REPOST: Ask Ila: Dental care in pregnancy

Ila Shebar answers a question from a concerned pregnant woman regarding oral health during pregnancy. Read about it in this Mass Live article below:

Ila Shebar is a nurse practitioner at Pioneer Valley Urology. | Image Source: masslive.com

 
Q: I am 3 months pregnant and find that my gums are bleeding frequently, especially with brushing my teeth. Is this normal?

Oral health is an important part of overall good health and you must maintain that even during pregnancy. It is very important to take care of your teeth and gums while pregnant, not just for you, but for your baby’s health as well. The hormonal changes that occur during pregnancy can increase your risk of gum disease. This can lead to health issues for you and for your baby.

You should, of course, be taking good care of your mouth even before you get pregnant. It is important to have regular check-ups and cleaning. Before you become pregnant have any oral health issues resolved.

You should schedule a dental examination if it has been more than 6 months since your last examination or if you are having any oral health problems. Prevention, diagnosis, and treatment of oral conditions, including dental X-rays (with shielding of the abdomen and thyroid) and use of local anesthesia is safe during pregnancy. Conditions that require immediate treatment, such as extractions or root canals may be managed at any time during pregnancy with care. Delaying treatment may result in more complex problems.

The increased level of the hormones estrogen and progesterone in pregnancy may make it easier for certain bacteria to grow and make gum tissue more sensitive to plaque. If you already have gum disease before becoming pregnant, pregnancy may make it worse.

After becoming pregnant be sure to let your dentist know that you are, and how far along you are. Postpone elective dental procedures until the pregnancy is completed. Routine dental care such as check-up and cleaning can (and should) be performed during the second trimester. Your dentist will want to know all medications, including prenatal vitamins that you are taking.

The hormonal changes that occur put pregnant women at an increased risk for pregnancy gingivitis. Gingivitis, inflammation of the gums, occurs in about 40% of pregnant women. It can lead to feelings of tenderness or swelling of the gums, often accompanied by bleeding. This occurs most often between the second and eighth months of pregnancy.

To help prevent this from occurring you need to continue to practice good oral hygiene during the pregnancy. It is the bacteria that cause the gingivitis, not the hormones, so you do want to clean your teeth and gums. Brush your teeth gently twice a day, or after every meal, with a fluoride toothpaste, and floss daily. Schedule that dental cleaning during the second trimester.

If you have morning sickness be sure to rinse your mouth with a baking soda solution (1 teaspoon of baking soda dissolved in 1 cup of water) after vomiting to clean the acidity off your teeth and stop stomach acid from attacking your teeth. You may need to switch to bland toothpaste if the one you are using increases nausea. Your dentist or hygienist can recommend a good brand.

You should be eating a healthy well balanced diet during pregnancy, and this is also important for your teeth and the baby’s teeth. Sugary snacks increase your risk of tooth decay. Your baby’s teeth begin to develop around the third month of pregnancy, peaking in the third trimester. Your healthy diet provides the nutrients for this to occur normally.

There have been studies that have demonstrated a link between gum disease and premature birth. One study published in The Journal of the American Dental Association found that pregnant women with chronic gum disease were four to seven times more likely to deliver prematurely (before gestational week 37) and underweight babies than mothers with healthy gums.

Mothers with the most severe periodontal disease delivered the most prematurely, at 32 weeks. This is more evidence of how important good dental hygiene is during pregnancy.

Call your dentist for an appt if you experience a toothache, gums that bleed easily and frequently, swollen, tender, or painful gums, or note any growths in your mouth, even if not painful.

Again, oral health care is an important and safe component of pregnancy and is strongly recommended.

Follow this Dr. John Pasqual Twitter account for more tips on maintaining proper oral health.

REPOST: 'My teeth were turning to mush': How 'bleachorexics' are stripping their enamel to the point of no return

Everyone wants to get bright white teeth but are you aware that constant bleaching can permanently damage tooth enamel? This article from The Daily Mail discusses the dangers of becoming a 'bleachorexic'.

**** 

America's long-standing fixation with impossibly white teeth is leading some to develop what dentists refer to as 'bleachorexia.'

According to Los Angeles-based cosmetic dentist Laurence Rifkin, over-bleaching is an all too common practice; one that causes severe and permanent damage by stripping tooth enamel and causing gums to recede.

'Once the enamel has been chemically eroded away, then it’s gone, it’s gone forever,' Mr Rifkin, who has even encountered people rubbing Clorox on their teeth in a desperate bid for a megawatt smile, tells Yahoo News.

Painfully white: According to cosmetic dentist Laurence Rifkin, over-bleaching is an all too common practice; one that causes severe and permanent damage by stripping enamel and causing gums to recede | Image Source: dailymail.co.uk

World Boxing Council champion Mia St. John tells Yahoo that she became so obsessed with over bleaching her teeth, her dentist had to intervene.

'He said my teeth could basically turn to mush just because I was destroying the enamel,' she reports.

Carbamide peroxide, the bleaching agent used in most whitening treatments, can make the teeth brittle and chalky, leading to hypersensitivity.

According to a recent survey conducted by the American Association of Cosmetic Dentistry, 96per cent of adults believes a good smile can make a person more attractive, and 74per cent consider a bad one to be a career disadvantage.

All those questioned said that if they could improve one thing about their smile, it would be whiter teeth.

Which is probably why Americans spend $1.4 billion annually on tooth whitening products, a 300per cent rise since 1996, and why many are ignoring product guidelines and bleaching their teeth more frequently than is recommended.

So how do you know if you're overdoing it with the carbamide peroxide?

Spoiler - if you are exceeding the number of regular treatments advised by your dentist, or with your at-home-whitening products, you probably are.

The main warning signs are excessive sensitivity, gum irritation and translucent blotches appearing on the teeth, Van Haywood, DMD, a professor in the Department of Oral Rehabilitation at the Medical College of Georgia, writes for Wedmd.

'Some people's teeth get more transparent if you continue whitening,' he states. 'You can see right through them and see the dark shadows of your mouth.'

Cautionary tale: In one of TV show Friends' most memorable episodes, Ross Geller leaves on his at-home whitening treatment for too long and ends up in quite the predicament | Image Source: dailymail.co.uk

It should also be remembered that depending on your teeth's natural shade, brightening them up to white-as-snow levels is actually near-impossible, no matter how much you frazzle them with bleach.

Most of the megawatt smiles we see paraded by celebrities from Kim Kardashian and Blake Lively to Brad Pitt and George Clooney are the results of porcelain veneers, not bleach.

Veneers are thin shells of medical-grade ceramic that are attached to the front surfaces of teeth, and will set you back anywhere from $800 to $2,500 per tooth.

New York-based cosmetic dentist Dr Jennifer Jablow, who is thought to have first coined the term 'bleachorexic' in 2005, assures, however, that with caution and realistic expectations, getting your teeth a few shades lighter can be pretty risk-free.

'Bleaching is very effective in moderation, and it's safe in moderation,' she told ABC last year.
'It's when you're bleaching all the time, beyond what is recommended, that's when you run into problems.





Read more related articles on proper oral health care by subscribing to this Dr. John Pasqual blog.

REPOST: Children as young as three suffering from severe tooth decay

Dental problems such as tooth decay and gum disease are starting to manifest in children as young as three. This article from The Guardian talks about how The National Institute for Health and Care Excellence is taking steps to address this alarming issue.

 There is misunderstanding about the importance of looking after children’s early milk teeth and gums, says Nice. | Image Source: theguardian.com

Children as young as three are suffering from severe tooth decay and people need to “act now to stop the rot”, health officials have said.

The National Institute for Health and Care Excellence (Nice) has urged local authorities to tackle a growing crisis in the state of people’s teeth in disadvantaged areas of England.

Tooth decay and gum disease are the two most common, largely preventable dental problems. Those most at risk are from the most vulnerable sections of society and who are dependent on others to care for them, such as young children and frail older people who need help to stay independent, Nice said.

The health body said schools and nurseries should help children brush their teeth, adding that severe tooth decay had been reported in children as young as three and in many cases was starting much earlier.

Professor Mike Kelly, the director of the centre for public health at Nice, said: “Children as young as three are being condemned to a life with rotten teeth, gum disease and poor health going into adulthood.

“Many children have poor diets and poor mouth hygiene because there is misunderstanding about the importance of looking after children’s early milk teeth and gums.

“They eat too much sugar and don’t clean their teeth with fluoride toothpaste. As a society we should help parents and carers give their children the best start in life and act now to stop the rot before it starts.”

Prof Kelly said there were wide regional differences in oral health, and said the situation was “bleak for many adults as well as children in disadvantaged areas”.

He added: “Diet, poor oral hygiene, smoking, alcohol and a lack of understanding about oral health are causing tooth decay, gum disease, tooth loss and increasing the risk of mouth cancers. These are also the risk factors causing many chronic conditions, including heart disease and diabetes.”

Nice suggests local authorities consider supervised tooth-brushing and fluoride varnishing programmes in nurseries and primary schools in areas where children are at high risk of poor oral health.

Professor Elizabeth Kay, foundation dean for the Peninsula Dental School in Plymouth, said: “Around 25,000 young children every year are admitted to hospital to have teeth taken out. Given that we know how to prevent dental disease this really should not be happening. If there were a preventable medical condition which caused thousands of young children (mostly around five years old) to end up in hospital to have body parts removed, there would be an outcry.”

Dr Sandra White, director of dental public health at Public Health England, said: “Tooth decay is the most common oral disease affecting children and young people in England, yet it is largely preventable.

“Whilst children’s oral health has improved over the past 40 years, one in eight (12%) three-year-olds have suffered from the disease, which can be very painful and even result in a child having teeth removed under general anaesthetic.

“Oral health is everyone’s responsibility and by expanding oral health education to the wider community so that nurseries, children’s centres and primary schools all play a role, we can reduce dental decay and ultimately improve the oral health of the local population.”

Subscribe to this Dr. John Pasqual blog to learn more about proper teeth care to avoid dental problems.

Frenectomy: What it is and when it is needed

Image Source: virginmedia.com

 
Oral frenula are soft folds of tissue found in the mouth. The labial frenulum attaches the inside of the upper lip to the gums between the two front teeth, while the lingual frenulum connects the underside of the tongue to the floor of the mouth.  

Lingual frenectomy

Image Source: ederorthodontics.blogspot.com

Some people are born with a lingual frenulum that prevents normal movement of the tongue, resulting in a condition called ankyloglossia, or “tongue-tie.” This sometimes occurs when the lingual frenulum is too short or is located too far down the tongue.

Infants with tongue tie often experience difficulty in nursing and could grow up to have speech difficulties or a protruding tongue. If left untreated, ankyloglossia can also cause caries amd gingivitis, due to food particles not being swept away because of the tongue's limited range of motion, and can negatively affect a child's self esteem. A child with a severe case of tongue-tie can have an unusual heart-shaped tongue.

Labial frenectomy

Image Source: caring4smiles.co.nz

A labial frenum which is too thick or tight can cause a gap to form between the two upper front teeth. A labial frenectomy can address this problem, but it is generally not recommended for young children. Orthodontics can often address the gap between the upper front teeth, unless the pain is severe or impedes normal eating and speaking functions, or if the gap widens once again after being corrected by braces.

Unlike frenotomy, which only removes a portion of the tissue under local anesthesia and is often referred to as “tongue-clipping,” a frenectomy entails the surgical removal of the lingual frenulum and is performed with general anesthesia.

Those who believe they are candidates for a lingual or labial frenectomy should consult with an oral surgeon on how to proceed.

Dr.. John Pasqual is an oral and maxillofacial surgeon and a clinical associate professor at the University of Florida School of Dental Medicine. For more articles on oral surgery and dental procedures, subscribe to this blog.

Preserving the jaw bone after the extraction of teeth

Image Source: therealfullhouse.wordpress.com

Sometimes, extraction is the most efficient way of treating pain, infection, bone loss, or fracture of the tooth. However, after the tooth is extracted, the special type of bone that exists solely to support the teeth can quickly degenerate. Without any preventive measures taken, the jaw bone can lose 30 to 60 percent of its volume within six months after the extraction.

The socket can also get damaged by disease and infection, which results in deformity of the jaw. The shrinking that happens after the extraction leads to unsightly defects and collapse of the lips and cheeks.

Image Source: serenitydentalclinic.com

Jaw defects also present problems in restorative dentistry, whether the treatment involves dental implants, bridges, or dentures. To prevent these from happening, patients can undergo a procedure called socket preservation, which can help maintain their smile’s appearance and improve their chances for success with dental implants in the future. 

There are many techniques that may be used to preserve the bone and prevent as much bone loss as possible . One common method involves filling the socket with bone or a bone substitute. Afterward, it is covered with gum, an artificial membrane, or tissue that stimulates proteins that would help the socket to heal naturally. 

Image Source: extremesmilemakeover.com

With the socket healing, shrinkage and collapse of the surrounding gum and facial tissues is effectively prevented. The newly formed bone, meanwhile, provides the foundation for an implant to replace the tooth.

Dr. John Pasqual is a board-certified oral and maxillofacial surgeon and fellow of the American Association of Oral and Maxillofacial Surgeons. Find more resources on dental procedures on this Twitter page.

A primer on dental sedation and anesthesia procedures

Image Source: beautyheaven.com.au

Many people are afraid of going to the dentist for many reasons: pain they've come to associate with certain dental procedures, or memories of unpleasant childhood experiences in the dentist's office. Some people even choose to live with uncorrected, often painful, dental problems rather than set foot in a dentist's office.

Thankfully, modern dentistry utilizes sedation techniques in order to address patients' anxiety and fear.

In sedation dentistry, a trained professional administers medication to help the patient relax during dental procedures. The following are some of the levels of anesthesia used.

General anesthesia The patient is unconscious, unable to sense pain, and will most likely not remember anything during the time he or she was anesthetized.

General anesthesia is administered by an anesthetist through an injection or as an inhaled gas. The anesthetist will monitor the patient throughout the entire dental procedure. General anesthesia is generally an option for extremely anxious patients.

Image Source: readanddigest.com

Deep sedation The patient is on the edge of consciousness: he or she cannot be easily awakened but might respond to pain.

Moderate sedation The patient is given a combination of sedatives and anesthetics to help him or her relax and to block the pain. The patient will be able to talk, but might slur his or her speech. He or she might not remember much of the procedure.

Minimal sedation The patient is completely awake yet relaxed. He or she will be able to breathe normally and respond to verbal prompts.

Image Source: deardoctor.com

Local anesthesia is used in minor dental procedures such as filling cavities or preparing teeth for dental crowns. The oral health care provider will swab the affected area with a topical anesthetic before injecting it with a local anesthetic. This numbs the area for a short period of time.

Most oral care practitioners can administer minimal sedation and local anesthesia. However, certificate holders in deep sedation and general anesthesia from the Commission on Dental Accreditation can perform these complex sedation and anesthesia procedures. Two examples are dental anesthesiologists and oral and maxillofacial surgeons.

Patients who are anxious about undergoing dental procedures and wish to know if they can become candidates for dental sedation should speak to a trusted and capable oral health care provider.

Image Source: blog.biolase.com

Subscribe to this Dr. John Pasqual blog for more articles about dental care.

Are dental implants necessary?

Dental implants are considered one of the most innovative improvements in dental care. These are replacements for teeth roots that grant a strong foundation for permanent or removable replacement teeth that look natural and authentic.

The necessity for implants is subjective. The choice affects individuals differently depending on personal condition, preference, and budget.

Image Source: mercola.com

According to Dr. Mark Wolff, an associate dean at New York University’s College of Dentistry, dental implants are better alternatives to bridges or dentures. Although all teeth replacement procedures serve the same purpose, proper implants are said to have no physical downsides and have reliable longevity.

Image Source: drjesusmedinajrdds.com

Among the many advantages of dental implants are improved appearance, speech, and comfort. Designed to fuse with the bone, dental implants eliminate the discomfort of removable dentures—allowing the person to speak without worrying that the replacement teeth will slip out of one’s mouth. They also improve oral hygiene as they do not require reducing other teeth, unlike bridges.

Image Source: costtoothimplants.blogspot.com

Despite their benefits, implants pose a common problem: the cost, which is rarely covered by health insurance. Practitioners, including oral surgeons, periodontists, or prosthodontists, normally charge patients from $3,000 to $4,500 for a single tooth.

Another consideration is health. Patients with uncontrolled chronic disorders, such as diabetes or heart disease, for example, are advised to be evaluated on an individual basis since the treatment is surgical and involves the bone of jaw or skull of the patient. The best way to asses one’s eligibility is to visit a dentist to see if implants are right for you.  

Dr. John Pasqual a board certified oral and maxillofacial surgeon with expertise including complicated facial surgery, dental extractions, and implants. Visit this Facebook page for more information on his practice.

An emphasis on surgeries of the facial complex

Image Source: womenshealthmag.com

Oral and maxillofacial surgery is a surgical specialty that is meant to treat various diseases, injuries, and defects in the head, neck, face, jaws, as well as the soft and hard tissues of the oral (mouth) and maxillofacial (jaws and face) regions. This field is recognized the world over as a specialty of dentistry, but it is recognized in some places as a medical specialty. 


Image Source: getholistichealth.com

Given the scope of the surgeries, dental school is a required training component for surgeons because of its focus on the facial complex. Additionally, it also requires years of hospital-based surgical and anesthesia training after graduation from dental school. Through these long years of study and training, oral and maxillofacial surgeons gain a thorough understanding of head and neck anatomy as well as form and function – knowledge necessary for the kind of operations that they’ll perform.

Image Source: loulouandtheboyinblue.com

Surgeries on the facial complex include dental implant surgeries, wisdom tooth removal, corrective jaw surgery, trauma surgery, and facial aesthetics among others. These surgeries are for managing a wide variety of problems relating to the mouth and facial regions and are meant to correct defects, restore or improve appearance after injuries, and provide relief from any discomforts.  

Dr. John Pasqual is a board-certified oral and maxillofacial surgeon and fellow of the American Association of Oral and Maxillofacial Surgeons. For more information about his work, visit the Pasqual Oral & Maxillofacial Surgery official website.