Treating Dry Mouth

Posted by drgracesun on October 21, 2009 under Healthy Smile | Be the First to Comment

My husband is an avid snow skier, and has been hitting the slopes since he was 16 years old. Now, in his late 60s, the joints in his back have become dislocated, and eventually became herniated. The rough sport has taken its toll on his back – he has had five (yes, five) back surgeries over the past several years, and as a result, his many surgeries have left him with a constant, staggering pain – an all too common scenario with athletic individuals, especially in the sports medicine field. Having tried several medications (without much luck), he finally came across Cyclobenzaprine, a muscle relaxant that works for him. Taking the edge off of the pain however hasn’t come without its price – xerostomia, or dry mouth, is the major side effect which my husband – and many others – have a hard time dealing with.

Cotton mouth, dry mouth – xerostomia has many names, but the feelings associated with a dry, parched mouth and throat are all the same. Xerostomia is a condition in which the salivary glands of the mouth do not function as they should, and provide a less-than-adequate supply of saliva into the mouth. In the instance I mentioned above, xerostomia is not just a medical condition that derives from poor oral hygiene or bad dietary habits, but can be a unpleasant side effect from prescription medication. As  explained in an earlier blog post on toothmingle.com about dry mouth, xerostomia can stem from over 400 prescription and OTC medications, including anti-depressants, anti-hypertensives, painkillers (like Cyclobenzaprine) tranquilizers, analgesics, diuretics and antihistamines.

In most cases, as it was with my husband, the dry mouth side effect is more than acceptable, as his back pain was debilitating – but there are steps one can take to help alleviate xerostomia. Avoid alcohol and caffeinated beverages as they can parch the oral cavity , leeching moisture and making the effects of xerostomia even more pronounced than normal. Dry and salty foods, processed foods (such as potato chips, candy and doughnuts) will also cause the mouth to become dry and parched. Smoking will also leave the mouth overly dry and uncomfortable (not to mention its devastating effects on your teeth and lungs).

Drinking water will definitely help curb dry mouth, so take small sips of quality water often. The important things to realize is how important it is to keep your oral hygiene in top condition.  Oftentimes, the random decay associated with dry mouth is hard to treat; fluoride treatment at home or at a dental office is a good idea. Keeping a humidifier in your bedroom can also help to eliminate some discomfort with dry mouth.

There are over the counter and prescription drugs available to eliminate symptoms and signs of dry mouth; if home remedies and correction of your diet and habits does not solve the problem, consult with your dental or medical professional.

“Do Redheads Feel More Pain?”

Posted by drgracesun on September 14, 2009 under Children, Current News Events, Information, Smart Smile | Be the First to Comment

Redheads feel more pain! New research published in the July 09 Journal of The American Dental Association found that painful experiences at the dentist might cause more anxiety for men and women with red hair, who were twice as likely to avoid dental care than people with dark hair. Red-headed children or adults might avoid dental visits and might be at a higher risk of affecting their dental health!

A child that has an unfounded fear of the dentist (or even a founded one, instilled by parents who aren’t very fond of their dentist or past experiences in the dental chair) are common, however due to a scientific quirk (thanks to mother nature), redheaded individuals do feel pain more intensely than non-red-headed persons. These extra sensitivities to pain might lead to negative experiences with dental visits, which as being parental health care providers, we should be aware of these phenomena.

There are two studies that exist. In 2004, research showed that people with red hair need twenty percent more general anesthesia than blonds or brunettes. A 2005 study indicated that redheads are more sensitive to thermal pain and are more resistant to the effects of local anesthesia. Researchers believe variants of the melanocortin-1 receptor gene play a role. This MC1R gene produces melanin, which gives skin, hair and eyes their color.

While blond, brown and black-haired people produce melanin, those with red hair have a mutation of this receptor. It produces a different coloring called pheomelanin, which results in freckles, fair skin and ginger hair. About 5 percent of whites are estimated to have these characteristics. The relationship between MC1R and pain sensitivity is still under study, researchers have found MC1R receptors in the brain and some of them are known to influence pain sensitivity. Non-redheads can also carry a variant of the MC1R gene. In this dental study that had 144 participants, about a quarter of the non-redheads had variants of the MC1R gene. These people also experienced heightened anxiety and avoided dental care compared with others who did not have the variant. There is no commercial test available for variations of the MC1R gene.

The best tips for redheads are to work on the prevention of dental problems, inform your health provider that you are highly sensitive, use TLC and be patient, wait a bit longer to let the anesthesia start to work and finally inform your doctor that you might require additional amounts of local anesthesia – because you are a special redhead!

“Got Chapped Lips?”

Posted by drgracesun on July 27, 2009 under Beautiful Smile, Healthy Smile, Information | Be the First to Comment

“Stop licking and peeling your chapped lips, just grease them and leave it alone!” Chapped lips, a condition whereby the lips become dry and sometimes even cracked (also known as cheilitis) can be unsightly, annoying and dreadfully uncomfortable. The causes of chapped lips can stem from environmental influences, like long-term exposure to dry, windy or severely hot/cold weather. Other causes could also include dehydration, salty food, a thyroid hormone imbalance, B vitamin deficiencies, hypersensitivity to cosmetic products, contacts with irritants or allergens, a fungus infection or physical illness.

Often times, our lips become dry because the layer of oil that is naturally produced by the body to coat the lips is removed, or is lacking. It can be difficult to pinpoint the exact cause of chapped lips, as it can often be multi-factorial. The sometimes-painful condition affects many many people!

Lip balm (or petroleum jelly like Vaseline) can sometimes provide relief for chapped lips, but this also depends on the degree of cheilitis in the lips. Medical grade lanolin USP can help to stimulate and repair lips, and is used in several lip repair products. Other steps you can take to eliminate or cure chapped lips are: Stay indoors and avoid windy, dry weather. Avoid alcohol, no spicy/salty or acidic foods, drink plenty of water and use a humidifier in your room if you are a mouth breather! Use lip care products from old remedies (like honey or duck fat) to products containing petroleum, lanolin, coconut oil, sheabutter, olive oil, jojoba oil, avocado oil, beeswax, vitamin E oil or aloe vera gel. An improved diet rich in Vitamin B2- riboflavin may also help, or take a supplement.

Avoid licking your lips: certain enzymes present in saliva can irritate the lips, and the evaporation of the water in saliva saps moisture from them. If you do have chapped lips, do not play with dead skin cells on the lips – pulling or peeling tissue from the lips can be damaging, the dead skin should naturally exfoliate or can be removed with small, sterilized sugical scissors.

When the corner of the mouth is cracked, this condition is called angular chelitis, and can be an indication of a riboflavin deficiency (and possible a yeast infection). Apart from improving one’s diet and taking a B vitamin supplement, try cutting down sugar intake and applying a lip moisturizer / antifugal cream. Avoid using lip gloss with a sponge wand applicator. Avoid kissing with your pets (I am sorry!) and regarding medication, it is known that Retinoids (isotretinoin and acitretin) are the most frequent drug-induced causes for chapped lips.

If you have tried different approaches to eliminate chapped lips and do not see improvement, it would be best to consult with a medical professional. Evaluate whether there is any underlying conditions requiring attention and/or treatment. Chapped lips can often be a sign indicating that there is health attention needed, so let’s have some lip care for our own good for health and beauty!

“What Killed Michael Jackson?”

Posted by drgracesun on June 27, 2009 under Current News Events, Information | Be the First to Comment

We were all stunned and saddened with the passing of Michael Jackson – it’s natural that we have a hard time accepting the early lost of such a talented person. Why did Michael past away in such sad and unexpected circumstances? Questions surrounding his prescription medications are being raised and the toxicology report might take up to eight weeks to reveal the facts. It is times like these that remind us to be cautions about using prescription drugs, especially potent painkillers, which should be discussed and brought to the public’s attention, to lower the risk of potential abuses.

Michael Jackson at The White House, 1984

Suffering from intense physical pain is one of the most unpleasant life experiences a person can go through. Modern medicine allows us to manage pain with over-the counter and prescription medications. When the pain level is intense and acute, prescription drugs will “take the edge off” of pain, and risks of adverse effects is low. On the other hand, when the physical pain becomes chronic, or repetitive, pain management with prescription drugs can become a very difficult task to sustain one’s physical and mental health and facing high risk of abuses. In America, problems of abusing prescription drugs can often times be bigger than street drugs.

The two narcotic analgesics (pain medications) mentioned in the media which were prescribed to manage Michael’s physical pain were Oxycontin and Demerol (from when he had suffered burns and over the years never stopped using prescription pain meds). Both of these drugs are opioid agonists which include such pharmacological effects as anxiolysis, euphoria, feelings of relaxation, respiratory depression, constipation, cough suppression and analgesia with abuse liability similar to morphine. When the 911 call happened, the description of ” not breathing”, which was respiratory arrest, could have been a consequence of the adverse effects of opioid agonists. There should not be any speculation as to what really happened to Michael as the toxicology report will not be ready for many weeks – he was under the care of a private physician, although an experienced cardiovascular nurse could have been an important person on staff for better patient monitoring and care.

The PDR (Physician’s Desk Reference) states that Oxycontin tablets are to be swallowed whole and not to be broken, chewed, or crushed (which can lead to the rapid release and absorption of a potentially fatal dose of oxycodone). When Demerol is intravenously administered, overdose can lead to circulatory collapse, cardiac arrest or death.

We need to be sympathetic with one’s suffering and pain – everyone should have an individualized pain management program depending upon certain physical and mental conditions, physical activity, diet and other habits. As for any health care provider, one needs to think about the long term health and well being of a patient, which at times might mean saying “no” to excessive requests for potent narcotics. Seeking solutions to correct the root of the problem and prevention should be at the forefront of any physician’s agenda. Initiating therapy at the appropriate point along the progression from non-opioid analgesics, like anti- inflammatory drugs (such as Ibuprofen) and acetaminophen (Tylenol) to opioid in pain management must be considered.

Michael, we all miss you! Strenuous 8-hour day rehearsals for shows set to open in London, combined different medications for treating chronic pain combined with ongoing mental stress proved a fatal combination for a true genius of our time.

“The Right Dentist?”

Posted by drgracesun on May 27, 2009 under Information | Be the First to Comment

Whether you have been going to the same dentist for 20 years or you haven’t seen a dentist at all for the longest time, it is important to find the right match – that is, finding the right dental professional for you. The relationship you have with your dentist is as important and personal as your relationship with your physician and hairdresser – you must trust and feel comfortable putting yourself in his or her well-trained hands.

I recently came across a person who had this to say about her dental experience: “I haven’t been to a dentist since 1992. Perhaps what I really need is a few years on a psychiatrist’s couch to reconcile my childhood and once again return to the dentist’s chair; otherwise, just knock me out, do what needs to be done, and wake me up when it’s all over.” This negative experience as a child is quite common of many patients I see, and of many adults who don’t go to the dentist, because of traumatizing childhood experiences.

If you are looking for a new dentist, ask for referrals from friends and family first. Is this dentist well experienced? Is this dentist known for pain-free treatment? Is this dentist well established in your community? Is this dentist interested in continuing education? These are questions that will help you establish a solid footing for beginning your match making! Even if you have a low budget, you can still find quality dental professionals who can take care of your smile in a manner befitting even the most unnerved patients. It is important to keep in mind that whether you believe your teeth are in good condition or not, a hygienist can clean deep-seated tartar and other mineral buildup on your teeth that you cannot clean with simply a brush and floss! Also, dental screenings are necessary to make sure no new problems have arisen in your mouth and that your teeth and gum are in good shape, even screening for oral cancer. Catching problems early on is always the least painful procedure – physically and financially!

“Do I Need Laughing Gas?”

Posted by drgracesun on April 27, 2009 under Information | Be the First to Comment

” May I have some laughing gas please?” is a popular request among the “high anxiety” or “wants to get away” group.

A patient is anesthetized with nitrous oxide.

Nitrous oxide gas (nitrous oxide and oxygen (N₂0-0₂)) is affectionately known as “laughing gas” due to its euphoric qualities when inhaled. Discovered in 1772 by Humphrey Davy, he had this to say about its effects: “On the day when the inflammation was the most troublesome, I breathed three large doses of nitrous oxide. The pain always diminished after the first four or five inspirations; the thrilling came on as usual, and uneasiness was for a few minutes swallowed up in pleasure.” When the gas is inhaled (at an approximately 50% nitrous oxide + 50% oxygen dilution), after several minutes nearly all pain dissipates from the body and a euphoric warmth spreads throughout the body. This pleasant feeling is not only pain-reducing, but can calm anxious nerves and relax all but the most fearsome patients. The calming, relaxing and euphoric qualities of nitrous oxide make it a prime candidate for anesthetizing patients who have irrational fears about dental procedures who are unable to get comfortable in the chair. Because laughing gas can be highly effective in treating moderate dental anxieties, nitrous oxide gas can also benefit the dental physician working on a patient – calm environments benefit everyone! Patients with high blood pressure, or who have had heart attacks in the past and are at risk from traditional IV anesthesia are prime candidates for nitrous oxide sedation.

The level of sedation and warmth felt in the body after inhaling nitrous oxide gas depends on the concentration of the dosage, and how long the gas is administered. Because the gas is administered into the lungs, it is saturated into the blood stream very quickly  and once the procedure is finished, there are no lingering “hangover” effects, meaning it is safe to drive home without an escort. Local anesthesia is still necessary for the treatment site, but needle-phobia will disappear with laughing gas. If you suffer from dental anxieties and have tried different techniques, seen different dentist and you still can not  face dental work with ease, it is worth while for you to try nitrous oxide during your next dental procedure. Have a discussion with your dental professional.

“Do I Need A Root Canal?”

Posted by drgracesun on under Healthy Smile | Be the First to Comment

Mark came in with a severe tooth ache, and after an examination, I could see the tooth was severely broken down. The basic options were to either save the tooth – going through root canal therapy and finishing with a post and crown restoration, or to remove the tooth and restore with a dental implant and crown. “Should I save my tooth, or should I pull it!” This is the eternal question!

Root canal therapy (also known as endodontic therapy) is a procedure of treatment for the pulp of a tooth once it has become infected – the inner pulpal material  must be removed, in order to protect and decontaminate the tooth from future microbial invasion to the jaw bone. Once a root canal procedure is performed, however, the lack of nutritional supply in the tooth (once the organic tissue is removed from the tooth during the procedure) will render the tooth brittle, the weakened tooth should be reinforced and restored properly, with a post and crown.

Root canal treatment does have a bad reputation due to the pain and the stigma associated with the procedure. Often times, a patient will have a root canal performed and think the procedure was a success, only to have pain and infection return several years down the line. The complexity of the anatomic root variation could be an obstacle and techniques can often be tedious, which is why specialized service is usually performed by a highly trained dentist or endodontist. Special tools like microscopes are also often necessary for a successful procedure. Advanced instrumentation and technique will ensure long-term success.

Regular dental checkups are vital to properly maintain your dental health. If the unhealthy dental condition requires a root canal treatment or an extraction, have your dental professional explain the pros and cons of each option, then make an educated decision. If there is a mystery pain, a 3-D image (Morita Survey of CT scan ) would be invaluable for proper diagnosis . Regular dental x-rays are not capable of capturing images of a cracked tooth nor accessory root canals (which are small and difficult to see). These tiny cracks or canal issues can lead to prolonged discomfort, which you may have thought was a figment of your imagination! If the prognosis was poor, or a tooth has broken down so much that it has become unrestorable, extraction and a dental implant might be a more sustainable investment to you dental health.  Prevention is always the best treatment! Brush and floss your teeth twice daily and after meals. If you have any dental pain, schedule an appointment with your dentist sooner rather than later.

“I Have Canker Sores!”

Posted by drgracesun on March 12, 2009 under Healthy Smile, Information | 3 Comments to Read

When you stay up way too late you might find pimples on your face and canker sores in your mouth – never fun to get! This painfully annoying little mouth sore – also known as an aphthous ulcer, can be quite bothersome to your eating and speaking actions for days. Thankfully, you can still kiss your loved ones with a canker sore, which are not contagious, different from viral cold sores (also known as a fever blister) caused by the herpes virus. Both are ulcerative sores in the mouth, but canker sores occur on the soft tissue inside the mouth. Cold sores tend to be on the outside of the mouth, around the lips.

Canker sores can arise for many reasons; the most common are stress factors, like a lack of sleep. Stress can wear down your body’s immune system, making your oral environment more susceptible to ulceration. Food allergies or sensitivities (to acidic fruits or toothpaste containing sodium lauryl sulfate for example) can trigger canker sore formation. The environment you are in can also stress your body and cause canker sores, like being in extreme heat or cold. Deficiencies in iron, folic acid, zinc or vitamin B12 will lead to a nutritional imbalance in your body, making you more susceptible to canker sores. Bacterial infection, hormonal imbalances and hereditary issues can all be causative factors. Finally, dental appliances or procedures which place pressure in specific parts of your mouth (like braces) can cause canker sores. Some physicians have theorized that canker sores are actually hereditary, but extensive research on this topic has not yet taken place.

So what do you do if you have a canker sore?  Improve your lifestyle! If you are able to extend your sleep cycle to between 7 and 8.5 hours of sleep nightly, maintain a balanced diet and master “stress management” at work, school and at home, your canker sore frequency will decrease. Canker sores are your body’s way of telling you to slow down and re-evaluate! Luckily, most canker sores will heal within 14 days (albeit painfully), unless your immune system was compromised. If you have a canker sore, avoid contact with it. Any unnecessary stimulation to the site can cause you to say ouch! Avoid spicy or acidic foods as this will further irritate the site. Make sure you are eating a well balanced diet, take supplements like vitamin B and C, and reduce your acidic fruit intake.

There are topical agents which can relieve canker sore symptoms, such as Milk of Magnesia, kenalog in orabase, tetracycline, suspension or low-level-laser-therapy (LLLT). Non-alcoholic mouthwash can also reduce the frequency of canker sores. If you do suffer from severe, frequent or lingering canker sores, speak with your dental professional or your primary health care physician.  Remember, the best path to a healthy, ulcer-free mouth is proper oral hygiene, a healthy lifestyle (including quality sleep) and a healthy, balanced diet – if you take care of your body, you can enjoy your quality of life even more.

“I Have Sensitive Teeth!”

Posted by drgracesun on February 15, 2009 under Healthy Smile, Smart Smile | Read the First Comment

Do you suspect you have a cavity because you have a sensitive tooth? Do you stay away from ice cream, even though your teeth are not your waist line?

Tooth sensitivity is a common problem. It can be brought on from temperature change, applied pressure or touch;  each sign and symptom tells a different story. There are two types of tooth sensitivity :

Dentinal sensitivity is quite common and is caused when the dentin , the layer of the tooth beneath the enamel , is exposed to your oral environment. As your teeth are used and abused, the outer enamel layer of the teeth becomes worn. Night grinding (bruxism), tooth decay, gum recession and damaged dental work (such as fillings) will all eventually cause the dentin  to become exposed. Because of dentin’s porous nature, when the protective enamel layer of your tooth is compromised, any food or temperature stimulation will affect the nerve endings within the tooth’s core , causing varying levels of pain.

Pulpal sensitivity is an inflammatory reaction of the pulpal tissues, including blood vessels and nerves in the center of the tooth. The causes of this type of sensitivity include tooth decay or infection, recent dental work, night grinding or injured and broken teeth.

To have your dental professional assess your dental condition, you must have a proper diagnosis ! Afterwards, your dentist will provide you with proper treatment options, which could include a proper oral hygiene program, cleaning the mouth after every meal using a soft tooth brush and appropriate toothpaste (containing fluoride or potassium), and brushing and flossing twice a day. Home fluoride rinse or gel can be used to desensitize and remineralize  your teeth. A night guard can be custom fitted to your mouth to protect your oral structure (worn while you sleep). A proper diet (eliminating sweets and/or acidic foods and beverages) will help prevent sensitivity. Your dental professional can work with you to harmonize and balance your bite so all teeth receive proper loading force as well – a proper fit and selection of dental restorations will assure integrity of pulpal health.And there is possibility for root canal therapy or Gum treatments if the problems are more advanced.

It’s time to start taking care of yourself – get the proper treatment for your tooth sensitivity and be worry free!

“Why Do I Grind My Teeth?” (Bruxism)

Posted by drgracesun on January 27, 2009 under Healthy Smile, Information | 3 Comments to Read

When I examine a patient’s mouth,  I often inform them “You have been grinding your teeth at night! If  you’re grinding at night as well,  please take a vacation – doctor’s orders!” We laugh, then get serious about what was just said. Common responses from patients include:

“How do you know that I grind my teeth?”

“Why do I grind my teeth?”

“I sleep with my mouth open; I do not grind my teeth!”

“Yes, I know, but I do not want to wear a night guard !”

Let’s have a discussion.

Teeth grinding is a multifactorial phenomenon, it can originate from bite problems, posture problems, stress, diet or even certain oral medications. You may experience one or multiple symptoms of night grinding, including sensitive teeth, receding gums, teeth chipping, teeth movement, flat teeth, broken teeth, damaged dental restorations (such as fillings), and even headaches and a sore jaw .

Usually, during the day, there is space between your upper and lower teeth – the teeth are not in contact, they come in contact only when they are being used to chew food. Eating food exerts approximately 5 – 10 pounds per square inch of loading force. This is normal and will not create wear and tear issues in the tooth structure. At night however, during sleep, facial muscle contractions (like the Masseter muscle) generate a much greater force, anywhere from 300 to 500 or even up to 1000 pounds per square inch of force! This is very powerful, and very destructive.

So how do we fix the problem? Management of night grinding can be approached from several angles. By wearing a night guard, immediate protection is provided when sleeping. The design of the night guard can be as simple as a thin coat of silicon rubber material which is custom-molded to fit over your teeth, or can be highly specialized to help realign your jaw when made from acrylic. Ask your dentist about this.

Grinding your teeth at night (bruxism ) occurs during the REM (Rapid Eye Movement) cycle of sleep, for light sleepers. If restful sleep can be induced, the REM cycle of sleep can be reduced, contributing to a more peaceful night for your mind and also your body (including your facial muscular system). This means less grinding!

Achieving restful sleep can be tricky, there are many techniques: meditation to clear your mind in preperation for a restful night of sleep, deep and slow breathing, and cutting out sugar and caffeine in the PM hours will all be helpful.