Inflammation: Friend or Foe?

As a dentist, I work with the body’s inflammatory responses nearly every day. Bacteria builds up around a tooth, and the gums swell with blood in an effort to fight the growing infection. This can happen for the simplest of reasons: a change in diet or home-care habits being the most common. But sometimes the mouth can have a more generalized reaction. Instead of inflammation developing in a single, localized area of infection, the gums swell and bleed uniformly throughout the entire mouth. Gingivitis like this may still be a reaction to too much bacteria all throughout the mouth, but sometimes gingivitis can develop even in a healthy mouth where plaque and bacteria are seemingly under control. Stress, dietary or environmental allergens and irritants, or an underlying systemic inflammatory disorder can all contribute to the development of chronic inflammation in the mouth.

Inflammation anywhere in the body is never a good sign, but in most cases it is a normal response to a physical injury, a localized infection, or an allergen. Your body is trying to help you fix the problem by sending extra blood to the area to speed healing and fight unwanted intruders. In a healthy system, this inflammation subsides as soon as balance is restored to the area: the bone is set, the infection is under control, or the allergen has been removed and processed out of the body. Sometimes, however, the body can get stuck in an inflammatory response even though the allergens, infecting bacteria, or physical injuries have been resolved. When this happens, inflammation is no longer a helpful partner in defending and healing your body. Inflammation and the immune system that triggers it are now at odds with your body – seemingly attacking otherwise healthy systems for reasons we still don’t completely understand.

What we do understand so far is that inflammatory disease anywhere in the body seems to be multifactorial in nature. Stress, diet, environment, and physical activity all seem to have a role in the progression or stabilization of nearly all chronic inflammatory conditions. Systemic inflammatory conditions also seem to have a unique relationship with inflammatory conditions of the mouth. We still don’t know if that relationship is actually causative, but the correlations between the two are extremely strong.

Inflammation, like pain, is a message from your body that something is wrong somewhere. Understanding that message can be tricky sometimes, especially when the body’s inflammatory response is the problem. To help you begin unravelling what your body may be trying to tell you, I’ve created a new resource article this month entitled Inflammatory Disease and the Mouth. It is my hope that anyone who has or suspects they may have a chronic inflammatory condition will read this article and share their concerns, questions, and self-observations with their medical and dental providers.

As always, if you are a current patient of mine, or you would like to become a patient, please feel free to call my office during our regular business hours with any questions or concerns you may have about inflammation in your mouth or a suspected inflammatory disorder.

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Listening to Pain: The Key to Healing

In my practice, I treat many patients who suffer from chronic pain. Malocclusion, or a misaligned bite, can stress the facial muscles, compress and malform the TMJ, and cause a great deal of pain in the jaw joints, face, head, ears, and neck. But in all the years I’ve been treating TMJ and chronic pain, I’ve never seen a patient who’s sole source of pain was exclusively from a bad bite or compressed joints. Chronic pain is nearly always multifactorial. There may be a primary underlying cause, but lifestyle habits and stress levels can not only crank up the volume on an existing condition like TMD, but also create a great deal of pain all on their own.

Many patients we work with have travelled a long journey trying to understand the clinical reasons for their pain. They have visited doctor after doctor, receiving different diagnoses, treatments, and medications. Some even undergo surgery in an effort to find some kind of relief, yet still they have pain. Unfortunately, many of these patients we work with are often completely unaware of how their own lifestyle habits and stress levels could be hindering their ability to heal. This is not the patient’s fault. As healthcare practitioners, it is our job to help patients understand not only what we can do to help them, but perhaps more importantly what they can do every day to help themselves.

No doctor can possibly understand what it feels like to be in your body better than you. Pain is your body’s way of telling you something is wrong. With a little time and careful listening, many patients can uncover physical habits and lifestyle choices that create or exacerbate their pain all on their own. Doctors can run tests and take x-rays, but a doctor does not live with you 24-7. Only you know that every time you skip breakfast, you end up with a headache. Or that every time you do a particular weight-bearing exercise, your teeth and jaw ache afterwards. Or that every interaction you have with a co-worker, friend or family member seems to trigger a migraine. Just by paying attention to when your body experiences pain and what is happening in and around that moment, you can gather more information about the possible triggers for your pain than any doctor ever could.

Now, can another person actually cause you physical pain just through conversation? Probably not, but the stress of that conversation may cause you to clench your teeth, tighten your shoulders, and breathe more shallowly. All of those things will definitely give you a doozy of a headache. Medication may help in the short term, but the ultimate cure for that kind of pain is to learn how to interact differently with the people in your life who cause you stress, or to eliminate those relationships altogether if possible. Medication can not do that for you, but practical tools do exist to help you manage relationship stress and decrease its effect on your physical body.

Pain is not a comfortable experience for anyone. It is not meant to be. Your body is trying to get your attention. Listen, look inward, and try to understand its message. You may be surprised at how much information you will receive.

In order to help you do just that, this month I have created a tool that will allow you to see more clearly the many messages your body is trying to send you through your pain. The Daily Headache Diary is a tool for you to use in conjunction with the entire Headache Series. By tracking your diet, medications, and answering a series of questions each day about your habits, you will begin to see if there are any patterns in your daily or weekly routine that regularly coincide with headache pain. That information is incredibly valuable. Even if you do not know what to do with it right away, keep listening, share your new understandings with your treating physicians, and try some of the simple adjustments suggested in the Headache Series to see how much headache pain you can reduce or eliminate all on your own. We are each our own best healers when it comes to chronic pain. Trust your body. It does not lie.

By the way, this is also a helpful tool for other types of pain.

Martha (Signature)

Silver Fillings Are More Expensive Than You Think

It’s hard to find many people over the age of 30 in the United States who have not had at least one silver filling in their lifetime. In fact, it’s really only been in the last 35 years that comparable alternative materials have been developed for fillings in the back teeth. Our back teeth can take a beating over a lifetime. Average chewing forces alone in the molars can exert about 70 pounds per square inch, but for people who clench and grind regularly this force can increase by 6 to 10 times as much, or more. Obviously, any material used to restore the back teeth needs to be strong and durable.

For many years, the argument for silver fillings has been based on their strength, durability, ease of placement, and cost. Silver fillings are the least expensive filling material available on the market and require the least amount of preparation work on the tooth in order to place them. Yes, silver fillings contain metals and mercury, but proponents believe that the risks of mercury exposure or metal sensitivity are low. Certainly, dental insurance companies would prefer to only pay for silver fillings rather than more expensive metal- and mercury-free alternatives. And for the low-income population without insurance or additional resources, proponents believe a silver filling is better than no filling at all.

There is some truth to that statement. However, the ease and inexpense of the initial placement of a silver filling is not the only cost associated with that filling over a lifetime. The truth is that no filling material will last forever, but silver fillings by their very nature can set up more long-term damage in the teeth than other alternative materials now available. Even if we set aside all the valid concerns about metals and mercury, silver fillings just aren’t the best materials on the market anymore.

Silver fillings are not bonded to the teeth, which means that the margins are not actually sealed. That unsealed microscopic channel between the edge of the silver filling and the tooth makes it nearly impossible to protect the margins, even with exquisite home care. Inadequate or irregular home care will definitely leave these unsealed margins extremely vulnerable to recurrent decay, causing the filling to need replacement with larger and larger silver filings over time. But that’s not the only weakness that a silver filling can present.

Silver fillings also expand and contract in relation to temperature changes in the mouth at a very different rate than the healthy tooth surrounding them. Over time, as we eat hot and cold foods, these differing expansion rates can set up fracture lines in the tooth enamel that leave the tooth even more vulnerable to recurrent decay and breakage. No filling material on the market can exactly match the expansion and contraction rate of enamel yet, but silver fillings are the most likely to set up these kinds of expansion fractures in the shortest period of time.

So if the mercury content, unsealed margins, and the expansion/contraction rate of silver fillings are all of concern, why are silver fillings still in use? The answers are simple: it’s cheaper and easier than newer, better materials. Cheaper and easier may make sense in the short term, but the more we learn about silver fillings and the long-term consequences for the health of our teeth, our bodies, and our environment, those silver fillings may be far more expensive over time than we realize.

In my practice, I have not placed a silver filling in any patient in more than 20 years. I would not place a silver filling in my own mouth, in my children, or in my grandchildren. I do agree that when the only option is a silver filling or no filling, then the silver filling is the better choice. But I do not agree that silver fillings are cheaper in any way other than the initial cost of placement. We can do better across the board and especially by our low-income population, and it is my sincere hope that by keeping the conversation open and continuing to make as much information available as possible, that someday we will.

To learn more about silver fillings and all the other options available in dental filling materials, please visit my newest resource article, A Comparison of Dental Filling Materials.

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The Benefits of Dental Bone Grafting

When I first started my practice back in the early 1980s, dental bone grafting was still a relatively complex surgical procedure that required live donor bone or bone marrow, usually harvested from healthy bone in another part of the patient’s body, in order to be successful. Dental implants were still a fairly new procedure, and the success rates of both treatments were variable at best, mostly due to higher risks of infection.

Today, dental bone grafting and implant placement are safer and more effective than ever before. Advances in synthetic bone materials have almost eliminated the infection risks that were so much more common when working with live donor bone. The process is much easier on the patient, requiring less surgical time and reducing post-operative pain to a minimum. In the last few years, the addition of bioactive proteins to these synthetic bone materials has improved grafting even further by speeding the process of wound healing and enhancing both bone and gum regeneration around tooth roots and implants.

Even for patients who are not considering an implant to replace a tooth that needs extraction, a bone graft now offers us the chance to preserve the shape and strength of the bony ridge long after the tooth is gone. This is important not only for the health and strength of the teeth surrounding the extraction site, but also for the possibility of implant, bridge, denture, or partial placement in the future.

The bony ridges of our jaws get their shape from actively holding the roots of our teeth in place. When a tooth root is extracted and not replaced with an implant or a bone graft, the ridge begins to resorb and reshape itself. Without that root tip, implant, or another section of bone to hold onto, the ridge will shrink in both height and width over time. The result over a period of years is often a section of bone that is narrow, short, and fragile. Implant placement becomes far more complicated in these areas, and sometimes is simply not possible.

But implant placement isn’t the only tooth-replacement option that can be complicated by thin, fragile bony ridges. Traditional dentures and partials always fit better when the bony ridge is thick and strong. Ideally, modern dentures and partials are now anchored with implants as well, in order to avoid the slipping, clacking, and messy adhesive solutions that were so common for our parents or grandparents. Even bridges placed over extraction sites can be esthetically compromised by bone resorption if the bone shrinks away from the suspended false tooth enough to show a gap. Simply put, thin and fragile bony ridges make every tooth replacement option more difficult, less comfortable, less successful, and sometimes even impossible.

A bone graft after an extraction may increase the cost of the procedure initially, but the cost of not replacing that bone over a period of years may add up to far more discomfort and expense than the initial savings justifies. I encourage everyone facing a tooth extraction to talk with your dentist about the pros and cons of proactive bone grafting in order to make the right long-term decision for your body. As always, current patients of mine are encouraged to call the office or bring their questions and concerns to any regularly scheduled dental appointment. Our goal is to offer you the most complete information about the potential long-term effects of all the treatment choices available to you, and to help you make the decision that best supports your health goals.

Martha (Signature)

Keeping Your Mouth Cancer-Free

It’s hard to offer any solid guarantees about any type of cancer prevention. Genetics and environment can certainly play a role. Some cancers have been correlated to habits like smoking, while others appear to sometimes have a viral component, and still others seem to simply come out of nowhere. But even though we still don’t know everything about why cancer starts in one person and not another, we do know a great deal about the everyday habits that can significantly increase your chances of developing cancer in the mouth regardless of other factors. In fact, as far as researchers can tell us so far, the risk factors for oral cancer are overwhelmingly related to controllable lifestyle choices.

Of all the potential risk factors for oral cancer, smoking tobacco, using smokeless tobacco products, and drinking alcohol regularly and in excess continue to be the highest-risk lifestyle choices a person can make. And for those who combine smoking or smokeless tobacco with drinking regularly, this risk is compounded significantly.

Now it is true that in comparison to the incidences of other types of cancer, statistically oral cancer is still relatively rare. However, individuals are not statistics, and for those people who do develop oral cancer, the effects can be devastating. Whole portions of the tongue, cheek, and jawbone can be lost in the most severe cases. Even with the current advances in prosthetic reconstruction, the structure of the face and the function of the jaw will never be quite the same after that kind of damage. So why risk it at all when the simple choice to not use tobacco and to drink only in moderation could be the key to preventing oral cancer from ever developing?

Unfortunately, the answers are not that simple. Alcohol and the nicotine found in tobacco both have addictive properties, and once a person starts a habit with one or both, it can be very difficult to break it. Certainly, helping our children to avoid starting these habits at all is the best first step in the fight against oral cancer. But many pre-teens, teens, and young adults still remain unaware of the risks. It is an undeniable characteristic of youth to believe in invincibility, but it is also striking how undereducated many young people still are about how the choices they are making right now could affect their health in the long-term.

Of specific concern right now is the growing use of smokeless tobacco products among teenagers. A recent study published in the Journal of the American Academy of Pediatrics, indicates that 5.6 percent of American teenagers use smokeless tobacco products. That seems like a small number, but it shouldn’t. The most recent 2012 US Census data estimates that there are 21.2 million 15 to 19 year-olds living in the United States. That means that well over a million American teenagers are likely using smokeless tobacco products right now. What is even more disturbing about the research findings is that the majority of these students using smokeless tobacco tend to perceive all tobacco products, smokeless or not, as less harmful overall.

Clearly, we need to do a better job of informing young people of all the dangers associated with excessive tobacco and alcohol use. In that effort, I have created a new resource this month discussing the multiple ways that cancer can affect the mouth so that you will be able to have more informed conversations with your children about all the potential dangers of starting these habits.

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