Taking Prescriptions? Some Supplements Can Cause Problems.

Posted on Sep 27, 2016 by William J. Claiborne, DDS MS

As baby boomers age, a growing number are turning to alternatives to prescription medications. Thus, there has been a growing demand for natural supplements. It is estimated that over 15 million Americans are using vitamins and herbal supplements along with prescription medications.

Surveys estimates show that herbal supplements are used by 12 – 24% of the American adult population with usage of those aged 65 and older doubling from 1999 to 2002.

Since supplements are available over the counter (OTC), many adults don’t see them as medications. So, when a new patient is completing their medical history form, these are not always listed. They should be.

Both medical and dental health care providers need this information to determine how these supplements will effect your body’s ability to clot properly during procedures that cause bleeding. Too, excessive bleeding can occur when these supplements are not acknowledged prior to procedures.

A number of aging adults take prescription medications to prevent arterial or venous thrombosis and stroke. When completing your medical history form, most patients readily acknowledge their use of these medications and understand that some drugs increase bleeding during certain procedures or hamper their ability to clot when bleeding. Knowing the patient is on these medications enables the medical or dental caregiver to monitor bleeding and clotting before complications arise.

However, patients are less informed that the use of OTC medications can impact bleeding in conjunction with their prescription medications. Yet, according to the Natural Medicines Comprehensive Database, approximately 180 dietary supplements have the potential to interact with warfarin and more than 120 may interact with aspirin, such as clopidogrel (Plavix) and dipyridamole (Aggrenox).

The National Institutes of Health (NIH) identified these supplements as having the potential to cause adverse bleeding interactions:
• Anise
• Dong Quai
• Omega-3 fatty acids in fish oil
• Ajoene in Garlic
• Ginger
• Ginkgo
• Vitamin E
• Fucus
• Danshen
• St. John’s Wort
• American Ginseng

The Centers for Disease Control and Prevention (CDC) shows the supplements having the highest sales include ginseng, ginkgo blob, garlic, St John’s wort and ginger. It is not unusual for a patient to take up to seven dietary supplements at the same time with some taken inconsistently.

In addition, the following herbs may affect blood clotting:
• High doses of Vitamin E
• Alfalfa
• Coenzyme Q10

While more studies are needed to determine precisely how these supplements alter bleeding or interact with prescription medications, it is important for medical and dental professionals to have consumption information in order to properly plan for procedures.

Warfarin (Coumadin®, Jantoven™), an oral anticoagulant, is used prevent and treatment VTE (venous thrombo-embolism), PE (pulmonary embolism), and atrial fibrillation (A-Fib) patients who are at risk of embolism. Warfarin is highly affected by medication use. In fact, more food and drug interactions have been reported for warfarin than with any other prescription medication.

A study in England noted a high number of patients were taking herbal supplements along with warfarin. In a survey of nearly 1400 patients, it was found that nearly 9% regularly took one or more of garlic,  ginseng,  ginkgo biloba, feverfew, ginger, and St. John’s
wort. Yet, nearly all admitted to failing to share this information with any of their health care professionals.

In addition to many herbal supplements, alcohol has been found to increase bleeding in warfarin users along with Vitamin C and Cranberry juice. However, the herbal supplements that tend to complicate clotting ability the most during bleeding include:
• Bromelain
• Cat’s claw
• Dong quai
• Evening primrose
• Feverfew
• Garlic
• Green tea
• Ginseng
• Ginkgo
• Horse chestnut
• Red clover

In addition to Aspirin’s ability to reduce mild to moderate pain, inflammation, and fever, it is also used in the prevention of myocardial infarction (MI) and cardiovascular problems, such as stroke. Aspirin may also be advised as added therapy during procedures like coronary bypass. While many users of Aspirin realize it “thins the blood,” many regular users fail to notify their dental professional.

As a periodontist, I perform a number of procedures that cause bleeding to tissues in the mouth. It is important for your safety and a successful outcome of your procedure to have this information prior to treatment planning.

While filling out those often-lengthy medical history forms seem daunting, the information they provide is necessary. It is also necessary that it be complete. Herbal and vitamin supplements taken regularly should always be listed.

If you have questions, please call 828-274-9440.

Tooth Loss NOT Natural Part Of Aging Process

Posted on Sep 12, 2016 by William J. Claiborne, DDS MS

Many of us can remember spending the night at our grandparents’ homes and being shocked to see their teeth soaking in a glass. Seeing our grandmother’s smile in a glass by the sink was a pretty unsettling sight!

While our grandparents may have been resigned to an eventual life with dentures, modern dentistry knows tooth loss need not be the case. Poor oral hygiene was not always the cause of tooth loss, either. Many in our grandparents’ era were taught to use a stiff toothbrush and baking soda and scrub their teeth hard. They thought that seeing blood in the sink meant they were doing a good job.

Today we know better. Substances such as baking soda and hard bristle toothbrushes are too abrasive for tooth enamel. Once enamel is worn away, the tooth becomes vulnerable to decay and cracks. Using modern techniques in brushing, flossing and keeping sufficient moisture in the mouth, adults can enjoy a naturally-healthy smile that lasts a lifetime.

In a five-year National Health and Nutrition Examination Survey, the statistics of tooth loss among older adults has declined somewhat over the years. However, still today those over the age of 65 only have an average 18.90 remaining teeth. Sadly, over 27% of seniors over the age of 65 have no remaining teeth at all.

The repercussions of tooth loss go far beyond the challenges of wearing dentures. Yet, dentures only contribute to the problems. The problem begins under the gums where your teeth were once held by the jaw bone. Without tooth roots to provide stimulation to the jaw, the bone begins to shrink. This process, known as “resorption,” leads to eventual tooth loss. This sets into motion a domino effect. It is a fact that the tooth beside where a tooth is now missing will be the next to go.

It is also a fact that people with their natural teeth live, on average, ten years longer than denture wearers. This is likely due to the ability to eat a healthy diet and stay active socially. People who wear dentures tend to decline social invitations since most are centered around food. The fear of embarrassing slips and uncomfortable rubbing makes most events seem a challenge.

You CAN keep your teeth all your life! Here are ways to help…

• Daily brushing and flossing is the gold standard in removing oral bacteria from the mouth. Brush for two minutes each time with a soft to medium bristle tooth brush using a fluoridated toothpaste. Use a swirling motion rather than a back-&-forth scrubbing motion. Floss daily. Brush your tongue or use a tongue scrapper to remove bacteria embedded in the grooves of the tongue.

• Be committed to your 6-month exams and cleanings, which give your mouth a periodic clean slate by removing accumulated tartar. Tartar is the cement-like attachments to teeth that the Hygienist scrapes off during cleanings. These are actually hardened colonies of oral bacteria that eat away at gum tissues and tooth enamel. These check-ups can also catch problems while still small.

• Keep your mouth moist. A dry mouth enables the growth of oral bacteria. 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.

• Limit carbs and sugar. The acids produced in the mouth by carbohydrates and sugary foods and beverages create an ideal environment for bacterial reproduction. While all foods trigger an acid attack in the mouth for 20-30 minutes after eating, sugar and carbs super-charge the reproduction of oral bacteria. This acid also softens tooth enamel, making them especially vulnerable.

When teeth are lost, adults encounter a complicated set of issues – and hard decisions. As a Periodontal specialist, 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.

If you have started to lose natural teeth already, let us help you halt the process! Call 828-274-9440 to schedule a consultation so we can discuss how you can regain your oral health for a lasting, healthy smile!

Avoid “Dry Mouth” And The Problems It Can Cause

Posted on Aug 30, 2016 by William J. Claiborne, DDS MS

We all have not-so-fresh breath on occasion. Some foods, certain illnesses and smoking can all lead to bad breath.

The problem, however, is when bad breath is persistent. This is an early sign of periodontal (gum) disease. If your bad breath is caused by gum disease, you may also be experiencing sore and tender gums and gums that bleed when brushing. If gum disease is not the problem, you may be suffering with dry mouth. However, it is important to know that dry mouth that occurs on a regular basis greatly increases your susceptibility to develop gum disease.

Oral dryness is what causes your mouth to feel stale and sticky when you wake up. This occurs because your oral tissues dry out during sleep. This provides an ideal environment for bacteria to multiply. As they thrive and reproduce, bacteria form a sticky film known as plaque.

Dry mouth can be caused by alcoholic beverages or coffee, which have a drying affect on oral tissues. Also drying are some medications that can decrease saliva flow. Saliva is designed to wash oral bacteria from the mouth. Many antihistamines and some medications for depression and urinary incontinence, among others, can cause dry mouth.

Medical conditions such as acid reflux, sinus infections, diabetes and bronchitis can also contribute to dry mouth. Breathing through the mouth because of snoring or a bad cold are drying to oral tissues as well.

Once we can determine the cause of your oral dryness, we can address the problem effectively. For example, if you take medications that have a side effect of oral dryness, there may be alternatives that have less drying effects.

In the meantime, take measures to lessen the negative effects of oral dryness. These include:
 – Brush at least twice daily for a minimum of two minutes. Use a tongue scraper or brush your tongue with your toothbrush after brushing.
 – Floss daily. If this is difficult, consider purchasing an electronic or water flosser.
 – Drink plenty of water throughout the day. Consider using an oral rinse that replenishes oral moisture. These are available without a prescription.

If you have symptoms of gum disease or feel you have persistent bad breath, we can help you avoid the problems that can result, including tooth loss. Call 828-274-9440 to schedule an examination. Or, feel free to begin with a consultation.

The Road To Gum Disease

Posted on Aug 03, 2016 by William J. Claiborne, DDS MS

People are often surprised to hear that they have developed periodontal (gum) disease. And no wonder. When gum disease first begins, it’s often without obvious symptoms. Then, once it’s fully underway, the warning signs are often ignored.

Yet, the road that leads to gum disease is shorter than you might imagine. Below is the typical process of how gum disease begins and progresses:

•  Oral Bacteria: We all have bacteria in our mouths. This warm, moist environment takes in an enormous amount of bacteria-laden items. Bacteria is on our food, utensils, the glass we drink from and the pencil we hold between our teeth. Of course, bacteria cannot be prevented altogether. However, the problem begins when too much bacteria accumulate.

•  Plaque: Without proper brushing, flossing, saliva flow and diet, oral bacteria can reproduce rapidly. Their accumulation over the course of a day forms a sticky film you feel on teeth. This is known as plaque.

•  Tartar (or Calculus): In just 48 hours, unremoved plaque can harden into tartar. This is actually a cement-hard colony of oral bacteria that attaches to teeth. And, like plaque, tartar will continually reproduce and grow as the bacteria feed on tooth enamel and tender gum tissues.

•  Gingivitis: This is actually the first stage of gum disease. At this level, gum tissues are under attack and become sore. They may bleed easily when brushing and you may experience an aching sensation in some areas. Your breath will no longer feel fresh. At this point, with proper measures, you can restore your gums to a healthy state. However, there is a fine line between being able to undo gingivitis and its progression to gum disease.

•  Gum Disease: At this level, the gums are inflamed and tender. You may notice them darken in color and begin to pull away from the base of some teeth. You’ll have persistent bad breath. As it progresses, pus pockets will form in some areas. Without thorough treatment, teeth will loosen and may eventually require removal.

Nearly half of American adults have some level of gum disease. Sadly, it is the nation’s leading cause of adult tooth loss. Yet, it’s one of the most preventable diseases with simple measures.

Twice daily brushing (at least two minutes per time), daily flossing, drinking ample water and limiting sweets and caffeine are simple ways to keep your mouth healthy between regular dental check-ups and cleanings. And, those 6-month check-ups are important. At this time, any tartar that has accumulated can be removed and signs of early gum disease can be noted.

Imagine losing your teeth and having to decide on a crown-&-bridge combination, partial, full denture or Dental Implants. These procedures can be avoided. And, contrary to what many believe, losing teeth is not a natural part of the aging process. With proper care, you can easily enjoy a smile of natural teeth all your life.

If you are experiencing symptoms of gum disease, call 828-274-9440. We’ll restore your smile and develop a program to help you keep it at its best.