The NobleDentist Blog

This is an article published recently on the dentistry.co.uk website – London.

A new chilli-based local anaesthetic that appears to prevent pain without causing numbness could have a huge impact on dental treatment, according to the British Dental Health Foundation.

The Foundation welcomed the work of the research, which was carried out by Harvard Medical School and Massachusetts General Hospital, and said the new anaesthetic could make procedures quicker, simpler and more convenient.

Dr Nigel Carter, chief executive of the BDHF, said: ‘Of course this research is still in its early stages but it could form the basis of a massive step forward in the battle against dental phobia.

‘According to our own surveys around one in five people who do not visit the dentist make this decision because they have a fear of pain.

‘Although dentistry today is already pain free, some people find the numbness caused by current anaesthetic quite uncomfortable and because their mouth feels unnatural they might perceive the treatment as potentially more painful experience than they otherwise would.

‘It is important that people visit the dentist regularly, as often as their dentist recommends and so anything that can make the experience more convenient and comfortable is welcomed by the Foundation.’

The chilli anaesthetic was created by scientists from a combination of capsaicin (the natural compound that makes chilli peppers hot) and a derivative of the local anaesthetic lidocaine. It works by selectively blocking pain-sensing neurons without interfering with other types of neurons, meaning that the subject doesn’t feel any pain but still reacts in the same way to other sensations such as touch or movement. It has only been tested on rats so far.

Dr Carter added: ‘Anaesthetics are most commonly used for treatments such as fillings and root canal work. Therefore if people find the numbing process uncomfortable then by far the best way to avoid it is for them to take care of their oral health so that they do not require treatment in the first place.’

This is an article by Sarah Mauet that was recently published in The Arizona Daily Star.

Chris Strong was distraught to discover not only that her daughter had a cavity at the tender age of 4, but that her 2-year-old son had one as well.

“I was really upset about it,” said the Tucsonan. “I took it as a personal affront to me.”
But she soon found out that her children are not alone. Cavities in kids are on the rise.

While tooth decay in baby teeth had been decreasing for the past four decades, the latest federal report from the Centers for Disease Control and Prevention provides the first statistical evidence that this trend is reversing. The new study shows 28 percent of 2- to 5-year-old children surveyed from 1999 to 2004 had cavities, compared with 24 percent of children surveyed from 1988 to 1994.

“All of Cammie’s friends in preschool have cavities,” Strong said of her daughter, Cameron, now 5. “One friend had eight cavities and the other had two.”

Tucsonan Linda Nazifi, a mother of four, has seen the high rate firsthand.

“All of my kids had at least one cavity in their preschool years,” she said. “The youngest was age 1.”
The American Dental Association recommends children visit a dentist by their first birthday. Laila Hishaw, one of three Tucson dentists certified by the American Board of Pediatric Dentistry, explained that baby teeth are weaker than permanent teeth.

“The enamel is thinner, so if we see a little cavity we do want to treat it because it will spread faster,” she said.
While baby teeth are temporary (though the molars can last until age 14), cavities can lead to pain and dental problems as well as overall health problems if not treated properly.

“Parents need to realize that they’re not just teeth,” Hishaw said. “They are connected to the body.”
Dental health is an important part of overall health, agreed Lisa Staten, an associate professor at the University of Arizona’s College of Public Health and the director of the Canyon Ranch Center for Prevention and Health Promotion.

While reasons for the upswing in children with tooth decay were not studied, experts say the pattern shows that children might be getting too much sugar and too little fluoride while not brushing properly.
Many factors that contribute to weight problems in children are also detrimental to their teeth.
“Kids are eating more prepackaged meals, less fruits and veggies, and more items that are pre-sweetened,” said Bruce Dye, of the CDC’s National Center for Health Statistics.

Multiple daily snacks also likely are contributing to the increase in decay, said Mary Hayes, a pediatric dentist and spokeswoman for the American Dental Association.

“It’s this idea of grazing,” she said. “With the wrong foods, you are simply allowing the bacteria to thrive and causing an acid attack on the tooth more often.”

It’s the same story with a child going to bed with a bottle or sipping juice all day. Hayes advises no more than 4 ounces of juice a day. After that, she considers it candy water.

Another problem is the popularity of bottled water, which typically doesn’t contain enough fluoride to prevent decay, according to the American Dental Association. Hishaw gives about half of her young patients fluoride supplements based on dental needs, and recommends the others drink fluoridated bottled water, which is often found in a store’s baby section.

“The reason it’s not necessary for adults is when we brush our teeth, the fluoridated toothpaste helps the teeth in our mouth,” Hishaw explained. “But as children, our permanent teeth are developing in our jaw, so when they drink the fluoridated water it works systemically and those permanent teeth that are developing will get fluoridated. When they come in, those permanent teeth are less susceptible to tooth decay — they’re stronger.”
Pediatric dentists are trained to work with the smallest patients. They have an additional two to three years of training after dental school and can handle special-needs cases as well as deal with behavior management of anxious children.

“We are the pediatricians of oral health,” Hishaw said.

Strong, who originally brought Cameron to a regular dentist, thinks her kids’ cavities could have been avoided if she had known to take them to a specialist from the beginning.

“Really, it makes a difference,” she stressed. “If you have kids you have to go to a pediatric dentist.”
In many pediatric dentists’ offices, everything from décor to demeanor is designed to make the tiny patients feel more comfortable. Even the terminology is kid-friendly — a local anesthetic might be a “sleepy bubble” and a laughing gas mask an “elephant nose” or a “pilot mask.” Hishaw told Strong’s son, Kenneth, that his cavity was a “sugar bug.”

“My son uses that expression when he brushes his teeth every night,” Strong said. “He says, ‘gotta get the sugar bugs.’ It’s so cute.”

Nazifi and Strong both said that their children enjoy visits to the dentist. That’s important because experts say the key to combating tooth decay is early prevention.

To fight “sugar bugs,” Hishaw suggests limiting snacks and drinks other than water between meals and getting enough fluoride either as a supplement or in bottled water, depending on a dentist’s recommendations. Parents should also help their children brush their teeth twice a day — three times if the child has had a sugary snack between meals.

“The good thing is that tooth decay is preventable,” Hishaw said. “Just get your checkups.”

This is an article by Bob Sullivan that was published recently in the Indianapolis Star – United States.

We’ve all had that embarrassing moment when a delicious lunch — heavily seasoned with garlic and onions — returns with us to the office in the form of bad breath, forcing our colleagues away until we get a clue.

We usually can remedy such problems with a quick brushing of the teeth or popping of a breath mint.

But what does it mean when moments like this become more frequent, and the quick fixes no longer work?

According to Dr. Breann Mundy, a dentist at Heartland Crossing Dental Care in Camby, chronic bad breath might be the first sign of a more serious health condition.

“Chronic bad breath, or halitosis, can be caused by several things,” Mundy said. “Remember, mouth rinses are cosmetic. They’ll mask the problem but they won’t solve it. You need to work with a medical or dental professional to figure out why you have the problem.”

Cavities

Dental caries — better known as cavities — are the most common infectious disease in the world. But what’s not commonly known is cavities can cause bad breath.
“The positive news is cavities are treated with a one-time procedure that takes care of the problem,” Mundy said.

Periodontal disease

In another familiar scenario, halitosis indicates gingivitis, a chronic swelling of the gums. Left untreated, gingivitis eventually becomes periodontal disease — a deterioration of the gum and bone surrounding the teeth.

“Your dentist can perform a deep cleaning to access debris your brush can’t reach,” Mundy said. “In more serious cases, they may refer you to a specialist (a periodontist) for a surgery to access debris under your gum and bone tissue.”

According to Dr. James Huseman, a dentist at Noble Creek Family Dentistry in Noblesville, “The progression from halitosis to gingivitis to periodontal disease usually takes a long time. It’s not just going to pop up over the weekend. The good news is, most people have plenty of time to go to their dentist to seek treatment.”
“Periodontal disease is a chronic problem, like diabetes,” Mundy warned. “Once it sets in, it requires lifelong monitoring and maintenance.”

Cancers of the upper oropharyngeal airway

In its most serious form, halitosis can be a sign of cancer in the mouth and upper digestive tract.

“Oral cancer is a very serious condition,” Mundy said. “Survival depends on catching it early. It’s vitally important to get screened once a year.”

Huseman added, “Dentists can perform oral screenings across the board, for all ages, including small children. It’s generally included as part of any comprehensive exam. Your dentist will look at all the soft tissue in the mouth to look for a wide variety of conditions and symptoms.”

This is an article by Dr Norman Swan that recently appeared in ABC Health Matters.

Occasionally there’s panic about dental amalgam because of the mercury in it. Amalgam’s the stuff used to fill your teeth. It’s been blamed for fatigue and brain damage in children and some people have gone and had their fillings re-drilled and replaced with a resin.

While resin composites look better, they don’t stand the stresses of chewing as well as amalgam and are more likely to fail with decay recurring in the tooth. They also cost more and are fiddly to use – so the skill of the dentist or dental therapist matters more.

Anyway two recent studies should reassure parents of children needing fillings. Both were trials comparing amalgam to resin and followed hundreds of children measuring IQ, memory, mental skills and kidney function. Out to seven years of follow up there were no differences even though the amalgam children did have slightly more mercury in their urine.

So while it’s possible there were subtle effects which weren’t detected, it’s very likely that amalgam is not a concern, which is good news for those wanting to make dentistry affordable as well as safe.

This is an article by Dr Nigel Carter (British Dental Health Foundation) that appeared recently in the Scotsman.

Ask the expert

My six-year-old son has lost his first milk teeth and the replacements are growing in really crooked. The dentist says that nothing can be done at this stage, but I would rather any braces be fitted now rather than when the poor chap is a looks-conscious teenager. Is there anything I can do in the meantime, I’d be prepared to pay for the treatments.

MM, Loanhead

It is actually quite normal for the adult teeth to come through slightly crooked. A child’s mouth is much smaller than an adult’s, so it is not surprising that it struggles to house adult-sized teeth at first. As the child gets older though the jaw will grow and the teeth will find the space they need. This does not mean your child needs braces in the meantime.

In fact, putting braces on a six-year-old could end up doing more harm than good and it is unlikely that you would be able to find a dentist to carry out the treatment anyway. At this age your son has a lot of development ahead of him and he needs to be given time for his jaw to grow. It is difficult to know how the teeth will develop before then and fitting a brace could affect the shape of the jaw as it grows. Once all of the teeth have come through though, it will be much easier to see exactly what needs to be done.

One thing is for sure, you don’t need to worry about braces having an adverse effect on your son’s image by fitting them in his teens. These days braces are actually very fashionable and, in some cases, you can hardly tell they are there. If you are prepared to go private there are all sorts of options available. You can have clear “invisible” braces that are very subtle and cool. Or your child may prefer coloured braces, especially if you suggest using the colours of his favourite football team. There are even some braces that fit behind the teeth and so are not visible from the outside of the mouth. By the time his teenage years come round there will probably be even more options available.

In the meantime, if you want to ensure your child’s dental health doesn’t deteriorate, then discourage him from thumb or pen sucking as this can worsen crooked teeth. In addition, make sure that he maintains good oral healthcare so that once his teeth have been straightened his smile will be white, as well as straight.

This article recently appeared in ABC Health Matters.

A class of common medications in Australia has been linked to necrosis of the jaw bones following dental procedures like extractions or implants.

The bisphosphonates are used to treat cancer in the bone and bone diseases like osteoporosis. The problem is that once you’ve been on the medications for over 18 months or so, depending on which one you’re on, there’s a risk that the socket heals slowly and painfully after a fairly major dental procedure.

If you’re taking alendronate – the brand name’s Fosamax – for osteoporosis the risk is lower than some of the newer drugs in this group like risedronate or Actonel. It also seems that people on these medications for cancer are affected more than those with osteoporosis.

All this has to be weighed up against the benefits of bisphosphonates especially the relief given to secondary cancers.

One thing people can do is have any major dental work completed before starting on one of these drugs or in the first few months of use.