The NobleDentist Blog

This article was recently published in the Craig Daily Press.

Growing evidence suggests a link between gum disease and premature, underweight births. Pregnant women who have gum disease may be more likely to have a baby that is born too early and too small. More research is needed to confirm how gum disease affects pregnancy outcomes. But it appears that gum disease triggers increased levels of biological fluids that induce labor. Data also suggests that when gum disease worsens during pregnancy, there’s a higher risk of having a premature baby.

What can I do to ensure I have a healthy pregnancy?

The best advice to women considering pregnancy is to visit their dentist for a checkup and to treat any oral problems before becoming pregnant. During your pregnancy, your teeth and gums need special attention. Regular brushing and flossing, eating a balanced diet and visiting your dentist regularly will help reduce dental problems that accompany pregnancy.

What oral problems might develop during my pregnancy?

Studies show that many pregnant women experience pregnancy gingivitis — when dental plaque builds up on the teeth and irritates the gums. Symptoms include red, inflamed and bleeding gums. Pregnancy gingivitis occurs more frequently during pregnancy because the increased level of hormones exaggerates the way gums react to the irritants in plaque. However, it’s still plaque — not hormones — that is the major cause of gingivitis.

Keeping your teeth clean, especially near the gum line, will help dramatically reduce or even prevent gingivitis during your pregnancy. And substituting sweets with more wholesome foods such as cheese, fresh fruits or vegetables is better for your teeth.

What can I expect when I visit my dentist during my pregnancy?

First, be sure to let your dentist know you’re pregnant when you schedule your appointment. It’s best to schedule your dental visit during the fourth to sixth month of your pregnancy. This is because the first three months of pregnancy are thought to be of greatest importance in your child’s development. During the last trimester, stresses associated with dental visits can increase the incidence of prenatal complications.

Typically, X-rays, dental anesthetics, pain medications and antibiotics (especially tetracycline) are not prescribed during the first trimester, unless it’s absolutely necessary. During the last three months of pregnancy, sitting for long periods of time in the dental chair can become uncomfortable. And there is evidence that pregnant women can be more prone to gagging. Your dentist, however, is prepared for this situation.

If you need to schedule an emergency visit, let the office know about your pregnancy before you arrive. Discuss any stresses, past miscarriages and drugs you are taking as these can all have an influence on how your dentist attends your needs. Your dentist may also want to consult with your physician before any treatment is started.

If you have any doubts or concerns, insist that your dentist and physician discuss your particular needs. If your dentist prescribes medication, do not exceed the prescribed dosage. This includes aspirin.

This is an article that recetly appeared on ABC Online News.

A Hobart dentist claims no emergency dental treatment will be available on Sundays when he goes on holiday in a fortnight.

Dr Michael Young says he is the only practitioner providing dental care in Hobart on Sundays.

Dr Young wants the Health Department to fully equip the dental unit at the Royal Hobart Hospital so that it can also provide emergency dental services.

“As I’m going on holiday, which involves two weekends, there will be no service at all for anybody in Hobart and to me it’s a bad situation,” Dr Young said.

The Director of Oral Health Services, Siobhan Harpur, says talks are continuing with the Australian Dental Association for out-of-hours emergency care for private patients at the Royal Hobart Hospital.

This article by Meagan Francis appeared recently in CNN Health.

For the first time in decades, cavities in kids are on the rise. As many as 28 percent of children ages 2 to 5 have cavities in their baby teeth. What can you do to keep your child’s teeth healthy? Answers to your most pressing dental questions, for babies on up:

Q: What’s the best way to keep my child from getting cavities?

A: The health of your child’s teeth is largely dependent on four things: diet, oral hygiene, tooth makeup, and the amount and quality of her saliva (which helps rinse away food and bacteria). Since saliva and the strength of her teeth are based mainly on genes—and out of your control—focus on what you can influence: eating and cleaning.

The kind of food in your child’s diet—and how frequently she eats it—matters. When sugar and starch meet up with normal bacteria in the mouth, they can create acids that dissolve the tooth’s structure and cause cavities. The more a child eats sugar and starches (processed snacks are the worst offenders), the more often her teeth are exposed to the acids. Eating regular healthy meals, rather than lots of small portions throughout the day, and drinking water (the fluoridated kind, for kids older than 1), will help prevent acids from settling on the teeth and stave off tooth decay. While a no-snack rule is unrealistic, offer more fruits and vegetables, as opposed to processed treats.

Just as crucial: Kids should brush at least twice a day and, ideally, after snacking, too. Keep in mind that the most important time to brush is before a nap or bedtime because saliva production slows during sleep (it’s linked to blood pressure and heart rate), giving acids far more opportunity to damage teeth.

At what age should I start taking my child to the dentist—and how often should he go?

A: Babies should see the dentist within six months of their first tooth’s appearance (usually around 6 months of age), and no later than age 1. Stick to that time frame and your child may need fewer fillings than kids who wait until age 2 or 3, says a recent study. At the visit, as long as there are no major problems, the dentist will typically count and inspect your child’s teeth (or tooth!), start to get him used to the office and staff, and talk with you about preventive care. The main goal is that a child have a happy and comfortable experience, says Beverly Mittelman, coauthor, along with dentist Jerome Mittelman, of “Healthy Teeth for Kids.” The rule of thumb is to bring your child back every six months or so for a routine cleaning and checkup.

Q: Are electric toothbrushes a good idea for kids?

A: They can be helpful for children who aren’t yet coordinated enough to brush thoroughly with a manual toothbrush (kids under 4 sometimes aren’t). They also often come with a two-minute timer that lets your child know when she can stop brushing. If you choose an electric model, make sure your child doesn’t apply too much pressure when she’s using it. If she does, the head of the toothbrush may not rotate and won’t be as effective. No matter which kind of brush you pick, be sure that she’s getting to those hard-to-reach places in the back of her mouth; this might require a little extra help from you until she’s 5 or 6 years old.

Q: Should my child get dental sealants to prevent cavities?

A: They’re no substitute for good oral hygiene. But sealants—thin plastic barriers that are painted onto the chewing surface of the back teeth—can help fend off decay if your child has deep grooves in his molars. Bacteria, plaque, and food particles can get into those grooves and are difficult to remove with a toothbrush. Though some research supports using sealants as a routine part of dental care for babies, baby teeth are less likely to be heavily grooved, and many insurance companies will pay for sealants only on adult teeth. If some (or all) of your child’s permanent teeth are in, talk to your dentist about whether he recommends sealants. There’s no drilling or anesthetic required, they won’t show when your child talks or smiles, and they aren’t painful—though he may be able to feel them with his tongue at first. Prices vary; if you have dental insurance, check to see if sealants are covered.

Q: I see a lot of natural toothpastes in the store these days that don’t contain fluoride. Are they OK for kids to use?

A: While fluoride protects enamel, non-fluoridated toothpastes are best for kids who can’t yet spit. Why? Swallowing fluoride and getting too much of it can lead to fluorosis, which causes stains on the enamel of permanent teeth. (What’s most important, whichever toothpaste you choose, is the action of brushing teeth, which does most of the cleaning.) When your child’s old enough to spit, talk to your dentist; she may be getting plenty of fluoride through tap water, fluoride treatments, and food. Also note: Infants under 1 do not need fluoride and are particularly vulnerable to fluorosis. The American Dental Association recommends that you use water that has no fluoride, or only a low level of it, for formula that needs to be reconstituted. Best bets are purified, deionized, demineralized, distilled, or reverse osmosis filtered water.

Q: Is it true that chewing xylitol gum can help reduce the risk of tooth decay?

A: Yes. The physical motion of chewing produces more saliva, which helps neutralize pH balance to prevent cavities. And studies have shown that xylitol, a natural sweetener that tastes like sugar, may suppress the growth of bacteria in the mouth.

For kids under 4, any type of gum is a choking hazard. But babies and toddlers can still reap the benefits of xylitol: If Mom chews it during her pregnancy and up to two years postpartum, her child’s less likely to develop tooth decay down the road (the bacteria that cause it are often passed from mother to baby through kissing or sharing food).

Q: My toddler grinds his teeth. Should I be concerned?

A: Tooth grinding (bruxism) happens occasionally in young kids. As your child’s mouth grows and changes, he may grind his teeth in order to comfortably align them with his jaw. While it can damage the enamel on baby teeth, they usually fall out before it becomes a problem. And experts say it’s uncommon for grinding to do serious harm to permanent teeth because the habit usually goes away on its own by age 6. If you’re still worried, or your child hasn’t outgrown it by then, talk to your dentist. She may suggest a mouth guard to wear at night, or she may refer you to a myofunctional therapist, who can work with him to balance the muscles in the mouth and get at the cause of the grinding.

Q: Do I really need to wipe my baby’s gums with gauze before his teeth come in?

A: It’s a good idea. It will help your baby get used to the feeling of brushing, and sometimes there’s a small opening in the gum before the tooth erupts—a perfect hiding place for bacteria, which the gauze will wipe away. Payman Pirnazar, a pediatric dentist in Los Angeles and the founder of BabyTeeth.com, recommends that you start wiping your baby’s gums after each feeding at around 6 months (it takes just a few seconds). Dentists say it may even have the added benefit of making teething more comfortable for your baby, since as you’re cleaning you’re also massaging the gums.

Q: What are the best kinds of fillings for children—and are there any new, less painful ways to drill for them?

A: Often it comes down to aesthetics. “If you have a child walking around with metal crowns, it’s not uncommon for other kids to start teasing him,” says Dr. Pirnazar.

And then there are practical issues: Filling a cavity with composite (a tooth-colored material made of quartz and resin) may take up to 40 minutes—as opposed to about ten minutes for an amalgam (metal) filling—which is a challenge when the patient is a wiggly kid. On the other hand, composite restorations don’t require the dentist to drill as much. And while the ADA maintains that the mercury content in metal fillings is safe, this has been debated, and some parents prefer to skip them.

Laser surgery is the newest way to drill and is said to be less painful, though it’s not yet widely available. Because the equipment is expensive, if your dentist offers laser drilling, ask whether there’s an extra fee for it.

Q: How is a pediatric dentist different from a family-practice dentist?

A: Pediatric dentists receive additional training in caring for children’s oral health. And they tend to make their offices child-friendly by offering videos, special chairs, or music. The caveat: Since pediatric dentistry is a specialty, there may be fewer practitioners to pick from in your area. Ultimately, though, sizing up any prospective dentist comes down to this: How does she relate to your children? Is she competent? Does she listen to your concerns? The answers to these questions are more important than her title.

This is an article by Carol Nader that recently appeard in The Age (Melbourne).

Fees and long public waiting lists are forcing more people to take out loans to pay for dental treatment.

Marilyn Webster, from the Good Shepherd Youth and Family Service that co-ordinates a national no-interest loan scheme for people in need, said more people were applying for loans for dental treatment.

“More people are taking out loans for dental work because of the failure of the Federal Government to adequately support the funding of public dental services,” she said.

“The group using these loans are people that are already eligible for the public system but can’t afford the private system.”

Ms Webster said public dental care had been caught in cost-shifting between the Commonwealth and states.

“The people that are suffering are the people that can’t afford to go privately for dental work,” she said.

“We think one of the reasons why they are growing is that the Howard Government cut back on public dental work and while a certain degree of that was picked up by state governments, the gap wasn’t totally filled.”

A survey of 4000 dentists by the Australian Dental Association has found wide variations in what dentists charge for the same procedure.

The survey of fees conducted last year, of which part has been released to The Age, found that the average cost of a set of dentures was $1594. But dentists charged $1100 to $2581.

The average cost of an oral examination was $50, but fees varied between $36 and $87.

State Government figures show that at March, the average waiting time in Victoria for general dental care was 23 months.

The average wait for dentures was almost 25 months. Waiting times for both have been steady since December.

The number of people on waiting lists fell between December and March — from 118,375 to 117,324 for general dental care, and from 20,500 to 20,398 for dentures.

Australian Dental Association national president John Matthews said the survey did not take into account that dentists sometimes gave some patients discounts. He said the wide variation in charges was in part due to dentists charging what they thought they were worth. Some of the variation could be due to dentists misinterpreting the question.

“There will be some people who regard themselves as the absolute best and tend to charge a higher fee,” he said. “Certainly you would want to get a second opinion if it seems outrageous.”

He said other cost considerations included the “Collins Street factor” — location — the cost of materials and staff wages.

Labor health spokeswoman Nicola Roxon said she was concerned about what some dentists were charging. “A service which should be a basic service for the community is increasingly a service that you can only access if you’re on a high income,” she said.

Labor has said it would reinstate federal funding for public dental health, and Ms Roxon indicated that it would also look at ways of helping those who were ineligible for public care but who could not afford a private dentist.

A spokeswoman for Health Minister Tony Abbott said that it was up to dentists and professional groups “to ensure costs charged are responsible and realistic”.

This is article recently published in Science Daily.

The Centers for Disease Control report that nearly 25 million women are infected with some form of the Human Papilloma Virus (HPV). Of those, more than three million are thought to have one of the four strains known to cause cases of cervical cancer and genital warts.

HPV is linked to oropharyngeal cancer and may be linked to oral cancers as well, and vaccines that have been developed to treat HPV might decrease the risk of these cancers, according to a study in the May/June issue of General Dentistry, the clinical, peer-reviewed journal of the Academy of General Dentistry (AGD).

James J. Closmann, BS, DDS, the lead author of the study, found that oral and oropharyngeal squamous cell carcinoma (OOSCC) have been linked to high-risk HPV strains, the same strains that cause cervical cancer.

Recently, a vaccine was developed to treat patients with HPV against cervical cancer, and this could have an effect on women’s oral health.

“More than 100 strains of HPV have been identified,” says Dr. Closmann. “They have been shown to cause other benign and malignant disorders, which now include those in the mouth. Nearly 30,000 new cases of oral and oropharyngeal cancer are reported each year. It’s possible that oral and oropharyngeal cancers could be reduced if vaccination were more widespread; however, additional research is needed.”

Additional research could result in a comprehensive test for dentists at patients’ semiannual visits. However, a dentist can perform a head and neck exam to detect early signs, despite the lack of a specific test. A possible connection between HPV and oral cancers, and the stronger link to oropharyngeal cancers, is even more of an indicator that patients should visit the dentist twice a year to identify irregularities early.

“Visiting the dentist on a regular basis is an important factor in the detection of any oral health complication,” says Laura Murcko, DMD, spokesperson for the AGD. “Taking preventive measures is especially important, and your dentist can check for early signs of oral cancer.”

Oral Health Tips for Women:

• Keep your dentist informed about changes in oral health.
• Visit the dentist regularly, which will help them to detect changes in the mouth.
• Ask your dentist to take a full medical history to determine if you are at risk for certain problems.
• Ask your dentist to perform a complete a head and neck exam to detect early signs of certain conditions.

Note: This story has been adapted from a news release issued by Academy of General Dentistry.