There are three main diseases that are dealt with in the dental field.
They are periodontal disease, caries (the term we use for cavities) and cancer.
Most people are familiar with the term cavity and cancer is in the media all the time. I’m sure everybody knows at least one person who has had experience with “the big C”. Periodontal disease does not have as much media coverage but is still very serious.
Cavities are areas of the tooth that have been broken down by acids. Cavities are the result of a contagious bacterial infection. These bacteria live in the mouth and produce acid during their digestion and elimination process. I know it sounds gross but think about our digestion and elimination process. That is what is going on in your mouth on a very tiny scale. There are millions of bacteria in there living their lives and using you as their bathroom. The elimination product from these bacteria is extremely acidic, and it eats into the tooth. This bacteria is most often spread from parent to child so it is very important to have cavities treated. You are more prone to cavities in the three years after having one if you do not have regular exposure to fluoride or have a diet containing sugars and acids. (Think carbonated drinks, even diet ones). The sugars include many simple carbohydrates and candy of course. If you eat something and it sticks in the grooves of your teeth for a while then you know these put you at risk. The bacteria produce acids for about twenty minutes after exposure to these things. It is worse to sip on a soda or juice all day than to sit down and drink the whole thing in a sitting since each exposure adds twenty minutes of acid exposure.
Risk factors for Cavities (also called tooth decay or caries)
- Having a cavity in the last 3 years, for kids they are at a higher risk if their mother, siblings or other care givers have had a cavity in the last 3 years-High Risk
- Frequent snacking on sugary or starchy foods or drinks, or carbonated beverages-High Risk
- Chemotherapy or Radiation Therapy- High Risk
- Reduced Salivary Flow (Dry Mouth is often caused by medications) Severe Dry Mouth, called Xerostomia- High Risk
- Eating Disorders-Moderate Risk
- Chewing Tobacco-Moderate Risk
- Poor Oral Home Care-Moderate Risk
- Root Surfaces Showing above the gum line-moderate risk
- Areas where food gets stuck between teeth, we sometimes call them food traps-moderate risk
- Orthodontic appliances, fixed or removable-moderate risk
- Developmental, Physical or Mental disabilities that prevent adequate oral health care-high risk
The more risk factors you have the more likely you are to develop a cavity. As you can see some of these risk factors can be changed by behavior changes, while others can’t. Products are available to help lower your risk. I will discuss these products in detail later.
- 1.1% neutral fluoride
- Over the counter fluoride rinse such as Act or Listerine Total Care
- >MI Paste or MI Paste Plus
- Chlorhexidine Gluconate
- In office fluoride treatments
Cancer is a very scary word. Although most people are aware of oral cancer they may not know the risk factors or what to watch for. No longer is oral cancer primarily related to smoking. It is being seen in an increasingly younger population. Screening is so important because by the time the patient sees something that they think may be cancer it is usually fairly advanced. Survival rates are so much better when cancer is detected early. As a general rule of thumb if you have a sore that doesn’t go away in two weeks call your dentist to get checked out.
There are several risk factors for oral cancer
- 40 years of age or older (most common age range when cancer is found)
- Patients 18 or older with any of the following risk factors
- Tobacco Use (smoking cigarettes, pipes or cigars as well as chewing tobacco and snuff)
- Chronic Alcohol Use (2+ ounces at least 3 days a week)
- The combination of tobacco and alcohol use puts you at an even higher risk
- HIV and AIDS
- HPV- the virus most commonly heard about related to cervical cancer
HPV is a sexually transmitted disease and is extremely common. If you are sexually active I would strongly recommend screening for oral cancer. Women are much more likely to know if they have been exposed, as they are screened during their yearly pap smears. Men can still be infected and not be aware. HPV is spread by oral sex, or even french kissing. Oral cancers associated with the HPV virus make up about 25% of oral cancers, luckily they tend to have better survival rates than those associated with smoking. The key is to catch oral cancer early
- Epstein Barr Virus (causes Mono) and Herpes (cause cold sores) have also been linked to oral cancer
- History of Cancer
- Patients age 65 or older with other risk factors mentioned are at the highest risk
Oral Cancer screening is extremely important. When you have an exam by the dentist or hygienist they look around the mouth for abnormalities. You may not even know they are doing it. Visual exams are not fool-proof. Often times by the time a lesion is clearly visible cancer may be fairly advanced. Your dental office may recommend a special kind of oral cancer screening which uses light which can detect lesions earlier than with the naked eye alone. Where I work we recommend them as a yearly exam to patients 18 and older.
Oral Cancer Screening Tools:
3 out of 4 people have some form of periodontal disease ranging from gingivitis to advanced periodontal disease. What they all have in common is bacteria. Periodontal disease is an infection in the gums. It is often called a silent disease because patients may not experience pain during the disease process. A red flag for disease is bleeding when brushing or flossing. THIS IS NOT NORMAL!! IT MEANS YOU HAVE AN INFECTION.
The way that the hygienist or dentist will know if you have periodontal disease is to do something called a periodontal chart or probing. I will explain this more in the section about treatments. Bleeding without bone loss means that you have gingivitis, a reversible form of periodontal disease that involves bacterial infection of the gums. If bone loss is found with or without bleeding it means that you have a more severe form of periodontal disease. Bleeding means you have active infection, lack of bleeding with bone loss means that the infection was active at some point but is now not active. If bone has been lost through periodontal disease it doesn’t grow back, but more loss can be prevented or slowed with a non surgical periodontal therapy called scaling and root planing and diligent home care. Periodontal disease is episodic. There may be periods of stability with periods of active infection. That is why periodontal maintenance appointments are so important. In most cases your hygienist will recommend a 3-4 month recall for periodontal maintenance to watch for any changes, remove bacteria from periodontal pockets and begin active treatment in any areas that may need it. Home care is extremely important for patients with periodontal disease. The patient plays a huge part in maintaining their health. Periodontal treatment will not work unless the patient and hygienist work together. In more severe cases a patient may be referred to a periodontist. A Periodontist is a dental specialist that deals with periodontal disease. At the periodontist you will still see a hygienist for the treatments that I mentioned. The periodontist may do other advanced treatments such as bone grafts. Not all periodontal patients are candidates for bone grafts. It depends on the way the bone has been lost. Every person is different but feel free to ask your dentist or hygienist what they think. If grafting is recommended you will be referred to a periodontist.
Who is at risk for periodontal disease?
Although anybody can develop periodontal disease there are some known risk factors.
- Poor Nutrition
- Poor Oral Home Care
- Hormonal factors such as menopause or menstrual cycle
- Clenching or grinding your teeth
- Some health conditions, the most common being diabetes
- Genetics- keep in mind everyone who has a parent who has dentures is not guaranteed to have the same problem. Many of these factors work together. Only about 30% of the population fall into this group. Remember people learn habits at home when they are growing up. Habits can be changed. Don’t give up on your teeth because you think that you were just born to lose your teeth like mom and aunt Sally. Maybe mom and aunt Sally grew up in a home where oral health just didn’t seem very important. You can choose to make your oral health important. It can’t hurt to try right.
Products that may be recommended to aid in Periodontal Treatment:
- Chlorhexidine Gluconate
- Stannous Fluoride
- 1.1% Neutral Fluoride
- Interdental Brushes
- Electric Toothbrushes
Please visit the following sites to if you want more information
American Dental Association Caries Risk Assessment Form
Oral Cancer Foundation. Chapter III: Risk Factors
American Academy of Periodontology. Gum disease: what you need to know.