Beware of Hidden Contributors to Gum Disease, Tooth Loss

Posted on Aug 19, 2023 by William J. Claiborne, DDS MS

Decades ago, oral health was something many people took lightly, often waiting until something hurt to see a dentist. The fierce pain of a cavity or abscess or the sharp jolt of something hot or cold on an area of gum recession were motivators to for a dental visit.

However, Americans are now realizing how very important their oral health is in how it relates to overall health.

The correlation lies with bacteria that live within the gum tissues. While all mouths contain “good” and “bad” bacteria, research has determined that the bad type can cause problems within and outside of the mouth.

The bad bacteria are inflammatory. An accumulation of these inflammatory bacteria are what lead to periodontal (gum) disease. Gum disease is the nation’s leading cause of adult tooth loss. Additionally, advanced periodontal disease – periodontitis – can trigger or even worsen serious health condition far beyond the mouth.

Although gum disease can begin without any obvious symptoms, once it exists, progression occurs in three stages, which are:

• Gingivitis – As the initial stage of gum disease, inflammation is triggered by plaque buildup at the gum line. When daily brushing and flossing fail to thoroughly remove plaque, toxins form that cause irritation to the gum tissues. Once signs emerge, they may include seeing blood in the sink when brushing or having sore, swollen gums. At this stage, however, damage may be reversed with prompt response.

• Periodontitis – As the disease advances, the bone structures and fibers that support teeth are damaged by the destruction of infectious oral bacteria. At this stage, inflamed gums form pockets below the gum line, filling with bacteria-laden plaque.

• Advanced Periodontitis – In the advanced stage of gum disease, fibers and bone supporting natural teeth are destroyed. This can cause teeth to shift or loosen, requiring aggressive treatment to prevent tooth loss. Eventually, some teeth may require removal.

As devastating as tooth loss can be to one’s overall health, the bacteria of gum disease can enter the bloodstream. Research has shown this infectious bacteria can trigger inflammatory reactions elsewhere in the body, correlating to heart disease, stroke, high blood pressure, some cancers (including lung and pancreatic), diabetes, arthritis, impotency, preterm babies, Alzheimer’s disease and more.

Obviously, people should be highly-committed to the care of their oral health. Yet, statistics in America along these lines are not impressive. The Center for Disease Control’s Division of Oral Health cites that 1 out of every 2 American adults 30 and over has periodontal disease. They also shared that periodontal disease is higher in men than women (56.4% vs. 38.4%) with high prevalence rates among smokers (64.2%) and adults 65+ (70.1%).

In addition to your twice-a-year dental check-ups and cleanings, there are other ways to support oral wellness between visits. One is in keeping the mouth moist, supporting sufficient saliva flow.

When saliva flow is insufficient, bacteria are able to accumulate and multiply rapidly. In addition to oral dryness as a part of the aging process, contributors can be consuming alcoholic beverages, caffeine, and as a side effect of many medications (both OTC and Rx).

One reason to keep your dental professionals aware of ALL the medications your take is in how they can interact with certain procedures, including numbing agents. For example, medications to reduce blood clotting, which lowers your risk for stroke and heart disease, can cause bleeding problems during oral surgery or periodontal treatment.

For those who take medications that help to strengthen bones, these have been associated with a rare but serious condition called osteonecrosis of the jaw. Simply put, it refers to death of the bone. The risk of these prescriptions is greater for those administered by injection or intravenously.

Osteonecrosis of the jaw commonly occurs after dental procedures (tooth extraction, implant placement). Over 90% of those who have experienced osteonecrosis are those who have taken the medication in repeated high doses due to cancer or other diseases.

However, 10% who experienced osteonecrosis were taking much lower doses, mostly intended to treat osteoporosis.

Certain medications also affect the ability to taste, including cardiovascular agents, central nervous system stimulants, non-steroidal anti-inflammatory drugs, respiratory inhalants and nicotine skin patches.

Some medications can also cause the development of oral sores, inflammation or discoloration of gum tissues in the mouth. These oral sores or discolorations may arise from taking medications for blood pressure, oral contraceptives and chemotherapy agents.

Dry mouth is a common side effect of a wide variety of medications, including prescriptive and over-the-counter. These include antihistamines, decongestants, painkillers, high blood pressure medications, muscle relaxants, drugs for urinary incontinence, anti-depressants and many others. Drying causes the soft tissues in the mouth to become inflamed and makes you more susceptible to infection. When saliva flow is depleted, your risk for tooth decay and gum disease increases.

Supplements that may seem unconnected to your oral health can actually effect your care more than you realize. It is important for your dentist to know if you take…

• Ginkgo biloba or evening primrose –  These herbs can reduce your blood’s ability to clot, possibly leading to excessive bleeding during and/or after a dental procedure.

• St. John’s Wort – This herb, which is often taken to reduce anxiety, can interfere with the metabolism of other medications, including sedatives, antibiotics and anti-inflammatory drugs such as prednisone and Decadron. When combined with St. John’s Wort, these drugs can be less effective. On the other hand, narcotics such as codeine, Vicodin and oxycodone can become more potent when taken with St. John’s Wort. This can lead to sleepiness, lethargy and dizziness.

• Valerian – This herb has mild sedative effects. If your dentist prescribes drugs for anxiety or painkillers containing codeine, the effects of both together are greatly accentuated. This can lead to severe sleepiness, lethargy and dizziness that can last into the next day.

• Calcium and magnesium – When these supplements are combined with certain antibiotics, they can decrease the antibiotics being properly absorbed. This can compromise your ability to fight off infection.

As a periodontal specialist, I find that most cases of dry mouth are due to factors that can be easily controlled with simple changes. If you have delayed or avoided dental care, call 828-274-9440 to request a consultation, or begin with a thorough examination in our Asheville periodontal office.

And, if you are experiencing signs of gum disease, please know this disease will only worsen without treatment. The sooner you have treatment, the less involvement your treatment will likely be.

We offer the latest techniques, technology, and skills while always making patient comfort a top priority. If dental fear or anxiety are concerns, please make us aware of this when you call or at your initial appointment. In addition to our standard comfort features, we offer Oral and I.V. sedation (“twilight sleep”).

How the “Bad” Bacteria in the Mouth Can Lead To Serious Health Problems

Posted on Aug 08, 2023 by William J. Claiborne, DDS MS

The human body is a fascinating structure. It seems every year there are new findings that show just how complex and amazing it is.

Recently, one of the biggest areas of interest has been the study of microbiome in the body. Once thought to be icky little cesspools, these colonies of microorganisms are now seen as having an important role in our health. For example, the microbiome in the gut has been shown to aid in digestion and it’s now seen that skin microbiome may potentially help people overcome conditions like acne and eczema.

As a periodontist, I’ve followed research in how microbiome is being recognized for having a positive role in oral health. While bacteria that convert sugar to acid are the driving force behind tooth decay, this means that those critters in our mouths are not always bad guys.

There are about 700 different species of bacteria in your mouth. Some can be “bad,” yet the good bacteria are able to give our overall health a “leg up” in certain regards.

Certainly, having a clean, healthy mouth helps to prevent cavities and periodontal (gum) disease. However, read on to learn how the health of your mouth can contribute to your overall health to a rather significant extent.

Over the years, numerous studies have been able to pinpoint how diseases – such as heart disease, diabetes, arthritis, and more – might be triggered. The “trigger” seems to consistently link back to internal inflammation.

Inflammation in the body has been shown to set actions into play that cause the onset or worsening of a wide variety of health problems. Periodontal (gum) disease is a chronic inflammatory disease. This means the bacteria attacking gum tissues are in a consistently active state.

When the bacteria of gum disease enter the bloodstream (through tears in weakened gum tissues), it can create inflammatory triggers far beyond the mouth. This bloodborne inflammation, in turn, results in higher risks for heart disease, stroke, diabetes, preterm babies, arthritis, respiratory diseases and even impotency.

How can this occur?

In chronic inflammation, the body’s defense mechanism becomes stuck in the ‘on’ position. This sets off a chain of reactions that alter the helpful response of the immune to a harmful one. When an area in the body stays in an inflammatory setting, damaging reactions can occur.

Once in the bloodstream, several species of harmful gum disease bacteria can add to existing inflammation, including that in the arteries, where it can lead to heart attack and stroke.

In one study of 265 stroke patients, researchers found that patients with gum disease had twice as many strokes (due to thickening and hardening of brain arteries) as patients without. Additionally, patients with gum disease were three times as likely to have a stroke involving blood vessels in the back of the brain, which controls vision, coordination and other functions.

In a separate study of over 1,100 patients who had not experienced a stroke, researchers noted that 10% had severely blocked brain arteries. They also found that patients with gum inflammation were twice as likely to have moderately severe narrowing of brain arteries.

Another example is in the similarities between tissues of gum disease and those taken from arthritic joints. Studies show that gum disease is not only a risk factor for arthritis (both are inflammatory diseases), one can contribute to the other. Thus, gum disease is a risk factor for developing RA and arthritic patients have a greater risk for gum disease.

Additionally, people with diabetes are more likely to have periodontal disease than people without it, likely because they’re more susceptible to contracting infections overall, according to the American Academy of Periodontology.

Studies also show that pregnant women with periodontal disease have a greater risk of having pre-term and low birth weight babies. These indications have been found in amniotic fluid and in fetal cord blood samples of infants.

Findings show, too, that the bacteria of periodontal disease may contribute to a higher risk of pancreatic cancer. For years, researchers at the National Cancer Institute and the American Cancer Society have conducted cancer prevention and screening studies.

By studying oral samples, notably higher levels of two types of oral bacteria were measured in study participants with pancreatic cancer. One oral bacteria was found to create a 50% increased risk for pancreatic cancer and the second oral bacteria led to a 59% greater likelihood.

Chronic inflammation, in any area of the body, is a health risk that poses severe health challenges now highly recognized in the medical field. Not surprisingly, we occasionally see patients who have been advised by their surgeons to have their gum health checked prior to surgery. This proactive measure is to reduce risk factors that could complicate surgical outcome.

Your body’s natural defenses along with good oral hygiene — such as daily brushing and flossing — helps to keep bacteria under control. Also, people should readily recognize the signs and symptoms of periodontal disease.

Healthy gums fit snugly around the base of teeth and be a light pink color. Although the initial stage of gum disease (gingivitis) may exist without obvious symptoms, common signs of gum disease include:

• Swollen or puffy gums
• Bright red or purplish gums
• Gums that feel tender or bleed easily
• Spitting out blood when brushing or flossing
• Frequent or persistent bad breath
• Pus pockets between some teeth and gums
• Loose teeth or a change in the way teeth fit
• Painful chewing
• Gums that pull away from teeth or are sensitive to heat and/or cold

Maintaining good at-home oral hygiene is easy and takes just minutes a day. Brush twice a day (two minutes each time) and floss daily. Drink plenty of plain water throughout the day and limit sugar. Have dental cleanings every six months and follow your dental hygienist’s recommendations to keep oral bacteria at minimal levels between visits.

If you suspect you have gum disease or have delayed (or avoided) having regular dental care, call our Asheville periodontal dental office to schedule an examination. Or, ask to begin with a consultation appointment. During this time, we can discuss any concerns and I’ll answer your questions. Call 828-274-9440.

Let’s help you achieve a healthy, confident smile that adds to the well-being of your overall health!

Sources:

https://www.jnj.com/innovation/4-things-scientists-know-about-the-bacteria-in-your-mouth

https://www.nih.gov/news-events/nih-research-matters/identifying-new-contributor-tooth-decay

https://pubmed.ncbi.nlm.nih.gov/26474422/

https://www.reuters.com/article/us-health-periodontitis-erectile-dysfunc/chronic-gum-disease-tied-to-risk-of-erectile-dysfunction-idUSKBN13K1UP

http://www.health.harvard.edu/press_releases/heart-disease-oral-health

https://www.cancer.org/research/cancer-facts-statistics.html

Grow Older With A Confident Smile That Is An Asset To Your Well-Being

Posted on Jul 27, 2023 by William J. Claiborne, DDS MS

Oliver Wendell Holmes, an associate justice of the U.S. Supreme Court from 1902 – 1932, once said, “Old age is always fifteen years older than I am.” 

For people who’ve reached “a certain age,” it becomes clear that the advantages of aging (such as having more confidence and living life at a slower pace) are mixed with many challenges, mostly regarding health. 

From aching joints to loss of muscle strength to poor eyesight and hearing loss, the aging process comes with health challenges that seem to grow in number and severity with each passing year. Sadly, increased risk of tooth loss is also part of the process.

Depending on the retention of wisdom teeth, a full set of adult teeth should be 28 to 32. However, in a five-year study by the National Health & Nutrition Examination Survey, Americans ages 75 and over were missing over 22 natural teeth with over 26% having no remaining teeth (known as being edentulous).

While tooth loss is often perceived as a normal part of the aging process, it is not. Keeping one’s teeth throughout a lifetime is very possible. The health benefits of maintaining  natural teeth include, among many others, living a longer life.

Healthy teeth rely on a healthy foundation — your gums. Good oral health has been shown to reduce risks for serious health conditions (including heart disease, stroke, and some cancers) elsewhere in the body. In addition to lowering a number of health risks, keeping your natural teeth is necessary for proper biting, sufficient chewing, digestional health and nutritional intake.

It has also been shown that wearing dentures is a poor method of replacing natural teeth. Even though they recreate the appearance of teeth and restore function (to varying extents), dentures can actually contribute to long-term problems.

Natural tooth roots help to nourish and stimulate the jaw bones that are the supporting structures of teeth. Without them, the bones begin to shrink. Known as “resorption,” this process of bone mass decline can eventually lead to tooth loss. Once resorption begins,, it continues at an ever-increasing cases year after year.

Tooth loss also causes a domino effect of sorts. Statistics show that adjacent teeth beside an area of tooth loss have the highest risk of being the next to be lost.

And the problems associated with dentures continue. The gum-colored base of dentures is porous. This surface provides oral bacteria with tiny hideouts that are breeding grounds for high levels of bacteria. Denture wearers have higher incidences of respiratory problems, including susceptibility to pneumonia. Studies have shown that senior adults who also sleep in their dentures have even higher risks.

Wearing your dentures for prolonged periods of time (such as while you sleep) coupled with the aging process itself can lead to Denture Stomatitis. This condition causes redness, swelling and tenderness in the mouth. While it is most common among denture wearers, it can also occur from a broad spectrum of antibiotics.

Nearly 89% of adults ages 65 and older report they are currently taking any prescription medicine. More than half of adults 65 and older (54%) report taking four or more prescription drugs (compared to 32% of adults 50-64).

While a number of both prescribed and OTC medications include the side effect of oral dryness for any age, age-related reductions in salivary production are more severe for older adults, causing irritation to oral tissues.

Medications including antihistamines, blood pressure medications, decongestants, pain medications, diuretics and antidepressants typically cause dry mouth, which can create inflammation and higher susceptibility to infection.

The aging process causes the condition of “dry mouth.” Saliva plays an important role in maintaining good oral health. A healthy saliva flow makes it easy to talk, swallow, taste, and digest food. A reduction in saliva flow can increase plaque accumulation as well as the risk of developing periodontal disease. 

Referred to as gum disease, this bacteria accumulation can lead to tooth decay, mouth sores and oral infections. Inadequate saliva can contribute to bad breath, dry and cracked lips, cause the fit of dentures to become uncomfortable, and result in higher oral infection risk.

An emphasis on maintaining good oral health needs to be front and center for older adults along with their overall health care commitment. Fortunately, good oral health is easy to achieve. Twice-daily brushing, daily flossing and having 6-month dental exams and cleanings can help to minimize problems and address those that do occur at their earliest stages.

It is also important to keep your mouth moist. Drink plenty of water throughout the day. Limit foods and beverages that are caffeinated, which are drying to oral tissues. These include coffee, tea, colas and chocolate as well as spicy foods. If you take medications that have drying side effects, use an oral rinse designed to replenish moisture. Also, chew sugarless gum to help promote saliva flow.

Your diet is an important part of a healthy mouth. Evaluate your food intake carefully. Begin by limiting carbs and sugar. While all foods trigger an acid attack in the mouth for nearly 30 minutes after eating, sugar and carbs super-charge the reproduction of oral bacteria.

When teeth are lost, adults encounter a complicated set of issues – and costly challenges that can reach far beyond the mouth. As a Periodontist, I’ve seen how simple measures can save people greatly in treatment time and expense AND prevent problems like gum disease, cavities and tooth loss.

According to Woody Allen, “You can live to be a hundred if you give up all things that make you want to live to be a hundred.” Your smile should be one of your best assets throughout your lifetime, complementing appearance and as an advantage to your overall health. Don’t let the detrimental impact of tooth loss and risks associated with gum disease make you look and feel old.

If you have begun to lose natural teeth, let us help you halt the process! We can also discuss replacing them with dental implants with our specialized skills in the diagnosis and placement of dental implant.

Call 828-274-9440 to schedule a consultation to discuss how you can regain your oral health for a lasting, healthy smile!

Sources:

https://www.nidcr.nih.gov/research/data-statistics/tooth-loss/seniors

https://www.kff.org/health-reform/issue-brief/data-note-prescription-drugs-and-older-adults/

https://my.clevelandclinic.org/health/diseases/21702-denture-stomatitis

Safe Tips for Cancer Patients To Protect Oral Health During Treatment

Posted on Jun 09, 2023 by William J. Claiborne, DDS MS

Cancer has touched so many in the U.S. It is a major, if not deadly, challenge for not just the cancer patient. The each individual diagnosed, it can also impact the lives of spouses, children, family members, and friends.

The progress in improving the rates of cancer survival in America are, fortunately moving in the right direction. As of January 2022, the National Cancer Institute shares that there are an estimated 18.1 million cancer survivors in the United States, representing approximately 5.4% of the population.

By 2032, the number of cancer survivors is projected to increase by 24.4% and by 2040, it is projected to grow to 26.0 million.

As progress continues, treatment for cancer remains a daunting ordeal. The long treatment time and extreme side effects associated with cancer treatment is seen as simply awful. The oncology teams that surround these patients are amazing, however, and try to lessen the burden throughout.

As a periodontist, I am familiar with the oral side effects of chemotherapy and radiation. I am very dedicated to these patients, and strive to help them be comfortable while protecting their oral health.

What’s important is to care for oral health in a way that keeps the patient comfortable while helping them to avoid any after-effects. This is where I differ with some advice for cancer patients since not all “tips” are good for the teeth and gums. For example, cancer patients undergoing chemotherapy may be advised to suck on on peppermint or lemon drops to relieve dry mouth. Not so fast…

Caring for oral health during any health condition that lowers the immune system can actually support your immune system by lowering systemic inflammation. Research has linked many health problems, including some cancers, to the bacteria of advanced gum disease (periodontitis).

Information shared by the American Academy of Periodontology states:
“Researchers found that men with gum disease were 49% more likely to develop kidney cancer, 54% more likely to develop pancreatic cancer, and 30% more likely to develop blood cancers.”

Oral dryness causes the tissues in the mouth to become inflamed, which places you at greater risk for infection. Insufficient saliva flow ups your risk for tooth decay and gum disease. So, it’s understandable that sucking on candy may help. However, the sugar from this candy that lingers in the mouth for long periods creates a higher risk of gum disease and the demineralization of tooth surfaces, opening the door for cavities.

One article in RDH Magazine shares these cautions for cancer patients:
• Products with drying and potentially irritating ingredients, like sodium lauryl sulfate, can increase risks for oral mucositis (the soft tissues in the mouth).
• Strong flavors can feel too sharp for tender tissue and can increase nausea.
• Inappropriate selection of toothbrush head sizes and bristles makes plaque removal more difficult and tissue trauma is more likely to occur. This may affect the patient’s ability to brush at all.
• Sugary and/or acidic products such as hard candies can increase risks for caries, erosion, and infection.
• Petroleum-based lip balms ultimately keep lips drier and create a dense barrier that can trap bacteria and impurities against the skin, which increases infection risks.

While chemotherapy is known to cause nausea, another common complaint of patients undergoing chemotherapy or radiation is having a metallic taste in the mouth. Just as certain components of oral medications can emerge in saliva, drugs administered intravenously can also emerge in the saliva, causing “metal mouth.”

However, it’s important to note that women who are menopausal or post-menopausal may experience changes in their mouths. They may experience dry mouth, pain and burning sensations in the gum tissue as well as altered taste, especially salty, peppery or sour.

In addition to chemotherapy, “dry mouth” is a common side effect of many medications, including prescriptive and over-the-counter. These include antihistamines, decongestants, painkillers, high blood pressure medications, anti-depressants, muscle relaxants, drugs for urinary incontinence and many others. Some medications, along with chemotherapy, can result in oral sores or spots of discoloration.

Because some spots and discolorations can be symptoms of oral cancer, keeping your dentist aware that you take these drugs helps he or she to monitor these areas closely and appropriately. However, other medications can cause sores in the mouth, inflammation or discoloration of gum tissues. These include those taken for blood pressure and oral contraceptives.

For some cancer patients, our dental laser is an option that can speed healing of these sores and restore comfort faster. Additionally, our Asheville periodontal dental office features advanced technology that often minimizes treatment and enhances patient comfort.

For those who take medications that help to strengthen bones, these have been associated with a rare but serious condition called osteonecrosis of the jaw, known as “death of the bone.” These medications, prescribed to help prevent or treat osteoporosis with certain versions administered by injection.

Osteonecrosis of the jaw commonly occurs after certain dental procedures such as extractions or implant placement. About 90% of those who have experienced osteonecrosis are those who took the medication in repeated high doses due to cancer or other diseases. However, 10% who experienced osteonecrosis were taking much lower doses, mostly intended to treat osteoporosis. Those who currently take these medications or have taken them within the past year should reveal this to their general dentist or dental specialist prior to any procedures – including a cleaning.

Periodontal (gum) disease, teeth with cavities or the loss of natural teeth can negatively affect physical, emotional, and financial quality of life. In addition to treating existing problems, our Western Carolina periodontal office is structured so our patients can avoid long-term damage to oral health. We are known for making patient comfort a priority – at every visit.

For an examination, call 828-274-9440. Or, ask to begin with a consultation.

Sources:

https://www.perio.org/for-patients/gum-disease-information/gum-disease-and-other-diseases/

https://www.rdhmag.com/patient-care/article/14294608/the-importance-of-oral-care-during-cancer-treatment