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

Sawdust Festival 2010

The staff took their annual field trip to the Sawdust Festival. Everyone had a very enjoyable day of shopping and having lunch together. It was a great day and a person could not ask for better weather.

Dr. Urban's Birthday Celebration

On August 4, 2010 the office staff gathered together as they usually do to celebrate Dr. Urban's birthday. We always look for reasons to celebrate and be together. It was similar to a 4th of July celebration with the sparkler style candles that lit up the cake. Fortunately the cake was large enough to accomodate the candles and fireworks. All of us had a great time and we now await the next birthday celebration.

Happy Birthday Dr. Urban!

Fractured Teeth, Causes and Implications

During routine examinations I will often detect fractures in teeth. The most common areas are your back teeth (molars and bicuspids). These teeth are used to pulverize food, bite into hard candy, hit the occasion pit in pit less cherries, and chew ice. I do not recommend chewing ice-EVER! However, I can’t argue with the rest. Things just happen over time. Teeth fracture because of:
1. Burrowing decay
2. Root canal treatment for dying nerves
3. Unusual clenching or grinding
4. Overbites
5. Trauma and accidents
6. STPD (stupid things people do)
7. Ageing

As far as STPD I can think of things like opening bottles with teeth, opening chip bags with teeth, wearing some piece of jewelry in your tongue, chewing ice and hard candy.

Examinations will detect fractures when they get big enough to see with a magnifying lens or exhibit unusual light reflections. I use a bite stick or a wet cotton roll to see if there is any tenderness to biting. Hopefully, the tooth will not hurt and I will recommend a restoration to protect the underlying tooth structure. It is established by the root canal specialists that if a tooth is crowned (capped or covered) soon enough, only twenty percent will need future root canals. The percentages just go up the longer an untreated fracture exists.

Fractures never heal or go away. That is why your dentist checks your teeth very closely. Fractures often do not hurt until the break occurs. When the break occurs it can be a simple chip or a fatal shear fracture through the middle of the tooth. Fractures can injure the nerve in the root canal. That is why the root canal is treated, filled and sealed. It is a must for the tooth to be returned to normal function with a build-up and a crown. I have seen hundreds of rotting teeth with old root canals that were never restored with a crown.

Get your kids started early with dental visits. Today we fill cavities very conservatively with bonded resin (white) filling materials. This will keep the tooth stronger throughout one’s lifetime and may prevent fracturing from developing. As a kid I had average size silver/mercury fillings placed (everyone did at that time). They weren’t big, but as time wore on my teeth weakened and I eventually needed four crowns to repair the damaged teeth. This is very typical of people my age.

Finally, let’s talk about longevity. I am sure that prehistoric people did not worry about fractured teeth and aging. By the time they were 30 they were old and started dying. Teeth usually do not start fracturing until you about age 40. Today my practice enjoys treating hundreds of people in their seventies, eighties, and nineties. Their teeth become “work hardened” and brittle. Fracturing occurs more often. Fortunately, dentists can routinely repair these problems so we can continue to enjoy eating and socializing for years to come.

The Perils of Piercing

Dentists want to preserve, maintain, and if necessary restore teeth to full function and health. Therefore we preach prevention, encourage daily brushing and flossing, and recommend fillings and crowns to repair decayed teeth. Also, we inform people of harmful habits that lead to unnecessary dental problems. One of these is oral piercing.

I have not seen mature people (over thirty- something) succumb to this desire to poke a hole in their tongue and place a metal stud to show off. However, I have seen our teens and twenty year olds carry their body piercing habits onto the lips and into the mouth.

Let me tell you about the good things that happen when this is done. Nothing!
Now let me tell you about some of the adverse events that have occurred as a result of oral piercing. There have been several reports of severe infections and death as a result of bacterial infections. In fact a young British woman died of blood poisoning and pneumonia within 48 hours of tongue piercing this year. Although this is rare it can happen and would never have occurred if she declined to have the procedure.

Also some young people have experienced tooth movement as a result of pressing the metal ball of the tongue bar against the front teeth. Spaces and gaps are now appearing between the two front teeth. Teeth move when constant light forces are exerted against them. This principle is the basis for orthodontics. When random forces are applied random unpredictable events occur.
In my practice I have witnessed fractured teeth as a result of the metal banging against teeth. This has resulted in some expensive restorative work.-work that would have been unnecessary without piercing and tongue bars.

Lastly, I have observed severe recession of the gums around the lower front teeth. Tongue bars press against the gums on the back of the front teeth and the gums shrink away leaving bare root surfaces. Consequently these teeth become very sensitive and eventually get loose. Lip plugs bang against the front of the teeth causing recession on the front side. A lot of these defects cannot be repaired and will develop into major problems later on in life. Again these self induced dilemmas would never have occurred without piercing.
The ADA does not recommend piercing “because of its potential for numerous negative sequelae”. I am not aware of any dentist who approves of this trend. I can only encourage everyone to spread the word.