Dr. Oz talks about Periodontal (Gum) Disease and Total Health

I guess it’s because I don’t watch a lot of TV, but I confess that – until quite recently – I had absolutely no idea who this guy Dr. Oz is.  A friend recently told me that Dr. Oz has some really good material about dental health that can be shared, and since it’s sometimes easier to use someone else’s material instead of having to write it all from scratch myself  🙂 , I figured I’d check it out, and WOW!  I’m impressed!  It’s sad to say, but many physicians really have no idea about how the health of the mouth is connected to the rest of the body, and how valuable their dental colleagues can be in diagnosing a number of medical conditions.  Dr. Oz is definitely not one of them!  I’ll kick things off here with one of his articles.  I have added some bold italics for emphasis (all mine).

The Mouth as a Marker for Disease:

Added to Articles on Tue 09/29/2009

The eye might be a window to your soul, but the mouth is the door to disease. While it might be hard to make the connection between tooth loss and a heart attack, what goes on in your mouth can foreshadow many diseases.

Pocket Watch

One look inside the mouth will reveal that there are bacteria everywhere. For the most, part we cohabitate without a worry – but badly-behaving bacteria can collect in gum pockets to cause swelling, bleeding and bone loss that in turn can cause teeth to loosen and fall out.

People with gum disease (periodontal disease and gingivitis), may harbor up to 500 species of bacteria, and the proximity of that bacteria to the normally sterile bloodstream can be worrisome. Bacteria can enter small blood vessels, travel to other parts of the body and release toxins and trigger inflammatory chemicals that assault arteries and organs. Gum disease and tooth loss is now considered a harbinger for coronary artery disease, infective endocarditis, bacterial pneumonia, diabetes, kidney disease and stroke. Periodontal bacteria have also been detected in the mouths and amniotic fluid of women who have experienced threatening premature labor, miscarriage and may contribute to low-birth weight.

Breath Tests

Breath can be telling too. More than 90% of the time bad breath (halitosis) emanates from bacteria living in gum pockets, under dentures and on the surface of the tongue. It is not only unpleasant to people close to you, but it may also be a clue to other medical conditions.

Oral cancers, lung cancer, certain leukemias and dry mouth syndromes such as Sjogren’s syndrome can cause bacterial overgrowth that contribute to bad breath. And sometimes a systemic disease produces distinct chemical odors:

• Sweet or fruity odor may indicate uncontrolled diabetes
• Mousy ammonia odor may indicate liver disease
• Urine-like fishy odor may indicate chronic kidney failure
• And fecal odor may indicate intestinal blockage.

To find out if you have foul-smelling breath, ask a truthful friend, or lick your hand and smell the saliva.

Tongue Tip-off

Changes in the tongue can also be a tip-off to disease. A pale, smooth, flattened and sometimes tender tongue can point to iron or vitamin B12 deficiency, a hallmark of the common blood disorder, iron-deficiency anemia. People with Crohn’s disease and ulcerative colitis may notice tiny ulcers. If the tongue looks like a geographic map with areas of dark and light it may indicate an autoimmune disorder such as psoriasis or discoid lupus erythematosus. Recurrent episodes of white patches indicate thrush, an overgrowth of the yeast Candida, which may indicate diabetes. Strawberry red swollen tongue with a white coating and big red bumps is a symptom of Kawasaki disease.

Telling Teeth

Hairline cracks in the teeth can indicate tooth-grinding, the sleep disorder bruxism or mental stress. People with bulimia have enamel loss on their front teeth from the assault of stomach acid from repeated vomiting.

Keep Oral Traditions

Keeping up with a good program of oral hygiene and tending to dental and gum problems before they worsen is key to keeping mouths healthy. People with declining dexterity may need to make modifications that assure that good dental care continues. Electric toothbrushes, vibrating gum massagers and dental water jets can help. Routine dental visits are crucial, especially if you are planning to become pregnant or are facing a course of chemotherapy, which can reduce immunity against oral bacteria and cause mouth sores.

Here’s some help for halitosis, guidance for gums and tips for tooth care.

• Investigate any changes in your oral health
• Brush in the morning, at night and after meals with a soft toothbrush or African chew stick
• Use a tongue scraper along the length of the tongue to remove odor-causing bacteria
• Use an antiseptic mouth rinse
• Floss between teeth and inside the crease where the gum and tooth meet
• Keep well hydrated and avoid mouth breathing
• Don’t smoke or be near someone smoking (that can cause smoker’s breath too!)
• Try chewing on neem leaves, green cardamom, cloves, parsley, guava peels and gum mastic for breath control
• Visit the dentist regularly

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Does dentistry last forever?

This is a question I’m frequently asked, especially when a patient is considering a significant investment of time and money into some form of cosmetic dentistry, such as:

• Porcelain veneers
• Bonding (tooth-colored fillings)
• Porcelain crowns and bridges
• Teeth whitening
• Even Six-Month Braces

It’s a very understandable question, and the simple answer to the question, “How long will my dental work last, Dr. Payet?” is “It depends.”

Just like a car, your teeth and gums require regular care to ensure that they are working properly.  Sure, you can go 10-20,000 miles between oil changes given how improved cars are nowadays, but do you really want to take the risk?  Same thing with teeth……….some people go for 5-10 years with no dental check-ups and are fortunate when they come in to find no problems, such as cavities or gum disease. But it’s not many people that are so lucky!

I always remember a quote from some lecturer at a dental conference years ago telling us his response whenever a patient asks the question, and it’s really the most honest, best answer that can be given, “Clearly the teeth that God gave you haven’t lasted your entire life, and since I can assure you that my work is not nearly as good as God’s, unless you die first, the work I do (no matter how excellent) will not last forever either.”

So what can cause your dental work to fail?

• Grinding your teeth — when the human jaw clenches, it can create an amazing amount of force, and over time, enough clenching will cause teeth to crack and break.
• Acidity — anything that increases the acidity in your mouth is good for the bacteria that cause cavities in particular, including Acid Reflux, Sodas, Power drinks (Monster, Red Bull, etc), Sports drinks (Gatorade, Powerade, etc).
• A very sugary diet — the bacteria that cause cavities love sugar.  High sugar content means the bacteria feed like crazy, produce acid, and the acid is what eats away the teeth to cause cavities.
• A compromised immune system — your saliva contains important antibodies that help keep the cavity-causing bacteria under control.  If your immune system is knocked back due to a disease or some medication, those antibodies will be decreased, allowing the bacteria to grow uncontrolled.
• Decreased saliva (dry-mouth syndrome) — again, due to medications or illness, the amount of saliva may be decreased.  With less saliva, there is less “washing” action of the teeth.
• Trauma — obviously.  LOL  One of my patients a few years ago fainted and fell face-first into a brick wall, shattering a front tooth.  Another ran into a pole, shattering another front tooth.  Clearly, if you are injured in such a way that your natural teeth would break, any dental work will break, too.
• Bad habits like chewing hard candy or ice regularly — hard candy and ice are just that — HARD!  Ice, in particular, is easily as hard as your enamel and as porcelain or bonding.  So if you bite down on ice frequently enough and/or hard enough, you can break your teeth and dental work.

That covers most of the major causes of dental work failing.  With regular care, use of appropriate mouthrinses and toothpastes, proper brushing and flossing, regularly scheduled check-ups and dental x-rays, using a nightguard, and being aware of diet, etc, your dental work can and should last a very long time.

But always remember — my dental work isn’t as good as the natural teeth God gave you, so my work probably won’t last forever either.  😉

A Complete Smile Makeover with Porcelain Crowns for Teeth Damaged by Bulimia

There are many reasons patients come to see me for cosmetic dentistry.  One of the most common reasons is because their teeth are badly worn down from grinding, often in combination with acid erosion that has eaten away at the enamel.  Treating these cases can be complex, because if we don’t properly diagnose and solve the problem that caused the worn, eroded teeth in the first place, then any cosmetic dentistry is sure to fail very fast.

When Jenni (not her real name, as she prefers to stay anonymous) first came to see me through a referral back in 2005 for a Smile Makeover consultation, she admitted that she had suffered from bulimia as a teen, about 20 years prior.  She had recovered from this debilitating disease and had been leading a healthy, normal life for many years, but her teeth had been so eroded that she was extremely self-conscious and embarrassed by her smile.

Since Jenni’s original issue had been addressed medically, we were safe moving forward with a greatly decreased risk of acid erosion causing problems again, although bulimics are at a much higher risk of GERD/acid reflux, so she is monitored regularly by her physician, and she uses a prescription strength fluoride rinse daily to help protect the teeth under the porcelain.

Due to complicating factors, Jenni’s case was just completed this year; however, I think you’ll see why Jenni is now happy with her smile again, although she doesn’t want everyone to know what she had done,  so she has asked me to not use her portrait.

Cosmetic dentist Dr. Charles Payet, of Charlotte NC, performed a Smile Makeover with Porcelain Crowns to Restore these Teeth Damaged by Acid Erosion/Bulimia

13yo girl with back pain, headaches, jaw pain, acid erosion of teeth, ADD, gastric reflux, sleeps poorly….

So what’s the connection amongst all these things?  Is it possible there’s one condition/issue that is a primary driving force behind all of these that, if addressed, could make an amazing difference in a young girl’s life……for her entire life?  The answer is (of course, or I wouldn’t be asking such obvious leading questions, right?  LOL 🙂 )

YES!!!!

So what’s the driving force behind all these health-issues, and what can be done about it?

SLEEP APNEA!!!

Let’s list all those conditions out again and start connecting the dots:

• Lower back pain (no history of any accidents or trauma — this one is a bit of a stretch, but since there are no other contributing factors, and she’s been checked for scoliosis (curvature of the spine) and cleared, the fact that she’s been suffering from back pain is most likely due to the muscle spasm involved in the other issues, and perhaps she needs a new mattress for better lower back support.
• Long history of headaches (decreasing somewhat recently, but still significant for a girl only 13 years old) – quite a bit of research now indicates that both chronic tension and migraine headaches are connected to sleep disorders, and it makes sense – if you can’t breathe well at night and your brain gets less oxygen than it really needs, your brain/nervous system will get hypersensitized; any little trigger will make it go haywire, make muscles spasm like crazy, and result in headaches.
• Jaw pain/TMJ pain – Same as with the headaches; when the nervous system goes haywire, the muscles spasm like crazy, and your jaws will hurt; the joints get way too much pressure and pain can result, also the tissue in the joint gets scarred.
• Acid erosion of teeth, signs of wear/bruxism on teeth – Connected to both the last 2 items (jaw pain/TMJ pain and headaches) AND to the next one (gastric reflux/GERD), if the muscles are spasming like crazy and making your teeth grind, they will show signs of wearing down.  When acid from the stomach gets sucked up the esophagus during that snoring (it’s a vacuum, really) and put in the mouth, especially at night, it sits there for hours and eats away at the enamel just like soda does.
• Gastric reflux (very odd in a 13yo girl) – With sleep apnea, the throat gets closed off and you literaly stop breathing for short periods.  When your throat suddenly opens again, it’s like a vacuum suddenly releasing and acid gets sucked up your throat from your stomach.  VERY dangerous, and lots of research shows it can drastically increase your risk of Barrett’s Esophagitis, which can lead to throat cancer and is VERY VERY VERY NASTY!!!!
• ADD (Attention Deficit Disorder) – Again……decrease the oxygen level to the brain every night…..do you think your brain will function at normal levels?  Nope!  Common sense, really, and yes, the research is pointing in this direction.
• Poor sleeping – Just like anyone who can’t breathe well at night, do you think you’ll sleep well?  Nope!  You can sleep for 10 hours, but if you have trouble breathing well for 6 of those hours, how do you think you’ll feel in the morning?
• Asthma – The research on this is a little bit more in the initial stages from what I understand (could be further along and more definitive, though), but again it just makes sense.  After all, what is asthma but inflammation of the lungs, right?  Well, if you have some acid reflux at night, it’d be pretty easy to inhale just a little bit of that acid during the episodes of apnea, and imagine even a tiny bit of stomach acid getting into your lungs…..talk about irritated lungs!

So……..it really doesn’t seem like a stretch, does it?  You probably first thought…….no way!  But when looking at all of the different problems that this young lady faces at such a young age, there has to be something going on.  Given she has a pretty big tongue, big tonsils, and a very narrow throat, it was easy to determine she is at high risk for sleep apnea.

I can only hope that her mother listened and takes her for a thorough evaluation.  Besides keeping her teeth healthy, proper diagnosis, perhaps removal of her tonsils, an oral appliance, and some other possibilities for treatment, treatment could literally add years of healthy living!!!

Heartburn and cavities (tooth decay), tooth erosion, and tooth wear, asthma, ADD/ADHD

Quite frequently I get very puzzled looks from patients when I ask them if they have heartburn or have ever been diagnosed with acid reflux.  First, they’re thinking, “Why in the world is my dentist asking if I have heartburn?” and secondly they’re thinking, “What in the world would heartburn have to do with my teeth?”  Thirdly, they get even more puzzled if I ask if they suffer from asthma or anything like ADD/ADHD.  So what’s the connection among all these conditions, and why am I, your dentist, asking these questions?

First, when it comes to the question about ADD/ADHD, please refer back to my recent post that followed up on NPR’s reporting on Sleep Apnea and Behavioral Issues.  There’s some great information in there for parents.

Secondly, when it comes to heartburn and teeth, think about this: Just what is heartburn? It’s also known as Acid Reflux, and when it gets severe, it’s known as Gastroesophogeal Reflux Disease, or GERD. It’s acid from your stomach, and what does acid from your stomach do?  The same thing that acid from any other source such as sodas, sucking on lemons or oranges, etc. – the acid literally eats away at the enamel of your teeth.  So yes…..if you have heartburn frequently, you are most likely also going to have many more cavities, see greatly increased/worsened wear on your teeth, probably will see increased gum inflammation.

So why do I also have ADD/ADHD and asthma in my post title?  Simple because heartburn/acid reflux/GERD may play a real role in both of these conditions as well, because they are also linked to sleep apnea.  While I could go into a lot of detail on the topic, there are others who have written it already, so I’m going to provide you the link to the Cleveland Clinic’s website relating to these topics (asthma & GERD), where you can read those extremely informative articles.

If you are concerned that you and/or your spouse or children suffer from these conditions, consider calling us for a consultation at 704-364-7069 or request an appointment through our website: Smiles by Payet Dentistry.

The Cleveland Clinic: Asthma & GERD