Nothing To Fear To Accomplish Healthy Smile Here

Posted on Apr 16, 2023 by William J. Claiborne, DDS MS

As a dental specialist, I find that many people are unfamiliar with exactly what a periodontist does. Yet, when they are recommended to see me (typically by their general dentist), it is because they need specialized care that falls under our unique set of skills.

A periodontist has advanced skills to help patients with a variety of needs that involve the gum tissues. These include:
– Treatment of all stages of gum disease (gingivitis, pregnancy gingivitis, periodontal disease, periodontitis)
– Reshaping gum tissues for esthetic enhancement (crown lengthening, gingivectomy for ‘gummy smiles’, repairing areas of gum recession)
– Diagnosis and placement of dental implants
– Treatment of lesions or cysts in oral tissues

Let’s begin with gum disease.

Because the majority of care I provide has to do with the treatment of all stages of periodontal disease, it may be helpful to understand how this develops. Although many people delay or avoid regular dental care (mistakenly thinking “if nothing hurts, then nothing must be wrong”), I have a close-up view of its destructive nature. Its formation creates cavities, periodontal (gum) disease, and leads to eventual tooth loss.

Even people who are committed to a regimen of thorough at-home oral hygiene (twice-daily brushing, daily flossing), can be doing an insufficient job of removing the daily buildup of plaque. Plaque is a sticky film of bacteria that accumulates in the mouth. When not thoroughly removed, it can harden into a mass that attaches to the base of, or in-between, teeth.

In the form of tartar, this cement-hard mass of bacteria cannot be brushed or flossed away. Once tartar forms, it can only be removed by a dentist or hygienist using special tools. Without removal, it will continue to amass and attack gum tissues, working its way beneath the gum line.

Below the gums lie the support system for natural teeth, consisting of tissues, ligaments and bone. When the bacteria reach an uncontrollable level, they become infectious. As these infectious bacteria accumulate further, symptoms of gum disease become more apparent, such as tender or swollen gums or seeing blood in the sink when brushing teeth. Breath odor may be bad on a regular basis.

As symptoms worsen, the gums become red with infectious and loosen their grip around the base of teeth. The gums may become spongy and pus pockets may form. Breath odor at this point is persistently putrid. Eventually, the structures that support teeth are compromised and teeth may loosen. Gum disease is the leading cause of adult tooth loss in the U.S.

Research has found that certain strains of oral bacteria from gum disease create reactions in the body that can trigger systemic inflammation. Thus far, research findings have shown a correlation between periodontal disease bacteria and some cancers (including pancreatic and lung), Alzheimer’s disease, pre-term babies, heart disease, stroke, diabetes, arthritis and erectile dysfunction (ED).

As if all that weren’t bad enough, one study suggests that gum disease relates to a reduction in one’s quality of life: “Periodontal disease has been linked to lower quality of life.” “Quality of life encompasses several domains, including psychological functioning and social relationships among others. Oral health-related quality of life has been shown to be reduced in patients with periodontal disease.” (https://www.hindawi.com/journals/prm/2017/5491923/)

While estimates show about 75 percent of American adults have some degree of dental fear or anxiety, over 47 percent have some level of periodontal disease. As a periodontist, both are alarming numbers. Nearly half our nation is walking around with a potentially life-threatening disease in their mouths.

Treating this may sound like it would be pretty intimidating. However, Although there are many treatments offered and at various levels, our main goal is to provide patients with comfortable and positive experiences at every visit. One way we accomplish this is through the advanced technology featured here in our Western North Carolina periodontal dental office. We feature some of the most advanced in dentistry, much of which is not available in dental offices elsewhere. Some of these features include:

LANAP With PerioLase MVP 7: Laser-Assisted New Attachment Procedure is an advanced protocol that efficiently and effectively treats advanced gum disease with the added advantages of a dental laser. This offers a non-surgical alternative for patients with moderate to severe periodontal disease. LANAP treatment leaves very little discomfort and has a quick recovery time. It has also been found to stimulate bone regrowth in damaged areas.

3D Cone Beam Imaging: Ideal for diagnoses and treatment planning, these images provide a clear view of the upper and lower jaw, used for: intricate review of endodontics; periodontics; orthodontics; implantology: TMJ; and prosthodontics, as well as dental and maxillofacial surgery. Because cone beam radiographs show sagittal, axial, and coronal planes, locating and tracking nerve canals optimizes implant placement. The process is quick, painless and at minimal levels of radiation.

CareStream Cone Beam Computer Tomography Imaging: This enhanced tomography works with 3D imaging for exceptional detail and range.

CS 3600 Intraoral Scanner: Rather than make impressions with bulky, goopy trays, this scanner quickly and comfortably captures digital impressions accurately and easily for creating precision models or appliances (crowns, inlays, onlays, bridges, orthodontic appliances and aligners, custom abutments). The scanner can also reach difficult–to–access areas in the patient’s mouth for superior results with improved patient comfort.

Computerized Dental Implant Placement: This advanced system for pre-surgical positioning of dental implants uses a 3D model of the patient’s jaw. Once the implant type is selected, a template is developed for optimal treatment success, even for complex cases.

In addition, we offer a unique environment for comfort. We understand how dental fear or anxiety can cause people to delay or avoid having dental treatment, sometimes for decades. We believe that every patient deserves respect, a gentle touch and knowing they are in a “lecture free” zone. For those who have high fear levels, we offer several sedation options, including oral and IV sedation.

Oral sedation is a pill that helps patients relax. It also has an amnesiac effect, leaving most with little or no memory of treatment afterward.

I.V. sedation (also known as ‘twilight sleep’) places the patient in a deeper sleep state and erases memory of the procedure. It is administered by a doctor of anesthesiology for optimal comfort and safety. In our Asheville office, anesthesia is overseen by a Medical Doctor (MD) who is a board certified Anesthesiologist.

With both sedation options, patients are closely monitored with advanced safety equipment throughout treatment.

I hope I’ve given you a helpful and positive picture of what a periodontist does and how he/she can help you with some challenging needs; all the while keeping you comfortable, minimizing treatment time, and shortening treatment time.

Although most of our patients are referred to us by other dentists and dental specialists, a referral is not required for accepting a new patient. Call 828-274-9440 if you feel we can make recommendations for your specific needs or provide helpful information.

Heightened Oral Cancer Risk From HPV Virus

Posted on Apr 10, 2023 by William J. Claiborne, DDS MS

April is National Oral Cancer Awareness Month. There is good reason that an entire month has been devoted to this dire health problem. With the growing statistics surrounding HPV and its ties to Oral Cancer, especially amongst adolescents, the need for education and clear, straight-forward discussions are needed.

First, know that the human papilloma virus (HPV) is the nation’s most common sexually transmitted virus. At least 50% of sexually active people will have genital HPV at some time in their lives. While awareness of HPV risk is gaining ground, it is not commonly known that the virus can spread through oral sex and linked to diseases in the mouth.

An estimated 20 million Americans are infected with the human papilloma virus. HPVs, which are a group of more than 200 viruses with 40 types, can easily spread through direct sexual contact, including vaginal, anal, and oral sex.

Virtually all cases of cervical cancer are caused by HPV. In the 1980’s, HPV was attributed to around 16% of mouth and throat tumors. Within two decades, that figure had increased to nearly 75%. According to the World Health Organization (WHO):

“Almost all cervical cancer cases (99%) are linked to infection with high-risk human papillomaviruses (HPV), an extremely common virus transmitted through sexual contact.”

A particular type of HPV, the high risk HPV 16, is found in cancer of the tonsils, vocal cords, base of the tongue, and oesophagus. A low risk HPV that causes genital warts may also be found in some cases of cancer of the vocal cords.

Oropharyngeal cancers include malignancies of the tonsils, soft palate, base of the tongue and throat. HPV is commonly transferred through genital contact but HPV spread through oral sex is what increases the risk of mouth and throat cancers.

Another fact that is not widely known is the higher risks for males. Oral cavity and oropharyngeal (throat) cancers are twice as common in men than in women. HPV-related oropharyngeal cancers occur more often in men. The development of oropharyngeal cancer due to HPV is about three times less prominent in females than in men of the same age.

About 10% of men and 3.6% of women have Oral HPV, which is transmitted through sexual or skin-to-skin contact. Oral HPV can spread through deep tongue kissing and oral sex. In men, symptoms may appear in the form of warts, growths, lumps, or sores on the penis, scrotum, anus, mouth, or throat.

Other factors that can heighten the risk that HPV will develop into cancer include:
• Smoking or chewing tobacco (increases oropharyngeal cancer risk)
• Weakened immune system
• Having many children (increases cervical cancer risk)
• Long-term oral contraceptive use (increases cervical cancer risk)
• Poor oral hygiene (increases oropharyngeal cancer risk)
• Chronic inflammation

The spread of HPV is said to be at an epidemic level. Thus, the Centers For Disease Control & Prevention (CDC)  which has prompted the recommendation for HPV vaccinations for ages 11 – 12 year olds. Being vaccinated before becoming sexually active can lower one’s risk of being infected by HPV types and several types of cancers associated with HPV.

Regardless of age, vaccines are available, which many doctors encourage for sexually active patients who have multiple partners. For those who are not vaccinated against HPV, condoms can lower the risk of developing HPV-related diseases, such as genital warts and cervical cancer.

However, HPV can infect areas that are not covered by a condom. Therefore, the risk remains high for many even with the use of condoms. Condoms do not give complete protection against HPV transmission, which can mean potential infection of areas not covered.

When it comes to oral cancer, alert us immediately if you experience any of the following symptoms that do not clear up within two weeks:
• Have difficulty swallowing
• Have lumps in the neck
• Experience pain in the mouth or ear
• Notice unusual spots inside the mouth (including the tongue) or on the lips

A periodontist is a specialist in the treatment of oral gum tissues and in the placement of dental implants. This dental specialist understands the unique health and risks to gum tissues.

In our Asheville periodontal dental office, we also offer some of the industry’s most advanced digital technology available. These features often minimize the extent of treatment needed, speed healing, and enhance comfort.

We also offer oral and IV sedation for many procedures. These sedatives are safely administered by professionals who are specifically trained in the administration of anesthesia. Here, patient safety and comfort are always priorities.

If you have ANY symptoms that may indicate oral cancer, do NOT wait until your next check-up to have these evaluated. Call 828-274-9440 for an immediate appointment.

Sources:

https://www.who.int/health-topics/cervical-cancer#tab=tab_1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4544688/

https://pubmed.ncbi.nlm.nih.gov/20116657/

https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/causes-risks-prevention/risk-factors.html#:~:text=Oral%20cavity%20and%20oropharyngeal%20cancers%20are%20twice%20as%20common%20in,seen%20more%20often%20in%20men

https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-fact-sheet

https://www.colgate.com/en-us/oral-health/hiv-aids-and-stds/dental-care-hpv-and-men#

Helping To Curtail Opioid Misuse

Posted on Mar 23, 2023 by William J. Claiborne, DDS MS

No one wants to be in pain. In the dental office, dentists and dental specialists see many patients enduring a great deal of pain, some of which increases in time to excruciating levels.

To resolve the pain, treating the affected area is the first step. Healing can take time and may involve a period of continued discomfort. While a dental profession wants to help patients avoid problems and pain that can arise from them, helping you get through painful periods with ease is certainly a priority.

Like others in the health care field, the field of dentistry has become rather resistant to prescribing harsh and addictive painkillers. The opioid epidemic in the U.S. is running rampant and we want to do our part in curtailing the availability of these meds.

I felt it may be helpful to share some statistics and research findings on the opioid use in America. Hopefully, this information will reassure that the dental profession is not being “stingy” with prescribing painkillers. We are trying to help control what can easily be misused or over-prescribed.

Drug overdose deaths involving prescription opioids rose from 3,442 in 1999 to 17,029 in 2017. From 2017 to 2019, the number of deaths declined to 14,139. This was followed by a slight increase in 2020, with 16,416 reported deaths. In 2021, the number of reported deaths involving prescription opioids totaled 16,706. These numbers are headed in the wrong direction, obviously.

Although physicians, dentists and others in health care have been under close scrutiny for the number of opioids prescribed, dentists are also being more diligent in limiting patient access to pain medications. Yet, there is still a concerning number who make access easier than it should be.

According to International Association for Dental Research findings shared from two studies amongst dentists and oral-maxillofacial surgeons (OMFS) (presented in March 2023), the goal is to identify high prescribers of opioids. The study, conducted at the University of Pittsburgh, used data to detect actively prescribing dentists between 2015-2019.

The study found that during this period, 2,741,030 opioids were prescribed by 199,145 dentists/OMFS. Researchers noted that over 35% of prescribers prescribed at low rates in 2015 with this percentage falling to nearly 18% in 2019. In this period, those who were “moderate” prescribers of opioids also decreased prescribing by over 82%. A slightly more active group of prescribers also decreased their number of these prescriptions.

However, 3.5% of prescribers found to be consistent in opioid prescriptions decreased in number, yet with minimal decline. For these, the rate in 2015 averaged nearly 55%. In 2019, the average was only down to 44.7%.

A particular concern in prescribing opioids is that of prescriptions submitted for children. While total opioid prescriptions have decreased in patients under 25 years of age, trends in opioid prescribing for children, adolescents, and younger adults (under 25 years of age) remains a concern.

In a study from 2013 – 2018, researchers found the opioid dispensing rate for younger patients decreased annually at a rate of approximately 15%. The largest decreases were noted for patients ages 15 to 24 years. Among children aged 0 to 5 years for whom an opioid was dispensed, the investigators observed annual increases from 2011 to 2014. For high-dosage prescriptions, these decreased from 2014 to 2018 although high-dosage, extended-release or long-acting remained at a concerning rate — nearly 28%.

Even amid an epidemic of abuse, opioid painkillers are still commonly prescribed to teenagers and young adults for conditions like tooth and back pain. Between 2005 and 2015, opioids were prescribed to teens and college-age adults at nearly 57 million visits to doctors’ offices and emergency departments.

Although more common in an ER, 15% of visits concluded with an opioid prescription with only a small decline over the 10-year study period.

A report on opioid prescription misuse by the University of Michigan shared another concern that contributes to the problem. When people get a prescription for opioid painkillers to ease pain, it is assumed that the patient has it filled right away. However, there are now findings that show some of these prescriptions are being filled more than a month later, long after acute pain should have subsided.

In 2019, 1% of opioid prescriptions from dentists and surgeons were filled more than 30 days after writing. Although the number is low, that percentage equates to more than 260,000 opioid prescriptions a year in the U.S.

This indicates to prescribing surgeons and dentists that the medications are being used for other than intended. Whether over-prescribed by the doctor or misuse by the patient, this adds to the risk factor for opioid overdose.

These delayed-fill findings have led to call for state and federal laws to better regulate the expiration periods for filling these prescriptions. Changing the systems of monitoring along these lines has been slow in coming. In 2019, 18 states allowed prescriptions for opioids and other controlled substances to be filled up to 6 months after writing with 8 states allowing dispension up to 1 year after the prescription date.

The entire team at our Asheville periodontal dental office is highly committed to providing patients with optimal comfort throughout treatment. Here, we make oral sedation available as well as I.V. sedation (“twilight sleep”). These help patients to relax fully or snooze during treatment, erasing most (or all) memory of treatment afterward.

We also want our patients to heal comfortably after periodontal treatment or dental implant placement. As a periodontist, this is helped by being respectful of gum tissues and all areas in the mouth DURING procedures. We work with each patient to help them remain comfortable during their post-procedure time. Often, this can occur without the need for heavy medications with many patients only requiring OCT pain meds.

When it comes to your treatment, our advanced imaging technology helps us to pinpoint precise areas for incisions, which helps to minimize discomfort and speed healing time. Additionally, performing treatment at an easy pace allows for minimal disruption to sensitive gum tissues.

A periodontist has advanced skills in the treatment of all stages of gum disease, the re-contouring of gum tissues, and in the placement of dental implants. This dental specialist can help provide an optimal result while helping you enjoy the highest level of comfort – during and after treatment.

Please call 828-274-9440 if you have questions about comfort, treatment, or dental fear. New patients are always welcome and a referral is not always needed.

 

Absorbent Gums Are On Front Line of “Hidden” Toxin Intake

Posted on Mar 15, 2023 by William J. Claiborne, DDS MS

When you hear someone mention the “gums,” the word often includes the pink, moist area inside the mouth. Not just the area inside the cheeks and under teeth, your oral tissue (“gingiva”) goes beyond what covers the upper and lower jaws and that which surrounds the base of the teeth. This includes …
• the lips
• inner lining of the lips and cheeks
• hard and soft palate
• gums that surround the base of teeth
• floor of the mouth under the tongue
• area behind wisdom teeth
• front two-thirds of the tongue

By design, these moist areas within the “oral cavity” are highly absorbent, so much so that these tissues absorb from anything put inside the mouth, including that which is quickly swallowed.

To help you understand just how important it is to maintain GOOD oral health, I thought it would be beneficial to share some of the BAD that the gum tissues endure. Because the mouth is the entry point for our bodies, you may be interested in seeing what foods and beverages contain some pretty scary ingredients.

According to the Environmental Working Group (www.ewg.org), these items include:

Nitrates and nitrites – are preservatives used in cured meats and linked to stomach cancer, esophageal cancer, and possibly brain and thyroid cancers.

Artificial sweeteners – can affect the hormones that regulate metabolism and have a negative effect on weight control.

Potassium Benzoate – A main ingredient in fireworks and rockets, this chemical preservative is found in many foods and beverages. It is commonly found in fruit juice, sparkling waters, soft drinks, jams, syrups and more.

Titanium dioxide – is a color additive used mostly in candy, which can damage DNA.

PFAS (polyfluoroalkyl “forever chemicals”) are used in food packaging and known to leach into the food itself. They increase the risk of cancer and damage the immune and reproductive systems, among many other health harms.

BVO (Brominated vegetable oil) – is used to stabilize citrus flavors in sodas and fruity drinks. It can cause neurological harm.

BHA (Butylated hydroxyanisole) – is a preservative used in cured meats and other foods. Multiple sources have identified it as a possible human carcinogen.

BHT (Butylated hydroxytoluene) – is a preservative found in cereals and other foods. This chemical cousin of BHA is a possible human carcinogen.

TBHQ (Tert-butylhydroquinone) – is a preservative used in Pop-Tarts and other processed foods. It may harm the immune system and weaken the effectiveness of vaccines.

Propyl paraben – is a preservative used in pastries and some tortillas. It causes developmental and reproductive harm.

That’s quite the long list. However, an even greater challenge to the gums comes from smoking. While everyone who smokes knows it’s “not good” for their health, it is less known the harm doesn’t come from the nicotine alone.

The American Lung Association lists the chemical culprits as:

Acetone—found in nail polish remover
Acetic acid—an ingredient in hair dye
Ammonia—a common household cleaner
Arsenic—used in rat poison
Benzene—found in rubber cement and gasoline
Butane—used in lighter fluid
Cadmium—active component in battery acid
Carbon monoxide—released in car exhaust fumes
Formaldehyde—embalming fluid
Hexamine—found in barbecue lighter fluid
Lead—used in batteries
Naphthalene—an ingredient in mothballs
Methanol—a main component in rocket fuel
Nicotine—used as an insecticide
Tar—material for paving roads
Toluene—used to manufacture paint

Puffing on E-cigs as a “safer” alternative?  That doesn’t preclude your oral health from the bombardment of chemicals in the vapor. Although the Food & Drug Administration (FDA) has not begun its review of any e-cigarette or its ingredients. Unfortunately, this means they have yet to issue standards on these products or submit specific warnings of their composition and effects.

The “e-juice” that fills the cartridges of e-cigs usually contain nicotine (which is extracted from tobacco and highly addictive), propylene glycol, flavorings and other chemicals. Studies have found that even e-cigarettes claiming to be nicotine-free contain trace amounts of nicotine. Additionally, when the e-liquid heats up, more toxic chemicals are formed.

Whether your e-cigarette contains nicotine or not, you may be surprised at the toxic toxic vapors contents below …

• Nicotine – a highly addictive substance that negatively affects adolescent brain development
• Propylene glycol – a common additive in food; also used to make things like antifreeze, paint solvent, and artificial smoke in fog machines
• Carcinogens- chemicals known to cause cancer, including acetaldehyde and formaldehyde
• Acrolein – a herbicide primarily used to kill weeds, known to cause irreversible lung damage
• Diacetyl – a chemical linked to a lung disease called bronchiolitis obliterans, or “popcorn lung”
• Diethylene glycol – a toxic chemical used in antifreeze that is linked to lung disease
• Heavy metals such as nickel, tin, lead
• Cadmium – a toxic metal found in traditional cigarettes that causes breathing problems and disease
• Benzene – a volatile organic compound (VOC) found in car exhaust
• Ultrafine particles that can be inhaled deep into the lungs

What does all this mean?  As an Asheville periodontist, it shows that the gums – on the front line of intake – take the first brunt of these chemicals and toxins, often when we don’t even realize we’re providing willing intake. It also shows how important it is to keep the mouth healthy.

The periodontal dental specialty is especially attuned to how the gums are more than the pink covering in the mouth. Healthy gums are known to support your overall well-being. In addition to being consumer-aware of what your mouth encounters, it is necessary to maintain a thorough oral hygiene routine at home and an involved relationship with your general dentist.

However, if you see signs of gum disease (bleeding or sore gums, persistent bad breath, receded gums, and/or gums that are red rather than a healthy pink), it is important to see a periodontal specialist as soon as possible. Gum disease will only worsen without treatment. It can also allow infectious bacteria to enter the bloodstream, which research has linked to serious (and even deadly) health problems.

Call our Asheville periodontal dental office to schedule a consultation. If fear or anxiety has prevented you from regular dental visits, we can discuss several options (including oral or IV sedation) to provide comfortable, relaxed appointments. Our friendly staff can help you arrange this private time together by calling 828-274-9440.

Sources:
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/gums
https://www.lung.org/quit-smoking/smoking-facts/whats-in-a-cigarette
https://www.ewg.org/consumer-guides/ewgs-dirty-dozen-guide-food-chemicals-top-12-avoid