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Posts for category: Oral Health

By Katelyn Nieten, DDS
October 12, 2021
Category: Oral Health
Tags: osteoporosis  
OsteoporosisCanCauseComplicationsForSomeTypesofDentalWork

October 20th is World Osteoporosis Day, putting the spotlight on this degenerative bone condition and the impact it has on millions of people. Not only does it significantly increase the risk of potentially life-threatening fractures, but it can also indirectly affect dental health.

This connection arises from the use of certain treatment drugs that ultimately could lead to complications following some forms of dental work. These particular drugs, mainly bisphosphonates like Fosamax™ and RANKL inhibitors like Prolia™, destroy bone cells called osteoclasts, whose function is to clear away worn out regular bone cells (osteoblasts). With fewer osteoclasts targeting them, more older osteoblast cells survive longer.

In the short-term, a longer life for these older cells helps bones afflicted by osteoporosis to retain volume and density, and are thus less likely to fracture. Long-term, however, the surviving osteoblasts are less elastic and more brittle than newly formed cells.

In the end, these longer living cells could eventually weaken the bone. In rare situations, this can result in parts of the bone actually dying—a condition known as osteonecrosis. The bones of the body with the highest occurrences of osteonecrosis are the femur (the upper leg bone) and, of specific concern to dental care, the jawbone.

The effect of these medications on the jawbone actually has a name—drug-induced osteonecrosis of the jaw (DIONJ). Fortunately, there's only a 1% risk of it occurring if you're taking these drugs to manage osteoporosis. It's also not a concern for routine procedures like cleanings, fillings or crown placements. But DIONJ could lead to complications with more invasive dental work like tooth extraction, implant placement or periodontal surgery.

It's important, then, that your dentist knows if you're being treated for osteoporosis and the specific drugs you're taking. Depending on the medication, they may suggest, in coordination with your physician, that you take a "drug holiday"—go off of the drug for a set period of time—before a scheduled dental procedure to ease the risk and effects of osteonecrosis.

Because infection after dental work is one possible consequence of osteonecrosis, it's important that you practice thorough oral hygiene every day. Your dentist may also prescribe an antiseptic mouth rinse to include with your hygiene, as well as antibiotics.

You may also want to talk to your doctor about alternative treatments for osteoporosis that pose a lower risk for osteonecrosis. These can range from traditional Vitamin D and calcium supplements to emerging treatments that utilize hormones.

Osteoporosis can complicate dental work, but it doesn't have to prevent you from getting the procedures you need. Working with both your dentist and your physician, you can have the procedures you need to maintain your dental health.

If you would like more information about osteoporosis and dental care, please contact us or schedule a consultation.

By Katelyn Nieten, DDS
October 02, 2021
Category: Oral Health
Tags: oral health  
CrackedMouthCornersHowtoResolveThisIrritatingProblem

In addition to the usual tooth and gum problems, dentists also see patients with soft tissue infections in and around the mouth. One of the more common of these is the irritation or "cracking" of the corners of the mouth.

Formally known as angular cheilitis (or perleche, a French word, meaning "to lick"), cracked mouth corners are localized irritations made worse by saliva accumulation or an accompanying yeast infection. They're prominent among children and young adults who drool during sleep or while wearing orthodontic braces.

Older adults can also develop cracked mouth corners because of deep wrinkle lines around the mouth ("marionette lines") or tissue irritation from wearing dentures. Teeth loss, especially in the back of the jaws, can weaken facial support leading to collapse of the bite, which can contribute to angular cheilitis.

The condition can cause anything from minor discomfort at the mouth corners to a yeast infection that spreads throughout the mouth and throat. Whatever the symptoms, treatment usually begins with antifungal medication in the form of a mouthrinse or a topical ointment. The dentist may also prescribe a steroid ointment like zinc oxide paste to control inflammation and serve as a barrier against infection.

If the infection has spread beyond the mouth corners, patients may also need to use an antibacterial mouthrinse (usually chlorhexidine) to clear up the infection and help prevent a relapse. Besides cleaning their appliances with chlorhexidine, denture wearers with angular cheilitis should also take their dentures out at night to reduce the chances of a reoccurrence.

Along the same vein, patients who contend with frequent cracked mouth corners and who have missing teeth should have those teeth replaced by some form of restoration. If that involves dentures, it's important to maintain a good fit with them to reduce the chances of tissue irritation. And patients with deep wrinkle lines around their mouth may be able to lessen them through dermatological treatment.

Even though cracked mouth corners rarely pose a major health problem, the discomfort they cause can be a drag on your daily life and activities. Remember that you don't have to suffer—a visit to your dentist could start you on your journey toward relief from this irritating problem.

If you would like more information on angular cheilitis and similar mouth conditions, 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 “Cracked Corners of the Mouth.”

By Katelyn Nieten, DDS
September 02, 2021
Category: Oral Health
Tags: tooth pain  
BothToothDecayorGumDiseaseCouldBecomeSomethingFarWorse

While mouth pain can certainly get your attention, what exactly hurts may be difficult to identify. It might seem to emanate from a single tooth, or a group of teeth. Then again, it might not be clear whether it's coming from teeth or from the gums.

Still, it's important to pinpoint the cause as much as possible to treat it correctly. One of the main questions we often want to answer is whether the cause originates from within a tooth or without.

In the first case, tooth decay may have entered the pulp at the center of the tooth. The pulp contains nerve bundles that can come under attack from decay and transmit pain signals. Incidentally, if the pain suddenly goes away, it may simply mean the nerves have died and not the infection.

The decay can also spread into the root canals leading to the root and supporting bone, and then make the jump into the gum tissues. One possible sign of this is the one mentioned earlier—you can't quite tell if the pain is from the tooth or the surrounding gums.

The root canals could also serve as a transportation medium for infection in the other direction. In that case, gum disease has advanced into the bone tissues around a tooth near its roots. The infection can then cross into the tooth. Again, both a tooth and the gum tissue around it can become diseased.

We have effective treatments for individual occurrences of interior tooth decay or gum disease: The former usually requires a root canal treatment to remove infected tissue and fill and seal the tooth from future infection; we alleviate gum disease by removing the dental plaque causing it and helping the gum tissues to heal. But combined tooth and gum infection scenarios are more difficult to treat, have a poorer prognosis and may require specialists.

To reduce the risk of either tooth decay or gum disease developing into this greater problem, it's best to take action at the first sign of trouble. So, see your dentist as soon as possible when you encounter oral pain or if you notice swollen or bleeding gums. The earlier we treat the initial outbreak of disease, be it tooth decay or gum disease, the better your chances of a successful and happy outcome.

If you would like more information on tooth pain, 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 “Confusing Tooth Pain.”

By Katelyn Nieten, DDS
August 23, 2021
Category: Oral Health
Tags: oral health   nutrition  
RefinedSugarCouldBeHarmingMoreThanYourTeeth

You've probably heard your dentist say more than once to cut back on sweets. That's good advice not only for keeping your teeth healthy, but your whole body as well.

As a carbohydrate, a macronutrient that helps supply energy to the body's cells, sugar is prevalent naturally in many foods, particularly fruits and dairy. The form of which we're most concerned, though, is refined sugar added to candy, pastries and other processed foods.

Believe it or not, three out of four of the 600,000 food items on supermarket shelves contain refined sugar, often hiding under names like "high fructose corn syrup" or "evaporated cane syrup." So-called healthy foods with labels like "low fat" or "diet" have added sugar and chemicals to replace the taste of fat they've removed.

But perhaps the biggest sugar sources in the average U.S. diet are sodas, energy drinks, and sports drinks. With the added volume of sugar in processed foods, the growing consumption of sweetened beverages has pushed the average American's sugar intake to nearly 20 teaspoons a day—more than three times the recommended daily allowance.

And right along with the increased consumption of sugar, cases of Type 2 diabetes, heart disease and other systemic diseases have likewise risen. And, yes, preventable tooth decay continues to be a problem, especially in children, with sugar a major contributing factor in the prevalence of cavities.

So, what can you do to keep your daily sugar intake within healthy bounds?

  • Check ingredient labels on packaged food for added sugar, chemicals or preservatives. If it contains sugar or "scientific"-sounding ingredients, leave it on the shelf.
  • Be wary of health claims on food packaging. "Low fat," for example, is usually an indicator of added sugar.
  • Drink water or unsweetened beverages instead of sodas, sports drinks or even juices. Doing so will vastly lower your daily intake of sugar.

A healthy diet with much less sugar and regular exercise will help you stay healthy. And with a lower risk for tooth decay, your teeth will also reap the benefits.

If you would like more information on the effects of sugar on your oral and general 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 “The Bitter Truth About Sugar.”

AfteraDevastatingInjuryPromptActionSavedSingerCarlyPearcesSmile

Performing for an awards show is a quite a feather in an entertainer's cap. So, up-and-coming country music star Carly Pearce was obviously excited when she gained a slot on last November's Country Music Awards. But an accident a couple of weeks before the event almost derailed her opportunity when she fell and knocked out two of her front teeth.

Fortunately, Pearce took quick action and, thanks to a skilled dental and medical team, was able to put her mouth back together before the show. Those watching her perform her hit single, “I Hope You're Happy Now,” as she smiled broadly would never have known otherwise about her traumatic emergency if she hadn't spilled the beans.

Orofacial injuries can happen to anyone, not just entertainers. You or someone you love could face such an injury from a motor vehicle accident, hard sports contact or, like Pearce, a simple slip and fall. But if you also act quickly like Pearce, you may be able to minimize the injury's long-term impact on dental health and appearance.

Here are some guidelines if you suffer a dental injury:

Collect any tooth fragments. Dental injuries can result in parts of teeth—or even a whole tooth—coming out of the mouth. It may be possible, though, to use those fragments to repair the tooth. Try to retrieve and save what you can, and after rinsing off any debris with cold water, place the fragments in a container with milk.

Re-insert a knocked-out tooth. You can often save a knocked-out tooth by putting it back in its socket as soon as possible. After cleaning off any debris, hold the tooth by its crown (never the root) and place it back in the empty socket. Don't fret over getting it in perfectly—your dentist will assist its placement later. Place a piece of clean cloth or cotton over the tooth and have the injured person bite down gently but firmly to hold it in place.

See the dentist ASAP. You should immediately see a dentist if any tooth structure has been damaged, or if a tooth is loose or has been moved out of place. If you're not sure, call your dentist to see if you should come on in or if you can wait. If a dentist is not available, go immediately to an emergency room or clinic. With many dental injuries, the longer you wait, the more likely the teeth involved won't survive long-term.

A dental injury could happen in a flash, with consequences that last a lifetime. But if, like Carly Pearce, you take prompt action and obtain necessary dental care, you could save an injured tooth—and the smile that goes with it.

If you would like more information about dental injuries, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “The Field-Side Guide to Dental Injuries.”



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