Your Breath and Your Health

This week's post is kind of a follow up to my last post on gum disease. Bad breath truly can be a debilitating affliction, it also is one of the major concerns patients have when they come to see me. Bad breath issues can be caused by several factors, from certain foods we eat to problems with acid reflux disease. Often it has it's origins from the bacteria in our mouth, including the ones responsible for periodontal disease and tooth loss.
In addition to bad breath and loose teeth, periodontal disease may have consequences for our entire body. There is solid evidence suggesting that infections originating in the mouth can spread to other areas, affecting major organs such as the heart, brain and lungs.  Furthermore, research has shown that there is an association between periodontal diseases and other chronic inflammatory conditions, such as diabetes, cardiovascular disease and Alzheimer’s disease.

Researchers have found that people with periodontal disease are almost twice as likely to suffer from heart disease as those without periodontal disease. Oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in the coronary arteries and contributing to clot formation. Blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks.

Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causes of periodontal disease as a risk factor for stroke, people diagnosed with suffering from a stroke were found more likely to have periodontal disease when compared to those in the control group.

In addition, medicine is becoming increasingly aware that periodontal disease may contribute to a host of other problems.  It can make it more difficult for people who have diabetes to control their blood sugar. Bacteria from the oral cavity can contribute to pneumonia or cause complications in patients who suffer from chronic obstructive pulmonary disease. Pregnant women suffering from periodontal disease are seven times more likely to give birth prematurely. The mouth truly is the gateway to our body, so if brushing, flossing and using a tongue scraper can't kill your bad breath get it checked out. 

A Healthy Smile… More than just your Teeth

So I decided to dust off this blog of mine and post some more things I feel might be interesting to my patients or anyone else out there for that matter. I was reminded of this blog when I had a new patient presenting with a tooth ache and several teeth needing to come out. The patient hadn't seen a dentist in a long time and was surprised to hear that the tooth bothering him couldn't be saved. " I brush every day and never had a cavity" he said. Which was true, but the gums and bone holding his teeth in place was so eroded that I could not save an otherwise healthy tooth. 

When we think of a healthy smile the first thing that comes to mind are straight, white teeth.  The truth is that healthy teeth are only half of our smile, the other half are healthy gums.  Often overlooked, gums give our teeth the strong foundation they need.  Healthy gums enable us to keep our teeth for a lifetime while gum disease, often painless can cause loose teeth. 

The primary causes of gum disease are the bacteria that make up plaque, the sticky colorless film that forms on our teeth.  If not removed each day by brushing and flossing plaque causes the gums to become tender and inflamed. Gingivitis is the mildest form of gum disease, resulting in red, swollen gums that bleed easily.  If left unchecked the plaque can harden and form into calculus, a rough substance that tightly adheres to teeth.  Calculus is a haven to both bacteria and their destructive byproducts, toxins.  As the gum disease establishes itself and progresses into deeper levels of the gum tissue it begins to create pockets around the teeth that can ultimately result in destruction of a tooth’s retentive fibers and supporting bone.  The advanced infection is known as periodontal disease; the tooth may loosen, cause pain, swelling and ultimately require removal.

When it comes to treating periodontal disease early detection is key. In the early stages most treatment involves a special cleaning which removes plaque and calculus from around the tooth and smooths the root surfaces.  More advanced cases may require surgical recontouring of the bone and repositioning of the gum tissue so it will be easier to keep clean.  After the professional treatment sticking to a maintenance program is crucial for patients who want to maintain the results of periodontal therapy.  Visiting the office every three to four months for spot cleaning and observation as well as smoking cessation and regular brushing and flossing are essential steps for a successful treatment outcome. 

There really is no reason to lose teeth in this day and age. I have a lot of patients in their 80s and even 90s with a functioning dentition. Regular exams and basic home care really can go a long way, since healthy gums not only are part of your healthy smile, they are one of the foundations to a healthy life. 

So About That Toothbrush We Give You

I had a very interesting conversation with one of my patients yesterday. I was wrapping up his six month hygiene exam and we started talking about toothbrushes. With a big smile on his face he declared "I love getting my toothbrushes from you, that way I don't have to buy my own". I must have had a perplexed look on my face because he followed up with "do I have to change them more frequently?"
In general you want to change out your toothbrush at least every three months, more often if you are a heavy handed brusher or you get sick with a cold or the flu. Old toothbrushes with worn bristles will not clean your teeth as effectively and can become a breeding ground for harmful bacteria. If you get sick, it is recommended to store your toothbrush away from those of other family members and replace it as soon the illness subsides.
As for daily toothbrush care, a few good habits will assure your toothbrush doesn’t turn into a high school biology experiment. Don’t forget that cavities and gum disease all originate from bacteria; every family member should have their own age appropriate toothbrush, no sharing! Washing your hands before and after brushing will avoid transferring bacteria from other parts of the bathroom onto your toothbrush (for that matter make sure you keep your brush stored as far away from the toilet as possible. Studies have shown that flushing a toilet will send bacteria flying up to six feet from the edge of the toilet bowl). Soak the brush in an antiseptic mouthrinse after brushing and store it upright to let it air dry before using it again. If you use an electric toothbrush with interchangeable heads make sure each family member gets their own.
On a side note, I always recommend soft bristled brushes with a small brush head, medium and hard bristled brushes can damage your teeth even when used with a light touch. This is especially important for electric toothbrushes since strong pressure combined with an oscillating motion quickly traumatizes the gums, possibly leading to irreversible gum recession and enamel wear. And no matter which kind of toothbrush you have, use it twice daily for at least two minutes.

To Floss or Not to Floss...

…well if you know me that certainly is not the question, I love it when my patients floss! As a matter of fact I once had a patient ask me what I would choose to have on me if I was stranded on a deserted island, a toothbrush or dental floss. Without hesitation I answered floss because most of the cavities I treat originate in between the teeth. Luckily none of us have to make that kind of choice but we do have several options as far as flossing goes.

One of the questions I often get asked is if the flossers or tooth picks are as good as the traditional string floss. In my opinion the string floss is the gold standard because it offers the greatest versatility. If handled properly it can reach into deep gum pockets, cover and clean a greater surface area and navigate tight contact areas more effectively. It is a little tricky to hold onto but like anything else a little practice will go a long way.

Flossers are a convenient alternative to string floss but they only work for patients with little or no gum recession. They lack the flexibility to wrap around curved areas of the tooth and often “bottom out” before they can reach deeper gum pockets.

Tooth picks really only are good at removing food from between teeth, they don’t get rid of the bacteria and can actually chip away at the tooth, creating areas even more vulnerable to decay. A safer alternative to tooth picks are interdental brushes that work well for patients with braces or large spaces between their teeth.

The bottom line: if used properly all of these devices can help reduce plaque and keep your teeth healthy. The most important thing is to find the one that works for you and to commit to using it every day.