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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

Six Reasons To Have Your Dental Implants Placed By A Periodontist


Posted on Jul 12, 2023 by William J. Claiborne, DDS MS

A periodontist is a dental specialist who is often in the background of various dental procedures. Yet, we are in the forefront when it comes to specialized skills that support specific treatment needs.

Most patients are referred to our Asheville periodontal dental office by general dentists and dental specialists to provide certain aspects of dental treatment, which may involve our skills in cosmetic dentistry, dental implants, and treating all stages of gum disease.

A periodontist has advanced training to properly diagnose and treat all stages of periodontal (gum) disease (including gingivitis and periodontitis) as well as placement of dental implants. In addition, periodontists are particularly skilled in performing cosmetic periodontal procedures to repair gum-related disparities such as a “gummy smile” or varying gum arches that “jumble” a smile line.

A periodontist receives an additional 3 years of training after 4 years of undergraduate school and 4 years of dental school. This long, rigorous pursuit of the periodontal specialty requires the individual to be highly committed to the advanced care he or she will provide. It is our goal to help people achieve good oral health, a confident smile they love to share, and prevent tooth loss that can result from diseases of the gums.

Dental implants are now seen as the preferred option for tooth replacement. They come in over 40 different types designed to accommodate various challenges and preferences. But, why should you have your dental implants chosen and placed by a periodontist? After all, some dentists perform this in addition to their general dentistry services.

Below are 6 reasons our dental implant patients have particular advantages…

(1). With specialized skills, a periodontist is especially respectful to oral tissues as sensitive layers that have an important role in the appearance of a smile and the health of teeth. Utilizing these skills, a periodontist can help to minimize incisions while effectively treating each area in the mouth.

(2). Rather than be limited to just one or two dental implant systems that were taught in a “crash course” by the implant manufacturers, our speciality understands the complete spectrum of implant systems. Some may be ideal for your needs while others may not. Some provide you with a non-removable (“fixed”) option while others may involve removable teeth. Our specialized skills give you the best choices you should have.

(3). Additionally, the proper selection of your dental implants may greatly save you in treatment fees. For example, the All-On-4 dental implant system needs only 4 implants per arch, and can be placed in shallow bone. The treatment fees are less since the number of implants is low and the need for bone regeneration for severe bone loss may not be required. For these reasons, a periodontist may be able to help you achieve your tooth replacement goals within a budget you can manage.

(4). In our Western NC periodontal dental office, our advanced technology includes 3-D Cone Beam Imaging. This is ideal for diagnoses and treatment planning through images that provide a clear view of the upper and lower jaw (including nerve canals), with rotations that show sagittal, axial, and coronal planes. The imaging process is quick, painless and at minimal radiation levels.

(5). Another feature is our Computerized Dental Implant Placement system. This advanced technology is designed for pre-surgical positioning of dental implants that 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. This minimizes disruption of gum tissues and targets implant placement at ideal depths and angles. Thus, treatment success rates are higher with faster (and more comfortable) healing time.

(6). Optimal comfort for our patients has always been a priority. For many, a desired level of comfort and relaxation includes sedation options. Here, 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. IV 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 Medical Doctor (MD) who is a board certified Anesthesiologist.

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

If you are considering dental implants, you may wish to begin with a consultation appointment. During this time, we can explain the vast difference in comfort, treatment time, and success available through our specialized skills and extensive technology.

Call 828-274-9440 to schedule. New patients are always welcome and a referral is not always required.

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

 

3 At-Home Tips To Lower Risk of Tooth Loss, Gum Disease


Posted on Jun 02, 2023 by William J. Claiborne, DDS MS

Gum disease is the nation’s leading cause of adult tooth loss and one of the most prominent diseases in the U.S., with over 47% of adults having some level.

Yet, this disease is far more devastating than many realize. When oral bacteria build to a point beyond the ability of the immune system to manage, inflammation sets in. This inflammation continues to build as the oral bacteria become infectious.

Oral bacteria is the cause of cavities, gum disease, and a long list of health problems as many years of research has shown. Oral bacteria can become bloodborne through tears in diseased gum tissues, allowing it to travel throughout the body. This can trigger inflammatory reactions that have serious consequences far beyond the mouth.

Because the initial symptoms of periodontal (gum) disease are silent, the early stages of the disease can be perplexing since patients don’t feel anything is wrong. However, like most diseases that form in our bodies, we don’t feel or see anything when they first begin. This allows the disease to progress without our knowledge.

Unfortunately, people tend to delay treatment until the symptoms of periodontal disease are obvious and uncomfortable. These include tender and swollen gums that bleed easily when brushing, consistent bad breath, and gums that are red in color rather than a healthy pink. As gum disease progresses, pus pockets form around teeth as bacterial accumulate. Eventually, teeth will loosen and need to be removed.

Although gum disease can begin without any obvious symptoms, once it exists, progression occurs in three stages (without treatment).

• 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 (gum disease) – As the disease progresses, 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, diabetes, arthritis, impotency, preterm babies and more.

Obviously, it is important that people are diligent in 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%).

https://www.cdc.gov/oralhealth/conditions/periodontal-disease.html#:~:text=A%20recent%20CDC%20report1,and%20older%20have%20periodontal%20disease.

As a proponent of dental implants to replace lost teeth, I must acknowledge that there is no perfect replacement for natural teeth. Natural teeth provide a stable, dependable means to chew and enjoy food while their tooth roots keep the jaw bones that support them nurtured and stimulated.

In addition to restoring chewing strength and stability, the dental field is a proponent of dental implants largely because of their ability to halt bone loss. Referred to as ‘resorption,’ this is the shrinking of bone mass, which occurs when tooth roots are no longer present in the jaw bone. 

Once resorption begins, it continues at an ever-increasing rate with each year. For those who wear a denture or partial, the pressure an appliance places on the bone ridge accelerates it further. Sleeping in an appliance puts pressure on the ridge 24/7, speeding up the rate of bone loss even more.

Resorption can even be seen; it ages one’s appearance far beyond their actual years. As the jaw bone thins, deep wrinkles form around the mouth. Over time, the mouth appears to have sunk into the face. Jowls form and the chin becomes more pointed (creating a ‘granny look’).

Throughout all this, a denture or partial easily slips, requiring more frequent applications of adhesives or pastes. Relines may help for a time, but each reline will only help for a temporary time as the bone continues to decline in height.

Because dental implants are positioned in the jaw bone, they recreate stimulation, which helps them maintain healthy bone mass. They provide dependable, comfortable chewing and speaking ability. And, best of all, they’re designed to last a lifetime.

However, the goal is to avoid the devastation of gum disease. And, this begins at home. While your involvement with your general dentist is very important (with check-ups and cleanings every six months), daily care is a necessary part of having a healthy mouth, lowering disease risks, and keeping your natural teeth (or halting the pace of further tooth loss).

How can you improve your at-home care? There are several ways you can up your game with a few simple add-on’s…

Findings of an 11 year study published in the Journal of Clinical Periodontology tracked the oral health of over 2800 adults. Their use of ELECTRIC TOOTHBRUSHES was monitored to watch for periodontal disease, cavities, and the number of natural teeth.

Participants were examined in 2002 – 2006, with 18% being electric toothbrush users. Follow ups were conducted after 6 and 11 years. At the time of their 11 year follow up, 37 had converted to using electric toothbrushes.

The study showed electric brushing promoted better gum health and slower progression of gum disease. Electric tooth brushing also related to a reduction in tooth loss by 20% (compared to those who brush with manual toothbrushes).

Although manual tooth brushing can be just as effective, it must be done in a proper manner. For manual brushers, some manual brushes can actually be destructive used incorrectly.

For instance, a hard bristle tooth brush can wear down tooth enamel and gum tissues. Too, some people feel the need to press down firmly when brushing and tend to use a scrubbing, ‘back & forth’ motion. This action can wear down the protective shell of tooth enamel, leaving teeth more vulnerable to decay.

To avoid damaging tender gum tissues, choose a soft bristle toothbrush. As you apply gentle pressure on the brush, use a swirling motion. By using a circular pattern over both sides of each tooth and along the tops, teeth are cleansed without wearing away gum tissues. Hint: If the bristles on your toothbrush are fanned out after a couple of months, it’s because you are applying too much pressure when brushing.

Whether using a manual or electric tooth brush, it is necessary to brush twice a day for effective results. In order to thoroughly remove the sticky film of plaque from teeth, you should also brush at least two minutes each time.

Another way to improve gum health, lower cavity risk, and prevent tooth loss is through FLOSSING. It is estimated that only 31% of American adults floss on a daily basis. Because brushing cannot dislodge all food particles caught between teeth, daily flossing should be a part of oral hygiene routines.

Proper flossing is easy for those who are in the habit of it and takes less than a minute. However, the key word here is “proper.” Flossing is best done with about 18 inches of floss. We recommend unwaxed but people with tight teeth find waxed helps them avoid having to ‘pop’ in-between teeth, which can cut into tender gum tissues. Wrap both ends of the floss around the forefingers. Use the thumbs and middle fingers to help maneuver the floss.

Go slowly as you move the floss back and forth to get in-between and scrape down each tooth’s side several times. Move the floss just slightly below the line where teeth meet gum tissues to dislodge bacteria at the base of teeth. Adjust the floss so you have a clean section after flossing every 3-4 teeth. Be sure to scrape the backs of molars (or the farthest back teeth) on top and bottom.

For those who have problems with manual dexterity or find the maneuver awkward, WATER FLOSSERS are effective alternatives (shown to be just as effective as manual flossing) and easy to use. A water flosser pulsates a stream of water between teeth that is forceful enough to dislodge trapped food bits but without harming teeth or gums. They are affordable, available online or in many stores, and easy to use.

Finally, I’ll add the need to keep the mouth moist. A frequent state of ORAL DRYNESS can cause bad breath and lead to higher risks of cavities and gum disease. Saliva, the mouth’s natural rinsing agent, helps to cleanse oral bacteria from the mouth. This keeps bacteria to a minimum and their ability to cause problems at lower risk.

When saliva flow is insufficient, however, bacteria are able to accumulate and multiply rapidly. Contributors to having a dry mouth can occur from consuming alcoholic beverages, caffeine, many medications (both OTC and Rx) and is a normal part of the aging process. Some medical conditions, including acid reflux, sinus infections, diabetes and bronchitis can also cause dry mouth. A bad cold, snoring or just being in the habit of breathing through the mouth are drying as well. Smoking is a major cause of dry mouth.

To overcome the risks imposed by a dry mouth, drink lots of water throughout the day (sports drinks and colas don’t count). Use an ORAL RINSE that is formulated to replenish moisture in the mouth. There are several available over-the-counter (look for ones that DO NOT contain alcohol, which is very drying to oral tissues).

As an Asheville periodontist, I specialize in the treatment of all stages of gum disease, the re-contouring of gum tissues, and the diagnosis and placement of dental implants. Our periodontal dental office optimizes patient outcomes and comfort through our vast array of advanced technology and a commitment to exceptional care. Call (828) 274-9440 to schedule an examination or ask to begin with a consultation.

If dental fear has prevented you from achieving the healthy, confident smile you desire, ask about Oral and I.V. sedation (“twilight sleep”). These are safely administered and recovery is generally quick.

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