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.
Facts You Should Know – Part 2
December 16, 2010
This week is a continuation from last week’s column on facts you should know if you are having any dental work done other than a simple filling.
STAINS and COLOR CHANGES: All dental restorative materials can stain. The amount of stain generally depends on oral hygiene as well as the consumption of coffee, tea, tobacco, and some types of foods or medicines. Dental porcelain usually stains less than natural tooth enamel, and the stain can be removed at dental hygiene cleaning appointments. Natural teeth tend to darken with time more-so than porcelain crowns. At the time a new dental porcelain crown or fixed bridge is placed, it may be an excellent color match with the adjacent natural teeth. Over time, however, this may change and bleaching or other appropriate treatment may be suggested.
BLEACHING: Bleaching provides a conservative method of lightening teeth. There is no way to predict to what extent a tooth will lighten. In a few instances, teeth may be resistant to the bleaching process, and other treatment alternatives may be advised. Infrequently, side effects such as tooth hypersensitivity and gum tissue irritation may be experienced. If these symptoms occur, technique modifications or products can usually alleviate the problem(s).
TOOTH DECAY: Some individuals are more prone to tooth decay than others. With a highly refined carbohydrate diet or inadequate home care, tooth decay may occur on areas of the tooth or root not covered by a dental crown. If the decay is discovered at an early stage, it can often be filled without remaking the crown or fixed bridge. Long delays in treatment, a loose temporary, or permanent crowns and bridges can result in additional decay, the “death” of a tooth nerve, which would require a root canal or even the loss of a tooth and/or teeth.
LOOSE CROWN or LOOSE FIXED BRIDGE: A dental crown or fixed bridge may separate from the tooth if the cement is lost or if the tooth fractures beneath it. Most loose crowns and fixed bridges can be re-cemented, but teeth that have extensive recurrent decay or fractures will usually require a new crown or new fixed bridge.
EXCESSIVE WEAR: Sometimes crowns and fixed bridges are used to restore badly worn teeth. If the natural teeth were worn from clenching and grinding the teeth (bruxism), the new crowns and fixed bridges may be subjected to the same wear. In general, dental porcelain and metal alloys wear at a slower rate than tooth enamel. However, excessive wear of the crowns or fixed bridges may necessitate an acrylic resin mouth guard (also called a protective occlusal splint or night guard.)
ADDITIONAL INFORMATION: Sometimes when teeth are prepared for crowns, due to the extent of wear, deep decay, large fillings or old crowns, the additional “trauma” to an already compromised tooth can possibly cause the nerve of the tooth to die. This usually requires root canal treatment. It does not normally require changes in your treatment plan.
MAINTENANCE: Even the most beautiful restorations can be compromised by gum problems, recurring cavities, and poor oral hygiene habits. Part of your dentist’s commitment to you is to provide you with the proper information to keep your gums and teeth (natural or restored) in good health. Professional cleaning by a dental hygienist at recommended intervals keeps your mouth healthy and can intercept potential problems early enough to avoid additional restorative work or unnecessary discomfort.
