While most dental problems are caused by disease or trauma, sometimes the root problem is psychological. Such is the case with bulimia nervosa, an eating disorder that could contribute to dental erosion.
Dental erosion is the loss of mineral structure from tooth enamel caused by elevated levels of acid in the mouth, which can increase the risk for decay and eventual tooth loss. While elevated acid levels are usually related to inadequate oral hygiene or over-consumption of acidic foods and beverages, the practice of self-induced vomiting after food binging by bulimic patients may also cause it. Some of the strong stomach acid brought up by vomiting may remain in the mouth afterward, which can be particularly damaging to tooth enamel.
It’s often possible to detect bulimia-related erosion during dental exams. The bottom teeth are often shielded by the tongue during vomiting, so erosion may be more pronounced on the unshielded upper front teeth. The salivary glands may become enlarged, giving a puffy appearance to the sides of the face below the ears. The back of the mouth can also appear red and swollen from the use of fingers or objects to induce vomiting.
Self-induced vomiting may not be the only cause for dental erosion for bulimics. Because the disorder causes an unhealthy focus on body image, bulimics may become obsessed with oral hygiene and go overboard with brushing and flossing. Aggressive brushing (especially just after throwing up when the tooth enamel may be softened) can also damage enamel and gum tissue.
Treatment must involve both a short — and long-term approach. Besides immediate treatment for dental erosion, a bulimic patient can minimize the effect of acid after vomiting by not brushing immediately but rinsing instead with water, mixed possibly with a little baking soda to help neutralize the acid. In the long-term, though, the eating disorder itself must be addressed. Your family doctor is an excellent starting point; you can also gain a great deal of information, both about eating disorders and treatment referrals, from the National Eating Disorders Association at their website, www.nationaleatingdisorders.org.
The effects of bulimia are devastating to mental and physical well-being, and no less to dental health. The sooner the disorder can be treated the better the person’s chance of restoring health to their mind, body — and mouth.
If you would like more information on the effect of eating disorders on oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Bulimia, Anorexia & Oral Health.”
With all the new tooth-colored fillings for cavities, it's easy to overlook metal amalgam. While this mainstay of dental care for over a century might not be as attractive as composite resins or glass and resin ionomers, it still has the advantage of strength and durability.
Amalgam is a stable metal alloy usually made up of silver, tin, copper and mercury. The metals are proportioned and mixed precisely to guard against “free” mercury molecules, which could pose a health hazard. The mixture is pliable at first, but then sets hard once molded into the prepared area of the tooth.
Besides strength, amalgam's other advantages include low cost, high resistance to wear and biocompatibility (not toxic to the body or allergy-producing). At the same time, it can require more tooth structure removal to accommodate a filling and cause higher sensitivity to temperature for a while after installation. Its main disadvantage, however, is appearance — it's now considered unacceptable from an aesthetic point of view to use it in visible areas like the front teeth.
Because of this, materials resembling natural tooth color are coming into vogue, especially as their strength improves. Still, dental amalgam continues to play a useful role, especially in less visible back teeth with higher chewing forces.
One past concern about dental amalgam is the inclusion of mercury in the alloy. As mentioned before, mercury is hazardous in a “free” form when not knit microscopically with other metals; as such it can emit a vapor that could enter the bloodstream and damage the nervous system. But after several studies by various organizations, the American Dental Association has concluded amalgam's precise mixture prevents the mercury from taking this form: although some vapor is given off during chewing it's far too low in concentration to pose any danger.
Dental amalgam continues to be an effective choice for fillings. Whether it's the right choice for you will depend on the type and location of a tooth to be filled, and whether durability is a higher concern than appearance. If we do recommend an amalgam filling, you can be assured it's a safe and lasting choice.
If you would like more information on your choices for dental fillings, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Silver Fillings — Safe or Unsafe?”
If your child has a toothache, there’s good news — and not so good news. The good news is the pain rarely indicates an emergency. On the downside, though, it may definitely be something that needs our attention.
Here, then, are 4 things you should do as a parent when your child tells you their tooth hurts.
Try to find out exactly where the pain is and how long it has hurt. Ask your child which tooth or part of the mouth hurts. You should also find out, as best you can, when the pain started and if it’s constant or intermittent. Anything you learn will be useful information if you bring them to the office for an examination. And, any tooth pain that keeps your child up at night or lasts more than a day should be examined.
Look for signs of recent injury. Your child may have suffered a blow to the mouth that has damaged the teeth and gums. Besides asking if they remember getting hurt in the mouth, be sure to look for chipped teeth, cracks or other signs of trauma. Even if there aren’t any outward signs of injury, the tooth’s interior pulp may have been damaged and should be checked out.
Look for signs of dental disease. Take a close look at the tooth your child’s complaining about: do you see brown spots or obvious cavities? You should also look for swollen gums or sores on the inside of the mouth. If there’s been no apparent injury, these could be signs of infection related to tooth decay.
Try to relieve pain symptoms. If you don’t see anything unusual, there may be a piece of candy or other hard food debris between the teeth causing the pain — gently floss around the tooth to dislodge it. If the pain persists give appropriate doses of ibuprofen or acetaminophen (not aspirin). If there’s swelling, you can also apply an icepack on the outside of the jaw. In any case, you should definitely schedule a visit with us for an examination.
If you would like more information on dental care for your child, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “A Child’s Toothache.”
When die-hard music fans hear that their favorite performer is canceling a gig, it’s a big disappointment—especially if the excuse seems less than earth-shaking. Recently, British pop sensation Dua Lipa needed to drop two dates from her world tour with Bruno Mars. However, she had a very good reason.
“I’ve been performing with an awful pain due to my wisdom teeth,” the singer tweeted, “and as advised by my dentist and oral surgeon I have had to have them imminently removed.”
The dental problem Lipa had to deal with, impacted wisdom teeth, is not uncommon in young adults. Also called third molars, wisdom teeth are the last teeth to erupt (emerge from beneath the gums), generally making their appearance between the ages of 18-24. But their debut can cause trouble: Many times, these teeth develop in a way that makes it impossible for them to erupt without negatively affecting the healthy teeth nearby. In this situation, the teeth are called “impacted.”
A number of issues can cause impacted wisdom teeth, including a tooth in an abnormal position, a lack of sufficient space in the jaw, or an obstruction that prevents proper emergence. The most common treatment for impaction is to extract (remove) one or more of the wisdom teeth. This is a routine in-office procedure that may be performed by general dentists or dental specialists.
It’s thought that perhaps 7 out of 10 people ages 20-30 have at least one impacted wisdom tooth. Some cause pain and need to be removed right away; however, this is not always the case. If a wisdom tooth is found to be impacted and is likely to result in future problems, it may be best to have it extracted before symptoms appear. Unfortunately, even with x-rays and other diagnostic tests, it isn’t always possible to predict exactly when—or if—the tooth will actually begin causing trouble. In some situations, the best option may be to carefully monitor the tooth at regular intervals and wait for a clearer sign of whether extraction is necessary.
So if you’re around the age when wisdom teeth are beginning to appear, make sure not to skip your routine dental appointments. That way, you might avoid emergency surgery when you’ve got other plans—like maybe your own world tour!
If you would like more information about wisdom tooth extraction, please call our office to arrange a consultation. You can learn more in the Dear Doctor magazine articles “Wisdom Teeth” and “Removing Wisdom Teeth.”
As if the preteen years didn’t give kids and their parents enough to think about, new oral health concerns loom on the horizon. Along with major changes to the body, brain and emotions, additional risk factors for tooth decay and gum disease appear during adolescence — the period of development starting around age 10 and extending through the teen years that marks the transition from childhood to adulthood.
Even with declining rates of tooth decay across the nation, the cavity rate remains high during adolescence. According to the American Academy of Pediatrics, 1 in every 5 adolescents has untreated tooth decay. What’s more, the onset of puberty — usually beginning around age 10-11 in girls and 11-12 in boys — brings changes in hormone levels that can affect gum health.
We all have millions of microorganisms in our mouth, representing hundreds of different species of mostly helpful, but some harmful, bacteria. Research has shown that total oral bacteria increases between ages 11 and 14, and new types of bacteria are introduced, including some that are not friendly to teeth and gums. Some unfamiliar microbes trigger an exaggerated inflammatory response to dental plaque, so gum bleeding and sensitivity are experienced by many children in this age group. In fact, “puberty gingivitis,” which peaks around age 11-13, is the most common type of gum disease found during childhood.
A combination of hormones, lifestyle changes and poor oral hygiene habits raises the risk of oral health problems among adolescents. A more independent social life may be accompanied by a change in eating habits and easier access to snacks and beverages that are sugary, acidic (like sports drinks and soda) or full of refined carbohydrates — none of which are tooth-healthy choices. And as children move toward greater independence, parents are less likely to micromanage their children’s personal care, including their oral hygiene routines. Good oral hygiene can keep dental plaque at bay, lowering the chance of having gingivitis and cavities. But let’s face it: Adolescents have a lot to think about, and keeping up with their oral health may not be top of mind.
To help your preteen stay on top of their oral health, keep healthy snacks at home for your children and their friends and make sure you are well stocked with supplies such as new toothbrushes, floss and toothpaste. In addition, most preteens (and teens) can benefit from gentle reminders about oral hygiene routines.
For optimal oral health through all stages of life, make sure your preteen keeps up with professional teeth cleanings and exams, and talk with us about whether fluoride treatments or sealants may be appropriate for your child.
For more on your child’s oral health, read “How to Help Your Child Develop the Best Habits for Oral Health” and “Dentistry & Oral Health For Children” in Dear Doctor magazine.
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