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.
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.
Keep The Mouth Moist To Minimize Bacterial Growth
Posted on Jul 22, 2021 by William J. Claiborne, DDS MS
When you think of an environment of a warm, dark, moist space, it would seem to be a perfect breeding ground for bacteria growth. For homeowners, the worry over this is often how easily mold forms in such places.
According to FEMA (Federal Emergency Management Agency), molds are microscopic organisms that thrive anywhere there is a moist environment. Growth can start on a damp surface within 24 to 48 hours.
Molds digest organic material, eventually destroying the material they grow on, and then spread to destroy adjacent organic material. (https://www.fema.gov/pdf/rebuild/recover/fema_mold_brochure_english.pdf)
As an Asheville periodontist, I can’t help but think of the similarities to the mouth. Bacteria in the mouth, when not removed, can multiply and form the sticky film that coats teeth and gums. This is known as plaque.
Like molds, plaque must to be removed to prevent its spread and destructive nature. This is what your twice-daily brushing and flossing regimen is intended to do. When plaque remains in the mouth for roughly 48 hours, it hardens onto teeth. This is tartar and typically forms between teeth or in chunks at the base of teeth.
Essentially, tartar is a hardened mass of bacteria. Like mold, tartar continues to grow if not removed. And, like mold, tartar can cause damage to what it is growing on and spread to surrounding structures.
In addition to a brushing and flossing routine, the mouth has a particular advantage in its ability to control bacteria growth. Saliva is a continual rinsing agent that moves bacteria out of the mouth before the reproductive ability begins or accumulation runs rampant.
However, a dry mouth, which can be the result of a number of factors, means saliva is operating at quite a disadvantage to oral health.
Oral dryness is a natural part of the aging process. It affects about one in five older adults. A dry mouth can also occur from:
• As a side effect of many medications (including prescription and OTC)
• Radiation therapy, especially for head and neck cancer
• Mouth-breathing, which may be due to nasal congestion or snoring
• Medical conditions, such as diabetes, Alzheimer’s disease, stroke and Sjogren’s syndrome
Mold has an odor. So does oral dryness, which reveals itself through bad breath.
Just as mold can destroy things like drywall, carpets and insulation, an overload of bacteria in the mouth can be destructive to teeth and gums. These living and breeding organisms thrive on gum tissues.
Although saliva is an aid in bacteria control, there is a limit to what the flow is able to manage. When oral bacteria reach a certain level, they cause inflammation in oral tissues. The early stage of this, known as gingivitis, causes the gum to become tender and swollen. When brushing, blood may be present in the sink when rinsing.
Gingivitis, at this stage, can be contained and resolved if quickly addressed. If not, the bacteria will continue to multiply. This creates inflammation in the gums. This means the inflammation has progressed to periodontal disease, which requires treatment since it is now below the gum line.
Beneath the gum line, the bacteria continue their attack on the structures that support natural teeth. This includes the bone structures surrounding tooth roots. At this point, the gums bleed easily and breath odor is persistently bad. The gums become red and swollen and may pull away from the base of some teeth (gum recession).
Resolving gum disease at this point requires a procedure known as scaling & root planing. This allows the dental professional to reach below the gum’s surface to remove the bacteria. More extensive than a dental cleaning, the gum tissues are numbed and the process may require more than one visit to complete.
If the disease is not treated, it will reach the stage of periodontitis. This is an advanced stage of gum disease that is highly infectious and destructive. Because it leaves the gum tissues in such a weakened state, the infection can easily penetrate beyond the gums and enter the bloodstream.
Symptoms of periodontitis are very uncomfortable. Gums turn spongy and breath odor is putrid. Pus pockets appear on the gums and it may become painful to eat. Some teeth may loosen and eventually need removal.
This is where the damage of periodontal disease bacteria becomes even more destructive. As bad as tooth loss is, hold onto your hat…
Because these bacteria can trigger inflammatory reactions elsewhere in the body, researchers have linked them to a wide range of serious health problems.
The bacteria of gum disease have been correlated to heart disease, stroke, some cancers, diabetes, arthritis, and preterm babies. This is rather telling as to the potency of this harmful bacteria and the destructive nature.
When mold in a house that began in one spot is ignored, the destruction spreads. That’s a pretty good reason to tend to the problem before it gets out of hand, right? Proper care for oral health is worth the minor investment of time and money to avoid the destruction that can occur, including keeping the mouth moist to support sufficient saliva flow.
Here are a few pointers to help you maintain oral moisture:
• Keep the mouth moist by drinking plenty of water throughout the day. Watch your limit of caffeine, including coffee, tea and colas.
• If you take medications that have a side effect of oral dryness, ask your doctor about options that may be less drying to the mouth. Or, increase your water intake and use a daily rinse to replenish oral moisture.
• If you snore or breath through your mouth during sleep, talk to your doctor about ways to resolve these problems. It may be as easy as adjusting your sleeping position or adding a side pillow. Or, an oral appliance may be advised.
• When medical conditions (acid reflux, sinus infections, diabetes, bronchitis) contribute to a dry mouth, be especially committed to your oral hygiene routine at home (brushing and flossing) and up your water intake.
• Know that alcohol (including beer and wine) are drying to oral tissues. Try to swish with water between drinks or have a glass of water nearby to periodically dilute the drying impact.
• Smoking (cigarettes, cigars, vaping) delivers toxic chemicals into the mouth, with the gums taking the first brunt. Be aware of this added risk to the drying effects and take added measures to keep your mouth clean and moist.
I hope you never need the specialty care of a periodontist. However, should you find yourself in need of our care, we place a priority on comfort and ensure a respectful, compassionate approach to each individual.
In our Asheville periodontal office, we provide sedation (“twilight sleep”) for patients during many procedures, if desired. Our office also features some of the most advanced technology available in dentistry, including cone beam imaging, laser dentistry, and computerized guidance for dental implants and other procedures.
Begin with a consultation appointment by calling (828) 274-9440. New patients are always welcome and a referral is not always needed.