional treatment and better brushing and flossing habits. If it’s left unchecked, though, gum disease can advance to periodontal disease, and that can be harder to control.
Gradually, plaque spreads and grows below the gum line. Toxins produced by the bacteria in the plaque irritate the gums. In response, the gums go into panic mode and turn on themselves, and the tissues and bone that support the teeth start to break down. The gums separate from the teeth, forming spaces that become infected.
As the disease worsens, the spaces around the teeth grow bigger and more of the gums and bone are destroyed. Eventually, the teeth can loosen and may need to be replaced.
Even that, however, is not the worst-case scenario. Mounting research is linking the inflammation from chronic infections, like periodontal disease, to an increased risk of more serious problems, including heart disease, diabetes complications, and pregnancy trouble.
All of this is meant to underline a single point: You are not too young for gum disease. The earlier that gum disease is caught, the better. It’s easy to feel kind of invincible in your teens and twenties, but that shield falls pretty fast at the first sign of trouble. You don’t need to be paralyzed with fear. Just don’t turn away from this screen thinking, That’ll never be me.
Let’s delve into treating periodontal disease. We’ve been looking at periodontal disease from a few different angles this summer. Some favor crime dramas for their beach reading. We’re into wellbeing.
In our last post, we discussed a few factors that may be putting you at greater risk of developing periodontal disease, like stress and smoking. Prior to that, we underlined some mounting research that’s indicating periodontal disease may put you at greater risk for developing heart disease and experiencing complications from diabetes.
We also highlighted the early warning signs and prevention tips for parents. Periodontal disease is rare in kids and only sometimes found in adolescents, but it still needs to be on your radar because it’s so easily preventable. And we kicked this short series off with a simple, straightforward explanation of what periodontal disease is.
Here, we’ll delve into treating periodontal disease. If you have it, it’s nothing to be ashamed of. Half of all adults in the United States have some form of periodontal disease. But it is something you’re going to want to treat as soon as you can because it’s going to progress and lead to bigger issues in your mouth and beyond.
Treating Periodontal Disease – No surgery required
For starters, you’re looking in the right place. Periodontists are dentistry’s experts in treating periodontal disease. We receive up to three years of specialized training in both non-surgical treatments and periodontal plastic surgery procedures. We’re also experts in replacing missing teeth with dental implants.
Let’s get into the non-surgical treatments first because they no doubt sound the least daunting, right? In fact, the early stages of periodontal disease are usually best treated with non-surgical therapy. We prefer to limit surgery to cases of absolute necessity, and even then, we’ll often start with a non-surgical treatment to limit the invasiveness of the surgical procedure.
Scaling and root planing is a careful cleaning of the root surfaces to remove plaque and tartar from deep pockets in the gums around the tooth. The tooth root is smoothed and bacteria are removed, allowing the gum tissue to heal and reattach to the tooth. Occasionally, the treatment will be supplemented with another therapy, like antibiotics, but, in the majority of cases, scaling and root planing is the full extent of the treatment, aside from ongoing checkups.
Treating Periodontal Disease- Reviving receding gums
Surgical treatments for periodontal disease come in a few different forms. A sudden sensitivity to hot and cold food and drinks is often a good indication of significant gum recession—if you haven’t already noticed it in the mirror. If it’s left unattended, it’ll progress to root decay and erosion.
Gum recession is usually remedied with a gum graft, which entails taking a thin piece of tissue, either from the roof of your mouth or a synthetic material, or gently moving it from adjacent areas, and creating a new stable, healthy seal around the affected tooth, or teeth.
More severe recession may be treated with a bone graft. As pockets deepen, they collect even more bacteria, which results in further bone and tissue loss. Eventually, if too much bone is lost, the teeth will need to be extracted. But, if treated in time, a bone graft will not only save the teeth, it’ll also encourage the affected jawbone to regrow.
With either procedure, coupled with a daily oral hygiene routine and regular checkups, you can reverse much of the damage caused by periodontal disease and improve your chances of keeping your natural teeth.
When a bone graft isn’t an option, osseous surgery is the next most effective means of halting moderate to severe periodontal disease. A local anesthetic is applied and then the infection is removed and the gum and jawbone are reshaped to create a more effective seal around the tooth.
Crown lengthening is a common cosmetic procedure where excessive gum and bone tissue are reshaped to expose more of the teeth, but it can also serve as a precursor to a restorative dental treatment. When a tooth is decayed, broken below the gum line, or there’s an insufficient amount of it to perform a crown or a bridge, a crown lengthening may be done first.
Treating Periodontal Disease – Get back to smiling more
If you’ve had a tooth or teeth extracted as a result of periodontal disease, a dental implant may be an option.
Dental implants, increasingly, are becoming the more popular choice for teeth replacement because they look and feel like natural teeth. They’re stable enough to let you eat pretty much whatever you want. And, just as importantly, no one will ever notice the difference—including you.
They’re also a permanent solution. A dental implant is an artificial tooth root that’s placed into the jaw to hold a replacement tooth or bridge. That intimate connection with the underlying bone and the surrounding gum tissue helps keep them healthy and intact.
Periodontists are best positioned to place implants, not only because we have special knowledge of the areas involved and the facilities to ensure that your implants look and feel just like your own teeth, but also because we have extensive experience working with other dental professionals. I’ve performed over 8,000 dental implant procedures, and I’ve witnessed my patients’ quality of life improve dramatically with each one.
We launched this little awareness campaign because periodontal disease is inching toward epidemic status at a time when it’s so easily preventable and dental care has never been more accessible. The takeaway we’ve tried to emphasize throughout is this: See a professional, whether for a regular checkup or an evaluation. Any reservations you may have pale in comparison to the threats periodontal disease poses when it’s left unchecked.
A few posts back, we referenced a disturbing statistic: Nearly half of American adults have some form of periodontal disease. In adults 65 and older, it jumps to 70 percent. The more we thought about that, the less we could explain why it was happening.
Oral health care has never been more accessible, yet periodontal disease is being described as “one of the most prevalent non-communicable chronic diseases” of our time.
There is a silver lining, though. This is one of the those cases where a little awareness could have a profound effect, so we decided to dedicate a few blog posts to answering all the questions about periodontal disease you never knew to ask. In the first post, we defined what it is and outlined a few easy-to-spot symptoms. In the next one, we discussed how periodontal disease may have a hand in some seemingly unrelated and very serious conditions, like heart disease and diabetes. Here, we’re highlighting some of the things that are putting you at risk of developing periodontal disease.
Check back next month for the conclusion of the series, when we’ll get into how you can treat your periodontal disease.
(Mostly) Self-inflicted factors for Risk of Developing Periodontal Disease
Let’s be clear: The leading cause of periodontal disease is plaque, which is rarely an issue when you maintain a daily brushing and flossing routine and see your dentist or periodontist a couple of times a year.
That said, there are some unhealthy habits that trump even the most diligent oral health care regimen. Let’s start with the most obvious: smoking and tobacco use. It shouldn’t come as a surprise that either isn’t doing your mouth any favors. In fact, tobacco’s been shown to be one of the most significant risk factors in the development and progression of periodontal disease.
Stress isn’t far behind. When there’s little reprieve, your body has a harder time fighting off infection, and periodontal disease begins as an infection. The same goes for a poor diet. Not consuming an adequate amount of nutrients hamstrings your immune system.
If you’re waking on a regular basis with a sore jaw, schedule an appointment with your dentist or periodontist. Clenching or grinding your teeth can put excess strain on the tissues supporting the teeth and even destroy them. And while you’re there, share any medications you’re taking. Some drugs, such as oral contraceptives, anti-depressants, and certain heart medicines, can affect your oral health.
Likewise, if you’ve recently been diagnosed with a systemic disease, like heart disease, diabetes, or rheumatoid arthritis, make sure your dentist or periodontist knows about it. Some can interfere with your body’s inflammatory response, which can worsen the condition of your gums.
And, now, for a couple of risk factors you have no control over. Like we said, periodontal disease is most rampant in seniors, so there’s aging, for one. You may also be genetically predisposed to getting periodontal disease. More positively, getting a genetic test before you ever show signs and, if necessary, seeking treatment will likely help you keep your teeth for your lifetime.
Women, what you need to know about your Risk of Developing Periodontal Disease
Unfortunately, the threats don’t end there. Though, the risk factors still looming breakdown largely along gender lines.
Preliminary research has indicated that pregnant women with periodontal disease may be at greater risk of having a baby that’s born too early and too small. It’s still too early on to say it with any certainty, but, because any infection is a cause for concern with a pregnant woman, it’s recommended, just to be on the safe side, that you have a comprehensive periodontal evaluation if you’re considering conceiving.
Girls (and their parents) should start paying closer attention to their gums with the onset of puberty. Increased levels of sex hormones, like progesterone and possibly estrogen, may increase the gums’ sensitivity and lead to a greater reaction to an irritation, including plaque.
Up to that point, periodontal disease is rare in kids and only sometimes found in adolescents. Though, it’s a critical time to instill those oral health care habits.
Some women experience a condition called menstruation gingivitis, during which the gums may swell and bleed and sores may appear on the inside of the cheek right before the start of a period. Typically, it clears up once her period begins.
And, women who are menopausal or post-menopausal may begin to notice discomfort in their mouths, including dry mouth, pain and burning sensations in the gums, and an altered sense of taste. A small percentage of women experience a condition called menopausal gingivostomatitis, where the gums become discolored and bleed easily. Estrogen supplements can help relieve the symptoms in most women.
Each of these conditions is a kind of gingivitis, the mildest form of periodontal disease. Untreated, it can progress to periodontal disease. But, everything can be addressed during a routine checkup.
Men, what you need to know about your Risk of Developing Periodontal Disease
For men, it’s less about fending off heightened inherent risks than it is getting out of your own way.
Men are more prone to periodontal disease than women by a pretty significant margin (56 percent vs. 38 percent). There are a couple of theories on this. Men may simply experience higher incidences of plaque and bleeding gums. They may also be more reluctant to see a dentist or a periodontist, which enables minor instances of gingivitis to flourish unchecked.
But, guys, there are a slew of reasons why you need to be paying better attention to what’s going on inside your mouths. For starters, men with a history of gum disease are 14 percent more likely to develop cancer than men with healthy gums. More specifically, men with periodontal disease are 49 percent more likely to develop kidney cancer than women, 54 percent more likely to develop pancreatic cancer, and 30 percent more likely to develop blood cancers. A half-hour in the exam chair every six months doesn’t seem like such a nuisance now, does it?
There’s even more to the cancer threat. A prostate-specific antigen (PSA) is an enzyme created in the prostate that’s normally secreted in small amounts. Its levels rise, however, when the prostate becomes inflamed, infected, or affected by cancers. Research is indicating that men who show signs of periodontal disease, like swollen or tender gums, as well as prostatitis, have higher levels of PSA than men with only one of the conditions, meaning prostate health may be associated with periodontal health, and vice versa.
Not to hit you again where it hurts most, but men with periodontal disease, especially those younger than 30 and older than 70, are at increased risk of developing impotence. Researchers are thinking that prolonged chronic inflammation—the very kind associated with periodontal disease—can damage blood vessels, including the ones down there.
So much of this, for men and women, comes down to simply being more aware of your health, both overall and in your mouth. Again, the top takeaway with periodontal disease is: It’s easy to prevent.