Monthly Archives: June 2011

Vitamin D and Your Oral Health

Medical researchers have long known that Vitamin D has many oral and overall health benefits, but there is growingconcern that deficiency of this critical nutrient is more common than once thought. Understanding the benefits of Vitamin D, where it comes from and who is at risk for deficiency could make an important difference in your general and oral health.

Somewhere along the way you can probably remember being told to have plenty of calcium in your diet to build strong bones and teeth… mothers admonish their children, and doctors advise pregnant mothers about the importance of getting adequate calcium. Fortunately calcium is everywhere – readily available in many of the foods we all love like milk, cheese, ice cream and even commercially added to orange juice, breads and cereals. Perhaps you didn’t know that without Vitamin D, the body can’t absorb that calcium… no matter how much of it you swallow!

According to a Canadian study, only about 10% of women in their second trimester of pregnancy had adequate Vitamin D levels, a phenomenon which was correlated the frequency of milk and prenatal vitamin consumption. Babies born to women with low levels of vitamin D during pregnancy may be at increased risk for tooth enamel defects and therefore, early childhood tooth decay. A diet lacking or low in vitamin D will contribute to a phenomena known as “ burning mouth syndrome”, symptoms of which can include dry mouth, a burning sensation of the tongue and oral tissues and a metallic or bitter taste. The condition is most common in older adults who, coincidentally, are frequently found to have a Vitamin D deficiency! Oral Health scientists have found that in addition to many general health benefits, Vitamin D helps to reduce inflammation in the body, which is widely known to have a direct impact on the development and severity of periodontal (gum and bone) disease. As a matter of fact, according to a study published in the Journal of Dentistry1 among 6700 research participants, those who had the highest blood levels of Vitamin D were about 20% less likely to have gum disease. Since more than half the people in the country have some form of gum disease, which may be a very good reason to drink your milk!

Vitamin D is produced naturally by the human body when skin is exposed to sunlight, but more often than not people choose to protect themselves from the harmful effects of ultraviolet rays. Sunscreen and protective clothing may prevent getting enough vitamin D from the sun; and deficiency is common among people who live in northern latitudes or otherareas that receive limited sunlight. Up to 50% of older adults have inadequate Vitamin D levels, perhaps partly due to decreased outdoor activity and sun exposure; and African Americans of all ages produce less Vitamin D, probably due to the darker color of their skin.

Although it is a rule of thumb that the best source of nutrients is a natural one, Vitamin D supplements are readily available over the counter and routinely recommended to individuals at risk for deficiency. The American Academy of Pediatrics recommends that Vitamin D drops be given to breast-fed infants, because breast milk usually has low levels of vitamin D. Do you have unexplained body or mouth symptoms? Could you be at risk … or have you been recently diagnosed with low Vitamin D levels? Your doctor and dental professional can advise you about the benefits of a supplement, and a recent discovery of Vitamin D deficiency is a good reason to schedule your regular dental checkup.

1. Journal of Dentistry (2005), 33:703–10.

Losing Sleep? Your Dentist Can Help Prevent the Deadly Effects of Sleep Apnea

Are you chronically sleepy during the day? Excessive snoring and waking up feeling unrefreshed are common symptoms of Obstructive Sleep Apnea (OSA), a sleep disorder in which interruptions in breathing occur because the airway becomes narrowed or blocked by excess tissue when throat muscles relax. Episodes of apnea (not breathing) can occur as often as every few seconds during sleep causing frequent waking, and as you might expect, some serious long term consequences including cardiovascular disease and even death.

About 4% of middle aged adults and 3-12% of children suffer from this treatable condition, and it is particularly common among overweight people. Most are not aware that the problem exists until family members either witness periods of apnea (not breathing), or raise concerns about symptoms such as heavy snoring. Unfortunately, difficulty staying alert during waking hours may lead to accidents or injury before the diagnosis of Obstructive Sleep Apnea is made.

The most common treatment for OSA is a Continuous Positive Airway Pressure (CPAP) machine. Worn when sleeping, the CPAP is a type of respirator consisting of a snug fitting face mask and pressurized air flow that keeps the throat open, allowing patients to breathe more easily and consistently. The benefits of treatment can be life changing… and life saving. Unfortunately, many patients with Obstructive Sleep Apnea have difficulty getting accustomed to wearing a CPAP mask, and give up after a short time because they find it intrusive.

There are several other ways to treat Obstructive Sleep Apnea, and if you think you may be experiencing some of the symptoms of this potentially serious sleep disorder you should bring it to the attention of your physician immediately. You should also be aware that your dentist may play an important role in treating your condition, especially if you are one of the people for whom a CPAP machine is not effective.

Surgery may be a recommended treatment is some cases, and could involve repositioning of the jaw by an oral and maxillofacial surgeon, or perhaps removal of excess tissue in the throat (including tonsils or adenoids) by an ear nose and throat specialist (otorhinolayryngologist). One of the more common and effective solutions for mild to moderate sleep apnea is an oral appliance, custom crafted by a dentist with specialized training in sleep medicine. These FDA approved devices resemble orthodontic retainers, but are designed to reposition the lower jaw (Mandibular Advancement Device), elevate the soft palate, and increase muscle tone of the tongue (Tongue Retaining Device), thus keeping the airway unblocked during sleep.

The effects of Sleep Apnea are not only dangerous, research has indicated that they truly invade reduce the overall quality of nearly every aspect of life. The first step towards getting a better night’s sleep is to have a thorough examination by a physician specifically trained to diagnose and treat sleep disorders. Depending on the seriousness of your condition, your doctor may request that you participate in a sleep study, which will provide your health care team with precise data about your breathing and sleeping habits. The results of the sleep study will assist in determining which treatment options are likely to be most beneficial to you.

If you have been losing sleep, you can rest assured that our office will work with you and your medical team to ensure that you obtain an accurate diagnosis and treatment for this condition.

Reasons for the Removal of Wisdom Teeth

Should you have your wisdom teeth removed? 

It’s true that removal of wisdom teeth is a very common practice, though not everyone knows the reasons for it. Just because wisdom teeth grow in doesn’t necessarily mean they need to be removed. In fact, there is much debate on whether to remove them or not, but they do often cause problems that call for extraction.

Wisdom teeth usually come in around mid/late teenage years to early twenties and are generally associated with pain. During growth, the pain may feel like pressure in the back of the mouth and the growth areas may feel sensitive to touch of a toothbrush, food, etc. The irritation most frequently occurs for one or both of these two reasons:

1. Newly growing in teeth don’t always grow in straight; they frequently grow in either angled towards the front, back, or even completely sideways. This angling causes them to impact other teeth or rub against the tongue or cheeks, which may result in irritation and possible infection. According to Scienceline, an NYU research program, the reason for the shifted growth of wisdom teeth is because human jaws have evolved smaller and smaller over time.

2. It can be difficult to clean in the crevices between the gums and wisdom teeth in the back of the mouth. This can lead to bacteria buildup and infections and soreness. Similarly, wisdom teeth might not even come all the way through the gum line, which results in soft gum tissue or cysts around the area of the tooth. This is especially difficult to clean and also causes bacteria buildup and infections.

Evolution has lead to wisdom teeth being unnecessary—they are officially included in Discover’s list of unnecessary body parts. Logically, they were needed when humans ate rough foods like raw meats, but overtime our diets and jaws have changed. Since we don’t need the teeth any more, it makes sense to have wisdom teeth removed in the case of oral health problems such as impacted teeth, bacterial infections, irritations, or cysts.

Preparing for Your Child’s First Dental Visit

The American Academy of Pediatric Dentistry recommends that a child see a dentist by their first birthday. Some parents may feel that this is too early, and perhaps that their child is not ready for the experience or that it isn’t really necessary. No matter how many children you have had, you know that there is always a great deal to learn about each little one’s unique personality and about caring for their unique health needs. These early dental visits are much more than exams and cleanings… they play a very important role in helping your child develop attitudes and oral health habits that will ensure a lifetime of healthy smiles.

Most importantly, from the very first visit your child begins to develop a trusting relationship with the dental team in his or her new dental home; and parents have the opportunity to learn homecare techniques customized for their child.

As parents, we want to comfort our children and prepare them for new experiences, but it is very important to remember not to transfer our own anxiety to our children on the process. Remember too, that the child has no expectation that anything will hurt or be unpleasant unless someone else makes a suggestion that gives him a reason to be afraid. A first visit should be a positive, happy experience that will encourage the child to want to cooperate and return for future visits. How should you prepare your child? Here are some tips:

DO try to schedule appointments early in the day when children are well rested and not hungry.

DO explain that it is important to visit a dentist to keep our teeth healthy. There are several excellent children’s books available to help with the preparation- try bringing one home in advance to introduce the subject with your child.

DO build excitement about the experience.

DO tell the child enough that she will know what to expect: “the dentist will count your teeth, and make them shiny, and maybe take some pictures!”

DO remain calm and positive in the exam room. Provide supportive coaching for your child.

DO reward your child’s good behavior- but be understanding about what this means. A few tears are okay.

DO be firm and flexible. It is important that the dental team and the parent – not the child be in charge of the appointment. Of course, we want to do the examination and cleaning, but we don’t necessarily have to perform every planned procedure (x-rays, fluoride, etc.) for the appointment to be a success.

DO bring your child along to a sibling’s appointment so he can watch what happens before it is his turn (but make sure that the child who is being watched is not likely to cry or be upset by the procedure). However…

DON’T encourage your child to watch an adult having their teeth cleaned up-close, especially if some bleeding is likely. That can be pretty scary for children; and furthermore, an adult cleaning is usually much more involved than a child’s cleaning and therefore not a very good example of what to expect.

DON’T use words like hurt, needle, x-ray, shot, or cavity. Children are very sensitive to words that they may not fully understand and even though they had no expectation about being hurt, they will once you have use the word!

DON’T wait until there is an emergency to schedule your child’s first visit. It’s hard to have a positive when something hurts!

DON’T tease or threaten. Parents sometimes try to lighten the mood with humor, but what may seem like an obvious joke such as, “Sarah wants to have all her teeth taken out” – doesn’t seem silly or funny to a child who is confused and in a stressful environment. Children may act out because they don’t have a good way to express their anxiety…threatening to take away a privilege often has the effect of increasing anxiety and exacerbating behavior problems.

DON’T tell children that if they don’t brush their teeth they will get a cavity and have to have a shot. First of all, it isn’t entirely true. Sometimes very small cavities can be filled with no anesthetic and some may not need to be filled at all. Secondly, this well intentioned statement prepares a child to expect the worst at every visit, and they arrive fearful and less cooperative.

Every child has a different level of tolerance; his emotional and physical maturity will help guide the first dental visit. Your child will be introduced to the dental chair and other equipment, and may learn how to brush his teeth properly if he is old enough. Parents should be assisting with homecare at least until around age ten – so this visit will be educational for everyone! A cleaning is usually planned for this appointment, but it may be a scaled-down version of an adult cleaning. Depending on your child’s needs, the hygienist may just clean with just a toothbrush. Fluoride may or may not be applied, and this will largely depend on whether the child can tolerate the flavor, not swallow it, and what other sources of fluoride (supplements, water etc.) he has access to.

The dentist may ask you questions about how you care for his teeth at home, and parents should come prepared to ask any questions they may have about their child’s oral health. Finally, the dentist will check for obvious cavities or other problems. There are no definitive rules on when to take the first x-rays of a child’s teeth. As long as there are no obvious areas of concern and his mouth is large enough to accommodate the film, then two bitewings are typically taken when the first permanent molar erupts at around age six.

We understand that every child is an individual with unique needs. Sometimes, especially if there are cavities that must be filled, the most important thing to accomplish at the First Dental Visit is simply to make the child feel comfortable enough to want to come back again. Let’s begin early and work together to ensure that your child has a lifetime of happy smiles and stress-free dental visits. What techniques have worked for you to ease your child through this experience?