Teeth, Gums and Electronic Cigarettes

Last spring a young woman came to our East Setauket office for dental care and – as I always do – I asked about her smoking history.  Smoking is strongly correlated with gum disease, loss of teeth, and oral cancer – so smoking history is a question I always ask.  She answered that she smoked electronic cigarettes.  The electronic cigarette?  What was that? I had never heard of it!

After that incident I read up on the device.  Electronic cigarettes satisfy the nicotine addiction but without inhaling the toxic chemicals that are found in tobacco smoke.  The e-cigarette turns liquid nicotine into a vapor which is inhaled by the individual.  The liquid comes in many flavors, such as mint or bubble gum, pina colada or peach.  But unlike skin patches and nicotine gum, these e-cigarettes have not been evaluated for effectiveness or for safety.  Nevertheless sales of e-cigarettes have been on the increase in the U.S. and in Europe.  European Union regulators are planning to regulate the device with greater vigor, starting in 2016.

E-cigarettes might be safer than inhaling tobacco smoke – a known carcinogen.  But there are still risks.  Nicotine is addictive and there are quality control problems at e-cigarette manufacturers.   There is also the concern among health officials that youngsters may begin with e-cigarettes and then progress to regular cigarettes.  The FDA needs to step up its regulation of e-cigarettes by considering a ban on flavorings that appeal to youngsters and a ban on sales and marketing to minors.   The electronic cigarette manufacturer, Lorillard Technologies, placed an ad in Sports Illustrated with a warning that “these are not a smoking cessation product and have not been evaluated by the Food and Drug Administration, nor are they intended to treat, prevent or cure any disease or condition.”  Another ad stated “WARNING: This product can cause mouth cancer.”

We need studies on the correlation of e-cigarettes and gum disease.  Let’s not replace one unhealthy habit with another.

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Look at all of the calculus (tartar) and plaque on the inside of these front teeth (top photo).  See how we removed the deposits with an in-office scaling and polishing (bottom photo).  Calculus like this can build up very quickly with improper homecare.  The deposits on the teeth attract harmful bacteria and their acidic byproducts.  This causes irritation and inflammation of the gum tissue.  See how red and swollen the gums are in the top photo. These gums will bleed as soon as touched.  The bone is also attacked and begins to resorb, or dissolve.  The tooth then has less bony support and, in time, the tooth will loosen and fall out.

The bottom photo was taken on the same visit after scaling and polishing. The gums look healthier – less red and swollen.  If caught in time, if the patient develops meticulous brushing and flossing habits,  if he returns for regular dental maintenance visits, the gums and bone will heal and he will keep his teeth.  If not, he will be a candidate for implants or a denture.  Don’t let this happen to you!


February brings National Pet Dental Health Month, sponsored by the American Veterinary Medical Association (AVMA) and other veterinary groups.  The goal is to alert the public to the significance of oral health care for pets.  Check out the AVMA website for more information on how to improve the dental health of your pets.  So don’t just turn away from Rusty’s bad breath.  The odor may signify that your pet is suffering from gum disease, which can be as devastating in a pet as in a human.  Dental health care should be a daily ritual all year for the pet as it is for his owner.  Most people brush their teeth every day, but how many pet owners do the same for their pets?

Veterinarians report that periodontal disease is the most commonly diagnosed problem in dogs and cats. This can lead to painful infections of the mouth, which can spread and become life-threatening.  By the age of two, 80% of dogs and 70% of cats have some type of periodontal disease.  The best prevention is regular brushing and regular visits to the vet.

The AVMA offers an informative video giving detailed instructions on how to brush your pet’s teeth. There is even an entire website devoted to pet dental health: www.petdental.com.

February is also children’s dental health month:  is there a connection here?



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.

I recently attended a dental lecture presented by Dr. Ed Brant, the Saint James periodontist with whom I often work with when a dental patient requires periodontal  treatment or dental implant placement.  His website is http://www.longislandreconstructiveperiodontics.com/.  The lecture was about the PerioLase for the Laser Assisted New Attachment Procedure (LANAP), which Dr. Brant has recently incorporated into his periodontal practice.

The PerioLase from Millennium Dental Technologies is a specialized Nd:YAG (Neodymium: Yttrium Aluminum Garnet) laser which performs soft tissue procedures to treat some kinds of periodontal disease  (http://www.lanap.com//).  The Periolase is an exciting laser modality.  It is minimally invasive, doesn’t require surgery, produce discomfort or a period of healing.  The laser is bacteriocidal and removes the diseased sulcular lining around the tooth.  The protocol includes antibiotic treatment, occlusal adjustment, a night guard and periodic professional cleanings at regular intervals.  The results are impressive.  I look forward to referring patients to the periodontist for laser periodontal therapy when appropriate.

During the first 17 days that they were trapped underground, the 33 Chilean miners were unable to brush their teeth.  It wasn’t until a five-inch diameter connecting hole was drilled into their deep underground chamber that they had access to toothbrushes and other supplies.  Several of the men thus developed gum disease. The situation is a dramatic illustration of the importance of proper dental health care and of how quickly dental problems can develop.  The men received medical evaluations when they were rescued and gum disease was one of the health problems that was evident.  The men also suffered from poor nutrition and stress-related trauma.  They all received a full dental check-up and periodontal scaling to remove the plaque and calculus buildup.  It is expected that all of the miners will have a full medical recovery but their ordeal is a reminder of how quickly an individual can develop gum disease and the importance of regular dental care.

A prospective patient came into my East Setauket dental office recently to ask about porcelain veneers. She was unhappy with how her front teeth looked. She had old composite bonding that was stained and chipped. Her teeth had spread out, there were spaces in between the teeth, and she noticed that her teeth were loose. She thought that her problem was just cosmetic, and she was concerned that her insurance company would not cover elective cosmetic procedures.

I took some close up digital photographs of her smile, as I usually do for consultations. We then discussed her photographs which I had enlarged on the computer screen. She could see the condition of her back teeth and the condition of her gums, and she began to realize that she had other problems that contributed to her unattractive smile. We took xrays to confirm that she had decay and defective fillings in her back teeth and she had the bone loss associated with gum disease.

My point is that what may appear to be solely cosmetic is often a symptom of underlying dental disease. Her needed dental work was not only cosmetic, and she was able to collect her insurance benefits. She completed the treatment, is now in good dental health and has a beautiful smile!

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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When asked about his propensity for gaffes, Vice President Joseph Biden told Brian Williams of NBC TV, “I’m too long of tooth to change who I am.” Did he really mean this? Does the VP have periodontal disease? Or was he just being metaphorical? If he has gum disease, maybe he’ll come out publicly like Whoopi Goldberg did recently (see my blog entry of May 17, 2009). He could tell us how he neglected his dental health until it was too late and how gum disease destroyed his teeth’s supporting tissues.

If people were thereby motivated to seek professional care, what a benefit to the nation’s dental health that would be! (Long of tooth refers to the length of the tooth as the gums recede and more of the tooth’s root is exposed.) If you notice any change in your gums or teeth (bleeding, swelling, odor, tooth movement, change in bite) contact our Long Island Dental office and we’ll do a periodontal evaluation of your teeth and supporting structures.charlie s angels download

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