Periodontal (gum) disease is a progressive bacterial infection caused primarily by bacterial plaque on tooth surfaces not adequately removed by daily oral hygiene. In fact, nearly all of us will develop gingivitis (inflammation of the gum tissues) if we fail to clean our teeth and gums for an extended period of time.
Some people, however, have a greater susceptibility for developing gum disease because of other risk factors not related to hygiene. Patients with diabetes are at particular high risk for acute forms of gum disease.
Diabetes is a chronic condition in which the body can’t adequately regulate the bloodstream’s levels of glucose, the body’s primary energy source. Type 1 diabetes is caused by inadequate production in the pancreas of the hormone insulin, the body’s primary glucose regulator. In Type 2 diabetes the body develops a resistance to insulin’s effects on glucose, even if the insulin production is adequate. Type 1 patients require daily insulin injections to survive, while most Type 2 patients manage their condition with medications, dietary improvements, exercise and often insulin supplements.
Diabetes has a number of serious consequences, including a higher risk of heart disease and stroke. Its connection with gum disease, though, is related to how the disease alters the body’s response to infection and trauma by increasing the occurrence of inflammation. While inflammation is a beneficial response of the body’s immune system to fight infection, prolonged inflammation destroys tissues. A similar process occurs with gum disease, as chronic inflammation leads to tissue damage and ultimately tooth loss.
Researchers have found that patients with diabetes and gum disease may lessen the effects of inflammation related to each condition by properly managing both. If you’ve been diagnosed with either type of diabetes, proper dental care is especially important for you to reduce your risk of gum disease. In addition to effective daily brushing and flossing and a professional cleaning and checkup every six months (more frequent is generally better), you should also monitor your gum health very closely, paying particular attention to any occurrence of bleeding, redness or swelling of the gums.
If you encounter any of these signs you should contact us as soon as possible for an examination. And be sure to inform any dental professional that cares for your teeth you’re diabetic — this could affect their treatment approach.
If you would like more information on dental care for patients with diabetes, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Diabetes & Periodontal Disease.”
You probably wouldn't be surprised to hear that someone playing hockey, racing motocross or duking it out in an ultimate fighter match had a tooth knocked out. But acting in a movie? That's exactly what happened to Howie Mandel, well-known comedian and host of TV's America's Got Talent and Deal or No Deal. And not just any tooth, but one of his upper front teeth—with the other one heavily damaged in the process.
The accident occurred during the 1987 filming of Walk Like a Man in which Mandel played a young man raised by wolves. In one scene, a co-star was supposed to yank a bone from Howie's mouth. The actor, however, pulled the bone a second too early while Howie still had it clamped between his teeth. Mandel says you can see the tooth fly out of his mouth in the movie.
But trooper that he is, Mandel immediately had two crowns placed to restore the damaged teeth and went back to filming. The restoration was a good one, and all was well with his smile for the next few decades.
Until, that is, he began to notice a peculiar discoloration pattern. Years of coffee drinking had stained his other natural teeth, but not the two prosthetic (“false”) crowns in the middle of his smile. The two crowns, bright as ever, stuck out prominently from the rest of his teeth, giving him a distinctive look: “I looked like Bugs Bunny,” Mandel told Dear Doctor—Dentistry & Oral Health magazine.
His dentist, though, had a solution: dental veneers. These thin wafers of porcelain are bonded to the front of teeth to mask slight imperfections like chipping, gaps or discoloration. Veneers are popular way to get an updated and more attractive smile. Each veneer is custom-shaped and color-matched to the individual tooth so that it blends seamlessly with the rest of the teeth.
One caveat, though: most veneers can look bulky if placed directly on the teeth. To accommodate this, traditional veneers require that some of the enamel be removed from your tooth so that the veneer does not add bulk when it is placed over the front-facing side of your tooth. This permanently alters the tooth and requires it have a restoration from then on.
In many instances, however, a “minimal prep” or “no-prep” veneer may be possible, where, as the names suggest, very little or even none of the tooth's surface needs to be reduced before the veneer is placed. The type of veneer that is recommended for you will depend on the condition of your enamel and the particular flaw you wish to correct.
Many dental patients opt for veneers because they can be used in a variety of cosmetic situations, including upgrades to previous dental work as Howie Mandel experienced. So if slight imperfections are putting a damper on your smile, veneers could be the answer.
If you would like more information about veneers and other cosmetic dental enhancements, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Porcelain Veneers” and “Porcelain Dental Crowns.”
With only a few teeth now showing in your baby’s mouth, you might think it’s too early to schedule their first dental visit. But you should, and here’s why: tooth decay.
Although adults are more likely to contend with dental disease, the exception for children is tooth decay. One kind of decay, early childhood caries (ECC), can wreak havoc in children’s primary teeth. While your child may or may not be at high risk for ECC, it’s better to err on the side of caution and begin regular checkups by their first birthday.
Since primary teeth eventually give way for permanent teeth, it may not seem that important to protect them from decay. But despite their short lifespan primary teeth can have a long-term effect on dental health for one primary reason: They’re placeholders for the permanent teeth that will eventually replace them.
If they’re lost prematurely to decay, nearby teeth can drift into the resulting open space. This can crowd out the intended permanent tooth, which may then erupt out of place (or not at all, remaining impacted within the gums). Protecting primary teeth from decay—or treating them if they do become infected—reduces this risk to the permanent teeth.
Besides regular cleanings, dentists can do other things to protect your child’s teeth from decay. Applying a high strength fluoride solution to teeth can help strengthen enamel against acid attack, the precursor to decay. Sealants on the biting surfaces of teeth deprive bacterial plaque of nooks and crannies to hide, especially in back molars and pre-molars.
You can also help prevent decay in your child’s primary teeth by starting a brushing regimen as soon as teeth start appearing. Also, limit sugar intake by restricting sugary foods to mealtime and not sending a child to bed with a sugary liquid-filled bottle (including juices or breast milk). And avoid possible transfers of oral bacteria from your mouth to theirs by not drinking from the same cup or placing any object in your mouth that might go in theirs.
Tooth decay can have long-term consequences on your child’s dental health. But by working together with your dentist you can help ensure this damaging disease doesn’t damage their teeth.
If you would like more information on tooth decay in primary teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Do Babies Get Tooth Decay?”
“To gain something, sometimes you have to give up something else.”
No, that isn't the latest viral meme on the Internet. It's actually a practical consideration that could arise in orthodontics.
In this case, the “something” to gain is a straighter, more attractive smile; the “something” you may have to part with is a few teeth. This may be necessary if there are too many teeth on a dental arch for its capacity, a situation called crowding. A lack of space is the main reason teeth come in misaligned.
Before we can correct this, we'll need to free up space to allow for tooth movement by removing one or more of the existing teeth. The ideal candidates are those that are near to the teeth we wish to move but not highly visible. The first bicuspids are the most frequent choices for removal: they're located behind the cuspids or eyeteeth (the pointed teeth right under the eyes).
Ideally, we'll remove the target teeth some time before we apply braces to give the gums a chance to heal. At the same time we want to preserve the bone that once supported the teeth we've extracted. This is because when we chew the forces generated by the teeth stimulates bone replacement growth. When a tooth is no longer there the supporting bone doesn't receive this stimulation and may ultimately reduce in volume.
We may try to prevent this by placing a bone graft in the empty socket immediately after removing the tooth. The graft serves as a scaffold to encourage new bone to grow. Hopefully when we're ready to apply braces, the bone will be strong and healthy to handle the movement of the teeth.
As the teeth move under the influence of braces, they'll begin to fill up the space created by tooth removal. Once it's completed, the extracted teeth won't be missed — the other teeth now straightened will completely fill out the smile.
The different steps in this process must be carefully planned and executed precisely, and it will take months or even years to complete. In the end, though, this complicated bite problem can be corrected and replaced with an attractive, straight smile.
If you would like more information on correcting a poor bite, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Removal for Orthodontic Reasons.”
As with most Western countries, we in the U.S. love our carbs. While fats and proteins make an appearance in our diets, many of us go full-tilt on sugars, starches and fibers.
Regardless of what some diet gurus say, we do need these organic compounds to generate energy for our cells. But carbs can also fuel inflammation: This is a mechanism in the body that isolates and protects healthy tissues from damaged tissues or toxins. Chronic inflammation, though, contributes to systemic conditions like diabetes, heart disease and, yes, gum disease.
And it's not just a matter of too many carbs in your diet. Not all carbs are equal: Some can actually stimulate inflammation, making conditions like gum disease worse. Others, though, might actually help decrease inflammation.
So, in terms of your gum health in particular, how do you know which carbs are better for you and which are worse?
It depends on their ranking on the glycemic index, a measure of how fast the body digests a particular carbohydrate to form glucose, the blood sugar that fuels our cells. The faster the digestion (higher on the glycemic index), the more likely they'll overload the bloodstream with glucose, requiring the release of the hormone insulin to bring the levels back to normal. Continuous insulin increases ultimately lead to higher inflammation.
High glycemic foods include those with added sugar, bakery items made with white flour, white rice or mashed potatoes. But there are also carb foods low on the glycemic scale—most vegetables, greens, beans, nuts and whole grains—whose slower digestive rates avoid the big blood sugar spikes and excessive insulin—and actually hinder inflammation.
So, if you want to control inflammation, reduce your consumption of high glycemic foods like chips, French fries, cookies and similar items. Instead, eat low glycemic foods like apples, bulgur wheat products, oatmeal, and other fruits, vegetables, legumes and nuts.
In short: steer clear of processed foods with added sugar, and indulge yourself in fresh “real” food. These also have the added bonuses of minerals, vitamins and antioxidants that keep your body functioning normally. And that can also make a big difference toward keeping your gums healthy and disease-free.
If you would like more information on diet and dental health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Carbohydrates Linked to Gum Disease.”
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