Dental Conditions

Root Canals
Root canal therapy, or endodontic therapy, is needed when the pulp or nerve of the tooth becomes infected or inflamed. The pulp of the tooth is within the root, which is a hollow structure. All the nerves, blood vessels and connective tissue that keeps the tooth alive is housed within the pulp and if it becomes infected, it needs to be replaced with material called gutta percha.

The pulp of the tooth can be affected by various things. Commonly, tooth decay allows bacteria into the soft inner tissue and causes infection. Other trauma to teeth like breaks or dental work like multiple fillings can wear down teeth and result in root canal therapy. Once in, the infection and inflammation often spreads, becomes very painful, and can threaten the life of the tooth. Other than extraction, root canal therapy is the only option to fix this problem.

General pain in the infected area is what brings most patients to the dentist. Prolonged sensitivity to heat and cold, discoloration, and discomfort in surround gum are also signs that patients can look for if they suspect they need root canal therapy. Dentists can easily find the infected tooth by using x-rays, which also give a good indication of the severity of the problem and what kind of work may be needed.

If a root canal is needed, the dental care professional will numb the tooth to remove the infected pulp within the root. Then the area is cleaned and filled to seal off the space from future infections. Often a crown or other application is placed over the tooth so that it will be able to regain its former functionality. The tooth is not “dead” at this point, but numb to senses like hot and cold. The tooth can still function in daily activities like eating, and does feel the pressure sensations that come along with it.

Most dentists can perform routine root canals, but your dentist may refer cases to a specialist called an endodontist who is more adept in edododntic procedures. Endodontists only focus on this type of work and are more experience in diagnosing difficult cases and performing complex surgeries.

Sometimes patients weigh the option of extraction of a tooth versus a root canal. Bridges and implants can be put in to replace the extracted tooth that is damaged. However, it is recommended that patients attempt to keep their natural teeth as much as possible in order to maintain their lifestyle. Implants and bridges are no replacement for natural teeth. They are more delicate than natural teeth, which may affect the foods a patient eats in the future and throw off their nutritional diet. If done properly, root canals are the most cost-effective way to deal with damaged nerves and maintain the naturalness of your mouth.

Postoperative Instructions
After a root canal, patients may experience anything from mild discomfort to pain in the surrounding bone area of the procedure. This can last up to 72 hours after the surgery, but can be dealt with in simple ways.

Chewing around the infected tooth should be avoided for several days. To combat any throbbing sensations, keep your head elevated as much as possible, even when lying down. Swelling of the gum area can be treated with a warm salt water rinse to keep the area clean. Outward swelling of the face can be minimized with an ice pack. Any antibiotics prescribed, should be taken and finished to avoid infection of the area, and pain medication can also be prescribed for individuals needing extra pain relief.

Cancer
Oral cancer is cancer of the mouth and the part of the throat called the pharynx. Approximately 34,000 people in America are diagnosed with oral cancer in a year and early detection is the key when battling this cancer.

Oral cancer is closely related to the use of tobacco, alcohol or combined usage of both substances, with 75 percent of cases being linked to the substances. Thus avoiding all tobacco products and drinking alcohol in moderation can lower your risk of oral cancer. Sunlight exposure to the lips is also linked to oral cancer of the lip and can be combated by using lip balms with sunscreen. That Nationally Cancer Institute also suggests a healthy diet with five or more servings of fruits and vegetables a day helps decrease the general risk of developing cancer.

With early detection, treatment and recovery statistics rise. Your dental provider can do an oral cancer exam during routine check-ups to look for signs of oral cancer. Common symptoms of oral cancer to make your dentist aware about include:

• A lump that increases in size
• A sore that lasts longer than two weeks
• Persistent bleeding in the throat and mouth
• Constant hoarseness
• Numbness in the mouth
• Changes in soft tissue appearance

Oral Cancer Screening
Most dental care providers perform routine oral cancer examinations during check-ups. This usually involves a dentist checking lumps and irregular tissue in the mouth, head, and neck areas. If your dentist is concerned about an area, they will take a biopsy of the area. Oral cancer is most commonly found on the tongue, floor of the mouth, and soft palate. It can also manifest in the lips, cheeks, and gums.

Oral cancer is the sixth most common cancer, and early detection is key to recovery. Therefore, self-examinations are recommended on top of exams done by your dentist. Smokers, spit tobacco users, individuals who spend a lot of time in the sun, and heavy alcohol drinks have a heightened risk at developing oral cancer and should be particularly aware of checking for irregularities of the mouth.

Common “red flags” to watch for and report to your dental care provider include:

• A lump that increases in size
• A sore that lasts longer than two weeks
• Persistent bleeding in the throat and mouth
• Constant hoarseness
• Numbness in the mouth
• Changes in soft tissue appearance

To do self-examinations for oral cancer, you will check your face and neck, lips, and the inside of your mouth.

Any lumps or swellings that you can visibly see in a mirror should be noted. Feel around your neck area for any lumps or tender areas that may be present. Also size and color changes in growths like moles could be warning signs.

Check the inside of your lips and feel the flesh with your thumb and forefinger to check for lumps, strange texture or color changes, and sores.

Check the inside of your cheeks, roof and floor of the mouth, tongue and gums for lumps, unusual sores, or red, white or dark patches anywhere inside.

If you have any suspicious symptoms of oral cancer, let your dentist know immediately. The most common treatment if cancer is confirmed will be to remove the infected area, and possibly involve radiation therapy to follow-up.

Oral Cancer Screening for Health Care Professionals

Early detection of oral cancer is essential in treatment and recovery for patients. Out of the estimated 34,000 Americans who are diagnosed with oral and pharyngeal cancer, only 50 percent will survive five years or more. These statistics can be greatly improved with early detection and oral cancer screenings are highly effective because warning signs of oral cancer can often be seen or felt easily.

Symptoms that may be signs of oral cancer include:

• White or red lesions that do not heal themselves in two weeks
• Lumps that develop in the oral soft tissue
• Soreness or the feeling that something is caught in the throat
• Ear pain
• Numbness in the mouth area
• Difficulty chewing, swallowing, moving the jaw or tongue
• Swelling of the jaw

There are several risk factors that heighten the presence of oral cancer in individuals. Tobacco use and excessive alcohol intake have been linked to oral cancer. A combination of the two substances is known to have an even greater risk of developing the disease. Exposure to sunlight without sunscreen can heighten the chance of lip cancer. Age can also be a factor, as older individuals have had longer exposure to the aforementioned risk factors. Oral cancer also develops twice as often in men than in women.

Each dental care professional should educate their patients of oral cancer risks during routine check-ups. Professionals should do an examination, track a history of alcohol and tobacco use, educate patients of the link between the controlled substances and oral cancer, and follow-up on any signs that might be oral cancer.

A typical oral cancer exam is a quick and easy way to screen for any signs of the disease. The following is a standardized exam created by the World Health Organization.

The examination is conducted with the patient seated. Any intraoral prostheses are removed before starting. The extraoral and perioral tissues are examined first, followed by the intraoral tissues.

I. The Extraoral Examination

• FACE: The extraoral assessment includes inspection of the face, head, and neck. The face, ears, and neck are observed, noting any asymmetry or changes on the skin such as crusts, fissuring, growths, and/or color change. The regional lymph node areas are bilaterally palpated to detect any enlarged nodes. If enlargement is detected, the examiner should determine the mobility and consistency of the nodes. A recommended order of examination includes the preauricular, submandibular, anterior cervical, posterior auricular, and posterior cervical regions.

II. Perioral and Intraoral Soft Tissue Examination

The perioral and intraoral examination procedure follows a seven-step systematic assessment of the lips; labial mucosa and sulcus; commissures, buccal mucosa, and sulcus; gingiva and alveolar ridge; tongue; floor of the mouth; and hard and soft palate.

• LIPS: Begin examination by observing the lips with the patient's mouth both closed and open. Note the color, texture and any surface abnormalities of the upper and lower vermilion borders.

• LABIAL MUCOSA: With the patient's mouth partially open, visually examine the labial mucosa and sulcus of the maxillary vestibule and frenum and the mandibular vestibule. Observe the color, texture, and any swelling or other abnormalities of the vestibular mucosa and gingiva.

• BUCCAL MUCOSA: Retract the buccal mucosa. Examine first the right then the left buccal mucosa extending from the labial commissure and back to the anterior tonsillar pillar. Note any change in pigmentation, color, texture, mobility, and other abnormalities of the mucosa, making sure that the commissures are examined carefully and are not covered by the retractors during the retraction of the cheek.

• GINGIVA: First, examine the buccal and labial aspects of the gingiva and alveolar ridges (processes) by starting with the right maxillary posterior gingiva and alveolar ridge and then move around the arch to the left posterior area. Drop to the left mandibular posterior gingiva and alveolar ridge and move around the arch to the right posterior area.

Second, examine the palatal and lingual aspects as had been done on the facial side, from right to left on the palatal (maxilla) and left to right on the lingual (mandible).

• TONGUE: With the patient's tongue at rest, and mouth partially open, inspect the dorsum of the tongue for any swelling, ulceration, coating, or variation in size, color, or texture. Also note any change in the pattern of the papillae covering the surface of the tongue and examine the tip of the tongue. The patient should then protrude the tongue, and the examiner should note any abnormality of mobility or positioning.

With the aid of mouth mirrors, inspect the right and left lateral margins of the tongue.

Grasping the tip of the tongue with a piece of gauze will assist full protrusion and will aid examination of the more posterior aspects of the tongue's lateral borders

Then examine the ventral surface. Palpate the tongue to detect growths.

• FLOOR: With the tongue still elevated, inspect the floor of the mouth for changes in color, texture, swellings, or other surface abnormalities.

• PALATE: With the mouth wide open and the patient's head tilted back, gently depress the base of the tongue with a mouth mirror. First inspect the hard and then the soft palate.

Examine all soft palate and oropharyngeal tissues.

Bimanually palpate the floor of the mouth for any abnormalities. All mucosal or facial tissues that seem to be abnormal should be palpated.

Smoking
Smoking is the most detrimental activity that afflicts oral health. It is the leading cause of oral cancer, as tobacco use accounts for nearly 75 percent of all oral cancer cases. Additionally, the high temperatures can cause inflammation within the mouth, tar deposits and stains mar teeth, causes bone loss in the mouth, and it is a major cause of gum disease.

The only way to combat the effects of smoking is to quit. Quitting smoking has been known to greatly decrease the risk of developing oral cancer, although it takes a 10 year hiatus from the habit for smokers to decrease their risk level to match that of non-smokers.

Dip and Chew
There is a common misconception that spit tobaccos like dip and chew are not addictive and are a safe alternative to cigarettes. In fact, spit tobaccos put more nicotine into the body than smoking and contain the same carcinogens as their tobacco counterparts. This highly addictive habit can lead to cancer of the mouth and throat, which are fast-spreading diseases that often need major surgery to combat. Many spit tobacco users need to remove sections of their mouth, jaw, or tongue to rid their body of the cancer.

Early detection of oral and throat cancers are essential for treatment and recovery. Frequent tobacco users should watch for the following warning signs and alert their dental care provider of them as soon as possible:

• A lump that increases in size
• A sore that lasts longer than two weeks
• Persistent bleeding in the throat and mouth
• Constant hoarseness
• Numbness in the mouth
• Changes in soft tissue appearance

Quitting Spit Tobacco

Dental Checkup
Preventive dental checkups are important even if you feel that your oral maintenance is good. Dental care professionals can catch early signs of many dental diseases for treatment, many of which are painful and costly if left unattended to for extended periods of time. Dentists can also do screenings for oral cancers and other diseases that have specific symptoms in the mouth and jaw area—these signs can be an indicator of other serious problems in the body. It is always good to keep your dental care professional up-to-date on your general oral health status. You dentist can take many preventive steps to save you time and money in the future.

Medications
There are numerous medications in the field today that can negatively affect your oral health at the same time they aid you in treating other health issues. Patients should be aware of how medications could be detrimental to oral health.

There are over 400 medications that list dry mouth (xerostomia) as a side effect. Patients who are affected by this unwanted system are at heightened risk for gum disease and tooth decay because saliva flow typically keeps bacteria and plaque from accumulating within the mouth.

Likewise, calcium channel blockers commonly used in to combat high blood pressure can result in gingival enlargement, when the gums swell so much that they grow over the teeth. This condition can cause severe infection and should be monitored by patients and dentists so that it can be caught in early stages for easier treatment.

Medications that are sweetened can leave residue on teeth that make them more prone to decay, especially if take over long periods of time. Cough drops, antacid tablets, and liquid medications—especially ones meant for children—are all examples of sugary medicine that could heighten decay

Less serious side effects from common medicine include teeth discoloration from the acne medication tetracycline, various medicines which can produce lesions or ulcers in a patient’s mouth, and oral sores or inflammation from popular oral contraceptives and blood pressure medications.

Letting your dental care professional know about which medications you are on can allow them to spot negative side effects early and begin treatment to ensure good oral health.

Chemotherapy
Chemotherapy drugs can harm normal cells, including mouth cells, while they are combating cancer cells. Oral problems like difficulty eating, talking, and swallowing can occur in patients undergoing treatment. Patients are also more likely to develop infections and have other uncomfortable side effects during chemotherapy.

Pain in the mouth and gums, dry mouth, peeling or swelling of the tongue, and change in taste are all common side effects of chemotherapy. Your dentist can assist in any serious mouth problems that can occur and ease discomfort of the situation. It is recommended to visit your dentist two weeks before you begin chemotherapy and talk about various options to keep your quality of life high while undergoing treatment.

The easiest preventive methods include keeping your mouth moist and clean. Drinking lots of water and using sugarless gum and sugar-free candies to stimulate saliva production can help keep bacteria from accumulating in the mouth. Proper brushing and flossing also effectively combat oral problems, and it is recommended that patients rinse their mouth several times a day with baking soda rinses. Choosing foods that are easy to chew and swallow can assist with discomfort, and eating in small bites. Soften foods with sauces, broth, gravies or other liquids if swallowing becomes difficult.

If pain increases or additional oral problems arise, contact your dentist.

Sores and Bumps
Canker sores and cold sores are painful conditions which affect the mouth. While they are often confused, they are not the same affliction.

Canker sores are limited to the inside of the mouth but can appear on the gums, cheek, tongue, and floor of the mouth. They are characterized as small red circular swellings which become white and inflamed when ruptured. The best way to treat a canker sore is to avoid further irritation of the area, which will be painful, and applying ointments with a topical anesthetic until the sore heals itself. Some spicy or rough textured foods may also irritate the area. Sores typically last 8-10 days. Canker sores are painful, but not contagious.

Cold sores are found outside of the mouth, mainly on the lips but can appear on the chin or even outside of the cheeks and nostrils. This blister takes about one to two weeks to heal, a process where it will eventually burst and crust over. These are caused by the herpes simplex virus and are contagious. Cold sores should avoid kissing or contact with the blisters, and even touching them with your hands can spread the virus to someone else. There are over the counter medicines and antivirals that can expedite the healing process, but they typically go away on their own.

Diabetes
The teeth and gums are affected with those with diabetes problems, as high blood sugar over an extended period of time can affect many other body parts. Mouth infections and gum disease can occur because the high blood sugar causes plaque and bacteria to multiply even more quickly than it does in those who do not have high glucose problems. If left untreated, these oral problems can eventually cause damage to the gum and bones that hold the teeth in place, and they or the teeth may need to be removed. Those with noninsulin-dependent diabetes mellitus (NIDDM) increase their risk of developing periodontitis (gum disease) by 20 times. Smokers with this disease have an additional risk as well, and it is recommended that smoking is avoided altogether.

Studies done on the Pima Indians of Arizona, an ethnic group who have the highest rates of NIDDM in the world, have led scientists to believe that there is a direct link between NIDDM and gum disease. Through a series of tests, they found that uncontrolled NIDDM definitely increased the susceptibility in subjects to infection. They also found that, in short term tests, deep cleaning to remove hardened plaque that leads to gum disease along with regular medications resulted in improvement in the average glucose levels. While more wide scale tests need to be done to assess what exactly the direct link is between oral health and NIDDM, dental care providers stress the necessity of heightened oral care and careful watch for gum disease.

If experiencing red, swollen gums; bleeding gums; loss of gum around the teeth; loose or sensitive teeth; or change in bite, you are advised to contact your dentist as soon as possible for treatment. Untreated gum disease often leads to tooth loss.

Preventive measures against gum disease include regular regiments of brushing and flossing, controlling your blood glucose, and visiting your dentist regularly to monitor gum disease. Smoking should also be avoided.

HIV-related Oral Problems
People with HIV are susceptible to multiple oral problems because of their compromised immune system. Most of these problems are painful, and often make it hard to chew and swallow. This can be especially problematic as people with HIV need extra nutrients so that their bodies can create enough energy to deal with the HIV virus. Fortunately, most HIV-related oral problems are treatable and a doctor or dentist can give you treatment options to improve quality of life.

Red canker sores or cold sores can be a painful and common occurance. Canker sores are limited to the inside of the mouth but can appear on the gums, cheek, tongue, and floor of the mouth. They are characterized as small red circular swellings which become white and inflamed when ruptured. The best way to treat a canker sore is to avoid further irritation of the area, which will be painful, and applying ointments with a topical anesthetic until the sore heals itself. Some spicy or rough textured foods may also irritate the area. Sores typically last 8-10 days. Canker sores are painful, but not contagious.

Cold sores are found outside of the mouth, mainly on the lips but can appear on the chin or even outside of the cheeks and nostrils. This blister takes about one to two weeks to heal, a process where it will eventually burst and crust over. These are caused by the herpes simplex virus and are contagious. Cold sores should avoid kissing or contact with the blisters, and even touching them with your hands can spread the virus to someone else. There are over the counter medicines and antivirals that can expedite the healing process, but they typically go away on their own.

Hairy Leukoplakia is caused by the Epstein-Barr virus and can appear as a white, hairy growth in the mouth. The white patches appear on the side of the tongue or on the insides of the cheek and lips. Mild cases do not usually require treatment, but severe cases can be prescribed a medication to reduce symptoms and ease discomfort.

Thrush is a fungal infection that appears as creamy or bumpy patches within the mouth—comparable to cottage cheese. A burning feeling can accompany this disease, and white or yellow patches will appear within the mouth. When wiped away, these patches can leave bleeding and redness of the areas underneath. Most prescription antifungal lozenges and mouthwashes can deal with thrush. Severe cases need to be dealt with by antifungal pills that can be prescribed by your doctor or dentist.

Warts can appear as white, grey, or pinking bumps similar to cauliflower. Those can appear throughout the mouth, but are not usually painful. A doctor can surgically remove warts of freeze them off with a “cryosurgery” when they appear on the inside of the mouth. Warts on the lips can be given a prescription cream as treatment. However, with both treatments, there is a chance that the warts can return again.

Dry mouth occurs when there is decreased saliva production. On top of being uncomfortable, dry mouth can heighten the risk of tooth decay and gum disease because saliva naturally helps to rid the mouth of accumulating bacteria. Dentists recommend drinking increased amounts of liquids, chewing sugarless gum, and sucking on sugarless candy to increase saliva production. Tobacco, alcohol, and salty foods should also be avoided, as they can contribute to dry mouth.

Dry Mouth
What do I need to know about dry mouth?

Everyone has a dry mouth once in a while--if they are nervous, upset or under stress.
But if you have a dry mouth all or most of the time, it can be uncomfortable and can lead to serious health problems.

Dry mouth...

• can cause difficulties in tasting, chewing, swallowing, and speaking

• can increase your chance of developing dental decay and other infections in the mouth

• can be a sign of certain diseases and conditions

• can be caused by certain medications or medical treatments

Dry mouth is not a normal part of aging. So if you think you have dry mouth, see your dentist or physician--there are things you can do to get relief.

What is dry mouth?
Dry mouth is the condition of not having enough saliva, or spit, to keep your mouth wet.

Symptoms include:

• a sticky, dry feeling in the mouth
• trouble chewing, swallowing, tasting, or speaking
• a burning feeling in the mouth
• a dry feeling in the throat
• cracked lips
• a dry, rough tongue
• mouth sores
• an infection in the mouth

Why is saliva so important?
Saliva does more than keep the mouth wet.

• It helps digest food
• It protects teeth from decay
• It prevents infection by controlling bacteria and fungi in the mouth
• It makes it possible for you to chew and swallow

Without enough saliva you can develop tooth decay or other infections in the mouth. You also might not get the nutrients you need if you cannot chew and swallow certain foods.

What causes dry mouth?
People get dry mouth when the glands in the mouth that make saliva are not working properly. Because of this, there might not be enough saliva to keep your mouth wet. There are several reasons why these glands (called salivary glands) might not work right.

• Side effects of some medicines. More than 400 medicines can cause the salivary glands to make less saliva. Medicines for high blood pressure and depression often cause dry mouth.

• Disease. Some diseases affect the salivary glands. Sjögren's Syndrome, HIV/AIDS, diabetes, and Parkinson's disease can all cause dry mouth.

• Radiation therapy. The salivary glands can be damaged if they are exposed to radiation during cancer treatment.

• Chemotherapy. Drugs used to treat cancer can make saliva thicker, causing the mouth to feel dry.

• Nerve damage. Injury to the head or neck can damage the nerves that tell salivary glands to make saliva.

What can be done about dry mouth?
Dry mouth treatment will depend on what is causing the problem. If you think you have dry mouth, see your dentist or physician. He or she can try to determine what is causing your dry mouth.

• If your dry mouth is caused by medicine, your physician might change your medicine or adjust the dosage.

• If your salivary glands are not working right but can still produce some saliva, your physician or dentist might give you a medicine that helps the glands work better.

• Your physician or dentist might suggest that you use artificial saliva to keep your mouth wet.
What can I do?

• Sip water or sugarless drinks often.

• Avoid drinks with caffeine, such as coffee, tea, and some sodas. Caffeine can dry out the mouth.

• Sip water or a sugarless drink during meals. This will make chewing and swallowing easier. It may also improve the taste of food.

• Chew sugarless gum or suck on sugarless hard candy to stimulate saliva flow; citrus, cinnamon or mint-flavored candies are good choices.

• Don't use tobacco or alcohol. They dry out the mouth.

• Be aware that spicy or salty foods may cause pain in a dry mouth.

• Use a humidifier at night.

Tips for keeping your teeth healthy
Remember, if you have dry mouth, you need to be extra careful to keep your teeth healthy. Make sure you:

• Gently brush your teeth at least twice a day.

• Floss your teeth every day.

• Use toothpaste with fluoride in it. Most toothpastes sold at grocery and drug stores have fluoride in them.

• Avoid sticky, sugary foods. If you do eat them, brush immediately afterwards.

• Visit your dentist for a check-up at least twice a year. Your dentist might give you a special fluoride solution that you can rinse with to help keep your teeth healthy.