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E-Cigarettes & Hookah Pens (Impact on Oral Health and Health Risks)

How e-cigarettes and hookah pens impact our oral health

by Ahlam Shaab | July 18, 2014|Mail

With the recent popularity of the recreational use of e-cigarettes and hookah pens as a “healthier” decision to traditional cigarettes, consumers are falsely convinced there are no harmful effects to these water vapor alternatives. The notion that these products pose no threat (or a lesser threat than the accompanying two) has encouraged smokers, nonsmokers and young people to consume them. Some consumers have bypassed any further research on these water vapor products and have already allowed it to become a replacement to cigarettes.

If we allow ourselves to think back to the introduction of cigarettes, we might remember their impact on society and popular culture. At one time, it was hard to find someone who did not smoke (Mad Men, anyone?) and the possibility that these addictive trends would endanger our oral health was far from anyone’s mind. Smoking was glorified, but also underestimated, which is why people are now either looking to quit, looking for alternatives, or simply not looking to change despite the dangers smoking does to an individual’s oral hygiene.

Researchers have conducted experiments on e-cigarettes and found that e-cigarette consumers acquired higher levels of chemicals toxins contrary to being advertised as harm reducing. E-cigarettes, contrary to popular belief, do contain formaldehyde, propylene glycol , acetaldehyde, as well as carcinogenic chemicals that can lead to oral cancer. Unfortunately, the e-cigarette consumers unknowingly have a higher risk of consuming toxins and nicotine then the traditional cigarette consumer. The nicotine absorbency is high in e-cigarettes due to the higher concentrations in the cartridges which varies depending on brand.  A recent survey conducted by The Centers for Disease Control and Prevention (CDC) found that 6.8 percent of youth in grades 6-12 and six percent of adults consume e-cigarettes. That accounts for 14.5 million adults and approximately 5 million youth (Centers for Disease Control and Prevention, 2014). I have witnessed that it is becoming a frequent trend to use e-cigarettes and hookah pens at social events and many young adults are not educated on these products.

This poses the question: will these products dwindle the number of nicotine consumers or hinder the movement to make smoking unappealing? The answer, well, more time and research will tell.

It is difficult to ignore how these water vapor alternatives effect our oral health. Authentic cigarettes are forced to adhere to certain regulations unlike e-cigarettes and hookah pens which are sold over the counter and contain no labels. E-cigarette still contain nicotine which can be severely harmful and cause damage to the mouth, gums, and the tongue. The nicotine in these products can still cause gingivitis, periodontal disease, tooth decay, loss of teeth and dry mouth among other effects yet to be discovered. The U.S Food and Drug Administration (FDA) spoke out on e-cigarettes stating they contain a toxic found in antifreeze which can lead to cancer. People do not know that e-cigarettes contain many cancer-causing chemicals, one of them being nitrosamines.

These modern smoking crazes have been advertised as an alternative to the harmful ingredients in hookah and cigarettes, however, we cannot simply abide by these new alternatives and cease to question their impact on our oral health. The best alternative to maintaining oral health and the blueprint of our smiles is to avoid tobacco products entirely.

 

Oral Hygiene For Your Dog

Oral Hygiene and Your Dog's Health

Save to mypetMD

By T. J. Dunn, Jr., DVM

It’s a fact. Most dog owners never take a good look inside their dog’s mouth. And that’s unfortunate because it is estimated that over 80 percent have significant oral pathology. Every day veterinarians are presented with patients for routine vaccinations or other minor afflictions whose oral health status is truly cause for alarm. Upon displaying the dog’s loose teeth, sore and infected gums, and rotting tooth sockets to the dog’s owner, the response usually is one of surprise and shock.

"Well, she does seem to have bad breath, Doctor" is the usual reply. "But I’m sure at her age she can’t have anything done now." My response is that the continual presence of bacteria and their associated toxins have a daily impact on the dog’s health; anything we can do to change that for the better is appropriate. Privately I’m thinking "How would you like that pathology going on in your mouth?"

Partly because the mouth is warm, moist and has significant nutrients present for organisms to grow on, the oral cavity of dogs is a perfect incubator for all kinds of bacteria. Most are normal and natural, but once plaque and calculus (tartar) form on the teeth the normal microbial flora gets out of balance — and if pathogenic organisms proliferate, trouble ensues.

Far too often veterinarians discover during the physical exam that their canine subject has a foul odor to the breath as a result of generalized periodontitis. But foul breath is a mere shadow of a much more insidious disease process. 

To help understand the topic of oral hygiene let’s take a look at a few basic definitions below:

Definitions	Click on image for close-up
Gingivitis - inflammation of the gums.
Periodontitis - a general term for a disease of the oral cavity that attacks the gum and bone and delicate tissues around the teeth.
Pyorrhea - inflammation of the gums and tooth sockets, often leading to loosening of the teeth and accompanied by pus.
Caries - an area of decalcification of the tooth enamel leading to cavities in the tooth. Caries are very rare in dogs.
Plaque - the first buildup of material adhering to tooth enamel. Composed of a mix of intercellular matrix of bacteria, salivary polymers, remnants of epithelial cells and white blood cells, it can cause caries, calculi buildup and periodontal disease.
Calculus (Tartar) - calcium carbonate and calcium phosphate combined with organic material, deposited on the surface of the tooth.

ADVERSE EFFECTS OF POOR ORAL HYGIENE

I asked a Diplomate of the American Veterinary Dental College, Jan Bellows DVM, of Hometown Animal Hospital and Dental Clinic in Weston, Florida, about the adverse health impact chronic periodontal disease can have on a dog. This is what he had to say, "The toxins from periodontal disease are absorbed into the dog's blood stream. As the kidneys, liver, and brain filter the blood, small infections occur causing permanent and at times fatal organ damage. After periodontal disease is treated, and the owners give proper home care, most dogs respond wonderfully due to the decreased pain and infection."

The adverse effects of periodontal disease are due in part, as Dr. Bellows states, to the toxins the bacteria secrete and the damage these toxins cause to delicate kidney, cardiac, and brain tissue.  In addition, many veterinarians believe that actual bacterial colonies can spread via the circulation and set up housekeeping within the animal’s tissues, commonly in the heart valve areas, kidneys and liver. Far better than extracting teeth, performing gingival flaps, filling erosions or doing root canal procedures, would be to prevent the health damaging periodontal disease in the first place.

VETERINARY DENTISTRY

Since most dogs presented with advanced periodontitis are older canines, owner concern regarding the safety of dental procedures always seems to be an impediment to performing dental procedures, especially since anesthesia is an important aspect of a thorough dental cleaning.

"Age," as Dr. Jones said, "is not a disease, and senior citizen dogs that are otherwise healthy are generally able to tolerate anesthesia for an elective procedure. Even though anesthesia safety will continue to improve, there will never be a time when there is no risk. The question is really whether the level of risk is appropriately measured against the damage to the dog’s quality of life if it does not have a dental procedure."

Dr. Jones also points out that in modern veterinary practices the anesthetics utilized are markedly safer than those used 15 or 20 years ago and patient monitoring during anesthesia has become quite sophisticated. The use of intravenous fluids during the procedure, warmed surgical surfaces to keep the patient’s body temperature stable, and preanesthetic blood chemistry evaluation all improve the opportunity for the patient to benefit from the dental procedure.

PREVENTION

One of the best ways to insure optimum oral health is to provide the dog with a well-balanced, meat-based dog food. Meat assists in keeping the mouth environment healthy. Actively encouraging the dog to utilize chew treats that require some "exercising" of the teeth, such as is provided by compressed rawhide chewies, hard rubber or nylon chew toys, can assist in keeping the mouth structures vital.   Brushing the dog’s teeth can be a big help, too, but needs to be done almost daily.  

One study in the Journal of Veterinary Dentistry, December, 1996, reported "Tooth-brushing every other day did not maintain clinically healthy gingiva in dogs. The daily addition of a dental hygiene chew to a regimen of tooth brushing every other day reduced the gingivitis scores and reduced the accumulation of dental deposits (plaque, calculus and stain). Daily tooth-brushing should be the recommendation to the dog owner irrespective of dietary regimen."

Newer dental care products that include antiseptic impregnated chewies, canine appropriate tooth brushes, and even flavored tooth pastes to "reward" the dog for allowing the brushing, are available online and in pet supply stores or veterinary hospitals. Also important are routine oral hygiene visits where under light anesthesia the patient can undergo ultrasonic teeth cleaning, close inspection of teeth and gingiva, and assessment of overall oral health. 

Addressing problems when they are minor and preventing the health damaging effects of bacterial contamination and systemic toxin release are immeasurably beneficial to the dog’s long-term health status.

The increase in number of Specialists in Veterinary Dentistry such as Dr. Bellows attests to the fact that we dog owners need to pay closer attention to our dog’s oral health status. And that begins with the simple task of looking closely at the dog’s mouth.

Dr. Bellows neatly sums up the need for optimum oral health throughout a dog’s life by telling me this, "When a client asks me how long their puppy will live, I usually respond 15-17 years if you brush their teeth daily … 11-13 years if you don't."

If that doesn't convince you, I don't know what will.

Importance of Baby Teeth

Healthy teeth and gums are vital to children’s general health. Good dental care should start even before those first baby teeth arrive. But how do you clean those tiny gums and teeth?

Baby teeth development

Baby teeth develop while babies are still in the womb. Newborns have a full set of 20 baby teeth hidden in their gums.
Most baby teeth appear between 6 and 10 months. In some children, teeth appear as early as 3 months. In others, they don’t arrive until around 12 months. Children get teeth at different times. A very small number of children are born with 1-2 teeth.
Baby teeth can arrive in any order, although the central bottom teeth are often first. All 20 baby teeth will usually arrive by the time your child is three years old.
The 32 adult teeth replace the baby teeth between the ages of 6 and 20 years. You can’t replace these teeth, so you have to look after them.
 

Teething

As each baby tooth gets to the surface of the gum, the gum opens up to show the tooth.
Many people think that ‘teething’ babies:

• cry a lot or seem extra cranky
• don’t feed as well as usual
• suck on objects such as toys, dummies and bibs
• have more dirty nappies more often
• pull the ear on the same side as the tooth coming through. 

These signs might be caused by teething – or they might just be a normal part of development or a result of minor infections and illnesses.
If your baby isn’t well, it’s always best to take her to the doctor, especially if she has a fever or diarrhea, or you’re worried about any other symptoms.

Babies sometimes rub their gums together when new teeth are starting to come through the gum. This isn’t usually a problem.

Things to try for teething
If you’re concerned about your baby’s teething, you can try:

• gently rubbing your baby’s gums with a clean finger – make sure to wash your hands first
• giving your baby something to bite on, such as a cold (but not frozen) teething ring, toothbrush or dummy
• cooking mushier foods, which need less chewing
• giving your baby something firm, like a sugar-free rusk, to suck on.

If your baby still seems unhappy or uncomfortable, it’s time to see your GP or child and family health nurse. Teething might not be the problem.

If your baby likes a dummy, don’t dip it in food and liquids such as honey and sugar. It’s also a good idea to encourage your baby to let go of the dummy after he’s about 12 months old.

Dental care for baby teeth and gums

You can start cleaning and caring for your baby’s gums well before the first tooth appears. A couple of times a day, just wipe her gums gently using a clean, damp face washer or gauze.
As soon as teeth arrive, you can clean them twice a day (in the morning and before bed). Wrap a clean, damp face washer or gauze around your finger and wipe the front and back of each of your baby’s teeth.
If your baby doesn’t mind, you can introduce a small, soft toothbrush designed for children under two years. Use only water on the toothbrush until your baby is 18 months old (unless a dentist tells you to do something else).
Once your child is 18 months old, you can use a pea-sized amount of low-fluoride toothpaste on the toothbrush.

Don’t use toothpaste with babies under 18 months of age (unless recommended by your dentist).

The best way to clean your baby’s teeth

1. Place your baby in a position where you can see his mouth, and he feels secure.
2. Cup your baby’s chin in your hands, with his head resting against your body.
3. Clean his teeth using soft, circular motions.
4. Lift his lips to brush the front and back of the teeth and at the gum line.

Keeping the toothbrush clean
After cleaning your baby’s teeth and gums, rinse the toothbrush with tap water.
Store the toothbrush upright in an open container to allow it to air-dry.
If other family members’ toothbrushes are stored in the same place, make sure the brushes don’t touch. This reduces the risk that decay-causing germs will travel between brushes and into your baby’s mouth. And there’s no sharing when it comes to toothbrushes! One for each family member is best.
You should replace toothbrushes every 3-4 months, or when the bristles get worn or frayed.

Early childhood decay

Early childhood caries (ECC) is a common and severe form of cavities found in very young children (0-4 years of age). Without treatment, decay can spread deeper into the tooth, causing pain and infection and even damage to the underlying adult tooth. The baby tooth or teeth may need to be removed. Unfortunately, because of their young age, children may require treatment under sedation or general anesthesia at a hospital.

If a baby tooth is missing too early other teeth may move into its space and block the way for the permanent tooth.

Contributing factors to early childhood decay:

• Diets high in sugar
• A high frequency of snacking and/or frequent meals as well as sticky and sugary snacks.
• Sustained use of the baby bottle or sippy cup (especially at bed time)
• Lack of tooth brushing and flossing
• Limited access to fluoridated water

To prevent cavities:

• Keep your child's teeth clean. This is the easiest way to keep teeth healthy.
• Limit sugar filled foods and drinks (particularly for babies). Milk, juice and formula all contain sugar. Avoid using the bottle and sippy cup to sooth your child. Fill them with water instead.
• Visit the dentist by age one or within six months of when you see the first tooth. Through regular examinations your dentist will monitor the development of your child’s teeth and gums to catch problems early and prevent disease.

Thumbsucking and Baby Teeth

Thumbsucking is a natural reflex for children. Sucking on thumbs, fingers, pacifiers or anything they can get their mouths on can help babies learn feel safe and secure. Thumbsucking is a soothing action for babies, and can even help them lull themselves to sleep.

Thumbsucking is all well and good, until your child’s permanent teeth come in. Then it can cause problems. Crooked teeth and bite problems can result from thumbsucking. Also, the roof of the mouth can become unnaturally constricted or elevated and the jaws may not develop properly. The intensity of sucking matters, too. Aggressive suckers may even develop problems with their baby teeth.

Children usually stop sucking their thumbs between the ages of two and four years old, or by the time the permanent front teeth are ready to erupt. Which is good news for those emerging adult teeth! But if you have trouble getting your child to stop thumbsucking, try the following tips.

How to stop thumbsucking:

• Limit the time your child sucks their thumb to when they are in their bedroom or only during naptime

• Praise your child for not sucking

• If your child sucks their thumb for comfort, try to correct the cause of an anxiety

• Recruit your dentist in encouraging your child to stop thumbsucking

• Remind your child of their thumbsucking habit by putting a sock over their hand when they nap or sleep

Children Oral Hygiene & Diet

Just as it is for adults, good oral hygiene and a well-balanced diet are good for children. It’s good for their teeth and it’s good for their overall well being. And good habits start young. So gently clean your baby’s gums after every feeding and give your baby healthy foods.
Even though it may be tempting to let your child fall asleep with a baby bottle in their mouth, don’t. You may not be able to see any baby teeth in your child’s mouth, but they’re there. And they’re just as susceptible to tooth decay. So letting a baby fall asleep with a bottle full of breast milk, formula, juice or any sweet drink is like soaking those developing teeth in sugar. That wouldn’t be good for anyone’s teeth, especially your baby’s, and it can result in baby bottle tooth decay. Good oral health and diet is pivotal to establishing a lifetime full of happy, healthy smiles. All it takes is brushing, flossing, and eating right. The key is to start those positive habits at an early age.

Canker Sores: Causes, Remedies & Prevention

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Canker Sores: Causes, Remedies and Prevention

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Canker sores go by a number of other names as well as the main medical one of aphthous ulcers or recurrent aphthous ulcers.
These terms include aphthous stomatitis or recurrent aphthous stomatitis, aphthae and mouth ulcers.
Aphthous ulcers are easily identified in the mouth and well known, but is there anything that can be done about them? Are there times when canker sores require medical attention? This article answers these and other questions with easy-to-understand information about canker sores.
In the UK, the term "mouth ulcer" is used instead of "canker sore." When British people are talking about common mouth ulcers, they are typically referring to canker sores and not other forms of mouth ulcer such as herpetic ulcers.

Contents of this article:

1. What is a canker sore?
2. Treatments and prevention

Fast facts on canker sores
Here are some key points about aphthous ulcers in the mouth. More detail and supporting information is in the article.

• Canker sores are a very common type of mouth ulcer known as aphthous ulcers
• Canker sores are typically round and less than a centimeter across, with a white or gray-yellow center surrounded by a red margin
• Common canker sores are easy to identify by their appearance under a bright light
• The main symptom of canker sores is pain at the site of the ulcer, which is irritated further by certain foods and teeth cleaning
• While risk factors are proposed, common aphthous ulcers have no clearly identified causes
• Less common types of sore do have associations with other conditions that can often be addressed, such as mouth ulcers caused by herpesvirus
• Most aphthous ulcers do not need medical attention and can be home-treated for the symptoms
• Canker sores typically heal over naturally, usually within two weeks
• More persistent, severe, numerous or particularly recurrent canker sores should be seen by a dentist or doctor.

What is a canker sore?

Canker sores, also known as aphthous ulcers, are a common oral health complaint.

A canker sore is a type of mouth ulcer known medically as an aphthous ulcer. Aphthous ulcers are one of the most common complaints of the mouth, occurring at any age but being more likely in younger adults and women.
A first episode often occurs during adolescence, although children as young as 2 years may develop canker sores.
Many people have only occasional aphthous ulcers. The proportion of the population affected by recurrent episodes is estimated to range between 20% and 30%.

Causes of canker sores

Research has failed to give a scientific explanation of why canker sores develop, although there are known specific factors such as viral infection.
The causes of recurrent cases of canker sore - known as recurrent oral aphthous ulcers or recurrent aphthous stomatitis - are also unclear, although there are correlations with a number of factors.
A note for readers who use "mouth ulcers" to refer to what are canker sores: people more familiar with the canker term, such as in the US, may be referring to a broader group of lesions when they say mouth ulcers.

Fever blisters (cold sores)

Herpes infection leading to fever blisters can sometimes affect the oral mucosa, the same lining inside the mouth affected by aphthous ulcers.

Learn more about cold sores

Mouth ulcers in the broader group that are not canker sores may have a specific cause - fever blisters, for example (due to the herpes virus), or other infections and conditions.
Ulcers are sometimes associated with other conditions needing medical attention, such as inflammatory bowel disease, compromised immunity, allergies and nutritional deficiency.
All cases of aphthous ulcers lack a cure for the canker sores themselves, and treatment of the ulcers is largely confined to managing the symptoms.
While there is no firm understanding of why canker sores occur, a number of factors are thought to have some involvement, including:

• Hormonal changes
• Physical trauma (damage to the lining of the mouth, such as during dental treatment)
• Drugs
• Food hypersensitivity
• Nutritional deficiencies, including of iron, folic acid or vitamin B12
• Stress.

A report by the US Surgeon General cites up to a quarter of the general population being affected by recurrent aphthous ulcers, noting there may be higher numbers among selected groups, such as health professional students.

Symptoms of canker sores

Canker sores have clear features. The lesions cause local pain and can be easily irritated.
There are otherwise no further symptoms in simple cases, although the pain may cause feelings of being fed up with the mouth ulcer.
Common features of canker sores include them being:

• Usually well-defined, round, smaller than a centimeter across, and usually shallow in the mouth's lining, its mucosal surface
• White or yellow-gray center surrounded by an inflammatory red margin
• In medical terms, this means an 'erythematous halo' is seen around a fibrinous "pseudomembrane" formed over the mucosal ulceration (eruption/destruction)
• Often fading to gray over time
• Usually in the front part of the mouth, on its floor, inside of the lip (labial mouth), inside of the cheeks (buccal), or under the front or sides of the tongue
• Sometimes affecting the gums and, relatively uncommonly, the surface of the back part of the mouth
• Persistent for typically a week or two before healing.

When to see a doctor about canker sores

Common canker sores usually heal without the need for medical treatment. More severe or recurrent cases may be eased by prescribed treatments, although these do not "cure" such ulcers.

If canker sores persist without improvement for more than 2 weeks, a health care professional should be consulted.

Sometimes mouth ulcers are associated with other conditions that require medical attention. Examples are inflammatory bowel disease, compromised immunity, allergies and nutritional deficiency.
As a general guide, canker sores should be brought to the attention of a dentist or doctor when they:

• Persist for more than 2 weeks without improvement
• Get worse - including while being treated with home remedies
• Recur often - 2 to 3 times a year or more - or are particularly numerous or severe
• Are accompanied by other symptoms, such as fever, diarrhea, headache or skin rash
• Come with any concern at all that another condition may be related to them.

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 Treatments for canker sores

The good news is that the pain and discomfort of canker sores can be reduced by readily available prescription and non-prescription treatments and home remedies.
Simple cases of occasional canker sores are self-limiting; they will heal over and disappear without intervention.
No remedies are proven to change the course of aphthous ulcers themselves or the recurrence of the condition - treatments mostly just reduce pain, discomfort and complication.
Few treatments marketed for aphthous ulcers have been the subject of robust clinical testing.
When the sores are not associated with other conditions, science has so far failed to explain what causes them, and their management is focused on treating symptoms, reducing inflammation, and promoting the healing process by countering secondary effects that could slow this down, such as bacterial involvement.

Home remedies for canker sores

Even before reaching for any one of a large array of pain-relieving mouthwashes, gels or tinctures that can be bought from stores, one home remedy that may be possible with items already perhaps in the bathroom cabinet has been suggested by the US Library of Medicine.

Mouthwash can be useful in the treatment of canker sores.

This procedure can be followed three or four times a day:

1. Rinse with mild, over-the-counter mouthwash or salt water (with either, do not swallow)
2. Make a mixture that is half hydrogen peroxide and half water
3. Use a cotton swab to apply some of the mixture directly to the sore
4. Finally, dab a small amount of milk of magnesia on the canker.

So-called alternative therapies may be worth trying at home. A review of the management of aphthous ulcers written for the journal American Family Physician, published in 2000, listed a number of options, although it noted that there had been no randomized controlled trials to robustly test safety and efficacy:

• Anecdotes of relief and better healing from sucking on zinc gluconate lozenges (sold for the common cold)
• Vitamin C, vitamin B complex and lysine "may speed healing when taken orally at the onset of lesions"
• Sage and chamomile mouthwash 4-6 times a day may help - infuse equal parts of the two herbs in water
• Echinacea (herbaceous flowering plant) may have an immune modulatory effect to reportedly speed healing
• Carrot, celery and cantaloupe juices "have been reported as helpful."

Prescription therapies for canker sores

As mentioned at the beginning of this section on treatments, most aphthous ulcers are self-limiting, eventually healing without intervention. Treatment can only ease the pain and irritation, and help prevent complication.
More severe or persistent cases of canker sores need to be checked by a doctor to rule out associated conditions (such as inflammatory bowel disease, compromised immunity, allergies and nutritional deficiency) or to access prescription treatments. Again, any treatments aimed at the ulcers themselves are not certain to change their course but can ease the symptoms.
Antibiotics such as tetracycline may be prescribed to minimize inflammatory irritation by preventing bacterial aggravation.
Anesthetics, as well as being available in consumer products for canker sores, may also be prescribed as topical preparations to ease irritation and pain.
Other prescription treatments that may be used against problematic canker sores are tried empirically - without firm evidence, that is, but with the aim of seeing if they might help based on a theory (and assuming the safety considerations of prescribing the remedy).
The American Academy of Oral & Maxillofacial Pathology, for example, cites an association between recurrent cases of aphthous ulcers and an overactive immune system, so topical suppressant medications may help, such as locally applied cortisone.
With a similar mode - and again with limited evidence against aphthous ulcers - topical corticosteroids are a class of drugs often considered by doctors, including clobetasol ointment, dexamethasone rinse, fluocinonide gel (Lidex) and triamcinolone (Kenalog - in Orabase paste).

Avoiding spicy foods can help prevent the aggravation of canker sores.

Side effects are an important consideration with prescription drugs, and doctors should help with weighing these up when considering any potential benefit in the more difficult cases of canker sores.
One possible side effect of using corticosteroids against canker sores is a fungal infection in the mouth.
Particularly severe or recurrent cases of aphthous ulcers may be referred to oral specialists, who may consider systemic rather than locally applied (topical) drugs. These specialists may also be needed to make a more specific diagnosis - some rare cases of recurrent aphthous ulcers are diagnosed as Sutton disease, for example.

Prevention of canker sores

The question of what can be done to prevent canker sores in the first place has no clear answer. However, there are ways to prevent aphthous ulcers from getting or feeling worse.
Prevent aggravation of aphthous sores by avoiding:

• Abrasive foods or those that can stick in the mouth (potato chips, for example)
• Spicy, acidic or hot foods and drinks
• Traumatizing the ulcers (through harsh contact with toothbrush bristles, for example).

Written by Markus MacGill

        

Burning mouth syndrome

By Mayo Clinic Staff

Burning mouth syndrome is the medical term for ongoing (chronic) or recurrent burning in the mouth without an obvious cause. The discomfort may affect your tongue, gums, lips, inside of your cheeks, roof of your mouth or widespread areas of your whole mouth. Burning mouth syndrome appears suddenly and can be severe, as if you scalded your mouth.
Unfortunately, the cause of burning mouth syndrome often can't be determined. Although that makes treatment more difficult, don't despair. By working closely with your health care team, you can often get burning mouth syndrome under better control.
Other names for burning mouth syndrome include scalded mouth syndrome, burning tongue syndrome, burning lips syndrome, stomatodynia and glossodynia.
Symptoms of burning mouth syndrome may include:

• A burning sensation that most commonly affects your tongue, but may also affect your lips, gums, palate, throat or whole mouth
• A sensation of dry mouth with increased thirst
• Taste changes, such as a bitter or metallic taste
• Loss of taste

The discomfort from burning mouth syndrome typically has several different patterns. It may occur every day, with little discomfort when you wake, but become worse as the day progresses. Or it may start as soon as you wake up and last all day. Or discomfort may come and go.
Whatever pattern of mouth discomfort you have, burning mouth syndrome may last for months to years. In rare cases, symptoms may suddenly go away on their own or become less frequent. Burning mouth syndrome usually doesn't cause any noticeable physical changes to your tongue or mouth.

When to see a doctor

If you have discomfort, burning or soreness of your tongue, lips, gums or other areas of your mouth, see your doctor or dentist. They may need to work together to help pinpoint a cause and develop an effective treatment plan.
The cause of burning mouth syndrome can be classified as either primary or secondary.

Primary burning mouth syndrome

When no clinical or lab abnormalities can be identified, the condition is called primary or idiopathic burning mouth syndrome. Some research suggests that primary burning mouth syndrome is related to problems with taste and sensory nerves of the peripheral or central nervous system.

Secondary burning mouth syndrome

Sometimes burning mouth syndrome is caused by an underlying medical condition. In these cases, it's called secondary burning mouth syndrome.
Underlying problems that may be linked to secondary burning mouth syndrome include:

• Dry mouth (xerostomia), which can be caused by various medications, health problems, problems with salivary gland function or the side effects of cancer treatment
• Other oral conditions, such as a fungal infection of the mouth (oral thrush), an inflammatory condition called oral lichen planus, or a condition called geographic tongue that gives the tongue a map-like appearance
• Nutritional deficiencies, such as lack of iron, zinc, folate (vitamin B-9), thiamin (vitamin B-1), riboflavin (vitamin B-2), pyridoxine (vitamin B-6) and cobalamin (vitamin B-12)
• Dentures, especially if they don't fit well, which can place stress on some muscles and tissues of your mouth, or if they contain materials that irritate mouth tissues
• Allergies or reactions to foods, food flavorings, other food additives, fragrances, dyes or dental-work substances
• Reflux of stomach acid (gastroesophageal reflux disease or GERD) that enters your mouth from your stomach
• Certain medications, particularly high blood pressure medications called angiotensin-converting enzyme (ACE) inhibitors
• Oral habits, such as tongue thrusting, biting the tip of the tongue and teeth grinding (bruxism)
• Endocrine disorders, such as diabetes or underactive thyroid (hypothyroidism)
• Excessive mouth irritation, which may result from overbrushing your tongue, using abrasive toothpastes, overusing mouthwashes or having too many acidic drinks, such as lemon
• Psychological factors, such as anxiety, depression or stress

Burning mouth syndrome is uncommon. However, your risk may be greater if:

• You're a woman
• You're postmenopausal
• You're in your 50s, 60s or even 70s.

Burning mouth syndrome usually begins spontaneously, with no known triggering factor. But some studies suggest that certain factors may increase your risk of developing burning mouth syndrome. These risk factors may include:

• Upper respiratory tract infection
• Previous dental procedures
• Allergic reactions to food
• Medications
• Traumatic life events
• Stress
• Anxiety
• Depression

Complications that burning mouth syndrome may cause or be associated with are mainly related to discomfort. They include:

• Difficulty falling asleep
• Depression
• Anxiety
• Difficulty eating
• Decreased socializing
• Impaired relationships

You're likely to start by first seeing your family doctor or dentist for mouth discomfort. Because burning mouth syndrome is associated with such a wide variety of other medical conditions, your doctor or dentist may refer you to another specialist, such as a skin doctor (dermatologist), a doctor who specializes in ear, nose and throat problems (ENT) or another type of doctor.

What you can do

Here's some information to help you get ready for your appointment:

• Ask if there's anything you need to do before the appointment, such as restrict your diet.
• Make a list of any symptoms you're experiencing, including any that may seem unrelated to your mouth discomfort.
• Make a list of key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins, herbs or supplements that you're taking.
• Bring a copy of all previous consultations and tests you've had about this problem.
• Prepare questions ahead of time to help make the most of your time with your doctor or dentist.
• Take a family member or friend with you, if possible, for support and to help you remember everything.

Some basic questions to ask your doctor or dentist include:

• What is likely causing my symptoms or condition?
• Other than the most likely cause, what are other possible causes?
• What kinds of tests do I need?
• Is my mouth discomfort likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist?
• Is there a generic alternative to the medicine you're prescribing?
• Are there any printed materials that I can have? What websites do you recommend?

Don't hesitate to ask questions anytime you don't understand something.

What to expect from your doctor

Your doctor or dentist is likely to ask you a number of questions, such as those below. Be ready to answer them to make the most of your time.

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, seems to worsen your symptoms?
• Do you use tobacco?

There's no one test that can determine if you have burning mouth syndrome. Instead, your doctor or dentist will try to rule out other problems before diagnosing burning mouth syndrome.
Your doctor or dentist will review your medical history and medications, examine your mouth, and ask you to describe your symptoms, oral habits and oral care routine. In addition, your doctor will likely perform a general medical exam, looking for signs of other conditions.
You may have some of the following tests:

• Blood tests. Blood tests can check your complete blood count, glucose level, thyroid function, nutritional factors and immune functioning, all of which may provide clues about the source of your mouth discomfort.
• Oral cultures or biopsies. Taking samples from your mouth can tell whether you have a fungal, bacterial or viral infection.
• Allergy tests. Your doctor may suggest allergy testing to see if you may be allergic to certain foods, additives or even substances in dentures.
• Salivary measurements. With burning mouth syndrome, you may feel that you have a dry mouth. Salivary tests can confirm whether you have a reduced salivary flow.
• Gastric reflux tests. These can determine if you have gastroesophageal reflux disease (GERD).
• Imaging. Your doctor may recommend an MRI, CT scan or other imaging tests to check for other health problems.
• Temporarily stopping medication. If you take medications that may contribute to mouth discomfort, your doctor may suggest temporarily stopping those medications, if possible, to see if your discomfort goes away. Don't try this on your own, since it can be dangerous to stop some medications.
• Psychological questionnaires. You may be asked to fill out questionnaires that can help determine if you have symptoms of depression, anxiety or other mental health conditions.

In addition to medical treatment and prescription medications, self-help measures may improve your symptoms. You may find these beneficial for reducing chronic mouth discomfort:

• Drink more fluids, to help ease the feeling of dry mouth, but avoid carbonated beverages.
• Don't use tobacco products.
• Avoid alcohol and products with alcohol, as they may irritate the lining of your mouth.
• Avoid products with cinnamon or mint.
• Avoid spicy-hot foods.
• Avoid acidic foods and liquids, such as tomatoes, orange juice, soft drinks and coffee.
• Try different mild or flavor-free brands of toothpaste, such as one for sensitive teeth or one without mint or cinnamon.
• Take steps to reduce excessive stress.

Burning mouth syndrome can be uncomfortable and frustrating. It can reduce your quality of life if you don't take steps to stay positive and hopeful.
Consider some of these techniques to help cope with the chronic discomfort of burning mouth syndrome:

• Practice relaxation exercises, such as yoga.
• Join a chronic pain support group.
• Engage in pleasurable activities, such as physical activities or hobbies, especially when you feel anxious.
• Try to stay socially active by connecting with understanding family and friends.

There's no known way to prevent burning mouth syndrome. But by avoiding tobacco, acidic foods, spicy foods and carbonated beverages, and excessive stress, you may be able to reduce the discomfort from burning mouth syndrome or prevent your discomfort from getting worse.

Tooth Enamel Damage by Sugar-Free Drinks

Some sugar-free drinks can also damage teeth, experts warn

Written by Catharine Paddock PhD

Published: Monday 30 November 2015 

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Sporting a sugar-free label does not make a product tooth-friendly, warn oral health experts who urge consumers to be aware of the potential for sugar-free beverages and confectionery to be as damaging as those containing sugar.

The studies found that the majority of soft drinks and sports drinks led to softening of dental enamel - the outer layer of the tooth - by between a third and a half.

Researchers at the Oral Health Cooperative Research Centre (CRC), based at the University of Melbourne, Australia, tested 23 different types of sugar-free drinks - including soft drinks and sports drinks - and found those that contain acidic additives and those with low pH levels cause measurable damage to tooth enamel, even if they have no sugar.
While most people are probably aware of the link between sugar and tooth decay, what is perhaps less well understood is the nature of that link, and why drinks that are acidic - whether they contain sugar or not - can also be bad for our teeth.
Sugar is linked to tooth decay because it forms a plaque on the tooth surface that bacteria digest and convert to acid. It is the acid that attacks teeth by dissolving the outer layers of tooth enamel. Thus, drinks that are acidic - whether they contain sugar or not - can also erode teeth.
Eric Reynolds, a professor at Melbourne Dental School and CEO of Oral Health CRC, says:

"Many people are not aware that while reducing your sugar intake does reduce your risk of dental decay, the chemical mix of acids in some foods and drinks can cause the equally damaging condition of dental erosion."

He explains that at first, the acid strips away the surface of tooth enamel, but then, if it "progresses to an advanced stage, it can expose the soft pulp inside the tooth."

'A measurable loss of tooth enamel'

Oral health experts generally agree that the use of sugar substitutes - including, for example, xylitol, sorbitol and mannitol - in confectionery and beverages has helped to reduce tooth decay in children in industrialized countries.
However, in their newly released briefing paper, Prof. Reynolds and colleagues note that "consumers should be aware that many sugar-free products remain potentially harmful to teeth due to their chemical composition."
The paper summarizes studies in the Oral Health CRC that measured dental enamel softening and tooth surface loss following exposure to a range of drinks.
The studies found that the majority of soft drinks and sports drinks led to softening of dental enamel by between a third and a half.
They also show that both sugary and sugar-free soft beverages - including flavored mineral waters - cause a measurable loss of tooth enamel, with no significant difference between the two types of drink.
Also, six of the eight sports drinks tested in the studies caused loss of dental enamel. The two that did not had a higher calcium content, note the report authors.
The Oral Health CRC recommend that sugar-free products - including soft drinks, confectionery or candy, and sports drinks - should carry labels with information that helps consumers evaluate them in relation to their oral health.

'Current product testing and labeling regulations are insufficient'

Prof. Reynolds says "sugar-free" does not mean a product is safe for your teeth and adds:
"We have even found sugar-free confectionery products that are labelled 'toothfriendly' and which when tested were found to be erosive."
He and his colleagues suggest people check for acidic additives, such as citric acid and phosphoric acid, in the ingredients list when deciding which sugar-free products to buy.
They also suggest that after eating or drinking acidic products, you should not brush your teeth straight away, as this can remove the softened tooth layer. Instead, rinse your mouth with water and wait for an hour or so before brushing.
And if you drink acidic beverages - such as soda pop - on their own, then chewing sugarless gum afterward can help to increase saliva flow to neutralize the acid.
The Academy of General Dentistry, an organization of North American dentists, explain that because saliva helps neutralize acids and wash your teeth clean, the worst time to drink beverages high in acid, such as soda pop, is when you are thirsty, due to low levels of saliva.
Soda pop and other carbonated drinks are acidic because they contain carbonic acid - which results from dissolving carbon dioxide into them to make them fizzy.
Experts suggest you quench thirst with water, a much healthier alternative to soft drinks, pop or sports beverages.
Also, regular check-ups with your oral health professional can help to detect early dental erosion, which can usually be reversed with treatments to replace lost minerals. If the erosion is more advanced, then the lost surface may need a filling or a crown.
In their briefing paper, Prof. Reynolds and colleagues conclude:

"In light of its studies, the Oral Health CRC is of the view that current product testing and labeling regulations for foods and beverages are not sufficient to enable consumers to make informed choices in order to avoid the risk of dental erosion."

Meanwhile, Medical News Today recently learned that children exposed to secondhand smoke have double the risk of tooth decay. Writing in the BMJ, a team of researchers from Japan shows how children exposed to secondhand smoke at 4 months of age have a higher risk of tooth decay at age 3 years.