Tag Archives: oral health

Not Sleeping Well? Could Be You’re Bruxing

Today, we usually think of clenching and grinding teeth as a sign of stress or anger. And it often is. Consequently, we’ve seen quite a rise in this behavior since the onset of economic turmoil in 2008. But the phenomenon itself isn’t new at all. Our ancient ancestors did it, too, with the earliest records of it – via clay tablets found in the Mesopotamian Basin – dating back to about 3000 BC. Our modern word for the habit – bruxism – comes from the other side of the Mediterranean, though: from the Greek word ebruxya, which literally means “to gnash the teeth.”

Though statistics remain a little sketchy, estimates say about 5 to 20% of us are bruxers, with the higher number likely being closer to right. The habit is especially common during sleep. In fact, it’s the third most common sleep disorder after insomnia and snoring.

What’s more, those with another sleep disorder are more apt to be bruxers, too. Other risk factors include smoking, high caffeine intake, high alcohol intake, medication use and, of course, stress. But because bruxism is a habit, it can – and usually does – continue even after its cause has been dealt with. Among the problems it can lead to:

  • Poor quality sleep
  • Worn down teeth and fillings or other restorations
  • Fractured teeth
  • Inflammation and receding gums
  • Loose teeth and premature tooth loss
  • Persistent headaches and chronic jaw, face, neck and head pain
  • TMJ disorder

TMJ stands for temporomandibular joint, and you have one on each side of your head. Together, they’re the hinge that lets you open and close your mouth – something than can be hard or painful to do if the joints are damaged or dysfunctional. (To see why this may be so, check out these videos showing what both healthy and dysfunctional TM joints look like in action.) You may experience clicking, grinding or pain in your jaw joints, or ringing or buzzing in your ears. “When the joint puts pressure on the nerves, muscles and blood vessels that pass near the head,” says Dr. Nigel Carter of the British Dental Health Foundation, “it can often result in headaches and migraines.”

Even so, adds Dr. Carter,

The cause of your headaches could actually be the way your teeth meet when your jaws bite together, otherwise known as dental occlusion. If you do suffer from continual headaches or migraines, especially first thing in the morning, pain behind your eyes, sinus pains and pains in the neck or shoulders, you should consider visiting your dentist, as well as a doctor, as soon as possible.

To check my patients’ occlusion, I use an imaging system called Tek-Scan, which shows how the teeth come together. It lets us see places where your bite may be “off” or where there’s an imbalance of force when you close your jaw. Once we’ve found these imbalances, we can determine the best solutions for correcting them.

For TMJ issues, we have another diagnostic tool: BioJVA (joint vibrational analysis). BioJVA lets us take fast, non-invasive and repeatable measurements of your TMJ function by determining the amount and kind of vibration at the joints. With it, we can diagnose dysfunction more specifically, and, because it’s repeatable, we can easily measure your progress through treatment.

Splint therapy is one of the most common and conservative measures taken to bring relief and readjust the jaw and related musculature. You may have seen or heard of over-the-counter “night guards” meant to cushion the forces of clenching and grinding, the main virtue of which is their low cost. Unfortunately, they’re often of little help to serious bruxers, who pretty quickly grind right through them. Their fit can often be poor, as well, causing problems such as discomfort, damaged gums or increased clenching.

A custom splint, on the other hand, will fit your mouth precisely and will normally last much, much longer than an over-the-counter device. Here’s what one of my patients had to say after just the first week of wearing a night guard we provided him:

But wait, you say. If I’m sleeping, how can I know if I’m grinding my teeth? Here are a few questions to ask yourself:

  • Are your jaw muscles or neck achy when you wake up?
  • Is it hard to open your mouth first thing in the morning?
  • Do the biting surfaces of your teeth look worn down?
  • Do you have frequent headaches?
  • Has your bed partner ever complained about you making grinding noises while you sleep or told you about any mouth movements he or she has seen you make while sleeping?

As is the way with such questionnaires, the more “yesses,” the more likely it is that bruxing is an issue for you, in which case you should consult your dentist for help with remedies and relief…and a better night’s sleep.

Image by justin, via Flickr

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Exercise: Good for Muscles, Heart, Lungs & Yes, Teeth & Gums, Too!

If you’re unfamiliar with holistic approaches to health, you might be surprised by the fact that what’s good for general health is also good for your teeth and gums. Conventional wisdom says dentistry and medicine are two separate fields, not specializations within a single, broad field. So you see a dentist for your teeth and a physician for the rest of your body, as though one had nothing to do with the other.

Funny – how easily we can forget that the mouth is connected with the rest of the body!

Even physical exercise – or the lack of it – affects more that just our muscles, lungs and heart. Those are just the three areas where we feel it most. While we might get a “runner’s high,” we don’t really feel exercise in our brains, even as exercise has been shown to keep the brain fit and improve thinking. Likewise, we don’t feel exercise in our teeth and gums, but there are, in fact, established links between physical fitness and oral health.

For instance, check out the 2005 Journal of Dentistry study, which found that regular exercise lowers the risk of periodontitis (gum disease):

  • Never-smokers who exercised regularly “were about 54% less likely to have periodontitis” than those who didn’t exercise.
  • Former smokers who exercised regularly had a 74% lower risk.

Unsurprisingly, exercise did nothing to lower the risk of gum disease for smokers.

We see similar results when obesity is factored into the equation. For instance, one paper published last year in the Journal of Periodontology found that those with the lowest body mass index (BMI) and highest measure of physical fitness – gauged by percent body fat and maximum oxygen consumption – were less at risk for periodontal disease than other study subjects. “This study suggests,” wrote the research team, “that obesity and physical fitness may have some interactive effect on periodontal health status.”

In fact, there are three positive factors – “health-enhancing behaviors” – that have been shown repeatedly to reduce the risk of gum disease. They’re spelled out in the abstract of one last study I’d like to draw your attention to, also from the Journal of Periodontology:

After controlling for age, gender, race\ethnicity, cigarette smoking, other tobacco products, education, diabetes, poverty index, census region, acculturation, vitamin use, time since the last dental visit, dental calculus, and gingival bleeding, a 1-unit increase in the number of the three health-enhancing behaviors was associated with a 16% reduction in the prevalence of periodontitis (odds ratio [OR] = 0.84; 95% confidence interval [CI]: 0.77 to 0.93). Individuals who maintained normal weight, engaged in the recommended level of exercise, and had a high-quality diet were 40% less likely to have periodontitis compared to individuals who maintained none of these health-enhancing behaviors. [emphasis added]

So what are you waiting for? Get out there and get moving!

Images by Mait Jüriado and BBluesman, via Flickr

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The Oral Cancer Pandemic & How You Can Keep Yourself Safe

Once upon a time, oral cancer was a disease limited largely to tobacco users and heavy drinkers. For all others, the risks were thought to be very low, and the rate of disease remained fairly steady.

And then it started going up. And fast.

How fast?

Between 1974 and 2007, cases of white men with oral cancer shot up by 225%.

At the same time, there was a five fold increase in young adults with oral cancer.

Incidence has especially skyrocketed for women. In 1950, for every 6 men who developed oral cancer, only one woman did. Today, that ratio has narrowed to 2 : 1.

What happened?

HPV – human papilloma virus. This sexually transmitted virus, most known for causing cervical cancer, is now a major cause of oral cancer. Over half of us are at risk for contracting HPV at some point in our lives.

Perhaps you saw the recent episode of Dr. Oz dealing with these issues. If you missed it, you can watch it here – and I highly recommend that you do. He gives an excellent, plain-language overview of the issue, including discussion of warning signs/early symptoms and demonstrations of the different exams your dentist should perform so that if you do develop cancer, it can be caught and treated as early as possible.

As a rule, I screen each of my adult patients for cancer once a year using a tool called VELscope. This technology lets us look beneath the mouth’s soft tissues for lesions and abnormal growths that may indicate beginning oral cancers. VELscope testing is completely non-invasive and painless. We just aim a blue excitation light at the tissues and see how they respond: healthy areas appear fluorescent and problem areas, dark. I’ve used this device in my practice for several years now – not as an “extra” but as an essential.

If VELscope detects a problem, the next thing we do is an oral CDX brush test, which Dr. Oz’s guest dentist describes as a “pap smear for the mouth.” This procedure, too, is non-invasive and painless. We merely use a special brush to take a sample of cells from the problem area(s), save them on a slide and send them to a lab for analysis.

You can see these early detection methods demonstrated in Part 4 and Part 5 of the Dr. Oz video – screening tools that help save lives by letting us find the cancer early enough for effective treatment.

Of course, the best course of action is to prevent the cancer from occurring in the first place. Key things you can do to lower your risk:

  • Be sure your dentist gives you an oral cancer screening at least once a year if not at every visit. If he or she doesn’t – or if you’re not sure – ask for one.
  • Limit alcohol use.
  • If you smoke or chew tobacco, quit. (And if you don’t, don’t start.)
  • Practice safer sex. Always use condoms and/or dental dams, or completely abstain from oral sex.

Also be aware of these warning signs and contact your dentist immediately if you develop one or more of them:

  • A white or red patch in your mouth, or a sore that doesn’t heal within two weeks
  • Sore throat or ear pain, typically on just one side of the head, that doesn’t go away within two weeks
  • A lump in your neck
  • Voice changes or hoarseness that last more than a week

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Teeth Sensitive? Don’t Look Now, but Your Dentin May Be Showing


“Your teeth are crystals, just like rocks,” explained Dr. Linda Niessen. “You know you erode rocks from water and rain; you can erode the teeth from these acidic drinks.”

The “acidic drinks” being blamed here for rising rates of dental sensitivity following tooth erosion are sports drinks like Gatorade, which some people think of as healthier than soda. In fact, they’re just another kind of soft drink, as are many sugar-laden energy drinks, juice-based drinks and teas.

It’s no surprise that we see more tooth erosion these days. The increase has paralleled the monumental rise in soft drink consumption and accelerated after the introduction of energy drinks – which may be even worse for teeth than soda – and popularization of sports drinks among non-athletes. Since the late 70s, “soft drink consumption in the United States has doubled for females and tripled for males. The highest consumption is in the males between the ages of 12 – 29; they average 1/2 gallon a day or 160 gallons a year.” Here in California (PDF), nearly half of all children aged 2 to 11 drink at least one soft drink a day, as do more than 60% of teens and 24% of adults.

Eroded teeth are necessarily sensitive teeth. The dentin – the layer of tissue between the tough enamel and the delicate pulp – is no longer protected. Cold air or liquid touching it may send shockwaves of pain through the tooth and into the jaw, or hot liquids or foods may cause discomfort.

Eroded teeth are also more prone to deep decay, since pathogenic oral microbes (“bad germs”) have easier access to the delicate tissues inside the tooth. Helping the decay process along are the continual sugar baths they get from soft drinks. Not only do the sugars feed the bacteria that cause decay, they also reverse the flow of fluids in the tooth so that microbes and their acidic waste products are pulled into it rather than repelled. (Read more about your teeth’s natural defenses against decay.)

Of course, when it comes to tooth erosion, soft drinks aren’t the only culprit – just a common one. For instance, stress can be a factor, often leading to grinding, clenching and other behaviors that weaken enamel over time. They also contribute to gum recession, where exposed tooth root also means more tooth sensitivity. (Chronic stress is also a drag on your immune system, making your body less resilient, more prone to disease and dysfunction.)

Another factor – often overlooked – is the effect of pharmaceutical drugs. (The skyrocketing rate of prescription drug use likewise parallels the rise in soft drink consumption.) As I mentioned before, dry mouth is a common “side effect” of drugs as varied as antidepressants, anti-anxiety medications, antihistamines and muscle relaxants.

Dry mouth may not sound like anything too serious, but it’s got some significant dental implications, raising the risk of caries (cavities), tooth erosion and periodontal disease. This is because one of the functions of saliva is to wash away the microbes that make up dental biofilm (plaque) and food particles that feed them. Saliva is also a source of the calcium and phosophate particles that help keep tooth enamel strong. The less saliva, the more conditions favor decay and other tooth damage.

If dry mouth is an issue, there are remedies so you don’t put your teeth and gums at risk. In my office, for instance, we have products that can help, such as GC Dry Mouth Gel and the Dental Herb Company’s Tooth and Gums Tonic. But even just drinking more water can help relieve dry mouth, as can eating more foods that require chewing, especially foods like crunchy vegetables.

If grinding and clenching are a problem, your dentist can provide you with a splint to cushion and protect your teeth – as well as reduce the amount of associated pain you may be experiencing. (Neck, head, face, shoulder and back pain are all common, cascading effects of clenching and grinding.)

And, of course, moderating or eliminating soft drinks from your diet will also lower the risk of tooth erosion and sensitivity.

And if the damage is already done? Above all, see your dentist, so he or she can assess the situation, offer solutions and help you decide on the best course of action for fixing your teeth. In the interim, avoid stimuli that aggravate the pain and, when cleaning your teeth, use a very soft toothbrush and toothpaste formulated for sensitive teeth.

Image by stuartpilbrow, via Flickr

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What’s Ozone Therapy & How Is It Used in Dentistry?

If you’ve read much about “alternative medicine,” you may have run across discussion of something called “ozone therapy.” But what’s that?

The word “ozone” might make you think of pollution. We’ve all heard of the “hole” in the ozone layer caused by CFCs and other toxins. Maybe you’ve read that ozone is found in smog or know a little about its industrial uses, many of which tap into ozone’s disinfecting properties (including use as a pesticide, bacteriacide and fungicide).

Ozone also has a significant history in medical treatment, as well. According to Dr. K.W. Donsback,

Ozone therapy was used medically by Nikola Tesla in 1900. It has been in continual use for over 50 years in Europe and the USA, but due to our legal pressures, ozone is presently only widely used [as an orthodox treatment in Germany, Russia and Cuba]. When the proper protocols are followed, ozone has been proven effective in the treatment and possibly the elimination of over 40 common diseases.

Ozone therapies are among the safest therapies ever used. One European study of over 5.5 million treatments showed a side effect rate of .0007%, probably among the lowest of any therapy known. Side effects (like fever and weakness) are minor and temporary.

Ozone therapy also has a place in dental practice, although its use remains uncommon here in the US, owing to opposition from the dental/medical establishment. Among those dentists who do use it for oral healing and health, there are five main applications :

  1. Ozonated water may be used as a gargle or rinse to treat oral abscesses, gum problems, sore throats and ulcerations. It may also be used for irrigation.
  2. Ozone gas may be used as a preventive measure against tooth decay and periodontal disease.This is done by fitting a custom tray over the patient’s teeth and gums, and letting ozone into the tray for a short while.
  3. Teeth that might otherwise be subject to a root canal or extraction may be treated by washing an exposed nerve first with ozonated water, then with ozone gas.
  4. Ozone may be used as a disinfectant before a root canal or restorative dentistry is done. Ozonated water and gas can get through the walls of the tiny dentinal tubules, killing harmful bacteria that have taken up residence in these hard-to-reach, hard-to-clean places.
  5. Temporomandibular joint pain may be treated with ozone, where gas injected right into the TMJ can kill harmful microbes, as well as reduce inflammation and spur the growth of new cartilage.

Learn more about dental uses of ozone:

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Lifestyle Choices Increase Mouth Cancer Risks

New research has shown that young adults are increasing their risks of oral cancer through the lifestyle choices they make.

The number of young people being diagnosed with mouth, throat and food pipe cancer has doubled, and researchers believe this is due to excessive smoking, drinking and unhealthy diets among the young.

These cancers – known as upper aero-digestive tract cancers – are responsible for 10,000 deaths in the UK alone.

Researchers at Aberdeen University conducted a five year study, which examined 350 patients under the age of 50 with UADT cancers and compared the results to 400 people who did not have the disease. It was discovered that nine in 10 of the cancers had been caused by smoking, drinking and a lack of fruit and vegetables in the diet.

Professor Macfarlane, who led the study, said, “Our study aimed to determine whether smoking, alcohol consumption and low fruit and vegetable intake remained the most significant risk factors for UADT cancers in this age group, or whether other ‘novel’ factors, including genetics and infection, could be relatively more important.

“The results of our study further emphasize that the message we need to be communicating to the public remains the same – that smoking, drinking and diet are the major triggers of these diseases at all ages.”

Tobacco is considered to be the leading cause of mouth cancer, and those who drink alcohol and smoke to excess are up to 30 times more likely to develop the condition. Alcohol aids the absorption of tobacco in the mouth, which transforms saliva into a deadly cocktail that damages cells and can turn them cancerous.

Around a third of cases are thought to be linked to an unhealthy diet. Increasing evidence suggests that Omega 3, found in fish and eggs, can help to lower risks, as can high-fiber foods such as nuts, seeds, whole wheat pasta and brown rice.

Another key risk factor for mouth cancer is the Human Papilloma Virus (HPV). US studies have linked more than 20,000 cancer cases to the virus in the last five years. Transmitted via oral sex, people with multiple sexual partners are more at risk. Oral health experts suggest HPV may rival tobacco and alcohol as the most common risk factor.

Mouth cancer is twice more common in men than in women, though an increasing number of women are being diagnosed with the disease. Previously, the disease has been five times more common in men than women. Initial signs of the disease include a non–healing mouth ulcer, a red or white patch in the mouth, or unusual lumps or swelling in the mouth.

 

From a British Dental Health Foundation media release

Image: ndanger/Flickr

 

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Are You Only Partway Cleaning Your Teeth?

Brushing and flossing go together. Most of us know this, but while most of us manage to brush at least twice a day, only about half of us floss even once a day.

In other words, half of us are only partway cleaning our teeth.

A toothbrush can remove biofilm (plaque) from the exposed surfaces of your teeth, but it can’t thoroughly clean between teeth or below the gumline – areas that oral microbes love precisely because they’re dark, moist and harder to get to. Not flossing lets these microbes thrive. The result? Periodontal (gum) disease and, ultimately, tooth loss. What’s more, gum disease has been linked to other inflammatory conditions such as heart disease, diabetes and stroke.

So not only does flossing support good oral health but good systemic health, as well. It may even help your memory.

 

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Interestingly, flossing may not be a strictly human activity. Monkeys, for instance, have been seen flossing, both in and outside the lab. A recent “Improbable Research” column in The Guardian describes some of the findings, including observations of the macaque flossing with human hair. (More info about the macaque – and a link to video of the behavior – here.)

It makes you wonder: Is flossing a “natural” behavior of sorts? If so, then why do so many of us humans not just avoid it but come up with all kinds of excuses for it?

The most commonly given reason is a lack of time – even as brushing and flossing together take less than five minutes. But if you’re that pressed for time, why not multitask? Floss while you’re in the shower, say, rinsing your hair, or while you’re relaxing with TV or a book after dinner, or sitting at home in front of the computer .

Once you make flossing habitual, it won’t seem to take much time at all. Besides that, as the health of your gums improves, flossing will no longer cause bleeding or irritation, eliminating a couple more of the common excuses. And if standard, thin floss hurts your fingers, switch to thicker, softer dental tape. Bingo! Another excuse gone.

To learn more about the correct way to floss, see the guides at About.com and Animated-Teeth.com.

 

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