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For many people, eating disorders are part of every day life. These  abnormal eating habits may involve either insufficient or excessive food intake to the detriment of an individual’s physical and psychological health. The resulting effects of the dietary issues involved directly and indirectly relate to oral health problems.

Common Types Of Eating Disorders

Anorexia Nervosa (commonly called,  “anorexia”) –  This eating disorder is characterized by a refusal to maintain a healthy body weight, an obsessive fear of weight gain, and an unrealistic perception of current body weight. Anorexia can cause menstruation to stop, and often leads to bone loss, loss of skin integrity. It is a big stressor on the heart, there is an increase in the risk of heart attacks and related heart problems. This disorder also presents with an increased risk of death. Peer pressures play a role in an individuals’ obsession with their outer appearances. Recent research suggests it is not only about a person’s outward perception but genetics may play a role in the disease process.

Bulimia Nervosa (commonly called, “bulimia”) – This eating disorder is characterized by recurrent binge eating followed by purging. The purging can include self induced vomiting, excessive use of laxatives/diuretics, or excessive exercise. Fasting may also be used as a method of purging (self inflicted vomiting) following a binge.

Compulsive over-eating– This eating disorder is characterized by eating large quantities of food even when not feeling hunger. The food is generally consumed quickly and often with little to no regard for proper nutrition.

Dental Issues That Arise From An Eating Disorder

Tooth Enamel Erosion and Tooth Decay – It is quite common to see an increased incidence of tooth decay in all forms of eating disorder. It is also not unusual to see very extensive decay that leads to tooth loss. For bulimic and over-eaters, high calorie, high carbohydrate foods put the enamel at risk due to increased sugar levels in the mouth. Vomiting (either self inflicted or from eating an enormous amount of food) exacerbates the problem by incorporating stomach acid into the oral environment. Anorexics are also prone to regurgitation of stomach acid due to lack of food in the stomach.

It is quite common in patients with an eating disorder to need extensive dental work over and over again. This is especially true to the backs of the teeth, (facing the tongue) since these surfaces would be exposed the most to the stomach acids released from vomiting. The gum lines of teeth are also prone to decay when habits of snacking through the night and not brushing occur frequently.

Soft Tissue Damage – The force of repeated vomiting also takes a toll on the soft tissues in the mouth. This can result in swelling of the tonsils and the uvula in the back of the throat. Another indicator of an eating disorder may be a red and swollen tongue or a lacerated palate caused by vomiting induced by placing a finger into the back of your throat (fingernails and other implements will damage the palate).

Other Eating Disorder Dental Issues Include:

-Gum pain

-Chronic sore throat

-Inflamed esophagus

-Palatal hemorrhages

-Decreased saliva production – leading to dry mouth (xerostomia)

-Enlarged Parotid glands

-Problems swallowing

-Jaw alignment abnormalities

Dental Treatment Options

An eating disorder is a major health issue and create all kinds of problems both to our dental health and systemic health. Communication is important to not only get help to overcome the disease but also to get proper dental treatment.

Dental hygiene becomes extra important in patients with an eating disorder because some of the damage from stomach acids in the mouth can be minimized if patients brush, floss, and rinse following vomiting. This can lessen the effect of the acids on the teeth. Damage will still be done if the habits remain for long or short periods of time.

Standard dental treatment for an eating disorder can include:

-Dental Fillings

Root Canal Therapy

-Tooth Extractions

-Periodontal Surgery

Eating Disorder Conclusion

An eating disorder is a very difficult disease to diagnose and treat. Dentists need to know the warning signs to be able to get patients in need to seek proper help. Eating disorders can ultimately kill and should not be taken lightly. The dentist should be able to speak openly about oral symptoms of eating disorders if signs are present. This is a difficult topic to discuss for most but is nevertheless important. The patient must feel comfortable enough with their dentist to tell them they think they have an eating disorder. The dentist should  be clear about everything, portray empathy and care at every opportunity. Body language is very important. Trust between the dentist and patient is very important to establish before moving on.

Once habits are addressed, treatment and restoration of healthy teeth and smile go hand in hand.. The power of a beautiful, healthy smile can do wonders do our emotional well being. A positive self-image and self-esteem are critical for recovery from bulimia and a restored, healthy smile is evidence of those feelings. Does having a new smile help that process? Absolutely. It has been shown time and again to be life changing. Even more important is restoration of the teeth to a healthy state so that the patient can eat without pain and regain health.



Your toothbrush is an essential part of maintaining any oral hygiene regimen.Walking down any oral health aisle in a drug  will show you dozens of different toothbrushes and other oral health aids. How do you choose the right toothbrush for you? Also, once you do make that toothbrush selection, do you know how to care for it properly?

Choosing The Right Toothbrush

The best toothbrush for you is one that fits in your hands properly, reaches all areas, is soft, and easy to use. Toothbrushes come in different shapes, softness, and sizes for a reason, we all have different size hands and mouths. You want a handle that is able to allow you to hold it firmly. You also want a properly sized toothbrush head with soft bristles that is able to fit easily into all areas of the mouth. It is critical to be able to reach everywhere to maintain good oral hygiene.

Electric Vs Manual

There is always a question of electric vs manual  toothbrushes. While, the electric toothbrush cleans more effectively, it is not for everyone. Whether it be cost, storage, charging, vibration sensitivity or personal preferences, the electric toothbrush may not be your number 1 choice. Use what works best for you, just brush with proper technique, and thoroughly.  Electric toothbrushes are especially important for those with orthodontic braces, older population, and those who just need a little extra help to keep their teeth clean. It is important to use a light touch when using an electric toothbrush, and to let it do the brushing, not you.  The oscillating heads can be harsher on your teeth and gums than a manual toothbrush when you scrub with it instead of placing it on one tooth at a time.

How Often Should You Change Your Brush?

Keeping a toothbrush too long will lead to an ineffective toothbrush. As a toothbrush gets used, it begins to fray and collect dangerous bacteria. The recommended rate of change is every 3-4 months for both manual toothbrushes and electric brush heads. A good tip is, if you develop a bad cold or the flu in between that time, you should change toothbrushes after the illness is over. This is to avoid reintroducing that bacteria back into your system. Might even consider using a disposable toothbrush while sick.

Cleaning And Storing Your Toothbrush

Proper toothbrush use should include rinsing thoroughly after each use to remove any excess toothpaste as well as any debris that may be left on it. A good tip will be to soak your toothbrush in an antiseptic rinse to eliminate any bacteria they may be harbored on your brush. Do not leave your toothbrush near the toilet area as the bacteria from the toilet can easily travel to your brush  upon flushing. If you keep it in the cabinet, dry it off before putting it away. There are also ultra violet tooth sanitizers that you can use.

Toothbrushes should be stored so that they are able to air dry. This usually means storing them upright either in the medicine cabinet or near the sink. Bacteria generally need a moist environment to grow and prosper. Another good tip is to never share your toothbrush with anyone, as it can lead to transmission of disease and bacteria.

Toothbrush Conclusion

A clean, effective toothbrush is necessary to keep up your oral hygiene on a regular basis. Brushing should be done at least two times per day for a minimum of 2 minutes each time. Keep track of how often you change your brush, and keep the holder clean and disinfected as well. As always visit your dentist regularly for dental examinations, professional cleanings, and new toothbrushes!

 



Many believe that periodontal disease is a disease that is solely based on genetics. My grandparents had dentures, my parents had dentures, so will I. The truth is, that genetics plays a role, but is not a sentence for dentures. There are risks and limitations in the progression of periodontal disease… Can each patient limit the risks of developing full blown progressive periodontal disease?….The answer is a resounding…YES! It takes a good oral hygiene regimen, knowledge of the current state of your condition, and frequent professional cleaning to keep our mouths in a healthy, disease-free state.

Risk Factors Of Periodontal Disease

Patient Caused Risk Factors

Poor Oral Hygiene – This is an obvious one that each individual can control. Brushing, flossing, rinsing, and seeking regular dental care are essential steps to remain periodontal disease free and avoid progression beyond gingivitis.

Age – Research has shown that older people have the highest rates of periodontal disease. The research shows that over 70% of Americans 65 and older have periodontitis.

Smoking Or Tobacco Use – Tobacco use is linked with many serious illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems. Tobacco users also are at increased risk for periodontal disease. Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.

Poor nutrition– Eating an unhealthy diet will not supply you with the essential vitamins and minerals necessary for tissue healing and repair.

Anatomy – The local anatomic risk factors for periodontal disease include:,

1. Furcation anatomy. These are the spaces between roots of molars.  In many instances, the entrance of  such furcations are restricted enough to limit access for proper hygiene maintenance. Risk factors for periodontal disease are classified according to their involvement in tooth furcations. A Grade I CEP presents with minimal projection of enamel toward the entrance of the furaction. A Grade II CEP approximates the entrance of the furcation, and the tip of a Grade Ill CEP is well within the furcation.

2. Common anatomic deformities. These interfere with a patient’s ability to effectively remove plaque biofilm which are one of the risk factors for periodontal disease. An example are Cervical enamel projections (CEP). CEPs are tooth developmental deformities of the CEJ found on molars.

4. Palato-gingival grooves (PGG). POGs are tooth developmental deformities of maxillary central and lateral incisors. They begin in lingual pits and extend vertically onto root surfaces. PGGs could, on rare occasions, extend to the root apex. PGGs are commonly associated risk factors for periodontal disease with increased gingival inflammation, plaque accumulation, and probing depth.

5. Open contacts, loss of interdental papilla, and food impaction. Open contacts between teeth may allow for easy food impaction. Food impaction is defined as the forceful wedging of food between teeth. Loss of the pointed papilla between teeth leaves another area for food impaction.

Medications – Some drugs, such as oral contraceptives, anti-depressants, and certain heart medicines, can have an affect on your oral health, causing dry mouth, inflammation and gum tissue overgrowth. It is important to tell your dentist the medications you might be on so they can tailor a treatment schedule for your needs.

Other Disease – These include cardiovascular disease, diabetes, and rheumatoid arthritis.  These diseases can interfere with the inflammatory process, causing healing problems, and may worsen the condition of the gums.

Poor Nutrition – A diet without all the essential nutrients for our bodies to function can compromise our immune systems, decrease healing ability, and make tissue weaker and easier to breakdown. This will make it harder to fight off infection. Since, periodontal disease essentially begins as an infection, this lack of nutrition can make the periodontal disease develop and progress faster than it normally would. Studies have also linked obesity with an increased risk of periodontal disease.

Dentist Caused Risk Factors

Overhanging dental restorations – A poorly completed dental restoration typically has dental material overhanging the tooth. This creates an issue keeping the area clean and also creates an area for food and bacteria to build up. These overhangs can be irritating to the tissues and retain plaque and food more easily.

Violation of the “biologic width” –  is the height between the deepest point of the gum pocket and the bone. This distance is important to consider when fabricating any dental restorations, because they must respect the natural architecture of the gingival attachment if harmful consequences are to be avoided. These consequences include bone and tissue recession.

Open contacts and food impaction – If a dentist places a new dental restoration and does not create the proper tight contact between adjacent teeth, that area becomes a food and plaque trap. It will necessitate improved dental hygiene in that area to keep it clean. More often than not, food and debris will accumulate creating a localized area of periodontal disease.

Occlusal trauma – If a new restoration is not properly set in alignment with the other teeth, a patient can create damage to the tooth as well as the surrounding tissue just from the act of chewing. The bite should always be checked and adjusted after dental work to prevent trauma to an individual tooth.

Periodontal Disease Conclusion

Luckily, with the exception of the anatomy we are born with, all of these periodontal disease risk factors can be overcome. The first step is to practice good oral hygiene by brushing, flossing, and using an antibacterial mouthrinse. The second step is to choose a well qualified dentist and keep a regular schedule to help give you the best fighting chance at preventing,  treating and stabilizing periodontal disease.



Periodontal disease begins its life in the mouth with inflammation and breakdown from periodontal bacteria. Abundance of periodontal bacteria  cause inflammation and infection. So, it makes sense that, antibiotics specifically geared toward periodontal bacteria, could offer some hope in bringing the disease under control. Antibiotics have been used for decades to fight many diseases but it has only been the past few decades where antibiotics have come to the forefront for the treatment of periodontal disease.

Indications For Antibiotic Use In Periodontal Disease

Indications for the use of antibiotic therapy in periodontal disease include the following:

-Periodontal abscess

-Juvenile periodontitis

-Rapidly progressive periodontitis

-Chronic periodontitis with persistent severe gingival inflammation

-Refractory forms of chronic or aggressive periodontitis

-Protection from subacute bacterial endocarditis

-When surgical therapy is not an option

-To control local sites of inflammation

-As an adjunct to conventional mechanical therapy

Some of the common antibiotics used include Amoxicillin, Metronidazole, Clindamycin, Doxycycline, and Azithromycin.

Periodontal disease usually can be attacked in many different ways but the main parts are always in place. This includes Professional cleanings along with maintaining good oral hygiene at home. Without those two elements, no amount of antibiotics will help stop the periodontal disease from progressing. The cause of the problem needs to be addressed first and that includes good oral hygiene at home.

Risks Of Antibiotic Use In Periodontal Disease

There are general and specific risks in the use of antibiotic therapy in periodontal therapy. These include:

-Allergic reactions (delayed or immediate hypersensitivity)

-Gastrointestinal problems

-Development of superinfections by unaffected organisms

-Development of resistant bacterial strains

How Are Antibiotics Delivered?

Low Does Antibiotics – The theory behind using low dosages of antibiotics is not to kill the bacteria but change the way the body responds to the presence of infection. An important finding after years of research was that certain antibiotics (for example doxycycline) not only kill the periodontal disease causing bacteria but they also reduce the body’s production of collagenase. Collagenase is an enzyme naturally produced in the body that destroys gingival tissues. The main function of collagenase is to remove older tissue so it can be replaced with new tissues which happens over and over again in the course of a lifetime. However, when periodontal disease is present, the body overproduces collagenase causing the body to destroy old tissues as well as healthy tissues.

Doxycycline is one of those antibiotics that can combat collagenase enzymes even in very small doses. Periostat is commonly prescribed in dental offices for periodontal disease. Periostat is in capsule form containing just 20mg of doxycycline. Periostat has been shown to produce a reduction in inflammation with very limited side effects.

Local Antibiotic Therapy – While systemic antibiotics have a very limited use in treating typical periodontal disease, there has been increased interest in local antibiotic delivery. If an antibiotic can be delivered directly to the pocket, without the patient having to take regular doses, there are far fewer side effects, and fewer chances of resistant bacteria forming. In addition, with direct local delivery, the concentration of the antibiotic at the diseased site can be 100 times greater than taking the medication orally.

The most used local antibiotic therapy includes Atridox, Arestin, and PerioChip.

Usually local delivery antibiotics are used in the Periodontal Maintenance phase of therapy. This is when isolated areas of the mouth seems to be worsening. Their use is generally not recommended during the active phase of treatment. Certain patient seem to respond better than others, so further research is needed.

Conclusion

It is very important to note that using antibiotics is not the main component in attacking periodontal disease. It is used as an adjunct to the traditional staples like professional cleanings and at home dental hygiene maintenance. Getting periodontal disease under control is the first step to maintaining a healthy smile for a lifetime.