The Center for Advanced Dentistry Blog

Brushing 2 Times per Day Helps Reduce Heart Disease Risk

June 1, 2010

Filed under: Uncategorized — Tags: , , , , , — Dr. Benjamin Hornstein @ 8:55 am

The Scottish Health Survey ( which draws a nationally representative sample of the general population living in households in Scotland) had an objective  to see if self reported tooth brushing behaviour is associated with cardiovascular disease and markers of inflammation. 

The study concluded that poor oral hygiene is associated with higher levels of risk of cardiovascular disease and low grade inflammation, though the causal nature of the association is yet to be determined.

Over the past two decades, there has been an increasing interest in the possible link between dental disease, specifically periodontal disease, and cardiovascular disease.  Inflammation plays an important role in causes of atherosclerosis, and markers of low grade inflammation have been consistently associated with a higher risk of cardiovascular disease.  Consequently, contributing factors associated with inflammation and chronic infections, including oral infections such as periodontal disease, have been investigated to explain the relationship between dental disease and cardiovascular disease.  Poor oral hygiene is the major cause of periodontal disease, a chronic infection of the tissue surrounding the teeth. It is one of the most common chronic infections and is associated with a moderate systemic inflammatory response.  Systemic inflammation could represent the underlying mechanism that links oral health and cardiovascular disease.  Thus, oral infections might add to the inflammatory burden of the individual and result in increased levels of cardiovascular risk.  In this study, participants who brushed their teeth less often had a 70% increased risk of a cardiovascular disease event in fully adjusted models.

Infrequent tooth brushing is associated with cardiovascular disease, even after adjustment for age, sex, socioeconomic group, smoking, visits to dentist, BMI, family history of cardiovascular disease, hypertension, and diagnosis of diabetes.  These results largely confirm those of previous studies.  The role of oral health in the etiology of cardiovascular disease has received considerable attention. Periodontal disease is a complex chronic inflammatory disease, resulting in a loss of connective tissue and bone support of the teeth.  It is a major cause of tooth loss in adults aged over 40, and, according to the World Health Organization, affects people worldwide at prevalence rates of up to 10-20% for the most severe forms. Periodontal disease is highly prevalent, especially in late middle age when coronary artery disease is also most common, and it is caused mostly by poor oral hygiene.

Given the high prevalence of oral infections in the population, doctors should be alert to the possible oral source of an increased inflammatory burden. In addition, educating patients in improving personal oral hygiene is beneficial to their oral health regardless of the relation with systemic disease.

This study may be found in it’s entirety at http://www.bmj.com/content/340/bmj.c2451.full

Don’t Forget to Floss

May 26, 2010

Filed under: Uncategorized — Tags: , , , , , , — Dr. Benjamin Hornstein @ 10:48 am

Dental experts overwhelmingly agree that daily flossing is a critical, preventive step in reducing tooth decay and gum disease. Flossing removes plaque between teeth and below the gum line — dislodging the pieces of food trapped between teeth which otherwise cannot be brushed or rinsed away.

Plaque build up causes gum disease (gingivitis) which affects some two- thirds of the U.S. population, while advanced-stage gum disease (periodontal disease) is the leading cause of tooth loss in American adults and affects between ten and fifteen percent of the U.S. population.

To receive maximum benefits from flossing, use the following proper technique:

  • Starting with about 18 inches of floss, wind most of the floss around each middle finger, leaving an inch or two of floss to work with
  • Holding the floss tautly between your thumbs and index fingers, slide it gently up-and-down between your teeth
  • Gently curve the floss around the base of each tooth, making sure you go beneath the gumline. Never snap or force the floss, as this may cut or bruise delicate gum tissue
  • Use clean sections of floss as you move from tooth to tooth
  • To remove the floss, use the same back-and-forth motion to bring the floss up and away from the teeth

(Photos courtesy of Colgate.com)

When you are flossing, you are doing a great service to your mouth. You can easily remove food that is stuck in between your teeth, not only saving you from potential embarrassment if people see it, but also to help prevent bacteria from collecting up against the gum line and causing gum problems. Flossing may even help prevent bad breath. In addition, having food stuck in between your teeth is quite irritating and sometimes painful, so flossing can help your mouth feel comfortable.

Heart Disease and Gum Health

May 10, 2010

Filed under: Uncategorized — Tags: , , , — Dr. Benjamin Hornstein @ 9:17 am

I’ve had a number of patients say to me, “Doctor, my dentist says I should get my heart checked out, what does a dentist know about hearts?” Then after some tests, I have to tell my patients, that, yes, their dentist was right, they have a heart problem. There is definitely a gum-heart connection and that connection is inflammation. Untreated chronic inflammation can lead to severe health complications.

This is how it happens. When you consume anything, residue collects on your teeth, and this residue forms plaque. Plaque is a sticky deposit of mucus, food particles and bacteria formed at the base of your teeth within hours of eating. If you don’t remove the plaque it can cause gingivitis, the collection of plaque in pockets between swollen gums and the base of your teeth.

Gingivitis is also the source of bad breath. Left untreated, gingivitis can lead to periodontal disease; also know as gum disease. Your mouth has the highest concentration of bacteria in your body under normal conditions, but if you have gum disease, the bacteria count gets even higher. Inflamed gums present a good portal for bacteria to enter your bloodstream and move on to your heart. There it can damage your heart walls or values. It might also provoke blood-clotting, leading to stroke or a heart attack.

The Good News is – You Can Stop Gum Disease At Your Bathroom Sink

Sadly, gum disease is one of the easiest preventable diseases out there. Yet some 50 percent of the adult population has gum problems. Good dental hygiene can eliminate or slow gum disease and all it takes is making a conscious effort to brushing your teeth after every meal and flossing before you go to bed.

Here are the steps recommended by the American Dental Association

Brushing Your Teeth

  • Place your toothbrush at a 45-degree angle against the gums.
  • Move the brush back and forth gently in short (tooth-wide) strokes.
  • Brush the outer tooth surfaces, the inner tooth surfaces, and the chewing surfaces of the teeth.
  • Use the “toe” of the brush to clean the inside surfaces of the front teeth, using a gentle up-and-down stroke.
  • Brush your tongue to remove bacteria and freshen your breath.

Flossing Your Teeth

  • Break off about 18 inches of floss and wind most of it around one of your middle fingers. Wind the remaining floss around the same finger of the opposite hand. This finger will take up the floss as it becomes dirty. Hold the floss tightly between your thumbs and forefingers.
  • Guide the floss between your teeth using a gentle rubbing motion. Never snap the floss into the gums.
  • When the floss reaches the gum line, curve it into a C shape against one tooth. Gently slide it into the space between the gum and the tooth.
  • Hold the floss tightly against the tooth. Gently rub the side of the tooth, moving the floss away from the gum with up and down motions.
  • Repeat this method on the rest of your teeth. Don’t forget the back side of your last tooth.

Nutrients for a Healthy Smile

Nutrition plays an important role in gum health. Crunchy fruit and vegetables can actually clean your teeth as you are eating, and the acid delays the formation of plaque. Vitamins A, C, D, E and K and the B vitamins; folic acid; biotin; choline; calcium; zinc; and magnesium have all been found important for your oral health.

According to Aim International, two studies suggest that coenzyme Q10 and aloe are also helpful to gum health:

Two dietary supplements, coenzyme Q10 and aloe vera, are helpful to gum health. Coenzyme Q10 (CoQ10) may help with periodontal pocket depth. In early research, Dr. Edward G. Wilkinson, of the U.S. AirForce Medical Center, gave patients 50 mg of CoQ10 a day. His patients experienced reduced periodontal pocket depth. Wilkinson said, “Treatment of periodontitis with coenzyme Q10 should be considered as an adjunctive treatment with current dental practice.” Later studies have reconfirmed this. Hanioka, et al., say “These results suggest that the topical application of CoQ10 improves adult periodontitis” (Molecular Aspects of Medicine. 1994. 15 Suppl)

Aloe vera is known to kill bacteria. Dr. Eugene R. Zimmerman and Dr. Ruth A. Sims have (Aloe Vera of America Archives, Stabilized Aloe Vera, Vol. I) noted that aloe does have bactericidal properties. This means it may be useful in periodontal disease, which is a bacterial infection. Simply rub the liquid or gel on the gums.

When you take care of your gums and teeth, you are helping yourself on many levels. Superficially, you will retain your beautiful, white-toothed, smile. Your breath will smell sweet. Moreover, your heart and arteries will have an added protection against the onslaught of bacteria.

Mark Rosenberg, M.D.
Institute For Healthy Aging
http://www.vitalmaxvitamins.com

What are Mouth Ulcers (Aphthous Ulcers)?

May 6, 2010

Filed under: Uncategorized — Tags: , , , , — Dr. Benjamin Hornstein @ 10:24 am
Aphthous ulcers, also known as canker sores or oral ulcers, form on the mucous membranes and on the genitals. These ulcers are typically round or oval in shape and usually occur on the inside of the lips or cheek or under the tongue or on the genitalia. This is in contrast to angular stomatitis, which typically occurs on the corners of the mouth, or a cold sore (herpes infection) that usually appears on the upper or lower edge of the lip.

 Other identifying characteristics of a typical aphthous ulcer include:

  • appear as a yellow area initially
  • red line often encircles the ulcer
  • tend to turn white or gray in the middle
  • often painful, particularly when exposed to irritating foods, drinks, or movements
  • occupy a distinct area while other tissues are unaffected

Recurrent aphthous ulcers are usually smaller than 5mm and usually take about one to two weeks to heal completely. Larger ulcers that are greater than 10mm in size, called major aphthous ulcers, can take much longer to heal and may result in scars. Another type of aphthous ulcer, called herpetiform ulcers, present as many tiny ulcers that often appear on the tongue and typically heal within a month.

 According to DermNet’s June 15, 2009 article entitled “Aphthous Ulcers,” approximately 20% of the population experiences apthous ulcers, which often begin to appear in younger years. About 40% of people who develop these ulcers have a family history of these painful sores. The above web page also shows nice quality, close-up pictures of aphthous ulcers.

 Because aphthous ulcers may have many causes, many of which are still being investigated, it is important to seek the advice of a healthcare professional before attempting self-treatment of these ulcers.

Improve Your Smile with Veneers

April 29, 2010

Filed under: Uncategorized — Tags: , , , , , , — Dr. Benjamin Hornstein @ 12:14 pm

If you would love a gorgeous smile, like the ones you see on magazines or the big screen, we suggest porcelain veneers.  These thin shells of high-quality porcelain will cover the surfaces of your front teeth. While selecting traditional porcelain veneers, Dr. Hornstein will carefully consider your skin tone, facial features, and personal preferences.

The whole process, from design to placement, usually takes only two or three appointments. At the first visit, Dr. Hornstein will examine your teeth, take impressions, and prepare your teeth by removing a small amount of tooth enamel to make sure your porcelain veneers fit flush against the teeth and evenly with the gum line without appearing bulky. We will also fit you with temporary veneers, which give will give you a feel for your new smiles.  Even the temporaries are a stunning change.  Your family and friends will know something is different about you, but will not know exactly what it is.  That is what a subtle yet dramatic change in your smile does for your appearance.

During the final appointment, the dentist will make adjustments if necessary and then place your final restorations, so you will leave with a magnificent smile.

Below are some before and after photos of our patients.

Teeth1              

Over-The-Counter Snore Devices Can Lead to Jaw Joint Problems

April 13, 2010

Filed under: Uncategorized — Tags: , , , , — Dr. Benjamin Hornstein @ 3:44 pm

          We have a patient who treated himself for snoring.  He saw this great ad for a device on the internet.  It was fairly inexpensive and easy to use.  It was made of soft plastic that you boil and then fit to your own teeth.  The device was designed to bring the jaw forward so the tongue would not block the airway and thus stop the snoring.   Most people could probably tolerate such a generic appliance, but for some, this may cause a problem, as in the case of our patient.   (If you visit our website (https://www.cfad.net/gum-disease-treatment.html), you can learn more about how muscles, teeth, and nerves all work together for maximum function of chewing, breathing, and positioning the jaw.  This is called neuromuscular dentistry. )

When the teeth are placed in an abnormal position (as with this night-time OTC snore device), it affects not only the teeth, but the muscles that control the position of the jaw.  When this OTC appliance was boiled and fitted by the patient, the lower jaw was not lined up properly with the upper teeth.  This torqued the jaw to the right and put stress on the left jaw joint.  After wearing this devise for three months in this position at night, the left jaw joint developed clicking, popping and pain.   The patient was also unable to bring his back teeth together, which put even more stress on the jaw joints and made chewing difficult.  Had the patient not developed jaw pain and sought intervention, his joints might have become permently remodeled to this new position and surgery may have been required.  Thankfully we were able to release the muscles with electrical stimulation (TENS) and he was able to get his teeth back together.   At the Center For Advanced Dentistry, we are able to treat snoring and sleep apnea with a custom made appliance that is worn at  night.  This design is created using the principles of neuromuscular dentistry to prevent the onset of problems with TMD pain and other jaw problems.  If you snore and want a device designed just for you that is scientifically proven to relieve the problems associated with snoring and sleep apnea, call our office today.   Don’t treat yourself when the best professional help is just a phone call away.

Gum Disease and Your Overall Health

April 8, 2010

Filed under: Uncategorized — Tags: , , , , , , — Dr. Benjamin Hornstein @ 9:56 am

The American Academy of Periodontology (AAP) estimates that approximately three out of four Americans suffer from some form of gum disease — from mild cases of gingivitis, to the more severe form known as periodontitis. However, despite this prevalence, approximately only three percent seek treatment for their gum disease. With increasingly more research indicating that gum disease may be linked to several other diseases, including diabetes, heart disease and certain forms of cancer, maintaining healthy teeth and gums has become more important that ever.

According to Samuel Low, DDS, MS, Associate Dean and professor of periodontology at the University of Florida College of Dentistry, and President of the American Academy of Periodontology, the discrepancy between the prevalence of gum disease and the lack of treatment can likely be blamed on a lack of understanding of the effect periodontal disease can have on overall health. “Patients do not always seek the periodontal care they require because they are not aware of the long-term and potentially dangerous implications of untreated gum disease,” says Dr. Low. “Unfortunately, there are a variety of myths surrounding periodontal disease and its repercussions.”

In order to help distinguish between fact and fallacy regarding periodontal disease, the AAP has identified and addressed below some common misconceptions about oral health.

1. Bleeding gums are not that big of a deal. Red, swollen and bleeding gums are an important sign of periodontal disease. If you notice bleeding while brushing or flossing, or when eating certain foods, you should schedule a visit with your dental professional to be evaluated for periodontal disease. Studies have shown that in addition to tooth loss, gum disease may contribute to the progression of other diseases, including heart disease and diabetes, so it is important that you begin treating periodontal disease as soon as possible.

2. You don’t need to floss every day. Routine oral care, which includes brushing after every meal and before bedtime, and flossing at least once a day, is the best way to prevent gum disease. However, a recent survey estimates that only 13.5 percent of Americans floss each day. It is vital that you keep up with your daily oral care, and see a dental professional for a thorough check-up twice a year. If gum disease is diagnosed, a consultation with a periodontist, a dentist who specializes in treating periodontal disease, may be beneficial.

3. A visit to the periodontist will be scary. Periodontists are gum disease experts. They have received three or more years of specialized training following dental school centered on the diagnosis, treatment and prevention of periodontal disease. Periodontists are equipped with the latest treatments and technologies, using innovative tools such as digital radiography, ultrasound technology, biomarker measurement and laser therapy to help make your visit more comfortable.

4. A tooth lost to gum disease is a tooth lost forever. Gum disease is a major cause of tooth loss in adults. However, in addition to treating gum disease, periodontists are also experts in placing dental implants — a convenient and comfortable way to permanently replace missing teeth. A dental implant is an artificial tooth root that is placed into the jaw to hold a replacement tooth. Studies have shown that dental implants have a 98 percent success rate, and with proper care, allow you to speak, eat and smile with confidence. In fact, a survey conducted by the American Academy of Periodontology found that over 70 percent of respondents reported being “pleased” or “extremely satisfied” with the results of their dental implants.

5. Poor oral hygiene is the only way to develop gum disease. Forgoing good oral hygiene can certainly contribute to the progression of gum disease, but there are a variety of other factors that can also impact your risk. For instance, tobacco use has been shown to greatly increase your chance of developing gum disease. Stress, poor diet, and even genetics, can also play a role in the health of your gums.

About the American Academy of Periodontology

The American Academy of Periodontology (AAP) is the professional organization for periodontists — specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontists are also dentistry’s experts in the treatment of oral inflammation. They receive three additional years of specialized training following dental school, and periodontics is one of the nine dental specialties recognized by the American Dental Association. The AAP has 8,000 members world-wide.

Source: American Academy of Periodontology

If you snore, you may have occult sleep apnea.

March 4, 2010

Filed under: Uncategorized — Tags: , , , , , — Dr. Benjamin Hornstein @ 6:50 pm

If you snore, your bed partner may not be the only one who doesn’t have the benefit of restful sleep.   You may not be getting enough oxygen to meet your body’s needs.  One of the ways to measure the effectiveness of your sleep if you snore is to do an at-home sleep test.  The process starts with an evaluation in our office.  Dr. Hornstein will check your mouth and airway and all the necessary information will be gathered before the test.  This info will be sent to Sleep Optima, the company that provides the equipment and processes the insurance claims.  (You can get more information at www.mysleeptest.com.)    They will send the equipment right to your house with specific instructions about how to administer the test.  The test equipment consists of a headband that contains sensors that collect the needed information.  This info is interpreted by the microprocessor in the device.  It also has a nasal cannula that you wear in your nose (similar to how oxygen is delivered) that measures airflow and oxygen levels.   In addition to respiratory breathing rhythms, the sensors also detect sleep positions, stages of sleep, blood oxygen saturation, pulse rate, and snoring loudness.  After using the equipment for two nights, you then return the device back to Sleep Optima.  It takes about 7-10 days for the results of the tests to be available. 

Sometimes people who snore may not look like they stop breathing, but will have periods of low oxygen levels.  This is called occult sleep apnea or hidden times of low O2 levels (also know as hypoxia).   Since even occult apnea can lead to an increased risk of high blood pressure, stroke, heart attack and other problems, it is important to rule out sleep apnea in people who snore.  If you or a loved one snores, you should consider doing a home sleep test. 

It just might save a life!

Sign Your Dog Up For a Shot at Stardom

February 22, 2010

Filed under: Uncategorized — Tags: , , , , — Dr. Benjamin Hornstein @ 2:55 pm

Below is the link from Pedigree Dog Food featuring their Dentastix Treats for your dog’s teeth.  It is used to promote dental health in dogs.  You can upload your own dog’s photo and create a funny view of what might happen if you don’t care for his teeth.    Just a little humor to start your Monday.

https://www.pedigree.com/

Gum Disease and Pregnancy

February 15, 2010

Filed under: Uncategorized — Tags: , , , , — Dr. Benjamin Hornstein @ 1:53 pm

Periodontitis and pregnancy

February 8, 2010

Yiping Han, a researcher from the department of periodontics at Case Western Reserve University School of Dental Medicine, reports the first documented link between a mother with pregnancy-associated gum disease to the death of her fetus.

The findings are discussed in the article, “Term Stillbirth Caused by Oral Fusobacterium nucleatum,” in the February issue of Obstetrics & Gynecology.

An internet search in 2008 led a friend of a mother, who had just delivered a stillborn baby, to Han’s research lab — one of the few in the world working on understanding the role variations of the oral bacteria, Fusobacterium nucleatum, have on pre-term labor and stillbirths.

The mother delivered her full-term baby at Saint John’s Health Center in Santa Monica, Calif., at 39 weeks and five days.

During the 35-year-old mother’s pregnancy (her first), she told Han she experienced excessive gum bleeding, a symptom of pregnancy-associated gingivitis. Approximately 75 percent of pregnant women experience gum bleeding due to the hormonal changes during pregnancy.

“There is an old wives’ tale that you lose a tooth for each baby, and this is due to the underlying changes during pregnancy,” said Han, “but if there is another underlying condition in the background, then you may lose more than a tooth, but a baby.”

Bleeding associated with the gingivitis allowed the bacteria, normally contained to the mouth because of the body’s defense system, to enter the blood and work its way to the placenta.

Even though the amniotic fluid was not available for testing, Han suspects from work with animal models that the bacteria entered the immune-free amniotic fluid and eventually ingested by the baby.

Han says normally a mother’s immune system takes care of the bacteria in the blood before it reaches the placenta. But in this case, the mother also experienced an upper respiratory infection like a cold and low-grade fever just a few days before the stillbirth.

“The timing is important here because it fits the time frame of hematogenous (through the blood) spreading we observed in animals,” Han said.

Postmortem microbial studies of the baby found the presence of F. nucleatum in the lungs and stomach. The baby had died from a septic infection and inflammation caused by bacteria.

After questioning the mother about her health during the pregnancy, Han arranged for her to visit a periodontist, who collected plaque samples from her teeth.

Using DNA cloning technologies, Han found a match in the bacterium in the mother’s mouth with the bacterium in the baby’s infected lungs and stomach.

Han also ruled out by testing bacteria from the vaginal and rectal areas, which did not show the presence of F. nucleatum.

“The testing strongly suggested the bacteria were delivered through the blood,” Han said.

With preventative periodontal treatment and oral health care, the mother has since given birth to a healthy baby.

Han, who has spent the past decade taking her oral bacteria research from the lab to the bedside, says this points again to the growing importance of good oral health care.

In addition to this direct link from the mother to her baby, oral bacteria have been associated with heart disease, diabetes and arthritis.

The researcher suggests women, who are considering a pregnancy, seek dental care to take care of any oral health problems before getting pregnant. If pregnant, she encourages expectant moms to practice good oral health and alert the doctor to any gum bleeding.

Collaborating with Han on the case study were Yann Fardini, Casey Chen, Karla G. Iacampo, Victoria A. Peraino, Jaime Shamonki and Raymond W. Redline. The study had support from the National Institute of Dental and Craniofacial Research.

For more on the research, click here.

Taken from RDH emagazine

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