In an article published in the online journal “Cancer”, researchers at the MD Anderson Cancer Center in Texas noted a significant improvement with the salivary flow of patients both during and after head and neck cancer treatment when they also participated in acupuncture treatments. The test groups had improved salivary flow and lowered perception of dry mouth beginning within one month of treatment. The excitement of this study (and hopefully more to follow) is that dry mouth has a dramatic negative impact on all functions of your mouth, from speaking to eating, and includes other not-so-thought-of aspects such as sleeping comfort and development of decay. The possibility of lessening some of the secondary struggles of cancer treatment will be a welcome relief to many.
How Did I Get a Cavity Under My Crown?
This is a question we get asked many times and I think the answer is simple, but has often not been discussed. A crown is placed to structurally support a tooth when it has been broken, had root canal treatment, or simply has too much filling or decay to function with a smaller restoration. The crown is made to fit very closely to the shape of the prepared tooth and is held in place by very strong bonding agents or cement.
I think people hear “crown” (or also “cap”) and believe it is a synthetic material which prevents the tooth from decaying. The truth is the tooth under the crown is always susceptible to decay- especially when you consider the damage already done to a tooth to necessitate a crown. When a crown is placed, the micro-margin where it meets the tooth becomes an easily forgotten home for bacteria. If the crown is not tight to the tooth or the cement is not the correct type, bacteria can slowly eat their way under the crown and begin the decay process in a protected environment. The results of this can be catastrophic and dramatic. Most of our dental materials do not allow us to see “through” them with x-rays, just around and below. So having the margins of the crown visually checked at cleaning visits and taking advantage of the views x-rays will allow are important preventive steps.
At home, you have to pay close attention to brushing thoroughly (not roughly- you’re not scrubbing paint here!) at the margins of your crown and to always floss well where the crown contacts the adjacent teeth. Don’t underestimate how quickly bacteria can damage the remaining tooth under the crown.
Keep in mind that a crown still has to function in an environment which favors the growth of bacteria, so you have to take the steps to protect it. With some diligent care and regular check-ups, the goal is for your crown to last many years.
Osteoporosis, Bisphosphonates, and Dentistry
Bisphosphonates are a type of medication used to strengthen bone, most often in the cases of osteoporosis and when a patient has certain types of cancer or is undergoing certain chemotherapies. Common examples are Actonel, Boniva, Fosamax, and Aredia, although there are many others as well. They work by blocking the “bone eating” cells in the normal bone rebuilding process and allow the “bone building” cells to work double-time to strengthen weak bone. The benefits of these medications are integral to the health and safety of millions of lives to prevent skeletal weakening.
Our concern in dentistry is the that when someone has been taking one of these medications for a long period of time, there can be risks with certain dental procedures. As the bone strengthens, it becomes more dense. In a very small percentage of people, this increased density can be problematic after invasive dental procedures such as extractions and lead to a condition called osteonecrosis of the jaw. Now let me emphasize again that this is only a very slight RISK in a very small group of people. Let’s take some time to analyze this…
Our first goal is prevention of decay and gum disease in any patient, and this becomes paramount in patients using bisphosponate medications. By minimizing the amount of plaque and bacteria in your mouth, we can limit the negative effects they cause. If there is a need to treat a dental problem, ALMOST ALL dental procedures are safe to perform with NO CONCERN about the bisphosphonate medications. These procedures include cleanings, fillings, crowns, root canal procedures, and most gum surgeries. Again, this is a category of procedures commonly held as “unaffected” by the bisphosphonate drugs. There have even been several studies that show dental implant placement and success rates are equal and also unaffected by these medications. Our concern is most often linked to dental extractions, and increases with the number and difficulty of the extractions. The problem is that once the extraction is completed, the bone has a hard time healing and is potentially more susceptible to the natural bacteria in your mouth. In a very small percentage of patients, an infection can develop that can lead to loss of pieces of bone- what we call osteonecrosis of the jaw. Thankfully, active research is identifying ways to control this potential negative outcome. It has been shown that use of prescription mouth rinses before and continuing after the extraction, and also the use of antibiotics will help to allow the normal healing process to occur. The focus is to be prepared and informed so the whole dental team is aware and takes appropriate precautions. And again, it must be emphasized that this is thankfully only a very rare risk, but it must be discussed to prevent.
I have many patients taking medications of this kind and the confidence that stronger bones inspires in them is important. The reduction of risk of skeletal fractures of hips, vertebrae, wrists, etc. needs to be a focus of a healthy lifestyle, and that is what bisphosphonate medications can provide. The dental risks of these medications are FAR OUTWEIGHED by the other significant health benefits they provide, of that we are all in agreement. It is just important to be sure your dental health professional reviews and understands the role bisphosphonate medications (and all your medications) play in your life.
-Dr. Leon
Holiday Whitening Special
Now is your best opportunity to whiten your teeth. We have an incredible offer for the Holidays to safely whiten your teeth, either with in-office “power” tooth whitening, or with an at-home whitening system using custom trays. We are discounting our fees by $150 for each of these procedures for the months of December and January to make Holiday gifting or starting the New Year with a fresh smile even easier! Don’t let this offer pass you by.
Welcome to our Blog!
Landerhaven Dental Associates is the office of Doctors William Lavigna and Joseph Leon. We have successfully built our dental practice with the focus of creating long term value through the use of the finest materials and latest advances. The opportunity to communicate with our patients and with others looking to have dental questions answered is an essential part of our dental practice. We will be updating our blog based on current dental events, techniques, and materials, and we will also answer any questions and respond to comments. Please feel free to contact our office at any point to discuss anything you see on our blog, and please accept our sincere welcome for those of you who might be looking for a new dental office.
Welcome
Drs. Lavigna and Leon feel Landerhaven Dental Associates provides comprehensive care and practical preventive information for patients of all ages. We welcome children and adults, and have built our family practice taking care of their wide range of preventive, cosmetic, and reconstructive needs.