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Hi
Ho Silver by
Dr. Pietrini
When I was in high school, my chemistry teacher
asked us a trick question. What did the chemical
formula HiHoAg represent? The answer is "hi
ho silver" the line used by the Lone Ranger.
Many years ago one of my friends was undergoing
orthodontic treatment. We gave him the nickname
"the Lone Ranger," because you could
tell who he was by his silver teeth. Many of today's
braces are less noticeable and more comfortable.
The brackets, the part of the braces that hold
the wires, can be metal, clear, or tooth-colored
and are used more often than the large metal bands
of the past.
Orthodontics
is the branch of dentistry that deals with dental
and facial problems. Fixed or removable appliances
(braces) are used to correct these problems. Braces
aren't just for kids anymore. Of the approximately
4 million people currently wearing braces in the
United States, about 20% are adults. There is
no reason to spend the rest of your life being
embarrassed about your appearance. If your teeth
are crooked or your profile is uneven, you may
feel self-conscious about your looks. There is
no reason to spend the rest of your life being
embarrassed.
Orthodontic
treatment can improve overall health, by correcting
malpositioned teeth, a bad bite and some abnormalities
of the jaw. Treatment will enable the patient
to keep teeth and gums cleaner, and thereby prevent
tooth decay and gum disease. A patient who has
difficulty chewing is less likely to eat nutritious
food. A poor bite can also cause extra stress
on the chewing muscles, which may cause pain or
problems with the jaw joints. In addition, protruding
teeth are more easily chipped or fractured.
The
American Association of Orthodontists recommends
that children get an orthodontic evaluation by
the age of seven. If an eight year old has visibly
crowded front teeth, this condition will not be
self-corrected by additional jaw growth. By the
time the permanent six-year molars develop the
space available for the erupting front teeth will
not increase. We inherit certain mouth and jaws
features from our parents. For children, injuries,
thumb sucking, extensive decay and premature loss
of baby teeth can lead to a poor bite. In adults,
gum disease and loss of permanent teeth can contribute
to bite problems.
How
do braces work?
Braces are placed on the teeth to apply gentle
pressure, which over time will move the teeth
into their proper position. The orthodontist cements
or bonds brackets to the teeth. A main wire called
an "arch wire" is attached to the brackets
and is wired in place with a certain amount of
tension causing a slow controlled movement of
the teeth. Pressure on one side of the tooth causes
the bone to give away. As the tooth moves, new
bone is deposited behind the tooth. With proper
treatment, an attractive, healthy smile is the
end result.
Watch For the Bump
in the Road by
Dr. Pietrini
As we travel down
life’s road we may encounter many bumps. And, so
it is when it comes to dental health. I have
written in the past about oral cancer and the need
for thorough screening by the dental profession.
Fortunately, the vast majority of oral bumps and
lesions are benign (non-cancerous). These
conditions are divided into two main
categories—soft tissue and hard tissue.
The most common hard tissue
growths in the oral cavity are referred to as, “tori”.
In the upper jaw, they are mostly found in the
palate (roof-of-the-mouth). Those in the lower jaw
(mandible) are usually located in the area behind
and below the teeth. In a healthy mouth, tori are
usually of no consequence. When it is necessary to
make a full or partial denture for a patient, tori
could be a source of discomfort, possibly
interfering with proper placement of the
appliance. Depending on the size and location of
the tori, it can be more difficult to maintain
good oral hygiene. While it is important to
continue to examine the health of the tissue
around these areas, these are benign growths,
which do not require routine removal and biopsy.
The most common
soft tissue growths found in the mouth are called
fibromas. They can be located in the gum (the area
surrounding the teeth), cheek, lip or tongue.
These growths are fatty tumors, which usually
develop from a traumatic injury, unnatural biting
habits or irritation caused by fractured teeth or
dental appliances. I have treated patients who
have had fibromas ranging in size from smaller
than a pea to one inch or more in diameter. There
are several reasons for considering removal of
fibromas:
- Cosmetics
- Continued trauma to the
area when the patient is eating
- Difficulty in maintaining
good oral hygiene
- Despite reassurance from
the dentist that the growth is benign the
patient prefers to have a biopsy for positive
confirmation
Frequently, soft
tissue growths and lesions are associated with
infections of the teeth and gums. In some cases a
biopsy or bacterial culture may be in order to
determine the nature of the lesion and bacteria.
Several years ago, I was called in for a
consultation of a patient who was hospitalized
with a recurrent knee infection. The doctor in
charge of infection control at Gottlieb Memorial
Hospital obtained a bacterial culture from the
knee and determined that the bacteria present were
the same type as are commonly found in the oral
cavity. Even though the patient was not aware of
any dental problems, examination and x-rays
revealed that the patient had several infected
teeth, which were causing bacteria to travel
through the bloodstream to the soft tissue in the
knee. After removing the offending teeth, the
infection in the knee cleared up within a few days
and never returned.
A Little Young to
Be Hitting the Bottle by
Dr. Pietrini
When
my daughters were growing up, my wife was in
charge of most of their day-to-day care. I enjoyed
the occasions where I was able to hold them in my
arms giving them a bottle. That period of their
lives seemed to pass so quickly. In the past few
months, I’ve had the pleasure to be able to bond
with my granddaughter. Lately, when feeding her
she has developed the habit of slapping at the
bottle with her open hand prompting my question to
my daughter, “Isn’t she a little young to be
hitting the bottle?”
Whether an infant
receives nourishment by breast-feeding or with a
bottle, they are susceptible to ‘baby bottle tooth
decay’ if certain precautions are not taken. You
should prepare for the care of your baby’s primary
teeth before the first tooth erupts. Use a clean,
wet cloth to carefully wipe the baby’s gums. After
several of the primary teeth appear, brush them
twice a day with a small, soft-bristled brush.
There are toothpastes available that will not harm
your child if a small amount is swallowed—use a
dab no larger than the size of a pea, especially
if the paste contains fluoride. Too much fluoride
can cause mottled (spotted) enamel.
Fermentable
liquids such as milk (both cow’s milk and mother’s
milk), formula and juices contain sugars. Bacteria
break down the sugars into acids, which attack the
teeth and create cavities. If you observe the
following suggestions, you can help prevent ‘baby
bottle tooth decay’:
·
Never
give your baby juices or other liquids containing
sugar in a bottle.
·
If
your baby needs a bottle to fall asleep, it should
be filled with water only making sure that the
water contains fluoride.
·
Do
not allow your baby to walk around using a bottle
as a pacifier. An anatomically correct pacifier
will help satisfy the baby—never dip it in honey
or sweet liquids.
·
Once
the teeth have erupted, stop the nursing or
bottle-feeding if the baby falls asleep.
·
Start
teaching your child to drink from a cup before the
first tooth erupts. By 12-14 months, your child
should be drinking from a cup only.
I know of a case of
a dentist and his wife, who allowed their child to
fall asleep with a bottle containing sugar water.
Even though they knew better, they could not cope
with the baby crying during the night. As a
result, the child developed ‘baby bottle tooth
decay’, requiring extensive oral rehabilitation,
including crowns on several of her front teeth. It
is better to suffer with a few sleepless nights,
than to deal with the heartache associated with
your child developing extensive dental problems.
A You Too
Sensitive? by
Dr. Pietrini
Imagine taking twelve of your
family members to your favorite Italian restaurant
for dinner. Perhaps you have a Campari and soda
while looking over the menu. Then you have some
piping hot minestrone along with some hard-crusted
Turano bread followed by a cold iceberg salad with
vinegar (acetic acid) and oil. After completing
your hardy hot main course accompanied by a nice
red wine and ice water, you have Cappucino and a
biscotte with your spumoni, finally sipping some
Sambuca, while waiting for your bill. You scan the
check when it arrives, grit your teeth and sign
the credit card slip. Is there any wonder why
nearly 20% of all Americans have sensitive teeth?
Teeth can be sensitive to
foods and drinks that are acidic, sweet, hot or
cold. Hypersensitivity occurs when the hard shell
of enamel is decayed or worn away exposing the
inner core of the tooth called dentin. Tooth
sensitivity occurs because exposed dentin has
thousands of tiny tubes (tubules), which contain
microscopic nerve endings. Also, when gum
recession develops, the root surface made up of
dentin becomes exposed. There are several causes
for gum recession and sensitive teeth:
·
Periodontal (gum) disease
·
Brushing with a hard-bristled toothbrush
·
Using
a toothpaste which is too abrasive
·
Clenching or grinding your teeth
·
Eating or drinking acidic foods
Sometimes, things
that appear to be healthy for us can increase
hypersensitivity. Patients try to reduce calories
and sugar intake by consuming diet soft drinks.
These products contain carbonic acid, which can
destroy sound tooth structures. Some people are in
the habit of sucking on the rinds of oranges,
grapefruits or lemons. The citric acid can etch
the enamel and dentin. One of the most destructive
habits is crunching ice. The cold cause the tooth
to contract at the same time that a damaging of
force is placed on the teeth, which can cause
minute fractures in the enamel.
If a tooth has been
sensitive for several days, it is best to have a
dentist determine the extent of the problem.
Sometimes the pain is associated with a decayed
tooth. Once it has been established that the
problem is exposed dentin, there are several
possible remedies. Toothpastes with desensitizing
agents can block the dentinal tubules. Patients
usually get relief within a few weeks using these
products. If the problem persists, there are a
number of treatments available. Your dentist can
place sealants or varnishes over the exposed
dentin. For more than twenty years, we have used a
process in our office called iontophoresis. A
cotton applicator soaked in fluoride and attached
to a low-level electrical current is placed over
the exposed dentin for a few minutes. The fluoride
is drawn into the tubules and desensitizes the
nerve endings. This treatment will usually reduce
or eliminate the sensitivity for several months to
several years. Check with your dental office to
see what treatment is best for your condition.
The Tooth Fairy By
Dr. Dennis R. Pietrini
I decided to surf the Internet to see if there was
any information about the Tooth Fairy. There are
literally hundreds of articles and books available
on the subject. The legend seems to have started
in the British Isles. The tradition in England is
for the child to drop the tooth in a fire to avoid
the unpleasant task of looking for it after death.
The Vikings had a tradition of paying children for
the use of a baby tooth. They believed that having
a child’s tooth in their possession would empower
them in battle. American children placing a tooth
under their pillow for the Tooth Fairy seems to be
a kinder, gentler approach.
Each year, I find that I am
removing fewer teeth for children. As the American
public becomes better educated about healthcare
issues and nutrition, children are not losing as
many teeth through decay. Fluoride in the drinking
water, in toothpaste and in mouth rinses has
reduced the number of decayed and missing teeth by
more than 50 percent. When a cavity does occur, it
is important to attempt to restore the tooth. When
I first started my practice, parents would
frequently say to me, “just take it out, it’s only
a baby tooth.” Modern dentistry has made the
dental experience more tolerable for all patients,
especially for children.
With the aide of conscious
or unconscious sedation and better methods of
delivering local anesthetic, most dental
procedures can be done quickly and virtually
without pain. While high-speed dental drills
continue to be the most common instrument for
tooth preparation, high-tech devices such as air
abrasion machines and dental lasers are being used
by a growing number of dental practices. Most
pediatric dentists and many in general practice
are affiliated with hospitals where extensive
treatment can be done under general anesthesia.
This may be especially useful for the growing
number of children born outside the United States
who present with more complex problems and where
there may be a language barrier.
The primary (baby) molars
usually erupt at ages 1 to 21/2. It is
important to retain these teeth until the ages of
11 to 13 to aide the child with proper nutrition
and speech. Occasionally, a large cavity might
require a treatment referred to as a pulpotomy (a
simplified type of a root canal treatment). If the
tooth structure is weakened, a stainless steel
crown might be advisable. The early loss of a
primary tooth could effect the eruption of the
permanent teeth resulting in crooked or crowded
teeth affecting function and appearance. Your
dentist can make a space maintainer to hold the
position of the teeth until the permanent tooth
develops. Interceptive orthodontics in a young
child can often prevent the need of more complex
treatment at an older age.
Technology
That Would Amaze da Vinci By
Dr. Dennis R. Pietrini
Frequently, when I speak to
dental organizations, I title my presentation
“Technology that Would Amaze da Vinci.”
Leonardo da Vinci was an artistic genius that most
dentists admire. Leonardo was born in Vinci, Italy
in 1452. While his paintings “The Last Supper”
and the “Mona Lisa” are his most recognized
works, he also had many other talents.
Leonardo’s fascination with science and nature
lead him to record these studies in illustrated
notebooks. His works covered several
areas—sculpturing, painting, human anatomy,
mechanics and architecture. Being left-handed was
considered the work of the devil, but this did not
deter Leonardo. He was able to draw with both
hands at the same time and had the uncanny ability
to write backwards. I often describe dentistry as
the only profession that requires a person to work
on a moving patient, through a small opening with
both hands, upside-down and backwards using a
mirror.
Da Vinci would have been an
ideal dentist. When I took the Dental Aptitude
Test, we were required to carve objects from
pieces of chalk. In dental school we had to
produce anatomical drawings and carve teeth out of
wax. Repairing fractured, malpositioned and
discolored teeth calls for skills of a mechanic,
artist and sculptor.
Among da Vinci’s
mechanical drawings were studies of a tank and
other weapon systems, a submarine, a helicopter
and other flying machines. He was centuries ahead
of his time, since the industrial revolution did
not begin until the eighteenth century. As forward
thinking as he was, I still believe that he would
be amazed at the advances that have occurred in
dentistry.
In the early 1960’s the
high-speed, water cooled dental drill was
developed. Equipped with various sizes and shapes
of interchangeable burs, this dental instrument
affords the dentist the ability to rapidly remove
decay and sculpt teeth to restore function and
cosmetics. In recent years advancements in
air-abrasion and lasers have allowed dentists
other options to reduce the need for
drilling—often without the need of local
anesthetic. While many patients complain of the
high-pitched sound and vibration of the drill, it
will remain the instrument of choice for many
dental procedures.
Several advances in dental
diagnostics have occurred. Intra oral cameras and
digital recording of x-rays allows the dental team
to be able to create a computerized record of the
patient’s dental condition that can be displayed
on a monitor for easy viewing and provides the
ability for electronic transmission of
information. A small laser can be used to scan the
teeth to painlessly detect if decay is present.
High-intensity light sources can be used to
illuminate teeth to aide in detecting fractures
and decay.
Our office recently
purchased a new dual-wave laser that allows us to
treat hard tissue (teeth and bone) with one laser
wavelength and to be able to perform soft tissue
surgery with an additional wavelength. The
downside of all these advances is the cost of the
equipment. While many of these new technologies
give the dentist the ability to provide faster
more comfortable treatment to the patient, it is
their knowledge, training and artistic skills that
count the most.
The
Wisdom of it All By
Dr. Dennis R. Pietrini
I am often asked, “What
are wisdom teeth?” Most people have three molars
in each corner of their dental arches. They are
referred to as the six year-old and twelve
year-old molars and the wisdom teeth (third
molars), which usually erupt between the ages of
18-23—“the age of wisdom.”
For
some people wisdom teeth will erupt like the other
molars. If they grow in properly and are in normal
function, they can remain healthy. Most patients
do not have sufficient room in the jaw for their
third molars. These partially or totally unerupted
teeth are referred to as being impacted. By taking
a panoramic (full mouth) x-ray, a dentist can
often determine the position of the wisdom teeth
several years before they are due to erupt.
All
teeth develop in a follicle or sac. When the tooth
erupts fully, the follicle becomes part of the
ligament that holds the tooth in the bone and gum.
If the tooth remains impacted, this sac can
develop into a tumor or cyst. Fortunately these
cysts are almost always benign; however, they
frequently will fill up with fluid and blow up
like a balloon resulting in swelling, pain and
infection. Antibiotics can be prescribed to treat
the infection, but this is usually just a
temporary measure. Eventually the teeth will
require removal. Fully erupted teeth may also need
to be removed, if they become decayed, interfere
with proper biting, increase the risk of
periodontal disease or are non-functional.
Some
of the common symptoms and concerns associated
with wisdom teeth are:
·
Pain
·
Swelling of the gum tissue surrounding the
tooth
·
Swelling of the jaw
·
Infection
·
Pressure against the roots of the twelve
year-old (second) molars
Impacted
third molars may be the most common medical-dental
problem. Depending on the complexity of the case,
your dentist will help you determine your
treatment options. Many general dentists prefer to
refer their patients to an oral surgeon. With the
aid of nitrous oxide or a general anesthetic and
local anesthetic, this experience should be
virtually pain free. In our office we use a dental
laser to help reduce post-operative bleeding,
swelling, pain, infection and often the need for
sutures.
Dentistry
and Sea Hunt By
Dr. Dennis R. Pietrini
In
the 1950’s actor Lloyd Bridges starred as Mike
Nelson in the popular television series Sea
Hunt. He played the part of a professional
SCUBA diver. In several of the episodes, divers
were treated for the “bends”. This occurs when
a diver returns to the surface too quickly, not
allowing the body to adjust to the sudden change
in atmospheric pressure. Gas bubbles, especially
nitrogen, build up throughout the body reducing
the normal oxygen levels, resulting in pain,
hemorrhaging of blood vessels and in severe cases
death. The faster the victim is treated, the
better the recovery. The divers are placed in a
hyperbaric chamber that increases their oxygen
levels.
So,
what does diving have to do with dentistry?
Shortly after oxygen was discovered in the
1700’s, it was used to treat patients for a
variety of ailments. In Europe compression
chambers called “pneumatic spas” were in
vogue. Today, hyperbaric chamber therapy is used
in medicine and dentistry. By increasing the
levels of oxygen under pressurized conditions,
wound healing occurs faster for patients who have
severe cases of diabetes or who have received
radiation treatment.
This
year, nearly 30,000 Americans will be diagnosed
with cancer in the head and neck region. Depending
on the size and location of the tumor, radiation
therapy may be advisable. Techniques have been
developed to attempt to reduce the size of the
area covered by the radiation to avoid damage to
the surrounding normal tissues; however, if the
tumor lies in or near the bones in the head and
neck, a condition known as radiation necrosis may
develop. Damage to the salivary glands, nerves and
blood vessels will interfere with normal healing
and may cause increased tooth decay. It is often
necessary to remove all of the teeth in the area
of treatment to avoid future serious
complications.
By
administering hyperbaric therapy (several sessions
may be necessary) to patients prior to tooth
removal or oral surgery, the patient can be
treated more effectively with the positive effects
lasting approximately two years.
Because the increase of oxygen in the
tissues allows for better healing of the surgical
sites, it is now possible to delay the early loss
of teeth prior to radiation treatment.
The
Oral Surgery Department at Loyola University
Medical Center provides treatment for patients who
would benefit from hyperbaric therapy.
For additional information, please contact
our office or Loyola University.
Dental Insurance - At
Best A Limited Fringe Benefit By
Dr. Dennis R. Pietrini
I would like to have a
dollar for every time I have heard a patient
state, “I can’t afford that treatment Doctor.
I don’t have dental insurance.” In the early
1970’s, you could purchase a very nice home for
under $50,000. Today, it could cost that much for
a modest sized room addition. Many employers began
to offer dental plans in the 70’s. At that time
the annual maximum benefit averaged about $1,000.
Today the average benefit limit is still
$1,000—not even a reasonable cost-of-living
increase. Can you imagine if there was an annual
limit for your medical plan and your physician
told you that you needed a four-way heart bypass,
but your insurance will only pay for two this
year?
Dental insurance has become
one of the most requested employee benefits. Not
all plans are alike. They are business
arrangements between an employer and an insurance
company. The best plans allow the patients the
freedom of choosing their dentist. These dental
policies are generally more costly to purchase.
Less expensive for
employers and employees, yet more restrictive, are
policies that fall into the group of “managed care plans.” Preferred Provider Organization (PPO)
programs allow the patient to select a dental
office from a list of providers who have agreed to
discount and/or cap their fees. Usually the
patient’s co-payment is less. Many PPO’s
permit patients to have treatment by a
non-participating dentist of their choice;
however, the deductibles and co- payments may be
higher. Dental Health Maintenance Organization (DHMO)
or capitation plans are usually the least costly,
but most restrictive. The patient is assigned a
dentist or clinic that has contracted with an
insurance company and employer, usually for a
monthly fee per patient. The dentist agrees to
perform certain services at no charge to the
patient, while some treatment requires a
co-payment. In theory, the DHMO system rewards the
dentists who keep their patients healthy by
lowering their costs. The drawback is that many
clinics are overcrowded, poorly staffed and
under-funded. These plans might not provide for
prompt emergency care or for urgent care for
patients away from home.
In recent years,
“fee-for-service plans” have become more
popular. When an employer establishes a Direct
Reimbursement (DR) plan, a percentage of the
patient’s treatment is paid directly to the
dentist of their choice. This method of financing
dental care is the plan most preferred by the
American Dental Association (ADA). The ADA
provides a service to assist companies in
developing alternative reimbursement programs like
DR.
No
Easy Way Out By
Dr. Dennis R. Pietrini
Each year, Americans spend
more than a billion dollars on feel-good oral
hygiene products. Instead of brushing and flossing
on a regular basis, we look for the easy way out
by using other products such as oral irrigating
devices, mouthwashes and other rinses. These
alternative methods often feel better and seem to
be faster, but nothing is more efficient than the
old tried and true—a brush and floss.
Recently,
the U.S. District Court in New York ruled that
Pfizer, the manufacturer of Listerine, must stop
promoting their claim that its mouthwash was as
effective as flossing in fighting plaque and
gingivitis. Several studies have shown that using
non-prescription oral rinses and/or oral
irrigating devices can help to loosen and reduce
plaque. Actually, it is the mechanical action and
friction of the brush and floss that are the best
methods for removing plaque, which cause decay and
gum disease. I recently did a search and found
that in a typical well-stocked pharmacy there are
more than thirty brand-named mouthwashes and
rinses available, as well as many generic
products. There are several varieties available,
which are marketed for use as a(n):
·
Antiseptic (to mask bad breath)
·
Anti-cavity rinse
·
Anti-plaque rinse
·
Whitening and stain removal rinse
·
Rinse for patients with dryness of the
mouth
Many
dentists will prescribe anti-bacterial rinses
containing chlorhexidine gluconate, which helps to
inhibit the formation of calculus (tartar) and
plaque. These rinses are usually used for a short
period of time and are not a substitute for
professional treatment or routine home care.
There
are several brands of mechanical toothbrushes that
are very effective. At one time there was some
concern that these devices might be too abrasive;
however, the newest generation of products are
well designed with soft, polished toothbrush
bristles. I recommend trying one of the many
disposable mechanical brushes available. They are
an inexpensive way of seeing if you prefer to
replace your hand-held brush with a mechanical
one.
If
you like the fresh feeling of a mouthwash, rinse
with it before you brush and floss—it will help
loosen the plaque and food between your teeth and
gums.
Here
Comes The Judge By
Dr. Dennis R. Pietrini
A few weeks ago, a new
patient asked me, “Are you a judge?” My
immediate reply was, “No, I’m a dentist. Why
would you think I am a judge?” Her response was,
“I asked one of the women at the front desk if I
would need an injection for my treatment and she
told me that the doctor will judge what is best
for you.”
Traditionally,
many patients were too intimidated to question
their dentist’s judgment about their treatment
and care. Many times patients will tell me,
“You’re the doctor. Do what you think is
best.” While I appreciate the confidence that
they have in me, to borrow a familiar line, I
often tell them, “I believe in one God and I
have discovered that it is not me.”
In
recent years, patients have been able to access
many different sources for healthcare information.
On a daily basis, you can find articles
pertaining to oral health in magazines, in the
newspaper on radio and on television. More and
more patients are asking questions about
information obtained from surfing the Internet. I
find myself spending more time than ever reviewing
treatment options with patients. Modern dentistry
offers many options for safe, comfortable care.
Frequently, I will write up three or more
treatment options for a patient outlining the
various procedures and the costs. There is nothing
wrong with seeking a second opinion. I often tell
patients that you could have a panel of several
well-known dentists review a treatment plan and
they would recommend a variety of excellent
approaches for your care and the related costs.
High-tech
dentistry makes the dental experience more
efficient and comfortable. The horror stories of
sitting through long uncomfortable treatment
sessions are a thing of the past. With good
treatment and prevention, teeth can last a
lifetime.
If
you link to my website @ www.laserdentist.com, you
can find past articles that I have written and you
can also link to the websites of the American
Dental Association (ADA), the Academy of General
Dentistry (AGD) and the Academy of Laser Dentistry
ALD). Use the search site to get more information
about your area of concern.
Women's
Oral Health (Part I) By
Dr. Dennis R. Pietrini
Women tend to be more
concerned about their oral health than men. In my
general dentistry practice, we treat female
patients more than 60% of the time, yet their oral
health is no better than the average male.
Hormonal changes throughout a women’s life, as
well as local factors such as bacteria found in
plaque, smoking, drugs and alcohol consumption,
can make her more susceptible to a variety of oral
diseases.
A women’s oral health
care needs change as she transitions from puberty
through menopause. During puberty, the sex
hormones—progesterone and estrogen that cause a
female’s body to mature—can affect periodontal
health. The hormonal changes that occur during
menstruation, along with the irritation of
bacterial plaque can contribute to gingivitis
(red, swollen and bleeding gums).
Some women will avoid
visits to the dentist during pregnancy, fearing
that it might harm the baby. Actually, untreated
dental disease may put the baby and mother at a
greater risk of developing infection. Researchers
have found that as many as 75% of pregnant women
can develop “pregnancy gingivitis”. Often,
isolated areas between the teeth become swollen
resulting in what is referred to as a “pregnancy
tumor”. These enlarged areas are usually
difficult to keep clean resulting in pain and
bleeding while eating or brushing. If they do not
reduce in size after the birth of the baby, it may
be necessary to remove them surgically. Studies
indicate that women with active periodontal
disease are 7-8 times more likely to deliver
babies prematurely with a low birth weight.
Women taking oral
contraceptives may experience symptoms similar to
those of pregnant women—gums that are swollen,
bleeding and often painful. Following tooth
extraction, women are at greater risk than men in
developing a condition called “dry socket”. If
they are on birth control pills, the risk is
doubled. A “dry socket” occurs when an
incomplete blood clot fails to form, resulting in
localized, painful inflammation of the extraction
site. The estrogen in the pill apparently
interferes with the healing process. To reduce the
chance of this post-op complication, it is best to
perform the surgery during the non-estrogen days
at the end of the pill cycle. Also, women should
be reminded that taking antibiotics could
interfere with the effectiveness of the pill.
Other measures should be taken to prevent an
unwanted pregnancy.
In my next article, I will
discuss the effects of menopause and other
conditions and their relationship to women’s
oral health.
Women's
Oral Health (Part II) By
Dr. Dennis R. Pietrini
Last month, I began the
discussion of the unique oral health needs and
problems for women at the various stages of life.
In this article, I want to relate some of the
concerns for women during and after menopause.
They may experience several changes in their
mouths, including: burning sensations in the oral
tissue, dryness and alteration in taste,
especially relating to foods that are sour, salty
or peppery. Women also have a higher incidence of
certain oral conditions such as Sjogren’s
Syndrome, yeast infections and lichen planus.
These conditions must be monitored to make sure
they do not undergo cancerous changes.
Of the nearly
one-and-a-half million bone fractures suffered by
adult, Americans each year, most affect women.
Hormonal changes can result in the loss of bone
density leading to osteoporosis and periodontal
(gum) disease—several studies are being
conducted to determine if there is any connection
between the two. Besides maintaining good oral
health, with daily homecare and regular dental
visits, good nutrition and taking supplements such
as folic acid, calcium and vitamins B and C may be
helpful. Hormone
Replacement Therapy (HRT) can help to reduce bone
loss. It is advisable to discuss the risks versus
benefits of HRT with your physician.
Due to factors like
hormonal changes, smoking and poor oral hygiene,
nearly half of the women over the age of 55 have
periodontitis (gum disease). The bacteria found in
the plaque attached to the teeth and the
surrounding gum tissue produce toxins that are
released into the bloodstream, which causes an
immune response in the body. In healthy women,
their immune system can overcome this attack;
however, in some women this increase of bacteria
in the blood can lead to a greater risk of heart
disease, stroke and more severe cases of diabetes.
Most of us are aware of the
many risk factors for heart disease, including
family history, poor nutrition, lack of exercise,
obesity, high blood pressure and cholesterol and
smoking. In recent years scientists have
discovered the connection between poor oral health
and heart disease suggesting that these patients
have twice the risk of a fatal heart attack.
Proper, regular monitoring by your physician and
dentist can help reduce a women’s risk of oral
health problems.
Mandatory
Back-To-School Dental Exams By
Dr. Dennis R. Pietrini
A
new law was passed in Illinois requiring parents
to show proof that their children have had a
dental exam before they register for kindergarten,
2nd and 6th grades. The law
allows schools to withhold final report cards if a
child has not been examined. While the law exempts
students who are religiously opposed to or cannot
afford dental treatment, it may end up excluding
the children who most need the treatment. Some
school administrators are concerned that this
well-intended law may be difficult to enforce.
The
Academy of General Dentistry and the American
Academy of Pediatric Dentistry recommend that
children have their first dental check-up no later
than the age of one and every six months
thereafter. This may not be practical for many
families; however, I believe that children should
be examined by at least the age of 2 ½.
The sad reality is that I frequently see children
ages 3-4 that have a mouthful of cavities. Nearly
half of the children in the United States have
dental decay by the time they start second grade.
The
legislation was written to coincide with the three
grade levels when preventive care is most
beneficial. By the time a child starts
kindergarten, they should learn about good oral
hygiene and eating a proper diet. The first adult
molars usually erupt by the time a child is in
second grade and the second molars by sixth grade.
Shortly after eruption, these adult molars should
be evaluated for restoration with dental sealants
by:
·
Visual inspection
·
X-ray examination
·
Scanning with a diagnostic laser
If
no evidence of dental decay is noticed, the teeth
(including all grooves and pits) should be
thoroughly cleaned, etched with a weak-acid
solution, rinsed and sealed. The sealant is a
tasteless, odorless plastic-type material that is
painted into the grooves and pits. A
high-intensity light is used to harden the
sealant. This is a fast and painless procedure for
the child. When the other adult teeth, referred to
as the premolars, erupt they also should be
evaluated for sealant therapy.
All I
Want For Christmas Is My Two Front Teeth By
Dr. Dennis R. Pietrini
As
a child growing up in post-World War II, America,
one of my earliest memories of Christmas was
listening to a song by Spike Jones and His City
Slickers—All I Want For Christmas Is My Two
Front Teeth (1948). Since starting my private
dental practice in 1972, I have treated as many as
five generations of patients in some families.
Recently, a darling seven-year-old girl presented
with her two front teeth missing. It seems as
though it was just yesterday that her mother was a
little girl with her front teeth missing.
When
I examined the seven-year-old, I found that she
had several cavities in her primary (baby) molars.
Due to the extent of the decay, I had to give her
a local anesthetic to perform the required
treatment. As the numb feeling began to take
effect, she quipped, “My tongue feels wavy like
a camel’s back.” She was very co-operative and
allowed me to complete the treatment necessary to
retain these teeth. For future function and
development a child should not loose the primary
teeth prematurely.
In
the last sixty years, there has been a dramatic
reduction in the number of decayed, missing and
filled (DMF) teeth in American children. The main
reason for this improvement has been the addition
of fluoride to drinking water, toothpaste and
mouth rinses as well as fluoride applications in
dental offices. In the October 24, 2005 issue of Time
magazine, an article discussed the ongoing debate
about fluoridating communal drinking water.
In
the past, I have avoided editorializing in this
column; however, I feel in this case I must
express my opinion. As stated in the Time article,
the Center for Disease Control (CDC) considers the
addition of fluoride in the drinking water to be
“one of the 10 great public-health achievements
of the 20th century.” To quote the
CDC’s director of oral health, William Maas,
“A community can save about $38 in
dental-treatment costs for every $1 invested in
fluoridation.” Nearly every major medical/dental
organization or institution endorses the use of
fluoride, yet there are several antifluoridation
groups voicing their opposition. In a future
article, I will discuss why I believe that these
groups are very misguided.
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