Family & Cosmetic Care in a Comfortable, Relaxed Environment.

Serving Las Vegas and Henderson, Nevada since 1999.

Medications are any chemical substance used in the treatment, cure, or prevention of disease. It can also be used as a supplement to enhance a person’s physical or mental well being.

Over the course of our lives we will all, most likely, take some form of medication. The medications can just be a simple over the counter pain reliever or something prescribed by your physician for a more serious medical condition. Did you know many of these medications also affect your oral health?

Prescribed and over-the-counter drugs, vitamins, minerals, and herbal supplements can all cause oral health issues. Some of these issues include, dry mouth, inflammation, overgrowth of the gums, changes in taste and bone loss.

Oral Health Side Effects of Medications

Some of the most common oral health side effects include:

1) Xerostomia or Dry Mouth. Medications that can cause dry mouth by decreasing salivary flow include: antihistamines, decongestants,  high blood pressure medications, medicine for Parkinson’s disease, pain medication, and antidepressants. There are hundreds of medications that list dry mouth as a side effect. Xerostomia is quite common,and needs to be monitored for your oral health to be maintained. Without proper salivary flow, you will be more likely to develop more tooth cavities and periodontal infections.

Tips to Combat Dry Mouth

-Drink lots of water throughout the day to keep your mouth wet and moist. This will also help to rinse your mouth throughout the day to minimize tooth decay and bacteria buildup.

-Stop using or cut down on caffeinated drinks, sugary beverages, alcohol, and tobacco. All of these contribute to dry mouth.

-Chew gum to promote salivary production. Recommend a sugarless gum or one with xylitol.

-Avoid salty and spicy foods. This can not only dry you out further but cause some discomfort as you are unable to wash the spices away as quickly without the proper amount of saliva.

-Use a humidifier at bedtime. Many people feel this helps to keep their mouths moist through the night.  Works well for mouth breathers.

-Use an artificial saliva rinse, and dry mouth specific products. These will allow you to keep your mouth moist and avoid the problems mentioned above. Biotene is a good example of such products.

2) Abnormal bleeding. Medications known as blood thinners can cause prolonged bleeding of tissues in your mouth. These include aspirin and anticoagulants (such as Heparin). These medications work by lowering the ability of the blood to form clots. They are helpful in preventing heart attacks and strokes but they can cause excessive bleeding especially during any type of oral surgery, or even after a deep cleaning. It is therefore very important to tell your doctor or dentist if you are taking this type of medications.

3) Change in taste. Many drugs can give you a metallic or bitter taste. While others can totally change the way you perceive taste of different foods. Some good examples of these medicines are as follows:

-Heart medications. Such as beta blockers or calcium channel blockers.

-Flagyl (metronidazole). This is an antibiotic.

-Nicotine skin patches. These patches are used for people who want to quit smoking.

The only option for these patients usually is to deal with the side effects of the medication or ask your physician if there is some other medication that can work in its place.

4) Inflammation, gum overgrowth, mouth sores, or changes in color of the soft tissues in your mouth. These can include blood pressure medications, immunosuppressive drugs, oral contraceptives, and some chemotherapy drugs. If you are having issues with these drugs let your dentist know. You may need to increase your oral hygiene regimen to maintain a healthy mouth.

5) Tooth Cavities. Various medications contain sugar. Many children’s medications have a high amount of sugar in them to improve taste. Too much sugar as we know can lead to tooth cavities. Sugar can also be found in cough drops, antacid tablets, anti fungal lozenges, and many vitamins.

Tips to help lower risk of tooth decay from medications:

-Take the medications at mealtimes, not at bedtime.

-Drink water after taking medications.

-Make you or your children brush or chew sugarless (or xylitol) gum after taking the medication.

-Visit your dentist regularly for dental care.

6) Bone loss. Medications such as corticosteroids (like prednisone) and anti-epilepsy drugs can lead to bone loss. Medications used in the treatment of osteoporosis (bisphosphanates) can lead to a rare condition called osteonecrosis of the jawbone. This results in destruction of the bone. Symptoms can include painful, inflamed gums, loos teeth, jaw numbness, fluid in the gums or jaw, and bone that becomes exposed.

If you are taking medications for osteoporosis be sure to tell your dentist. The dentist may be able to prescribe you an antibiotic or non steroidal anti inflammatory drug (NSAID) to slow your bone loss.

7) Thrush, or an oral yeast infection. Thrush is caused by a fungus (Candida) and shows up in the mouth as white and red lesions on the tongue and/or surrounding tissues. Taking antibiotics, steroids, or going through chemotherapy can cause thrush. The general course of attack in dentistry is to recommend anti fungal mouthwashes or lozenges. If that does not work, then a stronger anti fungal medication will be needed.

Bottom Line on Medications and Your Oral Health

All of the medications listed above generally serve a greater purpose for the maintenance of your overall health. Therefore these side effects from medications must be dealt with, as we cannot just stop taking these medications. This is why it is so important to be open and honest to all your physicians and dentists letting them know everything you are taking. Your treatment may need to be altered or monitored closely by your dentist. You may not realize the impact your specific medications may have on your oral condition, but your caretakers do.

Diabetes Mellitus, or simply diabetes, is a group of metabolic diseases in which a person has high blood sugar. This is happens when the body does not produce enough

insulin, or because cells in the body do not respond to the insulin that is produced. The the classical symptoms of  Diabetes are, frequent urination (polyuria), increased thirst (polydipsia) and increased hunger (polyphagia).

3 Different Types of Diabetes

Type 1 Diabetes – This type results from the body’s inability to produce insulin. This type of diabetes usually begins at a young age and requires the person to inject insulin or wear an insulin pump. This form of diabetes has also been called insulin dependent diabetes or juvenile diabetes.

Type 2 Diabetes – This type results from insulin resistance. This occurs when the cells in the body are unable to utilize the insulin in the body in the right way. Can also be combined with a deficiency of insulin in the body. This form of diabetes is also called non insulin dependent diabetes or adult onset diabetes.

Gestational Diabetes – The last main form of diabetes occurs in women during pregnancy. Women who are pregnant may develop this form of diabetes and it may precede development of type 2 diabetes. Women with this form must be monitored closely for their own health as well as that of the baby.

Diabetes Effect on Dental Care

If you suffer from diabetes then you may be at a higher risk of developing many oral health issues vs people without diabetes. Diabetes increases your risk of developing periodontal disease. Diabetes reduces your ability to fight off infection. You are also more susceptible to acquiring oral infections (both bacterial and fungal) with diabetes , these infections also take longer to heal. Thrush is a common fungal infection prevalent in diabetics. Thrush (oral candidiasis) produces red and white patches in the mouth and on the tongue. These patchy areas can progess into ulcers which cause an itching, painful, burning sensation and difficulty swallowing. Diabetes also causes dry mouth. Dry mouth allows cavity bacteria to overgrow and quickly decay teeth.

So what can a diabetic patient do?

Top 5 Dental Tips for Diabetics

1) Maintain Good Oral Hygiene at Home. It is recommended to brush your teeth twice a day at the very least. Although

after every meal or snack is even better. Use a soft bristled brush or electric toothbrush with a fluoride toothpaste. Avoid aggressive brushing which can irritate your gums and lead to infection. Flossing should be done at least once per day. Flossing can be done with regular flossing or with various interdental cleaners on the market like the flosser. A good mouthwash can be recommended as well to help combat the level of bacteria in the mouth. Chew gum and try sugar free candy after meals to keep saliva flowing and acid levels down. Drink water often and keep sugary beverages to a minimum.

2) Good Control over your Blood Glucose Levels. This will help not only your oral health, but also your overall health. Maintaining good blood glucose levels will help reduce the risk of developing infections as mentioned above. If you do acquire a mouth infection you should see your dentist immediately. They can prescribe an anti fungal or antibacterial medication to treat the infection. Monitor your blood sugar level, and keep your blood sugar level within your target range as outlined by your physician. The better you control your blood sugar level, the less likely you are to develop periodontal disease and other dental issues.

3)  Regular Dental Exams and Cleanings. Diabetes patients should visit your dentist 2-4 times per year for dental examinations and professional cleanings. Remember to let your dentist know that you have diabetes. This should include whether or not it is well controlled and discussing any medications you may be taking.  Also, inform your dentist about any oral or dental problems you may be having, including dry mouth. To prevent low blood sugar during dental work, you might want to eat before your dental visits.

4) Denture Care. Patients who wear dentures are more prone to developing thrush. Dentures should be removed and cleaned daily. It is usually recommended to remove dentures for periods of time to give the tissues a chance to avoid irritations and to heal any irritations which might occur.

5) Do Not Smoke. Smoking is bad for the healthy individual but for those with diabetes it is doubly important to avoid smoking. Smoking increases the risk of serious diabetes complications, including periodontal disease and oral infections. If you do smoke, ask your doctor about options to help you quit.

Managing diabetes is a lifelong commitment that must include proper dental care. Your efforts will be rewarded with a lifetime of healthy teeth and gums.

 

Almost one third of all Americans diagnosed with cancer each year will develop oral health issues. Patients who undergo life saving treatments for various cancers are usually unaware they may develop painful and debilitating conditions following their cancer treatment. A thorough dental examination is a critical step in maintaining their overall health throughout cancer treatment. This includes examination prior to, during, and after cancer treatments. Untreated oral disease can also complicate cancer treatment. The dentists role in patient management can be beneficial to the patient beyond their oral cavity.

Cancer can be treated or slowed down with proper treatments like, chemotherapy and radiation therapy. The type of treatment can be very effective but also can have very debilitating or even painful side effects that can can affect other parts of your body. These can include your mouth, teeth, gums, oral tissues and salivary glands. Being aware of these possible cancer treatment side effects can help patients reduce and manage them with help from physicians and dentists alike.

How can your oral health be affected by cancer?

Chemotherapy and radiation therapy treatment for cancer can have oral side effects. This varies depending on the type of cancer and the aggressiveness of the treatment. Those side effects can display

American Cancer Society

American Cancer Society

themselves in different ways:

-Dry Mouth (Xerostomia). Salivary production and flow are affected because the salivary glands can be affected during treatments for cancer.

-Tooth Decay. This can happen very rapidly due to the dry mouth condition.

-Burning Mouth Syndrome. There might be a painful or burning feeling in the mouth, tongue and gums. This also occurs from the reduction in salivary flow.

-Erosion of teeth due to high acid in the mouth following reflux and vomiting

-Stiffness in jaws..

-Problems with eating, speaking, and swallowing.

-Alteration of taste sensation. Your ability to taste properly will decrease..

-Gum inflammation and swelling, Periodontal disease can develop.

-The immune system is weakened.

In order to manage all the side effects from cancer, your dentist can make you recommendations to keep your mouth comfortable and healthy.

Dental Examination Before Treatment of Cancer

A pretreatment dental examination can identify potential issues and help educate the patient about the importance of maintaining good oral care. This examination can be completed by a your local or by a hospital based dentist. The evaluation includes a thorough examination of hard and soft tissues It will also include x-rays to detect trauma and possible sources of infection. Before cancer treatment begins, the dentist can also do the following:

-Removal of orthodontic bands if highly stomatotoxic chemotherapy is planned or if the bands will be in the field of radiation.

-Evaluate comfort and fit of dentures and oral appliances.

-Any teeth that need to be removed or have large fillings, crowns, should be performed at least two weeks prior to the beginning of radiation therapy to allow for proper healing, and at least 7-10 days before myelosuppressive cancer chemotherapy starts.

-For adults receiving head/neck radiation, removing teeth that may pose a problem in the future. The jaw bone , after being exposed to radiation does not heal properly following trauma, a simple removal of a tooth can result in bone death (osteonecrosis) which can destroy large areas of jaw bone. If you receive head and neck radiation you will need to take extreme precaution to avoid needing extractions for the rest of your lifetime.

-For children, consider extracting highly mobile primary teeth and teeth that are expected to fall out during the cancer treatment window.

-Instruct patients on the maintenance of proper oral hygiene, nutrition, the use of fluoride gel, rinses, dry mouth products, and the need to avoid tobacco and alcohol use.

During the examination, the patient will also learn about home care to protect oral tissues and minimize oral complications. The dentist or hygienist will instruct the patient on special brushing and flossing techniques, mouth rinses, and other approaches to keep the mouth as moist and clean as possible to reduce the risk of infection and pain.

Oral Care during Treatment

Even with examinations before cancer treatment, regular oral exams and care are necessary during cancer treatment. Good communication and planning between physician and dentist can reduce the Dental Carerisks of oral complications and maximize the efficacy of dental and supportive care. Specific oral health symptoms to remember when treating patients undergoing chemotherapy or radiation include the following:

Symptoms can include:

-A sticky, dry feeling in the mouth.

-Trouble chewing, swallowing, tasting or speaking due to dryness in oral cavity.

-A burning feeling in the mouth.

-A dry feeling in the throat and tongue.

-Dry,Cracked lips.

-Mouth sores.

-A fungal infection in the mouth or at the corners of the lips, like oral candidiasis.

Chemotherapy Issues

-Fever of unknown origin may be linked to an oral infection.

-Have the patient schedule appointments carefully. Patients should be seen when blood counts will be at safe levels.

-Conduct blood work 24 hours before dental treatment to determine whether the patient’s platelet count, clotting factors, and absolute neutrophil count are at adequate levels to prevent hemorrhage and infection.

-If the patient has a central venous catheter, careful consideration should be given to implementing the American Heart Association (AHA) prophylactic antibiotic regimen before any dental work.

Radiation Therapy Issues

-Treat infections. Ulcerations and dry, friable tissues are easily infected.

-Nutrition.Instruct the patient on the importance of healthy eating to maintain nutritional status, emphasizing the need to avoid foods that irritate sore tissues or cause dental decay.

-Show patients exercises to reduce tightening of mouth muscles,( trismus). Fibrosis of the tissue may occur if the chewing muscles are in the direct field of radiation. Ask your dentist to teach you how to exercise and stretch these muscles properly to avoid or alleviate the symptoms.

Follow up Dental care

Patients may continue their regular dental care schedule once all complications from chemotherapy have subsided and blood counts have recovered.

Once radiation therapy has been completed and acute oral complications have subsided, the patient should be evaluated by a dentist every four to eight weeks for the first six months. After that the dentist can decide the schedule the patient needs based on findings.

Post Cancer Treatment

Head and neck radiation therapy can cause oral complications that continue or emerge long after treatment has been completed. Although cancer patients may no longer be under an oncologist’s care at that time, what they learn about oral health during their treatment will affect how they deal with subsequent complications. Patients receiving radiation therapy need to know about its risks:

-High dose radiation treatment carries a lifelong risk of osteonecrosis, xerostomia and dental cavities

-Because of the risk of osteonecrosis, people who have received radiation should avoid invasive surgical procedures (including extractions) that involve irradiated bone

-Radiation to the head and neck may permanently reduce the quantity and quality of normal saliva. Daily fluoride application, good nutrition and maintaining proper oral hygiene are very important.

-Radiation can change oral tissues. Dentures may need to be remade or relined after treatment is completed and the tissues have become stable. Some patients are never able to wear dentures following cancer treatment again because of friable tissues and xerostomia

-A dentist should closely observe children who have received radiation to craniofacial and dental structures. They want to ensure that abnormal craniofacial growth and skeletal development does not occur.

Cancer can be a very debilitating disease in many areas. But if planned accordingly before cancer treatment, we can limit those issues together and face them head on to create the scenario for the best possible outcome from cancer.

Diabetes affects almost 26 million people in the United States and is a growing problem due to the obesity epidemic.  The relationship between a person’s oral health and his/her diabetes is of utmost concern to health care professionals but especially dentists.

Patients with Diabetes have an increased risk of oral health issues due to poorly controlled blood sugars. Diabetes impairs white blood cells, which are the body’s main defense against bacterial infections.  These bacterial infections can affect everything in the mouth as well as the rest of the body.

A number of oral disorders are associated with Diabetes. The association between periodontal disease and diabetes has been studied at length with a definite correlation between the two.

The common oral health issues facing Diabetic patients include:

*Increased Dental Caries. There has been no study to effectively correlate this relationship. But anecdotal evidence leads me to believe this is a real problem for Diabetic patients withBioteneout good control over their blood glucose levels. Patients who are type 2 diabetics(meaning that it is not genetically caused but caused by diet) tend to eat more carbohydrates and sugary foods enhancing the possibility of increased caries rate. Also some patients experience xerostomia, which is more commonly referred to as “dry” mouth. I usually recommend Biotene for patients.Biotene  has the added benefit of containing a bio-active salivary enzyme protein system that actively combats bacteria, reducing bad breath, improving oral hygiene and relieving oral dryness.Some of the salivary dysfunction is caused by medications and age as well.

*Oral Mucosal Disease and other infections. Different types of oral disease are found, including lichen planus and recurrent aphthous stomatitis. People with diabetes that are often taking antibiotics to fight off infections are prone to developing Oral candidiasis(a fungal infection of the mouth and tongue). Oral candidiasis is found more frequently in patients with diabetes. Candidiasis occurs due to a patient being in a weakened immune state as well as a secondary response to the “dry” mouth mentioned above. This particular fungus thrives on the high levels of sugar in the saliva of people with uncontrolled diabetes.  This fungus results in a burning sensation in areas of the mouth and sometimes a loss or change in taste.

*Periodontal Disease (gingivitis and periodontitis) have been shown to have a direct link to Diabetes. It has been noted that elevated levels of Periodontal disease also lead to complications in management of blood glucose levels. This disease tends to be more prevalent and more severe in diabetic patients than in the general population. This is mainly due to the fact that diabetics have decreased wound healing and infection fighting ability.

Diabetics who smoke are at a much higher risk of disease.  Their risk factor can be as much as 20x more likely than non-smokers to develop thrush and periodontal disease. Smoking does seem to reduce blood flow to the gums and this can also affect healing in the tissue area.

Because people who suffer from diabetes can be more prone to symptoms that may harm their oral health, it’s very important to follow dental home care instructions and to note any changes in your oral health. Promptly schedule a dental consultation if you notice any changes.

Dental Hygiene for Diabetics

We always recommend visiting the dentist and hygienist at least twice a year but it is doubly important in patients with diabetes. They need to strive to keep their mouths as bacteria free as they can. In conjunction with proper brushing we also recommend that patients floss after every meal if possible. A daily mouthwash can be beneficial as well.