The incidence of oral cancer has been on a steady rise for quite some time. However, the cause and type of oral cancer has changed significantly along with the patient demographic. For years we thought of the patient who was at risk of oral cancer as being from a lower socioeconomic group, they most likely were a smoker and they had poor nutrition and oral hygiene. Today’s at risk group are younger, well educated and non-smokers. Not only are these two demographic groups different but their oral cancer is different.
I have been doing Invisalign routinely in my office for many years. Depending on the individual patient I sometimes see a chalky look to the teeth. It is very similar to the appearance that teeth get when we etch with phosphoric acid. The saliva pellicle is stripped off and the teeth even feel different to the patient’s tongue. As just a supposition I think that the pH of the oral environment is a contributing factor to this phenomenon. Whether a naturally acidic oral environment and saliva or a patient who drinks an abundance of acidic beverages, especially with the trays in.
Tooth sensitivity is something we encounter everyday in practice. One of the most common forms is hydrodynamic tooth sensitivity. Dentin is made up of a myriad of hollow collagen tubules. The ends of these tubules interface with the pulp at the center of the tooth. At the other end they terminate at the enamel or cementum, and are sealed. When the exterior end of the dentinal tubules is open fluid inside can move back and forth. There are numerous causes of this fluid movement including changes in pH, temperature, osmotic pressure and osmolality. When the fluid inside the tubules moves it tugs on the odontoblastic process at the pulpal interface and the pulp responds with a message of sensitivity or pain.
White spot lesions are very common both in kids and adults. One of the challenges with these lesions is how to treat them. There are several approaches from trying to bleach the surrounding tooth structure to make the color difference less noticeable to repairing the area with a composite restoration. The challenge with the bleaching approach is most often these areas are decalcified and need mineral support to the tooth structure. On the other hand taking away the lesion with a bur and restoring seems overly aggressive. In recent years I have been treating many of these lesions with MI paste and seeing great results. I recommend taking before and after photos to document the improvement. Here are the recommendations for using Mi paste to treat white spot lesions.
There are numerous artificial sweeteners on the market that report to be zero calorie and are added to “sugarless” gums, mints, candies and foods. Xylitol not only fulfills the diet requirement but helps prevent cavities. Xylitol has 9.6 calories per teaspoon compared to 15 for sugar, however it has 0 net carbs as it is a sugar alcohol and does not alter glycemic index. It has been understood for many years that xylitol is beneficial for patients at risk of getting cavities. This fact has made it very popular in the dental hygiene community. It is estimated that 80% of all hygienists discuss xylitol with patients and over 50% use xylitol products themselves on a daily basis.
Last Friday’s post looked at the concept of caries management by risk assessment ( CaMBRA) and it’s use to identify patients at risk for developing cavities. Identification of people with an elevated caries risk would be pointless unless we use that information to help them understand how to decrease their risk. One of the primary way sin which we assist patients is simply completing the assessment and creating awareness of the factors that combine to create their individual experience with getting cavities. Beyond simple awareness comes the addition of antimicrobials, topical fluoride application and behavior modification to try and balance out the risk factors present. I think about it as a scale or balance between the risk factors and the protective factors. the more risk a patient has, the more preventive measures we want to add to try and cancel out the risk. With that said, we also need to be realistic about what patients will and will not do routinely. We have an assortment of options for our patients so that they can help us understand what works and what doesn’t based on their personality and lifestyle.
I spent the morning in Minneapolis recording a video for 3M to help dental offices implement a CaMBRA system. CaMBRA stands for caries management by risk assessment and is a process for evaluating a patient’s caries risk and recommending preventive strategies that has been instrumental over the last decade. The California Dental Association and the American Dental Association have adopted the principles of CaMBRA and have assessment forms that can be downloaded to use in your office. There are variations int he risk assessment for small children(0-6yrs) and adults (7-up) but the basic premise is to place patients into a low, moderate or high risk category of risk for developing a cavity. I strongly support the use of a patient centered prevention protocol as part of the services we provide our patients.
In the next few weeks the legislature of the City of Phoenix will decide whether or not to continue fluoridation of the public water supply. The topic is being discussed everywhere, people have very strong opinions, and it is a conversation being repeated in state after state. My e-mail has been inundated with information on supporting continued fluoridation, asking me to speak to patients and take a stand. There are pieces of this conversation I am clear about.
- Water Fluoridation decreases dental disease
- The caries rate will increase without water fluoridation, and increased caries early in life leads to a lifetime of dental treatment.
- Fluoride is not evil and does not have the horrible medical implications those opposed claim.
In previous posts I tried to define a process called oxidative stress, which occurs when our cells are exposed to more oxidizing agents than they can detoxify. Fortifying our cells against this process, and even increasing healing is the premise behind the use of topical anti-oxidants. We have numerous studies that have shown that wound healing is diminished in the presence of oxidzing agents. In addition these studies have shown that the addition of a combination of anti-oxidants topically reverses the cell damage process and even encourages wound healing. From these original studies clinical research was completed. there are a variety of conditions on which the use of topical anti-oxidants has been shown to have a positive effect:
The link between periodontal disease and systemic disease has been clarified, and we are still uncovering new relationships that confirm he importance of maintaining periodontal health. For example inadequately controlled moderate to severe periodontal disease increases the systemic inflammatory load on our bodies. This increased inflammatory load may increase our risk of cardiovascular disease. It has been shown that patient’s who are diagnosed with periodontal disease in their early adult years have a four-fold risk of developing Alzheimer’s disease. There has also been a positive link confirmed between periodontal disease and obesity, as well as the known link with Diabetes. Active period therapy decreases the amount of systemic inflammatory cytokines, which are directly related to insulin resistance and stabilizing blood sugar in diabetic patients. This is important information that we can share with our patients, to help them understand the whole body value of a healthy periodontium.