You've probably heard that old song about the leg bone being connected to the knee bone; it's easy to see how the human skeleton links together. But the concept of anatomical parts being interconnected actually goes further than you might think. Problems in almost any part of the body can have profound effects in other areas. Your gums offer a perfect example.

Believe it or not, medical research has established a connection between gum disease and cardiovascular disease (CVD). They appear to be linked by inflammation, a protective response to infection. Inflammation can be characterized by a redness and swelling of the body's tissues that you can see. Or its effects can be less obvious.

Gum disease is an infection caused by bacteria, which build up in the mouth in the absence of regular or effective brushing and flossing. When left undisturbed, the bacterial biofilms (dental plaque) change over time so that a small set of highly pathogenic (“patho” – disease; “genic” – causing) organisms emerge that cause periodontitis (“peri” – around; “odont” – tooth; “itis” – inflammation).

Periodontitis can cause not just a localized inflammation of the gum tissue, but also a systemic (whole-body) inflammation. And this chronic, low-grade inflammation throughout the body appears to increase the risk of heart disease considerably. The good news is that there is a lot we can do about gum disease. And when we reduce the inflammation it causes, we can also reduce the risks for CVD and the heart attacks and strokes that can result.

The first step is a thorough, professional periodontal cleaning to remove the bacterial biofilm attached to the roots of the teeth. Sometimes a short course of antibiotics is prescribed to further fight the infection. Advanced periodontitis may require surgery so that we can reach all of the contaminated root surfaces for removal of the bacterial biofilm.

We will also review with you how you can prevent the growth of harmful bacteria through an effective daily oral hygiene routine. This is crucial to maintaining your oral health, which in turn affects your general health and overall well-being.

Contact us today to schedule an appointment to discuss your questions about the relationship between gum disease and heart disease. You can also learn more by reading the Dear Doctor magazine article, “The Link Between Heart & Gum Diseases.”

In our office, many of our patients are always asking us if over-the-counter (OTC) mouthwashes or mouthrinses are truly effective tools for curing bad breath. Unfortunately, nearly all of them merely mask any odorous smells temporarily — regardless of how refreshing they taste. There are mouthrinses available that are effective for treating gingivitis and tooth decay, but you must visit our office to obtain a proper diagnosis and a prescription for them. Reality is that a mouthrinse alone can't cure bad breath; however, there are products available that can make a positive impact on your dental health. The key is to match the right mouthrinse to your specific dental need.

• OTC mouthrinses that contain about 0.05% sodium fluoride are an effective tool that when combined with good oral hygiene can significantly reduce the development of tooth decay.
• OTC mouthrinses that contain alcohol, triclosan, sanguinaria extract, zinc and/or essential oils such as menthol can somewhat help reduce the bacteria in plaque, which in turn can reduce gum inflammation (gingivitis) and bad breath when used in combination with proper brushing and daily flossing.
• Prescription mouthrinses containing chlorhexidine may be more effective in helping to control both gingivitis and tooth decay in certain circumstances. This is because chlorhexidine inhibits the formation of dental plaque by preventing bacteria from sticking to your teeth.

While bad breath may seem unbearable, it is often treatable. The key is to determine and then address what is causing your bad breath. A simple trip to our office for a proper exam, assessment and thorough cleaning along with improved oral hygiene may just do the trick. Contact us today to schedule a consultation for an examination and treatment plan.

Learn More

To learn more about mouthrinses, read the Dear Doctor article, “Mouthrinses.”

What does it mean when your dental hygienist recommends root planing? To put it simply, root planing is a method of cleaning the roots of your teeth in order to avoid periodontal (“peri” – around, “odont” – tooth) disease.

Periodontal disease happens when dental plaque, a biofilm of bacteria, is not regularly removed and begins to build up on teeth near the gum line. The bacteria cause inflammation, and this in turn causes the gum tissue to detach from the teeth. The widening spaces between the gum tissue and the teeth, called pockets, are environments in which bacteria can continue to collect and cause further inflammation and infection. Ultimately, this can lead to infection, bone loss, and loss of teeth.

Root planing is a technique designed to avoid such dire results. The bacteria, along with products they manufacture as part of their metabolism, can become ingrained in the surfaces of the tooth's root (the part of the tooth that is below the enamel). These bacterial products will form hard deposits called tartar or calculus.

Deep Cleaning Your Teeth
Of course, the best idea is to brush and floss away the plaque before the bacteria begin to build up on your teeth. If this is not done and pockets begin to form, the bacteria and toxic products are more difficult to remove in order to deep clean your teeth.

The first step is scaling. My hygienist or I will remove superficial collections of calculus. If material still remains within deep pockets, root planing is the next step. It involves actually planing the surface of the root, smoothing the surface free of calculus, bacteria, and toxins that have ingrained into the root surfaces.

Root planing is most often done under local anesthesia so that you remain comfortable while the cleaning procedures are done. The initial cleaning may be done by an ultrasonic instrument that vibrates particles off the root surfaces and flushes the pockets with water. Small hand instruments called curettes are used to finish the process. Antibacterial medication may then be used to help clear away infection from the pockets. Sometimes you may experience some tooth sensitivity to hot and cold after the root planing. If needed, this can be treated by applying fluoride to the root surfaces.

Depending on the extent of your gum disease, it may not be possible to remove all the deposits at one appointment, and it may be necessary to have multiple appointments over a few weeks to remove the remaining deposits. Often after three to four weeks the inflamed tissues have healed, leaving you with healthy gums once again.

Contact us today to schedule an appointment to discuss your questions about dental hygiene and root planing. You can also learn more by reading the Dear Doctor magazine article “Root Planing.”

If you like soft drinks and carbonated colas, beware. Acids in these drinks may be dissolving the minerals in your teeth — a process called chemical erosion. And don't think that natural fruit juices or sports and high energy drinks are any better than sodas. They also contain acids that dissolve the surface enamel of your teeth. Once your enamel is lost, it is gone forever. It cannot naturally recover.

Sadly, teeth in children and teenagers — an age group most likely to drink large quantities of soda and juices — may be more easily eroded by acids. These youngsters have not had long-term exposure to fluorides which harden tooth enamel and protects them from acid erosion.

The Difference between Erosion and Decay
Chemical erosion is not the same as tooth decay (cavities). In chemical erosion, acids in your mouth react directly with minerals in the outer enamel of your teeth. In the case of tooth decay, bacteria in dental plaque (a bacterial film that forms on your teeth) utilize the sugars in the drinks and produce acids that attack your teeth.

After Acidic Exposure, Wait 30 Minutes to an Hour before Brushing
You may think that the solution to chemical erosion is to brush the acidic solution from your teeth as soon after drinking them as possible. But tooth brushing immediately after can actually accelerate chemical erosion and make it worse. After they are bathed in an acidic solution, minerals in the tooth surface become partially dissolved. Brushing at this time may brush away the affected layer. If you wait a half hour to an hour, your saliva will have time to neutralize the acids and harden the tooth surface by adding minerals back into it.

Drinks Less Likely to Cause Dental Erosion
Instead of drinking colas and sports drinks, stick to water and/or milk, which have the added benefit of supplying calcium to help add minerals back to the tooth surface.

If you must sip on juices or soft drinks, try to do so only at mealtimes. This is preferable to drinking them all day long, which leaves your teeth constantly bathed in an acid solution. Avoid swishing the drinks in your mouth, and sip them with a straw to reduce contact between acidic drinks and your teeth.

Contact us today to schedule an appointment to discuss your questions about acid erosion of teeth. You can also learn more by reading the Dear Doctor magazine article “Dental Erosion.”

Dental decay is an infectious and very common disease, but it's also very preventable. Today's dentistry has many tools at its disposal to accurately determine your risk for tooth decay, lower it, turn it around, and completely prevent it. What's more, we can even reverse early decay. You might never have to see or hear the drill again.

Striking the right balance between factors that promote oral health and those that cause disease is of the utmost importance. And knowing whether or not you have indicators of disease or risk for tooth decay is a great place to start.

We will scientifically calculate your risk for tooth decay by:

1. Recording and monitoring your oral and dental health: Our risk assessment/evaluation form allows us to gather information about critical dental health habits. Oral hygiene habits, use of fluoride toothpaste, tobacco smoking, frequent snacking on sugary foods and beverages, and past experience of decay are all examples of disease indicators that will help gauge your level of risk. For example, using fluoride toothpaste decreases your risk, but smoking and between-meal snacking increases it.
2. Testing for decay producing bacteria: You've probably heard of dental bacterial plaque, the biofilm that sticks to your teeth, forming in the tiny little grooves on the biting surfaces of the teeth where decay starts (and along the gum line). Today, acid-producing bacteria responsible for causing decay can be tested by simply sampling your biofilm on a swab, and placing it in a meter to accurately determine acid-producing activity. A high number indicates high risk. You can see it for yourself in less than a minute.
3. Saliva testing: A simple history will tell us whether your mouth is dry or moist most of the time. A saliva test will tell us if your saliva is acidic or neutral. A dry acidic mouth promotes decay, while a moist neutral mouth with healthy saliva promotes health. Measuring salivary “pH,” the measure of acidity, is another factor for determining your risk for decay and reversing it. Special rinses can help reduce decay-producing bacteria and reduce acidity.
4. Very early decay detection: Modern ultra-low-dosage x-ray equipment allows us to determine the very earliest signs of decay. Decay that is detectable with the naked eye (or feel with a dentist's instrument, an explorer) is already at an advanced stage. Catching the disease very early with the help of this sophisticated equipment can allow us to reverse early decay before it has even turned into cavities. It can actually be reversed with remineralizing fluids, rinses that put calcium back into the tooth surfaces reforming and hardening them.

This is a new and exciting era in the fight against tooth decay and we have all the tools to determine your decay risk and reverse it.

If you would like us to determine your risk for tooth decay, please call the office to schedule an appointment. To read more about disease indicators and risk factors for dental caries, read the Dear Doctor magazine article “Tooth Decay: How To Assess Your Risk.”