The NobleDentist Blog

Peruse messages and leave comments for the NobleDentist community.

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Hello and welcome to our community blog. My name is Dion Kramer and I am the managing director of NobleDentist.

This blog is designed to assist you with dental health issues. And to keep us in touch with members of NobleDentist.

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Beware Risks of Infection that Come with Piercings

Posted in Dental Health News by Dion Kramer on September 5, 2008

This is an artcile by Dr David Mady Jr that was recently published in The Windsor Star – Ontario, Canada.

Dear Dr. Mady: I am thinking about getting my tongue pierced very soon. All my friends at school have had it done, but my parents are really upset with me for even considering it. Can it really hurt me in any way if I do it?
—Jason in Leamington

Oral piercing of all types is becoming a very popular trend in our community, especially for those who wish to make a different type of fashion statement. What they are not taking into consideration is the effect that this deliberate wounding will have on their oral health.

I realize that you may be very determined to go ahead with having your tongue pierced, but before you proceed you must be informed about the potential hazards that this new look could pose on your health. Anytime a foreign body or jewelry is inserted through oral tissues, infection is a real possibility. Also this will not only change your looks but your lifestyle with respect to hygiene will instantly become much more complicated than before in order to avoid any type of infection or complication. Do you even know the sterility of the instruments used for the procedure and possible issues related to that?

Tongue piercing is probably the most popular of all oral piercing. Other types involve the lips and cheeks. Possible health related hazards from this procedure include localized tongue infections, airway obstruction, changes in speech, serious bleeding, allergic reaction and transmission of diseases such as HIV or hepatitis B. If your tongue swells as a direct result of piercing or secondarily from infection it can become difficult to swallow or maybe even to breathe. I don’t have to tell you what the end result will be.

Dental risks of tongue piercing include chipping, cracking and fracture of teeth, damage to tooth nerves and recession of the gums around the teeth in contact with the jewelry. Subsequently this recession can lead to tooth sensitivity and promote gum disease thus affecting the periodontal or support system of your teeth. It may also cause root decay because the exposed roots are softer than the crowns of the teeth and tooth loss may eventually result. Other oral tissues can also become damaged from oral piercing. Some cases of tissue trauma have been so severe that the individuals involved have had to remove their jewelry from their mouth and allow the hole to close and heal to prevent further problems.

If you have an oral piercing you must maintain above average oral hygiene including tongue brushing, irrigating the hole daily with water and rinsing with mouthwash every time you eat, drink, or smoke, especially for the first few weeks. You will additionally have to keep your jewelry clean by using an ultrasonic jewelry cleaner very frequently. It is always better to use jewelry that is good quality yellow or white gold or metal of surgical quality.

If you are contemplating an oral piercing, I do not recommend it and I strongly encourage you to discuss it with your dentist or hygienist. Oral piercing is poorly regulated and if you do not know and understand all of the factors involved, you may really be looking for trouble.

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Roxon Wants Closure on Dental Scheme

Posted in Dental Health News by Dion Kramer on September 3, 2008

This is an article by Mark Metherell that was recently published in the Sydney Morning Herald – NSW, Australia.

THE Federal Government is threatening to axe nearly one million individual dental services under its new program unless the Opposition gives way in the Senate and votes down the existing Medicare dental scheme for the chronically ill.

The Health Minister, Nicola Roxon, yesterday stepped up her campaign to force the closure of the Medicare scheme which offers benefits of up to $4,250 in major dental work and dentures for those with chronic medical conditions.

The Coalition so far has blocked the Government’s plans in the Senate and there is no guarantee of independent and Greens senators’ support.

Ms Roxon said failure to remove the Medicare program would mean that $290 million over three years would have to be withdrawn from its new Commonwealth Dental Health Program.

She said that unless the Government was able to end the Medicare service, she would have to reduce spending on the Commonwealth program which would mean NSW patients would lose about 327,200 services costing more than $90 million.

The Commonwealth program has yet to begin in NSW because the state and federal government are yet to complete funding negotiations.

But the Medicare dental scheme introduced in its current form last November has proved popular, particularly with disadvantaged people in need of costly dental treatment, according to dentists and doctors.

Ms Roxon has argued that the Medicare scheme is poorly targeted because patients had to have a chronic medical illness to qualify for the dental benefits.

The Association for the Promotion of Oral Health has called for the retention of Medicare dental, stating that about 10 per cent of the population had chronic conditions, many of them requiring dental treatment while Labor’s Commonwealth scheme was poorly funded and likely to provide realistic care for only a fraction of the estimated 600,000 people needing care.

But Ms Roxon said yesterday the new program would mean that hundreds of thousands of Australians would have improved access to dental health services while the strain on the hospital system would be reduced by delivering more accessible and better targeted dental care.

“In doing so it would help to reduce the 50,000 preventable hospital admissions for dental conditions every year,” she said.

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No Teeth for Low Income Earners

Posted in Dental Health News by Dion Kramer on September 1, 2008

This article by Rita Loiacono was recently published in Consult Magazine – Perth,Western Australia, Australia.

ORAL health needs more staff and money so low income earners have better access to dental services, according to the Australian Institute of Health and Welfare’s Dr David Brennan.

Dr Brennan’s comments follow the recent release of a report by the AIHW into the oral health of adult public dental patients from 2004-07.

The report, Oral Health of Adult Public Dental Patients, revealed pensioners and the unemployed suffer from poorer oral health related to their lower socioeconomic status and barriers to accessing dental services.

Among the findings were a high percentage of public dental patients with fewer than 21 teeth and more decayed teeth compared to the general population.

The report also showed high percentages of periodontal disease among public dental patients, particularly for those between the ages of 30 and 50.

Dr Brennan said low income earners faced an uphill battle towards improving their oral health.

“[Public dental] patients tend to face two problems,” he said.

“One is the very fact that they’re on a low income makes them at risk of high levels of disease but they also tend to face a lot of barriers to care in terms of long waiting times for appointments, especially for general care.

“Patients attending for relief of pain can often be seen in shorter periods of time but general care often has long waiting times for appointments and that basically reflects resource constraints in the public sector – lack of finances and supply of staff to meet the demand.”

Dr Brennan said dental services available to low income earners varied from state to state.

“The current system that exists in Australia for dentistry involves primarily private provision of services at a fee for service basis so that people either have to pay directly out of pocket or indirectly through insurance,” he said.

“That is in heavy contrast to the majority of medical and health services that are supplied through Medicare so there is quite a different system for dentistry compared to other health care.

“Often the emergency nature of public dental visits for relief of pain can limit the treatment options that are available and often things have to be done simply to relieve pain, so there might be additional treatment needs that are not treated.

“In general, historically, public dental services have been characterised by higher levels of extraction compared to private services.”

A statement released by the Department for Health and Ageing said at present the state and territory governments provide and fund public dental services but recently the federal government has announced new programs that involve additional funding to the states.

It said the New Commonwealth Dental Health Program would provide extra funding for the states and territories over the next three years to provide more dental visits to public dental patients.

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Kiss Bad Breath Goodbye

Posted in Dental Health News by Dion Kramer on August 27, 2008

This is an article that was published recently in the Edinburgh News – Edinburgh, Scotland, UK.

AS YOUR eyes meet, the anticipation of what’s to come builds. Slowly, you move towards each other and your lips finally touch.

Suddenly the moment is ruined as you recoil in horror when the full impact of their bad breath hits you like a ton of bricks. You gag, grab your coat and run.

Halitosis remains one of the last social taboos of the 21st century, with people suffering in silence rather than admit to having what is essentially a medical condition.

But bad breath (not to be confused with food breath or morning breath) affects an astonishing 96 per cent of the population at some point in their lives, due to a build-up of excess bacteria in the mouth that emits volatile sulphur compounds.

It can seriously affect not only relationships, but even job prospects, particularly if the sufferer’s role involves dealing with the public or making presentations to clients.

Now an awareness campaign has been launched to encourage people to freshen up their act. Fresh Breath Week, which started yesterday has been organised to bring the issue of halitosis, out into the open air.

There are many different types of bad bacteria in the mouth that cause halitosis, and dispelling the myth that oral malodour comes from the stomach is apparently the first step to finding a cure for sufferers.

Dr Phil Stemmer, founder of the Fresh Breath Centre, says: “Bad breath is no laughing matter – there have even been recorded cases of suicide due to halitosis.

“It has a huge impact on people’s lives. It can socially cripple a person to such an extent that they are afraid to speak to people, and it can often hamper their progress in the workplace. It affects their every waking moment. They avoid speaking to others or, when they do, they keep their hands over their mouths.

“The cause is almost always from the mouth, not the stomach as people tend to think. Excesses of bacteria give off odorous or smelly gases. It’s nothing to do with eating onions, garlic and curries. That will just give you morning breath. It’s much more serious and long-lasting than that.”

He adds: “Gums that bleed all the time are usually a sign of disease so watch out for these. The first thing to do if you think you have halitosis is to visit to your dentist or oral hygienist. Then get into a good oral hygiene routine.

“People are terribly embarrassed by halitosis. Yet it can be sorted out. We have a success rate of over 95 per cent. It gives them a huge confidence boost. We’ve helped many people whose relationships have split up. One lady wouldn’t leave the house for two years. And so many people have lost jobs over it, or have failed at interviews.”

The actual by-products of the bacteria responsible for bad breath are the oh-so pleasant-sounding cadaverine and putricine, together with indoles (the same gases that are given off by bowel bacteria).

Dr Jonathan Munns, a dentist based in Devon who runs the website freshbreathonline.com says he is aware of the problem because of patients who have been sufferers of halitosis – but he, too, has suffered from bad breath.

“As a dentist I am often in close proximity to people when talking and treating them. From a professional and socially acceptable perspective it is essential that I am quite sure that I am not offending people’s noses with smelly breath,” he says.

“I am lucky because I usually can wear a mask while working but I am even more fortunate because I believe I do know the cause and effective treatment for bad breath, and the cure doesn’t rely on sucking mints all day.

“Mouthwashes and mints don’t stop bad breath. Both products only temporarily mask over the problem. In fact, mouthwashes with any alcohol content will probably make halitosis worse by drying the mouth and increasing the presence of volatile, noxious gases.

“But there is a very effective way to treat and prevent the majority of bad breath. I would advise people to seek the opinion of a qualified dentist who can advise you about the state of your teeth and gums, together with offering you help with your own dental care.”

He says that rather than suffering the humiliation of asking someone if your breath smells, it’s safer too assume that all of us can have breath that smells offensive from time to time.

In order to prevent it, he says, we have to remove the plaque build-up on our teeth more effectively.

“Those who remove plaque less effectively tend to have halitosis together with gum disease,” he says. “When the gums become inflamed and swollen (gingivitis and periodontitis) they fill with more blood and the bacteria putrefy both food debris and blood. Any area where plaque accumulates can result in halitosis, even on plastic dentures which have not been regularly and thoroughly cleaned.

“So bad breath can largely be prevented by removing bacteria as far as possible from round the teeth and tongue on a daily basis.”

How to tell if you have a problem – and how to treat it

Try the lick-wrist test, which is far more effective than the hand-cupping technique. Stick your tongue out as far as possible, and lick the inside of your wrist using the back of your tongue. Allow the moisture to dry, and sniff.

Floss your teeth before brushing, and then smell the dental floss.

A constant bad, sour or even “metallic” taste in your mouth may be an indication that you suffer from bad breath.

To help prevent it, brush your teeth twice a day, preferably using an electric toothbrush, but always clean your tongue with a tongue-scraper as well. Brushing your tongue will just move the debris around, but a tongue-scraper will physically remove any bad bacteria lurking at the back of the tongue.

Use dental floss once a day.

Eat breakfast and at least two pieces of citrus fruit a day to stimulate salivary flow.

Drink at least two litres of water a day but steer clear of foodstuffs that cause dehydration such as coffee, alcohol and tea.

Twice a day, use a mouth rinse which physically removes the bacteria that causes bad breath, as opposed to just masking the smell. Shake it well then rinse and gargle for 30 seconds to remove clumps of debris, dead cells and bacteria. But make sure it’s alcohol-free. Alcohol in any shape or form makes bad breath worse because it dries out the mouth.

Bear in mind that another hazard for oral health is smoking. Apart from creating a risk of oral cancer, it increases gum disease by constricting blood vessels that deliver nutrients to the gums, contributes to bone breakdown and slows healing of the tissue.

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Homeless to Be Offered Shelter, and a Future

Posted in Dental Health News by Dion Kramer on August 25, 2008

This article was recently published in the Sydney Morning Herald – Sydney, New South Wales, Australia.

BULLIED at eight, raped at 11, a drunk by 13, Adam Reynolds has the classic traumatic past that leads to homelessness.

Mr Reynolds and his brother lived with their taciturn father in the tough Minto housing estate after his mother left when he was two. His father did his best. “The best dad I could have had,” he says. But it was not enough.

By 20, Mr Reynolds was in a cycle of living in and out of homeless shelters. The shelters, jointly funded by state and federal governments, provided a bed, food and a usually overwhelmed welfare worker. Some referred him to specialists, such as drug and alcohol counsellors, but Mr Reynolds was either too disorganised to go or discovered the wait for appointments was months. Now, aged 28, he is part of a new program called the Michael Project, which aims to stop the revolving door that spins the homeless from shelter to shelter.

The Federal Government has criticised the “churning” in its recent green paper on homelessness.

Funded by the largest single private donation in Mission Australia’s 149-year history, the Michael Project seeks to guarantee homeless people access to a range of services that will help them become independent. It is being officially launched today by the federal Minister for Housing, Tanya Plibersek.

The size of the donation is a secret at the request of the anonymous benefactor but it is large enough to also cover a major research component by the University of NSW and Murdoch University to track the progress of 150 clients over a year.

A barber, podiatrist, psychologist, dentist, occupational therapist, alcohol and drug counsellor, recreation officer and nurse are now accessible to the men who land at Mission Australia’s six city shelters and to the street sleepers helped by the Missionbeat vans. Some specialists have been hired and the charity has bought the services of a dentist at the Westmead oral health centre one a day a fortnight, and drives people to the appointments.

“We’re not getting people like Adam out of homelessness,” said Anne Hampshire, Mission Australia’s national manager of research. “You need to operate not just a house but a very intensive suite of services.”

Mr Reynolds is taking advantage of everything on offer. A cheerful extrovert, it is hard to imagine he tried to commit suicide when he arrived about three months ago. Now he is lined up to get his broken dental plate fixed and he is the star performer at the Milk Crate Theatre, a project for the homeless. He loved the trip to hear the Sydney Symphony rehearse, ran in the City to Surf and plays indoor soccer. His session with the podiatrist was “awesome”. Feet and teeth are particularly susceptible to problems among the homeless.

Every week he sees the psychologist about his agoraphobia: “I’ve never seen anyone in the past about my problem,” he said. At the literacy and computer skills class at the Parramatta College, Mr Reynolds is a keen participant.

He moved frequently before but now he is staying put for as long as he is allowed; even after he leaves the shelter, he will be able to have access to the special services. If the project improves his self-esteem and skills, Mr Reynolds, with his year 9 education and limited job history, will still face the huge barrier of the Sydney rental market.

“The Michael Project will not solve homelessness; a supply of affordable housing is the key,” Ms Hampshire said. “But we hope it will get people to a better place and we know extraordinary change can happen.”

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Lack of Dentists in Outback Forces Long Waits on Patients

Posted in Dental Health News by Dion Kramer on August 20, 2008

This is an article that was recently published in the Courier Mail – Brisbane, Queensland, Australia.

ANGER is building in the bush as regional Queenslanders have to wait up to three and a half years for basic dental care due to lack of cash and planning.

A dental association chief says underfunding and lack of government planning has created a nightmarish situation for anyone in need of a check-up outside metropolitan areas.

Without urgent attention the shortage of dentists could continue for another decade, says Queensland president of the Australian Dental Association John Wills.

Dr Wills said a shortfall in State Government funding was the main problem.

“Most regional and rural areas are undersupplied with dentists, public and private,” he said. “There is a lack of funding and there needs to be upgraded infrastructure so that dentists will want to work in these regions, before the situation will improve.”

Queensland Health says it employs the equivalent of 256 full-time dentists, 47 fewer than funded for.

Despite recent improvements in recruitment, a long-term shortage of dentists led to a blow-out in the time patients have to wait to get dental care. Queensland Health figures show a 172-week wait for almost 12,000 regional dwellers wanting a check-up in the public system.

Statistics for more urgent cases could not be supplied by Queensland Health because of different reporting systems across the state.

Queensland Health’s oral health unit director Margaret Smith said every effort was being made to recruit more dentists to the public system.

Queensland Health offers dentists salaries from $74,088 to $146,559 depending on their experience and specialist capabilities.

Dentists working in regional or remote communities are offered additional allowances of between 7.5 per cent of their salary for places such as Rockhampton, Gympie and Proserpine, up to 30 per cent in remote Cape York, Charleville and Hughenden.

Ms Smith said Queensland Health had been working to recruit dentists for rural communities and had recently employed a second dentist to assist the public dentist in Charleville.

Dr Wills was not convinced enough had been done to entice dentists away from metropolitan or major regional centres to service communities in remote and rural areas of Queensland.

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The Condition of Your Mouth Can Reveal a Lot About Your Sex Life

Posted in Dental Health News by Dion Kramer on August 18, 2008

This article by Dr Flora Stay was recently published in Natural News.com – Phoenix, AZ, USA.

As women, when we think about hormonal health, we usually consider issues related to our monthly menstruation, menopause, sexual health or weight gain. In reality, hormone imbalance can affect our total well-being. For example, women’s sexuality has to do with a lot of factors including physical as well as emotional issues. We especially experience the wrath of this imbalance during pre and post menopause and during our menstruation cycle, also known to some as the dreaded PMS (Pre Menstrual Syndrome). But you probably never considered one other important physical factor affecting your sexual mood, which surprisingly is gum disease, also known as the silent disease. This connection is rarely talked about and might at first seem an odd one, but it becomes obvious when you learn the science behind how it all works.

Your Mouth Has a Lot to Say About Your Overall Health

During the different stages of our lives when hormones are fluctuating, from puberty to menopause and pregnancy, many tissues are affected, including our gum tissue. The gums can swell up, bleed easily and become slightly redder during these times of hormone related events.

Often, once the hormone balances, the gums won’t necessarily go back to their healthy state automatically. If you practice good home oral hygiene, your gums will go back to normal, if not it will get worse. With this state of chronic gum inflammation, your hormones and even worse, the immune system, can be affected causing a cascade of events, thereby eventually compromising overall health.

Important Little Signs Not to be Ignored

Slight bleeding, red gums and even some swelling, are all signs of inflammation that accompany gum disease. Most people don’t pay any attention to the signs of inflammation when it occurs in the mouth. It’s no wonder a study published in Journal of Periodontology in January of 1999, reported that at least 23 percent of women ages 30 to 54 have severe gum disease (periodontitis) and 44 percent of women ages 55 to 90 who still have their teeth have gum disease. As far as the general public, the National Institute of Dental and Craniofacial Research reported about 80 percent of U.S. adults currently have some form of the disease.

This is surprising in our day and you may wonder how could so many people have gum disease. But truth be known, many people go to the dentist only “when it hurts”. If you’re one of these individuals, you need a new perspective on oral health, especially if you’re sex life is not as exciting as it used to be or you have a hard time managing stress.

When your immune system is healthy, it becomes easier to handle stress, and your mood and hormones stay in balance. If you’re feeling run down, feel unable to handle stress with no interest in sex, make a visit to your dentist. Many people may have suffered for years with mood changes and ill health while being treated only with drugs, with the mouth never considered as part of the whole picture. The drugs alone may not help you if chronic inflammation from your gums is not treated.

There really is no excuse not to get regular dental check-ups or to practice good home oral hygiene. Find your soul-mate dentist, have your mouth checked and enjoy a fabulous love life.

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A Healthy Mouth Equals a Healthy Body

Posted in Dental Health News by Dion Kramer on August 15, 2008

This is an article that was recently published in Natural News.com – Phoenix,AZ,USA.

There is a Chinese proverb that goes like this: “A smile will gain you ten more years of life.” These words were written countless centuries ago, yet today they ring more true than ever. The links between oral health and overall health are being established on a near daily basis and the implications are astounding! Imagine if by simply brushing and flossing regularly, you were able to prevent a heart attack? We may not be there quite yet, however a definitive connection has been established between gum disease and heart disease, diabetes and pregnancy complications. And while the research moves forward, what we are learning today is that a healthy smile truly may add ten years to your life.

At the root of this research frenzy is something that scientists refer to as biofilm. If the word “biofilm” renders images of horror films or sci-fi scream fests, then you aren’t far off. In real life, biofilm is the sticky, colorless film that develops on teeth and is more commonly known as plaque. It is this complex reef-like substance that builds up over time, setting the stage for gum disease and potentially leading to life-threatening health problems.

Gum disease is also referred to as periodontal disease and encompasses the various stages of the disease, including gingivitis and periodontitis. Periodontal literally translates to “around the tooth”. Interestingly, as the disease progresses it manages to burrow itself more completely around the affected tooth or teeth.

The beginning stage of gum disease is gingivitis, which occurs when plaque buildup begins to inflame the gums causing them to redden, swell and easily bleed. Typically there is little to no discomfort during this stage. Because of this, gingivitis is generally detected during a regular dentist visit. If diagnosed and treated, gingivitis is completely reversible.

If gingivitis is not treated, it can lead to periodontitis, which occurs when plaque spreads below the gumline. The bacteria associated with plaque produces toxins, which trigger further inflammation. Over time, this heightened inflammatory response will ultimately deteriorate the bones and tissue that support the affected teeth, eventually leading to tooth loss. Once periodontitis sets in, treatment is crucial to manage the inflammation and minimize damage.

It is estimated that 80% of all American adults have some form of gum disease. Smoking, genetics, stress, medications (including oral contraceptives, anti-depressants and certain heart medications), pregnancy, clenching or grinding your teeth, poor nutrition, diabetes and other systemic diseases have all been implicated as risk factors for the disease.

The link between gum disease and systemic disease is at the center of a number of on going studies. What we currently know is that definitive links do exists between gum disease and heart disease, diabetes and pregnancy complications. Currently researchers are examining the possibilities that either inflammation, bacteria or a combination of the two are at the heart of the link between gum disease and other health problems.

In the case of heart disease, doctors have long been aware that heart patients run the risk of developing a mitral valve infection after a routine teeth cleaning. Bacteria released during the cleaning process can enter the bloodstream and travel to the heart where an infection may occur. (For this reason, heart patients are generally prescribed antibiotics prior to dental work as a safeguard.) Now researchers are finding new links between oral health and heart health. In a study recently published in The New England Journal of Medicine, scientists found that treating severe gum disease can improve the function of blood vessel walls, thereby improving heart health. Researchers are now shifting their focus to determine if treating severe gum disease will result in fewer heart attacks, strokes and other cardiovascular problems.

Diabetics run a particularly high risk of gum disease, developing the disease at a rate 3 to 4 times higher than non-diabetics. The suspected culprit is the body’s inflammatory response, which can have devastating effects on blood sugar control. Diabetics with untreated gum disease find it nearly impossible to manage their blood sugar levels and diabetes therapies often fail to work. However, with regular treatment for gum disease, blood sugar levels can generally be controlled effectively. Interestingly, the link between gum disease and diabetes doesn’t always originate with an insulin problem. A study in the Journal of Periodontology recently reported that gum disease predisposed certain people to developing early signs of diabetes. Clearly a link between oral health and blood sugar control exists.

A study published earlier this year in the Journal of Periodontology revealed that bacteria normally found in inflamed gums has been found in the placentas of pregnant women with high blood pressure. Scientists had already suspected that a link between gum disease and pregnancy complications existed. This suspicion was further confirmed in a study conducted at the University of Chapel Hill. Steven Offenbacher, DDS, PhD who headed the study announced earlier this year, “Our findings indicate that periodontal disease progression during pregnancy contributes to preterm deliveries and especially very preterm deliveries (less than 32 weeks) which places the baby at high risk for neonatal problems and disability.” While these findings may seem bleak, the good news is that pregnant women can safely receive treatment for gum disease during their pregnancy. Successful treatment could minimize infection and inflammation and reduce the risks to the unborn child.

The research continues on as scientists set forth to further understand the implications of oral health. While a greater understanding is essential to solving this puzzle, there are steps that you can take at home to take charge of your own health today. I recommend the following steps to all of my patients in order to maintain a healthy and beautiful smile:

Make sure to brush after every meal and floss daily

See your dentist every six months for an examination and annually for radiographs

See your hygienist every four to six months for a thorough cleaning

If you notice swelling, redness or bleeding in your gums, consult your dentist right away

If you have been diagnosed with periodontal disease, follow and complete your treatment plan as described by your dentist, hygienist and periodontist.

Andy Rooney once said, “A smile is an inexpensive