It is not without purpose that dentists repeatedly herald the fact that your mouth tells us a great deal. Yes, it will communicate — and without words — whether you have been brushing or flossing. But it will also tell us a story of your overall health.
For centuries, even the physician began his examination of the patient with a look at the head, ears, eyes, nose and throat. He would ask you to “Say aah.”
Ever wonder why?
The specific reason is that the sound you make elev
ates the soft palate and allows for a clearer view of the back of the throat, but it also tests the function of the vagus and glossopharyngeal nerves. Doctors have an abbreviation they use to describe this evaluation: HEENT (head, ears, eyes, nose, throat). More recently, health professionals have been pushing for a modification to that standard evaluation, changing it to “HEENOT” instead (head, ears, eyes, nose, oral cavity, and throat).
Thus, health professionals can work together in the best interest of their patients. By performing a thorough oral exam, the dentist will often spot systemic problems and refer their patient to a physician for further evaluation. The family doctor can, in turn, evaluate oral health and alert the patient to the fact that it is time to see a dentist in order to get better.
Anyone following our blog or newsletter for any length of time has already been acquainted with the fact that what goes on in our mouths can affect the health of the rest of our bodies. Studies continue to show the links between oral and general health. By way of review – periodontal disease has been linked to complications with diabetes and pre-term labor in pregnancy. There is also a strong connection between poor oral health and rheumatoid arthritis, cardiovascular disease, strokes, and Alzheimer’s.
The fact that we perform an oral (and oral cancer) examination during your bi-annual checkups and “cleaning visits” does not excuse you from seeing your doctor for general health problems, and vice-versa. We are professionals in oral health and regular maintenance in our office helps you to stay healthy. So you want to be certain that each time your family doctor ask you to “say aah,” they then say “good job – everything looks great!”
The posting below is actually taken from our Weird Dental “Facts” section. It’s an assortment of dental trivia and facts — some true, some we’re not so sure about 😉 — but either way, we hope to entertain, as well as educate you, with our postings.
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This dental fact was prompted by a recent television program I watched that discussed three of the top life-threatening emergencies. We hope you never find yourself confronting this type of problem, so here is the Weird Dental “Fact”:
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A dental infection can kill you.
Weird?
Perhaps.
But also true.
A toothache left untreated can, over time, develop an abscess. (An abscess is an infection that fills with pus and debris.)
Periodontal disease, left untreated, can also develop an abscess over time.
The trouble with many dental problems, though, is that in their early stages they are seldom painful.
In fact, sometimes, they aren’t painful even after they become more advanced. So people tend to put off treating cavities and gum disease hoping it will just go away or get better on its own. Then, when it does get worse, they will often put that off as well This is where it can get really dangerous.
One complication of a dental infection is called Ludwig’s Angina. It’s a type of infection that can travel from the roots of the teeth to the floor of the mouth and under the tongue. The infection can spread very quickly, creating a swelling that can block your airway or prevent you from swallowing. This can be life-threatening.
It can be cured with quick treatment that gets the airway open and with antibiotics, but sometimes surgical intervention is also necessary.
The better solution is to never let your oral health become so neglected as to allow the possibility of this type of infection.
You go to the dentist every six months to have your teeth cleaned. Well, hopefully you are getting regular dental visits. Right? But, just what is the dentist doing when he cleans them anyway?
We’ll get into that shortly. And maybe you can even recall the dentist pointing out places where you had some tartar. But if you are like many patients, you nodded your head and he went on cleaning.
On the other hand, possibly you were thinking: “Just what the heck is tartar anyway? Isn’t that a Russian thing? Or, maybe, it has something to do with that white sauce. No, that doesn’t make any sense. Oh well, I don’t want to embarrass myself by asking.”
And it went in one ear and out the other.
Let’s try to clear it up a little. Tartar is basically hardened plaque. And plaque is the sticky mix of bacteria, food particles and proteins that forms in your mouth — pretty much every day. It sticks to your teeth, it gets underyour gums, and it builds up on your dental work. The trouble is that when plaque hardens, it builds up – actually, very much like a coral reef.
And like a coral reef it can spread out over a broad area. But the damage it causes hits you in two ways. Firstly, the bacteria that cover the tartar damage your gums from the toxins they secrete. This can cause the gums to become inflamed and to bleed. In its mildest form, this is called gingivitis. But secondly, the tartar acts as a foreign body. Get the idea of having something stuck in your teeth – say, a shell of popcorn. It won’t take long before the gums get puffy, red, and irritated. The thing is, if it’s popcorn, you notice it pretty much immediately. After all, one moment everything is fine, and the next you’ve got this thing stuck in your gums. And until you pick it out, your gum stays puffy and protests its presence with bleeding and, sometimes, pain.
The difference with tartar is that it generally forms more slowly. So, in most cases, people don’t even notice it growing. Nor do they notice what it is doing to their gums and the surrounding bone. Because when gingivitis is not gotten under control, it gets worse. Pockets form between your teeth and gums and get filled with more bacteria and more tartar. This leads to an infection called periodontitis.
Over time, your immune system kicks in, trying to use stronger methods to fight this problem that just isn’t going away. The result: it starts to work against you and breaks down your own bone. What’s more it usually does it painlessly. So many people don’t even realize they are losing bone until their teeth get loose. That’s why this is the number one cause of tooth loss worldwide.
So what is the dentist doing when he cleans your teeth? He’s removing the foreign body (the tartar) and what is basically a condominium for your harmful bacteria. But don’t feel too bad for your evicted bacteria. They will try squatting in a new home under your gums in less than twenty-four hours. And they are associated with such nasty effects as heart attacks, strokes, Alzheimer’s, pancreatic cancer, and more.
For the sake of your health, when it comes to tartar, you should care. Steps you can take to get matters under control include brushing after meals, daily flossing, and eating a healthy diet. Oh, and if you smoke, chances are you will build more tartar as well. There’s one more reason to quit.
Once tartar has formed on your teeth, only your dentist or hygienist can remove it. So, be sure to visit your dentist at least twice a year to remove any plaque and tartar that has built up and to prevent more serious, and costly, health problems.
Recently, a great deal of attention has been placed on economizing in all different aspects of life. Some people have even considered cutting back in the area of health care by putting off routine maintenance care. While this is a little like playing Russian roulette when it comes to dental health — for reasons I’ll explain shortly — there may be a better way to dodge the financial bullet. And it may be a much simpler one.
After more than twenty years of practice I have seen people consider all sorts of ideas to deal with rising dental costs. Often, people become fixated upon dental insurance as the primary solution to the majority of their dental needs. Because dental insurance generally tends to be pretty expensive relative to what it pays out, especially if you are buying it yourself, patients that rely on it exclusively often end up worse than when they started. Dental insurance typically has waiting periods before it can be used, during which time existing conditions advance, becoming more expensive.
In these cases, you have to wonder – if the premiums are costing you more than what the company pays you back – what’s the point? Obviously, this arrangement is a much better deal for the insurance company than for the patient. Let’s also consider that when I first started practice, dental insurance maximums averaged $1,000 to $2,000 annually. Twenty years later, they average . . . $1,000 to $2,000 annually. If insurance kept up with inflation alone, the annual maximum should easily be over $5,000. Don’t hold your breath for that one though. Patients would be better off just setting aside the amount they pay for premiums. They usually come out better in the end.
Putting off dental care often becomes more costly to patients for several reasons. Firstly, many dental conditions are actually painless in the early stages. Periodontal disease is a prime example. This is a condition in which the bone surrounding the teeth becomes lost, leading to a variety of circumstances including bleeding gums, loose teeth, bad breath and, eventually, tooth loss. It is the number one reason that people loose teeth world-wide. For the most part, it doesn’t hurt. When it does, if it does, it is usually too late. The tooth or teeth have to come out.
Likewise, dental decay usually doesn’t hurt in the early stage. Actually, I’ve lost count of the number of times it didn’t hurt in the advanced stage either – but this is usually the point at which the patient becomes aware of a problem. A piece of the tooth breaks off, or they actually experience pain. The tragedy of this scenario is that when it reaches this stage teeth often end up requiring more expensive root canal therapy or extraction. Dental costs can very quickly escalate as much as ten times from the cost of a simple filling to what it costs to complete a root canal and crown.
So what do you do? Focus upon prevention.
Here is a true story I hope will leave as big impression upon you as it did me at the time:
When I was a dental student, I recall a lecture give by one of my professors in which he made a powerful point on the subject of prevention. The seminar dealt with the subject of prosthetics – more specifically, the fabrication of crowns and bridges. This professor, however, was one of those rare dentists who actually had two recognized specialties. He was a professor of prosthetics, but he was also a periodontist. While this was a crown and bridge lecture, he taught us a very valuable periodontal lesson.
Here’s what he did. The seminar was pretty informal at this point. The professor told us he was going to put up some slides of patients and have us guess their ages – just by looking at their x-rays and then at pictures of their gums. As a student, I remember thinking this was a refreshing little game and most of the class was doing quite well calling out the ages. Looking at the x-rays, we would evaluate bone levels, tooth eruption patterns, tooth wear, number of restorations and similar factors to make our “guess.” Then we would look at the color and texture of the gums and appearance of the smile and offer up our estimate. The professor would then show us the face of the patient and tell us their age. This went on for a while and we all did pretty well.
He then put up the next slides and guesses rang out: “twenty-five,” “thirty,” “twenty-seven,” went the typical guesses. I don’t think I can remember seeing a single filling on those slides, though there could have been. Nothing changed when he showed us a picture of the gums. They looked like a teen-ager’s. Then he put up a picture of the face. The person pictured was obviously in their late seventies, maybe even early eighties.
Dead silence. Then there was a small commotion and most of the class pointed out that the slides got mixed up.
The professor paused, and said “No. This is correct. Let me tell you how I can be sure. This is a picture of my father. Those are actual x-rays and a recent picture of his gums. How is it that he has such excellent oral health?”
He then went on to tell us how when his father was a younger man, he had a visit with his dentist and he complained to him that whenever he ate, he would get food stuck between his teeth. His father wanted to know if there was anything he could do about it, because it was pretty annoying.
The dad’s dentist thought about it for a second and told him: “Well, I’ll tell you what I do when that happens to me. I go over to my wife’s sewing kit and take out a piece of silk thread and just pass it between my teeth.” As a student, I wondered when floss became invented. Evidently, it just wasn’t popular back in those days.
In any case, our professor went on to explain that his father did exactly that after every meal since he was a young man. His gums, teeth and bone levels were almost unchanged. That’s what he had to show for his efforts.
I filed the image in the back of my mind, but I have to be honest – I didn’t exercise the same level of commitment – just yet.
Oh, sure, I brushed, watched what I ate, and took vitamin and mineral supplements. But my flossing was sporadic. That is, until I really started looking at what happened to my patients and how those who flossed performed against those who didn’t. If you asked me today: do I floss regularly? Absolutely. You can’t buy cheaper dental insurance.
Flossing benefits your gums, your breath, your teeth, your lungs, your heart – in short, you.
Do you know that probably up to a third of the cavities I treat happen between the teeth? This is why regular exams are so important. You simply can’t see this area. For that matter, without x-rays, neither can I in most cases. But my point here is simply this: even if you brush after every meal and snack, without flossing this area never gets cleaned. Why would anyone become surprised that an area that never got cleaned could decay over time?
There are all sorts of reasons people don’t like to floss, but the reasons to do it are actually pretty compelling and very cost-effective. Think it over. Maybe floss is the most affordable dental insurance. . . .
Consider this article a public service announcement. I really dislike it when patients lose their teeth unnecessarily. My practice philosophy is that if a person has a dental problem, the goal is to handle that difficulty first, but then empower the patient with the correct knowledge that will keep him out of trouble from there on out. Ideally, my hope is that most future visits to my office will only be for routine maintenance.
Unfortunately, and all too often, I encounter new patients with teeth that are so badly decayed there is little hope of salvage. Possibly just as frequently, I find these patients scheduling a checkup – usually after a long absence from dental care – who are surprised to learn that they have any cavities at all. Sometimes they will think they lost a filling when, in fact, a piece of their enamel has broken away.
Why are they surprised? The common denominator seems to be the idea that cavities are supposed to hurt.
Well, sometimes they do hurt. But most of the time – especially in the early stage – they don’t.
In fact, by the time a tooth does start to hurt you it’s usually pretty bad. More often than not, it is so bad that a dentist is evaluating whether it can be treated with endodontic (root canal) therapy or whether it needs to be extracted. A little understanding of basic dental anatomy is helpful here.
Take a look at the illustration below:
The outer layer of the tooth is comprised of enamel. This is the hardest substance in your body. It breaks up your food and is designed to last you a lifetime.
And now, here is the important part for you to understand: it doesn’t contain any nerves.
It is more than ninety-five percent mineral. Water and organic materials make up the balance. And because it doesn’t have nerves, it doesn’t have feeling. This is actually quite practical since it wouldn’t do to have pain every time you bit into something. On the other hand, it also means that it can be decayed without giving you a warning.
In fact, decay can also travel into the supporting layer – the dentin – and still not cause you pain. It usually has to travel pretty close to the inner layer that contains the blood vessels and nerves – the pulp – before you feel it. Of course, by then, the tooth has generally undergone considerable destruction.
Another factor that makes spotting decay difficult is the way it spreads. I have drawn two black triangles into the enamel above. Notice that the narrow point is on the outside of the enamel. The broader base faces the inside of the tooth. This is how decay usually travels. Sometimes, it will undermine the interior of the tooth while the outer, harder enamel still maintains its form . . . until it eventually crumbles because the underlying supporting dentin has been eaten away by decay.
Many cavities also form at the contact point between two teeth. These are areas that you simply cannot see. Even the dentist needs an x-ray to spot these cavities in most cases.
So what does all this really mean? Spotting decay is not always that easy. As dentists, we use visual examination, but we also rely on probes, x-rays, and even laser detection devices to locate cavities. Even then, it can be difficult to find cavities under existing fillings.
Don’t rely on pain to tell you if you have a cavity in your tooth. If you do, you can be assured that your treatment is likely to be more uncomfortable, expensive, and may even result in the loss of a tooth that could have been treated much more easily earlier in the game.
If you have a loved one, who still has their teeth and hasn’t seen a dentist in a while, have them read this article. You may be saving them from quite a bit of discomfort – not to mention time and money – if they catch potential problems before they are hopeless.
Some of you may be thinking, “No big deal. If it’s that bad, I’ll just pull it.” OK, sometimes that is necessary, but therein lies a lesson for another day.
Dr. Richard Walicki is a dentist practicing general and cosmetic dentistry. While we hope you find the information contained herein interesting and useful, this blog is for informational purposes and is not intended to diagnose any oral disease. Dental conditions should be evaluated by your dental health professional or a qualified specialist.
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