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Eating disorders can affect dental condition

June 26, 2012 By

submitted by Dr. Michael Spadafora, D.D.S.

Recently, a distant relative asked if I would review the treatment plan proposed for his 17-year-old daughter in a large Midwestern city. He sent me the photos, as well as the extensive notes and plan that the treating dentist provided.

As I reviewed the information, I saw a large “red flag.” After consulting with my relative, my concern was validated.

The daughter had severe wear on the inside of her teeth; the tooth enamel was eroded beyond her years. My suspicions were correct – this teenager was suffering from bulimia, a common eating disorder that affects many, especially young women.

Bulimia and anorexia nervosa are eating disorders that have significant implications to the oral health of the patient. A bulimic patient usually will eat excessively (or binge) and then self-induce vomiting (purge).

The acids from the stomach can cause severe erosion of the teeth, as well as bad breath, mouth sores, and tenderness in the mouth.  The teeth can become very sensitive and the color, length, and shape of the teeth can be altered.

The patient suffering from anorexia nervosa also deals with oral health issues. The lack of vitamins, minerals, proteins and other nutrients necessary for good health shows itself in the mouth also. These patients can have bad breath, sensitive teeth, dry mouth, and tenderness in the mouth.

A big issue with anorexic patients is osteoporosis, which leads to tooth loss.

The dentist can be one of the first to suspect that the patient has an eating disorder. If the patient is underage, the dentist can share this suspicion with the parent or guardian. If the patient is 18 or older, the dentist can only encourage the patient to seek counseling for the disorder, but cannot share the information with others.

Modern dentistry provides us with options to treat patients who have had damage from eating disorders. I would, however, caution anyone, just as I told my relative, to resolve the eating disorder first.

If the dentistry is completed before the issues are handled, the dentistry has an increased likelihood of failure.

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No need to fear root canal therapy

April 24, 2012 By

submitted by Dr. Michael Spadafora, D.D.S.

Root canal. Few words in the English language strike fear in the hearts of the average person like these two simple words. I am here to tell you, however, that root canal therapy (RCT) gets a bad rap. RCT is one of the most misunderstood and feared procedures, while being one of the most valuable procedures that the dentist has to help you keep your teeth.

RCT is simply the removal of all pulpal tissue inside the tooth. It is done using a local anesthetic and is usually completed in one or two visits to the dental office. Depending on the complexity of the case, a referral to a specialist (Endodontist) may be necessary.

Once the pulpal tissue is removed, the dentist fills the disinfected space with an inert material (gutta percha) that is covered with a medicated sealer. The tooth then must be restored, usually with a crown. Sometimes the patient will be placed on a short course of antibiotics.

RCT is about 95% successful. The occasional failure of RCT is often caused not by the root canal itself, but by the lack of proper restoration of the tooth after RCT.  If the crown does not fit well, micro-leakage can occur, which may lead to infection and subsequent problems. This is why it is imperative that your dentist is very precise in taking the impressions and placing a well fitting restoration after RCT.

So why are people so afraid of these two little words? The answer is fairly simple – procrastination!

If the tooth is treated early when a problem begins, sometimes a root canal can be avoided or can be accomplished with little, if any, discomfort. As the infection progresses, the local anesthetic becomes less effective, sometimes leading to discomfort during RCT.

If you have sensitivity to cold or heat, or pain when you chew, call your dentist. Chances are good that early action can save you time and money.  And if a root canal becomes necessary, don’t be afraid.

It is a short-term issue for a long-term gain – keeping your teeth healthy and functional for a lifetime!

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You are ‘numero uno’ when it comes to dental health

March 28, 2012 By

submitted by Dr. Michael Spadafora, D.D.S.

As with any other science or technology field, the field of Dentistry is always changing. New products, new technologies, and new methodologies are constantly being introduced. In order to stay updated, the dentist has to avidly read and evaluate what is new in the industry.

A relatively new product in the industry is Arestin (minocycline HCL). Arestin is an antibiotic which is applied deep into the crevice between the gum and the tooth (periodontal pocket), as an adjunct to root plane and scaling (RPS) for periodontal disease.

Arestin is recommended for certain patients whose gum pockets are in the 5-6 mm range. Arestin is a drug that is applied by the hygienist or the dentist in the office, usually during an RPS appointment. Its purpose is to kill the bacteria that the RPS can’t reach.

While I am still monitoring the results with my patients, I am optimistic that Arestin is another valuable tool in the fight against periodontal (gum) disease.

In previous articles I have discussed the connection between healthy gums and a healthy body. Gum disease has been linked to a number of illnesses, most notably heart disease. Gum disease is a localized chronic infection that happens to be in your mouth.

There is no “closed door” to keep that infection from spreading.  That is why we must treat this disease aggressively. And that is why I decided to add Arestin as one more weapon in the battle against periodontal disease.

The thing to remember, however, is that RPS and antibiotics can only go so far. The most important factor in maintaining healthy gums is meticulous home care.

Nothing can take the place of following your dental professional’s advice in your own home. Your dentist and hygienist are your teammates – but you are the captain of the team when it comes to your oral health.

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When selecting a dentist, consider the factors

February 21, 2012 By

submitted by Dr. Michael Spadafora, D.D.S.

When selecting a new dentist, there are many factors to consider.  Some of these factors – like location, flexible hours and cleanliness of the office – are easy to evaluate. Others, such as the dentist’s education, his level of expertise, his use of current technology and his payment policies, can be determined with a little effort.

One factor, however, is a little harder to nail down, but is extremely important in maintaining your family’s oral health. This factor is communication.

When a patient first enters my office, I try to get to know him. This takes place in the new patient exam, where I carefully examine the patient (this includes an oral cancer screening) and speak with him about his dental wants and needs. The patient usually will have some digital diagnostic x-rays taken, and sometimes I will recommend having study models prepared.

After this first meeting, I take all of the information that has been gathered and I sit down to prepare a treatment plan, which is later presented to the patient. Occasionally, the patient has a problem which dictates one treatment option (a root canal, for example). Usually, however, there is more than one way to treat a dental problem.

These different options are not always optimal, but can often be used as stop-gap measures. The patient may have issues that preclude him from selecting the optimal treatment. Financial, time, and/or personal issues may convince the patient to delay or phase his treatment. Communication becomes the important element in this situation.

As the patient, you need to communicate these issues to the dental team. The dental team needs to understand your issues, and adapt the treatment plan to work within your situation. You and your dentist need to openly communicate about your dental health. If you can’t communicate well with your dental team, you may be better served in a different office.

I always talk to my patients about optimal dental treatment. This is a starting point, a goal to which to aspire. But life gets in the way. A good dentist will work with the patient towards the achievement of optimal dental health, handling the detours and enjoying the journey.

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Missing a tooth? No problem!

November 1, 2011 By

submitted by Dr. Michael Spadafora, D.D.S.

The problem of a missing tooth has become easier to solve since the advent of the dental implant. This procedure is becoming commonplace in today’s dental office.  It has certainly become one of the most predictable procedures performed in our dental practice.

So what is a dental implant and who are candidates for this procedure? A dental implant is nothing more that a metal screw (titanium) that is placed into the jawbone. It acts like an anchor for a false tooth or a set of false teeth. Anyone in reasonably good health who wants to replace a missing tooth (or missing teeth) is a candidate.

Enough bone in the area of the missing tooth is necessary to provide for the anchoring of the implant. Many patients ask me about the success rate of implants. Success rates vary depending on the locations in the mouth.  Success rate vary from 90-95% in the front upper jaw, while rates in the back of the upper jaw and lower front jaw can be in the 85-95% range. The best scenario for implant success is in the lower front part of the jaw where success rates can be as high as 98-100%

Relatively few things can go wrong with dental implants. The most common is failure of the implant to integrate or bond with the bone. Other complications can be fracture of the implant, infection or an inflammatory condition in the soft tissue or bone, damage to the nerve in the lower jaw and damage to the maxillary sinus or nasal cavity. These complications, usually accounting for less that 5% of all dental implant treatment, vary in severity and can usually be corrected. 

Dental implants have become very popular as more people become aware that there is a dental replacement system that mimics natural teeth. Dentures and removable bridges have obvious problems, often being loose and unstable. Fixed bridges, a permanent replacement solution, involves the cutting down of healthy tooth structures on each side of the missing tooth. Dental implants give patients a solution to missing teeth that is functional, does not require altering healthy teeth, and, best of all, provide an esthetically pleasing result.

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Infant and toddler dental needs

August 30, 2011 By

submitted by Dr. Michael Spadafora, D.D.S.

Infants and toddlers have dental needs, which is sometimes a surprise for parents.  Although not a pediatric dentist, I treat many very young patients in my office and have some guidelines for new parents.

When the first tooth erupts, the parent needs to become vigilant in making sure that the child has good oral hygiene.  In the beginning, it is simply a matter of wiping the erupted tooth or teeth with a soft washcloth, at least once daily.  As the child becomes able to handle a small toothbrush, either dipped in warm water or a very tiny bit of baby toothpaste, the parent needs to assist the child to ensure that the teeth are being cleaned.

Obviously, infants and toddlers should not be eating sweet foods and sodas, but even the starches that are present in early diets convert to sugars and can cause decay.  This is the reason we urge parents to not put their babies to bed with a bottle.  The liquid, which remains in the baby’s mouth while sleeping, contributes to tooth decay.

Baby teeth (also called primary or deciduous teeth) serve several very important functions.  In addition to allowing the child to chew properly, contributing to good nutrition, the baby teeth maintain the spaces necessary for the permanent teeth, which start to arrive around the age of six.

The first trip to the dentist is a matter of debate.  Some dentists suggest that as soon as the first tooth erupts (usually by six months) the child should be seen by the dentist.  My philosophy is that the first visit, which should be very calm, informative and non-threatening, should be scheduled when the child is three.  At this point most, or all, of the baby teeth have erupted.

It is important for parents to begin teaching their baby good oral hygiene habits.  These habits, combined with a warm relationship with a good dental health care team, are the best protection for the child’s oral health.

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