As a cancer patient, you know how important radiation and chemotherapy are to overcoming the disease. But these treatments often come at a price to other aspects of your health, including your teeth and gums if the treatment target includes the head or neck regions.
Radiation and chemotherapy are effective because they target and destroy cancer cells. Unfortunately, they may also kill non-cancerous, healthy cells; in the mouth, for example, they can damage the cells in the salivary glands and disrupt their ability to produce adequate saliva flow, leading to xerostomia (dry mouth).
This could seriously affect your teeth’s protective enamel shell. As we eat or drink, our mouth’s pH level can become too acidic. Acid is your enamel’s primary enemy because it causes the minerals in the enamel to soften and dissolve (de-mineralization). Saliva neutralizes acid and replaces much of the enamel’s minerals.
Without adequate saliva flow, the enamel will tend to erode over time. You can further aggravate the situation if you routinely consume acidic foods and drinks, like sipping energy drinks or soda during the day. Once the enamel is gone it can’t be replaced naturally, and the teeth will be in serious danger of tooth decay and eventual loss of function and appearance.
To avoid these consequences you should take steps during cancer treatment to reduce your risk for xerostomia or other unhealthy mouth conditions: limit your consumption of acidic foods and beverages; use mouth rinses to counteract acidity and inhibit bacterial growth; and promote saliva flow through medication.
It may be, though, that enamel erosion and subsequent tooth damage is unavoidable. In this case, you may need to consider restorative options with artificial crowns or other cosmetic enhancements — not only to improve your appearance but also to protect your natural teeth from further damage.
Before considering the latter, you should undergo a complete dental examination to assess your condition and make sure you have adequate bone and gum support, and any dental disease under control. From here, we can go about restoring the attractive smile that may have faded during your battle with cancer.
It’s hard to imagine, but little more than a century ago today’s “minor” bacterial and viral infections were often deadly. This changed with the advent of antibiotics, drugs which kill disease-causing microbes. Decades after the development of penicillin and similar antibiotics, we routinely rely on them for treating infection. They’re quite prominent in dental care in treating advanced forms of periodontal (gum) disease or reducing bacteria that cause tooth decay.
But the age of antibiotics may be in danger: their overuse in medicine and the food industry has led to the rise of resistant microbial strains — “superbugs” — that no longer respond to first line antibiotics or, in some cases, to second or third line drugs. The U.S. Center for Disease Control (CDC) estimates more than two million people annually will contract one of these superbugs of which more than 20,000 will die. If current practices continue, the growth of resistant strains (as well as allergic reactions among users of antibiotics) will increase. The answer is a more modified use of antibiotics.
For healthcare providers, this means adopting new protocols in which we attempt to prescribe antibiotics that specifically target an identified microbe (which we’ve determined through more rigorous diagnostic testing), and in limited amounts. We must also rein in the practice of antibiotic use in the food industry, routinely administered to livestock to prevent disease or to enhance growth. Many countries, including the U.S., are now moving toward a more limited practice in which only animals that are demonstrably sick receive antibiotics. This will limit their release into the greater environment, which is a contributing factor to growing microbial resistance.
Patients also play a role in the better use of antibiotics. We must first change the perception that antibiotics are a “cure-all” — the answer to every illness. It’s also important for patients who’ve been prescribed antibiotics to complete the course of treatment, even if after a day or two they feel better; stopping antibiotic treatment prematurely increases the chances targeted microbes develop a resistance to that particular drug.
Altering our perception and use of antibiotics will require a tremendous effort for all of society. But making these changes will help ensure antibiotics continue to serve humanity as an important health benefit well into the future.
If your sleeping partner snores, it could be more than an annoyance: it could be a sign of sleep apnea. This occurs when air flow into the lungs becomes obstructed in the throat for a few seconds during sleep. The obstruction can take many forms, but a common one arises from the tongue relaxing against the back of the throat, producing snoring sounds as air attempts to pass through this restricted area.
Sleep apnea can cause severe problems: lower daily energy levels and mood from poor sleep; lower oxygen saturation that could affect brain function; and increased risk for cardiovascular disease. So, if you’re awakened by your partner’s snoring (or they’re complaining about yours!), it’s important to have it checked and treated.
This begins with a visit to us for a complete oral examination. Like many dentists, we’re well trained in the anatomy and structures of the mouth, as well as the causes and treatment of sleep apnea. We’ll examine your mouth, take into account any possible symptoms you’re experiencing and, if your suspicions are correct, refer you to a sleep physician to diagnose if you have sleep apnea.
Treatment will depend on its cause and severity. An oral appliance worn during sleep is the recommended first treatment for mild to moderate sleep apnea that involves the tongue as an obstruction. We develop a custom appliance that helps move your tongue away from the back of the throat, reducing both apnea and snoring sounds. For more advanced sleep apnea you could benefit from a Continuous Positive Airway Pressure (CPAP) machine. This device generates continuous air pressure through a mask worn while sleeping that helps keep the airway open.
Of course, there are other causes for obstruction, some of which may require surgical intervention to relieve the problem. Abnormally large tonsils, adenoids or excessive soft tissue can all restrict air flow. Surgically removing or altering these structures could help reduce airway restriction.
Whatever type or degree of sleep apnea you or your partner may have, there are solutions. The right treatment will not only improve overall health, it will help both of you get a better night’s sleep.
If you would like more information on sleep apnea and how to treat it, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “If You Snore, You Must Read More!”
Everyone has to face the music at some time — even John Lydon, former lead singer of The Sex Pistols, arguably England’s best known punk rock band. The 59-year old musician was once better known by his stage name, Johnny Rotten — a brash reference to the visibly degraded state of his teeth. But in the decades since his band broke up, Lydon’s lifelong deficiency in dental hygiene had begun to cause him serious problems.
In recent years, Lydon has had several dental surgeries — including one to resolve two serious abscesses in his mouth, which left him with stitches in his gums and a temporary speech impediment. Photos show that he also had missing teeth, which, sources say, he opted to replace with dental implants.
For Lydon (and many others in the same situation) that’s likely to be an excellent choice. Dental implants are the gold standard for tooth replacement today, for some very good reasons. The most natural-looking of all tooth replacements, implants also have a higher success rate than any other method: over 95 percent. They can be used to replace one tooth, several teeth, or an entire arch (top or bottom row) of teeth. And with only routine care, they can last for the rest of your life.
Like natural teeth, dental implants get support from the bone in your jaw. The implant itself — a screw-like titanium post — is inserted into the jaw in a minor surgical operation. The lifelike, visible part of the tooth — the crown — is attached to the implant by a sturdy connector called an abutment. In time, the titanium metal of the implant actually becomes fused with the living bone tissue. This not only provides a solid anchorage for the prosthetic, but it also prevents bone loss at the site of the missing tooth — which is something neither bridgework nor dentures can do.
It’s true that implants may have a higher initial cost than other tooth replacement methods; in the long run, however, they may prove more economical. Over time, the cost of repeated dental treatments and periodic replacement of shorter-lived tooth restorations (not to mention lost time and discomfort) can easily exceed the expense of implants.
That’s a lesson John Lydon has learned. “A lot of ill health came from neglecting my teeth,” he told a newspaper reporter. “I felt sick all the time, and I decided to do something about it… I’ve had all kinds of abscesses, jaw surgery. It costs money and is very painful. So Johnny says: ‘Get your brush!’”
We couldn’t agree more. But if brushing isn’t enough, it may be time to consider dental implants. If you would like more information about dental implants, please call our office to schedule a consultation. You can read more in the Dear Doctor magazine articles “Dental Implants” and “Save a Tooth or Get an Implant?”
If you’ve suffered from problems with your jaw joints, known collectively as temporomandibular disorders (TMDs), then you know how uncomfortable and painful they can be. You may also have heard about the use of Botox injections to ease TMD discomfort.
Before you seek out Botox treatment for TMD, though, you should consider the current research on the matter. Far from a “miracle” treatment, the dental profession is still undecided on the effects of Botox to relieve TMD pain symptoms — and there are other risks to weigh as well.
Botox is an injectable drug with a poisonous substance called botulinum toxin type A derived from clostridium botulinum, a bacterium that causes muscle paralysis. The Food and Drug Administration (FDA) has approved small dose use for some medical and cosmetic procedures, like wrinkle augmentation. The idea behind its use for TMD is to relax the muscles connected to the joint by paralyzing them and thus relieve pain.
The FDA hasn’t yet approved Botox for TMD treatment, although there’s been some use for this purpose. There remain concerns about its effectiveness and possible complications. In the first place, Botox only relieves symptoms — it doesn’t address the underlying cause of the discomfort. Even in this regard, a number of research studies seem to indicate Botox has no appreciable effect on pain relief.
As to side effects or other complications, Botox injections have been known to cause pain in some cases rather than relieve it, as with some patients developing chronic headaches after treatment. A few may build up resistance to the toxin, so that increasingly higher dosages are needed to achieve the same effect from lower dosages. And, yes, Botox is a temporary measure that must be repeated to continue its effect, which could lead to permanent paralyzing effects on the facial muscles and cause muscle atrophy (wasting away) and even deformity.
It may be more prudent to stick with conventional approaches that have well-documented benefits: a diet of easier to chew foods; cold and heat applications; physical therapy and exercises; pain-relief medications and muscle relaxers; and appliances to help control grinding habits. Although these can take time to produce significant relief, the relief may be longer lasting without undesirable side effects.
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