The Golden Years
June 28, 2011
The Golden Years are much more “golden” if your teeth are in good shape. One of the most difficult areas I have had to address in my time as a dentist are issues concerning aging patients, specifically those who require assisted or nursing care.
Whether you are the one making decisions for someone else or you are older and can make your own decisions, it is easy to let home care and regular dental visits decrease as time goes on. Dental health needs to stay at the top of the priority list for many reasons. Quality of life and the link between oral health and systemic health are two big ones.
Patients I have seen for the past 15 years will come in and say, “I don’t need to fix that. How much longer do I really have to live?” And every time I respond the same way, “If you told me that you knew you weren’t going to be around next year I’d say I would agree with you…..but you’ve been saying the same thing for 15 years.” It’s worse when the patients lose key teeth when they had the opportunity to keep them for their lifetime.
When an elderly patient has a multitude of dental issues in which some significant decisions need to be made, I consider the following issues:
• What is the general health status?
• How old is the patient?
• What is the general prognosis medically?
• Has the patient ever worn anything removable in their mouth?
• What is the minimal amount of dentistry that can be done that will not alter the patient’s quality of life?
• What are other treatment options to maintain or improve the patient’s quality of life?
The general health status of the patient plays a big role in deciding how to approach a patient’s dental care. People who have medical problems and are well controlled are usually okay to receive general dental care. If a person is in good physical and mental shape it is hard to use age as a determining factor for dental care.
The most important factor which I believe needs to be considered is about quality of life. Studies have shown that loss of teeth results in a loss in quality of life. Some people with dentures have told me that they can eat anything. Others would pay anything to have their teeth back. The point is the enjoyment of eating. There is no one who could argue that eating with false teeth is as enjoyable as eating with real teeth.
In my opinion, the worst thing you could do to a 70+ year old person (or for that matter anyone, but the older you get the worse it is) is to remove teeth and make them wear something removable in their mouth. Dentures can be very difficult to adjust to and it is even harder when you are older. The problems with dentures not staying in, the patient not wanting to wear them, and impacting a patient’s nutritional intake are all issues that are much more difficult for the elderly.
The best way to avoid having to deal with major issues as you get older is to make sure you take care of your teeth while you’re younger. If someone you love ends up in a nursing facility, one of the most important things you could do for them is to make sure they get proper dental care. This includes the use of some home-care products on the market that greatly decrease the risk of dental caries.
Stressed Out?
June 21, 2011
Are you stressed out? It seems that stress levels in people are on the rise. We worry about school, work, finances, illness, children, relationships, and more. Some even worry about how much they worry. Not to add to your stress, but you should be aware that all that worrying could have a negative impact on not only your general health but also your oral health.
According to an article published last summer in the Journal of Periodontology, there is a strong relationship between stress and periodontal disease (gum disease). In addition to stress, other psychological factors, such as anxiety, depression, and loneliness, are linked to an increased likelihood of periodontal disease.
So how does stressing out about your next car payment, for example, lead to gum disease? Researchers believe that the hormone cortisol may be a factor. Cortisol , also known as the “stress hormone,” is secreted by the adrenal glands and involved in many functions, including proper glucose metabolism, blood pressure regulation, insulin release for blood sugar maintenance, immune function, and inflammatory response. An earlier study published in the same journal the year before found that increased levels of cortisol can lead to more destruction of the gums and bone due to periodontal diseases.
Behavioral factors may come into play. People who are under extreme amounts of stress or suffering from depression may be more likely to disregard good oral hygiene. They may even take on new behaviors that could negatively impact their oral health, such as the use of nicotine, alcohol, or drugs, all of which can affect the teeth and gums.
Your gums are not the only oral victims of stress. Another oral side effect is teeth grinding or clenching, which often occurs during sleep. This may lead to headaches, earaches, or toothaches. Facial muscles can become sore and jaw joints tender. Besides causing discomfort, grinding and/or clenching can lead to severe tooth wear, loosening of teeth, and cracked or fractured teeth.
It is important to find healthy things that help relieve stress. A regular exercise routine can do wonders for relieving stress, as well as having a balanced nutritious diet and getting enough sleep. If you find it difficult to manage your stress you should see your physician. You should also make your dentist aware of your stress level so that he/she can make any necessary recommendations.
I’ll leave you this week with a quote from A. Cornelius Celsus’s DeMedicina. He wrote this around the birth of Jesus Christ, 2000 years ago. He was a Roman author and medical historian.
Live in rooms full of light.
Avoid Heavy food.
Be moderate in the drinking of wine.
Take massage, baths, exercise and gymnastics.
Fight insomnia with gentle rocking or the sound of running water.
Change surroundings and take long journeys.
Strictly avoid frightening ideas.
Indulge in cheerful conversation and amusements.
Listen to music.
Still good advice 2000 years later.
Decay – 100% Preventable
June 7, 2011
I spent last week in Boston for the annual meeting of an organization I belong to called the American Academy of Cosmetic Dentistry (AACD). It was a great meeting. In the four days I was there I took eight classes, went to a Red Sox game, did a Duck Boat tour, and had dinner in the North End. It was great to be a “tourist” in Boston. I learned more about the history of Boston and a great deal of information to be able to provide better care.
There are a wide variety of courses to take at a meeting like this. Most of them are obviously related to cosmetic-based dentistry, but there are other courses offered. Of the eight classes I took, this one particular course struck me the most. It was on current research of dental decay. I know what you are thinking, booooooring; I did too before I took the class. I learned so much and want to share some of the material I learned with you.
Dental caries (decay) is on the rise. It is the #1 disease in children; it has a genetic component and has systemic effects. There are over 19,000 different bacteria that have been found in mouths and every person has about 1,000 different types. Not all of them cause decay and many of them have also been found to grow on artery walls.
Why the increase in decay? Most of it has to do with dietary trends. If you haven’t noticed, our society is getting fat. We snack more, eat more sugar/carbs, drink more soda, have more gastric reflux, take more mouth-drying medications, etc. Dental caries is a pH specific disease. The right bacteria, plus sugar, create acid which breaks down the enamel of the teeth. Add an already acidic environment and it is even worse. It is a 100% preventable disease. The problem is that changing behavior can be very hard to do.
It is time for the dental professional to take a different approach when treating this disease. More focus needs to be shifted to prevention of decay rather just treating it. Filling teeth is treating the result of the disease but does nothing to prevent it. The dentist needs to take a more active role in assessing individual’s risk factors. In the dental world this is referred to as CAMBRA, which stands for Caries Management By Risk Assessment.
Based on assessing an individual’s risk factors such as quality of home care, quality of salivary flow, medication issues, and dietary issues, a caries-preventive strategy can be established. There are many new products on the horizon to help combat and virtually eliminate this disease. However, dentists must take some responsibility and be open to a different management of this disease. They must also be able to motivate people to change habits, which is difficult. The bottom line is that if you want to be decay-free you can be.
For those at higher risk, there are some great products currently available and others to come. Everything from new toothpastes and gels with ions in them to rebuild tooth structure, sprays to neutralize pH and probiotics are on their way. Right now you can use things like sweetener replacement Xylitol, which by itself is cavity-fighting, but also works synergistically with fluoride. Prescription level toothpastes are also available and there is strong research for the topical application of fluoride varnish, the same stuff the kids get, for adults.
The evidence is very clear – this is a 100% preventable disease. Next time you go to the dentist and find out you have a new cavity, stop blaming the dentist or yourself, and ask to get a specific protocol for prevention of this disease based on your specific risk factors.
