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Dentistry is about more than just checking your teeth. Most dentists have extensive training, education, and knowledge of systemic and oral diseases, and the symptoms to be on the lookout for.  A good dentist will know how to diagnose these conditions, refer you to specialists, and sometimes prevent them from progressing. All of this adds up to comprehensive dental healthcare for you and your family.

Conditions Associated With Oral Medicine

Oral Cancer – Can be diagnosed in early stages by your dentist. If oral cancer is not diagnosed early, it can be life threatening. About 40,000 new oral cancer cases are diagnosed each year in the United States alone. Overall survival rate at the 5 year mark is just 42%. However, if diagnosed early, the survival rate significantly improves to just over 90%.

Routine dental examinations include a full head and neck examination. This allows the dentist to monitor for any changes in the tissue. Also, many dentists use a VELscope for early oral cancer detection. The VELscope is a special light that allows the dentist to see changes in the tissue before the naked eye can see them. This improves chances of early diagnosis via biopsy and thus, higher chance of survival.

If oral cancer diagnosis is confirmed, the patient needs to be monitored during cancer treatment to ensure there is minimal detrimental effect to the teeth and oral tissues. Chemotherapy tends to create oral issues like xerostomia (increases chance of fungal infections of the mouth), mucositis (very painful mouth irritations), tooth decay(due to dry mouth), radiation necrosis (bone death), and periodontal disease. This is why it is recommended that care is coordinated between the oncologist, physician, and dentist.

Following treatment, it is imperative to get routine oral cancer screenings as the chance of oral cancer recurring is quite high.

Temperomandibular Joint Disorder (TMD) – TMD issues can be extremely painful and uncomfortable. As TMD progresses it creates an imbalance in the facial muscles and bone structure leading to issues with simple facial movements and even chewing. Once it gets to this point, the issues get worse as the pain just increases as well as the imbalance. These patients will be at increased risk for tooth decay and periodontal disease since they will be unable to properly perform routine oral hygiene maintenance.

Treatment for TMD ranges from medications and steroids to manage the discomfort and pain to surgical options. Surgery is always the last resort as the surgery does not always pose the answer patients are looking for. Botox is a newer treatment used to freeze the muscles and attempting to restore facial muscular harmonies before the situation gets worse.

Anemia– Patients who are anemic tend to lose papilla on the tongue, giving it a bald appearance, also, fissures of the tongue increase in depth. Anemics also tend to crave ace, and brgin to chew on ice. This is a habit that can easily cause tooth fractures.

Herpes Simplx Viruses (HSV)  – This virus is responsible for cold sores (HSV-1) and genital herpes (HSV-2). Studies have shown that almost 70% of all Americans have been exposed to the herpes simplex virus. Luckily, even if exposed they do not always show symptoms of the virus. Those that do will show the classic mouth sores around the lips. These sores or blisters can be quite uncomfortable and embarassing.

Herpes Simplex virus generally does not affect our oral health unless they are so uncomfortable that we are unable to maintain proper oral hygiene. Treatments for cold sores include changes in diet, increase intake of certain vitamins like E and Zinc, as well as pharmaceutical options. Pharmaceutical options include Xerese and Viroxyn. Both have been shown to be effective in limiting symptoms of outbreaks.

Canker Sores (also called apthous ulcers) – Often confused with cold sores, they are very different. Most canker sores are single, isolated oral lesions usually caused by stress or trauma to oral tissues. Canker sores can occur a few times per year but are not known to be contagious. It is believed that canker sores have a genetic component to them but studies have not confirmed this to date.

It should be noted that canker sores can also be the sign of something more ominous and should be ruled out. General rule of thumb, is if they go away in under 7-10 days, only appear a few times per year, and are small there should be nothing to worry about. However, if they are large, last longer than 7-10 days and occur much more frequently, the patient should be investigated further for the presence of a systemic disorder. These disorders could include anemia, autoimmune disorders, or even inflammatory bowel disease. Sometimes the answer can be as easy as changing your toothpaste to a brand that is SLS (sodium laryl sulfate) free.

Treatment for canker sores include cauterization of sore (to facilitate faster healing), use of topical corticosteroid, or application of Debacterol. Most people will just allow the lesion to heal on its own. If the sore are SLS related, then changing toothpaste to a non-bubbling, SLS-free brand can bring instant relief.

Autoimmune diseases– Many different autoimmune diseases cause issue in the mouth, or face, and jaw joint. Oral fungal infections, arthritic TMJ, oral tissue sloughing and blistering, facial rashes, bone growth, and other symptoms can give your dentist reason to refer you to an immunologist for a thorough workup.

Oral Medicine Conclusion

The bottom line is a well educated and trained dentist is capable of diagnosing more than just tooth decay. Your oral health is inherently linked with your general health. Understanding the importance of regular dental care for you and your family will allow you to get a jump on many diseases that might develop. Early diagnosis is the key to treating many conditions and diseases.

Osteoporosis…What Is It?

Osteoporosis is a disease of bones that leads to a decreased density of bone and subsequent increase in risk of fracture. In osteoporosis, the bone mineral density (BMD) is reduced, bone micro architecture deteriorates, and the amount and variety of proteins in bone are altered.

Osteoporosis is a bone weakening disease that has affected millions of people worldwide. The National Osteoporosis Foundation estimates that osteoporosis is a health threat for about 44 million people in the United States alone. The disease is far more prevalent in women than men. According to The National Osteoporosis Foundation, women are four times more likely than men to develop osteoporosis.

Because of these numbers, it is important for women to maintain a healthy lifestyle and diet even in their youth. Exercise and a proper diet for young women can help build strong bone mass for the future to avoid issues (like osteoporosis) later in life. There are recent studies showing that women who drink wine in moderation tend to have higher bone density than those who abstain from alcohol.

Medications Used for Osteoporosis and their Dental Link

Certain osteoporosis medications (also called bisphosphonates) have possibly been linked to osteonecrosis

Osteoporosis - Marielaina Perrone DDS

Normal Bone Vs. Osteoporosis Bone

(or “death of bone”) of the jaw. Osteonecrosis is bone death caused by poor blood supply to the area. It is most common in the hip and shoulder, but can affect other large joints such as knee, elbow, wrist, ankle, and jaw. Osteonecrosis is a rare and serious disease that can causes destruction of the jawbone. a condition marked by pain, swelling, infection and exposed bone. The majority of cases of osteonecrosis of the jaw involve people with cancer who have been treated with intravenous bisphosphonates. A  number of cases of osteonecrosis of the jaw have been reported in people taking oral bisphosphonates for osteoporosis. These have been primarily associated with active dental disease or a recent dental procedure, such as a tooth extraction.

Osteonecrosis can occur at any age range and can affect a wide range of ethnicity’s. Osteoporosis is considered a very serious disease and is responsible for well over 1.5 million bone fractures per year.

According to the American Dental Association (ADA), osteonecrosis of the jaw linked with osteoporosis medications has mainly been seen in cancer patients who are receiving the bisphosphonates intravenously. In fact, 94% of the cases reported are linked to intravenously-administered bisphosphonates while only 6% are linked with the oral medications.

How Do Bisphosphonates Cause These Bone Issues?

Bisphosphonates are very effective in slowing down the breakdown of bone by targeting the cells which breakdown bone (osteoclasts). An unfortunate side effect is, that they also slow down the bone cells which create new bone (osteoblasts). In areas of the body where the bones do not change much after development, (leg, hip, arm bones), this is not very disruptive. In areas such as the jaw, where bone is constantly reforming and reshaping, the lack of strong bone rebuilding cells is inhibitive to forming new bone after an extraction.

Common Bisphosphonates for Osteoporosis Treatment

Osteoporosis Fosamax Marielaina Perrone DDS

Osteoporosis Medication – Fosamax

-Fosamax

-Boniva

-Actonel

-Didronel

-Skelid

What causes Osteonecrosis?

Osteonecrosis occurs when part of the bone does not get blood and dies. After a while the bone can collapse. If this condition is not treated, the joint will deteriorate and this will become severe arthritis.

Osteonecrosis can be caused by disease, or a severe trauma, that affects the blood supply directly to the bone. Many times, no trauma or disease is present. This is called “idiopathic osteonecrosis” (which means it occurs with no known cause).

Direct Causes of Osteonecrosis:

-Long term use of steroids.

-Abuse of alcohol.

-Sickle Cell Disease.

-Radiation therapy.

-Gaucher Disease. This is a genetic disease in which a fatty substance (lipid) accumulates in cells and certain organs.

-Decompression sickness from a lot of deep sea diving

-Break, Dislocation, fractures around a joint.

Diseases Associated with Osteonecrosis:

-Gout.

-Atherosclerosis.

Diabetes.

Osteonecrosis Symptoms

-Loosening of teeth.

-Pain in the Jawbone.

-Swelling in the area affected.

-Bone becoming exposed.

-Reoccurring Infection.

Osteoporosis Conclusion

It is good to remember that osteonecrosis of the jaw bone from bisphosphonate medication use is quite rare. The drugs being used to counteract osteoporosis have proven benefits to counteract a very serious disease and reduce bone loss. If you are taking any of the bisphosphonate drugs for osteoporosis call your physician before stopping them. It is also very important to inform your dentist that you are taking such medications so they can have it in their medical history in case something arises during your course of treatment.

Maintain a proper diet, exercise regimen, along with regular visits to your dentist and physician to keep your osteoporosis under control.