Patients often ask about whether there are any new technologies on the horizon, or currently in use, to help with different dental problems. There are many concepts being developed that could revolutionize the way care is delivered. My favorites are those that help prevent things, such as root canals.

Many people have felt the jolting sensation of a sharp pain in a tooth after drinking cold beverages. A tooth is made up of tubules, microscopic channels that extend from the inner layer of tooth called dentin, all the way to the center of the tooth containing the nerve. The sensation comes from the temperature travelling through open tubules, either from damaged dentin caused by decay or exposed dentin from recession of the gums.

If the sensation goes away in a split second the diagnosis is called reversible pulpitis (inflammation in the nerve of the tooth). If the pain lingers for more than a few seconds the diagnosis may be irreversible pulpitis and the treatment sometimes requires a root canal procedure to remove the damaged nerve.

Research being conducted at the University of Maryland School of Dentistry could provide dentists with a much less invasive treatment for pulpitis. Researchers are developing a new, patent-pending technique to deliver medication directly to the center of a tooth. The technique uses strong magnetic fields to move microscopic particles through the tooth’s dentin and into the pulp.

The research uses the tubules of the tooth as a vehicle to deliver medication that could reduce inflammation or treat infection. The technique would attach medication to nanoparticles. By creating the nanoparticles out of a magnetic substance, such as iron, the researchers can use a magnetic field to push those particles, and the attached medication, through the tubules and into the pulp.

Delivering steroid medication using these magnetic nanoparticles could treat inflammation in the pulp. An antibiotic could also be delivered to reduce the infection, or a local anesthetic could be used to anesthetize a tooth.

The research has shown that, even though the nanoparticles are tiny, they are able to deliver a large enough dose for medications to be effective. Studies are currently being conducted on extracted human teeth to determine the optimal size for the nanoparticles and the most effective biocompatible coating. By covering the particles with a biocompatible substance, starch for example, the body’s immune system won’t attack the nanoparticles.

Dentists have been treating inflammation of the pulp the same way for a long time, which is to remove the pulp of the tooth. When the pulp of the tooth is removed, the space the nerve occupied has to be filled with a material to prevent bacterial growth. Although effective, this devitalizes the tooth and comes with its own set of potential problems over time. These problems include a weakened tooth with a higher potential for fracture, as well as a much higher risk for recurrent infection.

This new research is a possible contemporary solution to an age-old problem. By delivering medication directly to the area of the tooth that gives the tooth its vitality, it could prevent the need for many root canals.

There are a lot of things that happen to the body during pregnancy. The oral cavity, the gateway to the rest of the body, is part of that. In a recent survey conducted by an insurance company, it was found that more than 75% of pregnant women and new mothers experience an oral health problem. The survey also found that almost half of the surveyed women did not visit the dentist during pregnancy despite having dental problems.

The researchers cited cost as one of the main reasons why pregnant women do not go to the dentist, and they found that women without dental benefits were twice as likely as those with benefits to not visit the dentist during pregnancy. However, their conclusion was that healthcare professionals may be able to increase the amount of women who prioritize oral health by simply talking to women about the importance of visiting the dentist.

It is important for pregnant women to visit the dentist because all infections, including ones in the oral cavity, may impact the health of their baby. In addition, according to the study, hormonal changes throughout pregnancy can increase the risk for periodontal disease.

I remember when I decided to go to dental school, my grandmother told me that she had all of her teeth at 82, except for the four she lost – one for each of her pregnancies. Now, I’m not sure what her frequency was back in those days of visiting a dentist, but the mere fact that she could correlate tooth loss with pregnancy always stuck in my head.

She, and the medical community, did not know back then that the risk for gum disease increased during pregnancy. We also did not know what effects this increase in inflammation did to the rest of the body, including the developing baby. We know more now.

For pregnant women, any infection, including tooth decay and gum disease, has the added possibility of affecting the baby’s health. Healthcare providers need to spend more time explaining the connection between oral health and overall wellness before, during, and after pregnancy.

While it is important to acknowledge the frequent reasons for avoiding the dentist and offer insight into overcoming potential barriers — such as providing details about what services are covered under a preventive visit and upfront communications about treatment costs for restorative services — educating about the potential consequences of failure to control dental problems should be first and foremost.

The takeaway is to “bring oral health into the conversation about overall health during preventive checkups,” the survey authors concluded. “Educating patients regarding the importance of regular dental exams, home care, and the potential impact of oral health on overall health as often as possible will have an incremental positive effect on the patient.”

It is clear from this study that cost is an issue for pregnant women (it is for the general population too) when it comes to getting dental care. If finances are the barrier, talk to your dental office to see how they can make it work for you. Don’t let lack of “insurance” be a barrier. Be an advocate for yourself. I’ll have more on this in future columns.

Last week I talked about a sometimes not so silent epidemic – sleep apnea. This week’s epidemic is much quieter but shares the general idea of decreasing the quality of life.

With more than 24 million diabetics and 57 million pre-diabetics in the United States, there are a lot of people affected by diabetes. That’s nearly a quarter of the nation’s population. The most up to date research shows the connection between dental health and diabetes has never been more critical.

As an indication of our general health, the rapidly rising rate of diabetes should be ringing alarm bells everywhere. The litany of health implications from diabetes is a long and grisly list. It is the sixth leading cause of death in the U.S. That is probably vastly understated because as many as 65% of deaths from diabetes are attributed to heart attack and stroke. People with diabetes have about twice the overall risk of death as those who don’t have the disease.

Complications from diabetes cut years off productive lives and interfere with the quality of those lives through a host of debilitating health effects. Heart disease and stroke rates are as much as four times higher among diabetics. Nearly three-quarters of diabetics have high blood pressure. Each year, diabetes causes blindness in as many as 24,000 Americans. It is the leading cause of kidney failure, nervous system disease, amputations – the list goes on.

The facts about the connections between oral health and diabetes are even more alarming than those about diabetes alone. Here are just a few:
Diabetics are twice as likely to develop gum disease. This is especially true if your diabetes is not under control. The gum disease then worsens your diabetes through an automatic response that your body uses to fight the infection.

People with gum disease are 270% more likely to suffer a heart attack than those with healthy gums.

People who have diabetes and severe gum disease have a premature death rate nearly eight times higher than those who do not have periodontal disease.

Those who have gum disease and diabetes together are more than three times more likely to die of combined heart and kidney failure.
In people who have type 2 diabetes, gum disease is a predictor of end-stage kidney disease.

In people who have pre-diabetes – blood glucose levels that are higher than normal but not in the diabetic range – gum disease makes it more likely that they will become diabetic.

Once established in a person who has diabetes, the chronic infection that causes gum disease makes it more difficult to control diabetes, and increases damage and complications in blood vessel disease.

These are simply the facts and, yes, they are sobering. If you have diabetes or are pre-diabetic, make sure you are doing all you can to control these diseases. These two diseases can twist each other into a tight downward spiral of amplifying negative health effects. Unless they are halted by your physician and your dentist working in tandem as a health care team, together with your commitment to hold up your end of the bargain, these effects can continue to compound.

Your dentist is here to address the greatest debate of our time: manual vs. electric toothbrushes. The choice between old school and new school dental care is in your hands, but do you know which is best for you? Learn more about your toothbrush options here!

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In March I completed a “mini-residency” program at Tufts in dental sleep medicine. In a nutshell, dental sleep medicine is the dentist’s participation in the treatment of sleep breathing disorders such as obstructive sleep apnea. Although the concept seemed relatively simple to me at the beginning of my journey, there is always more to the story.

About 7 years ago, I took a one-day class in dental sleep medicine. I found it intriguing how many signs and symptoms dentists see on a daily basis which could be relative to possible sleep breathing issues. For most of us, when we are “asleep”, we are unconscious and have no idea what is going on behind the scenes. However, a lot can be learned by observation and some simple questions.

The more I learned, the more I had trouble ignoring the many red flags I was seeing in patients. Wanting to delve deeper, I signed up for the program at Tufts. The program consisted of a rather intense literature review of the subject and many hours of lectures by both dentists, who have been in the field of dental sleep medicine since its start about 30 years ago, as well as sleep medicine physicians. Many sleep medicine physicians are ENTs or pulmonologists. Since the program at Tufts, I have also joined a national dental sleep medicine mentoring group to continue to learn more.

Incorporating what I have learned to help patients has been slow. Dentists and physicians don’t typically have a lot of interactions together. However, the relationship between the two is very important in the treatment of obstructive sleep apnea.

Obstructive sleep apnea is a medical problem and needs to be diagnosed by a physician. Of the many things I have observed in my short time treating patients in this arena, one thing is clear: patients do not talk to their doctors or dentists about sleep very often. Many of the issues that people live with (snoring, fatigue, grinding/clenching, hypertension, TMJ issues, etc.) deserve a conversation in relation to sleep.

When I ask patients about snoring, for example, I often hear, “I don’t think I snore but my husband/wife snores like crazy”. Just because you and/or your spouse snores, does not mean you have sleep apnea. Benign snoring is simply fluttering of soft tissue in the back of the throat with no obstruction of the airway space. However, it still is a medical diagnosis and in most cases cannot be established unless some form of sleep monitoring is done. Both sleep apnea and benign snoring are treatable….and it should be treated because it is disrupting to others.

Witnessed apnea events, on the other hand – that is a person visually and/or audibly witnesses a bed partner pause breathing during sleep – are a significant sign that there very well may be a sleep breathing disorder. Oxygen to the body may be depleted during these events. This should be discussed with your physician.

The key takeaway this week is to have a conversation with your doctor if you don’t feel you are sleeping well. If your bed partner is consistently snoring loudly or pauses breathing during sleep, have a conversation with your bed partner and decide if this is an issue which should be addressed. If there is no one sleeping in the room with you, email me and I’ll give you an app to evaluate how much noise you are making.

Sleep breathing issues are very much underdiagnosed, can be dangerous, and are very treatable. Talk to your physician and dentist about it.

What is your definition of oral health? Is there even a standard definition of oral health? One thing is clear, the definition of oral health is not solely the absence of pain. Pain is also not necessarily an indication of poor oral health.

It wasn’t until the year 2000 that oral health was brought to the forefront of the surgeon general’s report as a critical component to overall health. This was an important event, but unfortunately never amounted to much in terms of being incorporated into most healthcare policies.

In 2005 at the World Congress of Preventive Dentistry, participants from 43 countries made it clear that oral health is an integral part of general health and overall well-being. They even concluded that oral health is a basic human right.

In 2011, the United Nations recognized oral disease as an integral part of other non-communicable diseases such as diabetes, cardiovascular disease, stroke, chronic respiratory diseases and cancer. This association with these other diseases was based on common social determinants such as socioeconomic status, diet, tobacco and alcohol use, and not on the basis of transmission. However, there is still no solid definition of what oral health really is.

According to a more recent column in the Journal of the American Dental Association, the American Dental Association is working on a proposed definition of oral health. The authors of the column state, “A proposed definition is necessary to achieve a common understanding of the scope of oral health, to help understand the array of complex oral and systemic health issues facing dental and medical professions now and in the future, and to provide a rationale to position oral health professionals as partners within primary health care.”

The authors go on to say that the definition of oral health needs to align with the current definition of dentistry. That definition currently states, “dentists are responsible not only for the evaluation, diagnosis, prevention and treatment of diseases and conditions of the oral cavity, the maxillofacial area and adjacent areas but also for assessing their impact on the human body.”

As new tests and knowledge in the area of oral health increases, the days of simply recording missing and decayed teeth and poking patients with instruments to chart periodontal (gum) issues may not be enough to best serve patients. What we can learn from things such as genetic testing and salivary diagnostics will change the way we interact with our medical colleagues and greatly benefit our patients.

In conclusion, the authors state, “As the definition of oral health evolves and likely will continue to evolve well into the future, no matter how oral health is defined, the message remains: Oral health is essential to an individual’s general health and quality of life.”

There are great things on the horizon that will significantly impact the way your mouth is evaluated. These will not only benefit your teeth but will also mean an overall healthier you. However, dentists and physicians need to work together better for the benefit of the patient.
Watch for a discussion on that topic next week.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.stclairdmd.com.