One in ten Americans has diabetes, a serious condition that may increase the development and severity of other health problems—including gum disease. Because of this latter connection, dental providers join other health professionals during November's National Diabetes Month to call attention to this chronic disease and its effect on health and well-being.
There's another health condition with a diabetes connection that isn't as well known: obstructive sleep apnea (OSA). It's also of keen interest to dental providers, as dentists are often involved in the discovery and treatment of this common sleep disorder.
OSA is the temporary blockage of the airway during sleep by the tongue or other anatomical structures. The subsequent drop in oxygen awakens the body to remove the obstruction. People with OSA may not realize they have the condition, but their bed partner can often attest to their snoring, snorting and gasping for breath during the night. Such episodes can occur several times per night, depriving the person of sufficient sleep.
Chronic OSA can contribute to the development of other health problems, among them Type 2 diabetes. It can do this first by interfering with the metabolization of glucose (blood sugar). It may also increase the body's resistance to insulin, the primary hormone regulating glucose.
Fortunately, properly managing OSA can lower your risk for diabetes, and that's where dentists may be able to help. For one thing, we dentists are often the first to notice early signs of OSA—sometimes even before our patients do.
According to the American Sleep Apnea Association, as many as 80% of the estimated 22 million Americans with OSA may not know they have it. But dentists often identify OSA indicators while examining patients: signs like an enlarged tongue or tonsils, or patients falling asleep in the exam chair. While we can't formally diagnose OSA, we often refer symptomatic patients to a sleep specialist.
Dentists also offer an alternative to the most common OSA therapy, which is continuous positive airway pressure (CPAP). This therapy employs a motorized pump that delivers pressurized air into the throat via face mask to keep the airway open during sleep. Although effective, some people find a CPAP machine noisy and uncomfortable to use.
Alternatively, dentists can provide an oral device that can often help patients with mild to moderate OSA that's worn in the mouth during sleep. Most of the various types of these appliances either reposition the lower jaw with a hinge mechanism to keep the throat open or pull the tongue away from the airway through a suction effect.
Diabetes is one part of a chain reaction that can bring unexpected challenges to your health, including to your teeth and gums. You can slow or even stop its development with proper diet, exercise and good, restful sleep. Dealing with OSA is often part of that equation—and we may be able to help.
If you would like more information about the prevention and treatment of diabetes, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Oral Appliances for Sleep Apnea.”
For over half a century now, community water systems have been adding fluoride to drinking water to help reduce the risk of tooth decay. Numerous long-term studies have demonstrated the soundness of this practice, prompting the U.S. Centers for Disease Control to call water fluoridation one of the ten most effective public health measures of the 20th Century.
In the 1960s, after years of study into the teeth-strengthening effects of fluoride, the U.S. Public Health Service recommended that drinking water utilities add fluoride at a rate of between 0.7 and 1.20 milligrams per liter (mg/L) or parts per million (ppm) of water. This recommendation held fast until 2015 when the service changed the recommendation to no more than 0.7 mg/L.
Why the change to guidelines that had been in place for over fifty years? The revision was in response to an increasing occurrence of dental fluorosis. This condition happens when the teeth absorb more fluoride than necessary, leading to discoloration of the surface enamel, creating effects like small white spots or brownish “mottling.”
Dental fluorosis is the only known health condition caused by fluoride. As such, it doesn't damage the tooth itself, and is mainly a cosmetic problem. But it can still be avoided if fluoride intake is kept at moderate levels.
The original recommendation was sound science when first introduced. Since then, though, the prevalence of fluoride in everyday life has grown, with the chemical commonly found in dental care products like toothpastes or mouthrinses, as well as many processed foods and beverages and even infant formula. Our society's overall intake of fluoride has been growing as a result.
The new recommendation came after several years of research to verify water fluoridation levels of 0.7 mg/L would still be effective in the fight against tooth decay while lowering the risk of dental fluorosis. With this adjustment, this important and safe measure for keeping your family's teeth protected against disease is safer than ever.
Although energy drinks are but a blip on the historical timeline compared to coffee or tea, they've displaced these traditional stimulants among nearly half of today's adolescents and young adults. But these sweetened “processed” drinks are also controversial among healthcare experts—particularly the effect they may have on dental health.
Besides the added sugar found in many energy drinks—a prime food source for harmful bacteria—many energy drinks and their cousins sports drinks contain significant amounts of acid. High levels of acid soften and erode tooth enamel, which can lead to tooth decay.
During one experimental study, portions of tooth enamel were subjected to a number of name-brand energy and sports beverages. Over the course of a few days, researchers recorded significant enamel loss, especially involving the energy drink samples.
Abstaining from both energy and sports drinks is a sound way to avoid enamel erosion (the best hydrator, it turns out, is simply water). But if you do wish to continue consuming these beverages, here are a few common sense precautions for reduce the risk of harm to your teeth.
Partake only at mealtimes. Among its many abilities, saliva is able to neutralize oral acid and bring the mouth to a neutral pH level within 30 minutes to an hour. But if you're sipping on high-acid beverages throughout the day, your saliva may not be able to compensate effectively. Drinking energy drinks only during a meal helps saliva do its acid-buffering job better.
Rinse with water afterwards. Rinsing with a little water after eating or drinking something acidic can help reduce the pH levels in the mouth. That's because water is by and large neutral on the acidic/alkaline scale. Because it's not adding more, rinsing with water dilutes any concentrations of acid that may still be lingering in your mouth.
Don't brush immediately. Brushing is essential to overall hygiene, but if you do it right after you eat or drink, you could be doing more harm than good. That's because elevated acid levels that naturally occur after consuming foods and beverages can temporarily soften and demineralize the surface enamel. Brushing could remove microscopic bits of softened enamel. If you wait an hour to brush, you'll be giving saliva time to “re-mineralize” your enamel.
If you would like more information on the role of beverage acid in dental 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 “Think Before Your Drink.”
Tara Lipinski loves to smile. And for good reason: The Olympic-gold medalist has enjoyed a spectacular career in ladies' figure skating. Besides also winning gold in the U.S. Nationals and the Grand Prix Final, in 1997 Lipinski became the youngest skater ever to win a World Figure Skating title. Now a sports commentator and television producer, Lipinski still loves to show her smile—and counts it as one of her most important assets. She also knows the importance of protecting her smile with daily hygiene habits and regular dental care.
Our teeth endure a lot over our lifetime. Tough as they are, though, they're still vulnerable to disease, trauma and the effects of aging. To protect them, it's essential that we brush and floss every day to remove bacterial plaque—that thin accumulating film on teeth most responsible for tooth decay and gum disease.
To keep her smile in top shape and reduce her chances of dental disease, Lipinski flosses and brushes daily, the latter at least twice a day. She also uses a tongue scraper, a small handheld device about the size of a toothbrush, to remove odor-causing bacteria and debris from the tongue.
Lipinski is also diligent about visiting the dentist for professional cleanings and checkups at least twice a year because even a dedicated brusher and flosser like her can still miss dental plaque that can then harden into tartar. Dental hygienists have the training and tools to clear away any lingering plaque and tartar that could increase your disease risk. It's also a good time for the dentist to check your teeth and gums for any developing problems.
The high pressure world of competitive figure skating and now her media career may also have contributed to another threat to Lipinski's smile: a teeth-grinding habit. Teeth grinding is the unconscious action—often while asleep—of clenching the jaws together and producing abnormally high biting forces. Often a result of chronic stress, teeth grinding can accelerate tooth wear and damage the gum ligaments attached to teeth. To help minimize these effects, Lipinski's dentist created a custom mouthguard to wear at night. The slick plastic surface of the guard prevents the teeth from generating any damaging biting forces when they clench together.
The importance of an attractive smile isn't unique to celebrities and media stars like Tara Lipinski. A great smile breeds confidence for anyone—and it can enhance your career, family and social relationships. Protect this invaluable asset with daily oral hygiene, regular dental visits and prompt treatment for disease or trauma.
One of the major signs that a young person's dental development is nearing completion is the eruption of the last four permanent teeth: the third molars, located rear-most on either side of both the upper and lower jaws. But the advent of these molars, also called wisdom teeth, isn't always a cause for celebration: They can give rise to serious dental problems.
Wisdom teeth often arrive on an already crowded jaw, making them subject to erupting out of position or becoming impacted, totally or partially submerged in the gums. This can cause harm not only to themselves, but also to other teeth: They can impinge on and damage the roots of their neighbors; impede brushing and flossing and increase the risk of disease; and skew the alignment of other teeth to create poor bites that affect dental health and function.
Wisdom teeth are considered so prone to these problems (an estimated 70% between ages 20 and 30 have at least one impacted molar) that it's been a common practice to remove them before they show signs of disease or poor bite development. As a result, third molar extractions are the most common surgical procedure performed by oral surgeons.
But the dental profession is now reevaluating this practice of early removal. On the whole, it's difficult to predict if the eruption of wisdom teeth in a particular person will actually lead to problems. It may be premature, then, to remove wisdom teeth before there's sufficient evidence of its necessity.
As a result, many dentists now follow a more nuanced approach to wisdom teeth management. An impacted wisdom tooth that's diseased or contributing to disease is an obvious candidate for removal. But if the eruption is proceeding without signs of impaction, disease or poor bite development, many providers recommend not removing them early. Instead, their development is allowed to continue, although monitored closely.
If signs of problems do begin to emerge, then removal may again be an option. Until then, a more long-term watchful approach toward wisdom teeth may be the best strategy for helping a young person achieve optimal dental health.
If you would like more information on managing wisdom teeth treatment, 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 “Wisdom Teeth: Coming of Age May Come With a Dilemma.”
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