Xerostomia: Dry Mouth Syndrome

Xerostomia (dry mouth) is not a condition everyone should expect. You may notice it as you age due to a change in hormones, medication, and/or radiation therapy in the head and neck region.

Why Xerostomia Is a Problem

Saliva is important to oral health for several reasons. The flow of saliva helps clear debris from the oral cavity. It provides minerals necessary to support the process of remineralization. Tooth enamel daily underdoes acid attack that removes inorganic minerals from teeth. This is called demineralization. Remineralization is the opposite of demineralization. It occurs when inorganic molecules flow into a region of weekend enamel and make it stronger.

When the salivary flow is reduced, a chain of events occur. The natural cleansing action is diminished, as are the buffering action and remineralization properties of saliva. People with diminished salivary flow experience a very fast rate of decay, many times faster and over several teeth. This type of dental decay is typically noted along the gumline, around existing dental work, and on exposed root surfaces.

Prevention

• You can help prevent dental decay that can result from xerostomia.
• Brushing and flossing correctly at least once each day becomes very important.
• Frequent sips of water during the day can help moisten the mouth and can help clear debris.
• Daily use of a mouthrinse containing fluoride can help remineralize the teeth.
• Use toothpaste containing sodium fluoride.
• We recommend a daily brushing with a prescription, high-concentration sodium fluoride gel or paste. We will either dispense this or give you a prescription for it.
• Chew sugarless gum or a rubber band to help stimulate salivary flow.
• In moderate to severe cases, special fluoride delivery trays can be made for you to use at home. These will keep the high-concentration fluoride in a position to “soak” your teeth with fluoride for several minutes at a time.
• We recommend that you have your teeth cleaned, polished, and an office-applied topical fluoride treatment every 3 months while the condition persists. 

 Dry mouth can have serious dental consequences and must be treated accordingly. 

Junk Drink Alert

We have recently noticed a developing and serious decay problem. What we are seeing in out dental practice is tooth decay that progresses much more quickly than we are accustomed to seeing. This decay is seen around the margins of restorations (fillings) and crowns (caps) where the tooth and restorative material meet. In some individuals these restorations were only places a short time ago. From discussion with the patients who exhibited this extreme and unusual type of decay, there seems to be two common factors. First, by far and away, the majority of these people are female, and second, they drink diet beverages, mostly soda and bottled iced tea. Their brushing and flossing habits appear to be adequate. They are taking no medication. The age range is from 12 to 55 years. All seem to be concerned with their weight, which is why they are consuming the diet drinks.

Years ago, this type of decay was seen in patients who kept candy, mints, or other edible breath fresheners in their mouths for hours on end, causing decay at the gum lines of teeth. Although another factor or factors may be the actual or contributing causes if this problem, the only currently detected causes are the diet beverages—soda and artificially sweetened bottled iced tea.

Sugar in food and drink feeds the bacteria present in dental plaque, allowing the bacteria to produce lactic acid. The lactic acid breaks down the minerals in the tooth enamel, which causes cavities. Although diet drinks are sugar-free, they are also very acidic. By the time the saliva dilutes these acids enough to bring the mouth back to its proper acidity, new or additional decay may already be in progress. Or worse, before the mouth does recover its proper acid balance, the patient is already uncapping another bottle of that diet drink!

Suggestions for the reduction or elimination of this type of decay include reduction or cessation of the drinking of these diet drinks, rinsing your mouth with water as soon as possible after the beverage contact, use of fluoride mouth rinses, and stronger prescription topical fluoride treatments both in office (four times each year) and at your home. We may even need to recommend the use of special fluoride delivery trays to increase the time that fluoride can remain in contact with the teeth. This will help make the enamel of the teeth stronger to resist the acid attack that starts decay. It will also promote a better equilibrium in the constant enamel demineralization/remineralization process that occurs in everyone’s mouth. Decay lesions in the very beginning stages can be stopped and even reversed in this way.

Though most of us could stand to lose a few pounds, be aware that some of the things you put in your mouth, in the hope of losing weight, may actually have an adverse effect of losing teeth.

Have Missing Teeth Replaced

Most adults can expect to have 32 teeth. The four third molars, or “wisdom” teeth, are often extracted because they do not grow into the mouth well or there is not enough room for them in proper alignment. It is very small unusual to have wisdom teeth replaced. But the other 28 teeth are needed. Your mouth, jaw, and body developed together over millions of years. They are designed to operate together at peak efficiency. When you lose a tooth, the efficiency decreases and function suffers. When you lose a tooth, you lose some ability to chew food properly. This may mean that you either place more stress on the other teeth in order to chew all the food you eat, or you do not chew well enough and what is swallowed is not quite ready to be digested. This can lead to digestive difficulty. Or you might switch to a diet that consists of softer foods that do not have to be chewed as much. You might have to eliminate certain favorite foods because you cannot chew them thoroughly. For each missing tooth, you lose approximately 10% of your remaining ability to chew food.

Other problems also occur. The teeth adjacent to the space to the left by the missing tooth will eventually shift. If for example, a lower tooth is extracted, the opposing tooth in the upper jaw will grow slowly (or sometimes quickly) longer in a downward direction into the missing tooth space. This is called extrusion or supereruption. The teeth on either side of the missing tooth space will move and tilt off their proper vertical axis and drift into the missing tooth’s space. This can make these teeth more prone to decay and gum disease because it is much harder to keep the teeth clean when they are not aligned properly. Root structure that is normally covered by gum and bone may become exposed. All this can happen if one tooth is lost. Other major problems can occur if multiple teeth are lost. There is a loss of the arch length, the distance from the back of the last tooth on one side of your mouth to the back of the last tooth on the other side of your mouth. With collapsed bite and loss of vertical dimension, the distance from your chin to the tipoff your nose decreases, making your face shorter. Extrusion and movement of your maxillary (upper) alveolar bone until the gum tissue from the upper jaw can touch the teeth or gum tissue of the other jaw causes loss of facial tone and shape. The facial muscles of the cheeks and mouth sink into the edentulous (extraction) site. There can also be severe cosmetic problems when the extracted tooth’s space is visible when you talk or smile. This is not a pretty sight to anyone. There is a loss of self-image and self-esteem and a feeling that you are getting old. Once you start losing teeth, you can actually start to look old. Losing a tooth is pretty serious. The longer you wait after a tooth is extracted, the more difficult and expensive it can become to make the replacement you need. With very few expectations, it is better to replace missing teeth as soon as possible. Evolution designed you to chew your food with 28 teeth.

We will discuss with you the type of replacement that would be best suited for you. You can choose to do nothing at all and leave the space or spaces, but as you can tell, this is not usually recommended. You can have a fixed replacement made that could be an implant, a conventional bridge (crowns/caps), a bonded resin bridge, or a combination of implants and bridges. You could also have a removable partial denture made. The advantages of the fixed replacements are that they are not designed to come out of your mouth at any time, they are the easiest to live with, feel more like the original teeth, and are perhaps more cosmetic then removable dentures. A removable partial denture is held in place by metal claps that may be visible. It is bulkier and may interfere with your speech for a period of time. However, generally, dentures cost less than a fixed replacement.

Your chewing apparatus, jaws, and teeth were evolved to function in a particular fashion. The interaction is complex and marvelous. Loss of teeth degrades this function. Preserve your health. Replace missing teeth as soon as suggested.

If you have any questions, please call Omni Dental Group at 512-250-5012.

   

For a Lifetime of Great Oral Health

Prevention is the key to great oral health. Better diet, medical care, and other factors are allowing us to live longer lives. Unfortunately, our teeth have not adapted to our long life span and need help to last as long as we do. If you want to have your teeth for your whole life, here is what you do:

• Brush, floss, and use recommended dental aids correctly, at least once a day. Use fluoride-containing mouth rinse daily.
• Come to the office for the recare hygiene appointments at the intervals we recommend. Let us provide a prescription-strength topical fluoride treatment at every recare appointment.
• Let us take radiographs when we believe they are necessary.
• Teeth age at wear, just like the rest of your body. The outer covering of hard enamel can get thin, break off, or wear through and expose the softer dentin. Dentin erodes very quickly. When we see exposed dentin, let us get it covered and protected.
• Have sealants places on all teeth that can benefit from them.
• Don’t ask to “patch” anything. Patchwork dentistry is contrary to the concept of keeping your teeth trouble-free for a lifetime. If small repairs are possible and appropriate, we will tell you.
• Choose the procedure or restorative material that will last you the longest. All dental materials have a life expectancy, after which time they fail and must be replaced. Each time a tooth is redrilled, it gets weaker. Only solid, yellow gold could last for your entire life. Tooth-colored ceramics and porcelain may last as long. It is your choice.
• Bonded restorations (current state-of-the-art) require less drilling than silver fillings. Less drilling is good. The tooth retains more strength and the restoration lasts longer. Let us do the good stuff.
• Gum disease can start at any time. Genetics, diet, oral self-care, medications, and general health can all have an influence. Gum disease is both site-specific (most often starts in a localized area) and episodic (can begin at any time). It is also painless in its early stages. We will tell you as soon as we spot gum disease. It will need to be treated properly and immediately.
• Our treatment recommendations are always based on your needs, not on what your insurance company wants or its bottom line. There are dozens of common dental procedures that are not part of benefit packages. Dental insurance carriers are in business to make money. They want to pay out as little as possible as late as possible. An attitude of “If my insurance company doesn’t pay for it, I don’t want it,” only hurts you and YOUR oral health.
• We have listened to what you want, examined your mouth, and know your dental needs. Most patients can have all the best dentistry they want and deserve. It just takes a little planning. We can help with that, too. If you want all of your teeth, all of your life, follow the above recommendations and do it right the first time.

Diastemas: Closing Spaces Between Teeth

The cause

A diastema is space between teeth, that is, adjacent teeth that do not touch. There are a number of reasons why spaces may exist between teeth. The two most common are an arch length discrepancy (teeth are too narrow for the arch that supports them), or because there are congenitally missing teeth. The remaining teeth then either shift or merely don’t touch the next available tooth. The spaces between the teeth can be just a fraction of a millimeter wide or so wide that a straw can easily fit between the teeth.

The missing teeth can often do cause a cosmetic problem. In the present culture of the Western world, spaces or gaps between teeth are not regarded as being desirable or attractive.

Treatment Options

There are several options available to treat a diastema. Most of these options work well whether the spaces are large or small or whether there are several spaces or just on space between two teeth.

Orthodontics can be used to move the teeth into a more pleasing alignment. This could be done with a retainer or fixed bands and wires. Clear Invisalign orthodontics aligners are often used to close these spaces. The advantage is that complex restorations are usually unnecessary and you have to worry about the restoration chipping or breaking after years of service. The disadvantage of orthodontics to close a diastema is the time needed to move teeth, which can range from months to 18 months.

The other option is to have the teeth restored with bonding. The bonding can be done with either resin or with porcelain. The resin will be less expensive and work well to close small diastemas. The porcelain takes an additional visit, is more expensive, and is more appropriate for larger cases in which a more significant appearance modification is needed. This would include changing the color of the teeth, the length of several teeth, or the alignment of several teeth. As a rule of thumb for small spaces, a bonded resin will work well; for larger spaces, orthodontics and porcelain must be considered. Porcelain and resin both can be made to exactly match your existing tooth.

Each situation must be individually examined and evaluated before treatment. Often, we will require sturdy model impressions to be made so we can make measurements of the tooth length, width, and amount of separation between teeth. Using this method, we can show you how you can look through the use of a diagnostic “wax up” showing the new shape of the teeth.

An important point to remember is that if you also want a whiter appearing smile, we should complete the whitening process before the bonding process. Teeth can be whitened, but dental materials such as porcelains and resins cannot be whitened. The restorations are placed to match your tooth color at the time they are placed, so whitening has to come first.

Afterwards

After the teeth are moved orthodontically or reshaped with porcelain or resin, your appearance will change! Not only that, but also your teeth will feel different to you. Your lips will be supported differently. Air will be deflected from your teeth in a different fashion. Depending on the amount of change, you may even need to make slight adjustments to your speech. The good news is that all the adjustments take only several hours to a few days to make. Very quickly, additions and changes become natural for you and you don’t even notice that they were done, except that people will compliment you on how lucky you are to have been born with such beautiful teeth.

Reversing Decay

If you were asked to describe a cavity, you would probably say the process was similar to ruse—something that happens on the outside of the tooth that makes the tooth soft and creates a hole that would eventually be visible. You might even have the notion that bacteria are involved. And, you would be right in both cases.

The process of decay is a complicated interplay of an acidic and basic balance of chemistry in the mouth. Salivary flow and content, the presence of decay-causing bacteria, the age of the teeth, diet, and the level of plaque all play a role in the decay (demineralization) as well as the rebuilding (remineralization) process involved in tooth decay.

Demineralization

At the very earliest stage of the decay process, there is not an actual “hole” in the tooth. There is, however, an alteration of the mineral content of the enamel. This stage of decay is completely invisible to the eye. It cannot be detected by an x-ray. It is a microscopic change where, due to the level of acid in the immediate area, the building blocks of enamel (calcium and phosphate) begin to dissolve on a microscopic level. When the acid environment is left unchecked (plaque is allowed to accumulate undistributed against the tooth surface), more and more of the bonds between calcium and phosphate dissolve. This is a process called demineralization. If the acid challenge becomes severe and more of the underlying structure of the tooth begins to dissolve, the outer surface becomes unsupported. It is at this time that the actual hole, or what you call a cavity, appears.

Remineralization

When the outer surface of the enamel is still intact, with no break detectable, there is an opportunity for the bond between calcium and phosphate to become re-linked through a process termed remineralization. And the great news is that dental science discovered that in the presence of fluoride, these bonds actually become stronger that they were initially. It is in this way that an early cavity can be reversed. When this happens, the tooth does not need to be drilled and filled.

The process of demineralization and remineralization can be seen as a tug of war on the molecular level of all surfaces of all your teeth, all the time!

How You Can Promoter Remineralization

There are several steps you can take on a daily basis to help ensure that you are promoting remineralization. These are:

•          Control your diet: watch the type of decay-promoting foods you eat and the quantity
•          Improve your oral self-care by brushing and flossing daily
•          Use tropical fluoride on a daily basis
•          Use antimicrobials and other anticaries agents as directed on a regular basis
•          Maintain your dental hygiene recare schedule

The early stages of dental decay CAN be reversed with no loss of tooth structure, and you can help promote a healthy mouth by following just a few simple rules.

Sensitive Teeth

Teeth can become sensitive for man y reasons. Sometimes the sensitivity is an indication of a potentially serious problem. Other times, the dentally related problem may be small but effects (the sensitivity) are extremely aggravating. A tooth can become sensitive after it has been prepared (drilled) for a restoration (filling). You may have been anesthetized during the procedure, so you did not feel any discomfort when the nerve in the tooth reacted to the heat generated by the drill. The closer the drill comes to the nerve, the more likely it is to cause a sensitivity problem. The high-speed rotation of the bur in the drill generates heat, and the response of the nerve to heat is inflammation.  This inflammation is felt by you as a “sensitivity”. If the decay, fracture, or drilling was not too deep, this sensitivity will decrease over time. A week to a month or two is not an unusual length of time for the sensitivity to disappear. A good sign is the continued decrease of sensitivity. However, if the occlusion (bite) is off after the restoration has been placed, the tooth may either become sensitive or may stay sensitive. Once the bite is adjusted, though, the sensitivity should disappear.

Additional reasons for single sensitivity are decay, a defective restoration, or a fractured tooth. When a tooth is decayed, temperature changes and sweets will make it sensitive. If a filling is defective or failing, leakage around the filling may cause the tooth to become sensitive. In both of these cases, the solution can be as simple as removing the decay or defective filling and placing an appropriate restoration. If the tooth is fractured, you may be sensitive to temperature changes, or when chewing food. This fracture condition may be hard to diagnose. If you think you might have this type of sensitivity, please ask for the separate handout that explains the “cracked tooth syndrome” in much greater detail.

Tooth sensitivity can also be caused by a dying nerve. The can be the result of a deep cavity. Commonly, the sensitive tooth holds an old larger filling. The nerve may have been damages during the drilling and the nerve has been dying gradually ever since. If this is the problem, the tooth will need endodontic treatment.

Two other reasons for tooth sensitivity are related. One is an inadvertent notching of the tooth surface and/or recession of the gum tissue (exposing the root surface of the tooth) caused by improper brushing: either brushing too hard, brushing with a toothbrush that is too hard, or using an improper brushing technique. This sensitivity can range from mild to extreme; the degree of sensitivity does not appear to be related to the size of the root exposure or notch. Finally, purposeful repositioning of the gum tissue during gum surgery can also lead to tooth sensitivity. While recession from brushing is slow, gum recession following gun repositioning occurs very quickly. The portion of the tooth once covered with gum and bone may now be exposed. Root sensitivity in these instances can be quite severe and immediate. It can sometimes last for months or years if not treated.

Treatment Options

Treatment in these last instances is similar. If there is a notch is the tooth or the shape of the defect is appropriate, the defect is restored (filled in) with a bonded material. This can give immediate relief—sometimes fully. When there is no defect to be stored, the exposed and sensitive root surfaces are covered with a dentin-bonding or other material. This material is invisible and has very little thickness, so you do not notice any change in the appearance of the tooth; but it works. It may have to be reapplied after several months because the bonding material has worn away by toothbrushing.