Oral cancer: What you can do to help end this disease

By: American Dental Association, American Student Dental Association

🦷 The American Cancer Society estimates there will be 53,000 new cases of oral and oropharyngeal cancer in 2019, and the American Dental Association is working to provide members with resources that can help them do their part to fight and end this disease.

While April marks Oral Cancer Awareness Month, every day presents an opportunity to make a difference. Discover the ways you can do to end this disease via the American Student Dental Association. The Oral Surgery DC Team

The association published its clinical practice guideline on evaluation for oral cancer in 2017. It offers guidance for dentists on how to check for lesions, how to identify potentially malignant disorders and how to proceed in relevant clinical scenarios. The guideline points out that even though a variety of adjunct tools are marketed to dentists to enhance pick up of lesions because there isn’t evidence demonstrating that they improve screening, they aren’t recommended. And for situations where a lesion is observed, the guideline provides clinical pathways for follow up.

In addition to the guideline, the ADA has produced a chairside guide to walk you through the guideline’s recommendations, along with an instructional video that shows how to perform each step of a conventional visual and tactile exam on a patient. You also can watch a brief video on the ADA’s YouTube page that highlights how to check patients for oral cancer.

Given the current increase in HPV-associated oropharyngeal cancer, the most effective thing dentists can do to prevent oropharyngeal cancer is to encourage appropriately aged individuals to receive the HPV vaccine. Learn more about the ADA’s HPV vaccine policy at ADA.org, and check out this video from an ADA dentist who has a personal connection to the disease she hopes to one day defeat.

Source: https://www.asdablog.com/oral-cancer-what-you-can-do-to-help-end-this-disease/

What to do for healthy teeth and gums?

By: Jennifer Berry, Medical News Today

Good oral hygiene is necessary to keep teeth and gums healthy. But, take note that oral health is more than avoiding cavities and gum disease. Research has shown that there is an association between the health of a person’s mouth and their overall health.

Follow these tips from Medical News Today to improve not only your dental care practices but your overall health as well. The Oral Surgery DC Team

Experts consider oral health problems to be a global health burden. Without treatment, tooth decay or gum problems can lead to pain, problems with self-confidence, and tooth loss. These issues may lead to malnutrition, speech problems, and other challenges in a person’s work, school, or personal life.

People can prevent these problems with proper dental care, both at home and in the dentist’s office. The following are some best practices that can keep teeth and gums healthy.

1. Brush regularly but not aggressively

Most people are aware that brushing their teeth twice a day is one of the most important practices for removing plaque and bacteria and keeping teeth clean. However, brushing may only be effective if people use the correct technique.

People should brush using small circular motions, taking care to brush the front, back, and top of every tooth. This process takes between 2 and 3 minutes. People should avoid sawing back-and-forth motions.

Brushing too hard or using a hard-bristled toothbrush can damage tooth enamel and the gums. The effects of this may include tooth sensitivity, permanent damage to the protective enamel on the teeth, and gum erosion.

The American Dental Association (ADA) recommend using a toothbrush that has soft bristles. They also state that people should change their toothbrush every 3 months or when the ends start to look frayed, whichever comes first.

2. Use fluoride

Fluoride comes from an element in the earth’s soil called fluorine. Many experts believe that fluoride helps prevent cavities, and it is a common ingredient in toothpaste and mouthwash.

However, some dental products do not contain fluoride, and some people do not use it at all.

Evidence suggests that a lack of fluoride can lead to tooth decay, even if a person takes care of their teeth otherwise. A recent review found that brushing and flossing do not prevent a person from getting cavities if they do not use fluoride.

Many communities in the United States have added fluoride to their water supply. Several organizations recommend this practice, including the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and the ADA.

People can find out whether the water in their area contains fluoride by contacting their local government. Reverse osmosis water filters remove fluoride, and people who use well water will need to check the fluoride levels in this water to find out how much is present. Many bottled water brands do not contain fluoride.

3. Floss once a day

Flossing can remove plaque and bacteria from between the teeth, where a toothbrush is unable to reach. It can also help prevent bad breath by removing debris and food that has become trapped between the teeth.

Although there is a lack of long-term studies proving that flossing is beneficial, the ADA continue to recommend it. The CDC also state that people should floss their teeth.

Most dental health professionals recommend gently pushing the floss all the way down to the gumline before hugging the side of the tooth with up-and-down motions. It is important to avoid snapping the floss up and down between the teeth, which can cause pain and will not remove plaque as effectively.

4. See a dentist regularly

Experts recommend that people see a dentist every 6 months for a checkup. During a routine dental examination, a hygienist will clean the teeth and remove plaque and hardened tartar.

The dentist will check for visual signs of cavities, gum disease, mouth cancer, and other oral health issues. They may sometimes also use dental X-rays to check for cavities.

The results of a recent study confirmed that children and adolescents should see a dentist every 6 months to help prevent cavities. However, adults who practice good dental hygiene every day and have a low risk of oral health problems may be able to go less frequently.

The authors of a recent review state that there is a need for more high-quality studies to confirm the ideal frequency of dental checkups.

People can speak to their dentist about how often they need a checkup. The answer may vary depending on a person’s health history, age, and overall dental health. However, anyone who notices changes in their mouth should visit a dentist.

5. Do not smoke

Smoking harms the body’s immune system, which makes it difficult for the body to heal tissues, including those in the mouth. The CDC name smoking as a risk factor for gum disease, while the ADA warn that people who smoke may experience slow healing after a dental procedure.

Smoking also affects the appearance of the mouth, leading to yellowing of the teeth and tongue, and it can give breath a bad odor.

6. Consider a mouthwash

Some studies indicate that certain mouthwashes can benefit oral health. For example, one review found that mouthwash containing chlorhexidine, an antibacterial ingredient, helps control plaque and gingivitis. Mouthwashes with certain essential oils are also effective, according to a meta-analysis.

People may wish to ask their dentist which is the best mouthwash for their individual needs. A mouthwash cannot substitute brushing and flossing, but it can complement these practices.

Mouthwashes that may help with bad breath and dental problems are available online.

7. Limit sugary foods and starches

Consuming sugar can lead to cavities. Studies continue to highlight the significant role that sugar plays in adverse dental health outcomes. Common culprits include candy and desserts, but many processed foods also contain added sugar.

The WHO recommend that people limit their intake of sugar to below 10 percent of their daily calories. The authors of a systematic review concluded that lowering this to 5 percent would further reduce the risk of cavities and other dental problems.

Experts have also stated that starchy foods, such as crackers, bread, chips, and pasta, can cause tooth decay. The ADA explain that these foods linger in the mouth and break down into simple sugars, on which acid-producing bacteria feed. This acid can cause tooth decay.

Instead of starchy foods, the ADA recommend eating plenty of fiber-rich fruits and vegetables as well as dairy products without added sugar.

8. Drink water instead of sugary drinks

Sugar-sweetened beverages are the number one source of added sugars in the typical diet of those in the U.S. Sipping on soda, juice, or other sugary drinks can lead to a higher risk of cavities.

The ADA recommend drinking water or unsweetened tea throughout the day and only drinking sugar-sweetened drinks at meal times and in small volumes.

Tips for kids

A child’s primary teeth, which people sometimes call baby teeth, are just as important as their permanent teeth. Baby teeth help a child chew and speak. They are placeholders for future permanent teeth.

If a child loses a baby tooth to decay, this can disrupt the space in the mouth and make it difficult for the adult tooth to develop correctly.

With this in mind, it is best to introduce good dental care for children during infancy. The following practices will help keep a child’s teeth and gums healthy:

  • Wipe a baby’s gums with a warm, wet washcloth every day, even before they have any teeth. Doing this removes sugars from the gums and can help a baby become familiar with the feeling of cleaning their teeth.
  • Babies and toddlers should not go to bed with bottles or sippy cups. Milk and juice contain sugars that can cause tooth decay if they remain on the teeth for extended periods.
  • As a baby approaches 1 year of age, start getting them used to a sippy cup. Aim to stop using bottles by their first birthday.
  • Allow toddlers to sip water from sippy cups between meals, but save juice or milk for meal times only.
  • Once a baby has teeth, brush them twice a day with a soft baby toothbrush. Use a tiny amount of fluoride toothpaste, no bigger than a grain of rice. Children who are 3 to 6 years of age may use a pea-sized amount of toothpaste.
  • Parents or caregivers should brush the child’s teeth for them until they can clean all of their teeth thoroughly without help. Monitor them to make sure that they spit out the toothpaste.
  • Keep the toothpaste out of children’s reach when it is not in use.
  • The ADA recommend that children see a dentist within 6 months of their first tooth appearing or at 1 year of age, whichever comes first.
  • Parents and caregivers should not share eating utensils with a child or clean pacifiers by putting them in their mouth. Both of these actions can pass the adult’s cavity-causing bacteria to the child.

Summary

Practicing good dental care from infancy to adulthood can help a person keep their teeth and gums healthy. Brushing and flossing daily, not smoking, eating a healthful diet, and having regular dental checkups can help people avoid cavities, gum disease, and other dental issues. It may also benefit their overall health.

Source: https://www.medicalnewstoday.com/articles/324708.php?fbclid=IwAR2JFpPKmHx3XWZMBRanYShZhId1pzxlxrIxTV_Bb0EFrG4VZOSRPGNvvB0



Dentists without drills: Minimally invasive dentistry is on the rise

men's blue t-shirt

By: Katharine Gammon, USC News

😷 Are you afraid to go to the dentist or do you have phobia on dental drills? Well, not anymore!

Microdentistry is now part of the University of Southern California dental curriculum, and its focus on stopping cavities early and without drills can make a big difference for patients with dental anxiety. Learn more! The Oral Surgery DC Team

Ariella Glodowski could see on her X-rays that she had small caries lesions forming — even though they weren’t large, painful or even visible to the naked eye. The early detection gave the then-third-year dental student an opportunity to experience firsthand a minimally invasive dental procedure called resin infiltration, where early caries lesions are infused with resin rather than drilled and filled.

In December, she had the procedure, which she noted was nearly pain-free. “It was like a normal procedure except there was no drilling involved,” she said. “It was relaxing, to some extent, because there were no sharp objects involved, just some pressure.”

She was also relieved to know that she wasn’t losing any tooth structure to the drill. Often, when dentists complete traditional dental restorations they can end up removing healthy tooth tissue, which can result in more damage over time.

Minimally invasive dentistry: Leaving the drill behind

Resin infiltration is part of a growing trend in microdentistry, also known as minimally invasive dentistry, said Jin-Ho Phark, an associate professor of clinical dentistry at the Herman Ostrow School of Dentistry of USC and the dentist who performed Glodowski’s procedure.

“Patients tend to associate dentists with drilling, and they don’t like that,” he said. Plus, every time dentists complete a restoration, they have to drill away a little more of each tooth. Over time and multiple procedures, there is less and less healthy tooth structure to work with. “So,” he said, “we have been trying for a while to reduce the amount of drilling while still taking care of the disease.”

Caries and tooth decay can take a long time to develop. There might be many years before a patient feels any pain or physical evidence of a cavity due to caries, Phark explained. The trick to minimally invasive dentistry is to catch the decay before it becomes a big problem and stop it in the early stages.

“In the past, the standard was to wait until the lesion was big enough to be worthy to be drilled into,” Phark said. “With the new technique, we can stop the cavity early on and prevent it from breaking down and needing a filling at a later time.”

A dentist can use a special liquid resin to infuse into the lesions, which are porous. “We fill those pores with this resin,” Phark said. “It acts, in a way, like a sealant, and it’s a very preventive measure.”

Dentists have been using sealants to cover the grooves on chewing surfaces, and now they are using them to close up lesions developing between teeth. They apply the resin onto the tooth’s surface, and a network of pores within the enamel force the resin deep into the tooth. “After that, we harden the resin with blue light,” he said.

New in minimally invasive dentistry: silver diamine fluoride

In situations where the caries lesion has already progressed further and turned into a visible cavity, another minimally invasive dentistry technique gaining in popularity is the use of silver diamine fluoride. Though used internationally for years to stop caries progression, it has only recently been approved by the U.S. Food and Drug Administration for use in tooth sensitivity.

In its off-label usage, the antimicrobial, remineralizing compound is painted onto a tooth’s surface where cavitated lesions are visible, effectively halting any further caries cavitation. The method has been widely used in children or patients who might have a fear of the drill, Phark said. One negative side effect is that the compound can leave teeth blackened at the application site, which is why it has been widely adopted for children’s primary teeth, where it is only a temporary problem.

First in the nation? USC

USC is the first school to teach minimally invasive dental techniques on a large scale, already starting on the pre-clinical level. So far, these techniques have been offered only to patients in special clinics or advanced programs, such as advanced operative and adhesive dentistry. However, last fall Phark started teaching them to the first-year class in a new module called Cariology and Microdentistry. Once this class enters the clinic, they will be performing this kind of treatment on a regular basis.

Glodowski is excited to experience it firsthand and also to offer more drill-free options to her patients in the future as the technique becomes widely available. “Patients are going to be really happy that this is a possibility that works for them, especially if they have phobias about drilling,” she said. “It offers a more conservative approach, which is what we’re trying to strive for.”

Phark said resin infiltration, resin sealants, and silver diamine fluoride shouldn’t be expected to replace good oral hygiene and other healthy habits. Dental teams should start a larger conversation around health, which might even include having a nutritionist as part of the practice. “We are trying to be more and more preventive in the case of tooth decay and fight the causes of this disease, rather than patching up the consequences by drilling and filling,” he said.

The new cardiology curriculum is also paired with the implementation of new caries detection methods that use near-infrared, laser fluorescence and even the use of dental microscopes. This will help to detect and monitor such caries lesions more reliably.

The “death spiral of a tooth”

Part of what students learn is how to look at a patient’s history and ask questions to determine their risk of developing cavities. They also are trained to assess if patients have enough saliva, as saliva contains minerals that have a protective function for teeth.

There are very few downsides to the resin infiltration, though Phark said that some people don’t like the rubber dam that dentists have to place over the tooth to make sure there is no saliva and blood getting into the preparation. In addition, after the resin is placed, dentists can’t see it on an X-ray; they can still see the dark spot of the lesion, and they have to compare the size of the lesion to make sure the resin seal is working.

Still, the technique is far better than composite fillings, which last an average of five-to-seven years. “A young patient, a teenager, is going to live another 80 years,” Phark said. “You would replace that multiple times? And every time it gets bigger.”

He calls it the death spiral of a tooth: starting with a small filling, then a bigger filling and eventually a partial crown or a crown. “We are trying to stop this cycle that the tooth is going down from the beginning,” he said. “It’s especially important for adolescents.”

“This is a really exciting innovation,” said Glodowski, whose X-rays show the lesion isn’t growing under the resin. “I hope it will become more widely used in the future.”

Source: https://news.usc.edu/157157/minimally-invasive-dentistry-no-drilling/

Tooth whitening – don’t gamble with your teeth

By: Damien Walmsley, The Conversation

Are you one of those people who are dissatisfied with the color of our teeth? Have you tried to use some DIY methods and over-the-counter whitening products to whiten your teeth?

If so, here are some recommendations from The Conversation to know if it is safe to continue. The Oral Surgery DC Team

People seem to be hypnotized by the lure of having teeth that are whiter than an Oscars ceremony. Studies show that over half of us are dissatisfied with the color of our teeth. The seemingly insatiable desire for whiter teeth is welcome news for makers of tooth whitening products, judging by the huge array of over-the-counter kits on offer. They will certainly be cheaper than going to the dentist – at least in the short term. But they could end up being expensive in the long term, especially if they result in damage to the surface of the teeth and expensive dental procedures are needed to fix the problem.

Genetics and diet play a large role in why some people’s teeth differ in colour. A lifetime of smoking and consuming strongly coloured foods and drinks, such as curries, tea and coffee, contributes to the effect. If you can resist these foods and drinks, and give up smoking, the effects are not just cosmetic but could also improve the health of your teeth and gums. If you wish to pursue the option of tooth whitening, you should visit your dentist.

Hydrogen peroxide is regarded by the EU Council Directive 2011/84/EUas the most effective and safest way (although alternatives do exist) to whiten teeth, which is why dentists use it. But in the wrong hands and in the wrong concentration, these harsh chemicals can irritate the tender tissues inside the mouth, as well as the gums.

Before 2012, when the European Directive came into force, the market was poorly regulated, as the amount of hydrogen peroxide used in products sold over the counter varied widely across Europe, as was the amount that could be used by dentists in their surgeries. After an extensive review of the safety and effectiveness of hydrogen peroxide by an expert scientific panel, the EU restricted the amount sold over the counter to 0.1% and up to 6% by dental professionals.

DIY – destroy it yourself?

Home bleaching products are marketed as quick and easy to apply and cheaper than having your teeth whitened by a dentist. But there are two major problems. One, there’s no guarantee that the legal ones work. And, two, the illegal ones put the consumer at risk of damaging their teeth.

The strict laws governing the amount of hydrogen peroxide that can be used in over-the-counter products means that manufacturers look to other chemicals to whiten teeth. Some of these chemicals are questionable as there is a lack of research into their use for this procedure and they may damage teeth, according to a recent studypublished in the British Dental Journal.

The study looked at the safety of five commonly available over-the-counter products. Three used sodium chlorite as the active ingredient, which breaks down to chlorine dioxide in the acidic environment of the mouth. The whitening effect of sodium chlorite is not fully understood.

Four of the products contained citric acid as the “accelerator”, which will soften and dissolve the enamel. This may lead to a large whitening effect, but over time the enamel will be lost. Once enamel is gone, it cannot be replaced. A serious side effect is yellowing teeth as the underlying dentine, which is naturally yellow, comes to the surface.

As this was a laboratory study, we don’t know what effects these products have on the gums. It is known that bleaching products can cause sensitivity and irritation to the gums and teeth. In a dental practice, these symptoms are closely monitored by the dentist who will advise the person if it is safe to continue. Or they will stop the process until the person’s mouth returns to health.

Safe, cheap and effective: pick two

Over-the-counter whitening products are self-administered and so are open to misuse. The product may not be applied correctly, and it seems almost inevitable that some people will apply more, hoping to increase the whitening effect.

While the EU strictly governs the use of hydrogen peroxide, regulation in other countries is more relaxed. In the US, these products are classified as cosmetic – not medical. It is possible to buy products with either high concentrations of hydrogen peroxide (up to 25%) or other unregulated ingredients.

There are documented cases of damage occurring to teeth, gums and the mouth from their use, but as they are regulated as cosmetic products, manufacturers don’t have to submit reports of injury or other problems to the US Food and Drug Administration. Thanks to the internet, it’s possible to buy products with higher concentrations from anywhere in the world.

Given that you only have one set of adult teeth in your lifetime, there are easy steps you can take to protect your oral health that will also help with whitening. Avoid tooth decay by cutting down on sugar and make sure you brush your teeth twice daily with fluoride toothpaste, including the last thing at night. And you can always ask your dentist for advice if you are worried about the appearance of your teeth.

Source: https://theconversation.com/tooth-whitening-dont-gamble-with-your-teeth-113162?