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.

Alzheimer’s, Dementia, Depression, Anxiety Linked to Periodontal Disease


Posted on Dec 21, 2023 by William J. Claiborne, DDS MS

If you care about your health, this will be an important article to read. But be forewarned, there are a lot of little details that will eventually connect like puzzle pieces and (hopefully) end up providing a clear picture of what’s going on inside of you.

It’s a simple fact that all bodies have bacteria. While bacteria, over years past, have been looked upon as “bad guys,” science has now determined that some of these bacteria are actually important to healthy operation of the body.

Let’s begin with microbiome. These are like tiny liquid clusters of bacteria, fungi and viruses. These little cesspools are actually beneficial to digestive and skin health. But, in the mouth, which houses over 700 species of bacteria, weeding the bad from the good depends on maintaining a healthy body, which includes a healthy mouth.

Years ago, oral health recommendations were to brush twice a day, floss daily topped off by swishing with a mouthwash to kill lingering bacteria. There has been some pullback on the use of mouthwashes, however.

While they can be beneficial for those who have oral challenges (such as smokers or people who are undergoing chemotherapy), killing off the bulk of bacteria in the mouth also kills off the good bacteria. Although it’s not being said to NOT use mouthwashes, once a day is ample. Twice a day may be too much.

But, let’s go back to the bad bacteria. Research has found that certain oral bacteria can spurn the development of depression and anxiety. The team analyzed the relationship between salivary and tongue microbiomes to anxiety and depression. Findings showed that certain bacteria had a higher presence in people who had anxiety or depression.

As far as triggering mental disorders, the involvement of gum disease bacteria isn’t found in a clearcut path. The direct pathogens are still not determined. However, it has long been know that the inflammatory bacteria of periodontal disease is able to enter the bloodstream through diseased tissues. This means that the brain, which is fed by blood vessels, can be subject to the reactions these bacteria can cause in other areas of the body.

For example, the inflammatory nature of gum disease bacteria has long been linked to heart disease, stroke, diabetes and arthritis, along with others. It has been found that these bacteria can either trigger or worsen certain reactions that cause serious diseases. This makes the mouth a rather important part of having a healthy body.

It is also known that periodontal infection can accelerate cognitive impairments. Thus, funding is being devoted to support more in-depth investigations into just how it’s connected.

Findings thus far have been so concerning that the National Institute on Aging is supporting this research to the tune of $1.85 million through a grant to the University of Alabama Birmingham.

Their studies will focus on determining how periodontitis (severe gum disease) impacts primary immune cells in the brain and how they may activate the onset and progression of Alzheimer’s.

The concerns surrounding Alzheimer’s are becoming continually more dire, with an estimated 13 million being effected by 2050 in the U.S. alone. Since nearly half of American adults over the age of 30 have some level of periodontal disease, the risks for mental health needs, including dementia and Alzheimer’s disease, should make oral wellness a top priority.

Begin by knowing the signs and symptoms of gum disease, which are:

• Red, swollen or tender gums


• Seeing blood in the sink when brushing 


• Receded gums


• Loose or separating teeth


• Pus pockets on gum tissues


• Sores in the mouth


• Persistent bad breath

If you have any of these, know that these problems will only worsen without treatment. As a matter of fact, gum disease is the nation’s leading cause of adult tooth loss.

Begin with a thorough exam in our Asheville periodontal dental office. We offer advanced technology that helps to minimize the course of treatment and treatment time. Additionally, we offer oral and IV sedation (“twilight sleep”) for optimal comfort.

Call 828-274-9440.

Sources:

https://www.alz.org/co/news/oral-health-and-alzheimers-risk

https://www.uab.edu/news/research/item/13725-uab-researcher-receives-funding-to-study-link-between-periodontitis-and-alzheimer-s-disease

https://www.dental-tribune.com/news/study-links-oral-microbiome-to-depression-and-anxiety/

https://health.osu.edu/health/dental-health/does-mouthwash-kill-the-mouths-healthy-bacteria

 

What Gum Disease Bacteria Does To You That May Surprise You.


Posted on Dec 15, 2023 by William J. Claiborne, DDS MS

As we round the corner of another year, making oral hygiene a priority seems a distant thought in the midst of holiday preparations and activities of the season. But, it should be at all times in our lives, for many reasons.

Over the years, research has continuously shown that the bacteria of periodontal disease can have a number of harmful effects – in the mouth AND elsewhere.

This is because these inflammatory bacteria can enter the bloodstream and travel throughout the body. Studies show that these bacteria can activate or worsen a number of serious health problems.

People easily understand that a mouthful of bacteria can cause bad breath and gums that may be tender and redden in color. This makes sense, since an area with a skin cut can redden and swell if it doesn’t heal properly. Yet, because gum tissues are concealed behind cheeks and lips, it is easier to ignore problems that may be clear that something is wrong if more exposed.

To be clear, bacteria in our bodies is not always a bad thing. For example, certain bacteria in the gut actually enhance the process of digestion and help to keep the digestive system operating efficiently.

However, some bacteria are bad. These ignite when too much bacteria invade the body, causing the immune system to become overburdened. Bacterial overload can leave the body’s natural defense response, white blood cells, unable to conquer the infection. So, when a cut becomes infected, your doctor may prescribe an antibiotic to give the immune system added reinforcements.

And, when bacteria overload occurs in the mouth, an inflammatory reaction begins. This is the beginning of gum disease.

Signs of gum disease include bleeding or sore gums, persistent bad breath, receded gums, and/or gums that are red rather than a healthy pink. These are warning signs since gum disease will only worsen without treatment.

As gum disease progresses, gums begin to pull away from the base of teeth, gums become very tender and bleed easily when brushing, pus pockets form on gums and teeth may shift or loosen.

Unfortunately, gum disease is ignored too often by adults in the U.S. The CDC estimates that over 47% of Americans have some level of gum disease, which is also the leading cause of tooth loss.

A periodontist is a specialist in the treatment of all stages of gum disease and in the placement of dental implants.  He or she is the expert who can help to restore a bacteria-burdened “oral cavity” to a healthy state.

In addition to a healthy smile, the health of your gums can impact your overall health. By keeping the bacteria of advanced gum disease, known as periodontitis, you lower your risks of a long list of serious health problems that have been shown connected to gum disease bacteria. These include:

• Heart Disease & Stroke – 
According to research, having advanced gum disease makes you twice as likely to develop heart disease. This is due to clot-causing proteins that occur from oral bacteria that can clog arteries, including the carotid artery that supplies the brain with blood.

• Dementia & Alzheimer’s disease
 – Studies have shown that tooth loss from oral bacteria is a risk factor for memory loss and early stage Alzheimer’s disease. Apparently, oral infection cause inflammation triggers that can lead to the destruction of brain cells.

• Cancer – 
Researchers found that males with gum disease are 54% more likely to develop pancreatic cancer, nearly 50% more likely to develop kidney cancer and 30% more likely to have blood cancers.

• Diabetes
 – Because people with diabetes are more susceptible to infections, with 95% of whom also have periodontal disease.

• Erectile Dysfunction – 
Men with periodontal disease are 7 times more likely to have erectile dysfunction (ED).

• Premature Birth – Nearly 13% of U.S. babies are born premature, which can lead to breathing issues and infections. Infection in the mother’s body, which includes infection from periodontal disease, can create inflammatory reactions that are related to premature and low birth weight babies.

• Infertility – 
Research has found that gum disease can complicate attempts for a female to become pregnant.

• Respiratory Problems – 
When bloodborne bacteria from gum disease reaches the lungs, people with respiratory problems are at higher risk of pneumonia and acute bronchitis (COPD).

It has been said that the mouth is the gateway to the body. Whether it’s the holidays or vacation time or just a busy schedule, your oral health should be a commitment. It takes just minutes a day to brush your teeth thoroughly (at least 2 minutes each time), twice daily, floss daily and swish after meals.

Drink plenty of water, especially after consuming caffeinated beverages or alcohol (including wine). If you smoke, begin with a periodontal exam and ask our hygienist for at-home care instructions.

Call 828-274-9440 if you have questions about your gums or if you are experiencing any of the above mentioned symptoms of gum disease. Also, visit our website to learn more about our sedation options (including “twilight sleep”) and advanced technology, which often reduces treatment time while enhancing comfort.

 

 

 

 

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