In all of my years of practicing dentistry one of the things that has had a lasting effect on me has been when a patient presents with oral cancer. This connection is a result of having a few people close to me who were diagnosed and resulted in tragic outcomes. On the other hand, I have also known quite a few who were diagnosed early and had a positive prognosis. Early detection is critical which is why our practice is committed to screening for oral cancers using the latest innovative techniques.
According to the Oral Cancer Foundation, nearly 53,000 Americans will be diagnosed with oral or oropharyngeal cancer this year. It will cause 9,750 deaths, killing roughly one person per hour 24 hours per day. Historically the death rate for oral cancers is high due to the cancer being discovered and diagnosed late in development. Often it is only discovered after it has already metastasized to another location, like the lymph nodes in the neck. Prognosis at that stage of discovery is much worse than if it is caught early in a localized intraoral area. In the early stages, the patient may not even notice, so the oral cancer can grow without causing pain or obvious symptoms.
There are some specific risk factors such as smoking and tobacco use, heavy alcohol use, UV radiation (lip cancer), and a connection to certain strains of human papillomavirus. Even without clear risk factors, a person could still develop an oral cancer and because symptoms can go unnoticed in the absence of pain or obvious physical changes, an screening can be the most important step to early detection. A dentist can see and feel tissue changes while they are still very small and in the earliest stage. There may be a red or white patch of tissue that looks just like a typical canker sore, however any sore area of your mouth which doesn’t heal within 14 days should be looked at. Other symptoms may be a painless lump in the mouth, pain or difficulty swallowing, speaking or chewing, hoarseness that persists or numbness in the mouth.
If something suspicious is detected you may be referred to a specialist for a biopsy. In our office we now use the Velscope to perform enhanced oral cancer screenings along with an exam. There is an 82% survival rate when oral cancers are caught early. The screening is simple, painless and takes just two minutes. It can reveal tissue abnormalities before they become visible to the naked eye. I am pleased to be able to offer this technology to our patients.
For years my mother smoked cigarettes, from as early as I can remember until she finally quit. Come to think of it, she apparently smoked some while pregnant. This was not entirely uncommon. It’s a well-known fact that smoking causes lung cancer among other health concerns, but it is also known that smoking is an addictive habit not easily stopped by most people who start. Fast forward several decades and e-cigarettes, or vaping as it is also referred to, came along as perhaps a less harmful, possibly less addictive alternative for people trying to move away from traditional (combustible) cigarettes. I think the idea was that these are less damaging than cigarettes and may be used as a transition for those wishing to quit smoking cigarettes because they contain little or no nicotine, but let me tell you, more and more studies are showing that vaping/e-cigarettes are detrimental in their own right. I asked my grandchildren if they were familiar and learned that it is an unfortunate and all too common practice among some high schoolers. Kids congregate in the school bathrooms and inhale. The media has brought forth a host of stories on this alarming trend to be called an epidemic among youth. These have been dubbed the most commonly used tobacco product among teens in the US. As a result, the FDA is pushing hard to restrict access of e-cigarettes to youth and enforcing legal action and fines on retailers that have and continue to sell to underage users. It seems blatantly obvious that the marketing is directed at teens, with the colors and flavors resembling candy and other sweets. E-cigs are often designed to appear like ordinary objects like pens or flash drives. I have recently learned that e-cigarettes can also be used for delivery of marijuana or other drugs as well. I am not even going to address that at this time. I find this particularly concerning because the yet undeveloped adolescent brain is especially vulnerable to nicotine addiction.
Flavored liquid is vaporized and inhaled through a handheld electronic vaping device. A given liquid may or may not contain nicotine, although this trend is still new enough that the long term effects on oral health and overall health are unclear. The liquid also contains propylene glycol, a petroleum byproduct used in antifreeze, paint, liquid detergent and thousands of commercial food products. When heated, studies have shown these e-liquids to contain toxins such as diethylene glycol (also used in antifreeze), lead and chromium. I have seen patients with dry cough or chemical burns on the palate as a result of inhaling the e-liquid, but more often they are unaware because they perceive them as harmless. It makes me wonder how it affects their lungs. Xerostomia, or dry mouth, is another effect that can lead to increased tooth decay. I believe it’s important to educate patients and make them aware that e-cigarettes are not a healthy alternative to smoking. By explaining the negative effects and showing them the oral health issues with the use of the intraoral camera it becomes more real.
Recently my granddaughter experienced a canker sore, not an uncommon occurrence for her, but this one was on her throat. The pain was excruciating, more so because of the location. It hurt to swallow, to speak, and pretty much hurt constantly. It even kept her awake at night. Canker sores, also referred to as an aphthous ulcer, are small, shallow sores inside the mouth, under the tongue, cheeks, or along the gums.These lesions are usually no larger than a centimeter, are usually self-diagnosed and self-treatable and often clear up within a week or two, but the common point is they can be quite painful and irritating. I have seen patients from children to adolescents to adults who get them, but they seem to be more common in adolescents and young adults. The treatments, when necessary, range from over the counter natural remedies to mouth rinses, pastes ointments or sometimes a prescription medication.
Canker sores have varying causes, but can sometimes be prevented. Some people are more susceptible, so avoiding spicy or acidic foods, mouth injuries (like brushing too vigorously), and minimizing stress could help. Canker sores are not directly caused by a virus or bacteria, but are an autoimmune response, meaning the body attacks itself. In some cases, they could be caused by a vitamin or mineral deficiency, a hormonal imbalance, or a food allergy. Some medications can actually make certain individuals more prone, as in the case of some cancer treatments. Canker sores can even be hereditary. Determining the cause is not always easy, although doing so will help prevent them in the future. This is of little comfort to people when they already have one or are unable to directly attribute the cause to any of the aforementioned.
If and when I get the rare canker sore, I use a prescription oral paste to relieve discomfort. There are many different treatments and remedies I have heard of and some I have suggested. Rinsing with warm water and baking soda or salt, rinsing with an over the counter antiseptic oral rinse like Biotene, drinking chamomile tea with honey for the inflammation (not too hot), using an over the counter oral gel, ointment or paste. Clove oil has been shown to have fantastic ability to numb pain. My daughter uses clove oil and other essential oils for her canker sores with excellent results. As for my granddaughter and her canker sore on her throat, she found Chloraseptic sore throat spray brought the most relief. If you happen to get a canker sore you can try one of these suggestions or your own remedies. If you have recurring canker sores or some that last longer than fourteen days it could require more than an over the counter pain reliever and further investigation.
If you’ve ever thought about straightening your teeth but you didn’t want to go through the lengthy process of metal braces, then Invisalign just may be the answer you are looking for. The clear plastic aligners have become a popular alternative choice among adults and teens as well. Many of my patients who had metal braces years ago wish that Invisalign had been available to them.
Patients who want their teeth straightened and are considering braces ought to consider Invisalign. Here are some reasons why:
- The aligners are completely removable for eating, brushing and flossing.
- They are pretty much invisible.
- There aren’t really any dietary restrictions as with traditional metal braces and the risk of breaking a wire or bracket.
- The thin, flexible material is comfortable and will not irritate the mouth as metal braces can.
- The aligners can act like a mouthguard to protect the teeth from grinding.
The treatment plan for Invisalign is broken into stages. With the use of special computer software, Invisalign designs the clear plastic trays that will be worn for two weeks for a minimum of 20 hours per day. You then move on to the next set and so forth in order to gradually move the teeth into the best alignment.
Ask me about Invisalign if it is something that interests you. It has been a clear choice for many of our patients with remarkable results.
- What about amalgam fillings? Are they still used and do you replace existing ones?
We use porcelain or composite fillings for our patients and have for a number of years. Many patients still have amalgam fillings and if and when they require replacement we use the newer alternative materials. The controversy over the years surrounding amalgam fillings is in regards to mercury. It isn’t definitive whether mercury is a true safety concern or if it is harmless. The FDA had said any ties to diseases and autism, Alzheimer’s and MS is unfounded, but more recently has called for stricter regulations without sufficient evidence. In our practice, we take every precaution possible to ensure we meet and exceed safety guidelines and we use porcelain and composite for fillings.
- If I want to change the shape of my teeth what options do I have?
We can enhance the shape of teeth whether it is to close gaps, repair chipped or cracked teeth or have teeth appear longer. One way is by bonding, applying tooth-colored resin to the tooth surface and then harden it with a special light to “bond” it to the tooth. Crowns are another way to shape teeth. They are basically a cap that fits over the existing tooth, cemented into place and is visible above the gum line. Recontouring is another example of tooth shaping. And then there are veneers, thin translucent pieces of tooth-colored composite or porcelain are used to repair, strengthen and enhance the appearance of teeth. It is ideal for teeth that are chipped, cracked, stained or gapped.
- What are dental sealants?
Sealant is a thin plastic coating painted on the chewing surfaces of teeth (usually back molars) to protect enamel in the recesses or grooves. Studies have shown over the last two decades that the protective coating decreases tooth decay. This is ideal for children or people who are prone to cavities.
- Are dental x-rays safe?
The concern people have with x-rays is the exposure to radiation. Keep in mind that x-rays done at a routine dental exam expose a person to very low amounts of radiation, less than a day’s worth of typical background radiation from things like our TVs or spending time outside in the sunshine. Improvements in protective aprons and x-ray equipment allow for much less exposure to radiation than we had decades ago. X-rays allow dentists to see beneath the tooth’s surface and thus are the best diagnostic tool we have for identifying hidden tooth decay and periodontal disease. Uncovering problems before they become bigger is the goal. According to the ADA, how often a patient should have x-rays varies with age and history of tooth decay. The bottom line is that we do not want to do them unnecessarily.
- Can you just not use the drill?
The drill is used to create an opening and remove decay completely before filling and bonding the cavity. Drills are also used to remove plaque or old fillings. Most people’s fear is associated with the high-pitched sound of the drill and once a dentist begins the procedure, the patient is often able to relax as they soon realize it is harmless.
- Why is a teeth cleaning and checkup appointment necessary every 6 months?
Regular visits are so important because it is a preventative measure, avoiding problems before they start. We suggest twice a year, but if your teeth are in great condition and your habits are good then you might get by with once a year. We can usually catch small oral health issues before they become big issues. Many diseases and health conditions have symptoms that appear in the mouth so finding them early is essential to overall health.
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