At Heritage Dental Centre in Edmonton, we care about your dental hygiene. Continue reading to discover how to maintain oral health.
1. Facts About Fluoride
Both the Canadian Dental Association (CDA) and the American Dental Association (ADA) support the use of fluorides in dentistry as a safe and effective preventative measure against dental caries. Historically, fluoride as a decay preventative has been extensively researched for well over 50 years, and the research has been consistent in proving its safety and efficacy.
Humans ingest fluoride on a daily basis due to the fact that fluorides are found naturally in food and water and as an additive in public drinking water, toothpastes, and in oral prescriptions and rinses. So dentists must assess and account for these varied sources before considering any particular means of fluoride delivery to any individual, particularly children under the age of six, for whom over exposure can result in a condition of the teeth known as fluorosis.
Dental fluorosis is a change in the appearance of teeth and is caused when higher than optimal amounts of fluoride are ingested in early childhood while tooth enamel is forming. As long as the total daily intake of fluoride is maintained below specified levels, fluoride is a very important preventative measure in maintaining dental health of North Americans.
Both the CDA and ADA recognize the need to monitor the scientific literature with respect to levels of exposure to fluoride and general health to ensure the continued safe and effective use of fluorides in dentistry.
Fluoridated Toothpastes and Mouth Rinses
Both the American and Canadian Dental Associations acknowledge and support the use of fluoridated toothpastes and mouth rinses in the prevention of dental caries. The recommended usage of fluoridated toothpastes should be twice per day, with minimal rinsing of the mouth with water after brushing. In the case of children under six years of age, adult supervision during brushing is recommended, monitoring that only a small portion (e.g. pea-sized portion) of fluoridated toothpaste be used, as excessive swallowing of toothpaste by young children may result in dental fluorosis. Children under three years of age should have their teeth brushed by an adult using only a ‘smear’ of toothpaste. It is further recommended that until the child develops the manual dexterity to properly brush their own teeth, an adult should supervise this activity.
Fluoride mouth rinses are an effective preventative measure for at risk individuals and should be used according to the specific needs of the individual. Fluoride mouth rinsing is not recommended for children under six years of age.
Dentist Delivered Fluoride Applications
The use of fluoride gels, foams and varnishes are recommended based on an assessment for risk for dental decay, history of dental decay and consideration of facts such as whether the patient lives in community or area where the drinking water is not fluoridated.
Dietary fluoride supplements are available only by prescription in North America. They are intended for use by children living in non-fluoridated areas who are assessed as being at greater risk for dental decay. Supplementation, in these cases, is indicated in order to increase the level of fluoride exposure to levels similar to those of children living in optimally fluoridated areas.
2. Oral Hygiene Instruction
Oral hygiene instruction is helpful and educational information meant to teach and guide our patients to prevent new cavities, and to maintain healthy teeth and gums. At your initial oral hygiene visit, your hygienist will instruct you on the proper methods of brushing and flossing. Follow up visits will be to further assess your progress in maintaining good oral health, and to help review and reinforce techniques of cleaning at home.
The following are helpful recommendations:
Flossing is the foundation for healthy gums, so floss your teeth once a day. Dental floss will get into areas between your teeth and under your gums that your toothbrush cannot. Slide the floss between your teeth and wrap it into a "C" shape around the base of the tooth and gently under the gum line. Wipe the tooth from base to tip two or three times. Be sure to floss both sides of every tooth.
Brush your teeth twice a day, and make sure to brush your teeth after you floss, as this is a more effective method of cleaning your teeth. Use a soft bristled toothbrush (safer on your gums) and a circular motion that moves the brush bristles ‘away’* from the gums (*on the top arch, this would mean you are brushing in a circular direction which is top-down; on the bottom arch, you would be brushing in a bottom-to-top circular motion.) Use care to not speed through brushing, taking at least two to three minutes to do a thorough job.
Eat a well-balanced diet, avoiding excessive snacking between meals, especially sticky, sugary foods.
Use either a fluoride or antiseptic rinse as directed by the dentist or hygienist.
Twice-daily brushings and regular flossing are excellent for maintenance between office visits, but a healthy mouth and beautiful smile require routine general and preventative care to stay that way. Our practice offers hygiene care that includes regular oral examinations and cleanings. Our preventative hygiene services include fluoride, professional breath control and periodontal (gum disease) treatments designed to help you maintain your smile’s health and beauty. Keep your teeth and gums strong and disease-free. Contact our office today to schedule a cleaning or consultation.
3. Infection Control
With increased public awareness of global bacterial and viral outbreaks, we would like to provide you with some information about how modern dental offices are required to practice infection control.
Universal precautions were described in directives and guidelines issued by the Centers for Disease Control and Prevention (CDC) and the American Dental Association in 1987, and in standards published by the Occupational Safety and Health Administration (OSHA) in 1991. They are a ‘single standard of infection control’ that is used for each and every patient. These precautions require all dental staff involved in patient care to use appropriate protective garb such as gloves, masks and eyewear. After each patient visit, gloves are discarded, hands are washed with an antibacterial soap or a hand sanitizer, and a new pair of gloves is used for the next patient.
All instruments used on patients are either discarded or sterilized after every patient use. The sterilization procedure involves a series of thorough steps that are performed after each use on a single patient. The instruments are first washed. Then they are soaked in a disinfectant while run through an ‘ultra-sonic’ machine to further loosen any remaining particles from the instruments. Finally, they are sterilized under pressure with chemicals, or steam.
4. Medication and Oral Health
There are some medications that can have an adverse effect on your mouth and teeth.
In North America, in the 60’s and early 70’s, children who were exposed to an antibiotic called tetracycline developed varying degrees of dental problems, including discoloration of the teeth. The medication had its negative effect when either given to patients below eight years of age, or to pregnant mothers. The medication is no longer given by dentists or physicians to these two groups.
Dry Mouth Syndrome (Xerostomia)
Dryness of the oral cavity can result from a number of factors. Medications can influence the secretion of saliva from the salivary glands. The lack of normal saliva production leads to a very dry environment in the mouth. This dry environment results in an imbalance in the normal bacteria in the mouth and can lead to an overgrowth of microorganisms that result in increased dental decay and soft tissue infections of the mouth. Without saliva, your body loses one of its natural defenses to cleanse the mouth of harmful cavity causing bacteria.
Common causes of dry mouth include certain prescription medications (eg. antidepressants, antihistamines, pain medications, etc.), certain cancer therapies that might involve irradiation of the head and neck, chemotherapy, states of anxiety, Sjogren Syndrome, HIV/AIDS, diabetes, Parkinson's disease, and certain foods and tobacco.
5. The Link to Heart Disease
Poor dental hygiene (lack of brushing and flossing) can lead to other health problems not related to the mouth, including problems associated with the heart. Inflammation, which is the human body’s natural response to irritation, injury or infection of tissue, has been shown to be a major risk factor for heart disease. While inflammation is meant to have a protective effect, untreated chronic inflammation can lead to more severe health complications. Both periodontal disease (severe, chronic gum disease) and cardiovascular disease are inflammatory diseases, and inflammation is the common factor that connects these two disease states.
Medical research is now showing that periodontal disease may increase the inflammation level throughout the body. Since several studies have shown that patients with periodontal disease have an increased risk for cardiovascular disease, the American Academy of Periodontology (AAP) and The American Journal of Cardiology ® have developed clinical recommendations for periodontists (dental specialist with training in diagnosing, preventing and treating gum disease), dentists, cardiologists and internists.
This is why it is so important to practice good oral hygiene at home, including a twice daily routine of brushing and once daily regimen of flossing. By sustaining this habit of cleaning at home, you will keep the level of harmful bacteria low, thereby reducing the level of infection and resulting inflammation.
Prophylaxis is the prevention of an ‘occurrence’; For example, dental prophylaxis consists of removing plaque and cleaning the teeth to prevent cavities and gum disease.
Antibiotic prophylaxis is used in order to prevent the occurrence of bacterial infection from spreading from the mouth to the rest of the body, particularly during a dental cleaning or invasive procedure. It is possible for bacteria to move from the mouth via the very thin lining of the gum tissue that forms a collar all the way around a tooth (the sulcus; or base of the pocket around a tooth). Scanning electron microscope studies have found this lining to be only a single cell layer thick, therefore easily penetrated by bacteria.
The two general categories of patients requiring antibiotic prophylaxis are 1) those who must take the protective measure of an antibiotic in order to prevent bacteria from moving from the mouth to other vital organs. These are people that either have certain cardiovascular conditions (e.g. weakened heart valves) or who have a compromised immune system, and 2) those who receive it to prevent a severe local infection as a complication of a procedure, e.g. complicated wisdom tooth removal.
All of our patients with any heart condition or weakened immune system are strongly advised to inform us before undergoing any dental procedures in our office. We will assess your condition, and if necessary, confer with any attending physician(s) that you may have, in order to determine if you require antibiotics before any procedure.
6. Allergy to Latex
Latex allergy is a hypersensitivity to the naturally occurring protein found in rubber which may cause symptoms to arise. These symptoms may be as mild as skin irritations (contact dermatitis), hives, itchy eyes, runny nose, to more severe occurrences such as asthma and life-threatening anaphylaxis.
The symptoms and signs associated with anaphylaxis include:
Many medical and dental supplies contain latex, including gloves, blood pressure cuffs, urinary catheters, dental dams and material used to fill root canals, as well as tourniquets and equipment for resuscitation. The tendency to develop allergies to latex appears to be an inherited trait, and as with other allergies, the more intense and frequent the exposure to latex, the more likely one is to develop an allergy to it. Healthcare workers have a greater chance (up to 10%) to develop a latex allergy due to their repeated exposure to rubber based products. However, in recent years, there has been a move to decrease the addition of powder in these gloves (powder was used to ease the ability to put on the gloves and decrease perspiration of the hands within the latex gloves), and this appears to have decreased the occurrence amongst healthcare professionals of latex allergies.
Other groups at risk include those who have had various surgeries, especially those involving the nervous system and genitourinary tract system. Children with spina bifida also appear to have a higher occurrence of developing latex allergies.
If you have a known sensitivity or allergy to latex or any related items, please notify our office. Non-latex substitutes can be found for all of the latex-containing items that are normally used.
7. Oral Health and Seniors
Aging and Oral Health
North Americans are generally leading longer and healthier lives. Today's seniors are also enjoying good oral health, keeping their natural teeth longer than previous generations.
The maintenance of good oral health is stressed throughout one's life. It remains a very important corner stone to good overall health and quality of life. Neglect of teeth and gums leads to infections in the mouth. There is a growing body of medical evidence that shows that the inflammation that results due to the infection in the mouth may be closely linked to other diseases such as diabetes and heart disease, and in severe cases can even lead to respiratory infection like pneumonia. But, by simply keeping up with regular brushing and flossing as part of your daily regimen, you can maintain good oral health. Your regular dental visits are a further assurance to help screen for other serious diseases including oral cancer.
Follow the same simple rules that have supported you throughout your life including:
With increased age, seniors can be faced with several major overall problems related to their oral health:
Here are a few other influencing factors to consider and discuss with your dentists.
Cavities and Decay
Due to the lack of fluoride when many of today's seniors grew up, they had a higher tendency to develop decay at a younger age, and consequently had more fillings than many of today's younger population. Today, many of these fillings, if not looked after with proper oral hygiene at home, can develop re-decay around their margins. Another factor that leads to an increased incidence of decay in seniors is due to gum recession. Over time, if one is not careful in maintaining good oral hygiene, our gums can significantly recede. As the gums recede, the roots are more exposed and therefore susceptible to decay causing acids.
Gum disease (gingivitis and periodontitis) are essentially caused by the bacteria found in plaque. The research evidence suggests that older patients develop plaque more quickly, but that the majority can prevent and maintain their gums and their health by focusing on good home care and regular preventative care at the dentist's office.
The incidence of oral cancer is higher among seniors. Regular dental visits can help to spot early signs of oral cancer and pre-cancerous conditions.
Dry Mouth (Xerostomia)
Older adults are susceptible to dry mouth, an appropriate environment for bacterial growth. Dryness of the oral cavity can result from a number of factors. Medications can influence the secretion of saliva from the salivary glands. The lack of normal saliva production leads to a very dry environment in the mouth. This dry environment results in an imbalance in the normal bacteria in the mouth and can lead to an overgrowth of microorganisms that result in increased dental decay and soft tissue infections of the mouth. Without saliva, your body losses one of its natural defenses to cleanse the mouth of harmful cavity causing bacteria.
To help combat a dry mouth, avoid caffeine and tobacco. Make sure you drink plenty of water and avoid refined sugar.
Many seniors are prescribed medications that contain sugar and can cause dry mouth, both factors that can influence oral disease. Common causes of dry mouth include certain prescription medications (eg. antidepressants, antihistamines, pain medications, etc.), anxiety states, certain cancer therapies that might involve irradiation of the head and neck, chemotherapy, states of anxiety, Sjogren Syndrome, HIV/AIDS, diabetes, Parkinson's disease, and certain foods and tobacco. It's important to tell your dentist about any medications you are taking and other possible symptoms, such as abnormal bleeding, taste alterations and soft-tissue symptoms like swelling and discoloration.
Unfortunately, many seniors may begin to experience mouth or teeth problems that make them less likely to consume a healthy diet which further leads to a negative impact on oral health. Some of the reasons for this include a decrease in appetite, physical disabilities, dementia, such as Alzheimer's, or untreated tooth decay. All the more reason if possible for our aging population to try and keeping their natural teeth longer in life. By virtue of being able to use their teeth, seniors make better nutrition choices, allowing them to continue to enjoy a wide variety of foods that further support ongoing oral health.
While diseases of the mouth and surrounding areas are a serious health risk, their relationship to overall general health is often not considered important or is simply overlooked.
Gum disease that is left untreated can lead to an increased risk of diseases of the respiratory system. This is primarily caused when the toxic bacteria that are contained in plaque make their way from the mouth to the lungs. The result is either respiratory infections or worsening of already existing cardiovascular conditions.
Seniors that are living with diabetes are a more susceptible population group to the affects of periodontal disease (i.e. gum disease that has advanced to the point of causing loss of bone and tissue attachments around existing teeth). Diabetics with uncontrolled gum disease are therefore more susceptible to tooth loss.
Seniors that may have compromised immune systems due to existing chronic ailments or medications are more susceptible to getting fungal and viral infections of the mouth.
A great number of people complain of tooth sensitivity, but more so amongst the senior population. The sensitivity is usually the result of a lifetime of wear and tear of the teeth and gums caused by factors such as brushing too aggressively, lack of oral hygiene leading to receded gums and overall gum disease, broken and fractured teeth, bruxism (grinding of teeth), acidic foods and complications resulting from certain dental treatments. The triggers for tooth sensitivity can be anything from thermal stimulation (hot or cold foods or drink), sugary or acidic foods, even just breathing in cold air.
Many seniors who have lost some or all of their teeth are wearing removable dentures to replace those missing teeth. The proper care and maintenance of these partial or complete dentures is paramount to maintaining the health of the mouth. Poorly fitting dentures, and those that are not removed regularly to allow oral tissues and existing teeth to be adequately cleaned, can lead to further dental and oral tissue problems. Seniors that wear dentures are advised to continue regular dental visits to ensure proper fit and function of their dental prosthesis.
Tips for Seniors and Caregivers
Regular dental visits are a perfect time to speak to the dentist about concerns that you may have with regards to your oral health (or that of someone under your care) and will help to spot trouble early. It is also a time to update the dentist as to any medical issues or medications that you may be taking that could adversely affect your oral health.
Some additional tips for seniors and caregivers:
Message to Caregivers
If you are caring for a senior who is faced with physical or cognitive deterioration, please take note of their oral health by simple observation inside their mouth for any problems. Their oral health does impact the quality of their lives, and upon their overall systemic health. Maintain their regular dental visits in order that any problematic symptoms or troubling signs can dealt with early. If possible, attend the dental visit with the elder in your care in order to provide as much relevant medical information as possible.
The American and Canadian Dental Associations, along with all North American regional dental associations and societies have been at the forefront in the battle against tobacco-related disease, working to educate the public about the dangers inherent in tobacco use and encouraging dentists to help their patients break the cycle of addiction. The dental community has continually strengthened and updated its tobacco policies as new scientific information has become available.
FAQs: Tobacco Products
What effects can smoking have on my oral health? Are cigars a safe alternative to cigarettes? Are smokeless tobacco products safe? The American Dental Association has some alarming news that you should know.
Smoking and Implants
Recent studies have shown that there is a direct link between oral tissue and bone loss and smoking.
Tooth loss and edentulism are more common in smokers than in non-smokers. In addition, people who smoke are more likely to develop severe periodontal disease.
The formation of deep mucosal pockets with inflammation of the peri-implant mucosa around dental implants is called peri-implantitis. Smokers treated with dental implants have a greater risk of developing peri-implantitis. This condition can lead to increased resorption of peri-implant bone. If left untreated, peri-implantitis can lead to implant failure. In a recent international study, smokers showed a higher score in bleeding index with greater peri-implant pocket depth and radiographically discernible bone resorption around the implant, particularly in the maxilla.
Many studies have shown that smoking can lead to higher rates of dental implant failure. In general, smoking cessation usually leads to improved periodontal health and a patient’s chance for successful implant acceptance.
9. Oral Piercing
While many people think this trend looks cool, it has many possible and harmful side effects.
Common symptoms after oral piercing include pain, swelling, infection, an increased flow of saliva (“spit”) and injuries to the gums:
And the jewelry itself can be hazardous or cause other problems:
Since oral health is important for overall health, the effects of an oral piercing may have a greater impact than one may think. Unfortunately, many people with oral piercings don't realize that these side effects could happen to them.