Smithtown Sisters: Identical Teeth?

Karen and Meg are sisters. They started out with almost identical teeth.  But Meg smoked a pack of cigarettes a day for over 20 years. Karen never smoked. Guess which teeth below belong to Meg and which teeth belong to Karen? You guessed it – Meg’s teeth are at the top; Karen’s below.  Smoking is connected to periodontal (gum) disease. The bone resorbs, leaving a long tooth.  Without support of bone, the teeth loosen and move out of position. In Meg’s case, the front teeth became more crowded and became very protrusive. The teeth were so loose that she knew that it was only a matter of time before they would fall out , and she had already lost a couple of back teeth.  By the time she came to our dental office the gum disease was so advanced and the teeth so out of position that dentures were the best option for her.  She was very unhappy about the condition of her teeth, and she was excited at the prospect of having new teeth that would make her look more like her younger self. We will fashion our custom immediate denture for her.  Photos to follow!

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Good discussion of how to close the gap in today’s New York Times: http://well.blogs.nytimes.com/2013/09/12/ask-well-gap-toothed-2/?smid=tw-share

A study published in the March issue of the Journal of the American Dental Association (JADA) by researchers at the University of Buffalo compares postmenopausal women who have smoked to postmenopausal women who never smoked.  They concluded that smokers are at a much higher risk of losing their teeth.  Women have better oral health care and visit the dentist more regularly then men, yet women have more tooth loss than men of the same age.  Heavy smokers (26 pack-years of smoking, meaning the equivalent of having smoked a pack a day for 26 years) were twice as likely to have lost teeth due to periodontal disease, than those who have never smoked.

The study suggests that cigarette smoke may exacerbate gum disease or that the chemicals found in smoke may favor plaque forming bacteria.  Nicotine also reduces bone density.

Anecdotal evidence in my office supports the connection between smoking and tooth loss.  When I sit down with a patient to review their medical and dental history, I always ask about their smoking history.  When they arrive “long of tooth,” with loose teeth and missing teeth, I usually find that smoking is part of their history.

We have known for many years that smokers have a higher risk of gum disease.  In 2004 the US Surgeon General stated that scientific evidence was sufficient to conclude that there was a causal relationship between tobacco and periodontal disease.  But recently, researchers at the University of North Carolina – Chapel Hill concluded that even exposure to secondhand tobacco smoke increased risk for the disease.  Exposure to secondhand smoke for several hours a day can double the risk of severe periodontal disease.  People exposed to secondhand smoke for 25 hours or less every week had a 29% increased chance of the disease and for people who were exposed to more than 26 hours the odds were two times higher.  The study is in the American Journal of Public Health and can be found at

http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2010.300069.

Smoking and gum disease go together like (love and marriage?).  Oral cancer is also linked to smoking.  I often speak with my patients about their smoking habits and their efforts to quit the habit.  Some patients have used the nicotine gum and nicotine patches but with uneven success.

The annual market for nicotine replacement products was over $800 million in 2007, compared to $129 million in 1991.  But now a long-term study of nicotine replacement therapy shows that the approach has no lasting benefit and may backfire.  The study was published this week in the Journal Tobacco Control.  According to the study, nicotine replacement may help people quit but it does not prevent relapse in the longer run.  Motivation, social environment, support from friends and family and workplace rules also play a role.  New smoking laws, media campaigns and tobacco taxes also have an effect.

The Great American Smokeout which encourages people to stop smoking for 24 hours will take place this year on November 18.  The goal is that the decision to stop smoking will last much longer than the one day.  This annual event is sponsored by the American Cancer Society.

Quitting smoking is not easy because tobacco contains nicotine which is addictive.  As Mark Twain once said, “Quitting smoking is easy. I’ve done it a thousand times.”  I have made it a goal in my Long Island dental office to help my patients who smoke to break the habit once and for all.

Smokers are at risk for oral cancer and periodontal disease.   Cigarette smoking has also been linked to increased risk of heart disease, stroke, diabetes, and respiratory disease.

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!

An overwhelming majority of people who have periodontal (gum) disease are also at high risk for diabetes and should have screening for diabetes.nA recent study showed that 93% of subjects who had gum disease were at high risk for diabetes compared to 63% of subjects without the disease.nThe study recommended diabetes screening for people over 45 years of age who have a body mass index (BMI measuring weight and height) of 25 or more and for people under 45 with a BMI of 25 or more and one additional risk factor. The study can be found in the Journal of Public Health Dentistry.

For more information about periodontal disease click on our periodontal webpage.

Are you old enough to remember the Ipana toothpaste ads from the 1950’s?
Well, those ads highlighted Bucky Beaver advocating that “You should brush three times a day and visit your dentist two times a year!”   Thus it was a Madison Avenue advertising executive who created the 6-month checkup!  There was no scientific basis at all for this 6 month interval.

While it’s not a bad idea to have twice yearly visits to the dentist, more frequent visits may be indicated for patients with gum disease.  Laboratory research shows that the bacteria associated with periodontal disease become more active after 90 days. If these bacteria are periodically disturbed and debrided, the tissue will show a healthy response.  At 3-months, less destruction will have taken place and the tissue will be healthier than if the patient waits six months.

We’ll be happy to see you at our East Setauket dental office and evaluate your periodontal status.

When I read about Supreme Court nominee Judge Sonia Sotomayor’s finances, I noticed that she owed money to her dentist. I haven’t had a good look at her teeth, but as she does have diabetes and there is a strong link between diabetes and gum disease, there is a strong possibility that she suffers from the latter. Gum disease needs to be controlled with frequent visits to the dentist for periodontal scalings. If neglected, surgery and/or tooth loss can result. This can be costly. If you suffer from diabetes, be sure to visit the dentist regularly for a periodontal examination. Healthy gums should have a firm, stippled consistency, should not be swollen or bleed or have an odor.

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