Wear Red! Go Red for Women!

Wear Red!  Go Red for Women!

Have you seen these ads and wondered what wearing red is all about? February is a popular month to see hearts, and the color red, in general. No wonder the American Heart Association (AHA) designates this month for Heart Disease Awareness in women. Men are affected also, but women take the cake when it comes to deaths from heart disease.

Heart disease is the #1 killer in women. In fact, it is responsible for 1 in 3 deaths of women each year. That’s an astounding number considering breast cancer kills approximately 1 in 31 women each year. Are you aware of the warning signs, symptoms or risk factors that could affect you or a woman you may know?  www.goredforwomen.org is a great website to inform you of these, as well as ways to prevent or control this disease.

Why would a dental blog be discussing heart disease, you wonder? Many people are not aware that oral health, specifically having periodontal disease is a huge risk factor contributing to your heart’s health, as well as your entire body.

Periodontal disease can affect your overall health. Over time, it may increase the risk for heart disease and stroke. Several studies have shown that people with periodontal disease may be more likely to have coronary artery disease than people with healthy mouths.

Science has two explanations for this association. One is that the bacteria that cause periodontal disease can release toxins that travel through the bloodstream and help form fatty plaques in the arteries. These plaque deposits can lead to serious problems, such as blood clots, which can block blood flow. This in turn, can lead to a heart attack.

The other explanation is that these bacteria cause the liver to make high levels of certain proteins, which causes inflammation in the blood vessels. Inflammation could also lead to a heart attack or stroke.

Heart attack or stroke can sometimes present as jaw pain. This can be a warning sign of one of these medical emergencies. You should never disregard this pain as just a hard day, or perhaps too much strain during work or exercise. Always mention to your dentist if you have had jaw pain. Most importantly, ask your dentist what the status is of your periodontia, otherwise known as gums. Also, inform the dentist if you have high blood pressure, Congestive Heart Failure, suffer from angina (chest pain), or have had heart surgery. These may require extra measures before or during dental treatment.

Thanks for your time, hopefully this was helpful. Now kiss your loved one and enjoy a piece of dark chocolate! (One piece a day can have added health benefits)

Kristina Wagers, RDH

https://www.goredforwomen.org/home/about-heart-disease-in-women/

www.colgate.com

Baby, This Juice is For You!

Baby, This Juice is For You!

For our younger patients, yes, this really existed...and it was delicious! But at 10% juice, not quite up to snuff nowadays.

                Being a parent is tough.  There are so many options for every aspect of raising a child.  From  providing a nutritious diet, to choosing a college and everything in between, parents are bombarded with life-changing decisions.   In past research, juice has gotten a bad rap for contributing to Early Childhood Caries/cavities (ECC) .  New studies have indicated that 100%  juice (with no sugar added) does NOT contribute to ECC. This is great news, as it is hard enough to fit all of the fruit and veggie servings into our children's diets with our busy schedules.

                The ADA defines ECC as the presence of one or more decayed (cavity), missing (due to cavities) or filled tooth surfaces in any "baby" tooth in a preschool-age child between birth and 71 months of age. Many of you may have noticed this on the Kindergarten exam form. 

            Some suggestions for preventing cavities in young children are:

• Mom keeping her own mouth healthy, as the bacteria that cause disease can be transmitted (Yes, dental cavities may be contagious!).

• Stop breastfeeding after baby has teeth

•  No liquids other than water in a bottle at bedtime, when teeth are present

• Encourage cup drinking, not sippy cup for prolonged use

• Nutritious diet

• Have an exam done by the dentist within 6-12 months of first erupted tooth, and ask about what preventative measures may be necessary.

• Avoid sugary drinks such as soda and juices with sugar added

• When sugary drinks are consumed, limit them to meal-times (vs. sipping for extended periods of time).

                We can't protect our children from everything in life, but with a little extra effort, hopefully we can protect them from cavities! Lastly, if your child (or yourself) gets a cavity, don't beat yourself up. It is no indication of what kind of person or parent you are. It simply means that your (or your child's) mouth has the bacteria present that cause cavities. Some folks get cavities easier than others!

Kristina Wagers, RDH

References:

Journal of American Dental Association, December 2014 Volume 145, Issue 12, Pages 1254–1261

http://www.ada.org/en/about-the-ada/ada-positions-policies-and-statements/statement-on-early-childhood-caries

http://juicyjuice.com/article/nutrition-ignition/

http://media-cache-ec0.pinimg.com/736x/0a/8c/18/0a8c18890e8c803a80f6d8cfc3bd4a0d.jpg

Dental Health and Breast Cancer

Dental Problems Associated with Breast Cancer

This month, I am tasked with being aware of two things that hold special significance in my life. The most recognizable is obviously breast cancer awareness month. From flight attendants to football players, folks across the country show their support by donning pink in their everyday attire. Thanks to my profession, I am also a fan of dental hygiene (and by proxy, the awareness thereof). In this article I am going to link the two, and explain why dental hygiene is even more important for some breast cancer survivors.

Breast cancer is notorious for bone metastasis. Thankfully, campaigns such as Breast Cancer Awareness Month, have strongly encouraged folks to participate in early screening efforts to minimize the chance of a late stage disease. When the unfortunate late diagnosis occurs, sometimes anti-resorptive agents are used as an adjunctive treatment. Examples of these fall into the bisphosphonate class (Zometa, Aredia). These drugs are used to treat a variety of bone diseases, including osteoporosis, which affects a similar demographic as breast cancer. When I think of these drugs, I think of Sally Field. Unforunately, not this Sally Field:

It's all in the mustache, fellas.

But, this Sally Field:

So, what does this have to do with teeth? I'm glad you asked! These drugs turn off the cells that allow the bone to heal properly. This can sometimes result in a condition known as anti-resorptive related osteonecrosis of the jaws (ARONJ) or Bisphosphonate related osteonecrosis of the jaws (BRONJ). This occurs most often with the use of IV drugs of these classes after invasive dental surgery (tooth extraction, jaw surgery, periodontal surgery, apicoectomies, implants). It is extremely painful, and extremely difficult to treat. Therefore, prevention is key. The sad thing is that I seldom (never in my private practice career), get a request from a physician for a dental consult prior to patients taking these drugs. Dentists usually find out our patients are taking these drugs after they have already started. A screening prior to beginning treatment allows the dentist to determine if surgery is necessary before the drug is taken, which can save our patients the agony of going through ARONJ/BRONJ. I mean, what can be worse than breast cancer, chemotherapy, and radiation? Probably having breast cancer, chemotherapy, and radiation while also dealing with painful areas of exposed, non-healing/dead bone in your mouth.

If you are already taking one of these medications, here are my recommendations to help minimize the risks of needing dental surgery. 

1) Maintain regular dental checkups (3-6 month recalls/cleanings/maintenance).

2) Comply with recommended x-ray frequency, as suggested by your dentist.

3) Consider fluoride varnish to prevent dental cavities,

4) Use an electric toothbrush to help improve your brushing technique.

5) Use caution when eating sharp foods (tortilla chips, etc), especially if you have several bony areas in your mouth. Believe it or not, non-healing ulcers have developed from seemingly harmless trauma in at-risk patients, not just from surgery!

6) Treat small areas of decay before surgery is necessary (in other words, be less prone to "watch" some cavities).

If you are undergoing chemotherapy/radiation, please consult your dentist and/or oncologist for recommendations on the management of dry mouth or burning/sore mouth ("mucositis") related to your treatment.

So, why is breast cancer month important to me? From a professional perspective, my residency training helped me to better understand the special dental considerations that are necessary when caring for cancer patients. From a more personal perspective, My Momma had breast cancer, and our family is blessed enough to still have her around 6 years later to play with her two grandchildren. My Grandmother had breast cancer, and is still living well and enjoying with her grandchildren and great-grandchildren. My mother's close friend, Nancy Wilson, was not so fortunate. She and my mother went through diagnosis/treatment at the same time, but Nancy lost her fight. One of my teachers in dental school, Dr. Janet Lee lost her fight with breast cancer after I graduated from dental school. She was an educated woman who never missed a mammogram or women's health visit, and wound up with Stage IV Metastatic disease that eventually took her life.

So for me, October offers two reminders. The first is that folks who will be taking medications (as the ones mentioned above) for bone diseases need to have a dental consultation prior to starting treatment. And the second is to count your blessings and enjoy every sandwich.

Resources:

The movie "Smokey and the Bandit", directed by Hal Needham. Seen here from left, Burt Reynolds as Bandit and Sally Field as Carrie. Initial theatrical wide release May 27, 1977. Screen capture. © 1977 Universal Pictures. Credit: © 1977 Universal Pictures / Courtesy Pyxurz.

http://www.celebrityendorsementads.com/celebrity-endorsements/celebrities/sally-field/

Fluoride

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The resemblance is uncanny!

Like most people, I probably watch too much TV. NBC's Parks and Recreation is our (my wife and I) favorite. My love for this show has now peaked, with the introduction of Jeremy Jamm. Yes, he is a dentist (orthodontist), and he is hilarious. I won't belabor this point, but you should just check out the show, and get "Jammed."

Recently on the show, Jamm played the role of a nefarious city council member who was opposing community water fluoridation of the fictional town of Pawnee, Indiana (while instead favoring the supplementation of the water with "Drinkums," a sugary product of a fictitious snack company). While the show broached this topic in a hilarious way, the outcry of the townspeople and fellow city council members was historically accurate and satirical.  A couple of the paraphrased comments included, "Fluoride is used by the communists to control our minds," "Cavities are why small-town dentists like me can afford such boss rides." There have been numerous unsubstantiated claims that fluoride is linked to x-y-z. If you are so inclined, you can search for those yourself. The only certainty is that the most common disease in America, which also happens to be one of the largest causes for absenteeism in our schools, is actually helped by water fluoridation. I am of course talking about tooth decay.

I am from a high risk cavity area, and did not have fluoridated municipal water (my fellow Big Creekers will recall "City Water") until my freshman year of high school. In elementary school, we used to have to use "swish" every so often in school as a fluoride supplement. And as most of you from my generation will recall, it was gross. Luckily, delivery of fluoride has improved. My preference for fluoride supplementation, as determined on an individual patient basis, is fluoride varnish. Varnish is a tooth colored delivery that adheres to the teeth for about 12 hours to improve fluoride uptake, and is extremely fast to apply. Foam fluoride supplements are also successful, but have to remain in the mouth for 4 minutes (all while trying to keep a young kid from throwing up!). 

To summarize, fluoride supplementation (when appropriate, based on a variety of factors influencing cavity risk), is a very effective way to minimize the need for more invasive dental treatment. Fortunately, this treatment is also very affordable...especially when compared to fillings, crowns, or root canals.  

If you would like, check out the ADA's recommendations on fluoride supplementation HERE.

A more patient-centered breakdown of fluoride is located HERE.

A good dental decay/fluoride  page courtesy of the CDC is HERE.

References:

1. "Fluoride." Parks and Recreation. NBC. 21 Nov. 2013. Television.
2. Photo was taken from tumblr at http://nbcparksandrec.tumblr.com/post/64341710172/jamm

Teething

This is perhaps the dental topic that draws my ire most consistently. While facebook creeping, as I tend to do, I often see parents make comments about little Suzie’s fussiness and fever. Society has subconsciously brainwashed us to offer condolence and explanation once we catch whim of this unfortunate occurrence. After all, no one likes to hear of a sick baby. The top comment is usually from a grandmother or aunt, and goes along the lines of “Oh no, is she sick?” A perfectly logical comment. About 2 or 3 comments later, however, someone will undoubtedly say, “Teething?” To an anti-dentite, this may be of no significance to you. As a dentophile, this breaks my heart. Teeth are consistently the butt of much criticism. They are too yellow. They are too crooked. They are sensitive. They hurt. They caused an abscess. They bit my cheek in the same spot 5 times! One thing that teeth should not be blamed for, however, is a fever. Once you’ve picked yourself off of the ground, please continue reading. Macknan et al. reported that vomiting, diarrhea, and fevers greater than 102 degrees (among other symptoms) were not significantly related to teething in their study of 125 children/475 erupting teeth published in 2000. One theory is that teething babies wind up chewing on their hands more to help soothe their tender gums. This innocent action can introduce not-so-innocent viruses from baby’s hands into baby’s system and can result in a baby with a fever greater than 102 degrees. Alternatively, a fever greater than 102 degrees occurring during teething could simply be a coincidence. The moral of the story is to give your teeth a break for a few minutes at least, and take that baby to the pediatrician if his/her fever exceeds 102!

If you don’t believe me, check out the ADA’s article about teething HERE

And you can find a link to the study referenced above HERE