Spittle, Drool, and Slobber

Last week I was in my office on break and eating a peanut butter cracker snack. As I was chewing the cracker got caught in the back on my throat and I was beginning to wonder if I was ever going to be able to swallow. At that very moment my mouth began to water up and the food bolus slid easily down to make room for another cracker. Once again saliva came to the rescue.

Dentists have a love-hate relationship with saliva. While saliva is always “in the way” during dental procedures we wish there was more saliva for our patients with dry mouth. Let’s look at the functions of saliva to get an appreciation of this important lubricant and discuss ways of dealing with dry mouth.

During chewing the saliva is lubricating the movement of food from our mouths to the esophagus. Salivary enzymes (amylase and lipase) begin the digestion of starch and fat in our foods (remember the peanut butter crackers?). Saliva also aids in taste by trapping the thiols (flavor chemicals) contained in food and allowing taste buds to operate. Mucous is the ultimate body lubricant and is especially important to facilitate food movement. Interestingly, mucous is not digestible and once swallowed will pass through with the feces.

Saliva also protects and buffers the teeth from food acids and harmful bacteria. Dry mouth promotes bad bacteria because the pH levels become acidic. As it turns out a high acidic level turns on the bad bacteria and the incidence of cavities dramatically increases.

Other enzymes include lactoferrin, lysozyme, lactoperoxidase, and immunoglobulin A which aid the body’s immune response system. Furthermore, since saliva reflects what is going on in the rest of the body doctors can use saliva as a diagnostic medium. Wouldn’t it be great if you can spit into a vial rather than having blood draws or spinal taps to screen for disease? Saliva tests may ultimately be used to determine biomarkers for Alzheimer’s and heart disease. Research is continuing in this area.

Xerostomia is a condition of inadequate salivary output. It is characterized by an excessively dry pasty feeling in the mouth, difficulty with chewing and swallowing, burning oral tissues, and increased cavities and gum disease. Xerostomia is brought about by a lack of production from the salivary glands due to age, disease, radiation therapy, and medications (to name a few).
Unfortunately, there is no cure-only treatment. Occasionally, discontinuing certain medications will reverse the condition. Otherwise, your dentist will recommend over the counter remedies to help stimulate salivary output. For more serious cases a prescription of pilocarpine mg in a lollipop can be provided. This lollipop can be sucked on for 10-20 seconds and be placed back into its case for future use. The pilocarpine stimulates the tiny salivary glands to pump out more saliva. This has been very satisfying for my chronic dry mouth patients.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Oral Bleeding

As a dentist I have always been curious why more people are not alarmed when they see blood in their mouth. I suppose it is because most oral bleeding is painless and momentary. Oral bleeding is out of sight and out of mind.

Oral bleeding can be caused by trauma or disease. Traumatic sores are noticeable and usually heal within a few days. These include cheek biting, lip biting, and scuffing of the oral lining from hard foods. Cheek biting that occurs over and over can be corrected by your dentist with minor alterations to offending teeth that catch the cheek and lip. Habitual gnawing on the cheek can create a fibrous bump that frequently gets caught up between the teeth. This bump should be removed by your dentist.

Oral bleeding from gum disease usually does not hurt and sometimes gets minimized. It is a serious sign of trouble. It seems odd that bleeding from the skin, ears, nose, stomach, and intestines raises alarm signals whereas oral bleeding goes unnoticed and sometimes undetected.

As I have mentioned in previous articles your dentist will exam your mouth for dental decay, gum disease and other abnormalities in the soft tissue, tooth alignment, jaw function, erosion, abrasion and attrition. Even with all our technological improvements with identifying gum disease it still remains that bleeding is the number one indicator for activity level for this problem.

Bleeding is caused by harmful bacteria invading the space between the gums and teeth. The body’s immune response will try to stop the invasion and swelling of the gums that is occurring. This “battlefield” will leak blood upon gentle probing, flossing, and brushing. As blood leaks out bacteria leak into the blood system and circulate around the body. The body’s immune system will generally take care of the invaders. However, if a person has a compromised immune system and is not healthy these bacteria can invade other vital organs. The inflammatory load on the body is increased and other inflammatory related diseases can be affected.

I would advise that we look at any bleeding as a portal of entry into our body by invading organisms. That especially includes oral bleeding. The mouth is very exposed to bacteria, viruses, fungus, and molds. Fortunately, the mouth is protected by our immune system and has proven to be very forgiving. Yet the oral immune system can be overcome by bad habits. Ignoring warning signs, like bleeding, is not advised. Consult with your dentist if you are aware of bleeding when brushing and flossing. Ask your dental hygienist if they can detect any bleeding sites that could be serious.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

What is Halitosis?

Basically it is bad breath. We all have it, what do we do with it?

Let us review some of the causes of bad breath. Bacteria growing in the oral cavity, food rotting between teeth, and diseased gum tissues predominantly cause halitosis. I am not concentrating on dietary eliminates such as onion breath that slowly dissipates as the body eliminates it from the digestive tract. In my experience most bad breath emanates from the mouth.

Dry mouth caused by ageing and a host of medications results as salivary output diminishes. The natural rinsing of the sticky biofilm on teeth, tongue and gums is missing. Rampant growth of bacteria occurs and the mouth odors increase.

If you really want to blow somebody away with your breath, smoke cigarettes. Tobacco addiction is a serious condition. All of our statistics relating the incidence of gum disease with bacterial population types go flying out the window when coupled with cigarette smoking. The preponderance of my patients with advanced periodontal disease are smokers. See you doctor or dentist about smoking cessation programs.

Finally, bacteria growing between the gum and teeth can overwhelm the host (you) and periodontal infection occurs. I haven’t come across any abscess or chronic infection that had a pleasant odor, especially in the mouth. What is it about halitosis bacteria that smell? Bacterial waste contains hydrogen sulfide (similar to rotten eggs). It is pungent and pervasive if not contained.

Treatment of bad breath may mean a visit to the dentist for a diagnosis. You may be tested with a halimeter that can measure sulfide emissions. It is not always necessary to have a machine tell you what others have been saying for years. The dentist will try to determine if your halitosis is chronic or just periodic. We all have periodic halitosis. Usually, thorough and gentle tooth and tongue brushing several times a day will be all that is needed. Chronic halitosis may require a dietary change to include more roughage to facilitate self-cleaning of the back of the tongue.

Regular periodic visits to your dental hygienist to detect and prevent periodontal problems from getting worse and can recommend products to reduce bad breath. I favor the mouth rinses that specifically target neutralizing the sulfides with oxidizers. Chewing gums for dry mouth or just self-cleansing are great. Try the sugarless gums containing xylitol. Xylitol also inhibits certain bacteria types that cause cavities. Keep hydrated and avoid alcohol-containing mouth rinses because they will dry out the mouth.

There are a small number of you who are halitophobics. Halitophobics are deluded into thinking they have bad breath when they don’t. Halitophobia may become extreme and adversely affect the lives of people with this affliction.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Dental Sealants

You may have heard the latest concerns about dental sealants that are placed on children’s teeth and the possibility of BPA exposure. BPA is found in many plastics and canned goods. It may be linked to heart disease and developmental problems.

Dental sealants have been widely used for over 40 years as a way to “plug” the tiny crevices in the chewing surfaces of the teeth and prevent decay-causing bacteria to take up residence and cause cavities. When carefully placed on fresh, young, and decay-free teeth they are very effective at preventing cavities during adolescent years. Over time they will wear thin and come off. It is hoped that by the time this happens the now mature adolescent will be better disciplined at maintaining oral health.

One of the materials used in sealants and tooth colored fillings is BPA. As a part of the filling or sealant it seems there is no evidence of harm. The controversy is the thin “uncured” layer that remains after setting. In the case of fillings this layer is eliminated during the contouring and polishing phase. In the case of dental sealants this layer is often not removed and washes away in a few hours. It is this 3 hour time exposure that has made headlines recently.

While the exposure is minute and there has been no direct link to any health problems dental sealants have been red flagged. The latest study raised these alarms even though there was not a harmful quantitative amount established. The authors of the study kind of threw it at the wall to see what stuck. I think the benefit of this approach is just to increase the awareness of the dental community that dental sealants are beneficial and can be placed safely without exposure to BPA.

As to the controversy of using BPA containing resins to restore teeth and whether the amounts used are enough to cause concern I have no opinion. I have no opinion because it appears the “fix” is rather simple. As to the warning that pregnant women should not have sealants I honestly cannot recall placing sealants in children over 14 years.

Your dentist can ensure that sealants are BPA-free by just wiping off the uncured top layer with the same cleaning paste used to brush your teeth. That is it-end of story.
The larger story is the presence of BPA in plastics used in water bottles and linings of canned goods.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com