Article in the Chicago Tribune regarding dental implants: Say Goodbye to Yesterday’s Dental Implants
A recent article published by the American Academy of Periodontology stressed the importance of getting your gums checked regularly.
I am very grateful for my committed staff and was pleased to read the following patient review on Wellness.com:
“Their staff is the most friendly, welcoming staff I’ve ever dealt with. They are so warm and professional, and make the whole experience that much better. I never have to worry about them overbooking appointments. They definitely believe in quality over quantity here and it is much appreciated. They were by far one of the best I’ve ever seen in their field. It was obvious that they’ve been exceeding their clients’ expectations for many years. They explained all the risks and benefits of my treatment options. Everything was explained in detail, all my questions were answered, and I felt a lot better about choosing a treatment plan. Not only do my appointments never get canceled last minute, they take time out of their day to send me a reminder so I don’t forget. They are extremely reliable.”
Read our reviews on Wellness.com.
Recently I wrote about a study that established a connection between Alzheimer’s Disease and periodontal disease. The key finding in the study was the discovery of Porphyromonas gingivalis in the brains of Alzheimer’s patients.
I wanted to give this bacterium a little more attention and reveal its association to a harmful disease: rheumatoid arthritis.
P. gingivalis is one of many bacteria in the mouth, but when it comes to gum disease it is the prime suspect. It is known as one of the keystone bacterium which leads to periodontal disease. It has several qualities and tools which aid in destroying the supporting structures of teeth.
One of those tools is an enzyme called collagenase that injures the fibers that attach the teeth to the bone.
P. gingivalis is also very stubborn to antibiotics, due to several features of the bacterium. Specialized enzymes called gingipains help create a food supply engine for the bacteria, and cleverly impair the immune system’s attempts to eradicate it.
In its attempt to invade the structures of the mouth it also clears the way for other bacteria. It does this partly by changing the chemical stability of the oral cavity, which makes the environment more hospitable to infection by other damaging microbes. In this way, P. gingivalis works together with other bacteria known to cause periodontal disease and damage to the supporting structures of teeth.
Connection to Rheumatoid Arthritis
Rheumatoid arthritis (RA) is an autoimmune disease where the immune system attacks the body by creating systemic inflammation. It is commonly known to affect flexible joints, but also affects tissues and organs. It can also produce inflammation in the lungs, the membrane around the heart, and the whites of the eyes.
P. gingivalis is linked to Rheumatoid arthritis through an enzyme contained in the bacterium: PAD. One of the things PAD does is convert an amino acid called arginine into another amino acid called citrulline.
RA patients tend to have significant levels of antibodies to citrulline, which reflects a presence of this amino acid, and an immune response to it. Patients with RA tend to also have periodontal disease.
Interestingly, citrulline is also found among the destroyed cells found in Alzheimer’s disease, and in smokers.
Bacteria Must Be Removed by Periodontal Intervention
Gum disease, simplified, is a disease of bacterial infection and inflammation, both which attack and damage the supporting structures of the teeth.
It is becoming more established, year after year, that the damaging effects of periodontal disease are not limited to tooth loss. Exact cause and effect mechanisms are unclear, but the associations between gum disease and systemic diseases such as diabetes, heart disease, Alzheimer’s disease, and rheumatoid arthritis are clear.
Treatment of periodontal disease is not only critical for keeping and maintaining healthy teeth, it is also an important contributor towards overall systemic health. Regular periodontal cleanings to remove harmful bacteria such as P. gingivalis are also crucial to both oral and systemic health.
Researchers have found a bacterium that is known to cause gum disease in the brains of patients who were diagnosed with Alzheimer’s disease.* This reinforces a well known oral health-systemic health connection, and also that maintaining oral hygiene may play a direct role in preventing serious diseases.
Although the exact cause and effect mechanism is unknown, what was shown in the study is that this bacterium, Porphyromonas gingivalis, was present only in the brains of Alzheimer’s patients, and was not present in the brains of those who did not have the disease.
“When you get down to it, the foundation of my practice is addressing bacterial infections of the mouth. Where we find bacteria, we find inflammation, and structural damage to the teeth. This particular study is interesting, because this specific bacteria found its way into the brain, probably through the bloodstream, only in the Alzheimer’s patients. It is uniquely direct evidence that the consequences of gum disease expand well beyond the gums and teeth. It makes a statement that ongoing oral hygiene, in the office of a periodontist, and in the home of patients, is very important.”
* This study was published in The Journal of Alzheimers Disease
Saliva is a part of our physical experience that we tend not to think much about, although we are constantly aware of it. Medically speaking, despite our indifference to it, saliva is a very important part of our physiology and plays a critical role in oral health.
What Is Saliva?
Saliva is produced in the mouth, by three major salivary glands: the parotid, submandibular, and sublingual. In addition, there are several smaller glands that also produce about 10% of the total saliva in the mouth.
On a daily basis, a healthy person produces from 500 milliliters to 1.5 liters of saliva, which is roughly two to six cups. Salivary production is highest in the afternoon and slows down while sleeping at night.
Saliva production is increased with chewing.
Saliva is composed primarily of water. In addition it is composed of many helpful substances that assist the body in breaking down food, protecting the teeth, and performing other important functions.
How Does Saliva Contribute to Oral Health?
Saliva plays an important role in maintaining healthy teeth and gums and performs several functions. Among other things, saliva:
- Washes away the bacteria that causes cavities, sugars that work with bacteria to create cavities, and the food that provides metabolic support for these germs.
- Contains elements that destroy bacteria.
- Helps digest food particles that support bacteria and cavities.
- Contains protein antibodies that can destroy oral bacteria.
- Calcium and phosphate in the saliva strengthen the enamel of the teeth (remineralization).
Dry Mouth and Its Implications
The medical term for dry mouth is xerostomia. A lot of things start to go wrong when the glands in the mouth do not produce enough saliva.
First of all, a dry mouth is uncomfortable. Without enzymes to break down and mucin to lubricate food, eating, drinking, and swallowing becomes difficult and sometimes painful.
Germs thrive in this dry, pasty environment. The food particles that serve as fuel for bacteria are not washed away and the teeth are not remineralized by the calcium and phosphate present with normal saliva production. As a result, cavities tend to become rampant, and periodontal disease progresses.
Periodontal disease has been found to have a negative systemic effect on general health and has been connected to serious diseases such as diabetes, heart disease, stroke, and other conditions.
So, dry mouth is more than just an irritation. It is a condition that can become a health issue if not addressed.
What Causes Xerostomia?
Xerostomia is more prevalent in seniors. However, aging alone is rarely the cause. Dry mouth is a common side effect to many medications, and people tend to start taking more medicines as they get older, in order to treat the common conditions that come with age.
Over 500 medicines, 60% of the most commonly prescribed drugs, are known to produce dry mouth as a side effect.
Patients who are undergoing chemotherapy or radiation treatment for cancer, especially head and neck, commonly present with xerostomia. When all goes well, patients with head and neck cancer can expect to live for many years. Commonly dry mouth can persist long after treatment is complete, along with the complications that result.
Not drinking enough water and becoming dehydrated causes dry mouth. Anxiety can also contribute to reduced salivary output. Sleeping with an open mouth is another common cause.
More rarely, autoimmune damage to the salivary glands can occur, in diseases such as Sjogren’s Syndrome.*
Bad Habits Contribute
Bad habits such as the abuse of alcohol, smokeless tobacco, cigarettes, marijuana, and other drugs can cause damage to the salivary glands and cause xerosomia, as well as cancer.
Primarily, Treatment Involves Rigorous Oral Hygiene and Prevention
If you are undergoing cancer treatment or have the symptoms of xerostomia for other reasons, I suggest you make an appointment with your periodontist, along with your primary care physician and ear, nose, and throat specialist.
A visit to the periodontist is important to address the high levels of plaque, calculus, cavities, and bone loss that are a common result of long term dry mouth. It’s important to start preventative treatment, if possible, and to address any periodontal disease with appropriate periodontal procedures, as quickly as possible.
Fluoride treatment is effective in adding protection to the enamel of teeth through remineralization and is especially indicated in patients who suffer from dry mouth, regardless of the cause.
A periodontist can also discuss your situation with you and give you specific instructions on oral hygiene.
For patients undergoing cancer treatment, it is important to establish good oral hygiene habits which should include routine exams and cleanings, even after completing cancer treatment. When you have xerostomia, meticulous oral care is critical.
Other Treatment Options
In addition to periodontal procedures and proper hygiene, there are other treatments that can help address dry mouth symptoms.
Saliva substitutes, topical agents, saliva stimulating lozenges, and sugarless gum can provide transient relief of xerostomia. There are over the counter oral moisturizers that can provide relief, such as Optimoist, Biotene, and Oral Balance.
For cancer patients, there are other options. Pilocarpine is a stimulant that is known to cause salivary glands to produce more saliva. Please contact your ear, nose, and throat specialist for more information on pilocarpine.
Of course, making sure you drink enough water is important.
If you have any questions regarding xerostomia or any other oral health issues, please contact our office.
*The causes of xerostomia are numerous, and this is not a complete list of potential causes.
At the turn of the last century, most Americans could expect to lose their teeth by middle age. That situation began to change with the discovery of the properties of fluoride…
– Oral Health in America: A Report of the Surgeon General
In 1945, responding to research that fluoride seemed to prevent tooth decay, the city government of Grand Rapids, Michigan took a vote and decided to become the first municipality in the world to manually introduce fluoride into the community water supply. They also commenced a 15 year study to determine whether this change would affect cavity rates among 30,000 children. After only 11 years, cavity rates among children born after the change dropped 60%.
Since that time the majority of communities have followed suit and dental cavities are no longer considered a public health problem.
The issue of water fluoridation has become a controversy (in Naples as well), with many claims that fluoride is in fact a health hazard, causes cancer and other diseases, and is a violation of individual rights.
In this article I am going to avoid the controversy (there’s plenty to be found with a Google search) and give a little background on what fluoride is, how it protects against cavities, and give some common sense advice on choices regarding fluoride.
What Is Fluoride?
A chemistry teacher would explain that fluoride is a negative ion (an anion) of fluorine, which is an element you can find on the Periodic Table (F). The term fluoride is also a general term to describe a compound that contains fluoride. Calcium fluoride and sodium fluoride are both examples of fluorides.
Fluoride exists commonly in nature, mostly in the Earth’s crust. Consequently fluoride exists naturally in both seawater, fresh water, and certain foods. In some areas of the country (parts of Colorado, for example) fluoride levels are much higher than in places like Southwest Florida.
Fluoride Slows Down Tooth Decay
Tooth enamel is made up mostly of hydroxyapatite crystals and is the hardest substance in the body. A cavity begins with a bacterial infection, specifically of two common bacteria, in plaque. When these bacteria combine with the carbohydrates in food debris, it produces an acid which can dissolve, or demineralize, the enamel.
This process takes time.
The body, through minerals such as calcium and phosphate, ingested in food and presented in the saliva, has the ability to naturally rebuild lost enamel. However, in many cases and for different reasons, natural processes are unable to stop decay.
The introduction of fluoride into the saliva accelerates and improves upon this natural process of remineralization. Exposure to fluoride, in a dentist’s office, through the water supply, in toothpastes, varnishes and other means, introduces fluoride ions into the saliva. These ions combine with dissolving hydroxyapatite to form a harder and more acid resistant veneer on the teeth.
This is why the dental community is overwhelmingly in support of fluoridation. It gives teeth more protection from the acid that leads to cavities.
Should You Drink Fluoridated Water?
My recommendation is that you not worry about fluoride in tap water. Although I don’t drink gallons every day, I do consume tap water. However, this is a personal choice. If you have concerns, then don’t drink it. This will keep you from ingesting fluoride into the stomach and into your body.
Should You Avoid Fluoride Altogether?
I do not recommend avoiding fluoride altogether. For the reasons explained, fluoride gives your teeth additional protection from demineralization and decay. Fluoridated toothpaste, used twice a day, gives your teeth significant additional protection against demineralization, and gives the body a leg up on protecting teeth. Avoiding fluoride toothpaste deprives you of the benefits that come with stronger tooth enamel, including the potential to keep your natural teeth for a lifetime. Used correctly, fluoride toothpaste is not swallowed and is a sensible middle ground between ingesting fluoridated water systemically and avoiding fluoride altogether.
I also recommend using fluoridated mouth rinses, which are also not ingested, but afford additional protection to the teeth, particularly in hard to reach areas such as at dental crown margins and between the teeth.
The Bigger Picture
As seen by the very first use of fluoride in a public water supply, the protective benefits of fluoride for our teeth are without reasonable dispute. However regular dental checkups and cleanings are also important for optimal oral health and for detecting and treating dental caries which can occur even with the use of fluoride. So make sure to practice good oral hygiene habits and see your oral health care provider regularly.