Recent Lecture On Periodontal Disease Stresses Importance Of Treatment

by Gregory R. Bowen, DDS

On a recent Friday I attended the Hollers Memorial Lecture sponsored by the UTSA Dental School alumni. This lecture is held annually and features distinguished practitioners from around the world. I try to attend this lecture every year for this reason.

Inflammation of the Gums 

The topic of discussion involved a topic that has received some attention over the last few years, namely, the effect of inflammation and infection of one part of the body having destructive effects on other organ systems that may be far removed from the source of the infection. Inflammation we're concerned about as dentists, is inflammation of the gums.

As you may know, inflammation is the bodies reaction, biochemically, to injury, bacterial, or viral assault. Every day, our bodies fight off multiple attacks by microorganisms, and are constantly repairing small injuries we may not even be aware of.

One of the primary battlegrounds in this microscopic war is the oral cavity. It is normal for millions of bacteria to be found in just a drop of saliva. Most of these bacteria are harmless and even do some good by preventing other more harmful organisms to proliferate. The harmful bacteria which live in the gums and on the teeth in the plaque they form, are “crowded” out and so don’t overpopulate.

However in the form of periodontal disease, which is the inflammation of the gums, harmful bacteria that live in the small space between the gum and tooth- the “pocket” overgrow and begin to cause inflammation.

Most of us, are genetically equipped to fight off these organisms and maintain health even with poor oral hygiene. About 35% of the population are genetically unable to control these organisms. We inherit this from our parents.

When periodontal disease occurs, most of the teeth and surrounding gums are infected, producing a large cross section of irritated tissue. The toxins from the bacteria and biochemicals produced by our bodies during the course of fighting this infection find their way into the blood stream and have a negative effect on blood vessels. The linings of these vessels become irritated and cause white blood cells to migrate into the linings of the vessels. LDL Cholesterol sticks to the lining and the result is a gradual closing of the vessel. If this vessel is in the heart or brain, stroke and heart attacks result.

People with periodontal disease are 4 times more likely to have this happen. Those who smoke increase the likelihood of periodontal disease 4 more fold. Diabetics are even more prone and there is definite link between periodontal disease exacerbating diabetes and vice versa. Our bodies produce biochemicals that actually damage our own tissues in order to get at the harmful bacteria which can migrate into the cells, between the cells, and even into the bone. Sort of like a person taking a sledgehammer to a wall to get at a water leak.

Fortunately, we have a new treatment for periodontal disease. The Periolase Laser! In my next article, we’ll take a closer look at the laser that is revolutionizing the treatment of periodontal disease in San Antonio.

Dental Fears "Seen" By Scientists; Therapists May Hold Key to Overcoming Them

by Andrea L. Algar

Sound of the dentist's drill can create anxiety for some, unleashing a variety of symptoms such as rapid heartbeat, sweating and nausea. For others, studying why this happens is a compelling mystery.

Dental Fears

The Society for Neuroscience reported at a recent meeting in San Diego that researchers now believe they are closer to understanding why some have anxiety and others do not. Scientists in Japan have discovered that some patients display different brain activity which could be the key to effectively handling dental fears for those more predisposed to it. The goal, of course, would be to ease anxiety symptoms and perhaps eventually eliminate fears at the dental office.

The study was conducted scientifically, of course. With the help of psychiatrists, two control groups were created after assessing how much patients feared a trip to the dentist. Researchers then divided the research subjects into two groups; low fear and high fear. 

While playing sounds usually found in a dental office such as suction instruments and drills, responses were measured in the brain for both groups by scanning subjects in an isolated MRI where brain activity results would not be influenced by visible or audible responses. The sounds were mixed with a variety of different sounds deemed "neutral" so that reactions to the dental sounds could be measured reliably. The MRI images gave researchers results they could actually "see". 

What researchers discovered was that those in the low fear group displayed more activity in the brain when responding to the dental sounds than when they heard the neutral sounds. The activity occurred in the auditory areas of the brain. In the group of high fear subjects, however, they found more intense levels of activity in the part of the brain called the left caudate nucleus, thought to play a role in learning.

This research supports the findings of behavioral psychologists who have learned that cognitive-behavioral methods can be extremely effective in treating a variety anxiety disorders, including dental fears and phobias. Richard C. Raynard, Ph.D., Clinical Psychologist and anxiety disorder specialist, explains, "Many people have small amounts of dental anxiety, which is normal. It is quite common for people to experience brief episodes of anticipatory anxiety, primarily from a fear of the unknown (i.e. what will be needed, how much will it cost, will it hurt, will other people notice)." 

Dr. Raynard elaborates, "For about 10% of adults, however, levels of anxiety can be quite severe. Some even develop full-blown phobias. For these people, fears can bring on symptoms such as heart palpitations, sweaty palms, dry mouth, nausea, dizziness, and a host of other body symptoms. The pattern of anxiety, physical symptoms, then worry actually reinforces the anxiety and can lead to episodes of panic and avoidance.  Over time, patients may avoid all dental visits, including dental emergencies." 

The news is good, however, even for those with dental phobias. "Dental fears are highly treatable with a form of behavioral therapy which includes desensitization. Visits to a psychologist with this specialized training and experience can help reduce or eliminate dental fears and allow for needed dental work to be done without the grip of anxiety or panic," states Dr. Raynard. 

Dentists who are sensitive to patients with anxiety is important. Dr. Gregory R. Bowen, a San Antonio dentist with over 30 years experience, believes that there are a number of reasons why people can develop dental anxiety. Early dental experiences, not being informed before a procedure, and even listening to someone else's story about a dental visit can affect one's views of the dentist and create unneeded and unwanted anxiety. "Dental fears can be learned. Dental anxieties are more common in children with parents or caregivers who have dental fears. In my experience, those with anxiety are also far more likely to report pain during a dental visit, where the vast majority of patients do not experience pain. In fact, many patients report a reduction in pain following a dental visit. Dental fears can be addressed in a variety of ways once your dentist is aware that you're anxious," explains Dr. Bowen. "It's important so that we can help our patients feel comfortable and trust that we will do everything we can to minimize their anxiety."

Dental research will continue to explore how to integrate the use of cognitive-behavioral methods along with dentistry that is sympathetic to those who have anxiety. Some dentists already have an understanding of this relationship and, like Dr. Bowen, have taken steps to make trips to the dentist more relaxing for anxious patients.

REFERENCES:

Official Website: Society for Neuroscience

OASIS: 2013 SfN Conference Abstracts

Richard C. Raynard, Ph.D.: Panic Update, Panic Doctor Website

Dr. Bowen: Website for Dr. Gregory R. Bowen, DDS

Why Is Treating Gum Disease So Important?

by Andrea L. Algar

Gum Disease

It's shocking to think that something so easily "put on the back burner" can put your health at such risk. As I dig deeper into the perils of periodontal disease, more commonly referred to as "gum disease", it is startling to see just how many diseases can form or worsen from it.

People talk about the importance of treating gum disease, but many just don't understand why, or how severe the problems can be.

First, understand the symptoms of gum disease:

• tooth sensitivity
• redness of the gums
• inflamed, irritated gums
• bleeding gums
• pus between teeth
• sores in the mouth
• plaque formed around teeth
• persistent bad breath
• loosening of teeth and/or dentures

Then, look at how gum disease can quickly progress:

• plaque spreads below the gum line
• pockets form around the teeth
• abscess / infection develops
• sores in the mouth
• deterioration of the jaw bone begins
• bone recedes from around the tooth
• bone loss results in sunken facial appearance
• skin looks more wrinkled and aged
• teeth loosen and become unstable
• tooth loss occurs as bone loss progresses

Gum disease can take many forms:

• Gingivitis
• Aggressive Periodontitis 
• Chronic Periodontitis 
• Periodontitis with Systemic Disease
• Necrotizing Periodontitis

What is not discussed as often are the health consequences of this progression of gum disease. As bone loss progresses, it puts one a greater risk for medical conditions. Researchers have been able to tie gum disease to serious health conditions such as:

• bone loss in mouth
• diabetes
• pancreatic cancer
• heart disease
• respiratory diseases
• pneumonia
• osteoporosis
• throat and/or mouth cancers
• pancreatic cancer
• blood cancer
• kidney cancer

What are common factors that put you at risk for developing periodontal gum disease?

• age
• tobacco use / smoking
• stress
• grinding your teeth
• medications
• genetics
• poor nutrition
• obesity
• cardiovascular disease
• rheumatoid arthritis
• diabetes

For decades, the only solution to gum disease was cut and sew surgical methods which were painful and took months. But this is no longer the case. Upcoming articles will take a took at state-of-the-art treatment methods which are quickly revolutionizing the treatment of gum disease. I've interviewed Dr. Gregory Bowen, one of the first dentists in San Antonio to obtain revolutionary new equipment called Periolase. He will be providing details on how the LANAP procedure works and what it means to San Antonio men and women who may have gum disease, whether in early stages or those with gum disease that has progressed into bone loss.

The great news is that early symptoms of gum disease may be easily treatable through increased attention to simple dental care activities like brushing and flossing.  If you suspect that you have gum disease consider a visit with a qualified dentist to get a professional assessment. Don't put your health at risk.

RESOURCES FOR ADDITiONAL INFORMATION:
American Academy of Periodontology
Dr. Gregory R. Bowen, DDS - San Antonio Dentist Specializing in Periolase Laser Gum Treatments
MedicineNet - Gum Disease
National Institute of Dental and Craniofacial Research
Periolase - LANAP procedure for non-surgical gum disease treatment
WebMD - Periodontal Disease, Gum Disease

ACA And Dental Insurance - What You Need To Know

by Andrea L. Algar

There's been a lot of talk about the consequences of the Affordable Care Act (otherwise known as Obamacare), but all the talk seems to focus on medical insurance and/or the costs that are spiraling beyond initial estimates. But what, if anything, has been said about dental insurance benefits with the Affordable Care Act?

Impact of Good Dental Care
in America

The American Dental Association released the statement, “Taking care of your teeth and gums isn’t just about preventing cavities or bad breath. The mouth is a gateway into your body’s overall health. And since gum disease and other health problems may be linked, brushing and flossing are more important than ever. See your dentist regularly to keep your smile, and yourself, healthy.”

Why then is only dental care for children included in the Affordable Care Act? For many adults, concerns over the cost of dental care has kept people from getting needed dental care early on when costs are lower and less tooth and gum damage has been done. Costs can even feel so prohibitive that many skip routine care or preventive care visits that are shown to save both money and the progression of tooth and mouth problems which can lead to more costly procedures like root canal treatment, the need for crowns, or periodontal work for gum disease.

It has been well documented that chronically poor dental care contributes to financial difficulties, stress, pain, and even one's health. Dentists all over the country are seeing more patients with rotting teeth, with heart disease caused from poor dental hygiene, and people in chronic pain from dental problems. Some surgeons now consider a patient's dental health to assess the risks of surgery. Life-saving surgeries can be compromised if a patient has gum disease or tooth infections.

Under Obamacare a patient’s surgery will likely be covered, but the patient may owe his dentist in full. Most men and women in the United States will continue to obtain dental insurance through their employer or they will do without dental insurance altogether. A good number of men and women in San Antonio do not have dental insurance. This is a tragedy considering how beneficial routine dental care and preventive dental care can be. There are a wealth of studies that demonstrate the financial and health gains that can be achieved by men, women and children who utilize dental care regularly.

Government believes we all deserve affordable health care, there's little debate in that. Why, though, is dental care so limited as part of the Affordable Care Act?  Would we be better served having fuller access to affordable dental care? What do you think?

Top Ten Reasons to See a Dentist in San Antonio

by Andrea L. Algar

Let's face it, going to the dentist is usually not at the top of everyone's "I really want to do this" list. Many put off going to the dentist until it is absolutely necessary. But is this best?

I've traveled quite a bit in my lifetime. Because of this, I've seen many dentists. I've been to some okay dentists, a couple of not-so-good dentists, and one good dentist I didn't mind seeing regularly. I've even done consulting work for a couple of dentists, and I've done a lot of research in the field of dentistry. Following a cross-country move, I found myself looking again for a dentist who was experienced and skilled, and someone I could trust. I know it can be hit-or-miss, and it can feel overwhelming. But, when you meet the right dentist you'll know.

You may be surprised to learn that good dentists really are on your side. They believe in preventive measures to help you keep your teeth, mouth and gums healthy and your smile looking beautiful. They're aware that their patients are concerned about how much dental care might cost, and a good dentist will discuss alternatives with you. Bottom line is that good dentists love happy patients, and they understand that it's up to them to earn your trust.

Most top ten lists are usually rather simple. They're geared to one particular type of reader, such as the consumer. But, like many things in life, there are often two sides to the story. In this case, I thought it would be interesting to see why patients feel the need to see the dentist, as well as why dentists believe it's important to get proper dental care.

Enjoy the two lists for the Top Ten Reasons to see a Dentist in San Antonio, Texas!

Top 10 Reasons to See a Dentist - 
Why Patients Seek Out Dental Care:

1) Treat a toothache / ache in jaw or mouth
2) Treat tooth abscess or infection
3) Whiten teeth - Get teeth cleaned at dentist
4) Fix knocked out, cracked, broken or lost tooth
5) Fill cavity or replace an old filling
6) Routine checkup
7) Straighten teeth, fix a gap
8) Get help for loose teeth / dentures
9) Treat a sports injury to mouth, gums, teeth, tongue or jaw
10) Injury to jaw, tongue, mouth, gums or teeth from auto accident

Top 10 Reasons to See a Dentist - 
Benefits Dentists Want You to Know About:

1) Dental care saves you money in the long run - It's affordable and most dentists offer flexible payment plans. Caught early, tooth decay prevents the need for more costly care such as root canal therapy. Studies show the dramatic benefits of preventive dentistry.

2) Dental care can improve your self-esteem and your confidence. Studies show that those with attractive smiles display more confidence. This type of confidence can have positive effects on your work, family and social life.

3) Oral Screenings. Your oral health impacts your overall health. There are strong links between good dental habits and one's overall health. The health of your teeth and gums can affect nearly every system in your body including your circulatory, digestive, respiratory and even your reproductive. Poor oral health can lead to serious illness and disease. Dentists can often spot things in your mouth that reflect potential health problems such as diabetes, hypertension and cancer. Even something like bad breath (halitosis) can be a sign of something more serious such as liver or kidney disease, chronic bronchitis, sinusitis, tooth decay or gum disease.

4) Fight periodontal disease. Gum disease is a common problem, and one that can lead to serious health issues such as heart disease, increased risk of stroke, and high-risk pregnancy. It can also cause complications with diabetes, respiratory conditions and osteoporosis. Your dentist can help prevent gum disease. If you do develop periodontal disease, your dentist can offer treatments that will prevent it from worsening. New laser treatments are the most effective treatments available and can even reverse gum disease if caught early. Dr. Gregory Bowen, a San Antonio dentist who has been using the Periolase laser for six years, explains, "With this new laser technology, patients don't have to suffer with gum disease. There is no more need for painful cut-and-stitch gum surgery."

5) Maintain healthy teeth and bones. Your dentist can help you keep your teeth longer, preventing the need for dentures, implants and dental procedures. With modern dental care, men and women are able to keep their teeth for much longer.

6) Correct wear and tear to teeth. Cavities can occur and can go unnoticed until there is pain or until discovered in a dental exam. Many older adults have metal fillings from decades earlier which now need replacement. Jaw pain is important to address, as it may indicate a wide range of potential problems including TMJ. Cracks, chips, tooth wear and tooth loss may also need to be addressed in order to maintain good dental health. The newest technologies allow dentists to provide top quality caps, crowns and tooth colored fillings right from their office for same day solutions to old problems.

7) Good preventive dental care. Dental checkups and tooth cleanings are recommended twice yearly. Even with the best brushing and flossing, plaque can build up below the gum line and in hard to reach places. Your dentist can also provide treatments to help provide protection as well.

8) Straighten crooked teeth. Whether your an adult or have children with crooked teeth, it's never too late to consider modern braces. Advances in braces has lead to invisible braces, as well as tooth straightening in as little as six months.

9) Prevent tooth loss. The ultimate goal of every dentist is to help prevent the loss of teeth, whether from improper hygiene, bad genes, or accidents. Dentists want you to be able to keep your own teeth as long as possible, and then provide alternatives if you've lost them.

10) Help you achieve a healthy mouth and whiter teeth. The ultimate goal for dentists. Of course, most would also love it if you were so happy with their services that you refer friends, family and co-workers to them. It's the best "thank you" they can receive.

Finding a good dentist to help you maintain healthy teeth and an amazing smile just makes good sense. Help spread the word about the benefits of good dental care. Share this with a friend!

RESOURCES FOR MORE INFORMATION:
Andrea Algar - How to Find the Right Dentist - Your Step-By-Step Guide

Fact or Fiction: Number 1 Infectious Disease In Children Is Tooth Decay

by Andrea L. Algar

An recent article on OregonLive.com made the bold headline that the "No 1 infectious disease among kids is tooth decay; early dentist visit matters," sparking more than a few comments about how true this claim may be, or whether it was "propaganda". I was a bit surprised by the skepticism so I decided to do some research.

Early Dental Care
Essential To Good Health

Common sense would seem to suggest that, sure, the earlier a child is introduced to the dentist, the greater the chances are that he/she will not develop any unrealistic fears, receive good oral health training, and perhaps do a better job of brushing and flossing.  And, research does seem to back up the claims that the earlier we involve our children in dental care, the better. The ultimate goal, of course, would be to have our children develop such good dental care habits that they do not develop any cavities and end up with a mouth full of beautiful, healthy teeth.

But even in today' advanced society, there is controversy. And it certainly exists when it comes to dental advice. The American Academy of Pediatric Dentistry's (AAPD) published report on the state of oral health of children in the United States seemed to strike a nerve for some. The report concluded, "Tooth decay has become epidemic among our youngest children." It went on to express fears that the Affordable Care Act (ACA) may actually worsen the trend, and concluded, "What is most frustrating for our organization, the American Academy of Pediatric Dentistry (AAPD), is most tooth decay is preventable."

The AAPD hopes that by launching their new educational campaign, more people will learn the importance of teaching our children good oral hygiene early on. They say that children should be learning these skills as early as one year of age. Does the AAPD have an "agenda"? Well, yes! I think they hope to spread the message that early intervention is key in preventing a lot of common dental problems that, if left untreated, can become serious health issues.

The actual report (see link below) contains 149 reference citations supporting their claims. And, their findings seem to be backed up by the Centers for Disease Control (CDC) and the American Dental Association (ADA). The AAPD research demonstrated the importance of good oral health and how something as "simple" as a cavity can have long-term consequences such as:

• dental pain
• ear, sinus and brain infections
• chewing difficulty
• loss of teeth
• greater risk of tooth impaction
• gum disease
• poor speech
• interrupted sleep
• self-esteem issues
• poor school performance
• health issues such as asthma

Long term, chronic tooth disease can lead to:

• obesity
• diabetes
• heart disease
• death

I thought the paper was well done. I hope it helps to get the message out to parents.

Not all dentists treat children, but even those who treat adults only know that proper introduction to dental services is essential in helping children develop good dental hygiene habits that can last a lifetime. Preventive care has always played a significant role in avoiding common problems such as cavities as children grow into adulthood. For those who did not have the best dental habits as a child, the message seems clear. Seek out good dental care so problems can be addressed and more serious consequences avoided.

RESOURCES FOR MORE INFORMATION:
AAPD - The State of Little Teeth
ADA - Disease Prevention
CDC - Children's Oral Health