Category Archives: Oral Health

Oral Cancer: To Screen or Not to Screen?

April is Oral Cancer Awareness Month, and this year, it’s involved some controversy.

It began with the release of a Consumer Reports article that included oral cancer screening among 8 “to avoid.”

“Most people,” they wrote, “don’t need the test unless they are at high risk, because the cancer is relatively uncommon.”

Not long after, a government task force said “that there is not enough published evidence to recommend for or against screening for oral cancer by primary care professionals.” Though dentists aren’t considered “primary care professionals” in this case, it’s an easy detail to miss.

So is CR right about when they say such testing isn’t necessary?

While it’s true that oral cancer used to be rather rare, with mostly smokers and heavy drinkers being at risk, that’s no longer the case. As we’ve noted before, rates have been skyrocketing, largely due to the human papillomavirus, or HPV. More than 35,000 new cases are diagnosed each year, and the 5 year survival rate is only 50%. Part of the reason for that last statistic is that many oral cancers are detected quite late – which is why dentists have been speaking up more and more about the benefits of early detection.

Unlike many other kinds of cancer screening, a screen for oral cancer is hardly invasive. At minimum, it involves a visual exam that can quickly and easily be done as part of a routine dental exam.

oral_cancer_check

Many also use technology to aid to visual screening. In our office, we have a device called VelScope, which uses a blue excitation light to make healthy areas appear fluorescent and problem areas, dark. This isn’t some extra procedure; once a year, it’s a part of every adult patient’s exam.

Brian Hill, executive director of the Oral Cancer Foundation, nicely sums up the case for screening:

It isn’t an invasive exam, there’s no radiation (no long-term exposure issue), it is painless, it’s usually free, and you’re already sitting in the dentist chair. Why would you not get it?

Indeed.

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Bad Breath? Good News!

If you decide what to read on the basis of whether or not it has a catchy title, you likely missed “The Efficacy of Different Mouthrinse Formulation in Reducing Oral Malodour: A Randomized Trial” in the Journal of Clinical Periodontology (presuming, of course, you’re the type who reads things like the Journal of Clinical Periodontology).

rinseSo let’s call it “How Well Do Different Mouthwashes Get Rid of Stinky Breath?” instead.

Are you interested now?

The randomized, double-blind trial was small and simple: For one week, 18 participants used one of three rinses. Two products – Halita and Meridol with zinc lactate – contained at least one antimicrobial agent (Halita contains cetylpyridinium chloride and chlorhexidine in addition to the zinc). The other contained fluoride.

Sulfur levels and organoleptic (“sniff test”) scores were taken twice to measure odor – once 15 minutes after their first rinse and again at the end of the week. The first took note of masking effects, while the second noted therapeutic effects.

Those were the rules, but how did it turn out?

All three rinses did fine with respect to immediate freshness, but only those with antimicrobials showed a therapeutic effect. They also had the most powerful masking effect.

Does this mean chemical clean is the way to go?

All have their downsides. Chlorhexidine and cetylpyridinium chloride tend to stain the teeth. The latter may also irritate the soft tissues of the mouth or trigger allergic reactions. Fluoride, of course, has its own problems.

And none have proven much better than more natural products, which raises the issue we’ve noted before:

If the effects of natural substances on oral [pathogens] are at least as good as those of a chemical substance, why opt for the chemical?

One alternative we especially like is Natural Dentist Healthy Gums Mouth Rinse. This natural mouthwash helps control periodontal disease and biofilm (plaque) build-up through its blend of cleansing and soothing botanicals including echinacea, golden seal, grapefruit seed, aloe vera gel and calendula. It contains no alcohol, artificial sweeteners, dyes or preservatives, and will not stain the teeth.

For other easy ways to improve your breath, see our previous post.

Image by twenty_questions, via Flickr

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Filed under Oral Health, Oral Hygiene

Coffee & Cancer: Java to the Rescue?

Some research can’t help but be greeted with a yawn, “duh!” or rolling eyes – like the obesity study done a couple years ago at Tel Aviv University. Participants sat around doing nothing more than eating, playing games and reading. The conclusion? Relaxing can make you fatter. (There’s actually a rationale for such “duh” studies, which you can read about here.)

coffee_greenAt the other end of the spectrum are studies that surprise, such as the one on oral and throat cancer published last month in the American Journal of Epidemiology. Analyzing data from a 26 year span of the American Cancer Society’s Cancer Prevention Study II, researchers found that people who drank four cups of caffeinated coffee a day were at a 49% lower risk of death from throat or oral cancer as those who occasionally or never take coffee. (Full research article here)

This isn’t to say coffee is a magic bullet against these cancers. Far better to start by eliminating risk factors such as tobacco and heavy alcohol use, a poor, sugar-rich diet and unsafe sexual practices. (As mentioned, the virus responsible for the recent rise in oral cancer rates – HPV – is most often sexually transmitted.)

Yes, moderation and healthy living may sound less adventurous than whiling away the bohemian hours at your favorite hip coffee shop, but they’re your health’s most reliable friend.

Because oral and throat cancers can be hard to see in their early – and thus, easiest to successfully treat phase – it’s also important to see your dentist regularly for screening. Here in Dr. Erwin’s office, all adult patients are screened annually with VELscope. This device uses a blue excitation light to identify tissues that need a closer look. If any are found, we go to the next step: a CDX brush test, which is likewise painless and non-invasive.

Oral Cancer Screening at a Glance

And then there’s coffee – perhaps – with its beneficial effects. The current belief is that these come courtesy of phytochemicals. These are naturally occurring compounds in plants that often have antioxidant properties, and a number of those found in coffee may contribute in the fight against cancer.

Now the bad news: Coffee is also one of the top causes for tooth enamel damage. Not only does it stain, but it makes the oral cavity temporarily more acidic, giving a boost to some of the bacteria that want nothing more than to leave you in dentures. If you do drink coffee, be sure to wait 20 to 30 minutes before brushing your teeth afterwards. This gives your saliva time to neutralize those acids. Brushing while conditions are still acidic further raises risk of enamel erosion.

Stains, we can remove. Once enamel’s gone, it’s gone.

Learn more about oral and throat cancers

Image byTakkk, via Wikimedia Commons

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Why Exercise?

Exercise might be one of the most overlooked factors in dental health. While most people are at least aware that physical activity is part of being healthy, far fewer know that it helps their teeth and gums, too.

For instance, as we noted before, research shows that those who exercise have a much lower risk of periodontitis (gum disease) than those who don’t, especially former smokers. (For most, smoking pretty much guarantees gum disease and tooth loss.)

Physical activity also helps your body better assimilate nutrients like calcium, a crucial mineral for the remineralization of teeth.

Here are 5 more “hidden” benefits, courtesy of integrative physician Dr. Eudene Harry, author of Live Younger in 8 Simple Steps:

  1. Younger looking, more blemish-free skin
    The increase in circulation and perspiration that occurs with exercise delivers more nutrients to your skin while allowing impurities and waste to be removed. The result? A healthier complexion!
  2. Natural “feel-good” chemicals
    Exercise releases endorphins, the brain chemicals that boost your mood and make you feel happy, as well as relieve stress, and enhance your self-esteem and self-confidence. Exercise has also been shown to increase neurotransmitters, such as serotonin and dopamine, which gives us a natural high and allows us to sleep better.
  3. Constipation prevention
    Exercise increases the contractions of the wall of the intestine, helping to move things along through the intestinal tract more easily, and decreasing the time it takes to pass through the large intestine. But wait an hour or two after eating before exerting yourself: Exercising too soon after a meal can divert blood flow away from the gut and toward the muscles, weakening peristaltic contractions (and slowing down the digestion process).
  4. Prevents brittle bones
    Walking, jogging, dancing, weight training and yoga are all weight-bearing exercises that help strengthen bones. Swimming and bicycling are exercises that are considered non-weight bearing. During weight-bearing exercises, bones adapt to the impact of the weight and the pull of muscles by building more bone cells, increasing strength and density and decreasing the risk of fractures, osteopenia and osteoporosis.
  5. Enhanced immunity
    Physical exertion increases the rate at which antibodies flow through the blood stream, resulting in better immunity against sickness. The increased temperature generated during moderate exercise makes it difficult for certain infectious organisms to survive.

40 more reasons to exercise

We hope you and yours have a joyful Thanksgiving – a wonderful start to your holiday season ! We’ll be back to our regular posting here on November 30.

Image by bookgrl, via Flickr

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Filed under General Health, Oral Health

HPV, Oral Cancer & Gum Disease

According to the CDC, more than 36,500 new cases of mouth and throat cancer are diagnosed every year. The 5 year survival rate is only about 50%.

But that rate is a whole lot better in cases where the cancer is detected early. That’s why, in my office, oral cancer screening – using VelScope – is included in every adult patient’s exam at least once a year.

A recent paper underscores why this matters.

Published last month in Head & Neck Oncology, the study confirms that

oral sex with multiple partners is one of the significant risk factors for oral cancer and oropharyngeal cancer. Young people, who increasingly practice oral sex especially with many partners, may be driving the increase in these cancers.

The culprit, as we’ve discussed before, is HPV (human papillomavirus). More known for causing cervical cancer, HPV is also a major cause of oral cancer. In fact, it’s surpassed tobacco as the leading risk factor: While smoking rates have plummetted, oral cancer rates have soared. And that risk increases along with sexual activity. According to the current research,

HPV infection is likely to be sexually acquired with increased risk of oropharyngeal cancer with either many (more than 26) lifetime vaginal-sex partners or six or more lifetime oral-sex partners.

Why is the mouth so vulnerable to HPV transmission?

It must be remembered that the oral cavity is a battlefield of healing mucosal micro abrasions which could in the right circumstances of altered local host defenses allow viral inculcation, infection and entrenchment leading to somatic genetic change. Changes in immuno-tolerance at these “special” immuno-modulating sites…combined with further environmental triggers then lead to cancerous changes. Basically, viral “genes load the gun and environment pulls the trigger.”

So maybe it’s no surprise that earlier research has suggested a connection between gum disease and oral cancer. The initial study found that precancerous lesions were twice as prevalent – and tumors, four times as prevalent – in those with periodontal disease than those with healthy gums. Inflammation appears to be the key factor, as lead author Dr. Mine Tezal recently discussed in an interview with Dr. Bicuspid about her ongoing research:

The results of our recent study suggested an association between chronic local inflammation and tumor HPV status of head and neck cancers. HPV infects only basal cells of the epithelium and gains access through breaks in the mucosa….

In this inflammatory environment, HPV is also shed in greater amounts leading to increased risk of viral transmission. If prospective studies in cancer-free populations confirm that chronic inflammation is a significant factor in the natural history of oral HPV infection, the public health implications would be important.

Thus, another cancer-preventive measure, she suggests, is to control inflammation in the mouth. And she likewise confirms what the Head & Neck Oconology paper showed: frequency of exposure to the virus matters. A lot.

HPV is a commonly transmitted virus and the majority of the infections are cleared rapidly by the immune system without causing disease. Rather than the mere presence of the virus at one time point, its persistence is critical for the development of HPV-related diseases. [emphasis added]

Learn more steps you can take to lower your risk of oral cancer from my earlier post “The Oral Cancer Pandemic & How You Can Keep Yourself Safe.”

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4 Things You Might Not Know About Kids’ Oral Health

 

Some interesting facts as we wind down National Children’s Dental Health Month:

  1. Oral health affects how kids do in school.
    According to research published in the American Journal of Public Health, children with poor oral health are three times more likely to miss school because of dental pain and do tend worse academically. Missing class isn’t the issue. Kids who skip school to get routine preventive care show no drop in academic performance.
  2. Bacteria that cause tooth decay can colonize before the teeth come in.
    Earlier this year, scientists using DNA sequencing identified hundreds of bacterial species in the saliva of infants. These included S. mutans, which plays a very big role in the development of early childhood caries (EEC). Such findings underscore the need to begin oral hygiene early and take your child for their first dental visit shortly after their first tooth erupts or around their first birthday.
  3. Teething gels that contain benzocaine can be a problem.
    Benzocaine is a pain-killer commonly found in products such as Orajel, and the FDA recommends against it for teething infants. Why? Such gels raise the risk of methemoglobinemia, or “blue baby syndrome” – a blood disorder that keeps oxygen from getting to the body’s cells. Let your child use teething rings instead, or gently massage their gums with your finger.
  4. Secondhand smoke can damage children’s teeth and gums.
    Studies have found that children regularly exposed to secondhand smoke have more cavities, worse periodontal health and factors that exacerbate both problems: reduced salivary flow, more acidic saliva and higher levels of pathogenic bacteria.

Image by CarbonNYC, via Flickr

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Gum Disease? Smoker? Why You Need to Kick the Habit Before Getting Treatment

According to a recent poll, 1 in 10 smokers try to hide the fact from their physician. Most say they do this to avoid getting get lectured about their habit. And that’s understandable. After all, most smokers know they should quit. Many have tried. But the pleasures, rituals and effects (physical and mental) – and so, the addiction – often win out.

Since so much of tobacco’s damage isn’t readily visible in a routine medical visit, hiding the habit may be fairly easy – especially if you’re a light smoker, as the poll says many hiders are. Hiding it from a dentist, though, is tougher. Yes, you can mask bad breath for a while. Yes, you can diligently whiten your teeth. But you can’t mask things like bleeding gums, bone and tooth loss or cancerous lesions.

While most Americans have some degree of gum disease, the problem, as noted before, is much worse among smokers. According to research published in the Journal of Periodontology, over half of all cases may be due to smoking, and smokers are four times more likely to develop it. Why? Among other reasons, they “may be more than 10 times more likely than nonsmokers to harbor the bacteria that cause periodontal disease and are also more likely to have advanced periodontal disease.”

And no, it’s not just about cigarettes. You don’t get a free pass just because you smoke cigars or a pipe. The effect is similar. And the more you smoke, the greater the risk. Chewing tobacco carries its own oral health risks.

While gum disease can lead to bone and tooth loss, it’s not a necessary cause. Smoking alone is enough of a trigger, and its effects persist even after decades of living smoke-free. While we can try to spur new bone growth or at least slow the rate of loss, there’s currently no sure-fire fix.

Because of tobacco’s pernicious effects on both the hard and soft oral tissues, an increasing number of periodontists refuse to treat smokers until they kick the habit. Smokers may be surprised, frustrated, hurt or even offended by this. Obviously, they care enough about their oral health to consult with a specialist. But that care needs to motivate a successful quit, as well. After all, would you start repairing a flooded home while water was still gushing in? Or a fire-damaged home while flames are still raging?

For while periodontal treatment may help in the short term, long-term prognosis for smokers is poor. This is borne out both clinically and through research.

Among the latest research is a study just published in the American Journal of Medical Sciences. For it, the authors reviewed over 40 years of research on the impact of smoking on perio surgery outcomes. Of the two dozen studies that met their criteria, 2/3

showed that reductions in probing depth and gains in clinical attachment levels were compromised in smokers in comparison with nonsmokers. Three studies showed residual recession after periodontal surgical interventions to be significantly higher in smokers compared with nonsmokers. Three case reports showed periodontal healing to be uneventful in smokers.

But this can be new incentive to quit. No one wants to waste money on treatments not likely to help much or last long. So the choice becomes one of continued tobacco use and worsening oral health or quitting and getting help to regain periodontal health and keep as many natural teeth as long as possible. (After all, replacing teeth isn’t cheap either: a single implant can cost several thousand dollars!) For the good news is that although the risk of tooth loss persists, the effects of smoking on gum tissue are reversible. You can undo a lot of damage.

You just have to quit the cigs first.

Some natural, drug-free tips for quitting smoking

Abstracts on the tobacco-perio health link

 

Image by Marko Miloševic, via Flickr

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