Oral Health; Treatment

Oral Health; Treatment

The primary goal of periodontal therapy is to remove the bacteria in the periodontal pocket that cause the disease. Controlling the infection treats gum diseases. A dentist, dental hygienist or periodontist begins treatment by first giving thorough instructions on at-home oral hygiene. He or she will then remove the plaque and tartar on the teeth above and below the gum, by a procedure called scaling and root planning, or another called periodontal debridement. These procedures are performed with ultrasonic instruments, and/or with sharp hand instruments to scrape the surfaces of the teeth clean. The purpose of removing the plaque, tartar and bacteria is to allow the gums to heal rapidly. These procedures may require local anesthesia. Some dentists and periodontists are also using lasers to disinfect the periodontal pockets.

Your dentist might also prescribe a special anti-germ mouth rinse containing a chemical called chlorhexidine to treat gingivitis. In cases of chronic periodontitis, a local antibiotic/antimicrobial may be placed directly into the periodontal pocket in the form of fibers, chips, gels or microspheres containing powder encapsulated in a polymer. This kills the bacteria directly at the site of infection, with little or no systemic (bodily) absorption. This prevents the majority of problems associated with systemic antibiotic use, such as bacterial resistance or allergic reaction. For other forms of periodontitis, a systemic (taken by mouth) antibiotic may be necessary to treat that particular form of periodontal (gum) disease. A low-dose systemic antibiotic might be prescribed, not to kill bacteria, but to help control the immune response to the bacteria. It is critical that this low-dose antibiotic be taken exactly as prescribed.

After scaling and root planing or debridement, you must brush and floss your teeth every day to keep plaque from accumulating again. If scaling and root planing do not bring the infection under control, periodontal surgery might be necessary. Flap surgery involves lifting back the gums, removing the bacteria, tartar and other disease-causing substances, and then sewing the gums back in place. Regenerative periodontal surgery aims to decrease pocket depth by adding bone to the pocket and increasing the attachment level of the periodontal ligament (the ligament that holds the teeth into the jaw bone); grafting procedures are used for recession.

In addition to controlling infection, women need to be aware of their special needs during the various phases of life and under certain conditions. Here are some specific guidelines:

Menstruation: Just prior to or during menstruation, some women may experience the following symptoms: gums swell and bleed; cold sores and canker sores; it takes longer to stop bleeding after oral surgery. If you notice these symptoms around the time of your period, ask your dentist or dental hygienist about more frequent cleanings, gum treatment, antimicrobial rinses and topical or local anesthesia to ease discomfort.

Eating disorders: Eating disorders are more prevalent in women, often occurring between ages 17 and 24. As these are serious medical conditions, psychiatric/medical care should be obtained. In addition, discuss this with your oral health care provider, as oral complications can be minimized or controlled with appropriate care.

Oral piercing: Some women have oral piercings and use various types of jewelry in their mouths or on their lips or faces. If you choose to get an oral piercing, take care to minimize potential life-threatening complications. Infection, hemorrhage, broken teeth, and other problems can result if those performing the procedures are not knowledgeable about oral anatomy and infection-control procedures.

If a woman is going to have her tongue pierced, she must understand that the metal of the tongue bolt is harder than the enamel of the teeth, and repeated contact between the metal and the enamel will result in fractures of the teeth. This damage can be reduced by:

* Using a shorter bolt, which will ensure less contact between the bolt and teeth, reducing the chance of tooth fracture.

* Have the spheres on either end of the bolt made out of plastic, which also will reduce the amount of damage to the adjacent dentition.

Some women undergo a procedure called “tongue splitting,” in which the tongue is cut down the middle and induced to heal in that state, leaving a forked tongue. The American Association of Oral and Maxillofacial Surgeons has come out with the position that this is mutilation, and is being performed by individuals without proper credentials and training. This can result in severe infections, severe and possibly life-threatening bleeding and loss of function to the tongue. The practice of tongue splitting should be discouraged.

Pregnancy: If you are considering pregnancy, or are pregnant, follow these tips:

* Contact your dentist and dental hygienist and make him or her a part of your prenatal health care team.

* You may need more frequent dental check-ups and debridement.

* Keep brushing. During pregnancy, the gums may become sensitive and uncomfortable, especially during brushing or flossing, prompting some women to avoid good daily oral hygiene. This avoidance sets up a vicious circle. As oral hygiene becomes even more uncomfortable, the cycle continues. During your pregnancy, it’s important to brush at least twice a day with a fluoride toothpaste and floss every day.

* Take prenatal vitamins because your baby’s developing teeth depend on your proper intake of vitamins and minerals.

* Follow a balanced diet and remember to take the vitamins prescribed by your health care professional every day. If you take chewable vitamins, do not use those containing sugar.

* Sip water. When some women become pregnant, they find they prefer to eat smaller meals, more frequently throughout the day. Following this dietary pattern increases your risk for gum disease and tooth decay because you’re constantly exposing your teeth to food, especially the sugars and starches that set the stage for bacterial infection. After each small meal, drink or rinse with water. Drinking water throughout the day keeps up the saliva level in your mouth, which can help prevent tooth decay. Rinsing and spitting removes food particles from teeth.

* If you suffer from morning sickness, and vomiting is part of your pregnancy, immediately rinse your mouth before you brush your teeth. Rinse with plain water, or with a neutralizing solution of water mixed with baking soda (1 quart water mixed with 1/4 tsp baking soda and 1/4 tsp salt; salt may be eliminated- do not swallow) and clean your teeth with a fluoride toothpaste. Bringing stomach acids into your mouth can dissolve tooth enamel.

* Ask about fluoride treatments or rinses. If you have or are prone to tooth decay, or are vomiting a great deal, talk to your dentist and dental hygienist about in-office or at at-home fluoride treatments. A simple fluoride rinse once a day is very effective in controlling tooth decay. Your dentist or oral health care professional can also custom-make trays for you to use at home for fluoride gels.

* Plan for the future. It’s important for parents to get information on their child’s oral health when their children are very young. If they don’t, their children may suffer unnecessary dental problems. Generally speaking, when a child has all of his or her primary teeth in place is a good time to a first oral exam. The American Academy of Pediatric Dentistry and the American Academy of Pediatrics recommend that a child have his or her first oral health care appointment around age one. The American Dental Hygienists’ Association (ADHA) suggests an oral health visit as soon as a baby’s first tooth erupts.

* Ask about Early Childhood Caries (ECC), formally called Baby Bottle Tooth Decay. Dental caries (decay) is an infectious disease and can be passed from one individual to another through kissing and from sharing utensils from mother to child, for example. It can also be passed from a pregnant woman to the fetus, and subsequently the child. Dental caries can be prevented by a combination of community, professional and individual measures including water fluoridation, professionally applied topical fluorides and dental sealants and use of fluoride toothpastes. Yet, tooth decay is the most common chronic disease of childhood. See the section on pregnancy above.

Contraception: If you take oral contraceptives, they may make your gums swell and bleed. If you need to schedule a dental procedure, be sure to time it right. If you need to have a tooth extracted, for example, schedule the procedure on the day when you are taking the placebo pill (it is usually a different color than the rest of the pills) in your supply of oral contraceptives.

Menopause: This normal transition can trigger a variety of oral health problems. Here’s what you can do to keep your mouth healthy:

* Call your dentist or oral health care professional. Talk to your dentist and dental hygienist if you experience any oral problems related to menopause. Saliva substitutes may be prescribed to reduce dry mouth. health care professional

* Inquire about substitutes. In some cases, medications cause dry mouth or other oral health problems. Ask your health care professional if there are substitutes for the medications that you are currently taking. Perhaps another brand name, or a different dosage, can help.

* Some middle-aged women may begin to experience a burning sensation in the lips, palate and tongue-a poorly understood (and difficult to diagnose) condition known as Burning Mouth Syndrome (BMS). According to the Academy of General Dentistry, it is sometimes accompanied by dry mouth, thirst, altered taste perception, changes in eating habits, irritability, depression and reduced desire to socialize and interact with others.

If you experience any of these symptoms, your oral or general health care professional will first seek to rule out other conditions, such as anemia, leukemia, severe vitamin deficiency, undiagnosed diabetes, or a yeast or candida infection of the mouth.

Medications used to treat the disorder include: antibacterials, analgesics, vitamin and mineral replacements, capsaicin (a natural chemical found in cayenne pepper), benzodiazepines, antihistamines and antidepressants.

* Ask about Sjogren’s syndrome. This condition is more common in postmenopausal women. It is an autoimmune condition in which immune cells mistakenly attack and destroy tissue of the salivary glands (located in the mouth) and lacrimal glands (located in the eyes).

Symptoms of Sjogren’s include dry mouth, dry eyes and stiff, painful joints. If you experience these symptoms, ask your oral or general health care professional to examine you for Sjogren’s syndrome.

Osteoporosis: Because research has revealed a possible link between osteoporosis and bone loss in the jaw, you should:

* Determine your risk. Health experts recommend that women over 65 should be screened for osteoporosis. Postmenopausal women under age 65 who have suffered bone fractures or who are at high risk for osteoporosis should also be screened. If you are a premenopausal woman with any risk factors for osteoporosis, talk to your health care provider about getting a bone density test. This quick test measures bone strength, predicts if your bones are at risk for fracture, may be helpful in monitoring the effects of treatment if the test is conducted at intervals of a year or more and can help predict your future risk for osteoporosis.

* Talk to your dentist and dental hygienist about your concerns associated with osteoporosis. Ask them what you can do to slow down oral bone loss. You will be taking steps to lower your risk of tooth loss.

* Call on calcium. According to national surveys, many women consume less than half of the daily recommended amount of calcium. The National Osteoporosis Foundation recommends between 1,000 mg daily (for women 19 to 50 years old) and 1,200 mg daily (for women 51 years old and older). Good calcium sources include low-fat dairy products, broccoli raab (rapini), calcium-fortified juices, breakfast cereals, cereal bars and waffles.

* Don’t forget vitamin D. Vitamin D plays a major role in calcium absorption and bone health. Experts recommend a daily intake of between 800 and 1000 IU. Besides taking a nice walk in the sun, good food sources of vitamin D include fortified dairy products, egg yolks, saltwater fish and liver. As we age, our skin is less effective in converting sunlight into Vitamin D, and many women and men use sunscreen to prevent them from skin cancers. Older individuals should rely on supplements and foods to get their daily recommend allowance of Vitamin D.

* Reach for soy. Soy products, including soy milk, are good sources of calcium, which is an important mineral in building bones and teeth, and in maintaining bone strength.

* Watch that sugar. Some women chew antacid tablets as a source of supplemental calcium. The problem is, in women with dry mouth, or who are prone to oral problems, the sugar content of the tablets can cause tooth decay. If you chew antacid supplements, be sure to brush and floss afterward. Don’t stop taking them until you talk to your health care practitioner about alternative calcium sources.

The American Academy of Periodontology. Last modified July 2003. http://www.perio.org. Accessed Aug. 2003.

The American Dental Association. Copyright 1995-2003. http://www.ada.org. Accessed Aug. 2003.

U.S. Department of Health and Human Services. “Oral Health in America: A Report of the Surgeon General”. Washington, DC: USDHHS, Office of the Surgeon General, 2000. http://www.surgeongeneral.gov. Accessed Aug. 2003.

“Gum-chewers Have New Reason to Smile” Academy of General Dentistry. http://www.agd.org. Accessed Dec. 2002.

“Burning Mouth Syndrome May Flare Up In Middle-Aged Women.” Academy of General Dentistry. http://www.agd.org. Accessed Dec. 2002.

“Oral Health: Preventing Cavities, Gum Disease, and Oral Cancers” US Centers for Disease Control and Prevention. Reviewed April 2003. http://www.cdc.gov. Accessed Aug. 2003.

“Obesity and Periodontal Disease in Young, Middle-Aged, and Older Adults” Journal of Periodontology, May 2003 (Vol. 74, No. 5). http://www.perio.org. Accessed Aug. 2003.

Editorial Staff of the National Women’s Health Resource Center 2002/02/01 2005/06/13 Oral health, the condition of the mouth (including the gums, teeth, and jawbone), goes far beyond white teeth and no cavities. Gingivitis,Oral health,Periodontal disease,Periodontitis,Plaque,Scaling and root planning,Tartar,Xerostomia

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