Beware of Hidden Contributors to Gum Disease, Tooth Loss

Posted on Aug 19, 2023 by William J. Claiborne, DDS MS

Decades ago, oral health was something many people took lightly, often waiting until something hurt to see a dentist. The fierce pain of a cavity or abscess or the sharp jolt of something hot or cold on an area of gum recession were motivators to for a dental visit.

However, Americans are now realizing how very important their oral health is in how it relates to overall health.

The correlation lies with bacteria that live within the gum tissues. While all mouths contain “good” and “bad” bacteria, research has determined that the bad type can cause problems within and outside of the mouth.

The bad bacteria are inflammatory. An accumulation of these inflammatory bacteria are what lead to periodontal (gum) disease. Gum disease is the nation’s leading cause of adult tooth loss. Additionally, advanced periodontal diseaseperiodontitis – can trigger or even worsen serious health condition far beyond the mouth.

Although gum disease can begin without any obvious symptoms, once it exists, progression occurs in three stages, which are:

• Gingivitis – As the initial stage of gum disease, inflammation is triggered by plaque buildup at the gum line. When daily brushing and flossing fail to thoroughly remove plaque, toxins form that cause irritation to the gum tissues. Once signs emerge, they may include seeing blood in the sink when brushing or having sore, swollen gums. At this stage, however, damage may be reversed with prompt response.

• Periodontitis – As the disease advances, the bone structures and fibers that support teeth are damaged by the destruction of infectious oral bacteria. At this stage, inflamed gums form pockets below the gum line, filling with bacteria-laden plaque.

• Advanced Periodontitis – In the advanced stage of gum disease, fibers and bone supporting natural teeth are destroyed. This can cause teeth to shift or loosen, requiring aggressive treatment to prevent tooth loss. Eventually, some teeth may require removal.

As devastating as tooth loss can be to one’s overall health, the bacteria of gum disease can enter the bloodstream. Research has shown this infectious bacteria can trigger inflammatory reactions elsewhere in the body, correlating to heart disease, stroke, high blood pressure, some cancers (including lung and pancreatic), diabetes, arthritis, impotency, preterm babies, Alzheimer’s disease and more.

Obviously, people should be highly-committed to the care of their oral health. Yet, statistics in America along these lines are not impressive. The Center for Disease Control’s Division of Oral Health cites that 1 out of every 2 American adults 30 and over has periodontal disease. They also shared that periodontal disease is higher in men than women (56.4% vs. 38.4%) with high prevalence rates among smokers (64.2%) and adults 65+ (70.1%).

In addition to your twice-a-year dental check-ups and cleanings, there are other ways to support oral wellness between visits. One is in keeping the mouth moist, supporting sufficient saliva flow.

When saliva flow is insufficient, bacteria are able to accumulate and multiply rapidly. In addition to oral dryness as a part of the aging process, contributors can be consuming alcoholic beverages, caffeine, and as a side effect of many medications (both OTC and Rx).

One reason to keep your dental professionals aware of ALL the medications your take is in how they can interact with certain procedures, including numbing agents. For example, medications to reduce blood clotting, which lowers your risk for stroke and heart disease, can cause bleeding problems during oral surgery or periodontal treatment.

For those who take medications that help to strengthen bones, these have been associated with a rare but serious condition called osteonecrosis of the jaw. Simply put, it refers to death of the bone. The risk of these prescriptions is greater for those administered by injection or intravenously.

Osteonecrosis of the jaw commonly occurs after dental procedures (tooth extraction, implant placement). Over 90% of those who have experienced osteonecrosis are those who have taken the medication in repeated high doses due to cancer or other diseases.

However, 10% who experienced osteonecrosis were taking much lower doses, mostly intended to treat osteoporosis.

Certain medications also affect the ability to taste, including cardiovascular agents, central nervous system stimulants, non-steroidal anti-inflammatory drugs, respiratory inhalants and nicotine skin patches.

Some medications can also cause the development of oral sores, inflammation or discoloration of gum tissues in the mouth. These oral sores or discolorations may arise from taking medications for blood pressure, oral contraceptives and chemotherapy agents.

Dry mouth is a common side effect of a wide variety of medications, including prescriptive and over-the-counter. These include antihistamines, decongestants, painkillers, high blood pressure medications, muscle relaxants, drugs for urinary incontinence, anti-depressants and many others. Drying causes the soft tissues in the mouth to become inflamed and makes you more susceptible to infection. When saliva flow is depleted, your risk for tooth decay and gum disease increases.

Supplements that may seem unconnected to your oral health can actually effect your care more than you realize. It is important for your dentist to know if you take…

• Ginkgo biloba or evening primrose –  These herbs can reduce your blood’s ability to clot, possibly leading to excessive bleeding during and/or after a dental procedure.

• St. John’s Wort – This herb, which is often taken to reduce anxiety, can interfere with the metabolism of other medications, including sedatives, antibiotics and anti-inflammatory drugs such as prednisone and Decadron. When combined with St. John’s Wort, these drugs can be less effective. On the other hand, narcotics such as codeine, Vicodin and oxycodone can become more potent when taken with St. John’s Wort. This can lead to sleepiness, lethargy and dizziness.

• Valerian – This herb has mild sedative effects. If your dentist prescribes drugs for anxiety or painkillers containing codeine, the effects of both together are greatly accentuated. This can lead to severe sleepiness, lethargy and dizziness that can last into the next day.

• Calcium and magnesium – When these supplements are combined with certain antibiotics, they can decrease the antibiotics being properly absorbed. This can compromise your ability to fight off infection.

As a periodontal specialist, I find that most cases of dry mouth are due to factors that can be easily controlled with simple changes. If you have delayed or avoided dental care, call 828-274-9440 to request a consultation, or begin with a thorough examination in our Asheville periodontal office.

And, if you are experiencing signs of gum disease, please know this disease will only worsen without treatment. The sooner you have treatment, the less involvement your treatment will likely be.

We offer the latest techniques, technology, and skills while always making patient comfort a top priority. If dental fear or anxiety are concerns, please make us aware of this when you call or at your initial appointment. In addition to our standard comfort features, we offer Oral and I.V. sedation (“twilight sleep”).

How the “Bad” Bacteria in the Mouth Can Lead To Serious Health Problems

Posted on Aug 08, 2023 by William J. Claiborne, DDS MS

The human body is a fascinating structure. It seems every year there are new findings that show just how complex and amazing it is.

Recently, one of the biggest areas of interest has been the study of microbiome in the body. Once thought to be icky little cesspools, these colonies of microorganisms are now seen as having an important role in our health. For example, the microbiome in the gut has been shown to aid in digestion and it’s now seen that skin microbiome may potentially help people overcome conditions like acne and eczema.

As a periodontist, I’ve followed research in how microbiome is being recognized for having a positive role in oral health. While bacteria that convert sugar to acid are the driving force behind tooth decay, this means that those critters in our mouths are not always bad guys.

There are about 700 different species of bacteria in your mouth. Some can be “bad,” yet the good bacteria are able to give our overall health a “leg up” in certain regards.

Certainly, having a clean, healthy mouth helps to prevent cavities and periodontal (gum) disease. However, read on to learn how the health of your mouth can contribute to your overall health to a rather significant extent.

Over the years, numerous studies have been able to pinpoint how diseases – such as heart disease, diabetes, arthritis, and more – might be triggered. The “trigger” seems to consistently link back to internal inflammation.

Inflammation in the body has been shown to set actions into play that cause the onset or worsening of a wide variety of health problems. Periodontal (gum) disease is a chronic inflammatory disease. This means the bacteria attacking gum tissues are in a consistently active state.

When the bacteria of gum disease enter the bloodstream (through tears in weakened gum tissues), it can create inflammatory triggers far beyond the mouth. This bloodborne inflammation, in turn, results in higher risks for heart disease, stroke, diabetes, preterm babies, arthritis, respiratory diseases and even impotency.

How can this occur?

In chronic inflammation, the body’s defense mechanism becomes stuck in the ‘on’ position. This sets off a chain of reactions that alter the helpful response of the immune to a harmful one. When an area in the body stays in an inflammatory setting, damaging reactions can occur.

Once in the bloodstream, several species of harmful gum disease bacteria can add to existing inflammation, including that in the arteries, where it can lead to heart attack and 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% 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.

Another example is in the similarities between tissues of gum disease and those taken from arthritic joints. Studies show that gum disease is not only a risk factor for arthritis (both are inflammatory diseases), one can contribute to the other. Thus, gum disease is a risk factor for developing RA and arthritic patients have a greater risk for gum disease.

Additionally, people with diabetes are more likely to have periodontal disease than people without it, likely because they’re more susceptible to contracting infections overall, according to the American Academy of Periodontology.

Studies also show that pregnant women with periodontal disease have a greater risk of having pre-term and low birth weight babies. These indications have been found in amniotic fluid and in fetal cord blood samples of infants.

Findings show, too, that the bacteria of periodontal disease may contribute to a higher risk of pancreatic cancer. For years, researchers at the National Cancer Institute and the American Cancer Society have conducted cancer prevention and screening studies.

By studying oral samples, notably higher levels of two types of oral bacteria were measured in study participants with pancreatic cancer. One oral bacteria was found to create a 50% increased risk for pancreatic cancer and the second oral bacteria led to a 59% greater likelihood.

Chronic inflammation, in any area of the body, is a health risk that poses severe health challenges now highly recognized in the medical field. Not surprisingly, we occasionally see patients who have been advised by their surgeons to have their gum health checked prior to surgery. This proactive measure is to reduce risk factors that could complicate surgical outcome.

Your body’s natural defenses along with good oral hygiene — such as daily brushing and flossing — helps to keep bacteria under control. Also, people should readily recognize the signs and symptoms of periodontal disease.

Healthy gums fit snugly around the base of teeth and be a light pink color. Although the initial stage of gum disease (gingivitis) may exist without obvious symptoms, common signs of gum disease include:

• Swollen or puffy gums
• Bright red or purplish gums
• Gums that feel tender or bleed easily
• Spitting out blood when brushing or flossing
• Frequent or persistent bad breath
• Pus pockets between some teeth and gums
• Loose teeth or a change in the way teeth fit
• Painful chewing
• Gums that pull away from teeth or are sensitive to heat and/or cold

Maintaining good at-home oral hygiene is easy and takes just minutes a day. Brush twice a day (two minutes each time) and floss daily. Drink plenty of plain water throughout the day and limit sugar. Have dental cleanings every six months and follow your dental hygienist’s recommendations to keep oral bacteria at minimal levels between visits.

If you suspect you have gum disease or have delayed (or avoided) having regular dental care, call our Asheville periodontal dental office to schedule an examination. Or, ask to begin with a consultation appointment. During this time, we can discuss any concerns and I’ll answer your questions. Call 828-274-9440.

Let’s help you achieve a healthy, confident smile that adds to the well-being of your overall health!


Grow Older With A Confident Smile That Is An Asset To Your Well-Being

Posted on Jul 27, 2023 by William J. Claiborne, DDS MS

Oliver Wendell Holmes, an associate justice of the U.S. Supreme Court from 1902 – 1932, once said, “Old age is always fifteen years older than I am.” 

For people who’ve reached “a certain age,” it becomes clear that the advantages of aging (such as having more confidence and living life at a slower pace) are mixed with many challenges, mostly regarding health. 

From aching joints to loss of muscle strength to poor eyesight and hearing loss, the aging process comes with health challenges that seem to grow in number and severity with each passing year. Sadly, increased risk of tooth loss is also part of the process.

Depending on the retention of wisdom teeth, a full set of adult teeth should be 28 to 32. However, in a five-year study by the National Health & Nutrition Examination Survey, Americans ages 75 and over were missing over 22 natural teeth with over 26% having no remaining teeth (known as being edentulous).

While tooth loss is often perceived as a normal part of the aging process, it is not. Keeping one’s teeth throughout a lifetime is very possible. The health benefits of maintaining  natural teeth include, among many others, living a longer life.

Healthy teeth rely on a healthy foundation — your gums. Good oral health has been shown to reduce risks for serious health conditions (including heart disease, stroke, and some cancers) elsewhere in the body. In addition to lowering a number of health risks, keeping your natural teeth is necessary for proper biting, sufficient chewing, digestional health and nutritional intake.

It has also been shown that wearing dentures is a poor method of replacing natural teeth. Even though they recreate the appearance of teeth and restore function (to varying extents), dentures can actually contribute to long-term problems.

Natural tooth roots help to nourish and stimulate the jaw bones that are the supporting structures of teeth. Without them, the bones begin to shrink. Known as “resorption,” this process of bone mass decline can eventually lead to tooth loss. Once resorption begins,, it continues at an ever-increasing cases year after year.

Tooth loss also causes a domino effect of sorts. Statistics show that adjacent teeth beside an area of tooth loss have the highest risk of being the next to be lost.

And the problems associated with dentures continue. The gum-colored base of dentures is porous. This surface provides oral bacteria with tiny hideouts that are breeding grounds for high levels of bacteria. Denture wearers have higher incidences of respiratory problems, including susceptibility to pneumonia. Studies have shown that senior adults who also sleep in their dentures have even higher risks.

Wearing your dentures for prolonged periods of time (such as while you sleep) coupled with the aging process itself can lead to Denture Stomatitis. This condition causes redness, swelling and tenderness in the mouth. While it is most common among denture wearers, it can also occur from a broad spectrum of antibiotics.

Nearly 89% of adults ages 65 and older report they are currently taking any prescription medicine. More than half of adults 65 and older (54%) report taking four or more prescription drugs (compared to 32% of adults 50-64).

While a number of both prescribed and OTC medications include the side effect of oral dryness for any age, age-related reductions in salivary production are more severe for older adults, causing irritation to oral tissues.

Medications including antihistamines, blood pressure medications, decongestants, pain medications, diuretics and antidepressants typically cause dry mouth, which can create inflammation and higher susceptibility to infection.

The aging process causes the condition of “dry mouth.” Saliva plays an important role in maintaining good oral health. A healthy saliva flow makes it easy to talk, swallow, taste, and digest food. A reduction in saliva flow can increase plaque accumulation as well as the risk of developing periodontal disease. 

Referred to as gum disease, this bacteria accumulation can lead to tooth decay, mouth sores and oral infections. Inadequate saliva can contribute to bad breath, dry and cracked lips, cause the fit of dentures to become uncomfortable, and result in higher oral infection risk.

An emphasis on maintaining good oral health needs to be front and center for older adults along with their overall health care commitment. Fortunately, good oral health is easy to achieve. Twice-daily brushing, daily flossing and having 6-month dental exams and cleanings can help to minimize problems and address those that do occur at their earliest stages.

It is also important to keep your mouth moist. Drink plenty of water throughout the day. Limit foods and beverages that are caffeinated, which are drying to oral tissues. These include coffee, tea, colas and chocolate as well as spicy foods. If you take medications that have drying side effects, use an oral rinse designed to replenish moisture. Also, chew sugarless gum to help promote saliva flow.

Your diet is an important part of a healthy mouth. Evaluate your food intake carefully. Begin by limiting carbs and sugar. While all foods trigger an acid attack in the mouth for nearly 30 minutes after eating, sugar and carbs super-charge the reproduction of oral bacteria.

When teeth are lost, adults encounter a complicated set of issues – and costly challenges that can reach far beyond the mouth. As a Periodontist, I’ve seen how simple measures can save people greatly in treatment time and expense AND prevent problems like gum disease, cavities and tooth loss.

According to Woody Allen, “You can live to be a hundred if you give up all things that make you want to live to be a hundred.” Your smile should be one of your best assets throughout your lifetime, complementing appearance and as an advantage to your overall health. Don’t let the detrimental impact of tooth loss and risks associated with gum disease make you look and feel old.

If you have begun to lose natural teeth, let us help you halt the process! We can also discuss replacing them with dental implants with our specialized skills in the diagnosis and placement of dental implant.

Call 828-274-9440 to schedule a consultation to discuss how you can regain your oral health for a lasting, healthy smile!


AI in Dentistry – A Good Thing.

Posted on Jul 05, 2023 by William J. Claiborne, DDS MS

I remember when microwave ovens first appeared on the market. My mom wouldn’t even go near one in operation. Now, we know how to use them and the good things that come from their use.

Shoot forward 50 years and, like it or not, AI (artificial intelligence) is here. Self driving cars and round vacuums that move along floors are no longer Jetson-like imaginings. They’re blending into our lives in ways that are beneficial and non-threatening.

Like the microwave oven easing its way into day-to-day living, it’s logical that some people fear AI as a bad thing. After all, movies made decades ago prompted a vision of robots meandering among the human race as a new, threatening species.

As an Asheville periodontist, I’ve already seen – and incorporated in use – the positive aspects of breakthrough technology. Understanding its detection capabilities and accuracy, I’m particularly excited about the potential AI brings to the medical and dental fields.

You may be surprised to know that dentists are already beginning to turn to AI technology to quickly and accurately detect and prevent periodontitis, decay, bone loss and other gum health issues.

For example, a medical technology company in Boston has developed an AI platform that can assess X-ray images to an extent of over 50 times what can be detected by dentists through visual reviews. This allows dentists to give more effective treatment recommendations for patients while supporting the potential to avoid (or minimize) existing problems from developing or worsening.

For patients, AI assessments can also be reassuring. For those who anticipate particular treatment needs – a root canal, for instance – these assessments can zero in on exact issues so treatment planning is as conservative and as minimal possible, while being fully effective for the particular need.

Not just in medical and dental offices, but we’ll likely see AI used mainstream in many sectors. It can optimize accuracy in organizational materials, financial and budget projections, construction, farming, etc. For those of us in the periodontal dental field, AI has a vast potential to greatly improve the oral – and overall – health of our population.

Gum disease affects over 47% of American adults. With the help of AI, we can identify a higher percentage of cavities in earliest development stages while cutting the rate of misdiagnosis in half (thus curtailing over-treatment, in some cases). AI analysis will also aid in early detection of abscesses, lesions and oral diseases. It can prove to be a remarkable asset in catching oral cancer, helping to increase its poor survival rate or minimize the severity of treatment.

Through decades of research and extensive studies, keeping good oral health has been shown to be a supporting factor in good overall health. By keeping the “bad” bacteria in the mouth to manageable levels, the immune system operates more efficiently. Too, risk of medical complications from diabetes, heart disease and other illnesses can be significantly decreased.

It is suspected that many people are unaware that they even have periodontal (gum) disease, mainly because gum disease often begins with no obvious symptoms of its presence. Then, once symptoms appear (such as seeing blood in the sink when brushing), people may shrug this off as normal, or merely a sign they are being thorough in their brushing technique.

Gum disease is a particular problem for our aging population. The normal aging process dries out our hair, skin, and yes, the mouth. When the mouth is dry and saliva flow is insufficient, bacteria accumulation is more likely. This, in turn, provides a more welcoming environment for bacteria growth.

Too, many medications on the market – both prescription and OTC – have a side effect or oral dryness. This is double trouble for seniors, who already have “dry mouth” to combat. However, for people who smoke and/or are consumers of caffeine, they fall into this risk group as well.

Caffeine is present in coffee, tea, most colas, and (darn!) even chocolate. It can be in high concentrations in things like energy drinks and “power” bars. Caffeine-fortified foods can surprisingly include marshmallows, some cereals (and breakfast bars), jelly beans, gummy bears and frozen waffles.

Although AI will be an added perk to diagnosing oral health problems, it is the dentist and the patient together who have much more important roles. While regular dental check-ups help to remove existing buildup on teeth (known as plaque, which can harden into tartar), at-home care is what helps to prevent problems between visits.

It is first important to know the signs and symptoms of the various stages of gum disease. Warning signs include:

• Red, swollen, or tender gums or other pain in your mouth
• Bleeding while brushing, flossing, or eating hard food
• Gums that recede or pull away from the base of teeth
• Loose or separating teeth
• Pockets of pus between gums and teeth
• Sores in the mouth
• Persistent bad breath
• A change in the way your teeth fit together when you bite
• A change in the fit of partial dentures

The dentist-patient relationship can never be replaced by AI. Once you find a dental office where you feel respected, comfortable, and have total confidence, technology itself is merely an add-on.

If you have not had regular dental care or feel you have symptoms of gum disease (as listed above), it is recommended that you renew your commitment to your smile and your overall health with a complete periodontal dental examination.

During this time, your periodontist will note any areas that are diseased or at risk of developing such. He or she will explain recommended treatment and discuss a comfortable pace for your individual needs. Payment plans can also be discussed after determining the type of treatment most appropriate for your care.

If dental fear or anxiety has kept you from regular dental care, our NW Carolina periodontal dental office has a reputation for helping adults overcome the obstacles it can pose. Please share your concerns prior to or during your examination appointment. We offer several comfort options (in addition to our reputation for a gentle touch) and can explain what may be best for your care. We offer oral and IV sedation (twilight sleep), which are administered safely and with advanced monitoring equipment.

Too, our vast array of advanced technology often helps to minimize treatment while optimizing comfort. Please learn more about these features at: BiltmorePerio-Technology

We can’t stop progress, nor should we resist it. While most anything can be used with ill-will, I see AI in dentistry as a positive part of providing exceptional oral health to our patients – and our adult population!

But first, we must get you into the office. And that’s your decision. We don’t have technology to coax you in and hope you will take that step on your own before problems force you into a dental chair (which is often the case, unfortunately).

Call 828-274-9440 for an appointment or to have your initial questions answered.



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