Serious Disease Connections To Oral Health
Posted on Oct 12, 2021 by William J. Claiborne, DDS MS
As an Asheville periodontist, I have advanced skills in the diagnosis and treatment of all stages of periodontal (gum) disease. Over the years, I have closely followed the extensive amount of research that associates the health of the mouth with overall health. There are amazing connections between the bacteria of gum disease to severe (and even deadly) health problems far beyond the mouth.
Periodontal disease is an infection that destroys gum tissues and the structures that support teeth. As gum tissues are attacked and weakened, the bacteria of gum disease can enter the bloodstream through tears in diseased tissues.
This infectious bacteria is capable of causing inflammatory reactions elsewhere in the body. Systemic inflammation is the now-known epicenter of a number of major health problems, including heart disease, stroke, high blood pressure, diabetes, arthritis, impotency and more.
You may be interested to read about just some of the correlations between oral bacteria of gum disease and…
Dementia & Alzheimer’s disease: Gum disease occurs when infection of the oral tissues develops. It causes bleeding gums, putrid breath odor, loose teeth, and even tooth loss. Oral bacteria and the inflammatory molecules that develop can enter the bloodstream, making their way to the brain. Previous lab studies have suggested that this is a potential risk factor in the sequence of events that lead to dementia.
In data from the National Health and Nutrition Examination Survey (NHANES), different age groups at baseline, with up to 26 years of follow-up, analyzed over 6,000 study participants. The researchers examined whether gum disease and infectious oral bacteria were linked to dementia and deaths.
Participants had received a dental exam for signs of gum disease as well as blood tests for antibodies against causative bacteria. The team analyzed antibodies against 19 oral bacteria for an association with the diagnosis of Alzheimer’s, diagnosis of any kind of dementia, and death from Alzheimer’s. Of these 19, Porphyromonas gingivalis is the most common culprit of gum disease. In fact, a recent study suggests that plaques of beta-amyloid protein, a major hallmark of Alzheimer’s disease, may be produced as a response to this infection.
Erectile Dysfunction: In the U.S., an estimated 18 percent of males have erectile dysfunction. Men over the age of 70 are more likely to have ED compared to 5 percent between ages 20 – 40.
Studies have shown an association between gum disease and pancreatic cancer. From analyzed data of five studies between 2009 – 2014, the studies covered 213,000 participants aged 20 to 80.
Each study found erectile dysfunction (ED) was more common among men being treated for chronic periodontitis, particularly for those younger than 40 and older than 59. After accounting for other health factors, erectile dysfunction was found to be 2.28 times more common for men who had advanced gum disease than for men without it.
Stroke: In one study of 265 stroke patients, researchers found that patients with gum disease had twice as many strokes due to thickening and hardening of brain arteries as patients without. Additionally, patients with gum disease were three times as likely to have a stroke involving blood vessels in the back of the brain, which controls vision, coordination and other functions.
In a separate study of over 1,100 patients who had not experienced a stroke, researchers noted that 10 percent had severely blocked brain arteries. They also found that patients with gum inflammation were twice as likely to have moderately severe narrowing of brain arteries.
Pre-Term Babies: The elevated hormone levels during pregnancy create a higher vulnerability to gum disease; the reason about half of pregnant females experience swollen, red and tender gums that bleed while brushing. Known as Pregnancy Gingivitis, the gums are more susceptible to inflammation, thus more sensitive to the bacteria of gum disease.
Studies have shown that gum disease increases the risk for preterm delivery (before 37 weeks) and low birth weight babies. Gum disease also increases the risk for poor obstetrical outcomes, late miscarriage and pre-eclampsia. For example, the preterm birth rate for women without periodontal disease is approximately 11 percent compared to nearly 29 percent for females with moderate to severe gum disease.
Through tears in gum tissues, oral bacteria can enter the bloodstream. Once this bacteria reaches placental membranes, it can trigger inflammation that can cause preeclampsia or labor.
Arthritis: For decades, it was perceived that RA (rheumatoid arthritis) patients had such a high risk of gum disease due to poor oral hygiene because of dexterity problems with using a toothbrush. However, more recent studies now show that gum disease is actually a risk factor for arthritis.
While genetic factors certainly contribute to greater RA susceptibility, the true source has been determined to be inflammatory reactions. This inflammation is triggered primarily by bacterial infections, with oral bacteria being a significant contributor to inflammatory arthritis.
They found that people with severe periodontal disease also had severe rheumatoid arthritis. Patients with the most plaque, bleeding and gum tissue breakdown had worse RA by all measures, including disease activity and inflammatory markers. Other studies have found that even with treatment, RA patients with periodontitis continue to have worse arthritis symptoms and are 50% less likely to be in remission.
The relationship between gum disease and arthritis isn’t seen only in adults. Kids with juvenile idiopathic arthritis (JIA) have inflammatory mouth bacteria not found in their healthy peers. Different types of bacteria seem to correspond to specific aspects of JIA. Some are associated with higher disease activity and others with a greater number of affected joints.
Pancreatic Cancer: Research reveals that the bacteria of gum disease may contribute to a higher risk of pancreatic cancer. Through a cancer prevention and screening study, the National Cancer Institute and American Cancer Society studied oral samples. Their findings showed notably higher levels of two types of oral bacteria in study participants with pancreatic cancer. One bacteria was found to create a 50 percent increased risk for pancreatic cancer and a second bacteria led to a 59 percent greater likelihood.
The results indicated a significantly positive association between periodontal disease and the risk of pancreatic cancer.
Although I could go on and on citing studies and research findings, I think you get the picture. The need for good oral health is indisputable.
Signs and symptoms of gum disease are gums that bleed when brushing, frequent bad breath, tender gums that turn red in color, swollen gums, receded and sensitive gums. If you have any of these, please know that gum disease will only worsen without treatment. It is also the leading cause of adult tooth loss.
For an examination, or to begin with a consultation, call 828-274-9440.
Postponing Dental Care Can Be Expensive
Posted on Sep 29, 2021 by William J. Claiborne, DDS MS
Most of us have seen the movie, “Gone With The Wind,” It’s pretty hard to forget the last line of Scarlet O’Hara: “I’ll think about that tomorrow.”
Procrastination is something we all do, some more than others. We all tend to “back burner” things we don’t want to do. As a periodontal dental specialist, I’m guilty of this on occasion.
However, I see a number of patients who have developed periodontal (gum) disease because they delayed or postponed dental care; care that would have easily helped them avoid the problems associated with it.
The reason 6-month dental check-ups are so beneficial is in their ability to give patients a twice-a-year clean slate in oral wellness. During this time, the dentist and hygienist can examine the mouth for signs of abnormal wear, bite alignment, and point out areas that need extra attention in oral hygiene routines at home. (This is especially true for people who have crowded or crooked teeth, as bacteria can easily accumulate in these tight angles.)
This dental appointment also allows the hygienist to remove plaque or tartar that has formed since the patient’s last check-up. Both are accumulations of oral bacteria, which will continue to reproduce rapidly without regular removal.
Plaque starts the process. It is the sticky film you probably feel on teeth when you first wake up. This film is actually a layer of bacteria that has rapidly reproduced during the night. (If you snore or breathe through your mouth during sleep, oral dryness can accelerate the rate of reproduction even more.)
Although it is more obvious on teeth, the film of plaque also coats the gum tissues and tongue. If not thoroughly removed within 48 hours, these bacteria amass to such a level that the plaque hardens. This is known as tartar.
Tartar typically forms between teeth and at the base of teeth. This is why daily flossing is helpful. It scrapes off plaque in areas the toothbrush may not reach, or may not be cleaning sufficiently.
Once tartar forms, however, it can no longer be removed by brushing and flossing. This is what the hygienist is picking at and scraping off teeth during dental cleanings. If not removed, these bacterial colonies continue to grow. And bacteria breed at an amazingly fast pace.
Just how quickly can these oral bacteria amass?
According to information shared by RDH Magazine: (https://www.rdhmag.com/infection-control/water-safety/article/16404976/oral-bacteria-how-many-how-fast)
“some species of oral bacteria can double their numbers every 20 minutes under ideal conditions in a Petri dish.”
This means that one million bacteria can grow to 14 million within an hour. Accumulated bacteria can even be seen in the mouth as a white coating on the tongue. The back of the tongue is typically whiter in color since tooth brushing doesn’t reach there and dislodge embedded bacteria. (This is why it’s important to brush your tongue every day when toothbrushing, or use a tongue scraper.)
Tartar holds such a high number of bacteria that these organisms can cause damage to teeth. They bore into tooth enamel and eat away at oral tissues.
Bacteria are ramped up by foods we eat. They especially love lingering food particles caught between teeth and foods containing sugar. (This is yet another reason to floss daily.)
Initially, gum disease causes tender gums that may be swollen. They may bleed when brushing, which is typically noticed when spitting. Symptoms may also include frequent bad breath, gums that are more red in color than a healthy pink, and soreness when brushing or flossing.
Keep in mind, this is just the beginning. This stage is known as Gingivitis and is just a prelude of what’s to come. If prompt measures are taken as soon as these symptoms arise, Gingivitis may be overcome without requiring dental treatment. Thorough brushing (twice a day, at least), daily flossing, and keeping the mouth moist with plain water may be effective in overcoming Gingivitis.
If not resolved, Gingivitis can progress to periodontal disease. During this level of gum disease, breath odor is persistently bad. The gums bleed easily when brushing and are more red in color. Gums are sore and tender. As the disease worsens, the gums become spongy and pus pockets may form at the base of teeth.
Eventually, the bone tissues and gums become so damaged by periodontal bacteria that some teeth may loosen. This stage is periodontitis and is an infectious disease that can cause devastation far beyond the mouth.
Periodontal disease is the nation’s number one cause of adult tooth loss.
These potent bacteria can enter the bloodstream, creating inflammatory reactions that can activate or worsen a number of serious health problems. These include heart disease, stroke, high blood pressure, diabetes, arthritis, preterm babies, some cancers, impotency, erectile dysfunction, and Alzheimer’s disease.
That’s a pretty serious list. As research continues to study the far-reaching effects of these infectious bacteria, the list seems to lengthen more.
Have you been putting off dental care? Treating advanced gum disease and replacing teeth are both pretty involved procedures.
In many cases, I’ve found patients avoid or delay dental care due to feeling it is too expensive or having fear associated with dental visits. Yet, the price (in time and money) from not properly caring for oral health is steep in many ways.
The devastation caused by these bacteria can be easily avoided with simple measures at home and 6-month dental visits. An at-home dental care regimen should only require about 5 minutes per day. A dental check-up usually takes about an hour.
If you are very uncomfortable during dental cleanings, tell your hygienist. He or she may be able to provide a pre-treatment rinse or a topical swab for more sensitive areas. (Just know that until your gums get into healthier shape, it is the inflammation caused by oral bacteria that makes them more sensitive.)
The obstacles that typically prevent patients from receiving the care they need are:
Cost: Most dental practices offer payment plans that are interest-free with no down payment required. If you don’t have dental insurance, ask about any discounts they may offer or consider using a credit card.
Dental fear: In our Asheville periodontal dental office, we offer both oral and I.V. sedation (“twilight sleep”), if desired. We understand that many adults have anxiety or fear when it comes to dental treatment. Our entire staff is committed to providing all patients with a gentle touch, a respectful environment, and compassionate care.
Embarrassment or feeling a smile is “hopeless”: We see many adults who have “bombed out” mouths. This can happen for a number of reasons. Here, we are a “judgement-free” perio office and treat every patient as we would want our loved ones treated. And, no smile is hopeless. We have a great many patients who are testaments to that!
For patients who have lost natural teeth, for whatever reason, a periodontist has advanced skills in the diagnosis and placement of dental implants. Once your gums are restored to a healthy state, we can discuss that tooth replacement option, if you like.
As with most things in life, delaying care is a sure recipe to get deeper in the problem. Be committed to your daily oral care routine and keeping regular dental appointments. If you are having symptoms associated with any stage of gum disease, however, I am a dental specialist in treating even advanced levels.
Call 828-274-9440. A referral is not needed.
Misconceptions Of Oral Health
Posted on Sep 14, 2021 by William J. Claiborne, DDS MS
As a periodontal dental specialist, I have advanced skills in the treatment of gum disease and dental implants. In my specialty, I see patients who have various issues related to oral health. Some of these can be resolved with minor treatment and others require more involved procedures.
In many cases, however, a factor in the severity of certain issues occur because it was assumed the problem would resolve itself. Some patients have also assumed that certain signs or symptoms were “normal”.
The health of the mouth is largely reliant on the condition of the gum tissues. This moist, soft covering of tissues is a protective blanket for the structures underneath. Gum tissues protect the structures that support natural teeth as well as their roots.
Yet, because the gums are not visible as are teeth, it is easy to “back burner” problems. Some of these problems DO resolve on their own. However, in too many cases, what is set aside eventually requires extensive treatment; treatment that may have easily been avoided with early care.
I’d like to address some of the more common issues I see that are misconceptions…
Assuming seeing blood in the sink when brushing teeth is normal: Srubbing teeth so rigorously that they bleed is not a sign of doing a good job. This action not only wears away precious tooth enamel, it wears away the gum tissues that wrap the base of teeth.
Gums that bleed when brushing are also a symptom of periodontal (gum) disease. In addition, gum disease can cause tenderness, swelling or frequent bad breath. Without treatment, gum disease will progress further. This is why it is the nation’s leading cause of adult tooth loss.
Protect tooth enamel and gum tissues by using a soft to medium bristled toothbrush and a non-abrasive toothpaste (never substances such as baking soda). Using a swirling motion (rather than going back-&-forth), avoid applying too much pressure. Make sure that the tips of the bristles are contacting the surfaces of teeth. Hint: If you notice your toothbrush’s bristles flay outward after a month or so of use, you’re pressing too hard.
Ignoring gum recession: The gums are designed to snugly wrap the base of each tooth, serving to seal out bacteria. Although the aging process and oral dryness can shrink gum tissues, a common cause of receded gums is gum disease.
Gum recession is what causes sensitivity to hot, cold or the bristles of a toothbrush. Oftentimes, a bite of ice cream can send a jolt of pain. Even without the sensitivity, recession can leave the darker tooth root areas exposed. This leaves the tooth vulnerable to damage by oral bacteria.
Ignoring frequent bad breath: Bad breath is typically a by-product of bacteria build up. Although certain medical conditions can contribute to bad breath, keeping oral bacteria levels under control will minimize the risk of having smelly breath odor.
Saliva is what controls a significant amount of oral bacteria. However, without regular brushing and flossing, bacteria can quickly exceed what saliva is able to manage.
This is why it is important to brush twice daily and floss daily. These small tasks help to control bacteria by removing the sticky buildup of plaque. If not removed, plaque hardens into what is known as tartar. Tartar is a destructive mass of bacteria that can no longer be brushed or flossed away.
Having gum depth measurements of four and over: During regular check-ups, hygienists check gum health by gently using a probe along the base of each tooth. This is done to indicate loosening of gum tissues on the front and back sides of teeth. A good check-up will have no depth measurement higher than a three.
If the depth measures a 4 or 5 (or higher), the gums are not sealing out oral bacteria sufficiently. This may be an indication of gum disease. The higher the number, the more advanced it is.
Assuming tooth loss is normal: Some people assume tooth loss is a natural part of the aging process. This is not accurate. Adults lose teeth due to accidents, decay or (most often) gum disease.
Occasionally, a tooth that needs crowning or filling is deemed a “problem” tooth. This causes some people to want the tooth removed rather than repaired. Yet, missing tooth roots in the jaw bone triggers a process of bone shrinkage. This is known as resorption.
Resorption occurs without the stimulating presence of the tooth root. As the bone declines in height and width, neighboring teeth can also be affected. Adjacent tooth roots in areas of insufficient bone structure are at a higher risk of cavities, gum disease, and tooth breaks or fractures. Statistics show that a tooth adjacent to a missing tooth is most likely the next to be lost.
When a tooth must be removed, we recommend replacing it with a dental implant. Because an implant is positioned in the bone, it helps halt bone loss and protect the well-being of neighboring teeth.
Not reacting to spots on the tongue, lips or inside the cheek: People occasionally develop canker sores inside the mouth. These can be caused by stress or having an acidic diet. Both should go away within ten days or so.
Any spot or change inside the mouth or throat that does not resolve on its own within two weeks should be seen immediately. This may be a sign of oral cancer and may appear as a red or white spot. Or, it may cause hoarseness or difficulty swallowing. If caught early, oral cancer can be successfully treated. Acting promptly is highly important as it can lead to disfiguring treatment and be even deadly.
Assuming oral health is contained in the mouth: It has been shown that having good oral health is an advantage to having good overall health. The potent bacteria of gum disease can enter the bloodstream and cause inflammatory reactions elsewhere in the body. Research has correlated a number of serious health problems with the infectious bacteria of gum disease. These include heart disease, stroke, some cancers, Alzheimer’s disease and arthritis.
As an Asheville periodontist, I believe that adults can improve their oral health by being informed patients and committed to having a healthy smile.
A good resource on maintaining good oral health is the web site of the American Academy of Periodontology: www.perio.org (go to Patient Resources). Or, call our Asheville periodontal dental office at 828-274-9440.
Why You’re Losing Teeth (and how to halt the process)
Posted on Jul 29, 2021 by William J. Claiborne, DDS MS
The inevitable. Murphy’s law. Sooner or later.
It is to no surprise that life throws us occasional curves, some being out of the blue and others being somewhat predictable. As an Asheville Periodontal Specialist, one that comes to mind is the path to losing teeth.
Losing natural teeth is a challenge to both oral and overall health. And, there’s nothing that will definitively replace natural teeth once they’re extracted (although dental implants come pretty close!). Keeping natural teeth and gums healthy is the best way to support your health as you age.
According to a 2017 article published by Dentistry Today that shared recent study findings:
“people who had lost 5 or more teeth by the age of 65 years were more likely to suffer from cardiovascular disease, diabetes, and osteoporosis, all of which could severely limit life expectancy. Many of these illnesses previously have been linked to a person’s quality of life and socioeconomic status. The study concludes that the number of teeth in aging humans can affect longevity and life expectancy.”
Of course, no one wants to lose a natural tooth. Yet, many people assume that tooth loss is simply a natural part of the aging process. It’s not.
Through the years, certainly, accidents, injuries, decay, gum disease and deep fractures in teeth can result in loss of teeth. Regardless of how committed some people are to their oral hygiene regimen at home and regular dental check-ups, unexpected occurrences can lead to the need for an extraction.
However, the people who are committed to their oral health are far less likely to endure the undesirable outcome of tooth removal. The measures are simple and take very little time.
• Brush your teeth at least twice a day, for a minimum of two minutes each time.
• Floss daily.
• Avoid snacking and limit sugar.
• Drink plenty of water.
• See your dentist twice a year for exams and cleanings.
• Don’t smoke.
Although smoking cessation is a tough task for most people, the other items listed above require just minutes a day and cost very little. What they help you accomplish is PREVENTION. Rather than have problems treated, many instances surrounding tooth loss could have been prevented.
It is far less costly and time consuming to be attentive to your oral health than deal with the repercussions of insufficient oral upkeep. Losing a tooth will require a lifelong commitment, regardless of how it is replaced. And, replacing teeth is absolutely necessary.
When a tooth is lost, whether it can be seen in a smile or not, it no longer supports the surrounding teeth. The tooth above (or below) can elongate. Neighboring teeth can tilt or turn since they lack the bolstering affect provided by the now-missing tooth.
These factors can lead to chipped, fractured or broken teeth. They can also be an issue in bite misalignment. A misaligned bite can cause stress or strain on the temporomandibular joints (TMJ). The results can be frequent headaches, sore jaw joints, ear ringing, dizziness, and difficulty opening the mouth fully.
Another problem lies in the absence of the missing tooth’s roots. When these roots are missing, there is a lack of stimulation and nourishment to the jaw bone in this area. Without this, the bone begins to shrink, or resorb. Bone mass decline affects the stability of the adjacent teeth. It is known that the next tooth to be lost will most likely be one bordering a missing one.
The path to tooth loss, other than accident or injury, is actually a pretty predictable one. For people who take their oral hygiene lightly, it’s not a matter of “if” but “when”. Bacteria buildup in the mouth should be removed regularly, which is why twice-daily brushing is advised. If not thoroughly removed, their growth runs rampant.
Saliva flow helps in moving some bacteria out of the oral cavity. However, as people age, saliva flow decreases. Add to that the many elements that are drying to oral tissues: caffeine (including coffee, tea and colas), many medications, snoring, and some health conditions.
Oral bacteria that accumulate in the mouth for more than 48 hours first create a sticky film that coats the teeth and gums. This is plaque. If not removed through brushing and flossing, plaque transforms into hardened masses on the base of (or between) some teeth. This is tartar, which can no longer be brushed or flossed away.
As tartar spreads, the gums become inflamed. This causes gingivitis – the first stage of gum disease. Gingivitis causes the gums to become tender, swell, and sometimes bleed when brushing. Breath odor can become frequently bad.
If not resolved quickly, gingivitis can progress into full-blown gum disease. At this stage, the gums are red, inflamed, tender, bleed easily and breath odor is bad, even shortly after brushing.
As gum disease worsens, gums loosen their strong seal around the base of teeth. This allows entry of these infectious bacteria below the gum line. The structures that support natural teeth (including bone) are attacked, which can cause some teeth to loosen.
The advanced stage of gum disease is periodontitis. This means that gum tissues are red, spongy, have pockets of pus, bleed even when eating, and breath odor is putrid. To add insult to injury, this devastation doesn’t remain only in the mouth. Through tears in diseased gum tissues, the inflammatory bacteria of gum disease can enter the bloodstream.
This bacteria has been linked to serious, even life-threatening, health problems, as severe as stroke, heart disease, some cancers and Alzheimer’s disease. It can cause inflammatory triggers that worsen diabetes and prostatitis and cause preterm births.
Obviously, it’s important to keep your teeth and gums healthy. And, if tooth loss does occur, consider replacing it/them with dental implants. As an Asheville periodontist, one of my areas of advanced skill is in dental implant diagnosis and placement.
Dental implants are the closest thing to the look, feel and function of natural teeth. They restore dependable biting and chewing, without the need to be removed for cleaning. Best of all, confidence in smiling and laughing returns.
We frequently see Western NC adults who feared they would lose teeth due to periodontal disease and/or had already lost one or more natural teeth. Through our advanced skills and computerized technology, we are often able to fully restore people to excellent oral health and halt the progression of tooth loss.
If you have avoided seeing a dentist because of fear or anxiety, please know that we provide our patients with an environment of respect and comfort. We offer I.V. sedation (‘twilight sleep’) as well as oral sedation to create a totally relaxed state throughout treatment.
If cost is a concern, we also have payment plans that can help you achieve the smile you desire while making monthly payments that fit your budget.
Why allow tooth loss to happen? It CAN and SHOULD be prevented and we can help you regardless of your current oral condition. Call 828-274-9440 to request a consultation appointment. This will take place in a private consultation room where your questions will be answered thoroughly.