Smoking and Your Mouth by Douglas Urban, DDS

So you have considered quitting smoking? It’s too expensive, you can only smoke in your garage, and people avoid your smoke plumes. If that wasn’t enough let me nudge you a bit further to making the final decision to quit. Consider your mouth, throat and lungs to be the inside of your chimney. It gets black and sooty in your body as well as your chimney.

Sadly most of my patients that require a lot of dental work in their adult years have a history of smoking. This results in more dental chair time and expense. Furthermore, the chances of a favorable long term outcome from treatment are diminished due to smoking. Let me explain why this is so.

First, smoking increases the chance of acquiring oral cancerous lesions. These lesions are painful to remove and healing is slow and painful. Also, oral cancer can kill you.

Tobacco smoke can cause white patches and brown patches to develop in the mouth. White patches can be precancerous and brown patches may be due from increased melanin pigmentation. Regardless, your mouth has changed for the worse.

Tobacco smoking will increase the severity of gingivitis and periodontitis. I can’t save teeth if there is no supporting bone to hold them in place. Acute necrotizing ulcerative gingivitis is a condition where the gums in between the teeth become very sore and chewing is difficult. A higher percentage of my patients with this diagnosis are smokers.

Smoking can cause delayed wound healing by diminishing the blood flow. Also, the microfiber attachment of the gums to the teeth breakdown and allow bacterial infiltration in the deepened crevices.

Smoking will cause chronic coughing and sinus infections as the body recoils from the ash that gets in the airways. This increased inflammatory load on the body can diminish the immune system. Consequently, fungal infections and ulcerations will occur.

On the lighter side smoking can create a condition of black hairy tongue (looks just like it sounds) altered taste, bad breath and tooth stains.
I know that most of you reading this are not smokers. Avoidance and denial keep smokers from seeing warning signs. However, you might have friends or loved ones (children) that smoke and you would like to help them quit. I hope I have given you enough ammunition as a dentist to be of help.

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

XYLITOL- the sweet alternative by Dona Fujioka, R.D.H.

Dental decay is the most common infectious disease that we’ve been battling for years; especially in children. Sugar is mostly to blame. Advances in dentistry have helped prevent decay but it doesn’t change the fact that we cannot avoid sugar in our diets. Limiting sugar consumption is a more realistic approach.


Xylitol, which is a sweet alternative, offers many dental benefits. Incorporating it into our diets will help prevent decay. Xylitol is a five-carbon sugar alcohol compound. They are carbohydrates that resemble sugar, but without its harmful effects. Xylitol is NOT an artificial sweetener. Artificial sweeteners are based on a six-carbon monosaccharide unit, like fructose and glucose. Streptococcus mutans, bacteria that causes decay, uses these units as a food source. They excrete waste, which produce plaque biofilm that can lead to tooth decay. Xylitol, on the other hand, is not a food source for Streptococcus mutans. Instead, xylitol blocks its harmful effects and builds protective factors. Xylitol is a natural component found in plants, vegetables, and berry-type fruits, such as strawberries and raspberries. It can also be manufactured from sugar and starches. Despite its presence in plants and vegetables, we do not eat enough of these foods to obtain sufficient amounts of xylitol to gain dental benefits. Because of this, research continues to find ways to deliver xylitol into our diets.

Currently, xylitol is obtained in the form of toothpaste, mouthwash, candies, mints, and chewing gum. It has been proven that frequent consumption is more effective than the amount consumed. It is more effective if consumed throughout the day.

With all the knowledge about xylitol, consumers are encouraged to use it on a regular basis. To get the maximum benefit, the product should contain 100% xylitol. It should be the first ingredient to obtain the greatest dental benefit.

SOURCE: Wonders of Xylitol by Susan Clark RDHEF
RDH Magazine

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, scummy tongue and diseased gum tissues are the predominant cause bad breath or 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 90% of breath originates from the mouth.

Bacteria grow between the gum and teeth and on the surface of the tongue. They can double in population every 20 minutes. The overpopulation can overwhelm the host (you) not get properly cleaned away by natural forces like chewing. Infections have a very characteristic smell. I haven’t come across any abscess or chronic infection that had a pleasant odor, especially in the mouth. 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 sensitive noses can detect. The dentist will try to determine if your bad breath is chronic or just periodic. We all have periodic halitosis. Usually, thorough and gentle tooth brushing, flossing and tongue scraping 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 bacterial infections 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. Two gums I recommend are Hersey’s Ice Breakers Ice Cubes and Trident XTRA Care. Xylitol, aside from being an artificial sweetener, also cannot be digested by harmful bacteria. Keep hydrated and avoid alcohol-containing mouth rinses because they will dry out the mouth.

Finally, get in the habit of scraping your tongue after brushing your teeth. The tongue can be a safe harbor of bacteria and can re-infect the newly cleaned teeth in a matter of minutes. Brushing the tongue is not adequate and a specially designed scraper is recommended.

THE LINK BETWEEN PERIODONTAL DISEASE AND RESPIRATORY DISEASE by Dona Fujioka, R.D.H.

There have been studies linking periodontal disease to the other inflammatory diseases, such as cardiovascular disease, diabetes, and various other ailments. Recently, there have been studies supporting an association between periodontal and upper respiratory disease; respiratory disease, including pneumonia, acute bronchitis, and chronic obstructive pulmonary disease (COPD). Statistically speaking 9 out of 10 adults have some form of periodontitis. Because respiratory infections can be debilitating, it is important to further investigate the connection between the two conditions.

Upper respiratory infections typically occur when different types of bacteria are inhaled into the lungs. Bacteria that cause periodontitis can also be inhaled into the respiratory tract and increase the risk of infection. Studies have been shown that due to the presence of oral pathogens, the inflammatory response weakens the host’s immune system, thereby increasing the risk for developing or aggravating respiratory infection. Even though the presence of bacteria is what determines the disease, it is the host’s response to the bacteria that is essential in the initiation and progression of the disease.

It has been found that a group with respiratory disease had poor periodontal health compared to the healthy group. Despite studies showing the link between to the two conditions, more research is necessary to determine if and how the inflammatory response to the periodontal bacteria leads to the development or exacerbation of respiratory infection.



SOURCES: Donald S. Clem DDS
Sharma N., Shamsuddin H.

SLEEP APNEA AND ITS EFFECTS written by our hygienist, Dona Fujioka

SLEEP APNEA is the frequent stoppage of breathing caused by relaxed tissues in the throat during sleep. The breathing pauses may last between 10 to 20 seconds and can occur up to hundreds of times per night.95% of the millions of people who suffer from apnea have not and may never be diagnosed.

TYPES OF SLEEP APNEA

OBSTRUCTIVE- most common type. Occurs when the soft tissue in the back of your throat relaxes during sleep, causing a blockage of the airway (snoring).

CENTRAL- less common type. Involves the central nervous system. It occurs when the brain fails to signal the muscles that control breathing. People with central sleep apnea seldom snore.

COMPLEX- a combination of obstructive and central sleep apnea.

Untreated sleep apnea results in daytime sleepiness, fatigue, slow reflexes and poor concentration. It can also lead to serious health problems including diabetes, high blood pressure, heart disease, stroke and weight gain.

SIGNS AND SYMPTOMS

- LOUD AND CHRONIC SNORING
- LONG PAUSES OF BREATHING
- CHOKING, SNORTING, OR GASPING DURING SLEEP
- DAYTIME SLEEPINESS

SIGNS AND SYMPTOMS OF SLEEP APNEA IN CHILDREN
- continuous loud snoring
- may adopt strange sleeping positions
- bedwetting
- excessive perspiration at night or night terrors
- CHANGES IN DAYTIME BEHAVIOR:
o Hyperactivity or inattention
o Developmental and growth problems
o Decreased in school performance
o Irritable, angry, or hostile
o Breathing through mouth instead of nose

NOT EVERYONE WHO SNORES HAS SLEEP APNEA, AND NOT EVERYONE WHO HAS SLEEP APNEA SNORES.

• THE BIGGEST TELLTALE SIGN IS HOW YOU FEEL DURING THE DAY.*
Scientists are now examining the relationship between heart disease and sleep apnea.

These are known:

People with coronary artery disease whose blood oxygen is lowered by sleep disordered breathing may be at risk of ventricular arrhythmias and nocturnal sudden death. CPAP treatment may reduce this risk.

Apnea may cause coronary artery disease and hypertension

In obstructive apnea, the right side of the heart may suffer damage because it has to pump harder to support the extra effort of the lungs trying to overcome the obstruction of the airway.

Central apnea may cause high blood pressure, surges of adrenaline, and irregular heart beats.


RISK FACTORS FOR OBSTRUCTIVE SLEEP APNEA

Overweight
Male
Related to someone who has sleep apnea
Over the age of 65
Black, Hispanic, or a Pacific Islander
Smoker

PHYSICAL ATTRIBUTES THAT CAN CAUSE SLEEP APNEA

Thick neck receding chin
Deviated septum enlarged tonsils or adenoids (common
In children)


LIFESTYLE CHANGES THAT CAN HELP SLEEP APNEA

Lose weight avoid alcohol, sleeping pills, and sedatives
Quit smoking avoid caffeine and heavy meals
Maintain regular sleep hours

BEDTIME TIPS FOR PREVENTING SLEEP APNEA

Sleep on your side prop your head up
Open your nasal passages try the tennis ball trick

MEDICAL TREATMENT FOR CENTRAL AND COMPLEX APNEA

Treating the underlying medical condition causing the apnea
Oxygen while sleeping
Breathing devices

CPAP- Continuous Positive Airflow Pressure- most common treatment for moderate to sever obstructive apnea.

DENTAL DEVICES FOR SLEEP APNEA
Mandibular repositioning device
Tongue retaining device
SURGERY

May remove tonsils, adenoids, or excess tissue at the back of the throat or inside the nose, or reconstruction of the jaw to enlarge the upper airway.

SOURCES: Melinda Smith, M.A.
Lawrence Robinson
Robert Segal, M.A.

HPV and Oral disease

With all the recent dialogue about the HPV virus I felt it would be good to clarify why your dentist is concerned.

The Human Papilloma Virus (HPV) is a common sexually transmitted disease that has been associated with cervical cancers in woman. There are two vaccinations that are currently available for girls before they become sexually active. Although these vaccines appear safe the decision should be run by your doctor to determine whether they should be administered.

Evidence is growing that shows a strong correlation of cancer of the mouth and throat associated with HPV. The rate of increase is alarming and seems to be a result of the increase in oral sex. In fact there are more oral cancers detected every year than cervical cancer. Experts estimate over 34,000 cases of oral cancer detected every year. More than half of these are HPV related.

Your dental team should be performing a visual oral cancer exam on a regular basis. Beginning cancers usually are not detected by the individual who has it and it can be very difficult to spot in the back of the mouth. There are several diagnostic tests your dentist can perform to make this detection easier to accomplish.

If a warty bump appears your dentist may elect to observe it for a while to see if it will disappear on its own or recommend a biopsy. Although biopsy is the most definite way to confirm the nature of the bump we certainly do not want to biopsy everything we see in the mouth. Again, there are tests available help make this determination easier by “looking” under the primary layer of tissue with dyes and fluorescent lights.

Oral cancer exams are no longer performed on middle aged smokers and drinkers. They should be performed on young adults who have no history of smoking. In the future I expect an oral diagnostic test will be readily available for HPV.

Your dentist (me included) does not encounter HPV lesions very often in the general practice. The numbers will confirm that it is still not a very frequent occurrence. The alarming factor is the upward trend of HPV related STD’s and what it may mean in the future. As a precaution it is best to submit to a quick visual inspection of oral cancers by your dental team. Hopefully, the exam and test will be uneventful.

Oral Fungal Infections

As I was channel surfing recently I came across a science show concerned with fungus. The fungi group ranged from molds and mildew to edible mushrooms and yeasts for baking. There is a fungus that is the largest living organism on the planet and fungi that invade the body. It was rather creepy, but mankind has been living with fungi since we first popped up on the scene. The microbes that make up the fungus group are diverse and can reproduce sexually, asexually, and by the spread of spores.

Your dentist is on the front line to help control and fix the damage caused by all the harmful microbes that can inhabit the mouth. There are over 30 different bacteria that cause tooth decay and over 60 that cause gum disease.

Virus infections can alter the body’s susceptibility to bacteria and infect the soft tissue in and around the mouth. They can create painful repetitive sores and be just a nuisance or be very fatal. But let’s discuss the fungus group of microbes and why your dentist is concerned.

The most common fungal infection of the mouth is called candidiasis or thrush. These fungi are normally present in the body and are warded off by the healthy immune system. When something interrupts or overloads the immune response the fungi can become rampant. This is called an opportunistic infection and can result in a burning sensation, tenderness and pain. The cheeks or tongue will get a whitish coating that can be scraped off. Your dentist is trained to spot these signs and prescribe the correct remedy. Usually nystatin troches 4-5 times a day for 2 weeks will kill the fungus.

Conditions that alter the immune system include diabetes, chronic dry mouth, chemotherapy, inappropriate use of steroid inhaler, HIV/AIDS, mononucleosis, stress, and nutrient deficiencies.

Fungus infections can occur under dentures and in the corners of the lips. I have prescribed antibiotics and people have developed fungal outbreaks. Topical nystatin creams with mild steroids like triamcinoclone provide excellent results.

Oral fungus infections do not occur over night and take time to develop and spread into surrounding tissues. If you think you have symptoms do not hesitate to contact your physician or dentist for treatment. Fungal infections can spread down the throat and into the digestive tract and become very serious.