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.
As any baseball fan will tell you, baseball players for years have been using chewing tobacco (also known as smokeless tobacco). Did you know, that the risk of developing oral cancer by using smokeless tobacco products is just as high as from smoking cigarettes?
Smokeless tobacco is tobacco that is not burned. It is also known as chewing tobacco, oral tobacco, spit or spitting tobacco, dip, chew, and snuff. Most people chew or suck (dip) the tobacco in their mouth and spit out the tobacco juices that build up, although a spit less smokeless tobacco has also been developed. Nicotine in the tobacco is absorbed through the lining of the mouth.
People in many countries use smokeless tobacco, but America’s favorite pasttime has been the one that has popularized it for many young Americans. Up until recently, major league baseball players were able to carry it in their back pocket on the field. Generally, you could see the outline of the tin in their back pockets as well as from time to time they would remove it to refill the tobacco in their mouths. Now, under new rules agreed to by the players union and owners, major league baseball players can no longer carry the smokeless tobacco tins in their pockets onto the field. They are also banned from using smokeless tobacco during televised interviews, team or league sponsored appearances, autograph signings and other events where fans are present. They can, however, continue to chew it while they play as long as those familiar round tins are not visible in their back pockets.
How Does Smokeless Tobacco Differ From Smoking?
Smokeless tobacco contains at least three known carcinogenic agents: N-nitrosamines, polycyclic aromatic hydrocarbons, and the radioactive polonium 210. Also, abrasive ingredients are added to the chewing tobacco that inflict tiny nicks in the gums and thin epithelial lining of the cheeks in order to more quickly transport nicotine (and carcinogenic additives) into the bloodstream. Prompted by the irritating juices from smokeless tobacco left in the mouth for prolonged periods of time, precancerous leukoplakias (white areas) develop into cancers in 3-5% of smokeless tobacco users.
Unlike lung cancer from smoking tobacco, which typically develops after decades of use, these precancerous lesions can come on very quickly.
Celebrities promoting chew are very influential. About 12-15 million in the United States will use a chewing tobacco product this year alone. Six million Americans use it every day. And according to the National Cancer Institute, between 35-40% of professional baseball players use smokeless or “spitting” tobacco.
Despite many advances in the treatments options for oral cancer, including surgery, radiation, and chemotherapy, these patients still have only a 60% chance of a five-year survival rate.
Cosmetic Effects of Smokeless Tobacco
The detrimental and readily apparent cosmetic effects can be far greater — and develop far more quickly — with spitting tobacco than with cigarettes.
There are many visible signs of smokeless tobacco use. These can include:
-Tooth abrasion – The gritty abrasives in smokeless tobacco scratch and wear down teeth and gums.
-Loss of Tooth Enamel – Premature loss of tooth enamel can cause teeth sensitivity.
–Gum Recession – Injured gums pull away from the teeth. This can result in permanently damaged periodontal tissue, increased sensitivity to heat and cold, loss or breakdown of supporting bone structure, and accelerated loss of teeth.
-Tooth cavities – Sugar is an additive in smokeless tobacco and stays in the mouth while using chewing tobacco. Thereby, increasing risk of tooth decay.
-Discolored teeth – Stained teeth are the rule in smokeless tobacco users.
–Halitosis or Bad breath – Sticky tobacco residues are a breeding ground for bacteria.
-White corrugated tissue – chronic irritation of the same area of the mouth causes the gum or lip tissue to form a white calloused appearance. This is generally precancerous, but can become cancer.
Signs of Oral Cancer
-A sore that will not heal or go away.
-Prolonged sore throat that never seems to go away.-Difficulty chewing or swallowing.-Restricted movement of the tongue or jaw.-A feeling of something in the throat.-Numbness of the tongue or other areas of the mouth.
Conclusion on Smokeless Tobacco and Oral Cancer
Smokeless tobacco causes oral cancer, esophageal cancer, and pancreatic cancer. Using smokeless tobacco may also cause heart disease, gum disease, and oral lesions other than cancer, such as leukoplakia (precancerous white patches in the mouth).
All tobacco products, including smokeless tobacco, contain nicotine, which is addictive. Users of smokeless tobacco and users of cigarettes have comparable levels of nicotine in the blood. In users of smokeless tobacco, nicotine is absorbed through the mouth tissues directly into the blood, where it goes to the brain. Even after the tobacco is removed from the mouth, nicotine continues to be absorbed into the bloodstream. Also, the nicotine stays in the blood longer for users of smokeless tobacco than for smokers.
The level of nicotine in the blood depends on the amount of nicotine in the smokeless tobacco product, the tobacco cut size, the product’s pH (a measure of its acidity), and other factors.
Many believe smokeless tobacco is a harmless habit, it most definitely is not. The effects of smokeless tobacco happen very quickly and can affect young people as well as old.
There are many methods available to help with quitting. Remember, it is a habit, albeit a life threatening one, but it can be stopped. If you want to live a healthier life, you’ll need to stop using tobacco products entirely.
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.
Oral cancer affects approximately 40,000 people in the United States each year. Oral Cancer kills one person every hour, every day totaling about 8,000 deaths per year. Only a little more than half of those 40,000 diagnosed, will be alive in 5 years. This is a number that has stayed steady for quite a number of years. Around the world, the problem is even greater with about 640,000 new cases of oral cancer each year. Historically, the death rate for oral cancer is higher than in cancers such as cervical cancer, Hodgkin’s lymphoma, laryngeal cancer, testicular cancer, and endocrine system cancers (thyroid).
While not all oral lesions become malignant, the majority are removed surgically. The key is to find lesions as early as possible. One of the more effective ways for early detection is screening with a velscope. The velscope is a quick painless way to find tumors in the mouth that are not yet visible to the eye. As many as 1/3rd of patients with cancerous oral lesions experience a recurrence of their oral cancer. Researchers have been studying this issue for years in attempts to figure out why the oral cancer returns and how to either stop it or slow it down or to avoid surgery altogether.
Oral Cancer Study
After more than 30 years of research, scientists at Ohio State University College of Dentistry, might have found a key to give oral cancer survivors hope for the future. That hope lies in a combination of black raspberries and
fenretinide (a drug that has been used to treat certain cancers, rheumatoid arthritis, acne, and psoriasis, has been found to also slow the production and accumulation of a toxin that leads to vision loss in Stargardt’s patients).
The study conducted consisted of using a topical gel application containing freeze dried black raspberries directly on precancerous lesions in the mouth. This gel application reduced clinical and microscopic premalignant features (Pharmaceutical Research, April 2010, Vol. 27:4, pp. 628-643). Early results have shown definite efficacy of the freeze dried black raspberry gel while the placebo showed no effect.
How Does It Work to Stop Oral Cancer?
The study believes that the berry compounds work at the cellular level by activating two related pathways in the premalignant cells. These pathways are:
–Apoptosis. A genetically determined process of cell self-destruction that is a normal physiological process. Cells only live and reproduce new cells for a set amount of times until they die. Tumor cells, on the other hand continue to divide and produce without dying off. Normal cells have this ” programmed cell death”, to eliminate DNA-damaged cells, uncontrolled cell growth, and tumor formation.
–Terminal Differentiation. Final stage of cell division, where the cell may stay in this phase and no longer proliferate (grow more cells).
The benefit of all this, is that damaged cells do not continue to divide and multiply and are therefore sloughed away by the body.
The goal of the research is for the raspberry compound (in a gel or mouthwash), to encourage the epithelium to differentiate, creating a barrier to ward off development of oral cancer. The data initially supports that the black raspberry gel is doing just that. It is thought to be re-educating the cells to differentiate away from the cancerous state.
While the black raspberry gel was quite effective in many of the patients involved in the study, not all of them responded equally well to the black raspberry gel treatment. The theory is that is a direct reflection of individual patient differences in metabolism. So, the researchers added the chemotherapy agent fenretinide. The black raspberry gel in combination with fenretinide was more effective, acting as a one-two punch in fighting the oral cancer lesions.
The fenretinide will be delivered as a patch whereas the black raspberry gel can be placed directly on the lesions in the mouth. The theory by the research team is that this will treat both visible lesions and lesions that are yet to develop.
Oral Cancer Conclusion
This could be potentially game changing oral cancer research if the results continue to stay strong throughout the research study. Until the study progresses further, our only hope is to diagnose oral cancer as early as possible. This can be achieved via the use of the Velscope Oral Cancer Screening System. This is a tool that gives the dentist the best chance of diagnosing oral cancer and precancerous tissue as early as possible. Very important to see a dentist using this system and to go for regular dental examinations.