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McCarley Family Dentistry - McKinney, TX

From Dr. McCarley's Desk

 Dr. McCarley sitting at his desk

The Secret Inside: Patients with Eating Disorders

AGD Journal, October 2010 Vol. 38, No. 10

Eating disorders are real, complex, and often devastating conditions that can have serious consequences on your overall health and oral health. Telltale early signs of eating disorders often appear in and around the mouth. A dentist may be the first person to notice the symptoms of an eating disorder and to encourage his or her patient to get help.

What are the different types of eating disorders?

Anorexia nervosa is a serious, potentially life threatening eating disorder character by self- starvation and excessive weight loss.

Bulimia nervosa is a serious, potentially life- threatening easing disorder characterized by a cycle of bingeing and compensatory behaviors (i.e., self-induced vomiting, use of laxatives, diuretics, or enemas) designed to undo or compensate for the effects of binge eating.

Binge eating is an eating disorder characterized by recurrent episodes of uncontrollable eating without the regular use of compensatory measures to counter the effects of excessive eating. Binge eating may occur on it own or in the context of other eating disorders.

Pica is an eating disorder that is described as "the hunger or craving for non-food substances." It involves a person persistently mouthing and/or ingesting non-nutritive substances (i.e., coal, laundry starch, plaster, pencil erasers, and so forth) for at least a period of one month at an age when this behavior is considered developmentally inappropriate.

How do eating disorders affect health?

Eating disorders can rob the body of adequate minerals, vitamins, proteins, and other nutrients needed for good health. Without the proper nutrition, gums and other soft tissue inside your mouth may bleed easily.

Frequent vomiting may affect teeth as well. Repeated exposure to strong stomach acid can cause much of a tooth's outer covering (enamel) to be lost, resulting in changes to the teeth's color, shape, and length. The edges of teeth may become thin and break off easily. Eating hot or cold foods or drinks may become uncomfortable. Repeated vomiting can cause mouth sores, dry mouth, cracked lips, and bad breath.

How do dentists detect eating disorders?

Changes in the mouth are often the first physical signs of an eating disorder. Bad breath, sensitive teeth, and tooth erosion are just a few of the signs that may indicate whether a patient might be suffering from an eating disorder. A dentist who determines that a patient has an eating disorder can refer the patient to the appropriate medical personnel, as well as teach the patient about how to minimize the oral effects of the eating disorder.

Can a person recover from an eating disorder?

Yes. Professional help, nutritional counseling, and having a good support network all play a crucial role in the recovery process.

Fetal Alcohol Spectrum Disorders

AGD Impact journal, Vol. 38, No. 9, September 2010

Fetal alcohol spectrum disorders (FASD) is an umbrella term that describes the range of effects that can occur in a person whose mother drank alcohol while pregnant. FASD affect an estimated 40,000 infants each year- more than spina bifida, Down syndrome, and muscular dystrophy combined.

What causes FASD?

The ultimate cause of FASD is alcohol intake by a pregnant mother. However, alcohol itself may not be directly responsible for all (or any) of the effects of FASD. What may be responsible are byproducts generated when the body metabolizes (“burns”) alcohol. The end result is a decrease in the number of brain cells (neurons), abnormal locations of neurons (due to disturbance of their normal migration during fetal development) and gross malformation of the brain. Damage to the unborn baby is permanent. There is no cure for FASD.

What are the effects of FASD?

The effects of FASD vary among affected individuals. The effects can include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications. Often, a person has a mix of these problems. FASD include the following categories:

  • Fetal alcohol syndrome (FAS)- this is indicated by a pattern of neurological, behavioral, and cognitive deficits along with specific facial features.
  • Alcohol-related neurodevelopmental disorders (ARND)- this term is used when only central nervous system abnormalities are present as a result of fetal alcohol syndrome. ARND is characterized by problems with memory and motor skills.
  • Alcohol-related birth defects (ARBD)- this is indicated by defects in the growth of skeletal and major organ systems.
  • Fetal alcohol effects (FAE)- this term is sometimes used to describe children who had prenatal exposure to alcohol but do not have all of the symptoms (particularly the facial features) associated with FAS.

Who is at risk?

Any pregnant woman who drinks alcohol is at risk of having a child with FASD, regardless of her education, income, or ethnicity. According to the U.S. Department of Health and Human Services, women who are at particularly high risk of drinking during pregnancy and having a child with FASD include:

  • Women with substance abuse or mental health problems
  • Women who have already had a child with FASD
  • Recent drug users
  • Smokers
  • Women who have multiple sex partners
  • Recent victims of abuse and violence

How can FASD be prevented:

While there is no cure for FASD, it is 100% percent preventable when pregnant women abstain from alcohol. There is no known safe amount of alcohol to drink while pregnant. There is also no known safe time during pregnancy to drink and no safe kind of alcohol. Good reproductive care before knowledge of pregnancy also assists to a great extent in the prevention of FASD. If you have questions about FASD, talk to your doctor and your dentist.

Fight with Fluoride

AGD Impact, Vol. 38, No. 8, August 2010

Fluoride is a natural mineral that is found in various concentrations in soil and drinking water.

Why is fluoride important?

Everyday, a tooth's enamel (the outer layer that makes a tooth hard) has minerals both added to it (remineralization) and removed from it (demineralization). During remineralization, minerals such as fluoride, calcium, and phosphate are added to the enamel layer via food and drinks that contain these minerals. Minerals are lost (demineralization) when acids- from bacteria in the mouth and certain foods and drinks- attack the enamel. Tooth decay results when the enamel loses more minerals than it receives.

How does fluoride prevent tooth decay?

Fluoride helps to prevent tooth decay by making the tooth more resistant to acid attacks. Fluoride also helps to speed remineralization of erupted teeth in both children and adults.

Where is fluoride found?

Although some foods such as seafood and certain teas, naturally contain fluoride, the primary source of fluoride is drinking water. Tap water in most cities in the United States contains fluoride. Some, but not all, bottled waters contain fluoride.

Fluoride also can be applied directly to teeth through tooth pastes and mouth rinses that contain fluoride. You can buy these products at most pharmacies and grocery stores.

Dentists can also apply fluoride directly to your teeth in the form of a gel, foam, or varnish. These products contain a much higher level of fluoride than toothpastes and mouth rinses.

When should fluoride use begin?

Infants and children between the ages of 6 months and 16 years should receive fluoride. Their primary teeth and permanent teeth develop during these ages, so the stronger their enamel is, the better. Because most children receive their first permanent teeth at around age 6, the Centers for Disease Control and Prevention recommends prescribing fluoride supplements for children between the ages of 6 and 16 who are at high risk for dental caries (cavities) and whose community water is less than optimal. In areas that have minimal fluoride in the water, fluoride supplementation may begin earlier.

Although fluoride is an immediate concern for children and adolescents, adults can also benefit from fluoride. Topical fluoride- including toothpastes, mouth rinses, and fluoride treatments- is as important for fighting tooth decay in adults as it is for strengthening the teeth of children.

When is additional fluoride necessary?

Additional fluoride treatment can benefit children and adults with certain oral conditions, including dry mouth, gum disease, and cavities. Dry mouth makes an individual more prone to tooth decay because the decreased saliva production makes it harder to wash away food particles and thus decrease the cavity-causing acids. Gum disease can expose more of the tooth and tooth roots to bacteria, increasing the chance of tooth decay. Patients who have many cavities and develop new ones each year may benefit from additional fluoride treatments.

Additional fluoride might also be appropriate for patients with crowns, bridges, and braces, as the portion of the tooth that isn't covered by a crown, bridge, or brace may be at greater risk for tooth decay.

To find out if you and/or your children are receiving enough fluoride or should consider fluoride treatment or supplements, ask your dentist. He or she may prescribe fluoride supplements (in liquid or pill form) or offer suggestions for increasing the amount of fluoride you receive.

Mouth Breathing Can Create Health Issues
AGD Impact magazine, June 2010

For some, the phrase “spring is in the air” is quite literal. When the winter snow melts and flowers bloom, pollen and other materials can wreak havoc on those suffering from seasonal allergies, usually causing a habit called “mouth breathing”.  The physical, medical, and social problems associated with mouth breathing are not recognized by most health care professionals, according to a study published in the January/February 2010 of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD).

Dentists typically request that their patients return every six months, which means that some people see their dentist more frequently than they see their physician.  As a result, dentists should be the first to identify the symptoms of mouth breathing.  Dentists who understand the problems associated with mouth breathing are in the best position to help their mouth breathing patients from the disorder’s many adverse effects.

“In our modern society, bottle- feeding, processed foods, food additives, synthetic materials, and industrial pollutants greatly contribute to allergies and upper airway obstruction, or mouth breathing, in patients,” says Yosh Jefferson, DMD, author of the study.  “It is an unrecognized epidemic that touches almost every family in the industrialized countries. “

Over time, children whose mouth breathing goes untreated may suffer from abnormal facial and dental development, such as long, narrow faces and mouths, gummy smiles, gingivitis, narrow palates and high palatal vaults, and crooked teeth.  In addition to swollen tonsils, these are the tell-tale signs of mouth breathing problems.  The poor sleeping habits that result from mouth breathing can adversely affect growth and academic performance.  As Dr. Jefferson notes in his article, “Many of these children are misdiagnosed with attention deficit disorder (ADD) and hyperactivity.”  In addition, mouth breathing can cause poor oxygen concentration in the blood stream, which can cause high blood pressure, heart problems, sleep apnea, and other medical issues.

“Children who mouth breathe typically do not sleep well, causing them to be tired during the day and possibly unable to concentrate on academics.”  Dr. Jefferson says.  “If the child becomes frustrated in school, he or she may exhibit behavioral problems.”

Treatment for mouth breathing is available and can be beneficial for children if the condition is caught early.  A dentist can check for mouth breathing symptoms and swollen tonsils.  If tonsils and/or adenoids are swollen, they can be surgically removed by an ear-nose-throat (ENT) specialist.  If the face and mouth are narrow, dentists can use expansion appliances to help widen the sinuses and open nasal airway passages for greater efficiency in nasal respiration.

“If mouth breathing is treated early, its negative effect on facial and dental development and the medical and social problems associated with it can be reduced or averted,” says Dr. Jefferson.

“After surgery and/or orthodontic intervention, many patients show improvement in behavior, energy level academic performance, peer acceptance, and growth,” adds Leslie Grant, DDS, spokesperson for the AGE.  “Seeking treatment for mouth breathing can significantly improve quality of life.”

Mouth breathing is considered harmful to the dento-oral complex, as it can lead to hypotonicity of the upper lip, hyperactivity of the lower lip, distocclusion, and harm to dental growth as well as bone growth, high vault of the palate, xerostomia, and adenoid face.  Its co-morbidities include asthma, temporomandibular joint (TMJ) pain, and obstructive sleep apnea.

Dr. Jefferson notes that his study was presented “in the hope that both health care professionals and the public will become more knowledgeable about and more vigilant in assessing mouth breathing in children and adults, thus alleviating the many emotional, physical, and psychological problems associated with this condition.”

Take Care of Your Tot's Teeth
From the AGD Impact Magazine, February 2010

Has your child seen a dentist?  Taking your child to the dentist at an early age is the best way to prevent oral health problems.  A trip to the dentist can also educate your on how to properly care for your child’s teeth and to identify his or her dental needs.  Early visits will help to familiarize your child with the dental office, too, which helps to reduce anxiety and fear, and make visits more stress-free in the future.

Can tooth decay affect infants?
Yes.  Tooth decay in infants and young children most often occurs in the upper front teeth.  This decay, commonly referred to as “baby bottle tooth decay” is caused by prolonged exposure of a child’s teeth to liquids containing sugars.  Your dentist can tell you more about what you can do to help prevent the development of this condition.

When should my child first see a dentist?
The ideal time is six months after your child’s first (primary) teeth erupt or by the child’s first birthday.  This time frame is the perfect opportunity for the dentist to carefully examine the development of your child’s mouth.  Your dentist may even provide or recommend special preventive care to thwart oral health problems.

How can I protect my child’s oral health?
Parents should provide their child’s oral hygiene care until the child is old enough to take responsibility for the daily routine of brushing and flossing.  A proper regimen of preventive home care is important from the day your child is born.  To help prevent tooth decay, talk to your dentist and follow the tips below:

  • Clean your infant’s gums with a clean, damp cloth after each feeding.
  • As soon as the first teeth come in, begin brushing them with a small, soft bristled toothbrush and water.  If you are considering using toothpaste before your child’s second birthday, ask your dentist first.
  • To avoid teeth misalignment due to sucking, monitor excessive sucking of pacifiers, fingers, and thumbs.
  • Never allow your child to fall asleep with a bottle containing milk, formula, fruit juice, or sweetened liquid.
  • Avoid filling your child’s bottle with liquids like sugar water and soft drinks.
  • Encourage children to drink tap or fountain water.  If you purchase bottled water, make sure that it is fluoridated.  Fluoride makes the entire tooth structure more resistant to decay and promotes remineralization.
  • Find out if your public water supply is fluoridated.  If it is not, your dentist or your physician may prescribe fluoride supplements.
  • To build self-confidence, encourage the child to brush his or her own teeth when he or she is old enough.  Always monitor the child’s brushing technique and thoroughness to ensure proper technique.
  • The best way to teach a child how to brush is to lead by good example.  Allowing your child to watch you brush your teeth teaches the importance of good oral hygiene.

Does the AGD (Academy of General Dentistry) offer any resources for my family?
Yes!  Check out the AGD consumer website, www.knowyourteeth.com.  It’s the internet’s go-to resource for all things dental. Areas of the website include a dental diary with helpful calendar reminders, useful articles on dental care and oral health for patients of all ages, a “Life of a Tooth” animated timeline that explains how the teeth and mouth change over a lifetime, a dental advisor to whom you can pose questions, information on finding a highly qualified dentist for your family, and much more!

Working Together for Healthy Gums and a Healthy Heart
www.perio.org - the website for the American Academy of Periodontology, July 2009

Gum disease and cardiovascular disease are both major public health issues that impact a large number of Americans every day. While these two diseases impact separate areas of the body, research indicates that periodontal disease and cardiovascular disease are connected; having one disease may actually increase your risk of developing the other.

Inflammation’s Role
Periodontal disease and cardiovascular disease are both considered chronic inflammatory conditions. Inflammation is the body’s instinctive reaction to fight off infection. Inflammation is initially good for your body because it helps in the healing process. However, chronic and prolonged inflammation can lead to severe health complications. Researchers believe that inflammation provides the basis for the connection between gum disease and heart disease. And now, periodontists and those who treat cardiovascular disease are working together to provide the best care to patients.

The Perio-Cardio Connection
In July 2009, a consensus paper was published in both the Journal of Periodontology and The American Journal of Cardiology. The paper was jointly developed by periodontists and cardiologists. Periodontists are dentists with advanced training in the treatment and prevention of periodontal disease, and cardiologists are doctors who specialize in treating diseases of the heart. The paper summarizes the evidence that links periodontal disease and cardiovascular disease, and provides clinical recommendations for periodontists and cardiologist to use in managing their patients living with, or at risk for, either disease.

What Does this Mean for You?
You might be surprised when your periodontist now asks even more questions about your medical history, especially questions about your family history of heart disease and any behaviors that may affect your heart health such as smoking. Your cardiologist may start to ask you about your dental history and might even look in your mouth to evaluate your teeth and gums! These new recommendations are intended to help periodontists and cardiologists better manage your risk factors for future disease progression, and ensure your well-being. Hopefully by working together with your periodontist to ensure healthy teeth and gums, you will also ensure a healthy heart throughout your life.

"Toothpaste Nitty-Gritty"
From the AGD Business Impact Magazine, January 2010

Toothpaste has many functions: it eliminates and/or masks bad breath, removes dental plaque and food from your teeth, and polishes your teeth and removes stains over time. Overall, toothpaste promotes good oral health.

What’s in toothpaste?
Toothpaste, also known as dentifrice, is available in paste, gel, or powder form. Despite the many types of toothpaste that exist, some ingredients are common to most varieties.

These include:

  • Abrasives to grind away the leftover food and plaque on your teeth with the help of your toothbrush. In addition, abrasives polish your teeth and remove stains over time.
  • Fluoride to make the entire tooth structure more resistant to decay and promote remineralization, which makes your teeth stronger.
  • Antimicrobial agents, such as xylitol or triclosan, to fight the bacteria of dental plaque and gum disease.
  • Surfactants (detergents) and foaming agents to carry away the debris from the mouth and between teeth.
  • Anti-tartar agents to help prevent the formation of tartar, also referred to as calcified plaque.
  • Desensitizing agents to relieve tooth sensitivity.
  • Binding agents, which bind all the components of the toothpaste together.
  • Humectant to prevent your toothpaste from drying up.
  • Flavor to make the brushing experience more enjoyable.
  • Sweetening agents to make the formulation more suitable for oral use

Why do toothpastes contain abrasives?
Like other products that are designed to clean, toothpastes contain abrasive agents to help scrub and remove stains while also polishing and cleaning teeth. Abrasives also make the teeth appear whiter by removing stains from the tooth surface. While toothpaste must be abrasive enough to scrub away stubborn stain and harmful bacteria, it must not be so abrasive that it wears away vita tooth enamel.

How do I minimize the risk of tooth wear?
Wear on the teeth can be minimized by selecting the right toothpaste and by practicing proper brushing techniques, which includes using short and gentle strokes in a circular motion with a soft-bristle brush.

How do I know which toothpaste is right for me?
When it comes to choosing the best toothpaste for you, it’s important to think about your unique oral health needs. Some toothpastes aim to alleviate pain associated with sensitive teeth. Some help to control plaque and tartar. Some are designed to remove stains and whiten teeth. Because each brand of toothpaste is uniquely formulated to perform a specific function, speak with your dentist to determine which is right for you.

"Diabetes and Oral Health"
From the Academy of General Dentistry Impact Magazine, January 2010
By Jacqueline M. Duda

Diabetes mellitus- often referred to simply as diabetes- is a syndrome of abnormal carbohydrate, fat, and protein metabolism that results in acute and chronic complications due to the absolute or relative lack of insulin. There are three principal types of diabetes: type 1, which results from an absolute insulin deficiency; type 2, which is the result of insulin resistance and an insulin secretory defect; and gestational, a condition of abnormal glucose tolerance during pregnancy.

According to the American Diabetes Association, 23.6 million children and adults in the United States (7.8 percent of the total population) have diabetes, which an additional 57 million people have pre-diabetes- a condition in which a person's blood glucose levels are higher than normal but not yet high enough to be diagnosed as diabetes. In 2007, 1.6 million new cases of diabetes were diagnosed in people ages 20 and older. Although these numbers suggest that a significant percentage of dental patients know that they are diabetic, nearly 1/3 of adults with diabetes in the United States remain undiagnosed.

The role of the dentist
Data from the Third National Health and Nutrition Examination Survey (NHANES III) reveals that subjects with periodontitis have a significantly higher prevalence of diabetes than subjects without periodontitis (12.5 percent versus 6.3 percent, respectively). Some independent studies also show that diabetics with severe periodontitis experience more diabetes-related complications and worse metabolic control than diabetics without periodontitis.

The parallel conclusions drawn from independent medical and dental research continue to reinforce the mouth-body connection. “Oral health is body health- you really can't separate the two,” says Lee Shackelford, DDS, FAGD, MPA, Academy of General Dentistry (AGD) Region 17 Director, and dental consultant for TRICARE Management Activity (TMA) Dental Care Branch in Falls Church, VA.

The population at large might not recognize the connection between oral health and systemic health, but the dental profession certainly is aware of it. Within the next few years, Dr. Shackelford says, most oral health care providers can expect a more active and collaborative role in identifying, treating, and educating patients with diabetes-and a number of educators agree with this assessment. “We're now seeing that dentists can play a role in not only improving oral health but in improving overall health, particularly in people with diabetes, says Maria Emanuel Ryan, DDS, PhD, associate dean for strategic planning and external affairs, professor, and director of clinical research at Stony Brook School of Dental Medicine, and an American Diabetes Association oral health spokesperson.

The growing evidence of the relationship between periodontal disease and diabetes affirms that proper oral health is necessary for good general health. “After 40 years of clinical research, it's clear that diabetes is a risk factor for periodontal disease,” says Jane Atkinson, DDS, clinical trials program director for the Center for Clinical Research at the National Institute of Dental and Craniofacial Research (NIDCR). As medicine and dentistry continue to bond over this relationship, the role of the dentist often emerges as the first point of care.

When it comes to prevention, dentist have always served on the front line; some patients see their dentists more often than they do their family physicians, which is one reason why dentists should be very clear with their diabetic patients about the importance of oral care. George King, MD, research director at the Joslin Diabetes Center and professor of medicine at Harvard Medical School in Boston, Mass., says that dentists can start by opening the lines of communication about dental problems with diabetic patients and advising them about aggressive methods of periodontitis prevention, such as flossing and brushing between teeth. Salomon Amar, DMD, a professor at Boston University's Henry M. Goldman School of Dental Medicine (BUGSDM) suggests extending preventative efforts to “include a dental consultation as part of the medical diagnosis for a diabetic patient.”

“Dentists can detect gingivitis, periodontitis, abscess formations, fruity of acetone breath, asymptomatic parotid gland enlargement, xerostomia, and cervical caries during a routine oral exam,” says JoAnn Gurenlian, RDH, PhD, president of Gurenlian & Associates, a consulting firm based in Philadelphia, Pa. Dr. Gurenlian teaches dental teams how to provide a standard quality of care for patients with diabetes, educating health care professionals about the multiple complications from diabetes that require the efforts of health care providers from a variety of disciplines. “I recommend that the dentist or hygienist contact the diabetic patient directly to see if the patient has been examined by his or her health care provider and if the patient has had the appropriate testing completed or received educational information,” she says. The dentist and hygienist should document their recommendations and referrals in the patient's chart to allow for notations about follow-up visits and the findings of medical evaluations. The entire dental team can help their patients understand the importance of achieving good oral health to improve glycemic control and vice versa, says Dr. Gurenlian.

Factors that complicate oral care
Thomas Van Dyke, DDS, PhD, director of the Clinical Research Center at BUGSDM, explains that diabetes and periodontal disease impact each other (at least in part) through a shared inflammatory response. “The complications of diabetes are very much involved in this relationship; being a diabetic raises your inflammatory response,” he says.

The underlying mechanisms of periodontal inflammatory disease remain a subject of intense study. “Research has proven that the body itself has the capability to control inflammation, and its inability to do so stems from genetic susceptibilities,” says Hatice Hasturk, DDS, PhD, associate professor of periodontology and oral biology at BUGSDM. “Bacteria, of course, are necessary to launch the inflammatory response; however, later on, the initiated inflammatory cascade and chronicity of inflammation is dependent on the host response. It's a vicious cycle,” she says.

“Periodontal disease can make diabetes worse,” adds Dr. King. “If you have an infection anywhere in the body that in itself would make glucose control more difficult.”

If periodontal disease is not treated, major dental problems can develop. Dr. Shackelford notes that people with diabetes have higher blood sugar, creating a greater supply of triglycerides and polysaccharides (sugars and starches, respectively). The overabundance of sugars and starches causes a decrease in saliva flow, which can lead to erosion, root caries, plaque buildup, and periodontitis. Moreover, the prolonged healing times associated with diabetic patients can exacerbate infections and cause problems after surgical procedures in the oral cavity.

According to a report in the August 2002 Journal of Infectious Disease, “Periodontal disease is a significant cause of tooth loss among adults. It is initiated by pathogenic bacteria, which trigger an inflammatory response that is effective in preventing significant microbial colonization of the gingival tissues. In some individuals, the reaction to bacteria may lead to an excessive host response, resulting in periodontal tissue destruction.” If periodontal disease is left untreated in a diabetic patient, Dr. Amar says, “The magnitude of bone loss is significantly greater than that in the health periodontitis patient.”

Philip Trackman, PhD, professor of periodontology and oral biology at BUGSDM, says that dentists should treat oral infections (such as periodontal disease) aggressively to reduce inflammation; in addition, dentists should be aware that patients with diabetes may require more scaling and root planing procedures than nondiabetic patients. “The bone destruction,” says Dr. Trackman, who notes that the inflammation releases cytokines, which affect the patient's ability to heal and to generate bone. “The normal role of inflammation is to fight infection, but when that response is in overdrive, it hurts host cells,” he says. “The amplified response is out-of-control inflammation. This is an important aspect of what hurts the diabetic patient and drives many of the complications of diabetes.” For that reason, he says, dentists need to monitor these patients carefully.

People who live with diabetes on a daily basis are usually instructed to eat right, maintain regular physical activity, and if necessary, take medication. What many of these patients may not know is that these medications that help to maintain healthy insulin levels may lead to unexpected events at the dentist's office. According to a study in the November/December 2007 issue of General Dentistry, the AGD's clinical, peer-reviewed journal, diabetic patients especially need to communicate special needs to their dentists. This is due to harmful interactions that could occur because of the materials and medications used during dental appointments.

According to Dr. Hasturk, oral diabetic medications, such as metformin (i.e., glucophage), may leave a metallic aftertaste in the mouth for a short time, but there are no reports on the direct side effects of these medications on dental tissue; however, modified treatment protocols can be considered because the medication might cross-react with medications or procedures used during dental treatments. In addition, she notes, many diabetic patients also suffer from high blood pressure, cardiovascular disease, or kidney problems that may require an organ transplant. The calcium channel blockers, immunosuppressive drugs, and medications used to treat these conditions can cause gingival overgrowth, which provides an ideal environment (deep pockets) for the colonization of oral bacteria, thus increasing the risk for dental caries and gum disease in these susceptible individuals.

Complications from oral disease often lead to dietary changes, adds Dr. King. “For example, eating foods that are high in fiber, such as apples, tends to be difficult for individuals with periodontal disease or lost or damaged teeth, because the ability to chew properly has been compromised,” he says. In fact, untreated periodontal disease may change their diets- and thus their nutritional intake- by opting for food that is often and easier to chew. This approach is not advised, however, because soft food tends to settle around the gumline and between teeth, helping gingivitis-causing bacteria to grow. Patients with oral health complications should maintain a healthy, balanced diet, which helps to prevent gingivitis. A diet rich in fiber helps build the body's immune system, which allows it to better fight off the bacteria that cause gingivitis.

“The Mouth and Heart Connection”
From Academy of General Dentistry (AGD) Impact Magazine, December 2009

Cardiovascular disease is a class of disease that affects the heart and/or blood vessels. It is estimated that more than 80 million people in the United States have one or more forms of cardiovascular disease; these forms include high blood pressure, coronary heart disease (acute heart attack and angina pectoris), stroke, and heart failure. Studies have shown that there is a link between cardiovascular disease and periodontal (gum) disease, the chronic inflammation and infection of the gums and surrounding tissue. Forms of gum disease, such as gingivitis (gum inflammation) and periodontitis (bone loss) can be indicators for cardiovascular problems, which is why it is important for individuals at risk for cardiovascular disease to visit a dentist on a regular basis, practice good oral hygiene, and keep their dentist informed of any oral and overall health issues.

How are periodontal disease and cardiovascular disease connected?
It has been suggested that the inflammatory proteins and bacteria associated with gum disease enter a person's bloodstream and can cause various effects on the cardiovascular system. A study published in the February 2005 issue of Circulation examined the presence of bacteria known to cause periodontitis and the thickening of the blood vessel wall typically seen in heart disease. After examining samples from more than 650 participants, the investigators concluded that the presence of the same bacteria known to cause periodontitis was associated with an increased level of blood vessel thickening.

What can I do to keep my gums and heart healthy?
Practicing proper oral hygiene is essential to maintaining healthy gums. This includes flossing regularly, brushing twice a day with antibacterial toothpaste, and visiting a dentist at least every six months. A healthy diet and regular exercise can help improve both your cardiovascular health and your overall health.

What do my physician and dentist need to know?
It is important to keep all medical professionals up-to-date on your oral and overall health issues. Inform your physician if you have been diagnosed with a form of periodontal disease or are experiencing any issues with gum inflammation. Likewise, inform your dentist if you have been diagnosed with any form of cardiovascular disease, have experienced any cardiovascular problems, or have a family history of cardiovascular disease.

What other risk factors are associated with cardiovascular disease?
Individuals who are most at risk for cardiovascular disease include those over age 65, African-Americans, Hispanics, and males. While these particular factors cannot be changed, there are some risk factors that you can change through lifestyle management and/or medical treatment to reduce your risk for cardiovascular disease. These risk factors include smoking, high cholesterol, high blood pressure, physical inactivity, obesity, excessive alcohol consumption, and stress.

Questions? Be sure to ask your physician and dentist.

Resources: www.knowyourteeth.com
1.877.2x.A.Year which is AGD's toll-free referral number. Call to locate an AGD member dentist in your area.

“FDA Advises on Smokeless Tobacco Risks”
By Craig Palmer
From The ADA News, October 5, 2009

Washington- As a ban on most flavored cigarettes takes effect- the first tobacco regulation under the ADA-backed Family Smoking Prevention and Tobacco Control Act- the U.S. Food and Drug Administration advised parents of smokeless tobacco risks as well.

“Tobacco products that you don't smoke, like snuff and chewing tobacco, have also been shown to cause gum disease and cancers of the mouth,” said an FDA parental advisory issued as the agency announced a ban on candy- and fruit- flavored cigarettes for immediate effect September 22.

The Association, which supported the tobacco control law, will offer comments, at FDA's invitation, on approaches and actions the agency should consider in implementing the law.

The Association will also recommend nominees for FDA's newly established Tobacco Products Scientific Advisory Committee.

The ADA tobacco policy and resources are posted at www.ada.org/prof/advocacy/issues/tobacco.asp.

Dr. McCarley has just returned from the American Dental Association's Annual Session, held in Honolulu, Hawaii, in October 2009. Dr. McCarley was among the representatives in the Texas Delegation of the ADA House of Delegates.
The business of the ADA is centered on events and resolutions that transpire in the House of Delegates. Usually there are 30-40 resolutions brought before the House for discussion, modification, and voting into action. This year we had over 100 resolutions, many involving Dentistry involvement in the current Health Care Reform issue that America is experiencing.
The meetings became long, arduous, and heated at times. These are a few of the ADA policies that were adopted as seen in the ADA News. The website for the ADA is www.ada.org.

From the ADA News, November 2, 2009

“Delegates Expand ADA Health Care Reform Policy”
By Craig Palmer

¬ Honolulu- The 2009 House of Delegates at annual session in Honolulu last month expanded ADA health care reform policy for legislative advocacy.

The policy says, “The ADA shall direct its lobbying efforts to assure that legislators fully understand the consequences of any health care reform legislation.”

Dr. Ron Tankersley, ADA president, enunciated the extended policy in an October 22 “Deaf Colleague” e-gram delivered to more than 82,000 Association members, a higher than the usual 70,000-plus delivery rate for ADA e-grams.

“The ADA continues to advocate for a common-sense approach that maintains the private delivery system, does not penalize those who chose a higher level of health care, improves the public health infrastructure, and ensures that the insurance industry provides consumers with the coverage and care that they pay for,” Dr. Tankersley said. “Right now, no version of health reform merits our support,” he also stated.

Dr. Tankersley's e-gram notes the “very promising development” of support among U.S. House of Representatives and Senate Democrats for repeal of the McCarran-Ferguson federal antitrust exemption for the health insurance industry as part of health care reform.

“The ADA has been the most vocal group in Washington calling for this action, and there is growing momentum to strip the exemption away from health insurers,” Dr. Tankersley said.

Res. 60H-2009, adopted as amended, says that in addition to policy approved by the 2008 House of Delegates, “the ADA shall also advocate that any health care reform proposal:

  • maintains the private health care system;
  • should increase opportunities for individuals to obtain health insurance coverage in all U.S. jurisdictions;
  • assures that insurance coverage is affordable, portable, and available without regard to preexisting health conditions;
  • develops prevention strategies that encourage individuals to accept responsibility for maintaining their health and which may reduce costs to the health care system;
  • be funded in a sustainable, budget neutral manner that does not include a tax on health care delivery;
  • exempts small business employers from any mandate to provide health coverage;
  • include incentives for individuals and employers to provide health insurance coverage;
  • contain medical liability (tort) and insurance reforms;
  • encourage the use of electronic health records with rigorous privacy standards;
  • The American Dental Association supports health savings accounts, flexible spending accounts, or any other tax incentive programs that allow alternative methods of funding health care costs.”

The expanded health care reform policy also stipulates that:

  • “The ADA shall direct its lobbying efforts to assure that legislators fully understand the consequences of any health care reform legislation;
  • The ADA direct its lobbying efforts to inform our federal legislators of the ADA's existing health care reform policy and advocate for efforts to implement it; and
  • the ADA's Health Care Reform policy be promoted to the dental profession and the public through the ADA News, ADA Website, and other appropriate avenues of communication.”

The new policy expands on policy approved by the House of Delegates at the 2008 annual session in San Antonio. Res. 38H-2008 emphasizes that oral health is essential for a healthy America and integral to the healthy policy debate.

The 2008 policy responded to recommendations of the ADA's Future of Health Care/Universal Coverage Task Force 2007-2008 with the expectation (as indicated in the 2008 Annual Reports and Resolutions) that with this guidance “the ADA should be well positioned to participate in the discussion.”

For additional information and resources on health care reform and the McCarran-Ferguson exemption visit ADA's advocacy Website at www.ada.org/goto/advocacy.

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