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LinksAmerican Dental Association Colorado Dental Association Metro Denver Dental Society The Dawson Academy Cancer Screening Light IPSO Dental Seminars- International Partnership for the Study of Occlusion |
ArticlesFirst Aid Tips for Dental Emergencies Osteoporosis Medications Linked to Jawbone Destruction |
First Aid Tips for Dental Emergencies (page top)
When you least expect it, you or a loved one can experience a dental emergency that will probably happen at an inopportune time. Knowing what to do in case of an emergency can bide you some time until you can get to a dentist, and may help you save the tooth.
KNOCKED-OUT TOOTH First remain calm. Hold the tooth by the top crown part and not the root portion. If the tooth is dirty, rinse it gently in running water. Do not scrub the tooth or remove any tissue that is attached to the root. Gently insert and hold the tooth in the socket. Biting down on a piece of clean cloth or gauze will help hold the tooth in place. If this is not possible, place the tooth in a container of milk, or place the tooth in your mouth between your gum and cheek and go immediately to a dentist, within 30 minutes if possible. Do not place the tooth in tap water. Baby teeth are usually not reimplanted.
BROKEN TOOTH Gently clean dirt or debris from the injured area by rinsing with warm water. Place cold compresses on the face in the area of the injured tooth to minimize swelling. Save any broken tooth fragments and go to a dentist as soon as possible. A broken tooth needs to be evaluated for nerve and soft tissue damage. If the tooth is sensitive to temperatures or is sharp to the tongue, an over-the-counter (OTC) temporary dental cement or soft wax can be applied to the broken area. Do not use glue. Tylenol or ibuprofen can be taken for discomfort.
FRACTURED JAW Go immediately to a hospital emergency room. Immobilize the jaw by any means. A scarf, necktie or towel can be used to bandage the jaw. Wrap the bandage from the top of the head to under the jaw to prevent movement and to help reduce pain. Holding the jaw gently in place with your hands while traveling to the emergency room will also help. Apply ice compresses to control swelling. There is the potential danger of significant bleeding and the risk of breathing problems associated with a fractured jaw.
TOOTHACHE - Rinse the mouth vigorously with warm salt water to clean out debris. Use dental floss to remove food that might be trapped between the teeth. If swelling is present, place cold compresses on the outside of the cheek. Do not use heat and never place aspirin on the aching tooth or gum. Aspirin contains salicylic acid which can burn and damage the gum tissue. Take acetaminophen or ibuprofen for pain or try pain-relieving gels like Anbesol. See a dentist as soon as possible. A toothache is usually the result of a tooth abscess and antibiotics may need to be administered. If the toothache is caused from a lost filling or a broken tooth, covering the tooth with soft wax or an OTC temporary filling cement may help. A toothache will usually not heal on its own without dental treatment.
LOST CROWN If you cannot see a dentist immediately, you can try to snap the crown back on the tooth. You can use a denture adhesive or an OTC temporary crown cement to reseat the crown until you can get to a dentist. Avoid chewing on the loose crown. Do not use household glue. If the crown feels loose at all with the temporary cement, remove the crown and place it in a safe place. This will prevent accidental injury from inhaling or swallowing the crown.
CUT OR BITTEN TONGUE, LIP OR CHEEK Clean the area gently with a clean cloth or gauze. Apply firm but gentle pressure to stop bleeding. A moistened tea bag will promote clotting of the wound. Astringent tannins found in tea will help stop bleeding if pressure alone does not work. Apply cold compresses to reduce any swelling. Seek professional help if the bleeding does not stop in 15 minutes.
PREVENTION - There are some simple precautions you can take to avoid injuries to your face and teeth. Wearing a mouthguard when participating in sports will protect your teeth from injuries. Wear a helmet to prevent head and mouth injuries from falls when participating in physical activities such as skiing. Avoid chewing or biting on hard objects such as ice or hard candy to prevent cracked teeth.
This guide reflects public information available through the American Dental Association.
Osteoporosis Medications Linked to Jawbone Destruction (page top)
In the last decade, several studies have linked the use of medications used to treat and prevent osteoporosis to a condition referred to as osteonecrosis of the jaw (ONJ). This complication can cause severe, and even irreparable, destruction of the jawbones. Patients who are taking these medications need to be aware of the risk of developing ONJ. Furthermore, the possibility for the development of ONJ in dental patients highlights the importance of giving a clear and accurate medical history to all medical providers, including your dentist!
Osteoporosis is a skeletal disorder associated with thinning of the bone that leads to greater risk for bone fractures, especially in older patients. Osteoporosis affects about 10 million Americans, and millions more are at risk for developing the disease. Hip and spinal vertebra fractures are most prevalent in older adults, and the recovery process associated with this type of fracture is typically long and painful. These types of fractures can often lead to decreased independence and even death.
The medications currently used to treat and prevent osteoporosis and osteopenia are called bisphosphonates. They are a class of bone-strengthening drugs whose function is to inhibit bone loss. Annually, bisphosphanates are prescribed by the millions to both men and women. Typically, women are prescribed bisphosphonates more often than men because women are at greater risk of developing osteoporosis, especially after menopause. The most common trade names for several of these drugs are Fosamax, Boniva, and Actonel. You are probably familiar with them as they are advertised frequently on television. Bisphosphonates are used to treat other bone diseases such as Paget's disease and cancers of the bone, breast and prostate. For cancer patients, the medication is usually administered intravenously (IV). It is important to note that the risk of developing ONJ is much lower in patients taking the oral form of bisphosphonates than the IV forms (ie:Zometa and Aredia). Furthermore, the risk of developing ONJ is very low compared to the risk of developing fractures from osteoporosis without prescribed bisphosphonates.
The American Dental Association (ADA) strongly advises that patients about to start bisphosphonate therapy have a complete oral examination including x-rays preformed beforehand, and any extensive dental or periodontal treatment should be completed preferably two months prior to starting bisphosphonates. While it is impossible for dentists or physicians to totally eliminate the possibility of developing ONJ, or to predict which patients might develop it, regular dental visits and maintaining excellent oral hygiene are essential in helping to avoid this serious complication. Patients already taking bisphosphonates should continue with routine dental cleanings and exams. Dental implants are not advised, and root canal treatment should take preference over tooth extractions, if a tooth can be salvaged. It is also helpful for the patient's dentist and physician or oncologist to be in open communication with each other in order to weigh risks and benefts of bisphposphanate therapy in relation to dental treatment.
Symptoms of ONJ include: pain, swelling or infection of the gums or jaw, gums that will not heal, loosening of the teeth, numbness or a heavy feeling in the jaw, drainage, or exposed bone. Most cases of osteonecrosis of the jaw are diagnosed after tooth extractions or other invasive surgical procedures such as the placement of dental implants or periodontal surgery. ONJ can occur spontaneously in the bone of the bisphosphanate users, although the occurrence is rare. Tissue trauma from ill-fitting dentures or broken restorations is another common risk factor. It is important to note that ONJ is extremely rare and development of these types of symptoms listed above does not necessarily indicate that ONJ is present.
It is extremely important that dental professionals are provided with accurate medical histories for all patients, this includes a list of all medications and herbal products currently being taken, or those that have been taken in the past. This is especially true for bisphosphonate users because bisphophanates have a very long half-life, meaning they are not metabolized or excreted from the bones quickly. Bisphosphonates remain bound to the bone and metabolically active for many years, even after discontinuance of the drug. Although the incidence of ONJ is very low, the risk of ONJ appears to increase over time with continued use of bisphosphonate drugs. An accurate medical history is absolutely crucial for determining risk of ONJ in dental patients.
According to the ADA, the benefits of osteoporosis medications greatly outweigh the slight risk of developing ONJ; therefore, it is very rarely recommended that a patient discontinue bisphosphanate for dental reasons. This advertorial reflects public information available through the American Dental Association and the American Association of Oral and Maxillofacial Surgeons.
Oral Cancer: A Silent Killer on the Rise (page top)
According to the Oral Cancer Foundation, oral cancer is more deadly than breast, cervical and prostate cancer. The American Cancer Society estimates that more than 35,000 Americans will be diagnosed with oral cancer this year. Only slightly more than half diagnosed will be alive in five years.
Smokers and smokeless tobacco users are much more likely than non-tobacco users to develop oral cancer. Excessive sun exposure, gastroesophageal reflux disease (GERD), irritation from rough teeth or fillings, and family histories of cancer are other risk factors for oral cancer. It is important to note that over 25% of all oral cancers occur in people who do not smoke. Oral cancer, once considered a cancer that primarily affected males, over the age of 40, is now affecting more women, young adults, and even teenagers due to lifestyle choices.
The most alarming explanation for the increase of oral cancer in younger age groups is sexual transmission of the human papilloma virus (HPV) through oral sex practices. HPV is the virus that is the causative agent in more than 70% of all cervical cancers. The spread of HPV is rampant among sexually active young people. About 40 million Americans today have HPV, and the Centers for Disease Control (CDC) believes that as many as 80% of Americans will be infected with HPV at some point in their life.
Oral cancer can be life threatening if not diagnosed and treated early. Unfortunately most oral cancers are not discovered early and they spread (metastasize) to other parts of the body, compromising successful treatment. If cancer is diagnosed at a later stage, surgical removal of the cancer may require reconstruction of portions of the oral cavity or face that may result in disfigurement.
The signs and symptoms of oral cancer are many, depending on where the cancer manifests itself, and can include the face and neck. Oral cancer often starts as an unnoticed white or red spot, or a patch that is a mixture of white and red, and can occur anywhere in the mouth, throat or lips. Other symptoms are persistent sores or cracks, a thickening or lump, rough spots, crusts or eroded areas, difficulty with chewing, swallowing, speaking, or moving the jaw or tongue, hoarseness or a chronic sore throat. Unexplained numbness, tenderness, an earache, loose teeth, and a change in the way the teeth or dentures fit together are other symptoms. Having any of these symptoms does not necessarily mean you have cancer. An examination by a dentist or other medical professional should be scheduled as soon as possible to rule out oral cancer. A biopsy of the abnormal area may be needed to check for cancer cells. A biopsy is quick, inexpensive, and may be done with a local anesthetic.
A thorough head and neck exam should be preformed at least annually when having a routine dental exam to screen for signs of cancer or pre-cancerous conditions. Our office provides very thorough oral cancer screenings that include a visual exam, palpation of the glands in the neck and the thyroid, and we also utilize a specialized oral cancer screening light, the Identafi 3000. The revolutionary technology of this light functions across multiple wavelengths of light to identify biochemical and morphological changes in the cells of the mouth, throat, tongue and tonsils. The test is simple, painless and takes less than 10 minutes. Early detection of oral cancer or pre-cancer means early treatment and a cure rate over 80%.
Chocolate & Chese for Healthy Teeth? (page top)
Most of us have been taught that eating too much candy and sugar will cause cavities. Unfortunately, this is definitely TRUE. However, there are many good tasting snacks that are healthy for your teeth and eating some (surprising) foods can even help prevent cavities. So, how does eating sugar contribute to the development of cavities?
We all have bacteria in our mouths. Certain bacteria are needed to aid in breaking down and digesting our food, while other types of bacteria colonize on our teeth and form a sticky substance called dental plaque. Cavity- forming bacteria utilize sugars as their food source and then produce acid as a waste product. These waste acids remain in dental plaque and adhere to the tooth surface. Eventually, tooth enamel will start to break down (demineralize) because of the exposure to acid and subsequently a cavity (a hole in the enamel) can form. Sugar in contact with plaque will cause bacteria to produce acids within minutes of ingestion. Frequent exposure to starchy or sweet foods and beverages, such as soda pop, will produce continuous acid formation on the teeth.
One of the worst cavity-causing items to ingest is Soda Pop! Soda is usually sipped over an extended period of time, and averages around 10-12 teaspoons of sugar in a 12-oz. drink. Sodas also contain various amounts of phosphoric, citric, and carbonic acids that can contribute to demineralization of tooth enamel. These acidic ingredients are even present in sugar-free sodas.
What about foods that are actually good for the teeth? How about CHOCOLATE!! Most people are surprised to learn that the main ingredient in chocolate, cacao mass extract (CM) may actually be an anti-cavity agent. Recent studies have shown that CM may actually reduce the adherence of cavity-causing bacteria and thereby contribute to a decrease in the development of cavities. It is important to note that chocolate only has this effect when eaten alone, and the higher the amount of cacao, (as in darker chocolates) the better. Eating chocolate in combination with caramel or other sugars definitely changes it over to a cavity producer! Another great food that has been scientifically proven as an anti-cavity agent is CHEESE. There are several ways in which cheese may help prevent cavities, especially when eaten at the end of a meal. One of the most important ways is by helping stimulate the production of saliva, which helps neutralize the acidic conditions in the mouth.
Another great anti-cavity product is Xylitol. This healthy and natural alternative to sugar has been proven to inhibit the growth of bacteria that cause cavities. Xylitol containing chewing gum and candies are a much healthier alternative to sugar containing varieties. Also, chewing sugar-free gum stimulates saliva production and can help to rid the teeth of sticky food particles. Water, which is so important for good health in general, is also helpful in preventing cavities. Drinking plenty of water throughout the day, and especially after a sugary snack, will help dilute the acids produced by bacteria, and will help bring the saliva pH to a normal level more quickly.
Along with daily brushing and flossing, don’t forget to have your teeth professionally cleaned regularly to remove plaque and tartar (calculus) accumulations that can’t be reached by your toothbrush.
If you have any questions or would like to schedule an appointment, please call us at 303-674-6264. We are located at 3092 Evergreen Parkway, #100. www.laplazalaserdentistry.com. New patients are always welcome!