Are You at Risk for Oral Cancer?

According to the National Cancer Institute, about 36,500 new cases of oral and throat cancer will be diagnosed this year and 7,880 people will die from the disease, often because it is diagnosed too late. Here is sobering statistic reported by the Oral Cancer Foundation: among those newly diagnosed individuals, only a little over half will still be alive in 5 years… and these disturbing statistics have not improved very much in decades despite many new advances in our ability to detect and diagnose and treat the disease. How can this be? Unfortunately, the people who are at greatest risk may be least likely to have regular dental and medical checkups, for a variety of reasons ranging from health insurance to lack of awareness.

How much do you know about your risk for this deadly and destructive disease?

Lifestyle factors are chief among the major risk factors for oral cancers, and includes long term exposure to sun, such as would occur among people who spend their careers or leisure time outdoors. Heavy alcohol use is another lifestyle choice that increases risk; and tobacco use, regardless of its form accounts for about 75% of the cancers of the mouth, throat and lips that are diagnosed at 50 and older. When heavy alcohol use is combined with tobacco, the risk of developing oral cancer is 15 times greater!

Speaking of age, most oral cancer has historically been discovered in people over age 60. The Center for Disease Control reports that it occurs more often in men than women, and black people seem to be at higher risk than other races… but no one is really immune. About 5% of oral cancers have no known cause; and new evidence has emerged that the Human Papilloma Virus (HPV-16), a common sexually transmitted disease present in about 40 million Americans is responsible for an increase in the number of oral cancers among young adults.

Early signs of oral cancer are very often painless and difficult to detect without a thorough head and neck examination by a dental or medical professional. As a result the people who are inclined to put off dental visits – often those who have lost their dental insurance and postpone checkups for financial reasons – are most vulnerable. Oral cancer is treatable, but the tissues of the mouth and neck have a rich blood supply and numerous lymph nodes that enable undiagnosed oral cancer to spread to other parts of the body very quickly. Improving the average 50% survival rate depends upon the location and early detection of suspicious lesions – before they can spread.

What to be concerned about:

• A sore in the mouth – especially a painless one – that does not heal within two weeks
• A lump or thickening in the cheek.
• A white or red patch on the gums, tongue, tonsil, lip, or lining or floor of the mouth.
• A sore throat or a feeling that something is caught in the throat.
• Difficulty chewing or swallowing.
• Difficulty moving the jaw or tongue.
• Numbness of the tongue or other area of the mouth.
• Swelling of the jaw that causes dentures to fit poorly or become uncomfortable.
• Chronic hoarseness.

The American Cancer Society recommends that doctors and dentists examine the mouth and throat as part of a routine cancer-related checkup… and you should do a self examination periodically too: look in your own mouth with a flashlight or have someone do it for you:

• · Remove dentures or partials
• · Look and feel inside the lips and the front of gums
• · Tilt head back to look at and feel the roof of your mouth
• · Pull the cheek and both lips out to see the inside surfaces as well as the back of the gums
• · Stick out your tongue as far as you can and look at all of its surfaces
  • Lift up your tongue to examine the floor of the mouth
    • · Feel for lumps or enlarged lymph nodes (glands) in both sides of the neck including under the lower jaw.

Many people have some harmless, abnormal lesions in their mouth that never become cancerous, but it is important to be aware of them and bring them to the attention of the dentist for observation and diagnosis. A thorough head and neck examination is always a routine part of your regular dental checkup visit; it takes only a minute but it could save your life.

The Truth about Dental X-ray Safety

Do you hate to have dental X-rays taken? Be honest… of course you do. Everyone does. But, if you are one of the many people who has refused checkup x-rays or told the hygienist that you “don’t need x-rays because nothing is bothering me”, then you should know that you are not doing yourself any favors. In fact, you could be potentially trading a short term inconvenience for a long term, costly problem.

It is certainly true that dental x-rays are a valuable tool when diagnosing the source of pain… but one of the most important reasons for taking periodic x-rays is to identify the many oral conditions have no symptoms at all in the early stages. Patients who refuse x-rays on a regular basis are doing themselves a significant disservice – and worse, they are not getting their money’s worth! Even though they pay for a complete exam, problems may be lurking which cannot be identified except with x-rays.

The concept is similar to that of a mammography, colonoscopy, tuberculosis screening or your annual physical: if a problem can be detected early enough, it is usually less expensive to treat and will likely have a better outcome.

What kinds of problems might be going undetected?

About 20% of the tooth enamel is not visible to the eye during a dental examination and cavities very often begin in these invisible areas: between the teeth where they touch, and where the toothbrush cannot reach. Do you floss thoroughly and regularly? If your answer is anything other than “yes”, then your risk of developing cavities between the teeth is even greater. Gum disease may be completely painless and bleeding unnoticeable even while bone is slowly dissolving away around the tooth. Finally, visually detecting abnormalities around extensive cosmetic or prosthetic restorations like crowns, bridges and implants can be quite challenging; yet the risk of developing a problem is greater around one of these “foreign objects” than for a natural tooth.

So, if oral disease is painless and can’t be seen, how can you be sure that there are no problems? Using x-ray images along with a thorough visual inspection, your dentist can see the entire tooth, the underlying bone, and the roots. Insidious problems like periodontal disease or a dying tooth nerve can be identified even before any discomfort is ever felt. It is important to realize that there are many different types of dental x-rays and they don’t all reveal the same information; your dentist may order one or more of these depending upon your specific needs. For example the x-ray that is taken to check for the presence of wisdom teeth may not reveal cavities very well- and an abscess will not appear on the type of x-ray typically taken to check for bone loss and cavities. You should feel free to ask questions about your dentist’s recommendations!

That said, the reason why some people refuse x-rays is because they have concerns about safety. The American Dental Association has established guidelines for x-ray frequency based on individual patient needs and the safe dosage criteria established by the National Council on Radiation Protection and Measurements which take into consideration the many sources of radiation most people are regularly exposed to, You might be surprised to learn that people are exposed to more radiation in the environment (for instance, while in an airplane or during an afternoon in the sun) than during exposure of dental x-rays; and most dental offices take far fewer x-rays that would be considered safe.

Public safety is not just controlled at federal level. All personnel who take X-rays in any New York dental office must be trained regarding safety and precautions, and the equipment used must be regularly certified by the State as safe for use. Improvements in the quality and speed of dental x-ray film have made it possible to create images with less exposure to radiation than ever before; and digital x-rays further reduce exposure – by up to 90%!

Special circumstances

Although the dentist will nearly always postpone x-rays on pregnant women, the American Dental Association and the American Academy of Family Physicians have stated that they are in fact, safe during pregnancy when necessary.

Some recent television reports and news stories have raised questions about whether dental x-rays can increase the risk for thyroid cancer. The lead shield that is placed over your chest and abdomen during dental x-ray exposure usually has a thyroid collar to protect the gland from any stray radiation; you should know that that according to the American Thyroid Association , routine exposure of dental x-rays has not been proven to cause cancer.

All medical procedures carry some risk and the fact is that Physicians and Dentists use them anyway… provided that the benefits outweigh the risks. Dental x-rays are no exception to this rule, however your health and safety and are our primary concern. Rest assured that no patient care is ever “routine”. We never take more x-rays than are safe, or more than are necessary based on your needs and individual circumstances.

What are your concerns? Please feel comfortable asking your dental provider about the x-ray safety precautions that are used in our office, or about the specific recommendations we have for you.

The Implant Investment

According to the American Association of Oral and Maxillofacial surgery, about 69% of adults between 35 and 44 have lost at least one permanent tooth due to an accident, gum disease, or other oral condition such as a failed root canal or tooth decay. Although people tend to be healthier and keep their teeth longer than they did in previous generations, about a quarter of adults have lost all of their permanent teeth by the time they reach age 74. Obviously, deciding how to replace a missing tooth is an issue many people encounter at some point in their lifetime. There are many good and reliable options that can be offered by a cosmetic dentist, but in many cases a dental implant may be the best choice – in fact, sometimes it is the only choice!

Traditionally, a missing tooth has been replaced by either a fixed bridge or a removable denture. Unfortunately, neither of these options is a permanent solution and typically need to be replaced about every 5 -10 years. Furthermore, since most prosthetic replacements are not as good as what Mother Nature created, these replacement options come with potential problems – even well designed prosthetics affect the teeth around them upon which they rest. Fixed bridges require that a dentist cut down adjacent teeth to form an anchor for the replacement tooth; and removable “plates” made of metal or plastic can rub or wear on the nearby teeth which serve as anchors. When there is no healthy, stable tooth to form an anchor or if the anchor fails, sometimes the tooth cannot easily be replaced.

Even when bridges and dentures are beautifully and carefully made, some consequences are just unavoidable. Over time teeth adjacent to removable dentures and bridgework become more vulnerable to decay or gum problems simply because there is a foreign body the (replacement crown or metal plate) that collects plaque. After a tooth has been lost, the bone which once held the tooth in place in the jaw is no longer needed, so it begins to slowly dissolve away in the area where the tooth once was. This natural body process, called “resorption” leads to unnatural looking spaces under bridgework and changes in the fit of a denture which can cause slipping, soreness and chronic maintenance issues. Just a couple of decades ago, these undesirable side effects were considered the lesser of two evils, and the benefits of replacing a tooth outweighed the disadvantages. Today, dental implants all but eliminate these side effects and can even restore the smile of people who once had no options. What a wonderful option for a young person who has, perhaps, lost teeth due to an accident!

A dental implant is a titanium post that is embedded into the jaw bone by a cosmetic dentist or oral surgeon in the place where a tooth is missing. Over a period of several months, the post bonds with the jaw bone to create a stable foundation upon which a final restoration is placed to achieve a natural, cosmetically appealing result… the implant stands alone and does not affect the teeth around it. An amazing feature unique to dental implants is that the body actually interprets the titanium post the same as it would the root of a natural tooth, so no natural bone loss occurs over time.

People often wonder if this procedure is right for them, and that is a good question to ask. Dental implants can be the ideal solution to replace one or more individual teeth; or they can be used to create anchors which firmly hold a full denture in place without the progressive bone resorption that is otherwise inevitable. However, not everyone is a good candidate for the procedure: Several factors must be evaluated by the dentist before deciding to place an implant. Your dentist may have to order a specialized x-ray or CT scan that provides a three dimensional image of the existing bone, to ensure that there is enough to support the titanium post. This can be particularly important if the tooth to be replaced has been missing for a long time, or if you were born without it. An implant is more likely to fail in someone who smokes because the bone does not bond as well to the implant. People with poorly controlled diabetes don’t heal as well and may require a medical evaluation to decide how best to proceed.

Everyone who considers a dental implant should be aware that good home care and plaque control are essential because gum and bone infections can -and do- develop around an implant just like they would around natural teeth that are not kept clean. This avoidable problem, known as peri-implantitis, is one of the most common causes of implant failure.

What about the cost? Obviously that is an important factor to consider in any investment. The good news is that the cost of creating and placing an implant is often similar to the cost of making a fixed bridge, and with good care and maintenance the titanium post will never need to be replaced. Occasionally the porcelain crown that is visible in the mouth may need replacement for cosmetic reasons, and this can be done relatively simply. The not-so-good news is that not every insurance company pays for dental implants at the same level that they might pay for a bridge or denture, so in some cases there can be a larger out of pocket cost. Don’t let that be a deal breaker… think of it as an investment and weigh the out of pocket cost of replacing a bridge one or more times, remaking and refitting a loose denture, or costly complications should adjacent teeth become involved.

At one time, dental implants were considered by many to be a luxury, and many insurance companies considered them to be an “experimental” procedure. Today, the procedure is common and state-of-the-art… not a luxury, but a worthwhile investment in your oral health. What are your thoughts about investing in dental implants as a tooth replacement option? Would you like to learn more about the procedure? Have you had a positive experience with implants? You might be surprised to discover that in the long run, the dental implant that costs a bit more up front is much more cost effective over the long haul, not only in terms of dollars but also in terms of your oral health and happiness.

Osteoporosis and Periodontal Disease

Osteoporosis is a disorder characterized by bones that become thinner, more porous and more fragile over time. The condition affects about 6 million women and 2 million men Nationwide and has few if any symptoms in the early stages. As a matter of fact, for many people a fractured bone is sometimes the first indication that a problem exists. The good news is identifying the early signs of bone loss in the mouth may be reliable predictors of your risk for osteoporosis.
Scientists have studied the relationship between periodontal disease and osteoporosis for over a decade, recognizing that the bone that supports the teeth in the mouth becomes significantly more porous after about age 50 and is affected by conditions in the rest of the body. Periodontal disease is caused by inflammation and bacterial infection – it is not caused by osteoporosis; but osteoporosis can make bone loss from periodontal disease more severe. Risk of developing the disorder increases with age… over 40% of women over age 65 have signs of low bone density, primarily caused by a decrease in the amount of the hormone estrogen produced by the body after menopause. However, inadequate intake of Vitamin D and calcium, physical inactivity, smoking and certain medications and family history are also known risk factors.
Identifying the signs of bone loss in the mouth can help identify osteoporosis – and the sooner it is treated, the less likely it is to cause debilitating fractures, tooth loss from periodontal disease and a diminished quality of life. Even when teeth are already missing, loss of the bony ridges that holds dentures or partials in place will cause a poor fit. Studies have shown that patients with osteoporosis usually require new dentures more often than patients who do not have osteoporosis.
Not surprisingly treating periodontal disease and osteoporosis simultaneously can be very beneficial. A study published in the Journal of the American Dental Association in March 2011* by Stony Brook University researchers has generated some strong evidence for making sure that dental visits are an integral part of your personal health care plan. The two-year double-blind study involved Sub-antimicrobial-dose doxycycline (SDD), the only drug approved by the FDA for treating the most common type of periodontal disease. Researchers tested the drug in postmenopausal women with both periodontal disease and low bone density – and produced some encouraging results. According to the researchers, SDD not only reduced periodontal disease over a time, it but also reduced the risk of bone loss around the hips and spine.
A dental exam is not a replacement for a bone density evaluation when recommended by the doctor, but current research suggests that the dentist can help identify people at risk for developing osteoporosis by analyzing bone thickness and patterns on dental x-rays during routine dental checkup appointments. Of course, this is part of the comprehensive oral examination you receive at every check-up visit. Did you know how useful dental x-rays could be? Are you at risk?

Reference
Journal of the American Dental Association (March 2011, Vol. 142:3, pp. 262-273).

Oral Piercing: The Price of Beauty

Body piercing is a popular form of self-expression these days, but it isn’t as safe as you may have been told. The American Dental Association opposes the practice of piercing the tissues in and around the mouth and you may want to research and think about some of the consequences that the local piercer may not know about…

Even if the piercing salon is reputable and the equipment is sterile, the human mouth is a warm, moist environment with a rich blood supply and home to literally millions of bacteria. A piercing site is an open wound, and the perfect place for bacteria to enter the blood stream and cause serious or life threatening infections such as septicemia. When these bacteria multiply in the blood stream and colonize in distant parts of the body such as the heart, they can cause endocarditis, a serious (and sometimes fatal) inflammation of the heart valves and tissues.

Common problems following piercing in and around the mouth include scar tissue, excessive drooling and speech problems. Oral jewelry may interfere with chewing or swallowing, and excessive sensitivity to metals such as eating utensils – and even your own fillings- is not uncommon. Jewelry that is accidentally bitten will likely fracture or chip tooth enamel or fillings, damage which is not just cosmetic- it can necessitate a root canal and crown or even an extraction. When jewelry consistently rubs against gum tissue, recession that exposes the roots and sometimes the bone can occur. Unfortunately, these effects are often permanent and require surgery to correct. In practical terms, some other undesirable effects of an oral piercing include

Complications of tongue piercing are very possible: Damage to the blood vessels in the tongue can cause serious blood loss; and the nerve can be easily punctured causing numbness, loss of taste or movement – damage that is sometimes temporary, but can also be permanent. After a piercing the tongue will swell, as you might expect- but occasionally the swelling is serious enough to block the airway.
If your mind is made up, and you are still sure that you want an oral piercing, there are some precautions that can make your choice safer:
• Plan ahead: Speak to your dentist (the expert in oral anatomy) for advice about the location you have chosen.
• Be sure your piercer has good references and is professional and competent. Sterile equipment and a clean environment are essential.
• Get instructions for aftercare, and follow them. Kissing, alcohol, or touching the site with unwashed hands are out of the question until it has healed, and good oral hygiene is imperative to minimize the risk of infection. There are several good over the counter, alcohol free mouth rinses that are effective at reducing bacteria. If it becomes necessary, the dentist can prescribe an effective antiseptic rinse.
• The piercing procedure and your oral jewelry should use surgical grade stainless steel, which is hypoallergenic. However, watch for inflammation (redness, swelling and pain) that doesn’t go away- this could be an indication that you are allergic to the metal in your jewelry, and you will need to remove it.
• When the tongue has been pierced, a short length of barbell is best, because it moves less and is less tempting to play with. Even tapping of jewelry against your tooth enamel can create tiny fractures

• Plastic jewelry is always preferable to metal because it is gentler and kinder to the enamel.

• As with anything else in the mouth, oral jewelry collects plaque and food particles. Remove and clean it regularly, and replace it if it becomes damaged.

• Don’t wear oral jewelry during a dental visit because it can interfere with x-rays, but do be sure to tell the dentist or hygienist about your piercing so that they can examine the site and look for possible problems.

• Most importantly, if your piercing causes any sensitivity or discomfort don`t hesitate to remove it.
• See your dentist or doctor right away if you experience symptoms of illness!

Fashion trends come and go and although most are harmless and fun, the price of being trendy may be higher than you expected. The potential cost of an oral piercing can be anything from minor cosmetic issues and sensitivity to thousands of dollars worth of repairs to the teeth, or permanent damage to the nerves and skin in the mouth. Ask yourself if the fashion statement is worth the potential long term cost. Have you experienced any negative effects as a result of oral (lip, tongue, cheek, etc.) piercings?