We’ve come a long way since the early 1980s when we first identified the HIV virus. Although approximately 35 million people worldwide (including a million Americans) now have the virus, many are living relatively long and normal lives thanks to advanced antiretroviral drugs.
Still, HIV patients must remain vigilant about their health, especially their oral health. In fact, problems with the teeth, gums and other oral structures could be a sign the virus has or is moving into the full disease stage, acquired immunodeficiency syndrome (AIDS). That’s why you or a loved one with the virus should maintain regular dental checkups or see your dentist when you notice any oral abnormalities.
One of the most common conditions among HIV-positive patients is a fungal infection called candidiasis (or “thrush”). It may appear first as deep cracks at the corners of the mouth and then appear on the tongue and roof of the mouth as red lesions. The infection may also cause creamy, white patches that leave a reddened or bleeding surface when wiped.
HIV-positive patients may also suffer from reduced salivary flow. Because saliva helps neutralize excess mouth acid after we eat as well as limit bacterial growth, its absence significantly increases the risk of dental disease. One of the most prominent for HIV-positive patients is periodontal (gum) disease, a bacterial infection normally caused by dental plaque.
While gum disease is prevalent among people in general, one particular form is of grave concern to HIV-positive patients. Necrotizing ulcerative periodontitis (NUP) is characterized by spontaneous gum bleeding, ulcerations and a foul odor. The disease itself can cause loosening and eventually loss of teeth, but it’s also notable as a sign of a patient’s deteriorating immune system. The patient should not only undergo dental treatment (including antibiotics), but also see their primary care physician for updates in treating and managing their overall symptoms.
Above all, HIV-positive patients must be extra diligent about oral hygiene, including daily brushing and flossing. Your dentist may also recommend other measures like saliva stimulators or chlorhexidine mouthrinses to reduce the growth of disease-causing bacteria. Together, you should be able to reduce the effects of HIV-induced teeth and gum problems for a healthier mouth and better quality of life.
If you would like more information on oral care for HIV-AIDS patients, 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 “HIV-AIDS & Oral Health.”
“Less is more” is a truism for much of life. It’s also an important feature of an emerging approach to treating tooth decay known as minimally invasive dentistry (MID).
MID updates another revolution in dental care that occurred in the early 1900s. Treating decay took a quantum leap thanks to techniques developed by Dr. G. V. Black, considered the father of modern dentistry. Dr. Black’s approach (known as “extension for prevention”) involved not only removing decayed tooth structure, but also adjacent areas deemed vulnerable to decay, which made them easier to clean. On the downside, though, it also created larger than normal fillings.
As the practice prevailed through much of the Twentieth Century another weakness became apparent—the approach could not guarantee a treated tooth would not experience decay again. This became the real impetus toward MID—to find more comprehensive ways to treat decay with as little impact on the tooth structure as possible.
These efforts received a real boost from emerging technology. This was especially true in diagnostics with the rise of new devices like intraoral cameras and techniques like laser fluorescence that can enable dentists to detect decay much earlier. It’s now possible to catch the disease at an earlier stage before substantial damage to the tooth occurs.
MID has also led to new treatments that preserve more of the tooth structure. Traditional drilling is increasingly giving way to air abrasion, the use of a fine particle stream of aluminum oxide, glass beads or baking soda directed precisely at decayed structure and minimizing damage to healthy structure. We’re also using new filling materials like composite resin for restorations after treatment that are strong yet still life-like and attractive.
We also can’t forget the role of the twin daily hygiene practices brushing and flossing to remove bacterial plaque, the main source of dental disease. And regular dental cleanings and checkups round out the MID approach, helping to ensure that decay doesn’t get too far. The end result of this revolutionary approach: your teeth can experience less impact from treatment and remain healthier and more attractive in the long-run.
If you would like more information on minimally invasive dental care, 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 “Minimally Invasive Dentistry: When Less Care is more.”
Once upon a time, celebrities tried hard to maintain the appearance of red-carpet glamour at all times. That meant keeping the more mundane aspects of their lives out of the spotlight: things like shopping, walking the dog and having oral surgery, for example.
That was then. Today, you can find plenty of celebs posting pictures from the dentist on social media. Take Julianne Hough, for example: In 2011 and 2013, she tweeted from the dental office. Then, not long ago, she shared a video taken after her wisdom teeth were removed in December 2016. In it, the 28-year-old actress and dancer cracked jokes and sang a loopy rendition of a Christmas carol, her mouth filled with gauze. Clearly, she was feeling relaxed and comfortable!
Lots of us enjoy seeing the human side of celebrities. But as dentists, we’re also glad when posts such as these help demystify a procedure that could be scary for some people.
Like having a root canal, the thought of extracting wisdom teeth (also called third molars) makes some folks shudder. Yet this routine procedure is performed more often than any other type of oral surgery. Why? Because wisdom teeth, which usually begin to erupt (emerge from beneath the gums) around age 17-25, have the potential to cause serious problems in the mouth. When these molars lack enough space to fully erupt in their normal positions, they are said to be “impacted.”
One potential problem with impacted wisdom teeth is crowding. Many people don’t have enough space in the jaw to accommodate another set of molars; when their wisdom teeth come in, other teeth can be damaged. Impacted wisdom teeth may also have an increased potential to cause periodontal disease, bacterial infection, and other issues.
Not all wisdom teeth need to be removed; after a complete examination, including x-rays and/or other diagnostic imaging, a recommendation will be made based on each individual’s situation. It may involve continued monitoring of the situation, orthodontics or extraction.
Wisdom tooth extraction is usually done right in the office, often with a type of anesthesia called “conscious sedation.”Â Here, the patient is able to breathe normally and respond to stimuli (such as verbal directions), but remains free from pain. For people who are especially apprehensive about dental procedures, anti-anxiety mediation may also be given. After the procedure, prescription or over-the-counter pain medication may be used for a few days. If you feel like singing a few bars, as Julianne did, it’s up to you.
If you would like more information about wisdom tooth extraction, please call our office to arrange a consultation. You can learn more in the Dear Doctor magazine articles “Wisdom Teeth” and “Removing Wisdom Teeth.”
Stained teeth can be embarrassing — so much so you may even hesitate to smile. Before you seek out a whitening solution, though, there are a few things you need to know about tooth staining.
Tooth staining is more complex than you might think. There are actually two types: extrinsic, staining from foods and other substances of the outer surface of the enamel; and intrinsic, discoloration deep within a tooth that affects their outward appearance. The latter staining has a number of causes, including the type of dental materials used to fill a tooth, a history of trauma or the use of the antibiotic tetracycline during early tooth development.
There are some noticeable differences between the two types, although an examination is usually necessary to determine which you have. Extrinsic staining tends to be brown, black, or gray, or occasionally green, orange or yellow. Intrinsic staining can be red, pink or, if caused by tetracycline and fluoresced under ultraviolet light, yellow. If only one tooth is discolored it’s most likely intrinsic due to decay in the tooth pulp.
What can be done also depends on which type. Extrinsic staining can be modified through whitening, with either an office application or a home kit (there are differences, so you should consult with us before you decide). It may also be essential to modify your diet by restricting foods and beverages (coffee, wine or tea) known to cause staining and by eliminating tobacco use. You should also practice daily hygiene, including brushing with a toothpaste designed to diminish staining, and regular office cleaning and polishing.
Intrinsic staining can’t be addressed by these methods. Instead, you may need to undergo a procedure where we enter the interior of the tooth and insert a bleaching agent. If this isn’t an option, you can also choose a cosmetic restoration such as a porcelain veneer or crown that will cover the tooth to better match the color of your other teeth.
Dealing with stained teeth begins with a visit to our office to determine what type of discoloration you have and to learn your options. But regardless of what type you have, there is a way to a brighter smile.
If you would like more information on the causes and treatments of tooth staining, 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 Staining.”
Your temporomandibular joints (TMJ), located where your lower jaw meets the skull, play an essential role in nearly every mouth function. It’s nearly impossible to eat or speak without them.
Likewise, jaw joint disorders (temporomandibular joint disorders or TMD) can make your life miserable. Not only can you experience extreme discomfort or pain, your ability to eat certain foods or speak clearly could be impaired.
But don’t assume you have TMD if you have these and other symptoms — there are other conditions with similar symptoms. You’ll need a definitive diagnosis of TMD from a qualified physician or dentist, particularly one who’s completed post-graduate programs in Oral Medicine or Orofacial Pain, before considering treatment.
If you are diagnosed with TMD, you may then face treatment choices that emanate from one of two models: one is an older dental model based on theories that the joint and muscle dysfunction is mainly caused by poor bites or other dental problems. This model encourages treatments like orthodontically moving teeth, crowning problem teeth or adjusting bites by grinding down tooth surfaces.
A newer treatment model, though, has supplanted this older one and is now practiced by the majority of dentists. This is a medical model that views TMJs like any other joint in the body, and thus subject to the same sort of orthopedic problems found elsewhere: sore muscles, inflamed joints, strained tendons and ligaments, and disk problems. Treatments tend to be less invasive or irreversible than those from the dental model.
The newer model encourages treatments like physical therapy, medication, occlusive guards or stress management. The American Association of Dental Research (AADR) in fact recommends that TMD patients begin their treatment from the medical model rather than the dental one, unless there are indications to the contrary. Many studies have concluded that a majority of patients gain significant relief with these types of therapies.
If a physician or dentist recommends more invasive treatment, particularly surgery, consider seeking a second opinion. Unlike the therapies mentioned above, surgical treatments have a spotty record when it comes to effectiveness — some patients even report their conditions worsening afterward. Try the less-invasive approach first — you may find improvement in your symptoms and quality of life.
If you would like more information on treating TMD, 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 “Seeking Relief from TMD.”
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