There's no denying the array of adverse health consequences associated with failing to brush one's teeth - yet many of your patients probably still struggle with maintaining regular and thorough brushing.
Of course, we must continue to press forward and encourage patients to brush!
As you know, daily brushing prevents harmful bacteria from causing oral infections (e.g., tooth decay and gum disease). However, as we develop a deeper understanding of the oral-systemic link, it is clear that oral health has a strong connection to a wide variety of conditions beyond the oral cavity.
For example, there's reason to believe that keeping up with oral hygiene can protect from severe respiratory infections; a study from 2011 has linked gum disease to poor lung health.
Brushing regularly also fends off bacteria called fusobacterium nucleatum. High levels of this bacterium have been found in patients with colorectal cancer.
The bacteria connected to gum disease, P. gingivitis, is also believed to contribute to worsened rheumatoid arthritis. In studies with mice, researchers found a form of rheumatoid arthritis RA was further exacerbated with the addition of P. gingivitis, which promoted bone and cartilage breakdown.
The Science Behind Oral Health's Impact on Heart Health
When your patients brush their teeth twice a day – for at least two minutes – the risk for cardiovascular disease is lessened. Various studies have been performed on this subject, looking at it from different angles.
In the next section, we'll look at several studies that highlight how vital brushing teeth is to your patients' heart health.
One study assessed how lacking in oral hygiene causes bacteria to emanate in the blood. This leads to body inflammation, which is conducive to an irregular heartbeat and heart failure.
The researchers examined the results provided by 161,286, aged 40 to 79, who had no history of the conditions mentioned above. After routine medical examinations, information was collected about various health factors, including oral health and oral hygiene behaviours.
There was a follow-up after 10.5 years that showed 3% of participants with an irregular heartbeat and 4.9% with heart failure.
The findings revealed that those brushing their teeth 3-plus times per day had a 10% lower risk of experiencing an irregular heartbeat. It was also decided that adhering to those best-practice oral hygiene standards generated a 12% lower risk of heart failure after the 10.5-year follow-up.
Though, these findings didn't consider things like age, sex, socioeconomic status, regular exercise, alcohol consumption, body mass index, and comorbidities (e.g., hypertension).
Another study that was presented to the American Heart Association took an in-depth look at heart health.
More specifically, those involved in the research examined whether a person's teeth-brushing habits impacted their risk of experiencing a heart attack, heart failure or stroke.
682 people were queried about their oral hygiene habits. It was found through various mechanisms that those brushing less than twice per day for less than two minutes were at an increased risk of those negative heart-centric consequences.
Compared to those brushing at least twice a day for at least two minutes, less frequent brushers presented a three-fold higher possibility of experiencing those heart-related ailments.
The Facts Speak for Themselves: Oral Health is Simply “Health”
Some patients might brush aside (pardon the pun) the importance of brushing their teeth. They might mistakenly believe that keeping their mouths clean and fresh is mostly aesthetic in its function.
However, with the above information, you can show to your patients how vital brushing their teeth can be to their overall health.
Dental patients must have a full understanding that oral health isn't its own category. Instead, what happens in our mouths plays a role in the rest of our bodies. Such a notion should be a primary focus in how we all care for ourselves.
Given the circumstances, it is worth taking a closer look at the potential benefits and drawbacks of this commonly-used mouthwash.
What is Chlorhexidine?
Chlorhexidine (also known by its generic name, Chlorhexidine gluconate), is an antimicrobial oral rinse that, when coupled with regular tooth brushing and flossing, can be used to treat gingivitis. Chlorhexidine reduces the amount and diversity of bacteria in the mouth, which helps alleviate swelling, redness and bleeding of the gums caused by gingivitis.
Chlorhexidine is generally prescribed to patients for twice-daily use: once after breakfast and again right before bedtime. Like other kinds of mouthwash, patients are instructed to measure out about a half-ounce (15 milliliters) of the solution, swish it in their mouths for about 30 seconds, and then spit it out. Prescription mouthwashes with chlorhexidine have been widely available for more than 30 years.
However, mouthwash containing chlorhexidine has been shown to significantly increase the abundance of lactate-producing bacteria that lowers the saliva pH, which could increase the risk of tooth damage.
Why Oral Bacteria is Not Always a Bad Thing
Researchers at the University of Plymouth carried out a trial on the effects of mouthwash containing chlorhexidine, giving placebo mouthwash to subjects for a few days, followed by seven days of mouthwash containing chlorhexidine.
By the end of each period, the researchers analyzed the microbiome and pH levels in each person. They also looked at things like lactate, how well acids were neutralised (also known as saliva buffering capacity), as well as other factors related to oral health.
According to Dr. Zoe Brookes, co-author of the study and lecturer at the University of Plymouth's Peninsula Dental School, dental clinicians need more information about how mouthwashes can alter the balance of oral bacteria to in order to prescribe them correctly.
“This paper is an important first step in achieving this,” says Dr. Brooks.
Co-author Dr. Louise Belfield adds, “We have significantly underestimated the complexity of the oral microbiome and the importance of oral bacteria in the past. Traditionally the view has been that bacteria are bad and cause diseases. But we now know that the majority of bacteria – whether in the mouth or the gut – are essential for sustaining human health.”
The authors believe this is the first study to examine the impact of 7-day use of chlorhexidine on the oral microbiome – important insight, given the renewed popularity of this mouthwash in the current climate.
More information is still needed to determine how the chemical works on viruses, however, some suggest that chlorhexidine kills COVID-19 since it kills other viruses, like H5N1 (bird flu), H3N2 (influenza virus), and H1N1 (swine flu) and thus could help reduce the new infection rates among healthy people (or help to flatten the curve).
It’s estimated that 858,900 Canadian adults have been diagnosed with sleep apnea: a chronic condition that causes obstructed breathing sporadically throughout one’s sleep cycle. Without treatment, this condition can lead to serious complications and long-term health effects.
Fortunately, there are a variety of ways dental professionals can play a role in diagnosing, treating and helping patients mitigate the risks of sleep apnea.
Here, we’ll delve deeper into the research and review the role dentists and dental hygienists can play in helping patients with sleep apnea.
Obstructive Sleep Apnea: Cancer Risk and Other Health Complications
There is growing evidence to suggest a potential association between obstructive sleep apnoea (OSA) and cancer. Last year, researchers reviewed data on 20,000 adult patients with OSA from the European Sleep Apnoea Database (ESADA). Approximately 2% of these patients had a cancer diagnosis.
This new study highlights just one of the many adverse impacts of sleep apnea on one’s health. In addition to the potential link between OSA and cancer, adults living with untreated sleep apnea are at greater risk of developing high blood pressure, heart disease and diabetes.
There is also a discernable link between sleep apnea, strokes, and obesity, and chronic fatigue resulting from sleep apnea can increase the risk of these individuals being involved in motor vehicle accidents.
How Dental Professionals Can Help Patients with Sleep Apnea
So, how does this relate to our roles in the dental profession?
Although dental professionals are not able to diagnose patients with sleep apnea (diagnosis should be done at an accredited sleep center), dentists and dental hygienists can help screen patients for potential symptoms, guide them towards a proper diagnosis, and in some cases provide treatment to offset the effects of the condition.
Most people see their dentist or dental hygienist more often than their doctor, and the first signs of sleep apnea are frequently those found in the oral cavity.
For example, an enlarged tongue and/or tonsils, GERD, and tooth grinding/bruxism are telltale red flags for untreated sleep apnea. Upon discovering these indicators, dental professionals can interview the patient to screen for other potential sleep apnea symptoms.
Patients showing symptoms of this condition should be referred to their family physician. From there, a review of a patient’s overall medical history can occur to rule out the presence of sleep apnea.
Are you experiencing discomfort in your back molars or your gums at the back of your mouth? Do you have trouble opening and closing your jaws, bad breath or a low-grade fever? You may need a wisdom tooth extraction to remove an impacted third molar and prevent further discomfort and infection. Before you have your tooth removed, there are some critical facts you need to know about wisdom tooth extraction and the alternatives.
Alternatives to Wisdom Tooth Removal
Extraction is often recommended for wisdom teeth as a preventative measure to minimize misalignment, eliminate overcrowding, or when the tooth is infected. However, in some cases, you may not need to have your wisdom teeth removed.
A coronectomy is an alternative to wisdom tooth extraction and is recommended for patients when the wisdom tooth is impacted and presses on the lingual nerve or inferior alveolar nerve. These nerves control the sensation in your tongue, lips, and chin and can affect speech and chewing.
A coronectomy removes the crown of the tooth, leaving the roots in place. If the wisdom tooth root is not infected, a coronectomy may be an ideal alternative to wisdom tooth removal.
An operculectomy removes the gum tissue that can develop over a partially erupted wisdom tooth. Debris and bacteria can get caught in this tissue, causing painful infections and inflammation. Removal of the operculum reduces the risk of bacteria build-up and may prevent the need for a wisdom tooth extraction.
Bring a Chaperone to Your Appointment
Whether you have a wisdom tooth removal, operculectomy or coronectomy, your dentist will still administer anesthesia to make you more comfortable during the procedure. In most cases, the site will be numbed using a local anesthetic. However, for complex wisdom tooth extractions or if you suffer from dental anxiety, you may need to be sedated.
The side effects of sedation can take some time to wear off, so it is essential to bring someone along with you to drive you home after the procedure.
Rest with Your Head Raised
Your body’s natural reaction to tooth extraction is inflammation and swelling. However, uncontrolled swelling can lead to infection. To keep the swelling under control, rest with your head slightly elevated to drain fluid away from the area. You can also apply cold compresses to the side of your face and take over the counter anti-inflammatory medication.
Skip the Toothbrush
Avoiding brushing isn’t advice that you’ll usually hear from your dentist; however, you need to avoid using your toothbrush near the extraction site for the first 24 hours after surgery.
Also avoid spitting and rinsing, as well as drinking through a straw. The reason for this is that the blood vessels inside the empty tooth socket form a clot that seals the socket and prevents infection.
If the clot becomes dislodged, you are at risk of developing a condition called dry socket where the nerves of the tooth are exposed.
Stock Up on Soft Foods
Hard and chewy foods can aggravate the wound site, causing discomfort. Some nutritious foods for post-surgery recovery include yogurt, oatmeal, fruit and vegetable purees, eggs, and smoothies. Cold and tepid foods can also help to alleviate post-surgery swelling.
Bleeding Is Normal After Surgery
Although you may have stitches in the tooth socket, it is normal to experience some bleeding after surgery. Your dentist packs the empty socket with gauze which you should hold firmly in place for 30 minutes. Repeat until the bleeding abates. If the bleeding is excessive, call your dentist immediately.
Symptoms that you shouldn’t ignore include fever, numbness, increased swelling, pus from the wound or nose, and trouble swallowing or breathing. Any of these symptoms could indicate infection or nerve damage and need to be assessed by your dentist immediately.
Keep Your Wound Clean
There are several ways you can keep your mouth clean and hygienic. Rinsing with a saltwater solution helps to eliminate bacteria, clear debris from around the extraction site, and reduce discomfort after surgery.
Combine one cup of warm water with ½ a teaspoon of salt and gently swish the solution around your mouth for 20-30 seconds. Instead of spitting out the rinse, tip your head over the sink and open your mouth to expel the water gently.
Wisdom tooth extraction is a standard procedure to prevent impacted wisdom teeth from affecting your remaining teeth and jawbone. However, it isn’t always necessary to have your tooth extracted.
Dr. Fadi Swaida first graduated from the University of Western Ontario with an Honors BSc in Biology before graduating from the University of Manitoba’s Faculty of Dentistry. He is an active member of his church and enjoys football and being by the water! His outgoing personality and fun-loving character will ensure you always feel welcome at Dentist North York.
As a dental professional, you’re no doubt well aware of the negatives of temporomandibular joint syndrome or TMJ.
The temporomandibular joint connects the mandible (or lower jaw) to the temporal bone (or skull) in front of the ear. Other specific facial muscles that connect to the lower jaw are responsible for chewing.
When the pain of TMJ has been too much for over-the-counter pain meds, it’s been known for dentists to prescribe strong pain relievers such as prescription-strength ibuprofen. Patients have also been treated with low doses of tricyclic antidepressants like amitriptyline to relieve pain symptoms, but also to control bruxism and sleeplessness.
Furthermore, it’s not uncommon for patients to be offered muscle relaxants for their TMJ-related issues.
Then there is an array of therapies, like oral splints and even physical therapy used to treat the condition. If the patient is suffering enough, there’s also a mandibular or multi-joint surgery that can be performed. Really though, this list of treatments is only scratching the surface.
In fact, recently, Botox injections have been utilized to treat TMJ syndrome ‒ with a great deal of success.
How Useful Are TMJ Treatments?
A small anecdotal study involving 26 patients from 2012 discovered that Botox could substantially decrease the pain associated with TMJ for up to three months. It also could increase mouth movements.
There were two other studies, published respectively in 2003 and 2008, that revealed similar results.
Of the participants in the 2003 study, 90% displayed symptom relief after failing to respond to more conventional treatment methods.
As is the case with most experimental treatments, these small sample sizes aren’t enough for most experts to offer their 100% stamp of approval. Yes, the results are undoubtedly encouraging.
Still, to endorse the full effectiveness of Botox treatments for TMJ disorders, experts need to investigate the results of further studies.
Are There Any Side Effects to Botox Treatments for TMJ?
Despite the potential for positive results, Botox treatments for TMJ do come with side effects.
Pain, redness at the injection site, muscle weakness, and bruising at the injection site is common in the first week after treatment. More serious side effects include headache, respiratory infection, flu-like illness, nausea, and temporary eyelid droop.
Then there’s a chance that your patients might experience a fixed smile for up to 6 to 8 weeks. This condition is a result of the paralyzing effect that’s brought upon by Botox treatments.
A Breakdown of the Procedure
One of the primary benefits of Botox treatments for TMJ disorder is that it’s a nonsurgical, outpatient procedure. Meaning, it’s non-invasive. It’s performed right in the dental office and only lasts from anywhere between 10 to 30 minutes.
Commonly, there are at least 3 injection sessions that span throughout a several-month period. The number of injections required depends on your patient’s needs and the severity of their condition.
Botox can be injected in a patient’s forehead, temple, jaw muscles, or anywhere else in the face/head area where there are pain symptoms. Resulting pain from the injection itself is minimal. It resembles a bug bite, and a cold pack or numbing cream can help to ease any discomfort.
Patients will generally experience improvements several days after the treatment. Though they can return to regular activities immediately after leaving your office.
When Should Botox Be Used to Treat TMJ?
While this treatment is more synonymous with cosmetic enhancement, it’s increasingly being used in the dental industry therapeutically.
Botox injections treat the symptoms of TMJ instead of the syndrome itself. Meaning, it’s meant to soothe the jaw tension, teeth grinding-induced headaches and lockjaw that can result from TMJ syndrome.
Still, at this point, Botox treatments for TMJ disorder are only experimental. It’s considered to be an off-label approach that has yet to be approved by the Food and Drug Administration. As such, these injections are currently only an alternative when more traditionally successful methods haven’t been able to give patients relief.
The teething process can be difficult for both parents and young ones alike. It’s only natural that parents want to protect their children from anything that might be causing them pain ‒ but they don’t always want to treat the problem with pharmaceuticals.
So, many parents look for homeopathic, all-natural solutions for their toddler’s teething problem.
Recently, dental professionals have noticed the growing trend of parents are treating their toddler’s gum pain with a natural teething necklace. Let’s take a closer look at what this alternative ‘healing’ method entails.
What are Teething Necklaces?
Natural teething necklaces are abundantly available and can be purchased for about $20 from boutiques and big-box stores alike.
The necklace is made of something called Baltic amber, which was formed over 45 million years ago. It’s an organic fossil resin that’s produced by pine trees native to northern Europe and the Baltic Sea. This unique amber has been used since ancient times as both an ingredient in perfumes and in folk medicine.
People who believe in the healing properties of Baltic amber claim it soothes teething symptoms because it releases succinic acid. Apparently, the substance is absorbed as an analgesic through a child’s skin.
Is There Any Merit to This Homeopathic Treatment?
In short, no. There’s no scientific data that can prove these necklaces are useful in any way as treatments. Conversely, research suggests that this homeopathic healing device actually does much more harm than good.
The Cruel Reality of Teething Necklaces
Upon even the most surface-level investigation, you’ll find that succinic acid won’t be dispersed from your child’s necklaces unless it’s heated at 200 Celsius.
If the piece of jewelry breaks, a small bead might enter a toddler’s airway, causing them to choke. It’s also possible that the necklace can get caught on a child’s crib then wrap too tightly around their neck, causing strangulation.
Then, the jewelry might cut toddlers’ gums – which can lead to an infection.
For further context, studies by researchers from Nova Scotia tested the strangulation risk of 15 amber teething necklaces purchased from retailers in Canada. Their results showed that nearly half failed to open after applying 15 pounds of force for 10 seconds, which is an industry-standard.
Talking to Parents About Teething Necklaces
It’s always challenging to tell parents they’re doing something wrong with raising their children.
Therefore, when you notice a toddler wearing a teething necklace or a parent informs you that they’re utilizing the method, be sensitive to their situation.
Still, as a professional, you can inform them of the dangers that we’ve discussed above. In many cases, most parents will realize your advice is coming from a good place, so they’ll likely take immediate action.
You must provide these parents with a list of viable alternatives. After all, it’s unfair to drop a bomb about the teething necklace with no other solutions in mind.
Here are some practical alternatives to a teething necklace:
Large plastic toys that are safe for chewing
Cold or frozen cloths
Frozen bananas or apples
Massaging the gums
While we do understand any hesitation about traditional medicine for children, a mild pain reliever won’t do any harm when given to a toddler sparingly.
The Final Verdict on Teething Necklaces
Parents can go to unusual lengths to protect their children from pain. Sometimes they hear about alternative treatments that sound too enticing to pass up.
After all, an ancient analgesic with healing powers catered specifically to teething pain makes for an enticing proposition.
However, as an informed dental professional, you must discourage parents from purchasing these necklaces. It’s then equally as crucial that you provide viable alternatives to help with teething pain symptoms, so parents can take comfort in your care for their toddler.
As dental professionals, we’re constantly looking for ways to help patients feel safe and comfortable under our care.
Unfortunately, there’s little we can do to change the fact that dentistry is, by nature, quite invasive. We still have a ways to go when it comes to finding less invasive means to diagnose and treat our patients.
One promising solution in this area is saliva testing ‒ a fast, cost-effective diagnostic tool which requires no painful pokes or scrapes. Saliva tests are increasingly utilized as a noninvasive way to monitor oral health status, disease onset and progression, and treatment.
Here, we’ll look at the reasons why more and more dentists are welcoming saliva test kits into their practices.
Why Use Saliva Testing in Dental Practice?
Saliva is a truly flexible fluid. Yes, it helps us eat, speak and maintain good oral health ‒ but it also contains a wealth of biochemicals that can tell us a great deal about a person’s overall health.
In addition to oral health conditions, trace amounts of proteins and other substances linked to other systemic diseases can filter into saliva from blood serum. These salivary biomarkers have been investigated for detection and monitoring of diseases such as:
Various cancers, including oral squamous cell carcinoma
Herpes simplex virus 1 or 2
Chlamydia trachomatis and Neisseria gonorrhoeae
Unlike a blood sample, saliva (along with secretions from specific oral glands, mucosal transudate and gingival crevicular fluid) is painless and readily available to collect from patients for analysis.
In many cases, it is possible to collect and test saliva samples right there in the dental office using portable, rapid test kits. When laboratory analysis is required, saliva samples have greater stability than blood in transportation.
Suppose a patient comes to you with telltale signs of inflammation: painful, bleeding gums and the early stages of gum recession. You don’t need a saliva test to tell you that this patient is likely suffering from gingivitis. However, the results test could inform an individualized treatment approach that could provide the best possible outcome for them.
As Dr. Nagelberg explains, a salivary test report would specifically indicate which antibiotics are indicated for each type of bacteria found in the saliva sample. A patient who is dealing with high-risk, highly pathogenic bacteria such as Porphyromonas gingivalis and Tannerella forsythia would benefit from a treatment plan that is based on their increased risk of periodontal disease.
Efforts are underway to further the development of rapid, point-of-care tests to evaluate oral fluids. Ongoing research indicates that saliva could eventually be used to detect heart disease, diabetes, cancers and other conditions. Refinement of oral fluid tests may shed further light on our understanding of the oral-systemic link.
Imagine using a simple, chairside test to detect all manner of oral and systemic diseases. This could be the future of diagnosing periodontal disease, assessing cavity risk and more!
The Future of Saliva Testing in Dentistry
The development of salivary testing for the dental practice is still in its early stages.
Currently, there is still no established, uniform criteria for collecting human saliva in the dental practice. Although oral fluid testing by clinical laboratories is regulated to ensure test results are accurate, the regulations do not address the validity of the test. Additionally, to date, there are no FDA-approved salivary diagnostic tests for evaluating the risk of periodontal disease or dental caries.
Still, saliva testing for oral and systemic disease holds many advantages that make it ideal for use in dentistry. Surveys show that these types of chairside tests are appealing to dentists and patients alike.
Geographic tongue, an inflammatory condition in which red, smooth patches without papillae appear on the surface of the tongue, is generally harmless. However, the pattern of these red patches (often called “islands”) may appear dramatically “geographic” in some patients and cause cosmetic concern. Often, these smooth, red patches will also migrate across the tongue, hence geographic tongue’s other name—benign migratory glossitis.
That said, let’s dive into how you might diagnose geographic tongue, some symptoms to be aware of, and the available treatment options.
Symptoms of Geographic Tongue
In most cases, geographic tongue is asymptomatic, but the inflammation can become uncomfortable for some patients. Aside from the appearance of physical symptoms, patients with geographic tongue may also experience increased sensitivity or tongue tenderness.
Sensations of pain or burning are sometimes reported when those with geographic tongue consume foods and beverages which are spicy or highly acidic.
Diagnosing Geographic Tongue
Due to its dramatic, characteristic appearance, diagnosing geographic tongue is typically rather straightforward and can be confirmed with only an outward examination of the tongue—it's the management of this diagnosis which makes your awareness of the condition so important.
Understanding Geographic Tongue’s Implications in Overall Health
If geographic tongue is harmless and infrequent, you may be wondering why it’s essential to understand its signs and symptoms in order to make an appropriate diagnosis.
As a dental professional, the role you play in the overall well-being of your patients is crucial—by having awareness of geographic tongue and its implications in an individual's overall state of health, you become a valuable contributor to their quality of life.
And, while geographic tongue is generally considered idiopathic, ongoing research suggests that it may actually be a manifestation of systemic disease.
For example, scientific literature has suggested a relationship between geographic tongue and psoriasis, indicating that geographic tongue could be an oral manifestation of this skin condition. As a result, it’s recommended that general practitioners and dental professionals work together prudently to check for oral symptoms in psoriatic patients and to check for skin lesions in otherwise healthy individuals diagnosed with geographic tongue.
Others have posited that geographic tongue might be caused by vitamin B deficiency or irritation from alcohol or particular foods. For reasons we don’t yet understand, geographic tongue appears less frequently in people who smoke and more commonly in those with allergies.
In other cases, however, geographic tongue manifests in otherwise healthy individuals, complicating the search for a direct cause or consistent association with other diagnoses.
It’s critical that you partner with a patient’s other healthcare providers in order to suggest appropriate management, especially when the patient experiences physical discomfort or anxiety surrounding geographic tongue.
For example, you might recommend rinsing with lukewarm saltwater, alkaline rinses, or anesthetic rinses to provide relief for mild cases of geographic tongue, or you may suggest that a patient follow up with their dermatologist if you suspect that their geographic tongue may be linked to a skin condition like psoriasis.
It has also been reported that some psoriasis patients who utilize systemic treatments have found improvement in their oral health and symptoms of geographic tongue, too.
Your Role as a Dental Professional
While we don’t fully understand the reasons why geographic tongue occasionally manifests, your prudence in identifying this condition during routine dental hygiene appointments and examinations can make all the difference in how a patient manages their overall health.
Remain aware of your duty to consult with their other providers and be prepared to provide information in order to educate the concerned patient. Your contributions will lead not only to better oral health but also to improved overall wellness.
Thyroid conditions present oral and systemic manifestations that can challenge even the most seasoned dental professionals. Up to 15% of the general population has some form of thyroid abnormality, and many people have never been properly diagnosed - which makes treating them all the more complicated.
As a registered dental hygienist, there are ways you can help to identify and manage the oral manifestations of thyroid diseases. Here, we’ll discuss two of the most common thyroid diseases you’ll see in your practice: hypothyroidism and hyperthyroidism.
Many people who have hypothyroidism present only a few or very mild symptoms. However, those with severe hypothyroidism can experience numerous symptoms including slow metabolism, weight gain, lethargy, sensitivity to cold, and puffiness of the face.
When treating a dental patient with hypothyroidism, you may notice one or more of the following common oral manifestations:
Salivary gland enlargement
Compromised periodontal health
Glossitis, or inflammation of the tongue marked by soreness, swelling and change in colour
People who experience severe hypothyroidism as a child may present long-term dental and craniofacial manifestations in adulthood, such as:
Micrognathia, or undersized jaw
Macroglossia, or oversized tongue
Oral Manifestations of Hyperthyroidism
Hyperthyroidism, also called overactive thyroid, is the unregulated production of thyroid hormones. It is most often called by an immune system disorder called Grave’s Disease and usually affects women under 40, but it can occur in people of all ages.
Many of the symptoms of hyperthyroidism mirror hypothyroidism in reverse - sensitivity to heat, weight loss, increased cardiac output are common. It can also cause emotional instability, tremors, abnormal heart rate and hypertension.
A dental patient who has hyperthyroidism may present the following oral manifestations:
Increased susceptibility to periodontal disease and dental caries
Enlarged extraglandular thyroid tissue (mainly in the lateral posterior tongue)
Treating Dental Patients Who Have a Thyroid Disease
As a registered dental hygienist, it is important to understand how thyroid dysfunction could affect your patient care.
First, you are well-positioned to notice the symptoms of hypo- or hyperthyroidism and aid in early diagnosis. Your keen eye could be what points a patient in the right direction to receiving treatment for their condition.
For patients who have confirmed thyroid disease, it’s also important that you and your colleagues deliver care that will help, not harm. Complications can occur from improperly treating dental patients with thyroid disorders.
Rebecca Marie Friend, BS, RDH demonstrates this perfectly in a recent column for Today’s RDH. When an elderly patient came in presenting with hypothyroidism, Rebecca took the time to carefully review the patient’s health history and discuss the patient’s medications, including over-the-counter remedies. Not only did this discussion reveal an important oversight by the patient’s doctor, but Rebecca was able to provide the patient with a better understanding of the condition.
Rebecca also provides the following recommendations to hygienists and other dental professionals in treating dental patients who present with thyroid disorders.
Establish communication with the patient’s endocrinologist and other healthcare providers. This will ensure that you are kept up to date with the patient’s medications and the rest of the healthcare team is aware of the patient’s oral manifestations.
Plan treatment in a way that limits stress and infection. Patients with hypothyroidism are at greater risk of infection due to increased bleeding and delayed wound healing.
Treat the oral manifestations of hypothyroidism and hyperthyroidism as needed, including periodontal disease, caries and xerostomia.
Conduct an extraoral head and neck examination at each appointment. This will help you detect changes to the patient’s thyroid region.
Be sure to always use a thyroid collar when taking patient X-rays. The thyroid gland is very sensitive to radiation, and excessive exposure is a known risk factor for thyroid conditions.
Help the patient feel comfortable in the chair. People who have hypothyroidism could use a blanket to help keep their legs warm, while those with hyperthyroidism might appreciate you turning the thermostat down a few extra degrees.
Dr. Jiyoung Ahn is an associate professor and associate director for population science and the Laura and Isaac Perlmutter Center at New York University. She conducted a study, lasting a decade, that was focused on how oral bacteria can lead to periodontal disease and increase a patient’s chance of developing esophageal cancer.
What is Esophageal Cancer?
The esophagus is the long hollow tube within the body that connects the throat and mouth to the stomach.
Esophageal cancer is 3 times more likely to be found in men than women.
Esophageal cancer develops from malignant cells that form inside the esophagus, typically becoming a large tumor or mass that continues to grow.
There are two major types of esophageal cancer that develops in different ways and areas.
Squamous cell carcinoma – cancer is formed inside the lining of the esophagus in thin flat cell. Usually it is found in the upper and middle part of the esophagus.
Adenocarcinoma – within the glandular tissue is where a tumor forms. Typically, it forms in the lower section of the esophagus, near the stomach.
The reason it has such a low survival rate is because it is caught in the late stages. When it is too far along. If left untreated, it can eventually spread to nearby organs such as lymph nodes, stomach, liver and lungs.
Periodontal disease is an advanced form of gum disease. It stems from gingivitis, or inflammation of the gingival.
Healthy gums should be pale pink and tightly fitted around your teeth. With periodontal disease your gums become swollen or puffy, bleed when brushing or flossing and the gums are receding.
This occurs because of trapped bacteria under patient’s gums causes irritation. When plaque builds up to tartar, it requires professional care to remove.
While gingivitis is reversible, advanced periodontal disease is not. It leads to tooth decay and tooth loss.
With the leading cause of periodontal disease being poor oral health, make sure you have good oral habits. This includes brushing twice and flossing daily and regular dental checkups.
Dr. Ahn's Study
This study was based on prior research on how periodontal disease was associated with cancers in the mouth, head and neck. The study was primarily based specifically on the oral microbiota found as a result of periodontal disease.
Dr. Ahn’s goal was to identify whether the oral microbiota increased the chances of developing either adenocarcinoma or squamous cell carcinoma later.
Dr. Ahn found that after a decade, 106 patients developed esophageal cancer. They extracted their oral DNA and compared to the previous test.
Certain types of bacteria were linked to higher rates of esophageal cancer. Porphyromonas gingivalis connected to squamous cell carcinoma and Tannerella forsythia caused a higher risk of adenocarcinoma.
Both of these bacteria are linked to periodontal disease.
However, there was an interesting discovery regarding other types of bacteria. Several bacteria actually helped lower the chances of patients being diagnosed in the future.
Dr Ahn hopes to conduct more research in the future. She believes that learning more about the different bacteria will allow doctors to identify the disease predictively. It will help diagnose patients earlier and prevent the later stages of the cancer from occurring.