Care for our aging teeth

Methuselah reportedly lived to the ripe old age of 969 (is that doggie years?). Conveniently he missed the great flood by a week and probably didn’t brush and floss every day because he lost his teeth 800 years earlier. I am sure that if he had cared for his teeth and seen his dentist he could have held on to them much longer.

As we all know aging takes its toll on our physical attributes. The mouth and our dentition are not immune to the march of time. Let me briefly review some of the most common changes that can occur.

Saliva output usually diminishes as we get older. It makes sense considering other glands in our bodies start slowing down as well as the salivary glands. Eventually a “dry mouth” condition develops and teeth lose their lubricating and protective film. Oral bacteria flourish and destructive decay and gum disease that had been in remission for our “mid-life” years returns. There are several over the counter products that can promote salivary output to ease the feeling of dry mouth. Prescription formulations are available for more severe types of dry mouth.

As teeth wear against each other there is microscopic loss of the hard tooth enamel. Through the years this enamel wears thin or entirely disappears until the softer dentin core of the tooth is exposed. At this point the wear rate becomes rapid and the teeth will become noticeably shorter. The smile becomes old and worn and the teeth may look jagged and twisted due to the uneven wearing of the edges. The youthful healthy appearances of the face changes and the teeth no longer show up in a smile. Your dentist can restore lost tooth structure or make removable mouth guards to slow down this wear rate.

If Methuselah drank coffee, tea, and soda drinks for 969 years, his teeth darkened from food stains leaking into the enamel. This probably started when he was 40 years old. He probably didn’t notice because there were not a lot of mirrors and models on magazine covers to remind him of what he looked like. Fortunately for us there are products which can be applied that will help restore the teeth to a more attractive and brighter shade.

Your dentist can monitor and advise you of how your dentition is “accepting” the aging process. Early warning signs can be detected and monitored by regular visits to your dental team.

Oral Cancer

Let me review the facts about oral cancer. The American Dental Association has estimated that there are about 36,000 new cases of oral cancer diagnosed every year in the United States. About 25% will die from this disease. Disturbingly, about one half of these new cases occur in people under 50 years old and most are non smokers. There is a five-fold increase in the incidence of oral cancer in people under 40.

Why are the demographic changes occurring? Some attribute the increase to the sexual revolution and the accompanying increase in oral sex. The culprit is the HPV virus that is a known risk factor for oral, head, and neck cancers.

As with most cancers early detection can reduce the morbidity and certainly the treatment required to rid the individual of the tumor. What doctor actually spends all of their time looking into your mouth to fix cavities, heal infected gums, improve smiles, clean teeth, and remove bad teeth? Your dentist of course!

Dentists and hygienists spend a few moments at every examination studying the soft tissues of the mouth to detect any changes, growths, and discolorations. Although visual examination can be effective dentists have a variety of screening tests that can be performed to detect changes under the soft tissues of the mouth.

These include a mouth rinse and examination with a fluorescent light, an oral scraping, and special optical lights. These tests can assure the dentist and the patient that everything is probably okay. In a few cases a referral to the oral surgeon for a confirming biopsy is necessary. In a minority of these biopsies further treatment is required.

The seriousness or incidence of fatality of oral cancer should require a thorough examination and aggressive treatment. Annual examinations are recommended and follow-up necessary. In general any mouth sore should not last more than two weeks.

I remember when my uncle was informed that he had a squamous carcinoma on his tongue. Thinking it would heal and go away he did nothing about it for three months until the pain was overwhelming. The cancer had spread into the jawbone so the surgeon was forced to remove half of his jaw and tongue. My uncle had to retrain himself how to eat food again in front of a mirror. Speech was greatly hampered and the facial deformity was obvious.

Please see your dentist at regular intervals.


For answers to your dental questions, contact

Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Optimistic Advertising

As a kid I remember the big news in dentistry was the debut of the air driven high speed dental drill. Before the invention of the air turbine dental hand piece it would take a dentist quite some time to remove decay and prepare the tooth for a filling. It would take a very long time for larger inlays and crowns. The ordeal to have one tooth worked on was time consuming, somewhat frustrating, and smelly. The high speed dental drill was going to decrease this time involvement and be almost painless. The public (including me) was very excited about the painless part.

After fifty years of service this technology has certainly made it easier to perform dentistry, however, most dentistry still requires local anesthesia. The euphoric painless part of the news was optimistic and not proven. Recently, lasers have been advertised as pain free dental tools requiring little or no anesthetic for dental cavities. Micro sand blasting cavities and chemical solutions for dissolving have largely come and gone. Although these technologies are promising they haven’t delivered what the manufacturer’s were promising-a replacement for the dental drill. Depending on the depth of the decay and each individual’s threshold of pain these technologies may allow some “needleless” dental work. In my experience there has been no 100% assurance that dental work without anesthetic is possible-yet.

The point is that when a person reads or hears about a miraculous dental advancement offering pain free “needleless” dentistry stop and think about it. Talking to your dentist is the best way to wade through this overly optimistic advertising. Believe me your dentist would love nothing better than to perform dentistry without local injections. No stress with happy outcomes really “makes my day”.

On a more positive note the advanced technologies have added another tool to the dental office to provide more conservative tooth preserving dentistry. High speed drills allow the dentist to prepare a tooth in minutes with cooling water spray to wash away the debris. Lasers can be used for surgical procedures with rapid healing response. Micro sandblasting is very conservative and improves the bond strength of your dental fillings in tiny crevices.

Recently, ads on the radio and newsprint have claimed to overhaul your mouth in one visit while you sleep, place implants at a very low cost, etc. For most of us these are just “hooks” to get us interested. These treatments will cost the same as with your own dentist. Sleep dentistry is common and your dentist can usually accommodate your needs with oral medications or an onsite anesthesiologist. Also, your dentist will use implants and materials that are proven and manufactured by reliable companies.

As an afterthought dentistry is more about relationships than a per tooth service. You and your dentist have invested a long time in nurturing this relationship together. When a crisis occurs or a tooth ache develops you should be comfortable in hitting the speed dial on your phone and getting a hold of your dental office and know who is on the other end of the line.

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

Happy Birthday Teri!

Happy Birthday to our wonderful lady, Teri!!! She will be dining with her family tonight!

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