Indianapolis Crown Specialist Blog
Posts for category: Oral Health
Periodontal (gum) disease is as common as it is destructive. Almost half of all adults 30 and older have some form—and those numbers increase to nearly three-quarters by age 65.
Fortunately, we have effective ways to treat this bacterial infection, especially if we catch it early. By thoroughly removing all plaque, the disease-causing, bacterial biofilm that accumulates on tooth surfaces, we can stop the infection and help the gums return to normal.
Unfortunately, though, you're at a greater risk for a repeat infection if you've already had gum disease. To lower your chances of future occurrences, we'll need to take your regular dental exams and cleanings to another level.
Although everyone benefits from routine dental care, if you've had gum disease you may see these and other changes in your normal dental visits.
More frequent visits. For most people, the frequency norm between dental cleanings and exams is about six months. But we may recommend more visits for you as a former gum disease patient: depending on the advancement of your disease, we might see you every three months once you've completed your initial treatment, and if your treatment required a periodontist, we may alternate maintenance appointments every three months.
Other treatments and medications. To control any increases in disease-causing bacteria, dentists may prescribe on-going medications or anti-bacterial applications. If you're on medication, we'll use your regular dental visits to monitor how well they're doing and modify your prescriptions as needed.
Long-term planning. Both dentist and patient must keep an eye out for the ongoing threat of another gum infection. It's helpful then to develop a plan for maintaining periodontal health and then revisiting and updating that plan as necessary. It may also be beneficial to perform certain procedures on the teeth and gums to make it easier to keep them clean in the future.
While everyone should take their oral health seriously, there's even greater reason to increase your vigilance if you've already had gum disease. With a little extra care, you can greatly reduce your chances of another bout with this destructive and aggressive disease.
If you would like more information on preventing recurring gum disease, 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 “Periodontal Cleanings.”
Are bleeding gums something you should be concerned about? Dear Doctor magazine recently posed that question to Dr. Travis Stork, an emergency room physician and host of the syndicated TV show The Doctors. He answered with two questions of his own: “If you started bleeding from your eyeball, would you seek medical attention?” Needless to say, most everyone would. “So,” he asked, “why is it that when we bleed all the time when we floss that we think it’s no big deal?” As it turns out, that’s an excellent question — and one that’s often misunderstood.
First of all, let’s clarify what we mean by “bleeding all the time.” As many as 90 percent of people occasionally experience bleeding gums when they clean their teeth — particularly if they don’t do it often, or are just starting a flossing routine. But if your gums bleed regularly when you brush or floss, it almost certainly means there’s a problem. Many think bleeding gums is a sign they are brushing too hard; this is possible, but unlikely. It’s much more probable that irritated and bleeding gums are a sign of periodontal (gum) disease.
How common is this malady? According to the U.S. Centers for Disease Control, nearly half of allÂ Americans over age 30 have mild, moderate or severe gum disease — and that number increases to 70.1 percent for those over 65! Periodontal disease can occur when a bacteria-rich biofilm in the mouth (also called plaque) is allowed to build up on tooth and gum surfaces. Plaque causes the gums to become inflamed, as the immune system responds to the bacteria. Eventually, this can cause gum tissue to pull away from the teeth, forming bacteria-filled “pockets” under the gum surface. If left untreated, it can lead to more serious infection, and even tooth loss.
What should you do if your gums bleed regularly when brushing or flossing? The first step is to come in for a thorough examination. In combination with a regular oral exam (and possibly x-rays or other diagnostic tests), a simple (and painless) instrument called a periodontal probe can be used to determine how far any periodontal disease may have progressed. Armed with this information, we can determine the most effective way to fight the battle against gum disease.
Above all, don’t wait too long to come in for an exam! As Dr. Stork notes, bleeding gums are “a sign that things aren’t quite right.” Â If you would like more information about bleeding gums, please contact us or schedule an appointment. You can read more in the Dear Doctor magazine article “Bleeding Gums.” You can read the entire interview with Dr. Travis Stork in Dear Doctor magazine.
Like other healthcare providers, dentists have relied for decades on the strong pain relief of opioid (narcotic) drugs for patients after dental work. As late as 2012, doctors and dentists wrote over 250 million prescriptions for these drugs. Since then, though, those numbers have shrunk drastically.
That’s because while effective, drugs like morphine, oxycodone or fentanyl are highly addictive. While those trapped in a narcotic addiction can obtain drugs like heroine illicitly, a high number come from prescriptions that have been issued too liberally. This and other factors have helped contribute to a nationwide epidemic of opioid addiction involving an estimated 2 million Americans and thousands of deaths each year.
Because three-quarters of opioid abusers began their addiction with prescription pain medication, there’s been a great deal of re-thinking about how we manage post-procedural pain, especially in dentistry. As a result, we’re seeing a shift to a different strategy: using a combination of non-steroidal anti-inflammatory drugs (NSAIDs), particularly ibuprofen and acetaminophen, instead of a prescribed narcotic.
These over-the-counter drugs are safer and less costly; more importantly, though, they don’t have the high addictive quality of an opioid drug. A 2013 study published in the Journal of the American Dental Association (JADA) showed that when two NSAIDs were used together, the pain relief was greater than either drug used individually, and better than some opioid medications.
That’s not to say dentists no longer prescribe opioids for pain management following dental work. But the growing consensus among dental providers is to rely on the double NSAID approach as their first-line therapy. If a patient has other medical conditions or the NSAIDs prove ineffective, then the dentist can prescribe an opioid instead.
There’s often hesitancy among dental patients on going this new route rather than the tried and true opioid prescription. That’s why it’s important to discuss the matter with your dentist before any procedure to see which way is best for you. Just like you, your dentist wants your treatment experience to be as pain-free as possible, in the safest manner possible.
As a parent you’re concerned with a number of issues involving your child’s health, not the least of which involves their teeth. One of the most common is thumb-sucking.
While later thumb-sucking is a cause for concern, it’s quite normal and not viewed as harmful in infant’s and very young children. This universal habit is rooted in an infant swallowing pattern: all babies tend to push the tongue forward against the back of the teeth when they swallow, which allows them to form a seal while breast or bottle feeding. Infants and young children take comfort or experience a sense of security from sucking their thumb, which simulates infant feeding.
Soon after their primary teeth begin to erupt, the swallowing pattern changes and they begin to rest the tongue on the roof of the mouth just behind the front teeth when swallowing. For most children thumb sucking begins to fade as their swallowing pattern changes.
Some children, though, continue the habit longer even as their permanent teeth are beginning to come in. As they suck their thumb the tongue constantly rests between the front teeth, which over time may interfere with how they develop. This can cause an “open bite” in which the upper and lower teeth don’t meet properly, a problem that usually requires orthodontic treatment to correct it.
For this reason, dentists typically recommend encouraging children to stop thumb-sucking by age 3 (18-24 months to stop using a pacifier). The best approach is positive reinforcement — giving appropriate rewards over time for appropriate behavior: for example, praising them as a “big” boy or girl when they have gone a certain length of time without sucking their thumb or a pacifier. You should also use training or “Sippy” cups to help them transition from a bottle to a regular cup, which will further diminish the infant swallowing pattern and need for thumb-sucking.
Habits like thumb-sucking in young children should be kept in perspective: the habit really isn’t a problem unless it goes on too long. Gentle persuasion, along with other techniques we can help you with, is the best way to help your child eventually stop.
If you would like more information on thumb sucking, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Thumb Sucking in Children” and “How Thumb Sucking Affects the Bite.”
When it comes to our children’s safety, there isn’t much nowadays that isn’t under scrutiny. Whether food, clothing, toys and more, we ask the same question: can it be harmful to children?
That also includes tried and true healthcare practices. One in particular, the routine x-ray, has been an integral part of dental care for nearly a century. As a means for detecting tooth decay much earlier than by sight, it has without a doubt helped save billions of teeth.
But is it safe for children? The reason to ask is because x-rays are an invisible form of electromagnetic radiation that can penetrate human tissue. As with other forms of radiation, elevated or frequent exposure to x-rays could damage tissue and increase the future risk of cancer.
But while there is potential for harm, dentists take great care to never expose patients, especially children, to that level or frequency of radiation. They incorporate a number of safeguards based on a principle followed by all healthcare professionals in regard to x-rays called ALARA, an acronym for “as low as reasonably achievable.” This means dentists and physicians use as low an exposure of x-ray energy as is needed to achieve a reasonable beneficial outcome. In dentistry, that’s identifying and treating tooth decay.
X-ray equipment advances are a good example of ALARA in action. Digital imaging, which has largely replaced film, requires less x-ray radiation for the same results than its older counterpart. Camera equipment has also become more efficient, with modern units containing lower settings for children to ensure the proper amount of exposure.
Dentists are also careful how often they take x-ray images with their patients, only doing so when absolutely necessary. As a result, dental patients by and large experience lower dosages of x-ray radiation in a year than they receive from natural radiation background sources found every day in the environment.
Dentists are committed to using x-ray technology in as safe and beneficial a way as possible. Still, if you have concerns please feel free to discuss it further with your dental provider. Both of you have the same goal—that your children have both healthy mouths and healthy bodies for the rest of their lives.
If you would like more information on x-ray safety for children, 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 “X-Ray Safety for Children.”
Can you have healthy teeth and still have gum disease? Absolutely! And if you don’t believe us, just ask actor David Ramsey. The cast member of TV hits such as Dexter and Arrow said in a recent interview that up to the present day, he has never had a single cavity. Yet at a routine dental visit during his college years, Ramsey’s dentist pointed out how easily his gums bled during the exam. This was an early sign of periodontal (gum) disease, the dentist told him.
“I learned that just because you don’t have cavities, doesn’t mean you don’t have periodontal disease,” Ramsey said.
Apparently, Ramsey had always been very conscientious about brushing his teeth but he never flossed them.
“This isn’t just some strange phenomenon that exists just in my house — a lot of people who brush don’t really floss,” he noted.
Unfortunately, that’s true — and we’d certainly like to change it. So why is flossing so important?
Oral diseases such as tooth decay and periodontal disease often start when dental plaque, a bacteria-laden film that collects on teeth, is allowed to build up. These sticky deposits can harden into a substance called tartar or calculus, which is irritating to the gums and must be removed during a professional teeth cleaning.
Brushing teeth is one way to remove soft plaque, but it is not effective at reaching bacteria or food debris between teeth. That’s where flossing comes in. Floss can fit into spaces that your toothbrush never reaches. In fact, if you don’t floss, you’re leaving about a thirdÂ to half of your tooth surfaces unclean — and, as David Ramsey found out, that’s a path to periodontal disease.
Since then, however, Ramsey has become a meticulous flosser, and he proudly notes that the long-ago dental appointment “was the last we heard of any type of gum disease.”
Let that be the same for you! Just remember to brush and floss, eat a good diet low in sugar, and come in to the dental office for regular professional cleanings.
If you would like more information on flossing or periodontal disease, please contact us today to schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine article “Understanding Gum (Periodontal) Disease.”
Along with thumb sucking, childhood teeth grinding is one of the top concerns anxious parents bring to their dentists. It’s so prevalent, though, many providers consider it normal behavior—the sleep-disturbing sound it can generate is often the worst consequence for the habit.
But that doesn’t mean you should brush aside all concern, especially if the habit continues into late childhood. Long-term teeth grinding could eventually damage the teeth and gums.
Teeth grinding (or clenching) is the involuntary movement of the jaws when not engaged in normal functions like chewing, speaking or swallowing. The action often produces higher than normal chewing forces, which over time can accelerate tooth wear, cause fractures, or contribute to loose teeth, all of which could increase the risk of dental disease. While it can occur at any time it’s most common among children during nighttime sleep.
While stress is the usual trigger for teeth grinding in adults, with young children the causes for the habit are more complex and less understood. Most doctors hold to the theory that most pediatric teeth grinding arises during shifts from lighter to heavier, rapid-eye-movement (REM) sleep. The child’s immature neuromuscular chewing control may engage involuntarily during this shift. Teeth grinding is also prevalent among children who snore or mouth-breathe, or who take anti-depressant medication.
But as mentioned before, there’s usually no cause for concern unless the habit persists beyond about age 11. If the habit isn’t fading, you should speak to your dentist about ways to reduce it or its effects. One way is with a custom-made night guard worn during sleep. The smooth, plastic surface of the appliance prevents teeth from making solid contact with each other during a grinding episode.
You might also seek treatment from an ear, nose and throat (ENT) specialist if your child is having issues with airway obstruction, which could also relieve teeth grinding. And children experiencing stressful situations or events may find relief both emotionally and physically from psychological therapy.
At younger ages, you can safely regard your child’s grinding habit as normal. But if it persists, it’s worth looking for ways to reduce it.
If you would like more information on your child’s teeth grinding habit, 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 “When Children Grind Their Teeth: Is the Habit of ‘Bruxism’ Harmful?”
In the quest for the ideal diet, people often stress over one particular food group: carbohydrates. And for good reason—some carbohydrates have been linked to chronic inflammation, a contributing factor in many diseases. One such condition in particular, periodontal (gum) disease, could permanently damage your dental health.
But before you throw all the carbs out of your diet, let’s take a closer look at them. Not all carbs are the same or contribute to inflammation to the same degree.
Carbohydrates are organic compounds existing in living tissues. In foods, the most prevalent of these are sugars and starches that break down during digestion into the simple sugar glucose, which the cells in an organism use for energy.
But not all carb-based foods digest at the same rate, measured along a scale called the glycemic index. High glycemic foods like sugar, baked goods or potatoes digest quickly and can rapidly increase the glucose levels in the blood (blood sugar). This sudden glucose spike then triggers an insulin surge from the pancreas to restore the level to normal. This process in turn can cause inflammation.
On the other end of the glycemic index are complex or unrefined carbohydrates that digest much more slowly, and don’t quickly elevate blood sugar like simple carbs. In fact, nutritional studies consistently show carbohydrates in most vegetables, greens, beans or whole grains may actually decrease inflammation.
Inflammation is also a primary factor in gum disease, caused by a bacterial infection in the gums. Chronic inflammation damages the gums’ attachment with the teeth and can contribute to eventual tooth loss. And if your body already has an overactive inflammatory response due to your diet, you could be even more susceptible to gum disease.
A change in your diet in relation to carbs could help reduce this risk. Eat less sugar, white flour, rice and potatoes and more complex carbs like fresh vegetables and fruits. For even more protection include foods rich in Omega-3 fatty acids (like certain fish and nuts) and less Omega 6 foods (fried food or pastries, or chips, for example). And don’t forget your antioxidants, vitamins and minerals.
Eating fewer simple carbs and more complex carbs will help reduce inflammation in the body. And that’s a good thing for your gums.
If you would like more information on how diet affects 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.”
Sure, it’s big news when celebs tweet selfies from the dental office… if you’re still living in the 20th century. But in Hollywood today, it’s harder to say who hasn’t posted snaps of themselves in the dentist’s chair than who has. Yet the pictures recently uploaded to Twitter by Mark Salling, the actor and singer who regularly appears as Noah “Puck” Puckerman on the popular TV series Glee, made us sit up and take notice.
“Getting my chipped tooth fixed. Also, apparently, I’m a big grinder,” read the caption. The photo showed a set of upper front teeth with visible chips on the biting surface. What’s so special about this seemingly mundane tweet? It’s a great way of bringing attention to a relatively common, but often overlooked problem: teeth clenching and grinding, also called bruxism.
Although bruxism is a habit that affects scores of people, many don’t even realize they have it. That’s because the condition may only become active at night. When the teeth are unconsciously ground together, the forces they produce can wear down the enamel, cause chipping or damage to teeth or dental work (such as veneers or fillings), or even loosen a tooth! While it’s common in children under 11 years old, in adults it can be a cause for concern.
Sometimes, mouth pain, soreness and visible damage alert individuals to their grinding habits; other times, a dental professional will notice the evidence of bruxism during an exam or cleaning: tooth sensitivity and telltale wear and tear on the chewing surfaces. Either way, it’s time to act.
Bruxism is most often caused by stress, which can negatively impact the body in many ways. It may also result from bite problems, the overuse of stimulating substances (caffeine, alcohol, tobacco, and illegal drugs), and as a side effect of certain medications. Sometimes, simply becoming aware of the habit can help a person get it under control. Common methods of stress reduction include exercise, meditation, a warm bath or a quiet period before bedtime; these can be tried while we monitor the situation to see if the problem is going away.
If stress reduction alone doesn’t do the trick, several other methods can be effective. When bruxism is caused by a minor bite problem, we can sometimes do a minor “bite adjustment” in the office. This involves removing a tiny bit of enamel from an individual tooth that is out of position, bringing it in line with the others. If it’s a more serious malocclusion, orthodontic appliances or other procedures may be recommended.
When grinding is severe enough to damage teeth or dental work, we may also recommend a custom-made night guard (occlusal guard), which you put in your mouth at bedtime. Comfortable and secure, this appliance prevents your teeth from being damaged by contacting each other, and protects your jaw joints from stresses due to excessive grinding forces.
Whether or not you have to smile for a living, teeth grinding can be a big problem. If you would like more information about this condition, call our office to schedule a consultation for a consultation.
Dental anxiety is a common problem: it’s estimated that one in two Americans admits to some level of nervousness about seeing the dentist. On the extreme side of this statistic about 15% of the population even avoid or postpone dental care because of it. While comedy shows routinely make fun of people’s fear of the dentist, the consequences of not receiving needed dental care due to dental anxiety are no laughing matter.
Fortunately, visiting the dentist doesn’t have to be a nerve-wracking, butterflies-in-the-stomach experience. Here are 3 ways to make sure your next visit is more pleasant.
The right dentist. Dental care is more than technical—it’s also personal and relational. The most important element for reducing dental visit anxiety is a provider you’re comfortable with and that you trust. It’s especially important for high anxiety patients to find a dentist who also has compassion for how they feel and won’t judge them—instead, working with them to find just the right combination of techniques and possible medications that encourage relaxation.
Oral sedation. For many people nervous about dental visits the answer could be prescribed sedation medication taken an hour or so before their appointment. Typically a mild sedative, the dose is just enough to help them relax. It’s also often coupled with other methods like nitrous oxide or local anesthesia for a pain-free and unstressed experience.
IV sedation. For people with high levels of anxiety, it’s often beneficial to increase the level of sedation. One of the best ways to do this is with an intravenous flow of medication that will place a person in a deeper state of relaxation. Although this method requires careful vital sign monitoring during the procedure, it’s often the best way to calm patients with high anxiety so they can receive the dental care they need.
Working with your dentist, you can develop just the right mix of these and other methods for making your dental visits easier. No matter what your level of anxiety, you don’t have to avoid the dentist nor needed dental care.
If you would like more information on reducing anxiety during dental visits, 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 “IV Sedation in Dentistry.”