So you have considered quitting smoking? It’s too expensive, you can only smoke in your garage, and people avoid your smoke plumes. If that wasn’t enough let me nudge you a bit further to making the final decision to quit. Consider your mouth, throat and lungs to be the inside of your chimney. It gets black and sooty in your body as well as your chimney.

Sadly most of my patients that require a lot of dental work in their adult years have a history of smoking. This results in more dental chair time and expense. Furthermore, the chances of a favorable long term outcome from treatment are diminished due to smoking. Let me explain why this is so.

First, smoking increases the chance of acquiring oral cancerous lesions. These lesions are painful to remove and healing is slow and painful. Also, oral cancer can kill you.

Tobacco smoke can cause white patches and brown patches to develop in the mouth. White patches can be precancerous and brown patches may be due from increased melanin pigmentation. Regardless, your mouth has changed for the worse.

Tobacco smoking will increase the severity of gingivitis and periodontitis. I can’t save teeth if there is no supporting bone to hold them in place. Acute necrotizing ulcerative gingivitis is a condition where the gums in between the teeth become very sore and chewing is difficult. A higher percentage of my patients with this diagnosis are smokers.

Smoking can cause delayed wound healing by diminishing the blood flow. Also, the microfiber attachment of the gums to the teeth breakdown and allow bacterial infiltration in the deepened crevices.

Smoking will cause chronic coughing and sinus infections as the body recoils from the ash that gets in the airways. This increased inflammatory load on the body can diminish the immune system. Consequently, fungal infections and ulcerations will occur.

On the lighter side smoking can create a condition of black hairy tongue (looks just like it sounds) altered taste, bad breath and tooth stains.
I know that most of you reading this are not smokers. Avoidance and denial keep smokers from seeing warning signs. However, you might have friends or loved ones (children) that smoke and you would like to help them quit. I hope I have given you enough ammunition as a dentist to be of help.

For answers to your dental questions, contact:

Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

There have been studies linking periodontal disease to the other inflammatory diseases, such as cardiovascular disease, diabetes, and various other ailments.  Recently, there have been studies supporting an association between periodontal and upper respiratory disease; respiratory disease, including pneumonia, acute bronchitis, and chronic obstructive pulmonary disease (COPD).  Statistically speaking 9 out of 10 adults have some form of periodontitis.  Because respiratory infections can be debilitating, it is important to further investigate the connection between the two conditions.

Upper respiratory infections typically occur when different types of bacteria are inhaled into the lungs.  Bacteria that cause periodontitis can also be inhaled into the respiratory tract and increase the risk of infection.  Studies have been shown that due to the presence of oral pathogens, the inflammatory response weakens the host’s immune system, thereby increasing the risk for developing or aggravating respiratory infection.  Even though the presence of bacteria is what determines the disease, it is the host’s response to the bacteria that is essential in the initiation and progression of the disease.

It has been found that a group with respiratory disease had poor periodontal health compared to the healthy group.  Despite studies showing the link between to the two conditions, more research is necessary to determine if and how the inflammatory response to the periodontal bacteria leads to the development or exacerbation of respiratory infection.

SOURCES: Donald S. Clem DDS

Sharma N., Shamsuddin H.

Dr. Urban on Today’s Dentistry

HPV and Oral disease

With all the recent dialogue about the HPV virus I felt it would be good to clarify why your dentist is concerned.

The Human Papilloma Virus (HPV) is a common sexually transmitted disease that has been associated with cervical cancers in woman. There are two vaccinations that are currently available for girls before they become sexually active. Although these vaccines appear safe the decision should be run by your doctor to determine whether they should be administered.

Evidence is growing that shows a strong correlation of cancer of the mouth and throat associated with HPV. The rate of increase is alarming and seems to be a result of the increase in oral sex. In fact there are more oral cancers detected every year than cervical cancer. Experts estimate over 34,000 cases of oral cancer detected every year. More than half of these are HPV related.

Your dental team should be performing a visual oral cancer exam on a regular basis. Beginning cancers usually are not detected by the individual who has it and it can be very difficult to spot in the back of the mouth. There are several diagnostic tests your dentist can perform to make this detection easier to accomplish.

If a warty bump appears your dentist may elect to observe it for a while to see if it will disappear on its own or recommend a biopsy. Although biopsy is the most definite way to confirm the nature of the bump we certainly do not want to biopsy everything we see in the mouth. Again, there are tests available help make this determination easier by “looking” under the primary layer of tissue with dyes and fluorescent lights.

Oral cancer exams are no longer performed on middle aged smokers and drinkers. They should be performed on young adults who have no history of smoking. In the future I expect an oral diagnostic test will be readily available for HPV.

Your dentist (me included) does not encounter HPV lesions very often in the general practice. The numbers will confirm that it is still not a very frequent occurrence. The alarming factor is the upward trend of HPV related STD’s and what it may mean in the future. As a precaution it is best to submit to a quick visual inspection of oral cancers by your dental team. Hopefully, the exam and test will be uneventful.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Dentists want to preserve, maintain, and if necessary restore teeth to full function and health. Therefore we preach prevention, encourage daily brushing and flossing, and recommend fillings and crowns to repair decayed teeth. Also, we inform people of harmful habits that lead to unnecessary dental problems. One of these is oral piercing.
I have not seen mature people (over thirty- something) succumb to this desire to poke a hole in their tongue and place a metal stud to show off. However, I have seen our teens and twenty year olds carry their body piercing habits onto the lips and into the mouth.
Let me tell you about the good things that happen when this is done. Nothing!
Now let me tell you about some of the adverse events that have occurred as a result of oral piercing. There have been several reports of severe infections and death as a result of bacterial infections. In fact a young British woman died of blood poisoning and pneumonia within 48 hours of tongue piercing this year. Although this is rare it can happen and would never have occurred if she declined to have the procedure.
Also some young people have experienced tooth movement as a result of pressing the metal ball of the tongue bar against the front teeth. Spaces and gaps are now appearing between the two front teeth. Teeth move when constant light forces are exerted against them. This principle is the basis for orthodontics. When random forces are applied random unpredictable events occur.
In my practice I have witnessed fractured teeth as a result of the metal banging against teeth. This has resulted in some expensive restorative work.-work that would have been unnecessary without piercing and tongue bars.
Lastly, I have observed severe recession of the gums around the lower front teeth. Tongue bars press against the gums on the back of the front teeth and the gums shrink away leaving bare root surfaces. Consequently these teeth become very sensitive and eventually get loose. Lip plugs bang against the front of the teeth causing recession on the front side. A lot of these defects cannot be repaired and will develop into major problems later on in life. Again these self induced dilemmas would never have occurred without piercing.
The ADA does not recommend piercing “because of its potential for numerous negative sequelae”. I am not aware of any dentist who approves of this trend. I can only encourage everyone to spread the word.

The National Institutes of Health estimates that over 10 million people suffer from TMJ problems. It can affect both sexes, but it is most common in women during their childbearing years.

TMJ is an acronym for the temporomandibular joint. This joint is located in front of the ear and basically holds the jawbone in place. Ligaments and a specialized cartilage disc hold the joint together during movement. Like any joint in the body it can suffer injury due to trauma. This injury of the joint may result in headaches, earaches, toothaches, limited jaw movements, clicking, popping, and dislocations. Let’s talk about trauma.

Grinding of teeth can create undo force and traumatize the jaw joint. Clenching or grinding of teeth (called bruxism) can occur during stressful situations and even while we are asleep. Nighttime grinding during sleep is characteristically loud and evident to others nearby. It is generally not possible to duplicate the same force exerted by this nighttime grinding while you are awake. Your body’s conscious defenses will not allow for this harmful action. Your dentist can make you a mouth guard to keep the teeth from grinding while you sleep.

Misaligned teeth can force the joint to close and open in a pattern that it was not built to withstand. Rupture of the cartilage capsule that cushions the joint and tearing of the ligament that stabilizes the joint during range of motion can be the long-term result of this misalignment. Clicking and popping are the usual signs of damage. Occasional tenderness may ensue with episodes of severe pain and limited opening. Adjusting the bite or orthodontic treatment will help alleviate this problem. Mouth guards and anti-inflammatory medications may also be indicated for short-term relief.

Temporomandibular joints that are not working properly may be painful and noisy. Since joint stabilization (i.e. splint with a cast) is not feasible it is imperative to follow your dentist’s instructions to not aggravate the joint while it is trying to heal. This means staying on a soft diet (preferably blended food), cut food into small bites, not chewing gums or hard chewy foods, and not opening your mouth any wider than the thickness of your thumb. Applying moist heat to the joint 20 minutes twice a day is better than dry heat. If the joint is inflamed, ice packs are more beneficial than heat. Your dentist will advise you on your situation.

Most TMJ problems are actually muscular in origin. Muscle pains are caused by severe spasms and contractions that can pull against the fragile joint and cause migraine-like headaches. Relieving the muscular contractions will result in improvement. This is accomplished with a specialized mouth guard that is worn only on the front teeth that reduces the muscular contraction intensity.

Once the joint is damaged the body tries to repair itself. In most cases our body’s repair effort is successful unless the joint is re-injured. Check with your dentist if you have experienced popping, clicking, or pain in the TMJ.

In previous articles I have discussed sleep apnea, acid erosion and worn out teeth. What do they all have in common? Why is my dentist concerned about acid reflux? Don’t teeth get worn out when we get older?
Dentists examine your teeth for premature wearing of the tooth surfaces. Some people’s teeth appear very short while others stay relatively unchanged. If the teeth are misaligned premature wear patterns will develop very early in life. That is why we recommended orthodontic correction in young adults. However, if a young adult has straight teeth yet they have abnormal wear , dentists look for other causes.
Abnormal wear can occur from inadequate lubrication from the saliva (dry mouth), an acid saliva, or from habitual grinding or gnashing of the teeth during the day and while we are asleep. It has been estimated that 30% of young children grind their teeth while sleeping. This usually disappears when the baby teeth are lost and replaced by the adult dentition. Unfortunately, adults only have one set of teeth to get by with for a lifetime so dentists take teeth grinding (pardon the pun) very seriously.
Sleep grinding episodes are related to sleep disorders. Severe snoring and pauses in breathing seem to trigger more grinding. Also, as you know the mouth is dryer at night and there is no lubrication (like well- greased bearings) to keep the teeth from abnormal wear and tear.
Acid reflux disease (GERD) can be the cause of disturbed sleep patterns. The acid contents of the stomach can gurgle up into the mouth while we are asleep. The acid level is similar to gargling with battery acid. It is very erosive and will quickly dissolve your teeth if left untreated.
So we now have the perfect storm of events occurring. As you can imagine with nighttime dry mouth, acid erosion, and teeth gnashing your dentition is in a very hostile environment. I hope you can better appreciate why your dentist may show concern over abnormal tooth wear.
The teeth will look extremely flat and worn. They will wear in odd patterns and lose a lot of vertical height. Eventually, spaces will appear at the gums between the teeth and you will look old before your time. Your dentist should take periodic close up photos of your teeth to monitor change.
What is the treatment for this problem? First, your physician should be made aware of acid indigestion and general sleepiness. Others around you may have heard uncommon snoring or mentioned a look of tiredness. Your physician may order a sleep study test to rule out sleep apnea (a life threatening problem). GERD will definitely require a change of diet, loss of weight, and usually medication. Your dentist will be able to provide a customized mouth guard to wear at night to protect the remaining teeth. Once stabilization is reached you may require restoring the teeth to their original condition.
Early detection and treatment will certainly keep the worn dentition from developing so quickly.

As a kid I remember the big news in dentistry was the debut of the air driven high speed dental drill. Before the invention of the air turbine dental handpiece it would take a dentist quite some time to remove decay and prepare the tooth for a filling. It would take a very long time for larger inlays and crowns. The ordeal to have one tooth worked on was time consuming, somewhat frustrating, and smelly. The high speed dental drill was going to decrease this time involvement and be almost painless. The public (including me) was very excited about the painless part.
After fifty years of service this technology has certainly made it easier to perform dentistry, however, most dentistry still requires local anesthesia. The euphoric painless part of the news was optimistic and not proven. Recently, lasers have been advertised as pain free dental tools requiring little or no anesthetic for dental cavities. Micro sand blasting cavities and chemical solutions for dissolving have largely come and gone. Although these technologies are promising they haven’t delivered what the manufacturer’s were promising-a replacement for the dental drill. Depending on the depth of the decay and each individual’s threshold of pain these technologies may allow some “needleless” dental work. In my experience there has been no 100% assurance that dental work without anesthetic is possible-yet.
The point is that when a person reads or hears about a miraculous dental advancement offering pain free “needleless” dentistry don’t get up false hopes. Talking to your dentist is the best way to wade through this overly optimistic advertising. Believe me your dentist would love nothing better than to perform dentistry without local injections. No stress with happy outcomes really “makes my day”.
On a more positive note the advanced technologies have added another tool to the dental office to provide more conservative tooth preserving dentistry. High speed drills allow the dentist to prepare a tooth in minutes with cooling water spray to wash away the debris. Lasers can be used for surgical procedures with rapid healing response. Micro sandblasting is very conservative and improves the bond strength of your dental fillings in tiny crevices.
Recently, ads on the radio and newsprint have claimed to overhaul your mouth in one visit while you sleep, place implants at a very low cost, etc. For most of us these are just “hooks” to get interested. These treatments will cost the same as with your own dentist. Sleep dentistry is common and your dentist can usually accommodate your needs with oral medications or an onsite anesthesiologist. Also, your dentist will use implants and materials that are proven and manufactured by reliable companies.
As an afterthought dentistry is more about relationships than a per tooth service. You and your dentist have invested a long time in nurturing this relationship together. When a crisis occurs or a tooth ache develops you should be comfortable in hitting the speed dial on your phone and getting a hold of your dental office and know who is on the other end of the line.

Last time I discussed using xylitol sweeteners to lower the incidence of tooth decay. This is good prevention. But what happens when decay first begins and teeth become sensitive? There is now a dental cream that can be applied at home that will help harden teeth by remineralizing the soft enamel of the tooth.

The active ingredient of this cream is RECALDENT™ (CPP-ACP). It is marketed by GC America Inc. in the product named MI Paste Plus. It is also available in the Trident XtraCare with Recaldent and Trident Recaldent Calcium Sugar-free tablets.

MI Paste is pleasant tasting and adheres to the tooth surface acting like a magnet for minerals to bond back onto the tooth surface. This makes the tooth tougher and more resistant to acid etching from bacteria, foods, and saliva.

Who would benefit from MI Paste? It is safe for 1 year old children to senior citizens. MI Paste is dispensed by dentists to people who have a moderate to high decay rate. It is good for people who have a high acid level in their saliva. MI Paste helps reduce the erosion caused by dry mouth. If bleaching your teeth causes them to be sensitive you should apply the cream immediately after bleaching. If you are undergoing chemotherapy or radiation therapy to the head and neck area, MI Paste will help protect the teeth during this trying time.

MI Paste without fluoride is a better dentifrice for little kids who can barely brush their teeth. When they become older they can use regular toothpaste and then apply a small amount to their teeth before school and before bedtime.

This cream is also recommended for kids wearing braces. It is very difficult to fully clean every nook and cranny while the brackets and wires are on the teeth. MI Paste helps neutralize the acid levels caused by the remaining bacteria. Despite all efforts to protect the teeth white spots may appear after removing the brackets. The cream can then be applied to help remineralize these white spots (some white spots can be the beginning of decay).

Dry mouth is a common symptom due to age, stress level, smoking, dehydration, mouth breathing, caffeine, alcohol, medication, medical condition, and chemotherapy. Erosion of the tooth surface will occur even faster if the mouth is dry. MI Paste will help restore the hardness of the enamel and reverse the erosion process.

The cream should be used until the dentist determines that the decay rate has stabilized, white spots disappear, and remineralization has occurred. Thereafter you can use the Trident products containing Recaldent to maintain the remineralized teeth. MI Paste can be purchased through your participating dentist or through Amazon.com

If it is so wonderful, why doesn’t everyone use it? Well the need must be compelling and the cost is about five times more than an equivalent amount of over the counter toothpaste. There is one last thing about MI Paste. It is sweetened with xylitol.

It is estimated that at the beginning of the 1900’s less than 1% of the world’s population was over 65 years old. By 2050 it will be a least 20%. This is quite a challenge for the dental community because people are generally keeping their teeth well into retirement.

We see functionally independent healthy older adults, frail older adults, and functionally dependent seniors. Each group has different dental problems. I have seen an increased rate of decay in adults due to gum recession, continued poor oral hygiene care, and dry mouth caused by numerous medications. This type of decay is rapidly destructive and quite costly to restore, if restoration is even an option.

Although implants are an option they are significantly more costly than frequent recall visits with the dentist.

Okay-for the good news-let’s talk prevention. Habits usually stay with us for a lifetime unless some dramatic change occurs within us. Developing good health habits like exercise, balanced and moderate diet, and vitamin supplements makes a high quality of life more attainable. Taking care of the digestive system starts with the mouth. We were given teeth for a reason so let’s keep them. Seeing your dentist in retirement years (I know employer provided dental insurance sometimes stops) is more cost effective than waiting for  big problems to develop. I recommend frequent (every 3-4 months) recall cleanings and exams to monitor the teeth, gums, mouth tissues, salivary output, and health changes for our seniors.

At these visits the dentist can help fight dental disease with prescribed antimicrobial mouth rinses like chlorohexidene. Also, your dentist can advise you on using prescription fluoride dental creams or topical fluoride applications. I like the new fluoride varnishes that we paint on for decay prone teeth of everyone from preschoolers to seniors. The hygienist should be allowed to closely monitor any changes in the health of the gum tissues before bone destruction is allowed to occur. Teeth should be evaluated for extreme wear and possible fractures and steps should then be taken to mitigate these problems.

Teeth yellow and darken as we age. Keep a healthy dentition looking good.  Consider bleaching-it is safe and everyone does it. Hopefully this information will give you an incentive to continue taking care of your teeth.

Finally, have the dentist screen you annually for early signs of oral cancer. Oral cancer has a higher mortality rate than cervical cancer and affects a larger population. Your dentist or hygienst can use a screening kit to closely scrutinize soft tissues for abnormal changes. It is a simple test that provides a highly reliable result for peace of mind.