Saving Teeth, Saving a Life in Stony Brook

 

I’ve saved many teeth in my years of practicing dentistry – after all, it’s my goal to help people keep their teeth.  But now I can say that I have saved a life.  It wasn’t a patient or a family member or a close friend but an acquaintance who has since become a friend.  I was at a dinner party when Lois approached me and said she wanted to ask my opinion.  She was having a crown made but the dentist couldn’t complete the work because she had sores in her mouth that hadn’t healed.  She wanted me to complete the dental work. She said that she was sucking her cheek and this caused the sores but she couldn’t stop the sucking habit.

 

I took her aside and asked her to pull aside her lip so I could see the area.  The entire cheek side of her lower right back teeth was covered with white pustules and much of the normal tissue had sloughed off. I had never seen a condition so serious.  I didn’t want to alarm her but I was emphatic that she needed to immediately see an oral surgeon for a biopsy.  She asked me if it was cancer. She said she didn’t want to know if it was.  My reply was that she needed to know so that it could be treated.  The next day I called her to be sure that she would follow through.  It took several phone calls on my part until she finally saw an oral surgeon for a biopsy.

 

Sadly the test was positive for well differentiated squamous cell carcinoma.  Lois will need surgery to remove the cancerous tissue and part of the jawbone, and then possibly undergo chemotherapy and radiation treatment.  Rehabilitation will take over six weeks, with limited speech and swallowing.  Lois is grateful to me for recognizing the pathology and for insisting that she have it diagnosed.  She has a long road ahead of her, but hopefully the cancer was caught in time.  I know I have saved a life.  Please don’t neglect yours. Don’t let fear keep you from the doctor – oral cancer that is caught early can be treated and cured.

 

 

 

 

The November,  2012 issue of the American Dental Association Journal included an update on common oral sores and irritations that I thought I would share with my blog readers.  Sores and irritations can develop in and around the mouth but fortunately oral sores and irritations usually heal on their own within a couple of weeks.  Four common mouth sores are canker sores, cold sores, leukoplakia and oral candidiasis.

Canker sores are small white sores with a red border that develop inside of the mouth.  They are not contagious.  The cause is often not known but can be due to trauma.  Canker sores heal in a couple of weeks but they can be painful. Topical anesthetics and antimicrobial mouthrinses may be soothing.  The sores may be irritated by spicy, acidic or salty foods.

Cold sores (fever blisters) are clusters of raised, red blisters that usually occur around the lips, under the nose or on the chin.  These are fluid filled blisters that can break open and the fluid leak out.  Scabs can then form until the cold sores heal.  Cold sores are cause by the herpes simplex virus and are very contagious.   The infection may be initially accompanied by flu or cold symptoms.  Cold sores typically will heal by themselves in about a week but there is no cure for the herpes virus.  Once you have been infected, the virus remains in the body and flare-ups can occasionally occur.  Topical anesthetics provide some relief from discomfort.  Antiviral drugs may be prescribed to reduce the healing time.

Leukoplakia is an overgrowth of cells resulting in a rough patch of white or grey tissue.  It can occur anywhere inside of the mouth.  The patches are not painful and are not contagious.  Leukoplakia may result from irritation from an ill-fitting denture or from chewing the inside of the cheek.  Tobacco users are also be prone to leukoplakia.  Treatment involves identifying the irritant.  Once the irritant is eliminated, the patches should disappear.  But leukoplakia can also be associated with oral cancer so a biopsy may be indicated if the leukoplakia looks suspicious.

Candidiasis (oral thrush) is a yeast infection that occurs on the soft tissues inside of your mouth.  It is a smooth white patch with a red base.  It can be sore or it might bleed.  It is caused by a fungus and usually develops when the immune system is weak.  People in poor health, old people, the very young and people with systemic diseases are at risk of oral candidiasis.  Steroids, antibiotics and cancer therapies can increase the risk of candidiasis.  Treatment consists of controlling the cause of the outbreak.  Candidiasis is common among denture wearers so daily cleaning of dentures is important.  Also  if dentures are removed at night, the denture-bearing tissues are allowed to regenerate.  Anti-fungal medication is also helpful.

If you see a lesion – make an appointment so a dentist can do a thorough oral examination,  make a diagnosis and take a biopsy, if necessary.

Major League Baseball (MLB) teams will be playing ball this year with limits on the use of smokeless tobacco.  As part of the agreement between the MLB and the Players Association, team members will not be allowed to keep smokeless tobacco in their back pockets or anywhere else in their uniforms when on the field or whenever ball fans are in the park.  Likewise they will not be allowed to chew a wad of smokeless tobacco when meeting fans or being interviewed.

Smokeless tobacco impacts on oral health as it can cause oral cancer.  Its use has risen nearly 37% among high school boys since 2003.  Baseball player are often role models for these youngsters who emulate their heroes – chewing, spitting, and reloading a wad of tobacco under their lower lip (dipping) – and follow the path to addiction.  The former San Diego Padres hitter, Tony Gwynn, who now coaches baseball at San Diego State University, is a prominent former dipping addict.  He was unsuccessful in quitting the habit and now has salivary cancer.  He has had four oral surgeries to remove cancerous tumors.

Remember the cold metal chain placed around the back of your neck before a dental procedure?  Well this chain that clips onto a patient’s paper bib to hold it in place has recently been under attack.

The dental chain can harbor potentially harmful germs.  A study at the University of North Carolina School of Dentistry found that one out of 5 bib chains that they tested were contaminated with bacteria.  The bacteria stems from saliva and dental plaque.  Cross-contamination is the spreading of bacteria and viruses from one surface to another – for example from the patient’s mouth through aerosols in the air to the dental bib chain.

We haven’t used the dental chain for several years.  Instead we use a disposable bib holder – safer for the patient and more comfortable as well.

Are wisdom teeth expendable? – that is the question.  Pros and cons appeared in an article “Prudence of Having That Tooth Removed” in the September 6, 2011 New York Times at http://www.nytimes.com/2011/09/06/health/06consumer.html.  The article advises against routine extraction of wisdom teeth (third molars) as scientific evidence supporting routine preventive extraction is lacking.  The author notes that “Each year, despite the risks of any surgical procedure, millions of healthy, asymptomatic wisdom teeth are extracted from young patients in the United States, often as they prepare to leave for college.”  I don’t know how she came up with the figure of “millions” but it seems excessive.  I don’t know of any oral surgeon who routinely extracts “healthy, asymptomatic” wisdom teeth nor would I routinely refer such teeth to a surgeon for extraction.  I only recommend extraction if there is a reason to do so.

However I think that the author underestimates the percentage of problems we see related to wisdom teeth.  If I see a problematic tooth then I would discuss extraction with the patient and guardian.  Sometimes there is a problem that is not obvious to the untrained eye.  There might be pathology evident on a radiograph but not visible to the patient.  The tooth might be decayed.  It might be impinging on the second molar, affecting the  prognosis of the second molar.  The tooth might have soft tissue impaction and recurring infections.  These are all good reasons for extraction, and all of the above do occur quite frequently.  People are often concerned that their third molars are causing crowding of the lower front teeth – but there is no evidence that this is the case.

An issue not discussed in the article is the prevalence of periodontal disease among adults, possibly affecting 60% or more of the adult population in the U.S.  If the patient is not adept at removing plaque from hard to reach third molars, it might be prudent to extract them, for the health of the rest of the dentition.

Nevertheless, surgery always carries a risk, including possible nerve damage and complications from the anesthesia.  If you do opt for extraction, ask for local anesthesia, which is generally safer than general anesthesia.  Follow post-op instructions: soft food for a couple of days, ice on the area, and analgesics if necessary.

Whether or not to extract wisdom teeth, like everything else in dentistry,  is a matter of judgment.  Your dentist needs to have good judgment and experience and have your best interest at heart.

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I routinely examine my patients for signs of oral cancer.  In 2010 there were about 36,000 new cases of oral and pharyngeal cancer (OPC) in the U.S. and over 7,000 deaths.  Prevention includes early detection of premalignant changes in the oral mucosa.

But you can also assist in prevention.  An article in the February, 2011 Journal of the American Dental Association reported on “Diet and Prevention of Oral Cancer.”  A diet high in fruits and vegetables is protective against OPC.  Vitamin C and E have antioxidant properties and may prevent DNA damage because they reduce exposure to the free radicals of oxygen.    Fruits and vegetables also contain phytonutrients which may act synergistically to prevent OPC and other cancers.  In contrast, nitrites in processed meats form nitrosamines which are carcinogenic and increase the risk of developing cancer.  The protective dietary factors of antioxidant vitamins, carotenoids, lycopene and fiber occur in plant foods: whole grains, nuts, legume, vegetables and fruits.  A plant food diet also minimizes pathogenic dietary factors including saturated fat and animal protein and nitrates.  Salted meat, processed meat and animal fat all increase the risk of oral cancer.  Dietary supplements are not a substitute for a diet rich in fruits and vegetables.

For more information about diet and prevention of oral cancer see: http://jada.ada.org/cgi/content/short/142/2/166

A retired couple came into my East Setauket dental office today for a consult.  They are on a limited income and were worried that I would tell them that they needed new dentures.  His dentures were loose – he kept denture adhesive in his back pocket for frequent application.  Her dentures had fractured, and she kept the dentures in her mouth with difficulty. One of the teeth had fallen out and a clasp on her partial denture had broken off.  New dentures would have been nice but given the couple’s health and financial circumstances, I suggested a denture repair and denture reline at minimal cost.  Were they ever relieved!

For denture repairs and relines, we take impressions and send the dentures to Lords Dental Laboratory, an excellent dental laboratory that specializes in dentures and partial dentures. Using our excellent tooth impressions, they reline the dentures and make necessary repairs.  The fit is vastly improved. You should not have to use adhesive if your denture is properly fitted.

I find that denture patients too often do not return for regular checkups.  But regular oral checkups are as important for people without teeth as for people with teeth. Your oral tissues change over time and we need to check that the dentures fit properly.  We also check for oral cancer, fungal and other oral pathologies.

Are your dentures loose? Broken? Missing teeth?  Are you afraid that you will need a new denture? Give us a call at 751-4433 and I’ll see what I can do for you with a denture repair and reline.

I recently came across an excellent article on the Mayo Clinic website at: http://www.mayoclinic.com/health/dental/DE00001.  The article “Oral Health: A window to your overall health,” discusses the connection between oral health and overall health.  It explains that your mouth may harbor the first signs of disease and that diseases of the mouth, such as gum disease, can cause problems in other parts of the body.
Your mouth is loaded with bacteria which can be kept under control with brushing, flossing and regular dental visits. Saliva also defends against bacteria because it contains enzymes that destroy bacteria. But if the bacteria are not kept in control, a gum infection, or periodontitis, can result.  Gum disease may provide bacteria with a means to enter your bloodstream. Dental treatment might also be a means whereby bacteria can enter the bloodstream.
•     Research has shown that heart disease, stroke and clogged arteries may be linked to oral health and periodontal disease.
•    Gum disease has also been linked to premature births.
•    Diabetes increases your risk of gum disease and oral infections. And poor oral health can make your diabetes more difficult to control.  Oral infections can cause your blood sugar to rise, requiring more insulin for its control.
•    People who have HIV/AIDS often exhibit oral manifestations, including ulcers, dry mouth and painful fungal, viral or bacterial lesions. One of the first signs of AIDS may be severe gum infection.
•    The first stages of osteoporosis, or bone loss, may manifest in loss of supporting bone of the teeth, resulting in loose teeth.
•    Other conditions that may first exhibit in your mouth include Sjogren’s syndrome, some cancers, eating disorders, sexually transmitted diseases and substance abuse.

The relationship between your oral health and your overall health provides another good reason to take care of your teeth and gums.  An investment in your oral health is an investment in your overall health!

In 1890, at the start of his second term of office, President Grover Cleveland noticed a rough spot on his palate.A biopsy confirmed a diagnosis of cancer, and surgery was indicated.The Government wanted to keep the President’s health a secret because there was a financial crisis at the time, and they did not want the public to be alarmed.

So the surgery was done in secret while the President was aboard his friend’s yacht traveling up the East River in New York.The surgical team, including a dentist, was sworn to secrecy.Dr. Hasbrouck, a New York dentist, administered the anesthesia. Two teeth were extracted and part of the maxilla was removed.Dr Hasbrouck also constructed an appliance to close the defect caused by the surgery, and the President was able to make a planned address to Congress shortly thereafter.

The President lived for many more years without a recurrence of the oral cancer, and he died in 1908 of a heart attack.The government did not officially acknowledge Cleveland’s oral cancer until 1917.Dentists today, as in Cleveland’s day, play a crucial role in the diagnosis and treatment of oral cancer and post-surgical reconstruction.In my dental office I routinely check my patients for oral cancer.Early treatment of cancerous lesions saves countless lives each year.For more on oral cancer, visit my blog post on oral cancer.

Do you suffer from painful mouth sores, commonly called canker sores, and which dentists call aphthous ulcers? Well, you are not alone. Up to 25% of the population experiences canker sores at one time or another, and we see canker sores frequently in our Suffolk County Dental office. The exact cause of aphthous ulcers is unknown but stress, lack of sleep, trauma to the teeth or mouth, or allergies may all trigger an ulcer, which is a break in the mucous membrane. There are various over-the-counter remedies, but no effective long-term treatment exists.

However a recent study demonstrated that one sublingual tablet per day of vitamin B12 (1,000 mcg) resulted in a significant reduction of aphthous ulcers. Painful ulcers can be soothed by avoidance of spicy food, rinsing with salt water or mouthwash, proper oral hygiene and non-prescription local anesthetic ointments.