Smoking and its affects on Dental and Oral Health

How Smoking affects Dental and Oral Health

Smoking is not only linked to lung cancer and heart disease, but it also damages the state of the mouth. Smoking increases the risks of tooth loss, but more importantly, it is the main cause of throat and oral cancers. In fact, smoking sets off 75% of all cancers of the mouth.

Smoking and overall health

Here are some facts of how smoking affects someone’s health:

• Smokers have an increased risk of heart disease (including stroke, chest pain and palpitations), cancer and emphysema. In fact, emphysema is found almost exclusively in smokers, and 35% of all cancers are from smoking.
• 95% of those who die from lung cancer are smokers. Lung cancer is killing more women than breast cancer, and cervical cancer in smokers is increased 8 to 17 times because of the increased concentration of nicotine on the cervical mucus.
• No amount of smoking is free of risk. The exact amount of risk depends on how long someone has smoked and how deeply were the inhale, as well as genetic factors.
• Tobacco smoking reduces the effectiveness of medications, such as pain relievers, antidepressants, tranquilizers, sedatives, ulcer medication and insulin.
• Smoking destroys certain vitamins and creates the need for other specific nutrients.
• With every puff of cigarette a person breathes in 4,700 different chemicals.
• Smokers are 4 times more likely to have gray hair and increased hair loss.
• More than 90% of all regular smokers began using tobacco at or before age 18.
• People who smoke are more likely to have sinusitis. 

Smoking and oral health

Although smoking and chewing tobacco does not increase the risk of having cavities, it can do lots of damage to the gums and other parts of the mouth:

• The risk of tooth loss in smokers is twice more than in non-smokers.
• Smoking is the main cause of throat and oral cancers.
• Smoking increases periodontal disease (gum disease). In fact, according to the Journal of Periodontology, smokers are about four times more likely than people who have never smoked, to have advanced periodontal disease.
• Smoking can cause inflammation of the salivary glands.
• Smoking delays healing after tooth extraction and can lead to a temporary and painful condition known as dry socket.
• Smokers have less success with periodontal treatments and dental implants.

Besides the significant and dangerous hazards mentioned above, other factors that smokers should consider include:

• Smoking is a major source of halitosis (bad breath).
• The loss of taste and smell can be caused by smoking and chewing tobacco.
• Smoking stains teeth reducing the aesthetics of a smile.
• Tobacco use can cause black hairy tongue, which refers to growths on the tongue, making it look hairy and turning it yellow, green, brown or black.
• Smoking might produce constant plaque and tartar build up.

Recommendations for smokers

To say "stop smoking" is an easier thing said than done. Nicotine addiction can be very strong and hard to lose, that is why tobacco companies are so successful with their products. But to stop smoking is also the most effective way to eliminate all the hazards that tobacco can cause, not only to oral health, but also to increase the chances of living a long and healthy life with the people we love.
Here some tips for smokers concerning their oral health:

• Although it's easier said than done, stop smoking or stop chewing tobacco!
• Have regular checkups with the dentist in order to verify the state of the gums and make sure no oral cancer is developing.
• Maintain a thorough oral hygiene plan by regularly brushing, flossing, using mouthwash and tongue cleaner, and by having regular professional cleanings at the dentist's office.
• Learn how to do an oral cancer self examination:
• Check for any sores around the face, neck or mouth that do not heal within two weeks.
• Check for frequent bleeding in the mouth.
• Check for white, red or dark patches on the cheeks, palate, tongue, or under the tongue; if such lesions do not disappear after two weeks, have them checked by a dentist.
• Check for swellings, lumps or bumps on the lips, gums, or other areas in the mouth.
• Notice any numbness, pain or loss of feeling in any area of the mouth.

It is evoked that the fresh clean feeling a person feels in the mouth after brushing and flossing may restrain the urge of smoking. Ironically, these simple tips also help to prevent periodontal diseases.


Information provided by www.studiodentaire.com

Root Canal Therapy

What is endodontic treatment?

“Endo” is the Greek word for “inside” and “odont” is Greek for “tooth.” Endodontic treatment treats the inside of the tooth. Root canal treatment is one type of endodontic treatment.

To understand endodontic treatment, it helps to know something about the anatomy of the tooth. Inside the tooth, under the white enamel and a hard layer called the dentin, is a soft tissue called the pulp. The pulp contains blood vessels, nerves, and connective tissue and creates the surrounding hard tissues of the tooth during development.
The pulp extends from the crown of the tooth to the tip of the roots where it connects to the tissues surrounding the root. The pulp is important during a tooth’s growth and development. However, once a tooth is fully mature it can survive without the pulp, because the tooth continues to be nourished by the tissues surrounding it.

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Why would I need an endodontic procedure?

Endodontic treatment is necessary when the pulp, the soft tissue inside the root canal, becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep decay, repeated dental procedures on the tooth, or a crack or chip in the tooth. In addition, an injury to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.

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What are the signs of needing endodontic treatment?

Signs to look for include pain, prolonged sensitivity to heat or cold, tenderness to touch and chewing, discoloration of the tooth, and swelling, drainage and tenderness in the lymph nodes as well as nearby bone and gum tissues. Sometimes, however, there are no symptoms.

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How does endodontic treatment save the tooth?

The endodontist removes the inflamed or infected pulp, carefully cleans and shapes the inside of the root canal, then fills and seals the space. Afterwards, you will return to your dentist, who will place a crown or other restoration on the tooth to protect and restore it to full function. After restoration, the tooth continues to function like any other tooth.

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Will I feel pain during or after the procedure?

Many endodontic procedures are performed to relieve the pain of toothaches caused by pulp inflammation or infection. With modern techniques and anesthetics, most patients report that they are comfortable during the procedure.
For the first few days after treatment, your tooth may feel sensitive, especially if there was pain or infection before the procedure. This discomfort can be relieved with over-the-counter or prescription medications. Follow your endodontist’s instructions carefully.
Your tooth may continue to feel slightly different from your other teeth for some time after your endodontic treatment is completed. However, if you have severe pain or pressure or pain that lasts more than a few days, call your dentist.

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Step-by-Step Endodontic Procedure

Endodontic treatment can often be performed in one or two visits and involves the following steps:
1. The endodontist examines and x-rays the tooth, then administers local anesthetic. After the tooth is numb, the endodontist places a small protective sheet called a “dental dam” over the area to isolate the tooth and keep it clean and free of saliva during the procedure.
2. The endodontist makes an opening in the crown of the tooth. Very small instruments are used to clean the pulp from the pulp chamber and root canals and to shape the space for filling.
3. After the space is cleaned and shaped, the endodontist fills the root canals with a biocompatible material, usually a rubber-like material called gutta-percha. The gutta-percha is placed with an adhesive cement to ensure complete sealing of the root canals. In most cases, a temporary filling is placed to close the opening. The temporary filling will be removed by your dentist before the tooth is restored.
4. After the final visit with your endodontist, you must return to your dentist to have a crown or other restoration placed on the tooth to protect and restore it to full function.
If the tooth lacks sufficient structure to hold the restoration in place, your dentist or endodontist may place a post inside the tooth. Ask your dentist or endodontist for more details about the specific restoration planned for your tooth.

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How much will the procedure cost?

The cost varies depending on how complex the problem is and which tooth is affected. Molars are more difficult to treat; the fee is usually more. Most dental insurance policies provide some coverage for endodontic treatment.
Generally, endodontic treatment and restoration of the natural tooth are less expensive than the alternative of having the tooth extracted. An extracted tooth must be replaced with an implant or bridge to restore chewing function and prevent adjacent teeth from shifting. These procedures tend to cost more than endodontic treatment and appropriate restoration.

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Will the tooth need any special care or additional treatment after endodontic treatment?

You should not chew or bite on the treated tooth until you have had it restored by your dentist. The unrestored tooth is susceptible to fracture, so you should see your dentist for a full restoration as soon as possible. Otherwise, you need only practice good oral hygiene, including brushing, flossing, and regular checkups and cleanings.
Most endodontically treated teeth last as long as other natural teeth. In a few cases, a tooth that has undergone endodontic treatment does not heal or the pain continues. Occasionally, the tooth may become painful or diseased months or even years after successful treatment. Often when this occurs, redoing the endodontic procedure can save the tooth.

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What causes an endodontically treated tooth to need additional treatment?

New trauma, deep decay, or a loose, cracked or broken filling can cause new infection in your tooth. In some cases, the endodontist may discover additional very narrow or curved canals that could not be treated during the initial procedure.

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Can all teeth be treated endodontically?

Most teeth can be treated. Occasionally, a tooth can’t be saved because the root canals are not accessible, the root is severely fractured, the tooth doesn’t have adequate bone support, or the tooth cannot be restored. However, advances in endodontics are making it possible to save teeth that even a few years ago would have been lost. When endodontic treatment is not effective, endodontic surgery may be able to save the tooth.


Information provided by the American Academy of Endodontics

Electric Toothbrush vs. Traditional toothbrush

Should You Use an Electric or a Traditional Toothbrush?

   Published by dental.net

When electrically powered toothbrushes were introduced in the 1960s they turned out to be ineffective, and prone to mechanical failure. During the years that followed, they tended to be used only by people with either dexterity problems or cognitive impairment, while the rest of the population stuck to traditional toothbrushes. The 1990s saw the introduction of a new range of oscillating-rotating and counter-rotational electrical toothbrush designs. When mated to more powerful motors, these competed with manual brushing and flossing for the first time, including essential inter-proximal cleaning between adjacent teeth, and improved gingival health due to better gum massaging.
Although for these reasons the modern choice may be almost automatically in favor of an electrical toothbrush, the following factors could still influence the final decision:

•    Affordability: This is always a factor when introducing new technology – it is pointless recommending an electric toothbrush to a someone who can't afford one.

•    Fear of Technology: Some people, particularly older people, have a genuine fear of technology and new things - it is pointless trying to recommend something that may never be used.

•    Dexterity: The ability to grip and guide the toothbrush handle is of the utmost importance. A young child with tiny fingers, or an older person with arthritic joints, both find it easier to rotate an electric toothbrush than guide a manual one consistently through an intricate pattern.

•    Cognitive Ability: The capacity to understand, may also dictate the use of electric technology. Generations of dentists have failed to get generations of normal patients to follow consistent patterns of manual brushing and flossing – for this reason getting an impaired person to move an electric brush randomly round their mouths is often the only workable solution.

For most people though, the modern electric toothbrush still wins hands-down for the following reasons:

•    Modern electric toothbrushes have counter-rotating heads that brush teeth in two directions, quickly and effectively dislodging food debris and plaque. While it is possible to achieve the same results with a traditional toothbrush, many people soon fall out of the habit, with an inevitably poorer longer-term outlook for their teeth.

•    The smaller brushing head and vibrating action mean that less force is necessary to achieve a result, in turn preventing injury if a poorly controlled device suddenly slips. It also facilitates proper cleaning in tight corners where plaque and debris congregate.

•    Finally, the counter-rotating action of electric toothbrushes counteracts the effects of our left or right-handedness that tend to favor movement in one or other direction only, thereby encouraging even, effective cleaning of all our teeth.

An electrical toothbrush is therefore the obvious hygiene choice for the average health conscious person. This choice should also be made in the light of other relevant factors. Whichever decision you make, it is still important to brush your teeth consistently, thoroughly and regularly.

Good Foods for Your Teeth

Date April 25, 2012 5:51 pm,   Published by dental.net

Oral health and diet are directly and strongly correlated. There are several kinds of important minerals and vitamins that your teeth need to stay healthy and function. Certain foods, which are useful for developing muscles and bones, also keep your gums and teeth healthy. As a result, a balanced diet that consists of fresh fruits, leafy vegetables and other healthy nutrients is extremely important for your teeth.

Many of us prefer popping a supplement pill instead of eating healthy food. However, only natural food will provide you with maximum benefits and help you when you have to go to the dentist. There are several natural components that can’t be substituted in the form of pills or health supplements. Dental experts believe that a healthy lifestyle and a balanced diet are the key to good oral health. Dietary measures must be taken since the initial days which will help you any oral health issues.

There are several things you may have to add or remove from your diet to ensure good oral health. Here are some foods you can consume for good dental health:

1) Green Vegetables: Green leafy vegetables contain vital components like Vitamin A and Vitamin B. These vital nutrients will keep gums healthy and prevent diseases like overgrown gums, bleeding gums, etc.

2) Whole Cereals: Consuming whole cereals and pulses will fill you with Vitamin B. Vitamin B will prevent chapped & dry lips and also cure mouth and gum ulcers.

3) Citrus Fruits: Citrus fruits such as oranges, gooseberries and limes are a rich source of Vitamin C. Vitamin C boosts your immune systems and will keep your gums and teeth healthy. Consuming foods rich in Vitamin C will keep your gum tissue healthy.

4) Calcium-Rich Foods: Calcium is extremely required and beneficial for good oral health. Milk and yogurt are extremely rich in Calcium and helps build strong jaws and teeth. Similarly cheese is also rich in Calcium and Phosphate. Good levels of Calcium in the body will ensure that your tooth enamel is healthy and strong.

5) Meats: Consumption of meats and eggs will maintain the required levels of Magnesium and Zinc in your body. Foods such as poultry, fish and meats are extremely important as they also contain protein that is essential for gum developments. Strong gums and teeth are the base of any healthy body.

6) Mineral Components: Legumes such as soybeans, raisins, nuts, sea food, and molasses are extremely rich sources of Copper. Copper is a must for maintaining good dental health. Including bananas, figs, apricots, dates, raisins and tomatoes to your diet will remove any Potassium deficiencies. Foodstuffs rich in Zinc, such as sunflower seeds, spinach, mushrooms and liver, are very important for teeth and gum health. Including Iron rich foods such as spinach, iron rich cereals, whole grains, beef, and dry fruits will make your teeth healthy and strong. You can easily prevent any oral or dental problems with the usage of these simple dietary measures. Make sure your daily diet is full of nutrition and well balanced.

            

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TMJ Disorders

Main Content

Temporomandibular joint and muscle disorders, commonly called "TMJ," are a group of conditions that cause pain and dysfunction in the jaw joint and the muscles that control jaw movement. We don’t know for certain how many people have TMJ disorders, but some estimates suggest that over 10 million Americans are affected. The condition appears to be more common in women than men.
For most people, pain in the area of the jaw joint or muscles does not signal a serious problem. Generally, discomfort from these conditions is occasional and temporary, often occurring in cycles. The pain eventually goes away with little or no treatment. Some people, however, develop significant, long-term symptoms.
If you have questions about TMJ disorders, you are not alone. Researchers, too, are looking for answers to what causes these conditions and what the best treatments are. Until we have scientific evidence for safe and effective treatments, it’s important to avoid, when possible, procedures that can cause permanent changes in your bite or jaw. This booklet provides information you should know if you have been told by a dentist or physician that you have a TMJ disorder.

• What is the temporomandibular joint?
• What are TMJ disorders?
• What causes TMJ disorders?
• What are the signs and symptoms?
• How are TMJ disorders diagnosed?
• How are TMJ disorders treated?
• If you think you have a TMJ disorder...
• Research
• Hope for the future

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What is the temporomandibular joint?

The temporomandibular joint connects the lower jaw, called the mandible, to the bone at the side of the head—the temporal bone. If you place your fingers just in front of your ears and open your mouth, you can feel the joints. Because these joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew and yawn. Muscles attached to and surrounding the jaw joint control its position and movement.
     
When we open our mouths, the rounded ends of the lower jaw, called condyles, glide along the joint socket of the temporal bone. The condyles slide back to their original position when we close our mouths. To keep this motion smooth, a soft disc lies between the condyle and the temporal bone. This disc absorbs shocks to the jaw joint from chewing and other movements.
The temporomandibular joint is different from the body’s other joints. The combination of hinge and sliding motions makes this joint among the most complicated in the body. Also, the tissues that make up the temporomandibular joint differ from other load-bearing joints, like the knee or hip. Because of its complex movement and unique makeup, the jaw joint and its controlling muscles can pose a tremendous challenge to both patients and health care providers when problems arise.

What are TMJ disorders?

Disorders of the jaw joint and chewing muscles—and how people respond to them—vary widely. Researchers generally agree that the conditions fall into three main categories:

1. Myofascial pain involves discomfort or pain in the muscles that control jaw function.
2. Internal derangement of the joint involves a displaced disc, dislocated jaw, or injury to the condyle.
3. Arthritis refers to a group of degenerative/inflammatory joint disorders that can affect the temporomandibular joint.

A person may have one or more of these conditions at the same time. Some people have other health problems that co-exist with TMJ disorders, such as chronic fatigue syndrome, sleep disturbances or fibromyalgia, a painful condition that affects muscles and other soft tissues throughout the body. These disorders share some common symptoms, which suggests that they may share similar underlying mechanisms of disease. However, it is not known whether they have a common cause.
Rheumatic disease, such as arthritis, may also affect the temporomandibular joint as a secondary condition. Rheumatic diseases refer to a large group of disorders that cause pain, inflammation, and stiffness in the joints, muscles, and bone. Arthritis and some TMJ disorders involve inflammation of the tissues that line the joints. The exact relationship between these conditions is not known.
How jaw joint and muscle disorders progress is not clear. Symptoms worsen and ease over time, but what causes these changes is not known. Most people have relatively mild forms of the disorder. Their symptoms improve significantly, or disappear spontaneously, within weeks or months. For others, the condition causes long-term, persistent and debilitating pain.

What causes TMJ disorders?

Trauma to the jaw or temporomandibular joint plays a role in some TMJ disorders. But for most jaw joint and muscle problems, scientists don’t know the causes. Because the condition is more common in women than in men, scientists are exploring a possible link between female hormones and TMJ disorders.
For many people, symptoms seem to start without obvious reason. Research disputes the popular belief that a bad bite or orthodontic braces can trigger TMJ disorders.
There is no scientific proof that sounds—such as clicking—in the jaw joint lead to serious problems. In fact, jaw sounds are common in the general population. Jaw noises alone, without pain or limited jaw movement, do not indicate a TMJ disorder and do not warrant treatment.

What are the signs and symptoms?

A variety of symptoms may be linked to TMJ disorders. Pain, particularly in the chewing muscles and/or jaw joint, is the most common symptom. Other likely symptoms include:

• radiating pain in the face, jaw, or neck,
• jaw muscle stiffness,
• limited movement or locking of the jaw,
• painful clicking, popping or grating in the jaw joint when opening or closing the mouth,
• a change in the way the upper and lower teeth fit together.

How are TMJ disorders diagnosed?

There is no widely accepted, standard test now available to correctly diagnose TMJ disorders. Because the exact causes and symptoms are not clear, identifying these disorders can be difficult and confusing. Currently, health care providers note the patient’s description of symptoms, take a detailed medical and dental history, and examine problem areas, including the head, neck, face, and jaw. Imaging studies may also be recommended.
You may want to consult your doctor to rule out other known causes of pain. Facial pain can be a symptom of many conditions, such as sinus or ear infections, various types of headaches, and facial neuralgias (nerve-related facial pain). Ruling out these problems first helps in identifying TMJ disorders.

How are TMJ disorders treated?

Because more studies are needed on the safety and effectiveness of most treatments for jaw joint and muscle disorders, experts strongly recommend using the most conservative, reversible treatments possible. Conservative treatments do not invade the tissues of the face, jaw, or joint, or involve surgery. Reversible treatments do not cause permanent changes in the structure or position of the jaw or teeth. Even when TMJ disorders have become persistent, most patients still do not need aggressive types of treatment.
Conservative Treatments
Because the most common jaw joint and muscle problems are temporary and do not get worse, simple treatment may be all that is necessary to relieve discomfort.
Self-Care Practices
There are steps you can take that may be helpful in easing symptoms, such as:

• eating soft foods,
• applying ice packs,
• avoiding extreme jaw movements (such as wide yawning, loud singing, and gum chewing),
• learning techniques for relaxing and reducing stress,
• practicing gentle jaw stretching and relaxing exercises that may help increase jaw movement. Your health care provider or a physical therapist can recommend exercises if appropriate for your particular condition.

Pain Medications
For many people with TMJ disorders, short-term use of over-the-counter pain medicines or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may provide temporary relief from jaw discomfort. When necessary, your dentist or physician can prescribe stronger pain or anti-inflammatory medications, muscle relaxants, or anti-depressants to help ease symptoms.
Stabilization Splints
Your physician or dentist may recommend an oral appliance, also called a stabilization splint or bite guard, which is a plastic guard that fits over the upper or lower teeth. Stabilization splints are the most widely used treatments for TMJ disorders. Studies of their effectiveness in providing pain relief, however, have been inconclusive. If a stabilization splint is recommended, it should be used only for a short time and should not cause permanent changes in the bite. If a splint causes or increases pain, or affects your bite, stop using it and see your health care provider.
The conservative, reversible treatments described are useful for temporary relief of pain – they are not cures for TMJ disorders. If symptoms continue over time, come back often, or worsen, tell your doctor.

Botox
Botox® (botulinum toxin type A) is a drug made from the same bacterium that causes food poisoning.  Used in small doses, Botox injections can actually help alleviate some health problems and have been approved by the Food and Drug Administration (FDA) for certain disorders.  However, Botox is currently not approved by the FDA for use in TMJ disorders.
Results from recent clinical studies are inconclusive regarding the effectiveness of Botox for treatment of chronic TMJ disorders. Additional research is under way to learn how Botox specifically affects jaw muscles and their nerves.  The findings will help determine if this drug may be useful in treating TMJ disorders.

Irreversible Treatments

Irreversible treatments that have not been proven to be effective – and may make the problem worse – include orthodontics to change the bite; crown and bridge work to balance the bite; grinding down teeth to bring the bite into balance, called “occlusal adjustment"; and repositioning splints, also called orthotics, which permanently alter the bite.
Surgery
Other types of treatments, such as surgical procedures, invade the tissues. Surgical treatments are controversial, often irreversible, and should be avoided where possible. There have been no long-term clinical trials to study the safety and effectiveness of surgical treatments for TMJ disorders. Nor are there standards to identify people who would most likely benefit from surgery. Failure to respond to conservative treatments, for example, does not automatically mean that surgery is necessary. If surgery is recommended, be sure to have the doctor explain to you, in words you can understand, the reason for the treatment, the risks involved, and other types of treatment that may be available.
Implants
Surgical replacement of jaw joints with artificial implants may cause severe pain and permanent jaw damage. Some of these devices may fail to function properly or may break apart in the jaw over time. If you have already had temporomandibular joint surgery, be very cautious about considering additional operations. Persons undergoing multiple surgeries on the jaw joint generally have a poor outlook for normal, pain-free joint function. Before undergoing any surgery on the jaw joint, it is extremely important to get other independent opinions and to fully understand the risks.
The U.S. Food and Drug Administration (FDA) monitors the safety and effectiveness of medical devices implanted in the body, including artificial jaw joint implants. Patients and their health care providers can report serious problems with TMJ implants to the FDA through MedWatch at www.fda.gov/medwatch or telephone toll-free at 1-800-332-1088.

If you think you have a TMJ disorder...

Remember that for most people, discomfort from TMJ disorders will eventually go away on its own. Simple self-care practices are often effective in easing symptoms. If treatment is needed, it should be based on a reasonable diagnosis, be conservative and reversible, and be customized to your special needs. Avoid treatments that can cause permanent changes in the bite or jaw. If irreversible treatments are recommended, be sure to get a reliable, independent second opinion.
Because there is no certified specialty for TMJ disorders in either dentistry or medicine, finding the right care can be difficult. Look for a health care provider who understands musculoskeletal disorders (affecting muscle, bone and joints) and who is trained in treating pain conditions. Pain clinics in hospitals and universities are often a good source of advice, particularly when pain continues over time and interferes with daily life. Complex cases, often marked by prolonged, persistent and severe pain; jaw dysfunction; co-existing conditions; and diminished quality of life, likely require a team of experts from various fields, such as neurology, rheumatology, pain management and others, to diagnose and treat this condition.

Research

The National Institute of Dental and Craniofacial Research (NIDCR), one of the National Institutes of Health (NIH), leads the federal research effort on temporomandibular joint and muscle disorders. In a landmark study, NIDCR is tracking healthy people over time to identify risk factors that contribute to the development of these conditions. Preliminary results from this study have identified a series of clinical, psychological, sensory, genetic and nervous system factors that may increase the risk of having chronic TMJ disorders. These new findings expand our scientific understanding of the onset and natural course of TMJ disorders and may lead to new diagnostic and treatment approaches.
Additionally, researchers are using data from a TMJ implant registry and repository that collected health information from patients who received implants and from those who had implants removed. Recent studies using the data have helped researchers plan for new pain medication trials and other research projects.
Pain Studies

Because pain is the major symptom of these conditions, NIH scientists are conducting a wide range of studies to better understand the pain process, including:

• understanding the nature of facial pain in TMJ disorders and what it may hold in common with other pain conditions, such as headache and widespread muscle pain,
• exploring differences between men and women in how they respond to pain and to pain medications,
• pinpointing factors that lead to chronic or persistent jaw joint and muscle pain,
• examining the effects of stressors, such as noise, cold and physical stress, on pain symptoms in patients with TMJ disorders to learn how lifestyle adjustments can decrease pain,
• identifying medications, or combinations of medications and conservative treatments, that will provide effective chronic pain relief,
• investigating possible links between osteoarthritis and a history of orofacial pain.

Replacement Parts
Research is also under way to grow human tissue in the laboratory to replace damaged cartilage in the jaw joint. Other studies are aimed at developing safer, more life-like materials to be used for repairing or replacing diseased temporomandibular joints, discs, and chewing muscles.

Hope for the future

The challenges posed by TMJ disorders span the research spectrum, from causes to diagnosis through treatment and prevention. Researchers throughout the health sciences are working together not only to gain a better understanding of the temporomandibular joint and muscle disease process, but also to improve quality of life for people affected by these disorders.

Bad Breath and Its Relationship to Oral and Systemic Diseases

“About 75 percent of bad breath or “halitosis” is caused by the mouth itself.  Other causes include gastric problems, sinus infections or severe gum disease,” says Mark Wolff, DDS, Ph.D., director of operative dentistry at the State University of New York at Stony Brook.
One of the key successes in treating bad breath is determining the cause. Once your dental professional determines what the cause is then treatment for it can then begin¹.
Bad breath can be caused by the following:

• External factors – foods such as onions and garlic, beverages like coffee and alcohol, and smoking
• Poor oral hygiene – where plaque and food debris is left on the teeth
• Oral disease – gingivitis and periodontal disease
• Dentures – plaque and food debris can form on dentures, which need to be cleaned daily
• Tonsils – cryptic areas (crevices) in the tonsils can allow food debris to become lodged in the tonsil area
• Respiratory tract infections – throat, sinus and lung infections
• Dry mouth (Xerostomia) – can be caused by salivary gland problems, medication, mouth breathing, radiation therapy and chemotherapy
• Systemic diseases – diabetes, liver, kidney, lung, sinus diseases and gastrointestinal disorders

How does Oral Disease Relate to Systemic Disease?
Recent research suggests a relationship between oral disease and systemic diseases (diabetes, cardiovascular disease, stroke, respiratory infections and Alzheimer disease) and other medical conditions. When the gum tissue becomes inflamed causing gingivitis to occur, inflammatory mediators called cytokines that are in the gum tissue can enter your saliva and can also become aspirated into the lungs. Bacteria that are responsible for periodontal disease can also enter the circulatory system around the teeth and travel to other parts of the body. Oral bacteria may cause secondary infections or inflammation of other tissues or organ systems in the body (2).
Who Should You See If You Have Bad Breath?
If you believe your diet is causing bad breath, then consult with a dietician or nutritionist who can work with you to modify your diet. If you have poor oral hygiene and are suffering from gingivitis (inflammation of the gum tissue in your mouth) or have periodontal disease (bone loss around the teeth sometimes referred to as “pyorrhea”), consult your dentist and periodontist and work with your dental hygienist to improve gingivitis and thorough oral hygiene instruction at home. The tonsils and respiratory infections will need to be followed by your physician or a specialist such as an ear, nose and throat physician or pulmonologist. A large majority of people in the United States are suffering from dry mouth due to medications they may be taking, salivary gland dysfunction and those who may be going through radiation and chemotherapy treatment for cancer therapy. Please consult your oral maxillofacial
surgeon, your physician or oncologist for their professional recommendations for prescription or over-the-counter products that can alleviate dry mouth symptoms. Those patients who are diabetics, have liver or kidney conditions, and gastrointestinal disorders should see their physician, urologist or gastroenterologist for their insights on how bad breath can be reduced regarding these systemic diseases. Contact your dentist office for a recommendation of which dental or medical professional you should see for your bad breath condition.


Information provided by Colgate

What is Periodontal Disease?

Periodontal Disease: Causes and Prevention

What Is Periodontal Disease?
What Causes Periodontal Disease?
Risks and Prevention

What Is Periodontal Disease?

If your hands bled when you washed them, you would be concerned. Yet, many people think it's normal if their gums bleed when they brush or floss. In a 1999 study, researchers at the U.S. National Institutes of Health (NIH) found that half of Americans over 30 had bleeding gums.
Swollen and bleeding gums are early signs that your gums are infected with bacteria. If nothing is done, the infection can spread. It can destroy the structures that support your teeth in your jawbone. Eventually, your teeth can become so loose that they have to be extracted.
"Peri" means around, and "odontal" refers to teeth. Periodontal diseases are infections of the structures around the teeth. These include the gums, the cementum that covers the root, the periodontal ligament and the alveolar bone. In the earliest stage of periodontal disease, gingivitis, the infection affects only the gums. In more severe forms of the disease, all of the supporting tissues are involved.
For many years scientists have been trying to figure out what causes periodontal disease. It is now well accepted that bacteria in dental plaque are the major villains. Researchers also are learning more about how an infection in your gums can affect your overall health.
In recent years, gum disease has been linked to other health problems. This is a new and exciting area of research. Many questions remain. Studies have produced varying answers about how much of a connection exists between gum disease and other medical problems. More research is needed.
Researchers are studying possible connections between gum disease and:

• Atherosclerosis and heart disease — Gum disease may increase the risk of clogged arteries and heart disease. It also is believed to worsen existing heart disease.
• Stroke — Gum disease may increase the risk of the type of stroke that is caused by blocked arteries.
• Premature births — A woman who has gum disease during pregnancy may be more likely to deliver her baby too early. The infant may be more likely to be of low birth weight.
• Diabetes — Diabetic patients with periodontal disease may have more trouble controlling their blood sugar than diabetic patients with healthy gums.
• Respiratory disease — Bacteria involved in gum disease may cause lung infections or worsen existing lung conditions. This is particularly important for elderly adults in institutions such as nursing homes. In this group, bacteria from the mouth may reach the lungs and may cause severe pneumonia.

What Causes Periodontal Disease?

Periodontal disease is caused by bacteria in dental plaque. Plaque is the sticky substance that forms on your teeth soon after you have brushed. In an effort to get rid of the bacteria, the cells of your immune system release substances that inflame and damage the gums, periodontal ligament or alveolar bone. This leads to swollen, bleeding gums, a sign of gingivitis (the earliest stage of periodontal disease). Damage from periodontal disease also can cause teeth to become loose. This is a sign of severe periodontitis (the advanced stage of disease).
You can prevent periodontal disease by practicing good oral hygiene and visiting your dentist regularly. Most people should see the dentist about once every six months. But if you already have gum disease you may need to visit more often.
Daily brushing and flossing, when done correctly, can help to remove most of the plaque from your teeth. Professional cleanings by your dentist or dental hygienist will keep plaque under control in places that are harder for a toothbrush or floss to reach.
If oral hygiene slips or you skip dental visits, plaque builds up on the teeth. Eventually, it spreads below the gum line. The bacteria are protected there because your toothbrush can't reach them. If plaque is not removed, the bacteria will continue to multiply. Your gum inflammation may get worse.
The buildup of plaque below the gumline causes the gums to become inflamed. As the gums swell, they detach from the tooth. This process forms a space, or "pocket," between the tooth and gum. Bacteria can grow rapidly in the pockets. This encourages further plaque buildup.
If left untreated, periodontal disease may destroy the periodontal ligament and the alveolar bone, the structures that support your teeth.
Another reason to remove plaque promptly is that over time it becomes hardened or calcified and turns into calculus. This is commonly called tartar. Even more plaque attaches to calculus because it's a rougher surface than tooth enamel. It's also rougher than cementum, a layer that covers the tooth root. Calculus and plaque build up in layers.
Using a tartar-control toothpaste may help slow the build-up of calculus around your teeth. It can't affect the tartar that already has formed below the gum line, however.

Risks and Prevention

The bacteria in plaque are the main cause of periodontal disease. But several other factors also can contribute. They include other diseases, medicines and oral habits. These factors can increase your risk of gum disease or make it worse once the infection has set in.

• Genes — Some people are more likely than others to get periodontal disease because of their genes. But your genes do not make gum disease inevitable. Even people who are highly prone to periodontal disease can prevent or control the disease with good oral care.
• Smoking and tobacco use — Smoking increases the risk of periodontal disease. The longer you smoke, and the more you smoke, the higher the risk. If you have periodontal disease, smoking makes it more severe. Smoking is a major reason that some cases of periodontal disease are resistant to treatment. Smokers tend to collect more tartar on their teeth. They often develop deeper periodontal pockets once they have gum disease. They also are likely to lose more bone as the disease gets worse. Unlike many other factors that affect the health of your gums, the decision to smoke or not is under your control. Quitting smoking can play a major role in bringing periodontal disease under control.
• Misaligned or crowded teeth, braces or bridgework — Anything that makes it more difficult to brush or floss your teeth is likely to enhance plaque and tartar formation. The more plaque and tartar you have, the greater your chance of developing gum disease. Dentists and periodontists can show you the best ways to clean your teeth, even if they are hard to clean. For example, you can use special tools and ways of threading floss to clean around bridgework or slide under braces. If overcrowded or crooked teeth are a problem, your dentist might recommend orthodontics. This could straighten out your smile and give you a better chance of preventing disease.
• Grinding, gritting or clenching of teeth — These habits won't cause periodontal disease. However, they can lead to more severe disease if your gums are already inflamed. These habits exert excess force on the teeth. This pressure appears to speed up the breakdown of the periodontal ligament and bone. In many cases, people can learn to stop this habit simply by recognizing when it is happening and then relaxing. If these efforts don't work, your dentist or periodontist can create a custom guard appliance to help reduce the pressure of clenching or grinding on the teeth. This device is sometimes called an occlusal guard, night guard, mouth guard or bite guard.
• Stress — Stress can make periodontal disease worse and harder to treat. Stress weakens your body's immune system. This makes it harder for your body to fight off infection, including periodontal disease.
• Fluctuating hormones — Whenever hormone levels go up and down in the body, changes can occur in the mouth. Puberty and pregnancy can temporarily increase the risk and severity of gum disease. So can menopause.
• Medicines — SSeveral types of medicines can cause dry mouth, or xerostomia. Examples include certain drugs for depression and high blood pressure. If you don't have enough saliva, plaque is more likely to form. This may lead to tooth decay (cavities). Other medicines may cause the gums to enlarge. This makes them more likely to trap plaque. These medicines include:
  
  • Phenytoin (Dilantin and other brand names), used to control seizures
  • Cyclosporine (Neoral, Sandimmune), used to suppress the immune system in people who have had organ transplants
  • Nifedipine (Adalat, Cardizem and others) and other calcium channel blockers, used to treat high blood pressure, chest pain (angina) or heart arrhythmias.
• Diseases — People with certain diseases have a higher risk of developing periodontal disease. For example, people with diabetes are more likely to get periodontitis than people without diabetes. Their gum disease is also likely to be more severe. Other diseases that increase periodontal disease risk include inflammatory conditions such as rheumatoid arthritis and HIV infection. Having one of these diseases can make the control of your periodontal disease more difficult. But a good periodontist or dentist who is aware of these problems can give you guidance on how to maintain your periodontal health.
• Poor nutrition — Nutrition is important for overall good health, including a working immune system and healthy gums and mouth. Severe vitamin C deficiency (scurvy) can cause bleeding gums.
• Information provided by Colgate