The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer. The following can be signs of the beginning of a pathologic process or cancerous growth:
- » Reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth
- » A sore that fails to heal and bleeds easily
- » A lump or thickening on the skin lining the inside of the mouth
- » Chronic sore throat or hoarseness
- » Difficulty in chewing or swallowing
These changes can be detected on the lips, cheeks, palate, gum tissue around the teeth, tongue, face, and/or neck. Pain is not always necessary to define a pathology and, curiously, is not often associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer. If you feel that you or someone you know have any of the symptoms that have been discussed or if you have any questions and/or concerns, please do not hesitate to contact our office so we may be of some assistance to you.
Please assist us at the time of your initial visit to the office by providing the following information:
- » Your referral slip and x-rays from your referring dentist.
- » A list of medications you are currently taking
- » If you have dental insurance, please bring any forms or insurance cards with you to the appointment.
Please Note: All patients under the age of 18 must be accompanied by a parent or guardian at the consultation appointment. Please notify the office if you have a medical condition or concern prior to surgery (e.g. artificial heart valves or joints, heart murmurs requiring premedication, severe diabetes, or hypertension.) If your referring dentist has taken x-rays, you may request that they be forwarded to us.
Periodontal Diesases and Their Prevention
Periodontal diseases are infections of the gums, which gradually destroy the support of your natural teeth. There are numerous disease entities requiring different treatment approaches. Dental plaque is the primary cause of gum disease in genetically susceptible individuals. Daily brushing and flossing will prevent most periodontal conditions.
Why is oral hygiene so important?
Adults past the age of 35 lose more teeth to gum diseases (Periodontal Disease), than from cavities. Three out of four adults are affected at some time in their life. The best way to prevent cavities and periodontal diseases is by good tooth brushing and flossing techniques, performed daily.
Periodontal disease and decay are both caused by bacterial plaque. Plaque is a colorless film, which sticks to your teeth at the gum line. Plaque constantly forms on your teeth. By thorough daily brushing and flossing you can remove these germs and help prevent periodontal disease.
Periodontal diseases can be accelerated by a number of different factors. However, the bacteria found in dental plaque, a sticky colorless film that constantly forms on your teeth, mainly cause it. If not carefully removed by daily brushing and flossing, plaque hardens into a rough, porous substance known as calculus (or tartar).
Bacteria found in plaque produces toxins or poisons that irritate the gums, which may cause them to turn red, swell and bleed easily. If this irritation is prolonged, the gums separate from the teeth, causing pockets (spaces) to form. As periodontal diseases progress, the supporting gum tissue and bone that holds teeth in place deteriorate. If left untreated, this leads to tooth loss.
The best way to prevent gum disease is effective daily brushing and flossing as well as regular professional examinations and cleanings. Unfortunately, even with the most diligent home dental care, people still can develop some form of periodontal disease. Once this disease starts, professional intervention is necessary to prevent its progress.
Worse still, more and more research points to the grave systemic consequences of allowing this chronic bacterial infection to persist in your body. Numerous medical researchers have reported links between active periodontal disease and numerous systemic illnesses. Heart valve damage and blood vessel narrowing (arteriosclerosis & clot formation), low birth weight babies and premature delivery, elevated blood sugar in diabetics, increased incidence of respiratory infections and other less serious effects are associated with bacterial contamination and bacterial toxins from diseased gums. Clearly periodontal disease is not the sole cause of these problems but it clearly plays a role for many people. As one well-respected physician said – “What other part of your body would you permit to be chronically infected and expect no consequence on your overall health?”
Nitrous Oxide Analgesia
Nitrous oxide, a sweet smelling gas, is a compound of nitrogen and oxygen. It is inhaled, along with oxygen, through a nasal mask. It is used for patients of all ages. It is also used in a number of dental treatments such as tooth restoration, placement of crowns, or for minor surgical procedures. Nitrous oxide is often used along with local anesthetics and pain medications. It has the effect of raising the discomfort threshold and may even make the time appear to pass quickly.
Conscious sedation is a minimally invasive technique which will calm you during dental procedures without the risk associated with general anesthesia. A depressed level of consciousness is reached that allows the patient to maintain a patent airway independently and to respond appropriately to verbal commands and physical stimulation. The drugs, doses, and techniques used are not intended to produce loss of consciousness. Such drugs include midazolam (Versed) , diazepam (Valium), and Meperidine (Demerol).
Anesthesia Do’s and Don’ts
DO leave the office accompanied by a responsible adult. This person will ensure that you travel safely, as well as provide immediate care at home. You should continue to have this adult with you for 24 hours after surgery.
DO remain quietly at home for the day and rest. You need rest both because you have received anesthesia, and because you have undergone a surgical procedure – even one that is considered minor. If, after a day, you still do not feel recovered, you may want to continue your rest for an additional day or two. Discuss your planned return to work with your physician.
DO arrange for someone to care for your small children for the day. Even if given instructions to play peacefully and not overtax you, children sometimes forget such directions or have trouble staying quiet for an entire day. The most predictable course of action is to leave small children and babies in the care of another responsible adult.
DO take liquids first and slowly progress to a light meal. Heavy foods can be difficult for your system to digest, thereby increasing the chance for discomfort. For your nourishment, start by taking liquids, then eat light foods, such as broth or soup, crackers or toast, plain rice, jello and yogurt.
DON’T drive a car for at least 24 hours. After anesthesia, your reaction may be impaired. Such impairment makes driving a car dangerous to you and to others. It is especially important that you don’t forget to make arrangements for someone else to drive you home from office.
DON’T operate complex equipment for at least 24 hours. The same logic that applies to driving a car similarly applies to the operation of other equipment. This includes equipment used at home, such as a lawnmower, as well as that which is used on the job, such as a forklift truck.
DON’T make any important decisions or sign any legal documents for the day. The potential for impairment relates not only to physical activities, but to your mental state also. Moreover, the anxiety that frequently accompanies important decisions is to be avoided. The day should be spent resting.
DON’T take any medications unless prescribed by or discussed with your physician. Some medications may adversely interact with anesthetic drugs or chemicals remaining in your body. Included are prescription drugs, such as sleeping pills or tranquilizers, and over-the-counter medications, such as aspirin.
DON’T drink alcohol for at least 24 hours. Alcohol is also considered a drug, meaning that an alcoholic drink has the potential to negatively react with the anesthetic in your system. This includes hard liquor, beer and wine.
Please carefully follow directions for medications. Take all medications with a full glass of water. If at any time you should become nauseous or experience itching or a rash while on medication, discontinue the use of all medications and contact our office. Women using birth control medication should be cautioned that antibiotics may reduce the effectiveness of birth control medications. Alternative methods of birth control should be employed while taking antibiotic medications.
The periodontal dressing is placed for your comfort. To facilitate the retention of this dressing, avoid chewing or cleaning in this area. Should the dressing become loose, gently remove it with a toothpick. If the dressing comes off and you are comfortable, rinse gently with a mild salt water solution or diluted mouth rinse, but avoid mechanical brushing and flossing. If the dressing comes off and you are uncomfortable, please call our office.
There will be a minimal amount of oozing for the next 24 hours. If you experience continuous or sudden bleeding, you should rinse with ice cold water several times and then apply a wet tea bag with firm pressure directly on the area. If bleeding does not stop within 15 minutes, call our office. To minimize the chance of a bleeding problem we suggest that you not smoke, spit or use a drinking straw for the first 24 hours. Keeping your head elevated for the first 6 hours after surgery will also minimize bleeding.
You should eat a well balanced diet, consisting primarily of soft foods which are easier to chew. Eggs, soft meats, fish, mashed potatoes, jello and puddings for the first few days will be easily managed and will not dislodge the dressing. Food supplements (Metrical, Nutrament, etc.) are also excellent. Please avoid nuts, popcorn and other crunchy food following surgery. We suggest that you not bite directly into hard foods such as apples, carrots or hard breads following surgery.
A slight amount of swelling is normal and may last for the first 2 or 3 days after surgery. Swelling can be minimized by the application of an ice pack over the operated area as soon after surgery as possible. Alternate the ice for 15 minute intervals (15 minutes on/15 minutes off) for the first 3 to 4 hours after surgery.
It is important that you maintain your mouth in a clean state. Although you should avoid the surgery area, treat the remainder of your mouth with the same high level of care which you have shown in the past. If a medicated mouthwash was prescribed, please use as directed. If no mouthwash was prescribed, gentle rinsing with warm salt water can be initiated on the second day following surgery.
The post operative periodontal procedure should be uneventful and comfortable. Do not exert yourself for the first few days and follow the instructions above and you should find that no post operative problems will develop. Please call us if you have any questions.
Diabetes and Periodontal Disease
The two-way relationship between periodontal disease and diabetes…
For years we’ve known that people with diabetes are more likely to have periodontal disease than people without diabetes.
Recently, research has emerged suggesting that the relationship goes both ways – periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.
More research is needed to confirm how periodontal disease can make it more difficult to control blood sugar.
What we do know is that severe periodontal disease can increase blood sugar, contributing to increase periods of time when you body functions with a high blood sugar. And, as a diabetic, you know that this puts you at increased risk for diabetic complications.
In other words, controlling your periodontal disease may help you control your diabetes. If you are among the nearly 16 million Americans in the U.S. who live with diabetes, or are at risk for periodontal disease, see a periodontist for a periodontal evaluation – because healthy gums may lead to a healthy body.
Respiratory and Peridontal Disease
It’s possible that if you have periodontal disease, you may be at risk for respiratory disease…
For a long time we’ve known that people who smoke, are elderly, or have other health problems that suppress the immune system, are at increased risk for the development of respiratory diseases like pneumonia, bronchitis, emphysema and Chronic Obstructive Pulmonary Disease.
Now growing research is beginning to suggest a new risk factor – periodontal disease. If you have periodontal disease, you may be at increased risk for respiratory disease. More research is needed to confirm how periodontal disease may put people at increased risk for respiratory disease. What we do know is that infections in the mouth, like periodontal disease, are associated with increased risk of respiratory infection.
If you are at risk for respiratory disease or periodontal disease, see a periodontist for a periodontal evaluation – because healthy gums may lead to a healthier body.
Pregnancy and Peridontal Disease
It’s possible that if you have periodontal disease and are pregnant, you may be at risk for having a premature, low birthweight baby…
For a long time we’ve known that many risk factors contribute to mothers having babies that are born prematurely at a low birthweight – smoking, alcohol use, drug use and infections.
Now evidence is mounting that suggests a new risk factor- periodontal disease. Pregnant women who have periodontal disease may be seven times more likely to have a baby that is born too early and too small.
More research is needed to confirm how periodontal disease may effect pregnancy outcomes. What we do know is that periodontal disease is an infection and all infections are cause for concern among pregnant women because they pose a risk to the health of the baby.
If you are planning to become pregnant or are at risk for periodontal disease, be sure to include a periodontalevaluation with a periodontist as part of your prenatal care, because healthy gums may lead to a healthier body and healthy baby.
Heart and Periodontal Disease
It’s possible that if you have periodontal disease, you may be at risk for cardiovascular disease…
For a long time we’ve known that bacteria may affect the heart. Now evidence is mounting that suggests people with periodontal disease – a bacterial infection, may be more at risk of having a fatal heart attack, than patients without periodontal disease.
While more research is needed to confirm how periodontal bacteria may affect your heart, one possibility is that periodontal bacteria enter the blood through inflamed gums and cause small blood clots that contribute to clogged arteries.
Another possibility is that the inflammation caused by periodontal disease contributes to the buildup of fatty deposits inside heart arteries. One out of every five Americans has one or more types of heart disease.
If you are one of these Americans, or if you are at risk for periodontal disease , see a periodontist for a periodontal evaluation – because healthy gums may lead to a healthier body.
Tobacco and Gum Disease
As you probably already know, tobacco use is linked with many serious illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems. What you may not know is tobacco users also are at increased risk for periodontal disease.
In fact, recent studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.
Whether you smoke, dip or chew tobacco, you are more likely to have periodontal disease – and to have it more severely – than those who do not use any form of tobacco.
As a smoker, you are more likely than nonsmokers to have calculus form on your teeth, have deeper pockets between your teeth and gums, and lose more of the bone and tissue that support your teeth.
If the calculus is not removed during a professional cleaning, and it remains below your gum line, the bacteria in the calculus can destroy your gum tissue and cause your gums to pull away from your teeth. When this happens, periodontal pockets form and fill with disease-causing bacteria. If left untreated, periodontal disease will progress. The pockets between your teeth and gums can grow deeper, allowing in more bacteria that destroy tissue and supporting bone. As a result, the gums may shrink away from the teeth making them look longer. Without support, your teeth may become loose, painful and even fall out. Research shows that smokers lose more teeth than nonsmokers.
Smokeless Tobacco Users
As a user of smokeless tobacco, your gums are more likely to recede, and you have a greater chance of losing the bone and fibers that hold your teeth in your mouth. If your gums recede to the point where the tooth roots are exposed, your teeth may become susceptible to root cavities or sensitive to cold and touch (not to mention the fact that your chances of developing oral cancer increase with smokeless tobacco use).
These problems, associated with tobacco use of any kind, are caused by the many chemicals, such as nicotine and tar, in tobacco. These chemicals have harmful effects on the periodontal tissues. They cause an increase in the accumulation of plaque and calculus (or tartar) that can irritate your gums and lead to infection. Following periodontal treatment or any type of oral surgery, the chemicals in tobacco can also slow down the healing process and make the treatment results less predictable.
Researchers also are finding that many of the following problems occur more often in patients who use tobacco:
- » Oral cancer
- » Bad breath
- » Stained teeth
- » Tooth loss
- » Bone loss
- » Loss of taste and smell
- » Less success with periodontal treatment
- » Less success with dental implants
- » Gum recession
- » Mouth sores
Why Quitting Makes Sense
Tobacco use is addictive, yet every year millions of Americans quit. The benefits include reduced chances of developing cancer, lung disease and heart disease, as well as less expensive health care. When you quit using tobacco, you also reduce your chances of getting oral and gum disease. Gums that are free of disease are essential to help you keep your teeth for a lifetime.
Quitting takes commitment – and it’s usually easier if you have help. To begin a tobacco-cessation program, talk to your periodontist or physician. They are prepared to help you.