Blog of the Day: Controlling Halitosis (Bad Breath)

                                                                           *webdicine.com

Bad breath is breath that has an unpleasant odor. It's also known as halitosis. This odor can occur from time to time, or it can be long lasting, depending on the cause.

Millions of bacteria live in the mouth, particularly on the back of the tongue. In many people, they are the primary causes of bad breath. The mouth's moist conditions are ideal for the growth of these bacteria. Most bad breath is caused by something in the mouth.

Some types of bad breath are considered to be fairly normal. They usually are not health concerns. One example is "morning mouth." This occurs because of changes in your mouth while you sleep. During the day, saliva washes away decaying food and odors. The body makes less saliva at night. Your mouth becomes dry, and dead cells stick to your tongue and to the inside of your cheeks. When bacteria use these cells for food, they produce a foul odor.

In addition, bad breath can be caused by the following:

Poor dental hygiene — Infrequent or improper brushing and flossing, allows bits of food that are stuck between the teeth to decay inside the mouth. Poor oral hygiene eventually will lead to periodontal (gum) disease, which also can cause bad breath.

Infections in the mouth — These can be caused by either a cavity in a tooth or by periodontal (gum) disease.

Respiratory tract infections — Throat, sinus or lung infections

External source — Garlic, onions, coffee, cigarette smoking, chewing tobacco. Smoking and drinking coffee, tea and/or red wine will contribute to your teeth becoming discolored.

Dry mouth (xerostomia) — This can be caused by salivary gland problems, medicines or "mouth breathing." A large number of prescriptions and over the counter medicines cause dry mouth.

Illnesses — Diabetes, liver disease, kidney disease, lung disease, sinus disease, reflux disease and others

Psychiatric illness — Some people may believe they have bad breath, but others do not notice it. This is referred to as "pseudohalitosis."

Symptoms

You may not always know that you have bad breath. That's because odor-detecting cells in the nose eventually get used to the smell. Other people may notice and react by stepping away from you as you speak, or making a face.

Other symptoms depend on the underlying cause of bad breath:

Infections in the mouth — Symptoms depend on the type of infection. They can include:

Red or swollen gums that may bleed easily, especially after brushing or flossing

Pus between teeth or a pocket of pus (abscess) at the base of a tooth

Loose teeth or a change in how a denture fits

Painful, open sores on the tongue or gums

Respiratory tract infections — Symptoms may include:

Sore throat

Swollen lymph nodes ("swollen glands") in the neck

Fever

Stuffy nose

A greenish or yellowish discharge from the nose

A cough that produces mucus

Dry mouth — Symptoms may include:

Difficulty swallowing dry foods

Difficulty speaking for a long time because of mouth dryness

Burning in the mouth

An unusually high number of cavities

Dry eyes (in Sjögren's syndrome)

Illnesses — Symptoms of diabetes, lung disease, kidney failure or liver disease

Diagnosis

A dentist or physician may notice bad breath during an office visit. Sometimes, the smell of the patient's breath may suggest a likely cause for the problem. For example, "fruity" breath may be a sign of uncontrolled diabetes. A urine-like smell, especially in a person who is at high risk of kidney disease, can sometimes indicate kidney failure.

Your dentist will review your medical history for conditions that can cause bad breath and for medicines that can cause dry mouth. Your dentist also will ask you about your diet, personal habits (smoking, chewing tobacco) and any symptoms. He or she also will ask who noticed the bad breath and when.

Your dentist will examine your teeth, gums, mouth and salivary glands. He or she also will feel your head and neck and will evaluate your breath when you exhale from your nose and from your mouth.

Your dentist may refer you to your family physician if an illness is the most likely cause. In severe cases of gum disease, your dentist may suggest that you see a periodontist (dentist who specializes in gum problems).

You will need diagnostic tests if the doctor suspects a lung infection, diabetes, kidney disease, liver disease or Sjögren's syndrome. The type of tests you get depends on the suspected illness. You may get blood tests, urine tests, X-rays of the chest or sinuses, or other tests.

Expected Duration

How long bad breath lasts depends on its cause. For example, when the problem results from poor dental hygiene, proper dental care will begin to freshen the mouth right away. You'll have even better results after a few days of regular brushing and flossing. Periodontal disease and tooth abscess also respond quickly to proper dental treatment. Bad breath caused by chronic sinusitis may keep coming back, especially if it is caused by a structural abnormality of the sinuses.

Bad breath that results from an illness may be a long-term problem. It often can be controlled with proper medical care.

Prevention

Bad breath caused by dental problems can be prevented easily with proper home and professional care.

Brush your teeth, tongue and gums after meals and floss daily. This is the most important factor if your bad breath is caused by dental problems

If your dentist recommends it, rinse with a mouthwash approved by the American Dental Association (ADA)

Visit the dentist regularly (at least twice a year) for an exam and tooth cleaning.

You also can combat bad breath by drinking plenty of water every day to help your body make saliva. An occasional swish of the mouth with water can loosen bits of food. Sugar-free gum or sugar-free breath mints can help you keep breath fresh and prevent plaque from forming. But be aware that consuming large amounts of sugar-free gum and/or mints that contain sorbitol may cause side effects. These can include diarrhea and bloating.

Treatment

The treatment of bad breath depends on its cause.

When To Call A Professional

Call your dentist promptly if you have bad breath with loose teeth or painful, swollen gums that bleed easily. Also, call your doctor if you have bad breath along with any of the following symptoms:

Fever

Sore throat

Postnasal drip

Discolored nasal discharge

Cough that produces mucus

Even if you have none of these symptoms, call your dentist or physician if your bad breath continues despite a good diet and proper dental hygiene.

Sometimes bad breath can be a sign that a medical condition needs attention right away. If you have diabetes, gastroesophageal reflux disease (GERD) or chronic liver or kidney disease, ask your doctor what bad breath may mean for your condition.

Prognosis

The outlook for fresh breath is usually excellent if you stick to your dentist's or physician's treatment plan.

Article from: Colgate Professional

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Blog of the Day: The Importance of Fluoride

What is fluoride?

Fluoride is a naturally occurring mineral found in rock, soil, plants and water sources. "Water fluoridation" is the controlled addition of fluoride to a community's water supply to adjust the amount of fluoride to a level that is ideal for dental health. Natural sources of water, such as seawater, can contain much higher levels of fluoride than the level of fluoride added to community water supplies.

How were the dental benefits of fluoride discovered?

In the early 1900s, a dentist in Colorado noticed that most local people had very little tooth decay. Research eventually linked the lack of tooth decay in the community to the natural levels of fluoride in the water supply. When another small town in Michigan achieved a dramatic reduction in tooth decay after adding fluoride to the town water supply in 1945, the world soon followed.

In 1953 Beaconsfield, Tasmania (now famous for its mine rescue) became the first Australian town to adopt water fluoridation and all Australian capital cities except Brisbane followed in the 1960's and 70's. The Queensland town of Townsville fluoridated its water supply in 1963, with subsequent studies showing that children in Townsville have significantly fewer cavities than children in Brisbane.

How does fluoride work?

Tooth decay begins when acids in plaque damage the outer surface of the tooth (the enamel). Fluoride acts in three main ways to strengthen teeth and make them more resistant to tooth decay:

It improves the chemical structure of the enamel, making it more resistant to acid attack.

It reduces the ability of the bacteria on your teeth to produce acid.

It promotes repair of any early damage to the enamel.

Research over the past fifty years has shown conclusively that fluoride at the recommended levels in the water supply strengthens teeth and protects them against decay. Other benefits include the saving of time and money that people need to spend on dentistry.

Is fluoride safe?

At the recommended level of around 1mg/litre, or one part per million, there is no scientific evidence of any harmful effects from fluoride in our water supply. According to the World Health Organisation, fluoridation of public water supplies is the most effective public health measure for the prevention of dental decay. Water fluoridation is recognised as one of the ten most significant public health measures of the 20th century.

Who benefits most from water fluoridation?

People of all ages can benefit from community water fluoridation. Fluoride has special benefits during tooth development so it is especially important to get the right amount of fluoride as a child. For adults who wish to keep their natural teeth throughout their lives, daily fluoride plays a continuing role in keeping teeth healthy.

How much fluoride do I need?

Drinking fluoridated water throughout the day is the safest and most cost effective way to ensure your teeth get the benefits of fluoride. Using fluoride toothpaste everyday increases the benefits. This combination is considered optimum for most people. For children under six years of age, daily intake of fluoridated water and a low fluoride (400 or 500 ppm) toothpaste is recommended. From age six, children should begin using fluoridated adult toothpaste. Some individuals may need additional fluoride to maintain good dental health. A dental professional can advise on other sources of fluoride that would be helpful for such individuals.

Article from: ahm.com

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Blog of the Day: Periodontal Disease Linked to Cardiovascular Disease

                                                             *dulskidds.blogspot.com

CHICAGO—April 18, 2012—The American Academy of Periodontology (AAP) supports the American Heart Association’s (AHA) scientific statement “Periodontal Disease and Atherosclerotic Vascular Disease: Does the Evidence Support an Independent Association?” recently published in Circulation. The statement concludes that observational studies to date support an association between periodontal disease and cardiovascular disease, independent of shared risk factors. The AHA’s statement confirms the conclusions of the statements published by the AAP and the American Journal of Cardiology in 2009 and the U.S. Preventive Services Task Force in 2008.

While current research does not yet provide evidence of a causal relationship between the two diseases, scientists have identified biologic factors, such as chronic inflammation, that independently link periodontal disease to the development or progression of cardiovascular disease in some patients.

The lack of causal evidence should not diminish concern about the impact of periodontal status on cardiovascular health. According to Pamela McClain, DDS, president of the American Academy of Periodontology and a practicing periodontist in Aurora, Colorado, "Periodontal disease and cardiovascular disease are both complex, multi-factorial diseases that develop over time. It may be overly simplistic to expect a direct causal link. The relationship between the diseases is more likely to be mediated by numerous other factors, mechanisms, and circumstances that we have yet to uncover. However, as the AHA statement points out, the association is real and independent of shared risk factors. Patients and healthcare providers should not ignore the increased risk of heart disease associated with gum disease just because we do not have all the answers yet."

The AAP believes additional long-term interventional studies are needed to better understand the specific nature of the relationship between periodontal disease and cardiovascular disease. Patients’ periodontal status should also be added to future longitudinal studies of cardiovascular disease. The AAP hopes that the American Heart Association’s statement brings attention to the association between the two diseases and the need for additional research in this area.

Dr. McClain encourages physicians and dentists to communicate the association between cardiovascular disease and periodontal disease to patients. “It is not as simple as telling a patient that brushing and flossing will ward off a heart attack,” says Dr. McClain. “Patients should be aware that by maintaining periodontal health, they are helping to reduce harmful inflammation in the body, which has been shown to reduce the risk of cardiovascular disease.”

Patients should expect to receive a comprehensive periodontal evaluation from their dental professional at least once a year, adds Dr. McClain. This includes a detailed examination of the teeth and gums, and an assessment of risk factors such as smoking, age, and overall health status. In addition, patients diagnosed with periodontal disease should be sure to inform their general health care provider and/or cardiologist to encourage better integration of their care.

“There is no compelling evidence to support that treating periodontal disease will reduce cardiovascular disease at this time,” says Dr. McClain, “but we do know that periodontal care will improve your oral health status, reduce systemic inflammation, and might be good for your heart as well.”

Article from: www.perio.org

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Blog of the Day: Dental Veneers

                                                                               *novasans.com

Dental veneers are very thin, custom made shells of tooth-coloured material placed on the front surface of the teeth in order to improve the appearance of the teeth. With these, bonded to the front of the teeth, the teeth can change shape, colour, size or length. Dental veneers fall into the category of cosmetic dentistry since they create a bright, white smile, usually with flawlessly aligned regular teeth. Dental veneers are view by many as the “ultimate smile makeover”. Getting a dental veneer usually requires two-three visits at the dentist.

The advantages of dental veneers are that they look very natural and are stain resistant but they are more expensive than composite resin bonding and may be more sensitive to hot and cold food and beverages. There are two main types of materials used for veneers including composite and dental porcelains. Porcelain veneers usually lasts around 10 years, whereas composite veneers can last as little as 1-2 years.

The Dental Veneer Procedure

Getting a dental veneer usually requires two-three visits at the dentist. The first for consultation, and the other two to make up and apply the veneers. Several veneers can be placed at the same visit. After the consultation and examination, the dentist will remove about half a millimetre of enamel from the front surface of the tooth. This amount is almost equal to the thickness of the veneer, which will be added later to the surface. Next, the dentist will make an impression of the tooth/teeth, which will be sent to a dental laboratory. It usually takes 1-2 weeks for the laboratory to construct the veneers and send them back to the dentistry.

At the second or third visit, the dentist will fit the veneer on the tooth and adjust the veneer to fit the tooth surface. After cleaning, polishing and etching the natural tooth, which roughens the tooth surface for ultimate bonding, a special cement used as bonding material is applied. When the veneer is placed on the tooth, a special light beam is applied to make the cement harden quickly. Once the excess cement is removed and the final adjustments are made, the procedure is completed. The procedure can be done with little or no local anaesthetic, in comparison to putting in a dental crown, which is a more extensive procedure.

Advantages of Dental Veneers

The colour of veneers can be selected to make dark teeth appear whiter; 

Veneers provide a natural tooth appearance;

Porcelain veneers are stain resistant

Disadvantages/Side Effects of Dental Veneers

Veneers are more expensive than composite resin bonding;

Since enamel has been removed from the tooth surface, the tooth may become more sensitive to hot and cold foods and beverages;

The process of putting on veneers is not reversible;

Veneers may not exactly match the colour of your other teeth;

The veneer colour can not be altered once in place on the tooth. So if you plan to whiten your teeth, you should do so before adding veneers;

Veneers are usually not repairable if they should crack or break off

How to Choose the Right Veneer Material

The different types of veneers all have advantages and disadvantages. Therefore, it is best that the patient discuss the choice of material with the dentist before making a decision. The dentist will then judge his recommendation upon the state of the patient’s natural teeth.

How Long Do Dental Veneers Last?

Porcelain veneers usually lasts around 10 years, whereas composite veneers can last as little as 1-2 years. To make the veneers last longer, it is important to follow a good oral hygiene and visit the dentist for regular check-ups.

Types Of Materials Used for Veneers

There are two main types of material used for veneers; composite and dental porcelain. A composite veneer can either be directly built up on the tooth or fabricated in a dental laboratory. A porcelain veneer can only be indirectly fabricated.

Article from: novasans.com

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Blog of the Day: Dental Work During Pregnancy

                                                    *perfectwinningsmile.com

Preventive dental cleanings and annual exams during pregnancy are not only safe, but are recommended. The rise in hormone levels during pregnancy causes the gums to swell, bleed, and trap food causing increased irritation to your gums. Preventive dental work is essential to avoid oral infections such as gum disease, which has been linked to preterm birth.

What about other regular dental work during pregnancy?

Dental work such as cavity fillings and crowns should be treated to reduce the chance of infection. If dental work is done during pregnancy, the second trimester is ideal. Once you reach the third trimester, it may be very difficult to lie on your back for an extended period of time.

 The safest course of action is to postpone all unnecessary dental work until after the birth. However, sometimes emergency dental work such as a root canal or tooth extraction is necessary.

 Elective treatments, such as teeth whitening and other cosmetic procedures, should be postponed until after the birth. It is best to avoid exposing the developing baby to any risks, even if they are minimal.

What about medications used in dental work during pregnancy?

Currently, there are conflicting studies about possible adverse effects on the developing baby from medications used during dental work. Lidocaine is the most commonly used drug for dental work. Lidocaine (Category B) does cross the placenta after administration.

 If dental work is needed, the amount of anesthesia administered should be as little as possible, but still enough to make you comfortable. If you are experiencing pain, request additional numbing. When you are comfortable, the amount of stress on you and the baby is reduced. Also, the more comfortable you are, the easier it is for the anesthesia to work.

 Dental work often requires antibiotics to prevent or treat infections. Antibiotics such as penicillin, amoxicillin, and clindamycin, which are labeled category B for safety in pregnancy, may be prescribed after your procedure.

What about x-rays used in dental work during pregnancy?

Routine x-rays, usually taken during annual exams, can usually be postponed until after the birth. X-rays are necessary to perform many dental procedures, especially emergencies. According to the American College of Radiology, no single diagnostic x-ray has a radiation dose significant enough to cause adverse effects in a developing embryo or fetus.

Fetal organ development occurs during the first trimester; it is best to avoid all potential risks at this time if possible. If non-emergency dental work is needed during the third trimester, it is usually postponed until after the birth. This is to avoid the risk of premature labor and prolonged time lying on your back.

Suggestions for addressing your dental needs during pregnancy:

The American Dental Association (ADA) recommends that pregnant women eat a balanced diet, brush their teeth thoroughly with an ADA-approved fluoride toothpaste twice a day, and floss daily

Have preventive exams and cleanings during your pregnancy

Let your dentist know you are pregnant

Postpone non-emergency dental work until the second trimester or until after delivery, if possible

Elective procedures should be postponed until after the delivery

Maintain healthy circulation by keeping your legs uncrossed while you sit in the dentist's chair

Take a pillow to help keep you and the baby more comfortable

Bring headphones and some favorite music

Article from: The American Pregnancy Association

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Blog of the Day: In-Office Power Whitening with Light Activation

Front teeth, the 6 to 10 teeth most easily seen when you talk or smile, are the teeth that can benefit most from an in-office “power” tooth whitening. Just as with back teeth, if there are medium- to large-sized fillings in the teeth, it is probably better if these teeth were protected with crowns. The in-office power whitening procedure is one of the most conservative and least expensive methods to attempt to lighten tooth color back to a more acceptable appearance.

                                                                                                      *hospitallane.com

The procedure involves isolating the teeth to be whitened and protecting the gum tissues and lips. A whitening solution is then mixed and applied to the teeth. A special light will be placed over each individual tooth for several minutes. The light will provide the energy for the chemical reaction to take place. This procedure will be repeated about three times for each tooth during the 60- to 90-minute appointment.

Most patients show great improvement after only one treatment. Since the protective biofilm that normally covers the tooth enamel is removed during the whitening procedure, you should avoid smoking and drinking pigmented liquids (coffee, tea, red wine) for about 24 hours after the whitening is completed. After 24 hours, the biofilm is usually back in place. The final color will usually regress one shade in the first 1 to 3 months, with most of the change occurring in the first week. Some teeth may need a second appointment (or a combination of in-office and tray system whitening) to achieve the desired result. The degree of whitening for any tooth is variable and impossible to predict. However, recent studies show that 97% of all patients who whiten their teeth are happy with the result. The color change should be satisfactory for 3 to 7 years.

If you have dental restorations (crowns, bonding), the plastics and porcelain will not change color. You may need to have some of those fillings redone once your teeth are lightened. We will let you know whether you can expect to have some fillings replaced due to the color change. If you are going to have fillings replaced, you should wait at least 2 weeks after the whitening is completed for the tooth color to stabilize before new restorations are placed. Some postoperative sensitivity is possible, but it usually disappears quickly. The tooth enamel or dentin is not damaged by the whitening process.

Call Omni Dental today at (512) 250-5012 to speak with one of our specialists about the latest ways of enhancing your smile and dental health. You can also go to our website: omnidentalgroup.com for more information!

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Blog of the Day: Implants, Crowns, and Bridges vs. Natural Teeth

Nothing can replace the natural teeth you were born with for chewing and function. However, very few people go through life without having teeth filled, crowns (caps) placed, or bridges and implants used to replace missing teeth. Crowns, bridges, and implants are the best answer and closest to your natural teeth, but they are not the same as healthy, natural teeth.

Crowns

                                         *perioimplants.us

Crowns are used to reconstruct a single tooth broken down by dental decay. Crowns are made of ceramic, resin, porcelain, porcelain plus metal, or resin plus metal materials. They are bonded or cemented onto the prepared tooth and cannot easily be removed from the tooth once placed. If the tooth was in good alignment before the crown was prepared, the crown will be in good alignment. If the tooth was misaligned before the crown, sometimes the crown may be made to obtain a more ideal shape and position. It is cleaned and flossed just like a natural tooth and is most like real teeth.

Bridges

Bridges are crowns that are attached together, suspending the crown portion of a false tooth in or over the space left by the missing tooth.  A bridge can be used to replace one or several teeth.  Sometimes a bridge is used to splint loose teeth together in order to make the teeth more stable. Bridges are usually made of metal covered with either porcelain or resin. Some of the newer bridges are made of all resin or all ceramic materials. They are cemented or bonded onto the existing prepared teeth and are not easily removed once placed. The bridge teeth can be brushed the same as natural teeth, but since they are attached together, must be flossed differently by using a floss threader or other device.

The teeth are generally the same shape as natural teeth. However, if the existing teeth (abutments) that are used to anchor the bridge have moved from their original position because a tooth or teeth have been missing for years, the added tooth (pontic) may be longer or shorter than the tooth that it is replacing.  With a bridge, the false tooth will most often butt up against the soft tissue ridge where the removed tooth was.

The shape of the tongue side of the false tooth varies. It is usually smaller on the tongue side and completely fills the space. Food will have more of a tendency to collect in this area, so you must be prepared to clean it. If the missing tooth has been gone a long time, the ridge may have shrunk considerably, and the pontic tooth will be longer than the teeth on either side. If this is the case, there are several periodontal procedures that can be done prior to the construction of the bridge. These procedures will build up the tissue to its former height. The more your mouth has changed from its normal state, the harder it is to make new teeth look and feel natural.

Implant Crowns

Implant crowns are used to replace single or multiple missing teeth. They are either cemented or screw-retained onto an implant fixture. The crowns are made of porcelain or resin and metal. But they have some significant differences from the natural teeth they replace. Teeth are supported by a root or roots that are irregular in shape. Implants are round. The cross-sectional of the implant will never match that of the tooth it is replacing. A multirooted tooth may be replaced by a single implant, so the manner in which an implant crown comes out of the soft tissue ridge will appear different from a natural tooth. There will be more space between the implant root and the adjacent teeth. Implant crowns are often cemented with temporary cement. This allows the dentist to easily take off the crown and evaluate how the implant is doing. Crowns on teeth are usually cemented with a final cement. Implant-supported crowns are wonderful, but not the same as natural teeth with crowns. Be prepared for some differences. Expect more maintenance on your part and in the dental office with crowns, bridges, and implants.

Smokers take note:  There is a heightened risk of dental implant failure among smoker as much as a 20% greater failure rate!

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Blog of the Day: What's eating your enamel?

The connection between diet and enamel erosion

by Alicia Almeida, RDH; Heidi Emmerling, RDH, PhD; Lauren McGreanor, RDA, RDH; Ashley Mitchell, BA, RDH

Eat your fruits and vegetables. Exercise. For a healthy lifestyle, these are important rules to live by. Ironically, our patients may be doing just that – eating their fruits and veggies and exercising the enamel right off their teeth.

                                                        *healthtrition.com

Enamel can be damaged by a number of factors: caries, abrasion, abfractions, and erosion. This article will focus on how we can better inform our patients about erosion, its dietary causes, and the preventive measures that can be taken.

A need certainly exists to better educate patients about enamel erosion. Information and knowledge about surface enamel wear and its causes, consequences, and prevention should be better understood in order for people to achieve optimal oral health.

Informal poll findings indicate that almost half of those surveyed did not know what enamel erosion is. Of those who did, approximately one-third were unaware of the cause. While almost all knew that diet played a role in enamel health, the same number did not know that frequency was a factor. Here's the kicker: 92% reported that neither their dentist nor dental hygienist spoke to them about enamel erosion.

Dental hygienists can explain to patients the difference between erosion and caries – that enamel erosion is the irreversible wear due to enamel and dentin being chemically etched away, and that this process, unlike caries, does not involve bacteria. Some signs and symptoms include a smooth, shiny surface; roundedness; cupping on occlusal surfaces; generalized loss of luster or brightness; and a discolored and yellowish appearance. Additionally, the teeth will frequently have increased sensitivity.

For the patient, enamel erosion is significant. First, it causes dentinal hypersensitivity. Also, as the enamel becomes thin, the teeth are more susceptible to decay, and enamel erosion could lead to complex and expensive restorative care. Therefore, patients have a vested interest in learning about causes and preventive measures.

Xerostomia is a factor in enamel erosion. Patients may not be aware of the protective properties of saliva: rinsing, buffering, and remineralizing. Reviewing the medical history for causes of xerostomia, as well as asking the patient about a history of dry mouth, gives the dental hygienist the opportunity to discuss the role of saliva and diet in erosion. Another thing to keep in mind is that saliva is more protective of enamel than dentin. Consequently, it is important to consult elderly people and others with dentinal exposure that they may be at a greater risk of dietary erosion than those with no dentinal exposure.

Other non-nutritive sources of erosion include GERD, bulimia, and alcoholism. In all of these cases stomach acids and vomit can enter the oral cavity, lowering the pH of the oral cavity. Additionally, swimmers exposed to chlorine can be at risk for erosion.

Most patients already know that diet plays a role in many oral diseases, such as the role of sugar in caries, for instance. They probably know that candy is bad because of the high sugar content. However, they might not know that sour candies are even worse. Erika Feltham, RDH, who has been passionately educating patients and other dental professionals about the harmful effects of sour candies explains how some candies' pH levels approach the level of battery acid (Quick Blast™ Sour Candy Spray, Warheads® Extreme Sours). Candies use ascorbic, acetic, adipic, citric, fumaric, lactic, malic, and tartaric acids to achieve the sour flavor. Sneaky labeling might conceal these acids: natural or artificial flavors, organic fruit juice extracts, and juice paste. Some of these sour candies not only contain a variety of acids, but are also coated in acid by using processes called powder acid blending, dusting, or encapsulated acid techniques.

Similarly, patients might have a hunch that soda pop is bad for oral health because it is loaded with sugar. However, dental hygienists can explain that, in addition to the very high fructose content, sodas are also acidic. Therefore, even diet sodas can wreak havoc on the enamel. Additionally, patients should be informed about the sugar and acid content of many sports drinks. Many patients might be misled thinking that sports drinks are healthy and have no consequences.

Because pH is such a critical factor in dietary enamel erosion, dental hygienists can give patients brief lessons in pH 101: Under normal conditions, the pH in the mouth ranges from 6.2 to 7.0. Enamel demineralization occurs when pH levels fall to 5.7. Elderly patients or those with exposed dentin need to know that root demineralization can occur when pH levels fall to 6.0. After consuming an acidic meal or snack, pH levels are likely to drop to these ranges, increasing the potential for erosion.

But what constitutes an acidic meal? Patients probably know that sucking on lemons is acidic, but they think nothing of consuming concentrated citric fruit juices. And there are other foods people often don't think of as acidic such as yogurt and applesauce. Almeida, McGreanor, and Mitchell wanted to see if erosion would occur with normal foods in the absence of plaque and if there was a correlation between erosion and the pH level. They took 12 extracted teeth and submerged them into 12 foods of variable pH ranges for two weeks (see Photo 1). The teeth were kept in airtight containers and were refrigerated at 37° F to prevent any bacterial growth. Sugar content was not thought to factor in to the results, as no plaque was present on the teeth to metabolize the sugar into acid end products. The foods were changed and pH levels checked every three days. See Table 1 for the foods, pH levels, and appearance of the teeth after the experiment.

The teeth soaked in the more acidic pH ranges (applesauce, oatmeal) were discolored, more yellow, and appeared very shiny and smooth; they appeared very different from their photos taken before the experiment. The teeth with the more neutral/alkaline pH (fudge brownie, avocado, butter) showed less effects of erosion and had fewer changes from their photos before the experiment. The control tooth showed no changes from before to after the experiment.

Patients may not know that foods we think of as healthy for our bodies may not be beneficial for our oral health. A healthy lifestyle indeed implies the consumption of food and beverages predominantly of vegetable origin which are usually acidic. Citric fruit juice (with a pH value of approximately 3.2), fruits in general, and vegetables are essential in a diet, but consumed in excess they have enough potential to cause erosion. Healthy lifestyles also imply physical exercise, which in excess also has great erosion potential since it increases GERD. Besides, if we add the loss of body fluids, the decrease in salivary flow that this exercise generates can either cause xerostomia and/or increase the consumption of sports drinks (whose general pH values are between 2.7 and 3.1). This is the best possible medium for generating acid erosion. Dental hygienists can encourage patients to think about the acids in sports drinks, concentrated fruit juices, and acidic fruits such as lemons and oranges. Hygienists can explain how typically healthy foods like applesauce and yogurt can lead to enamel erosion.

In addition to dietary recommendations, it is important to let patients know how to prevent enamel erosion from occurring. Here are some recommendations for patients to put tooth enamel to good use – to eat food, not the other way around:

• Drink water throughout the day.
•  Never brush the teeth after consuming acidic foods or beverages as the teeth are weak and time  should be given for remineralization.
•  After eating or drinking something highly acidic, rinse with water or fluoride to neutralize the acid.
•  Use sugar-free gum to stimulate salivary flow.
•  Use a straw when drinking acidic drinks to avoid contact with the teeth.
•  Use a fluoride toothpaste to strengthen the teeth and stimulate remineralization.
•  Reduce consumption of acidic foods and beverages.
• Snacking on low-pH foods frequently throughout the day means there are more opportunities for demineralization and less opportunities for remineralization.

Reviewing dietary and lifestyle factors that influence oral health are important. The types of foods and beverages consumed, individual susceptibility, the frequency and times of consumption, and oral hygiene practices are important factors influencing the clinical development of dental erosion.

Article from: RDHMag, Vol. 30 - Issue 9

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Blog of the Day: Getting an Occlusal (Bite) Guard

                                                                         *occlusalguard.net

Making a Bite Guard Appliance

The appliance constructed to eliminate or reduce the adverse effects of a bruxing and/or grinding habit(s) is made of a rigid plastic. It is custom-made to fit your mouth exactly. It will take two visits to complete. It can only be inserted one way;  it will not stay in place if it is inserted improperly. At the first visit we will make impressions of your upper and lower teeth and record the occlusal (bite) relation of your jaws. After the bite guard is made, you will return for a second visit a week or two later for adjustments and delivery. At the second appointment, the appliance will be adjusted so that your teeth properly meet the plastic. The appliance fits just around the biting surfaces of the teeth of the top jaw. It will not cover the roof of your mouth.

After the appliance has been delivered, you will be expected to return in a few weeks with the appliance for observation and possible further adjustments. You should at no time have any pain or soreness in muscles or joints around your face or ears, whether or not you are wearing the bite guard. It is meant to protect your natural teeth (enamel and dentin) from unnatural, pathologic wear caused by the bruxing or grinding habit. Since the plastic of the appliance is “softer” than your remaining enamel, the plastic will wear when you brux or grind. Expect the plastic to last about 2 years¾longer if you do not have a severe problem, shorter if the habits are very abusive.

Wearing Your Appliance

After you receive the protective guard, please wear it as instructed. If you grind or brux at night while sleeping (very common), wear the guard while you sleep. If you brux or grind during the day, try to identify when during the day you have the problem (stuck in traffic, talking on the phone, working at a desk) and wear the guard at that time. Becoming aware of the times of day or stresses that cause you to clench or grind may help you to break the habit.

If at any time, you develop soreness of the muscles around the temporomandibular joint or TMJ (jaw joint), stop wearing the bite guard and call the office. The TMJ is the hinge joint in front of each ear; you can feel them when you open and close your mouth. Do not wear the bite guard again until we have had a chance to evaluate your situation.

Length of Treatment

How long must you wear the protective appliance? It all depends on the nature of your problem. If this application is being used to prevent stress-related abnormal wear of your teeth, then you will need to wear it until you are no longer burdened by heavy stress. When the source of the problem is eliminated or resolved, the problem may disappear and you will no longer need to wear the appliance. We will periodically evaluate your condition.

When you are not wearing your bite guard, it should be cleaned with a soft toothbrush and water to remove any plaque and stored in a dry place.

Please bring your bite guard with you when you come in for your routine dental hygiene prophylaxis appointment so that we can check the appliance and make sure that it is functioning well. Always stay on the recare interval that we have designated for you. When dental problems are diagnosed in the very early stages, the treatment is usually easier (and less expensive).

Keep the bite guard clean. When you are finished wearing the appliance, brush it with a toothbrush and toothpaste, rinse it, dry it, and store it in the provided container. If it cannot be brushed immediately, at least rinse it under clean water to remove any saliva or debris.

Call Omni Dental today at (512) 250-5012 to speak with one of our specialists about the latest ways of enhancing your smile and dental health. You can also go to our website: omnidentalgroup.com for more information!

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Blog of the Day: A Link Between Diabetes and Dental Health

From: Roots International Magazine of Endodontology Vol. 8 - Issue 1/2012

An as-yet unceasing increase in the number of people with diabetes or prediabetes in the USA and across the globe makes it not so much a question of if, but when more dental professionals will need to become highly skilled in treating such patients. There are 26 million people with diabetes in the USA, and 95 per cent of them have a form of periodontal disease, compared with 50 per cent of the general population. Of those 26 million people, more than 7 million are unaware of their diabetes. Just as significant, 79 million people are estimated to have prediabetes, with as many as half unaware of it. A growing body of research suggests that the associaton between oral health and diabetes is bidirectional, placing dental professionals int he position of not just being able to help patients with diabetes control the illness, but also perhaps being able to help those with prediabetes avoid full onset.

In recognition of this link between oral health and diabetes, Colgate Total is donating US $100,000 and joining forces with the American Diabetes Association's campaign to Stop Diabetes by encouraging people to learn more about oral health care and Raise Their Hand to Stop Diabetes. Central to the campaign's focus is educating people on the importance of dental visits, as well as helping dental professionals, who are seeing growing numbers of patients with diabetes. Colgate's involvement also stems from its interest in promoting the use of antibacterial toothpastes such as Colgate Total to support gum health.

Also helping with the effort is Dr. Maria Emanuel Ryan, a periodontist and Professor of Oral Biology and Pathology at Stony Brook University, New York. Ryan, a globally known expert on the link between oral health and diabetes, recently spoke with Roots.

_Roots: What size patient base are we talking about in terms of the need for achieving greater awareness?

Dr. Maria Emanuel Ryan: Some of the talks I have given have been at the Centers for Disease Control and Prevention (CDC). They have an interest in this area because to them diabetes is an epidemic. Each year, we have 1.9 million new cases diagnosed in people 20 years of age and older. If the population of people with diabetes keeps growing at this rate, in the very near future it will be about one in three, which is a very significant number.

_What can dental professionals do to help identify patients who have diabetes or prediabetes but have not been diagnosed?

Certainly we can screen for diabetes. And this is being recommended by the CDC. One way is by risk assessment: knowing a patient's family history, looking at obesity as a risk factor, looking to determine whether the patient is in one of the populations in which risk factors may be higher (African-Americans, Pacific Islanders, Native Americans, Latinos and Hispanics), asking about gestational diabetes. Most patients with diabetes are type II patients, who tend to be older than 45 years of age. Risk factors such as hypertension and dyslipidaemia are also important to consider. Of course, there are the classic signs and symptoms: thirst, frequent urination, infections, numbness in extremities, leg cramps, vision problems. Unfortunately, with type II diabetes, there are many people who are unaware they have it. That's why the CDC is looking to oral health-care professionals for help. If a person has any of the risk factors, signs or symptoms, dental professionals can refer to the physician for additional screening, or obtain a random blood glucose level or even a fasting blood glucose level and then refer appropriate patients to the physician for diagnosis.

_What do dentists need to be aware of with their patients who have diabetes or prediabetes?

If patients are poorly controlled, then you may need to be very cautious in what procedures you might be doing because the patients' wound healing may be affected. You need to know whether they have any other long-term complications of diabetes. You need to work closely with the patients' physician and other health-care professionals. Many patients with diabetes, especially those who have a physician working very hard to tightly control their diabetes and whose blood glucose levels tend to run low, may have a higher risk for hypoglycemic events. Ask patients whether that is common for them because the more hypoglycaemic events patients have had, the more likely they are to have more - and the more likely they are to develop hypoglycaemic unawareness. That's when they don't get any of the classic signs: getting dizzy, feeling like they are going to pass out or getting confused. Some patients don't get those signs and symptoms, they can just suddenly become unconscious or have seizures.

_What can the dental professional do to confirm whether patients with diabetes have well-controlled blood sugar prior to treatment?

You can actively take the blood glucose level by doing either a random screening for blood glucose or even a fasting for blood glucose. If the level is greater than 126, the patient can be referred to a physician for further treatment. Another way to screen is the haemoglobin A1C test, a long-term marker of control that lets you know how well controlled someone with diabetes has been over the past two to three months. It used to be that only a centralized laboratory could do this, but now there are point-of-care tests. The only way you can help predict a hypoglycaemic event in your patient is to check blood glucose levels. Patients on insulin are at the highest risk of having a hypoglycaemic event at the time of peak activity of the insulin that has been administered, which is not when you want to be treating them. You also need to know what oral medications they may be taking because some may have a higher risk than others of causing hypoglycaemia.

_Research indicates that serious periodontal disease may affect blood glucose control and contribute to the progression of diabetes. Why is this?

In fact, the impact of periodontal disease may even be evident before someone develops diabetes. Recent research suggests that patients who have untreated periodontal disease, when followed for over 20 years, may be twice as likely to develop diabetes. Periodontitis is driven by infection and inflammation; and infection and inflammation can drive insulin resistance. Insulin resistance can lead to the development of diabetes and prevent good control of diabetes. By reducing infection and inflammation, you may actually prevent development of diabetes, and certainly you can make i easier to control diabetes. Some recent papers have suggested that if you don't treat the periodontal disease, not only is it more difficult to control diabetes, but people with diabetes are then also at higher risk for long-term complications such as cardiovascular disease and kidney disease, thereby increasing the risk for mortality.

_Are people with diabetes and prediabetes at risk for other dental problems?

If patients are not well controlled, they also tend to get more cavities or caries. They have a higher risk of developing oral yeast infections such as candidiasis. They may have enlarged parotid glands, which can lead to dry mouth. And because of the yeast infections in a dry mouth, they could report burning mouth or dry tongue. Dry mouth due to salivary gland dysfunction will drive periodontal disease and caries formation. Poorly controlled patients are also at greater risk for abscess formation. Gingival crevicular fluid is a serum transudate, so if your blood sugar levels are high, you have more glucose coming out of those pockets around the teeth. Your mouth has more glucose in it, so your teeth are bathing in glucose, increasing the risk for developing cavities. Working to improve home care with patients is of great help because such patients need to keep levels of bacteria as low as possible in the mouth. They can use antibacterial toothpaste or rinses. One of the toothpastes that's very effective at reducing the levels of bacteria for 12 hours is Colgate Total. I recommend that to many of my patients with diabetes. And, of course, we need to provide adequate care in the office. The treatment of infection and inflammation, providing periodontal therapy whether it's surgical or non-surgical, absolutely needs to b provided and should never be considered an optional or elective procedure.

_Are insurance organizations responding to the growing evidence of the connection between oral health and diabetes?

Some dental insurance companies are reimbursing dentists for screening, not only for diabetes but also for hypertension by checking blood pressure and for obesity by determining body mass index. Some dental insurance companies have begun to create expanded plans that begin to better address the oral health-care needs of patients with diabetes. This may help with access. Some patients - especially those without dental insurance - complain that if they go to the podiatrist, it's covered by their medical insurance, but if they're going to the dentist, it isn't covered by medical in most cases. This may be changing.

_Are there dental professionals specializing in the treatment of people with diabetes? If so, how does one develop such a specialty?

When your comfort level goes up, you will see more and more of these patients (by referral). Patients say, "You know, Dr. Ryan asks me questions that other dentists never asked me about my diabetes. And she seems to base her treatment plan around the answer to those questions." If you're comfortable talking to physicians about this, you begin to get more referrals from physicians who are treating and educating these patients. I often speak on panels with other health-care providers at local meetings organized by the American Diabetes Association, initiators of the Stop Diabetes campaign. And because the folks from Colgate recognized the importance of oral health in this , they have supported this campaign, which I think is very important. When I speak as part of a diabetes education health-care team, patients are already aware of what the podiatrist has to say, of what the ophthalmologist may be saying about their eyes and the cardiologist about cardiovascular disease. But when I start talking about the dental considerations, so many of them say to me, "I have never heard this before. No one's ever discussed this with me." It's important for all of us in the profession to share this knowledge not only with our patients but also with each other.

_Are there established, approved protocols for dental professionals to follow when treating patients who have diabetes or prediabetes?

No, but maybe we will be going in that direction. There has been a substantial effort by the American Dental Association to improve on continuing education in this area. There are efforts throughout the profession to improve on the transfer of knowledge from the published research to the practicing clinician. In the future, there may be programs through which people may become certified to manage higher-risk patients, such as those with diabetes or cardiovascular disease. There has been great interest by all members of the profession. Not just dentists, but hygienists and dental assistants are interested in how to better manage these patients. You're beginning to see practices develop protocols that are tailored to the provision of care to people with diabetes._

Editorial note: This interview was prepared by Robert Selleck, Dental Tribune America.

Dr. Maria Emanuel Ryan is a tenured full professor in the Department of Oral Biology and Pathology at Stony Brook University's School of Dental Medicine and a member of the medical staff at University Hospital at the Stony Brook University Medical Center. She has published more than 75 scholarly works and speaks frequently on emerging therapies, connections between oral and systemic health and the need for early detection of periodontal disease and oral cancer.

Call Omni Dental today at (512) 250-5012 to speak with one of our specialists about the latest ways of enhancing your smile and dental health. You can also go to our website: omnidentalgroup.com for more information!

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Blog of the Day: What is Gingivitis, exactly?

                                                                       *drperrone.com

Almost everyone knows what a cavity is. Because of the far-reaching effects of advertising by toothpaste and oral rinse manufacturers, by 2004 almost everyone has heard of gingivitis. What may not be quite clear to you, however, is exactly what gingivitis is. You may recognize it as a problem but not know why and how serious it might be. You may even know that it is a type of gum (periodontal) disease. You may also know that it is somehow related to plaque and tartar (calculus) on teeth. But why should you be concerned about having it?

Gingivitis is an infection of the gum tissues surrounding the teeth. It is a very common infection and affects almost 95% of the world’s population. This infection can be characterized by redness, swelling, and bleeding of the gums around the teeth. This gum infection absolutely needs to be treated as soon as possible. Gum infections are almost always preventable with sound daily oral self-care.

Gingivitis is the mildest form of periodontal disease and is reversible. By definition, there is no loss of bone that supports the tooth. If treated early, gingivitis can be eliminated. If left untreated, it can progress into the more serious form of periodontal disease called periodontitis.  In its more serious form, the bone and gum tissues can be permanently affected. Bleeding gums, one of the signs of gingivitis, are a sign of infection in the mouth. Your gum tissues should never bleed. It is not normal for blood to appear on your toothbrush when you have finished brushing. Gingivitis does not generally hurt, so you may not even know that you have it. It can be localized (around a few teeth) or generalized (around most or all of the teeth). Gingivitis is seen most often in patients who do not brush and floss well daily, but it can also be related to medication. Bad breath can be another sign of gingivitis. If you are using a mouthwash to get rid of bad breath, you may need dental attention. While bad breath can be related to some medical problems, most often it is just debris that is not cleaned properly from your teeth, gums, and tongue that is decomposing in the dark, warm, and moist environment of your mouth a perfect place to breed germs.

If you have bleeding gums, you should be concerned.  Healthy tissue anywhere in our bodies does not bleed. So what can you do to stop the bleeding?

We can help you eliminate the gingivitis. It involves a good professional cleaning and good oral self-care habits. Plaque (soft debris made up of bacteria) and tartar (calculus or hardened debris) must be removed before the gum tissues can heal and the infection can be eliminated. If it has been some time since you had your teeth cleaned properly, it may take more than one appointment to get you back into shape.

Get your teeth and gums cleaned on a regular basis. Keep them clean with daily brushing and flossing. The infection you have will be eliminated. If you keep your teeth and gums clean, they can be healthy and trouble-free for your whole life.

Call Omni Dental today at (512) 250-5012 to speak with one of our specialists about the latest ways of enhancing your smile and dental health. You can also go to our website: omnidentalgroup.com for more information!

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Blog of the Day: Prevention of Dental Disease in Infants and Children

                                                                           *shutterstock.com

There are a number of positive steps that you can take to ensure that your child has few, if any, cavities and dental-related problems. A daily routine of proper and effective oral self-care (toothbrushing and dental flossing) is the most important part of prevention. Scheduled visits with the dentist and dental hygienist for examinations and prophylaxis (cleaning) procedures are also very important for your child’s dental well-being. These suggestions will help keep your child’s teeth and gums disease-free.

1. Clean your infant’s teeth daily with a wet washcloth or a wet two-inch-square gauze pad.

2. Floss your child’s teeth daily until the child can develop the ability to do it alone. This may not be an easy transition, but it is well worth the effort.

3. Once the teeth can be seen breaking through the gum tissue, night bottles should contain only water. Fluids from night bottles pool behind the teeth while the infant sleeps. Night bottles containing milk, juice, punch, soda, etc. can cause extensive decay.

4. If you do not live in an area with fluoridated water, the infant should be given a fluoride vitamin supplement. Dosage will depend on the age and weight of the infant. This should continue until the child develops wisdom teeth¾well into the teen years. Your pediatrician or your dentist can write a prescription for these very important systemic fluoride vitamins.

5. Children do not develop the dexterity to properly brush and floss their own teeth until about age 6 or 7. You must make sure that the job is done well, even if it means doing this oral self-care for them. Your own good example of brushing and flossing your teeth daily will greatly enhance your child’s willingness and abilities in this area.

6. Your child’s first visit to the dentist should be as an infant, as teeth are just beginning to erupt. During this visit we will give you guidelines as to what you can expect in terms of oral development and what type of nutrition and oral self-care tips are appropriate for your child.

7. Your child’s first treatment visit to the dentist should take place at 2 ½ years of age. An examination, cleaning, and fluoride treatment will be completed at this time.

8. The topical fluoride treatment given at the time of the child’s regular cleaning appointment is important. It helps make the teeth that are already in the mouth stronger and more resistant to decay and plaque accumulation. Systemic fluoride vitamins strengthen the enamel of unerupted teeth. Topical fluoride takes over after that.

9. A plastic coating known as a sealant can be placed on the chewing surfaces of the back teeth. This sealant can reduce the incidence of decay on the treated surfaces by 90%. It should be placed on most back teeth, both premolars and molars, as soon as it is possible to keep these teeth dry enough for bonding the sealant in place. It is sometimes placed on baby teeth in special situations. A separate handout is available that will cover this topic in more detail. Sealants are usually applied when children are about 6 years old. The dentist or hygienist will advise you as to when he or she believes the sealant can be successfully placed.

10. When your child can understand and perform the “rinse and spit” routine, it is time to begin using a fluoridated mouthrinse. This is not a mouthwash used to cover bad breath. It is actually a nightly supplement to the topical fluoride treatments your child receives at the dentist’s office. However, it is not nearly as strong as the office version. This is not a prescription medication.

By faithfully following these suggestions, your child may never develop any decay. If decay should begin, it will be small and easy to treat. Nothing replaces thorough daily brushing and flossing or good eating habits. Routine dental examination and cleaning appointments are vital. You will find that following these instructions will prove to be very effective in helping your child to maintain optimal dental health.

Call Omni Dental today at (512) 250-5012 to speak with one of our specialists about the latest ways of enhancing your smile and dental health. You can also go to our website: omnidentalgroup.com for more information!

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