How A Periodontist Can Help Cancer Patients


Posted on Mar 18, 2024 by William J. Claiborne, DDS MS
For those who learn they have cancer, regardless of the type, it is a frightening diagnosis. While survival rates have been positively increasing over the years, it is a dreaded disease that requires challenging treatment regimens, even for those who have early stage cancer diagnoses.
Thanks to extensive research and advances in treatment options (including high-tech imaging that catches many cancers in their early stages) the survival statistics are climbing at a steady pace. In 2022, 69% of survivors have lived over 5 years since their diagnosis; 47% have lived over 10 years since their diagnosis; and 18% of survivors have lived over 20.
Encouraging, also, is that the number of cancer survivors is projected to increase by 24.4% by 2032.
Treatment for cancer can be very compromising to the immune system. One of the ways to support the immune system is by having excellent periodontal health. Having a healthy mouth can lower the demands on the immune system. Here’s why…
The mouth is home to millions of bacteria; some bacteria are good and some are bad. When the bad bacteria are well-managed (through proper brushing, flossing and regular dental check-ups), the gums remain healthy and protective to the structures below.
When bad bacteria over-accumulate, the immune system becomes strained as it attempts to combat their rapid reproduction. The bacteria become infectious, destroying healthy tissues. This leads to the loosening of gum tissues that snugly wrap the base of each tooth. Thus, bacteria are able to penetrate below the surface of the gums.
Here, bacteria attack the structures that support teeth, including bone. This destruction can cause teeth to loosen, leading to the need for removal in some cases.
Yet, it is not just the immune system that is challenged by the bacteria. Even for those in good overall states, having gum disease increases the risks for many health problems, such as heart disease, stroke, arthritis, diabetes, dementia and even certain cancers.
In a study by Harvard scientists from data that included almost 150,000 adults with a follow-up after 28 years, those with a history of periodontal disease were 43% more likely to develop esophageal cancer and 52% more likely to develop stomach cancer. The risk was even higher in those with gum disease severe enough to cause tooth loss (periodontitis).
Although the exact mechanism connecting gum disease and some cancers is still uncertain, studies continually show correlations. This can be in the form of triggering the onset or worsening those in development.
In one study from the late 1990s until 2012, study participants with severe gum disease showed a 24% higher risk of developing cancer. For edentulous patients (those who have no remaining natural teeth), there was an even higher risk.
As a periodontist, I have a firsthand view of how destructive the infectious bacteria of gum disease can be. Ridding any level of this can reduce the demands on the immune system. As such, we often care for cancer patients to relieve the problems in the mouth that some medications and radiation can cause (such as tissue infections and sores, pain or swelling in the mouth, and sensitivity to hot and cold). This is often done using a dental laser. Laser therapy is very comfortable and is safe for cancer patients and the process can expedite healing greatly.
I’d also like to take this opportunity to address, specifically, oral and oropharyngeal cancers since April is National Oral Cancer Awareness month. While some other cancers seem to be more present in the public eye, awareness of oral and neck/throat cancers needs to be greater. Oral cavity and oropharyngeal cancers occur most often in the following sites:
• tongue
• tonsils and oropharynx (the part of the throat behind the mouth)
• gums, floor of the mouth, and other parts of the mouth
The rest are found in the lips, the minor salivary glands (which often occur in the roof of the mouth), and other sites.
The American Cancer Society’s most recent estimates for oral cavity and oropharyngeal cancers in the U.S. are for 2024:
   – About 58,450 new cases of oral cavity or oropharyngeal cancer
   – About 12,230 deaths from oral cavity or oropharyngeal cancer
The average age of people diagnosed with these cancers is 64, but they can occur in young people. Just over 20% (1 in 5) of cases occur in people younger than 55.
Adult males are at the highest risk for oral cancer, with black males being the most susceptible. The risk also increases with age, especially after age 50. Although the risk typically peaks between the ages of 60 – 70, males between ages 50 – 59 tend to have the highest numbers.
It is important to be aware of the warning signs of oral cancer, including:
• A sore, irritation, lump or thick patch in the mouth, lip, or throat
• White or red patch inside the mouth
• Feeling something is stuck in the throat
• Difficulty chewing or swallowing
• Difficulty moving the jaw or tongue
• Numbness in the tongue or other areas of the mouth
• Unexplained swelling of the jaw
• Pain in an ear without hearing loss
While these symptoms do not always indicate oral cancer, any that do not clear up on their own within 2 weeks should be examined without delay.
This dental exam is painless. Many patients, if not told, are not aware that the dentist is performing it. During this, the dentist does a visual examination of oral tissues, checking the lips and inside of the mouth (including under the tongue). The dentist will also check the roof and floor of your mouth.
If suspicious areas are noted during the exam, the dentist will order a biopsy. In this, a small sample of tissue from the area of concern is removed and examined under a microscope. This will determine whether further tests are needed.
Unfortunately, the CDC reports that about 35% of adults over the age of 18 did not have a dental visit in 2019. This leaves those who are vulnerable or developing oral cancer at higher risk of it advancing. Those regular dental checkups go beyond the cleaning of teeth and lowering the risk of oral cancers adds greatly to the need to be committed to these appointments.
If you are experiencing symptoms of gum disease, please know that this disease will only worsen without treatment. If you have any of those listed below, please contact our Asheville periodontal dental office as soon as possible to schedule an examination.
Watch for:
Swollen or puffy gums
Bright red, dark red or dark purple gums
Gums that feel tender when touched
Gums that bleed easily
Seeing pink in the sink or toothbrush after brushing
Spitting out blood when brushing or flossing teeth
Bad breath that won’t go away
If fear has kept you from having regular dental care, our Western periodontal dental office offers both oral and I.V. sedation (twilight sleep). Feel free to call 828-274-9440 to arrange a consultation appointment to discuss any concerns you have regarding treatment or payment plans.
Sources:

As You Age, Avoid A ‘Melting’ Face With Dental Implants


Posted on Feb 26, 2024 by William J. Claiborne, DDS MS

It seems the older one gets, the more conscious he or she is to the need for good health practices. While periodic exams and check-ups are part of this, eating healthy and getting ample exercise are practical ways to support a healthy body.

The same principles apply to oral health. While annual physical exams are needed, regular check ups and dental hygiene cleanings are as well. Through decades of research, “bad” bacteria in the mouth can lead to inflammatory reactions that can offset or worsen a number of health problems far beyond the mouth.

For now, let’s focus on your gum health and the presence of teeth. While natural teeth are the ideal structure for biting, chewing and speaking, the rigors of age – the natural wear and tear – can take its toll on teeth. Decay, gum disease, accidents and certain illnesses can lead to losing a tooth or teeth over the span of a lifetime.

There are several ways to replace a missing tooth (or teeth). A crown-&-bridge is a longstanding method to replace one or several teeth in one area. Or, a partial denture can replace a “scattering” of teeth in the same arch. However, the downside of these oral prosthetics is what’s beneath the gum line.

Your natural teeth are supported by your upper and lower jaw bone, known respectfully as the maxilla and mandible. With these strong, study bones, tooth roots are held securely. Thus, biting and chewing occurs comfortably.

The jaw bones are actually kept healthy by the presence of tooth roots. These roots provide stimulation to the bone as well as nourishment that feeds through the tooth’s interior.

When a tooth is removed, so is the stimulation and nourishment to that area of the jaw bone. Without it, the bone begins to shrink. As it declines in height, the adjacent teeth are more vulnerable to loss. Statistics show that teeth adjacent to areas where natural teeth are missing will be the most likely to be lost next.

This has a domino effect. Partials can replace the presence of teeth above the gum line, but there is nothing to benefit the jaw bones below. Thus, tooth loss continues and can go from a few missing teeth to losing all teeth (being “edentulous”).

According to the Center for Disease Control & Prevention (CDC), 69 percent of adults between the ages of 35 – 44 have lost at least one permanent tooth. By age 50, Americans are missing an average of 12 teeth. For adults between the ages of 65 – 74, 26 percent are missing all of their natural teeth. That’s over one-fourth of the adult population over age 65.

Although dentures and partials mimic the presence of teeth, the jaw bones below are shrinking away, and at a rather rapid pace. The pressure of wearing a denture or partial actually speeds this process up, known as “resorption.”

As these bones decline in mass, deep wrinkles form around the mouth. The corners of the mouth turn downward. The chin takes on a more pointed form and the mouth sinks into the face. The nose seems to get closer to the chin as the jaw bones thin. Jowls form as facial muscles detach from shrinking bone structure.

Changes in facial appearance also take place when bone structures shrink. For example, as the jaw bone thins, deep wrinkles form around the mouth. The corners of the mouth will start to turn down, even in a smile. Jowls form on each side of the face as facial muscles detach from the shrinking bone structure.

As the jaw bone declines further, the chin becomes more pointed and the nose seems to get closer to it. This leads to a collapsed mouth that is known as a “granny look.” This look ages the appearance of an individual far beyond their actual years.

Not to be overlooked is the ability to comfortably bite and chew food. This is essential for the digestive process, since the first stage of digestion begins in the mouth. When adults struggle to eat with a denture or partial, the efficiency of this initial stage of digestion is compromised.

It’s not unusual for adults who have “rocky” or “slippery” dentures to opt for soft foods that dissolve easily in the mouth. These are often carb heavy and lack the nutritional value of a diet that combines healthy proteins, fruits and vegetables.

However, missing teeth or dentures that move when eating can cause other detrimental problems. When people sense their dentures may cause embarrassment when eating, speaking or laughing with others, social involvement can take a hit. According to a 2012 statement by the World Health Organization:

“Oral health is essential to general health and quality of life. It is a state of being free from mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking, and psycho-social well-being.”

As an Asheville periodontist, my dental specialty includes the diagnosis and placement of dental implants. Dental implants are the closest thing to natural teeth.

Dental implants were designed to recreate the presence of natural teeth both above and below the gum line. Because teeth attached to the implants are supported by the jaw bone, the study foundation restores the ability to bite and chew without movement or fear of embarrassing slips.

For patients who are missing a great deal of bone, we offer bone rebuilding that does not require a bone graft. We also perform sinus lifts (when the upper jaw has declined to a significant level) to restore sufficient bone distance between vital structures.

For many of our dental implant patients, their lives become more active with the restored confidence. They become more socially involved, have more self-confidence and higher self-esteem. And the advantages of dental implants over other tooth replacement options are numerous.

• Dental implants are designed to last your lifetime. They do not decay, need root canals or compromise neighboring teeth or bone structure.

• Because dental implants are positioned in the jaw, they recreate stimulation to the bone. This helps to preserve the bone’s mass, halting the pace of jaw bone shrinkage (known as resorption).

• Resorption is what causes changes in one’s facial appearance, aging one’s appearance far older than their actual age.

• Dental implants do not move or slip when eating, speaking or laughing. A denture is designed to fit the contours of one’s gum ridge; contours that exist at the time the denture is made. However, as resorption reduces bone height, the ridge that holds the denture flattens out over time. This is why a denture becomes ‘wobbly’ or ‘slippery.’

• Dental implant treatment is largely determined by the number of implants placed. In most cases, one implant can support more than one tooth. A full arch (all upper or lower) of teeth are typically supported by several strategically-placed implants.

• Unlike a crown-&-bridge, dental implants so not need the support of adjacent teeth. Therefore, it is not necessary to have teeth shaved down for crowning simply to serve as supports for a bridge.

In our Asheville periodontal dental office, we have highly-advanced technology that aids in the diagnosis and placement process of dental implants. These features help to enhance patient comfort, shorten treatment time, and provide optimal results. Advanced technology includes:

– Computerized Dental Implant Placement – an advanced system for pre-surgical positioning of dental implants using a 3D model of the patient’s jaw. Once the implant type is selected, a template is developed for optimal treatment success.

– Cone Beam Imaging – is ideal for diagnoses and treatment planning through images that provide a clear view of the upper and lower jaw (including nerve canals), with rotations that show sagittal, axial, and coronal planes in a process that is quick, painless and at minimal radiation levels.

– Dental Laser – This small, hand-held device is a tremendous asset when it comes to both the health and appearance of gum tissues. Not only does the laser eliminate or greatly minimize bleeding during procedures, it reduces numbing requirements, removes bacteria and easily uncovers gum tissue where dental implants have been placed. Additionally, laser dentistry can beautifully re-contour or repair gum tissue with a precision line.

As a periodontal specialist serving Western NC, I take great pride in the diagnosis and placement of dental implants with each selected based upon the patient’s individual needs and goals. We provide oral or I.V. sedation to ensure a comfortable experience and a friendly, respectful environment.

To schedule an examination appointment or to begin with a consultation, call 828-274-9440. A referral is not always necessary.

Do Different Age Groups Perceive the Importance of Oral Health Differently?


Posted on Feb 09, 2024 by William J. Claiborne, DDS MS

Just how important is your oral health?

Although Americans often focus on their smiles esthetically, it’s a far more important part of you than is often given due credit on a day-to-day basis. Yes, straight, white teeth help to enhance the appearance of a smile (as well as facial appearance), it’s what is typically not seen that has far greater importance.

About 50% of the world’s population over the age of 30 suffer from periodontitis. In the U.S., a developed country with excellent healthcare, a whopping 47% of adults over the age of 30 have some level of periodontal disease.

Because gum disease can begin without obvious symptoms, or be present without having pain, it is too easily ignored. This allows the disease to progress further.

The early stage, known as gingivitis, usually begins with swollen and tender gums that bleed easily when brushing teeth. As it worsens, the healthy pink hue of gums darken to more of a red color and breath odor is persistently bad. The gums begin to loosen their strong grip around the base of teeth, allowing infectious bacteria to reach bone structures that support tooth roots. In advanced stages (periodontitis), pus pockets form near the base of some teeth and gums become spongy in texture.

The bacteria of periodontal disease doesn’t just damage oral health. Through weakened oral tissues, the bacteria can enter the bloodstream and trigger inflammatory reactions. These reactions can worsen some serious health conditions and even activate others.

Research has found correlations between these bacteria and heart disease, stroke, diabetes, arthritis, some cancers (including pancreatic), preterm babies, erectile dysfunction, and Alzheimer’s disease.

In a 2020 study, individuals with gum disease who contracted COVID-19 were 9 times more likely to die. And, the study showed that COVID patients who already had advanced gum disease were 3 times more likely to end up in intensive care or on a ventilator. Evidence shows that poor oral health can increase viral infection severity, and even fatality rates.

But, does age play a part in the commitment to oral health?

A report commissioned by Delta Dental Plans Association revealed some concerning information regarding age groups and perceptions of oral health. With over 1,000 online participants, 87% listed their priority for maintaining proper oral care was to save money or avoid unexpected expenses. Two-thirds of the group listed their commitment to at-home dental hygiene as the desire to avoid tooth decay and gum disease. Yet, only 79% of adults stated they brushed their teeth twice a day with only 33% admitting to flossing daily.

In reviewing age groups, the report found that baby boomers (those born between 1946 – 1964) understand there is a strong link between their oral and overall health, but are less aware than other generations about the connection between poor dental health and chronic diseases (such as arthritis and diabetes). Those listed in the Generation Z group (born between 1997 – 2012) showed less commitment to their oral health as the “boomers,” but are more focused on eco-friendly and nontraditional oral care products. Only 76% of Generation Z agreed that oral health is closely connected to overall health.

An article in RDH Today recently shared that one-third of millennials (born between 1981 and 1996) admit to only brushing once per day, and the average millennial has gone over two days without brushing at all. Yet, 28% of young adults admit that ““The appearance of my mouth and teeth affects my ability to interview for a job.”

The study also shared that 27% of millennials are uncomfortable going to the dentist compared to 23% of respondents 55 years and older, and 56% of millennials have simply made an excuse not to go to the dentist compared to the 36% of those 55 years and older.

While fear remains a factor in a percentage of adults, this deterrent has existed for years among all ages. The American Dental Association conducted a survey on millennials, the fear issue was not the leading problem. Cost and inconvenient time and location were cited as the top excuses for avoiding regular dental care.

Excuses aside, here are some reminders about the benefits of maintaining good oral health:

• Technology – Today’s imaging technology (such as our Cone Beam technology and IntraOral scanners), allow us to treatment plan for the most conservative treatment possible. These amazing features provide amazing detail so treatment can be performed with precision for optimal outcomes.

• Comfort – In addition to the conservative treatment made possible by advanced imaging technology, we offer enhanced comfort options, including oral and I.V. sedation. Also referred to as “twilight sleep” or “sleep dentistry,” these sedatives are administered by a doctor of anesthesia who utilizes advanced safety monitoring equipment.

• Savings of Time & Money – The reason for 6-month dental check-ups and dental cleanings is to remove tartar buildup before damage can occur. Your hygienist and dentist can look for signs of gum disease so measures can be taken before the disease explodes into the need for more costly treatment to resolve the problem. Since gum disease is the nation’s leading cause of adult tooth loss, the associated expenses of replacing teeth can also be avoided by maintaining good oral health.

• Bolstering Overall Health – Although the Covid pandemic made us more aware of the benefits of vaccines and healthy habits such as hand-washing, it is our immune system that makes people more or less vulnerable. By investing in having healthy gums, the immune system is supported.

Be aware of the signs and symptoms of gum disease. These include:
Sore, swollen gums
Gums that bleed easily when brushing
Persistent bad breath
Gums that recede (pull away or loosen from the base of teeth)
Gums that turn red in color
Pus pockets that form at the base of some teeth
Teeth that loosen or shift

If you have any of these, you are urged to seek periodontal care as soon as possible. This disease will only worsen without treatment.

Call 828-274-9440 to schedule a consultation in our state-of-the-art Asheville periodontal dental office. A referral is not required.

 

Sources:

https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13435https://www.cdc.gov/nchs/fastats/dental.htm

https://www.deltadental.com/content/dam/ddpa/us/en/state-of-america%27s-oral-health-and-wellness-report/DDPA_State%20of%20Oral%20Health%20Report_2023-Release_FINAL.pdfse-you

https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/us-oral-health-well-being.pdf

https://www.todaysrdh.com/do-millennials-truly-have-worse-oral-health-than-their-parents/

https://nypost.com/2018/02/23/millennials-are-terrible-at-keeping-their-teeth-clean/

Dental Implants – Advantages of Specialized Skills, Advanced Technology, Optimal Comfort


Posted on Jan 10, 2024 by William J. Claiborne, DDS MS

It wasn’t that long ago when shopping for Christmas presents was quite the time-consuming ordeal. Today, we do searches for gift ideas online, check price comparisons, and have the items show up on our doorstep within a day or so.

Advancements through computerized technology have things running more efficiently and, in many cases, culminate into superior outcomes. This is true in dentistry, especially for those who opt for dental implants to replace missing teeth.

There are many reasons for people to choose dental implants, including:

– Designed to last a lifetime

– Look, feel and function like natural teeth

– Won’t decay or need repairs

– Restore chewing and biting comfort and stability

– Enhance overall health and confidence

– Halt the process of facial bone loss

Occasionally, dental implants are occasionally offered by general dentists. As a periodontist, however, I am referred most of our dental implant patients by other dentists and dental specialists. This is because a periodontist has advanced education and skills in the diagnosis and treatment of all areas of the tissues in the mouth (including the reshaping of gum tissues).

Periodontists are also specialists when it comes to the diagnosis and placement of dental implants. They are trained to understand the intricate concepts involved in selecting the proper type of implant based on each individual. These skills include the understanding of precision placements of implants at proper depths and angles. Additionally, periodontists are able to optimize your comfort and treatment outcome.

Still, another reason we are referred patients for dental implants because we can offer patients a wider variety of choices when it comes to implant systems.

There are many types of dental implants. Various systems are designed to support one replacement tooth (the “restoration”), a bridge of two or more teeth, or a full denture supported by several strategically-placed implants. Understanding the unique advantages of all systems enables us to choose the best type for the patient’s individual needs and goals.

For example, the All On Four dental implant system is designed to support non-removable teeth on just 4 implants (per arch). With its specially-designed implanted portions, these longer implants can fully distribute biting and chewing forces.

All-On-4 is an ideal choice for people who have lost bone mass due to lengthy periods of tooth loss. Because “All On 4” implants can be placed in minimal bone, many patients are able to avoid the need for bone rebuilding procedures prior to traditional implant placement.

In the placement, a periodontist is also the best “go-to” in dental implant skills. Here’s why…

For a dental implant to serve as a lasting tooth replacement system, it must be positioned in the jaw bone to specific depths and angles. An implant that is wrongly positioned can function less efficiently and lead to the need for removal.

For example, a periodontist can incorporate bone rebuilding procedures into treatment to a proper depth for patients missing a great deal of bone mass (typically due to missing natural teeth for many years). This can help to restore bone that has occurred in the mandible (lower jaw) or maxilla (upper jaw), which may also require a sinus lift.

Another example is a patient who has lost teeth due to periodontal (gum) disease. Because a periodontist combines advanced skills in treating gum disease as well as in dental implants, these patients have an added advantage when it comes to treatment success.

When it comes to the best way to pinpoint and tackle specific issues with our health, it makes sense to see a doctor who has received specialized training in that area. This helps to take the guesswork out of diagnosis and enhances the potential for a successful outcome in an efficient process.

A periodontist also has a reputation for being able to optimize patient comfort. Because a periodontal specialist is uniquely skilled in the care of gum tissues, he or she can provide a conservative approach to the placement process. Through respectful treatment of oral tissues (in both placement and exposure for restorations), less disruption to the gums allows for faster healing and higher comfort levels.

In our Western NC periodontal dental office, we incorporate our care with the advantages of some of the most advanced technology in dentistry; many options which are not readily available in other dental offices in our region. These computerized images offer advantages to patients in helping to minimize treatment needs.

These include:

  • LANAP (Laser-Assisted New Attachment Procedure) with PerioLase MVP 7 – an advanced protocol that efficiently and effectively treats advanced gum disease with the added advantages of a dental laser. This offers a non-surgical alternative for patients with moderate to severe periodontal disease and has even been found to stimulate bone regrowth in damaged areas.
  • Cone Beam Imaging – is ideal for diagnoses and treatment planning through images that provide a clear view of the upper and lower jaw (including nerve canals), with rotations that show sagittal, axial, and coronal planes in a process that is quick, painless and at minimal radiation levels.
  • CareStream Cone Beam Computer Tomography Imaging – is enhanced tomography that works with 3D imaging for exceptional detail and range.
  • CS 3600 Intraoral Scanner – quickly and comfortably captures digital impressions to create precision models or appliances accurately and easily (crowns, inlays, onlays, bridges, orthodontic appliances, aligners, custom abutments) without the need for bulky, goopy trays.
  • Computerized Dental Implant Placement – an advanced system for pre-surgical positioning of dental implants using a 3D model of the patient’s jaw. Once the implant type is selected, a template is developed for optimal treatment success.

For optimal comfort, we offer several sedation options, including oral and IV sedation. Oral sedation is a pill that helps patients relax. It also has an amnesiac effect, leaving most with little or no memory of treatment afterward. I.V. sedation (also known as “twilight sleep”) places the patient in a deeper sleep state and erases memory of the procedure. It is administered by a doctor of anesthesiology for optimal comfort and safety.

In our Western NC periodontal dental office, anesthesia is overseen by a Medical Doctor (MD) who is a board certified Anesthesiologist. With both sedation options, patients are closely monitored with advanced safety equipment throughout treatment.

Our goal is to help people move forward with treatment affordably for enhanced appearance, self-confidence and sense of security.

For those who have bypassed dental implants because of cost, our payment plans are often able to help patients enjoy the benefits of their dental implants without straining their budget. Most of these payment plans require no down payment, are interest-free, and have no prepayment penalty.

If you’ve considered dental implants in the past but have held back because of obstacles that may actually be overcome, begin by calling our Asheville periodontal dental office and speaking to our friendly staff at: 828-274-9440. Many dental implant patients find they were able to achieve the healthy smile they desired once they consulted with us and learned the options based upon their individual needs.

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