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Everyone knows the basic structures of the mouth including your teeth and gums. But there is more to your mouth than just those two anatomical parts. This means

Maintain Oral Health - Marielaina Perrone DDS

Anatomical Structures of the Mouth

maintaining good oral hygiene goes beyond just your teeth and gums.  In addition to your teeth and gums, your mouth is made up oral mucosa, the upper (maxilla) and lower (mandibular) jaw, the tongue, salivary glands, the uvula, and the frenulum. All of these structures play an important role when it comes to good oral health and are regularly examined by your dentist when you receive dental care.

Anatomical Structures of the Mouth

- Oral Mucosa. When you look in your mouth everything that is not a tooth is the oral mucosa. The oral mucosa is a protective lining and includes the gum tissues. This lining is very similar to the lining in your nostrils and inner ears. The oral mucosa plays a very large and essential role in maintaining your oral health. It is also important in maintenance of your overall health by defending against germs and other irritants that come into your mouth. The oral mucosa has a tough component called keratin. Keratin (also found in fingernails and hair) helps keep the oral mucosa protected from injury.

-Gums or gingival tissue. Your gums are the pink, attached, colored tissue that envelops and supports your teeth. Also covered by oral mucosa, gums play a critical role in your oral health. Healthy gums are firm, cover the entire root of the tooth, and do not bleed when brushed, flossed, or probed. Diseased gum tissue, or Periodontal disease can ultimately progress to tooth loss. This makes it essential to take care of your gums by flossing daily and brushing regularly.

-Upper (Maxilla) and Lower (Mandible) Jaws. Your jaws are an essential structure of the mouth and face. The jaws give your face its shape and are the structures holding your teeth. They are needed for chewing and speech. The Upper jaw or Maxilla is made up of two bones fused together and then to the rest of the skull. The lower jawbone (mandible) is separate from the rest of the skull which allows it to move up and down, and side to side in your jaw joint (TMJ) when you speak and chew.

-The Tongue.  This is an extremely strong muscle covered in specialized mucosal tissue that also includes the taste buds. The tongue is unique in that it truly plays a dual role in our health. The tongue plays an integral role in the ability to speak. It does this by allowing people to shape the sounds that come from your mouth. It’s other role is being a part of the body’s digestive system. The tongue is responsible for moving food over to your teeth and following chewing, the tongue moves to the back of the throat so it can force it down to continue on its path thru swallowing. In infants the tongue and jaw work as one to allow the infant to breastfeed.

-Salivary Glands. There are three different major salivary glands in your mouth and neck. These are the parotid, sub mandibular, and the sub lingual glands. There are also smaller, or minor salivary glands in your hard palate, soft palate, and inner lip. These glands are responsible for producing saliva. Saliva is critical to maintaining good oral health. It functions in the following ways:

1) Breakdown of food. Saliva contains special enzymes that help break down food. This makes it easier for you to digest your food.

2)Lubrication. Saliva aides in swallowing food by acting as a carrier of foods out of the mouth and into the throat. Saliva also keeps gums and teeth from drying out. This constant lubrication makes it more difficult for bacteria to stick and stay, and helps keep teeth and gums clean.

3) Protection of teeth and gums. Saliva is able to offer protection of teeth and gums by rinsing away food and bacteria. It is also able to neutralize acids or acidic foods that can wear down your teeth causing tooth cavities.

-The Uvula. The uvula is the small flap of tissue which hangs down at the back of your throat. The uvula is made up of muscle fibers as well as connective and glandular tissues. The uvula is covered by oral mucosa. The uvula’s functions are not fully understood as of yet. However, it seems to play some role in speech and in keeping the mouth and throat moist.

-The Frenulum Linguae. The frenulum or frenum, is an attachment of oral mucosa that connects and pulls two areas together. There is one major frenum attachment above your two front teeth connecting your lip to the adjacent gums, another major one is under the tongue attaching it to the floor of the mouth. There can be any number of minor frenum attachments from lip to gum or cheek to gum.  Children can be born with a frenulum that is too short, or not elastic enough, keeping the tongue almost tied down. This can  affect speech as the tongue is not able to protrude as far as necessary. A short frenum can also affect swallowing and feeding in babies.

Take notice the next time you are brushing your teeth, spend a minute looking at the parts of the mouth that lie farther inside the oral cavity. Knowing what these structures do and what they look like can help you to maintain optimal oral health, and notice changes that can occur. Your self awareness can help you point changes out to your dentist, and find out why they have occurred. As always, see your dentist regularly and have an open line of communication to ensure that your mouth is it’s healthiest!

 

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.