Posts for: September, 2014
One of the top concerns in healthcare is the interactions and side effects of medications. Drugs taken for separate conditions can interact with each other or have an effect on some other aspect of health. It's important then that all your health providers know the various medications you are taking, along with other lifestyle habits. That includes your dental team.
Calcium channel blockers (CCBs) are one type of medication that can have an effect on your oral health. CCBs are used primarily to control hypertension (high blood pressure), and to treat other cardiovascular conditions like angina or abnormal heart rhythm. They work by dilating blood vessels, which makes it easier for the heart to pump.
CCBs are now recognized as a contributing factor in the development of a condition known as gingival hyperplasia in which the gum tissues “overgrow,” extending in some cases abnormally over the teeth. This abnormal growth can be painful and uncomfortable, and can make oral hygiene more difficult to perform. The overgrowth of tissue can also be socially embarrassing.
There's also a secondary factor that can increase the risk for tissue overgrowth in patients taking a CCB — poor oral hygiene. In the absence of a good hygiene routine, a layer of bacterial plaque known as biofilm can build up on tooth surfaces and lead to various forms of gum disease, including hyperplasia. The overgrown tissue contributes in turn to this disease process by inhibiting effective oral hygiene.
If you've already developed gingival hyperplasia or some other form of gum disease, it's important for you to receive periodontal treatment for the disease as soon as possible. Once we have the condition under control, it's then a matter of regular dental checkups and cleanings to reduce the risk of disease, including gingival hyperplasia. We can also help you develop effective hygiene practices that inhibit this condition while you are taking a CCB.
If you would like more information on the effects of medication on oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Blood Pressure Medications.”
Our “baby” teeth begin appearing around six months of age — by age 10 or 13, they’ve largely been replaced by our permanent teeth. Though their lifespan is relatively short, baby teeth play an important role in our dental development. In fact, saving a damaged baby tooth is an extremely important treatment goal even though they will be eventually lost.
Baby teeth perform a number of functions as our mouth and facial structure develops during our formative years (infancy to early adulthood). Besides providing a means to chew food, baby teeth aid speech by providing contact points for the tongue while speaking. They help us relate to others socially through smiling and other facial gestures. And, in relation to our long-term development, they serve as both guides and “placeholders” for our permanent teeth until they’re ready to erupt.
Thus, a permanent tooth’s development could be stymied if its counterpart baby tooth is lost prematurely. It could come in misaligned or not erupt fully if adjacent teeth have drifted into the open space. The resulting malocclusion (bad bite) could require long-term orthodontic treatment with higher costs than treatments to save the baby tooth and avoid the misalignment.
There are various treatments to prevent and save at-risk baby teeth. Even a badly decayed tooth might be saved with a pulpotomy, a similar treatment to a root canal but less invasive. This is often followed with a stainless steel crown to cover the remaining tooth and restore some of its form and function.
If it’s not feasible to save a baby tooth, we may recommend installing a space maintainer that prevents other teeth from drifting into the resulting space until the permanent tooth is ready to erupt. This orthodontic appliance usually consists of a metal band cemented to an adjacent tooth with an attached stiff wire loop that extends across the gap and rests against the tooth on the other side. Although effective, space maintainers can break or become dislodged, require extra monitoring and are often cosmetically unappealing.
In any event, the primary goal should be to save a baby tooth, if possible. Doing so will prevent more serious long-term problems for permanent teeth.
If you have osteoporosis, one of the drugs you may be taking is alendronate, more commonly known by the brand name Fosamax®. Alendronate is a member of the bisphosphonate drug family, which inhibit bone resorption (the loss of bone mass). While an effective treatment of osteoporosis, alendronate may cause an opposite side effect in other areas of the body, the inhibition of new bone growth. This effect on the jaw in particular could result in an adverse reaction after dental surgery.
The main concern is a condition called osteonecrosis, or literally “bone death.” Bone tissue normally goes through a cycle of resorption (the dissolving of bone tissue) and new growth to replace the cells that have been lost through resorption. Osteonecrosis disrupts the growth phase so that the bone doesn’t recover properly after resorption. This results in the bone becoming weaker and less dense.
There have been a number of cases of increased osteonecrosis in patients on alendronate after experiencing trauma to the mouth. This includes dental surgery, particularly tooth extractions. In addition, patients with certain risk factors like diabetes, tobacco use or corticosteroid therapy appear more vulnerable to osteonecrosis.
Although the risk of osteonecrosis after dental surgery is small, many dentists recommend stopping the use of alendronate for three months before the procedure if you’ve been taking the drug for more than three years. This recommendation is based on a number of studies that seem to indicate three or more years of bisphosphonates therapy makes patients especially vulnerable to osteonecrosis. These studies also indicate stopping the therapy for three months significantly reduces the risk of developing the condition.
There’s still much to be learned about this link between alendronate therapy and dental health. It’s a good idea, then, to let us know what medications you’re taking (especially bisphosphonates) whenever you visit us for an exam. Knowing all your medications will help us develop the safest and most effective treatment plan for your dental care.
If you would like more information on bisphosphonates and their effect on oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Fosamax and Surgery.”
While dental implants are considered the gold standard for tooth replacement, removable dentures are still a viable choice, especially for patients with edentulism (complete tooth loss). Removable dentures have also undergone considerable advancement to improve their function, appearance and longevity.
But even with these advancements, dentures still require a fair amount of skill, experience and — of utmost importance — a sense of art. If you’re considering this option, long-term success depends on a careful process of construction, fit adjustment and regular checkups to maintain that fit.
Our first step is to determine exact tooth placement on each denture. Using facial features (or photos before tooth loss) we establish placement landmarks so that corresponding upper and lower teeth align properly. We also consider tooth size, their orientation in relation to the lip, and the needed space to leave between the upper and lower teeth when they are at rest. We make these determinations based on accepted standards of beauty, but also taking into account your particular comfort level with any features that might alter your appearance.
The denture’s gums must also look realistic when you smile, especially if your upper lip rises above the teeth to expose more gum tissue. We also want to match the color and texture of your natural gums, as well as incorporate palatal rugae, the little ridges behind the upper front teeth that aid with speech and chewing food.
When we first place the new dentures in your mouth, we may need to adjust them for balance between the upper and lower sets when they come together. An imbalanced fit could have an adverse effect on your ability to bite, chew and speak normally.
Your dentures should have a good, comfortable fit. Over time, however, you will encounter some degree of bone loss because you no longer have your natural teeth to stimulate bone growth and absorb the forces created during function when your teeth contact. This and other factors may cause your dentures to become loose and uncomfortable to wear. For that reason, it's important for you to visit us regularly to maintain that good fit and check the health of underlying tissues and bone.
Careful planning and denture construction help ensure your new dentures successfully restore form and function to your mouth. Regular monitoring will also ensure they continue to serve you well for as long as possible.
If you would like more information on removable dentures, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Removable Full Dentures.”
Your dental appliance plays a big role in restoring function and improving your appearance. Taking proper care of it will ensure it can do that for a long time.
Cleaning is a top priority. Though it might seem natural to use toothpaste, you should avoid using it on your appliance. The abrasives in toothpaste are necessary to break up plaque on natural teeth’s hard enamel surfaces, but will leave micro scratches on the surface of your appliance that eventually become havens for bacterial growth — a sure recipe for discoloration and unpleasant odors. If you plan to use boiling or hot water to disinfect your appliance, don’t. The heat distorts the plastic and can disrupt its precise mouth fit. You should also avoid using bleach because it can break down the composition of the plastic, can leave a strong odor, and can whiten the pink “gum tissue” areas of the denture.
Instead, use plain liquid detergent or hand soap with warm water to clean your appliance — and use a brush designed for it rather than your toothbrush. If you have a long-term appliance like a denture, you might consider investing in an ultra-sonic cleaner that uses high frequency sound vibrations to clean out small crevices a brush can’t reach.
Remember the old saying, “familiarity breeds contempt?” With dental appliances, too much time in the mouth breeds bacteria. Dentures, for example, should be taken out at night to allow saliva and its antibacterial capacity to work in your mouth. You also should be on the lookout for signs of infection — if anything appears amiss, contact us for an exam as soon as possible to minimize the effects of tooth decay or gum disease.
One final item: be careful where you place your appliance when it’s not in your mouth. Lying out in the open (like on a nightstand) is a tempting lure for the family pet or a curious child. Keep it in its case in accordance with the care instructions given you when you received your appliance.
Doing the right things — and avoiding the wrong things — when caring for your dental appliance will go a long way to increasing its life and reducing problems along the way.