ORAL CONDITIONS

The causes of bad breath are multifactorial and occasionally related to medical conditions or diet, but often related to your teeth, gums and oral hygiene.  The retention of bacteria in your mouth due to gum disease, decayed teeth or insufficient plaque removal is a leading cause of halitosis. After diagnosis and appropriate treatment, proper hygiene instruction and implementation can help to maintain health and fresh breath.

Teeth can break due to trauma, chewing or even as a result of wear and large restorations that weaken teeth.  When the break in the tooth is minor, the treatment is as simple as a direct restoration, or filling.  If the break involves a larger portion of the tooth or the tooth has an existing large filling, the ideal treatment may be an indirect restoration such as an onlay or a crown that covers and protects all or part of the remaining tooth structure.  Sometimes you will not see an obvious crack in a tooth but will have pain on function.  Occasionally the break is so severe that restoration of the tooth is not possible, but replacement is.

When a tooth breaks your prosthodontist will help assess the extent of the break and recommend the ideal treatment for you.

Bruxism and teeth grinding often occur at night while you sleep and are often the result of stress. This habit can be extremely destructive because it keeps the teeth in contact longer and with more force than normal and in time may wear away your teeth, strain your temporomandibular joint (TMJ), or tire the muscles used in chewing.

Although no cure for bruxism is available, your prosthodontist can fabricate a guard that will protect the teeth, support your TMJ and provide relief from muscle fatigue.  The occlusal guard, which is removable and usually placed on the upper teeth, manages bruxism by separating and carefully controlling the forces on your teeth.  Splints can easily be adjusted or replaced, making them a better recipient of these destructive forces.

Cavities are the result of the detrimental effects of acid on your teeth.  The acid can come directly from your diet, but is also the byproduct of bacteria.

Bacteria are found within plaque and produce acid, especially in the presence of carbohydrate-rich foods.  This acid, in combination with other acids in your mouth, is hard on your teeth.  Just like most materials, your teeth will dissolve in the presence of high levels of acid.  Your teeth can repair themselves if given the opportunity, but only to a point.  As long as it is in the beginning stage of demineralization and the proper environment is created, remineralization can occur. Certain situations create an acidic oral environment that increase the risk of demineralization of enamel.  Anything that causes a prolonged acidic environment sets the stage for demineralization.  Quite often medications and age cause people to have a dry mouth.  This decrease in saliva lowers a persons ability to buffer the acidic environment and can result in an increase in caries.  Likewise a person who has frequent exposures to sweets, creates an acidic oral environment that increases their risk of decay.  Dental caries can be avoided with proper oral hygiene, using toothpaste with fluoride, decreasing exposure to sweets and depending on your caries risk introducing things such as gum with xylitol. Being seen regularly by your dental provider is recommended so that when you are found to be at risk or if dental caries have already caused some damage, you can work to fix or prevent significant problems.

Chronic dry mouth, also known as xerostomia, is caused by lack of saliva for a long period of time. Multiple causes for dry mouth exist, including age, medications, chronic diseases, and certain medical treatments.

Chronic dry mouth is not only uncomfortable, but it increases your risk for dental caries and makes it difficult for dentures to fit properly.  When a person with this unusually high risk for dental caries is unaware of the risk, it often leads to widespread and significant problems that often require extensive repair or extraction.

The treatment for people with dry mouths often focuses on the prevention of dental caries.  We often have little control over the dryness so we treat the symptoms.  Fluoride application, diet counseling, and oral hygiene instruction are common ways to lessen the effects of dryness.

To help relieve symptoms of dry mouth you may want to drink fluids that do not contain sugar or acids, with water being the best.  You also may want to use sugar-free hard candy or gum to stimulate saliva flow.  Many people have also found some relief using over the counter saliva substitutes.

If you suffer from dry mouth, you should visit your prosthodontist more frequently than every six months to address your increased risk of tooth decay.

Gingivitis is an inflammation of the gums, also called gingiva.  As plaque accumulates on and around the gums, bacteria produce harmful byproducts that can be detrimental to your gums.  They can become red and bleed easily when touched.  Gingivitis can progress to a more serious condition known as periodontitis or gum disease, which is a chronic infection of the gums, surrounding bone, and supporting structures of the teeth causing the teeth to become loose.  Proper cleaning of the teeth prevents gingivitis. Your dental hygienist or prosthodontist can teach you how to properly clean your teeth using a manual or electric toothbrush, dental floss, and mouth rinses.  This is a very manageable disease process if proper care is maintained.

Gum disease is a term that refers to both gingivitis and the more serious condition of periodontitis. Periodontitis causes inflammation of your gums and loss of the bone that supports your teeth.

Left untreated, periodontitis can result in tooth loss and has been associated with coronary artery disease.

The most obvious cause of gum disease is poor oral hygiene, but several risk factors may increase your chances of developing gum disease. These risk factors include: smoking and tobacco use, family history, diabetes, stress, and in women, hormone changes associated with pregnancy and/or menopause.

If diagnosed with periodontitis, you will likely need a deeper cleaning to eliminate the bacteria deep within your gums.  After treatment and proper follow-up, your provider will be able to assess your progress.

Genetic and environmental factors can affect the development of teeth including the size and shape.  Misshapen teeth may be isolated to one tooth or may occur as part of a widespread condition throughout the mouth.  Common misshapen teeth include wisdom teeth, second premolars, and upper lateral incisors.

Misshapen lateral incisors result from a developmental flaw that causes the tooth to be small and pointed, looking like a peg.  Because upper lateral incisors play such an important role in the appearance of your smile, this misshapen tooth receives a great deal of attention.  A prosthodontist can determine the best treatment for any misshapen teeth and is uniquely qualified to restore a misshapen tooth, such as a peg lateral, giving you an esthetically pleasing smile.

One of the most common genetic defects affecting teeth is called ectodermal dysplasia.  Individuals affected by this syndrome often have abnormally small, misshapen or missing teeth.  A patient with this inherited disorder should have the dental problems evaluated early in life, and a prosthodontist’s training allows a comprehensive approach to the misshapen and missing teeth.

Treatments for these misshapen teeth include restorative options such as crowns, veneers, and composite resins and occasionally overdentures.

Tooth decay, gum disease and injury are common causes of missing teeth.  Some people are born without certain teeth, and this condition is called congenitally missing teeth. Genetic factors cause congenitally missing teeth and this condition is often seen in generations of a family. The most common missing teeth are wisdom teeth, upper lateral incisors, and second premolars/bicuspids.

Certain systemic conditions, usually inherited disorders, also result in multiple missing teeth.  One of the most common genetic defects affecting teeth is called ectodermal dysplasia.  Individuals affected by this syndrome often have missing teeth.  A patient with congenitally missing teeth associated with ectodermal dysplasia should have the dental problems evaluated early in life, and a prosthodontist’s training allows a comprehensive approach to the missing teeth.

It is important to replace missing teeth for proper chewing of food, jaw support, stability of the remaining teeth, and an attractive smile.  Missing teeth disrupts proper function and the teeth next to and above the missing tooth/teeth will shift, move, and tip into the space in time.  It is much easier to restore a missing tooth soon after it is lost than waiting a number of years after teeth have shifted significantly.  A prosthodontist can determine the best method to replace your missing tooth or teeth.

Missing teeth are replaced through removable partial dentures, fixed dental prostheses (“bridges”), or dental implants.  A discussion with your dental provider would help in determining which option is right for you.

About two-thirds of oral cancer in the mouth or oral cavity occurs in the floor of the mouth and tongue, but can occur in the upper or lower jaw, lips, gums, and cheek lining. Just behind the mouth is an area known as the oropharynx. Oropharyngeal cancer (one-third of cases) occurs in the back of the tongue, tonsils, and throat tissue. Oral cancer kills one American every hour of every day, according to the National Cancer Institute.

Early detection offers the best chance of survival, yet only one-third of oral cancer is found in the earliest stages when treatment is most effective.

Who are most at risk?

• Smokers: People who use tobacco are six times more likely to develop oral cancer. Eight of 10 oral cancer patients are smokers.
• Heavy alcohol drinkers: 80 percent of people diagnosed with oral cancer consume more than 21 drinks weekly.
• HPV infected: People with history of oral human papilloma virus infections are at greater risk to develop oral cancer even if they don’t smoke or drink.

What are the warning signs?

• Red or white patches in or behind the mouth
• Mouth sores or ulcers that bleed easily and do not heal
• Unexplained lump in the neck, throat or floor of the mouth
• Difficulty or discomfort swallowing
• Pain and tenderness in teeth or gums
• Change in the fit of dentures or partial dentures
• Visible change in mouth tissue
• Unpleasant sensations (pain, discomfort, numbness)
• Diminished ability to perform normal functions such as opening jaw, chewing or swallowing
• Unexplained swelling or fullness in the neck

Osteonecrosis of the jaw is a severe bone disease that occurs when there is a loss of blood to the bone. The primary symptom of osteonecrosis of the jaw (ONJ) is exposure of the bone through the gums that doesn’t heal for several weeks. This exposure may occur spontaneously or more likely following an invasive dental procedure such as extraction in patients with certain risk factors. Patients at risk for developing osteonecrosis of the jaw include:

• Patients receiving radiation therapy to the head and neck to treat cancer.
• Patients on long-term steroid therapy.
• Certain cancer patients with metastasis to the bone who use IV Bisphosphonates to decrease pain and the risk of bone fracture.

Although these patients have the highest risk to develop osteonecrosis of the jaw, other risk factors are advanced age, diabetes, gum disease, and smoking.

The long-term risk of developing osteonecrosis of the jaw for those patients using oral bisphosphonates in treating osteoporosis is unknown at this time, but it certainly seems less than those patients on IV therapy.

Various treatment options for osteonecrosis of the jaw have been explored; however, severe cases of ONJ still require surgical removal of the affected bone. A thorough history and evaluation of pre-existing problems and possible sites of dental infection are required to help prevent the condition.

The temporomandibular joint (TMJ), when not functioning properly, can cause a tremendous amount of pain.  The tissues behind the joint (retrodiscal tissues) have many nerves that run through them.  Once they become inflamed, any slight pressure will cause pain and perpetuate the problem.  Treatment involves unloading these tissues to allow them to recover and try to avoid allowing the problem to recur.

Depending on your history and symptoms, your prosthodontist may recommend a stabilization splint (bite guard) to treat your pain. This custom-made plastic device fits over the upper or lower teeth and is used to control the interaction between the top and bottom teeth and maintains the joint in a healthy position.  Stabilization splints are the most common treatments for TMJ disorders, including facial pain.

Facial or jaw pain in the chewing muscles or jaw joint is a common symptom of temporomandibular joint disorders. Facial pain may also be caused by dislocation or injuries which are internal changes to the joint involving a displaced disc, a dislocated jaw, or injury to the muscle. Arthritis and degenerative or inflammatory joint disorders also may lead to facial pain.

Facial pain may be relieved by eating soft foods, applying ice packs when pain occurs, and avoiding extreme jaw movements (including wide yawning, loud singing, and gum chewing). Since facial pain is often associated with stress and/or cramps in the chewing muscles, techniques to reduce stress and practicing gentle jaw stretching and relaxing exercises to increase jaw movement may be helpful. Short-term use of common pain medicines may provide temporary relief from jaw discomfort and facial pain.

Tooth discoloration may be caused by problems with the formation of the tooth enamel, problems within the tooth, or by simple stains from food, beverages, or habits.  Certain medications or chemicals taken by a pregnant woman or by a very young child can disrupt the development of tooth enamel and result in the tooth becoming discolored, mottled, or pitted.

Tooth discoloration also may be caused by a tooth that is chronically infected or necrotic with the tooth taking on a uniform grayish hue.  In this situation, the infection must be treated first and then the color can be corrected by bleaching or a restoration.  The simplest form of tooth discoloration is the stains caused by external factors such as food/beverages or tobacco use.

Tooth discoloration may be managed by a professional cleaning, tooth whitening procedure, and/or the placement of porcelain veneers.  These procedures may remove the discoloration and restore the teeth to their original brightness and whiteness.

Ideally, our teeth will function without any discomfort throughout our life, but unfortunately, most of us will experience at least one of the many conditions that can cause tooth pain.  There are many causes of tooth pain, including: dental decay, fractured or cracked teeth, damaged or leaking fillings, gum disease or grinding.

The type of tooth pain varies based on the condition, but may range from a fleeting sensitivity to a persistent dull ache. Only a dental professional can determine the exact cause of your pain and the appropriate treatment.

If you are experiencing pain from a tooth, it is recommended you see your dental provider to have the area assessed.  Sometimes the problem is larger than you might believe and you are weeks, days, or hours away from increased pain.