Soda and fruit juice are 'biggest culprits in dental erosion'

Soft drinks are the most significant factor in severity of dental erosion, according to a new study published in the Journal of Public Health Dentistry.

The most severe cases of dental erosion in the study were among people who regularly drank sugary soft drinks and fruit juices.

Dental erosion is when enamel - the hard, protective coating of the tooth - is worn away by exposure to acid. The erosion of the enamel can result in pain - particularly when consuming hot or cold food - as it leaves the sensitive dentine area of the tooth exposed.

The enamel on the tooth becomes softer and loses mineral content when we eat or drink anything acidic. However, this acidity is cancelled out by saliva, which slowly restores the natural balance within the mouth. But if the mouth is not given enough time to repair itself - because these acid attacks are happening too often - the surface of the teeth is worn away.

Anything with a pH value (the measure of acidity) lower than 5.5 can damage the teeth. Diet and regular sodas, carbonated drinks, flavored fizzy waters, sports drinks, fruit and fruit juices are all known to be harmful to teeth if they are consumed too often.

Study finds that a 'substantial proportion' of adults have dental erosion

The study finds that a substantial proportion of adults show some evidence of dental erosion, with the most severe cases being among people who drink sugary soft drinks and fruit juices.

Examining 3,773 participants, the researchers found 79% had evidence of dental erosion, 64% had mild tooth wear, 10% had moderate tooth wear and 5% displayed signs of severe tooth wear. The participants in the study with moderate and severe tooth wear consumed more soft drinks and fruit juices each day than the other groups.

Among participants with lower levels of tooth wear, the researchers found that milk was a more popular drink than soda or fruit juice.

Men were also found to be at twice the risk for dental erosion as women, and tooth wear became more severe with age among the participants.

Commenting on the study, Dr. Nigel Carter OBE, chief executive of the British Dental Health Foundation, says that while fruit juice may be a nutritious drink, the high concentrations of sugar and acid can lead to severe dental damage if these drinks are consumed often each day.

"Water and milk are the best choices by far, not only for the good of our oral health but our overall health too," says Dr. Carter. "Remember, it is how often we have sugary foods and drinks that causes the problem so it is important that we try and reduce the frequency of consumption."

He adds:

"Dental erosion does not always need to be treated. With regular check-ups and advice your dental team can prevent the problem getting any worse and the erosion going any further. The more severe cases of tooth wear can often result in invasive and costly treatment so it is important that we keep to a good oral hygiene routine to make sure these future problems do not arise."

Many sodas and fruit juices contain at least six teaspoons of sugar, and as they often come in portions that are larger than recommended, they can lead to tooth decay as well as dental erosion.

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Modern Diet Is Rotting Our Teeth

A study of the evolution of our teeth over the last 7,500 years shows that humans today have less diverse oral bacteria than historic populations, which scientists believe have contributed to chronic oral diseases in post-industrial lifestyles.

The researchers, from the University of Adelaide's Australian Centre for Ancient DNA (ACAD), the University of Aberdeen (Dept of Archeology), Scotland, and the Wellcome Trust Sanger Institute, Cambridge, England, published their study in Nature Genetics.

The authors say that analyzing the DNA of calcified bacteria on the teeth of humans throughout modern and ancient history "has shed light on the health consequences of the evolving diet and behavior from the Stone Age to modern day".

The scientists explained that there were negative changes in oral bacteria as our diets altered when we moved from being hunter-gatherers to farmers. Further changes were observed when humans started manufacturing food during the Industrial Revolution.

Study leader Professor Alan Cooper, ACAD Director, said, "This is the first record of how our evolution over the last 7500 years has impacted the bacteria we carry with us, and the important health consequences."

The introduction of processed sugar may have completely changed the composition of oral bacteria in humans.

"Oral bacteria in modern man are markedly less diverse than historic populations and this is thought to contribute to chronic oral and other disease in post-industrial lifestyles."

The scientists extracted DNA from calcified dental plaque (tartar) from 34 prehistoric human skeletons from northern Europe. They examined the changes in the nature of oral bacteria that were first present in prehistoric hunter-gatherers, through to the Bronze Age when farming became established, then to Medieval times and finally to the Industrial Revolution and later.

Dr Christina Adler, lead author, who was a PhD student at the University of Adelaide during the study, said "Genetic analysis of plaque can create a powerful new record of dietary impacts, health changes and oral pathogen genomic evolution, deep into the past." Dr. Adler now works at the University of Sydney.

The modern mouth exists in a permanent disease state

Professor Cooper said:

"The composition of oral bacteria changed markedly with the introduction of farming, and again around 150 years ago. With the introduction of processed sugar and flour in the Industrial Revolution, we can see a dramatically decreased diversity in our oral bacteria, allowing domination by caries-causing strains. The modern mouth basically exists in a permanent disease state."

Professor Cooper has been working with Professor Keith Dobney from the University of Aberdeen on this for the last 17 years. Professor Dobney said "I had shown tartar deposits commonly found on ancient teeth were dense masses of solid calcified bacteria and food, but couldn't identify the species of bacteria. Ancient DNA was the obvious answer."

Scientists examined tartar deposits found on ancient teeth in their study. (Photo: Alan Cooper/University of Adelaide)

Prof. Dobney explained that this study provides a completely new window on how human populations lived and died in the past. If we know the real genetic history of diseases humans still suffer from today, scientists might better understand them, and even treat them more effectively. "Being able to track them through time has huge implications for understanding the origins and history of human health - making the archaeological record extremely relevant and important to modern-day medics and geneticists," Dobney added.

In an Abstract in Nature Genetics, the authors wrote that "modern oral microbiotic ecosystems are markedly less diverse than historic populations, which might be contributing to chronic oral (and other) disease in postindustrial lifestyles."

It was not until 2007 that the team could control background levels of bacterial contamination properly. This became possible when ACAD's super-clean labs and stringent decontamination and authentications protocols became available.

The scientists are now expanding their studies geographically and chronologically, and including other species, such as Neanderthals.

There is some evidence that beeswax was used 6,500 ago in dentistry, scientists from Abdus Salam International Centre for Theoretical Physics, Italy, explained in the open access journal PLoS ONE on 19th September, 2012.

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Bad Breath Linked To Bacteria That Cause Stomach Ulcer And Cancer

New research from Japan found bacteria that cause stomach ulcers and cancer living in the mouths of some people with bad breath, even though they did not show signs of stomach illnesses.

The study was the work of Dr Nao Suzuki from Fukuoka Dental College in Fukuoka, Japan and colleagues and is published in the December issue of the Journal of Medical Microbiology.

Scientists recently discovered that infection by the bacterium Helicobacter pylori, which is carried by over 90 per cent of people in the developing world and 20 to 80 per cent of people in the developed world, was a possible cause of peptic ulcers and gastric cancers.

More recent research has also suggested that the human mouth, which is home to over 600 different species of bacteria (some of which cause disease), is a possible reservoir for H. pylori, particularly in the presence of periodontal or gum disease, a known cause of halitosis or bad breath.

Suzuki explained that bad breath or halitosis is common in humans and is mostly caused by gum disease, tongue debris, poor oral hygiene and badly fitted fillings (they trap bacteria).

"Bacteria produce volatile compounds that smell unpleasant, including hydrogen sulphide, methyl mercaptan and dimethyl sulphide. Doctors often measure the levels of these compounds to diagnose the problem. Gastrointestinal diseases are also generally believed to cause halitosis," said Suzuki.

Suzuki and colleagues decided to investigate the prevalence of H. pylori in the mouths of people with bad breath.

"Recently, scientists discovered that H. pylori can live in the mouth," said Suzuki, adding that:

"We wanted to determine whether the bacteria can cause bad breath, so we tested patients complaining of halitosis for the presence of H. pylori."

For the study, the researchers did DNA scans of saliva taken from 326 Japanese people; 251 had actual bad breath or halitosis and 75 did not. None showed any signs of stomach illnesses.

They found H. pylori and other bacteria that occur with periodontal or gum disease, called periodontopathic bacteria, including Porphyromonas gingivalis, Treponema denticola and Prevotella intermedia.

More spefically the results showed that:

• 21 (6.4 per cent) of the participants had H. pylori in their mouths.


• These participants also had higher levels of other markers for periodontal disease, including higher levels of: methyl mercaptan (a bad breath gas); each of the periodontopathic bacteria; tooth mobility; periodontal pocket depth (PPD); and occult blood in the saliva.


• Of the 102 participants with periodontal disease, 16 (15.7 per cent) had H. pylori in their mouths.

The researchers concluded that the presence of H. pylori in nearly 16 per cent of the participants with periodontitis suggested that:

"Progression of periodontal pocket and inflammation may favour colonization by this species and that H. pylori infection may be indirectly associated with oral pathological halitosis following periodontitis."

"Although the presence of H. pylori in the mouth does not directly cause bad breath, it is associated with periodontal disease, which does cause bad breath," said Suzuki, who said the team will now be looking into the:

"Relationship between H. pylori in the mouth and in the stomach. We hope to discover the role of the mouth in transmitting H. pylori stomach infections in the near future."

"Detection of Helicobacter pylori DNA in the saliva of patients complaining of halitosis."
Click here for Abstract.

Source: Journal abstract, Society for General Microbiology press briefing.

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Nagging Headache Often Linked To Dental Pain

Could that nagging headache and painful jaw be tied to your oral health? Many headache sufferers might want to consult their dentist as well as their doctor since headaches and dental pain have a lot in common, says Director of the Orofacial Pain and Oral Medicine Graduate Program at the USC School of Dentistry Glenn Clark.

Pain centered in the nerves and muscles running throughout the face and neck, as well as poor habits the discomfort may cause, can trap sufferers in a painful feedback loop, with head pain triggering jaw and neck pain and vice versa.

"Headaches and toothaches all transmit through the trigeminal nerve, the largest sensory nerve in the head that supplies the external face, scalp, jaw, teeth and much of the intra-oral structures," Clark says. "Pain in one branch of the nerve has the potential to activate other branches of the nerve, and when that pain is chronic and sustained, it is more likely to trigger a sequence of events that might lead to a headache. In people who have headaches, a continuous, sustained toothache can easily trigger one of the episodic headaches such as migraines."

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New Guidelines: Antibiotic Prophylaxis

Until recently, it was recommended that many patients with cardiac conditions receive short-term antibiotics prior to receiving dental treatment to prevent the risk of infective endocarditis (IE). The American Heart Association (AHA) has since revised those guidelines and the revisions bring good news for most cardiac patients: many patients who have taken prophylactic antibiotics routinely in the past no longer need them.

The American Dental Association (ADA) provided input to the AHA on the new guidelines, which were also developed in part by the Infectious Diseases Society of America and the American Academy of Pediatrics. This group reviewed and analyzed information from both national and international experts on IE and revised guidelines were released last April.

The updated guidelines state that patients who have taken prophylactic antibiotics in the past but no longer need them include people with:

-- Mitral valve prolapse

-- Rheumatic heart disease

-- Bicuspid valve disease

-- Calcified aortic stenosis

-- Congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy

These revisions are based on scientific evidence that conclude that the risks of taking preventive antibiotics, such as adverse reactions to the antibiotics and development of drug resistant bacteria, outweigh the benefits for most patients.

However, as with any guidelines, there are exceptions. Preventive antibiotics prior to dental procedures are still advised for patients with:

-- Artificial heart valves

-- History of IE

-- Unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits

-- A completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or catheter intervention, during the first six months after the procedure or any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device

-- Any cardiac transplant that develops a problem in a heart valve

The Pennsylvania Dental Association (PDA) stresses the importance of maintaining good oral hygiene habits as an essential and easy way to prevent IE, and offers the following tips:

-- Brush your teeth twice a day with an ADA-accepted fluoride toothpaste. Replace your toothbrush as soon as the bristles become frayed, about every three to four months. Floss daily to remove plaque stuck between the teeth.

-- Eat a well-balanced diet, limiting sugary snacks and beverages.

-- See your dentist regularly for cleanings and oral exams.

For more information on other oral health topics, visit PDA's website at http://www.padental.org.

Pennsylvania Dental Association
http://www.padental.org

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Homeopathic Teething Tablets Contain Inconsistent And Potentially Dangerous Levels Of Belladonna

Hyland's Teething Tablets, a homeopathic product aimed at relieving symptoms linked to teething contain inconsistent quantities of belladonna, which can be harmful to humans in high doses, the FDA (Food and Drug Administration) reports. The makers are issuing a recall. People who have bought this product are warned not to use them, and to get rid of them.

During the manufacturing process, small quantities of belladonna are added to Hyland's Teething Tablets. However, large doses of belladonna can be toxic and cause serious harm. Hence, any tablet or medication containing belladonna needs to be very carefully controlled to make sure the doses are accurate.

FDA laboratories found that Hyland's Teething Tablets do not contain consistent belladonna doses.

The FDA informs that there have been reports of adverse events in children which are linked to belladonna toxicity. Some reports received also describe incidences of children consuming too many tablets because the container caps are not child resistant.

Signs and symptoms related to belladonna toxicity include:

• agitation
• breathing difficulties
• constipation
• flushing of the skin
• listlessness, lethargy, fatigue
• muscle weakness
• problems urinating
• seizures
• sleeping too much

Parents, guardians and caregivers who have children with these signs and symptoms should see a doctor immediately, the FDA advises, especially if they have been taking Hyland's Teething Tablets.

The FDA adds that parts of the manufacturing operation in the Standard Homeopathic Company have been found to be "substandard". A manufacturing inspection is currently underway.

Health care professionals and lay people who witness side effects after Hyland's Teething Tablet use are encourage to report details online at www.fda.gov/MedWatch/report.htm, or call the following telephone number and request a reporting form, 1-800-332-1088.

According to the Standard Homeopathic Company, the makers of Hyland's Teething Tablets:

Belladonna is included in the Tablets to ease the redness, inflammation and discomfort of the child's gum that often occurs during the teething process.

.. Hyland's Teething Tablets contain homeopathically prepared forms of Calcarea Phosphorica, Chamomilla, Coffea Cruda, and Belladonna. These ingredients are all prepared in accordance with the Homeopathic Pharmacopoeia of the United States (HPUS).

HPUS has been recognized by the FDA since 1938 as the official compendium for homeopathic medicine in the U.S.

Source: FDA, Standard Homeopathic Company

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Dental Sealants Contain Bisphenol A (BPA) Derivatives Which May Seep Into Children's Mouths

A study has revealed that sealants and fillings used on children's teeth may expose them to bisphenol A (BPA), says an article in the medical journal Pediatrics. The researchers say it is not yet clear whether this is hazardous to the long-term health of a child, as exposure does not generally last long. Dental sealants, which contain a variety of BPA derivatives are effective in preventing the majority of dental cavities in children and teenagers.

Researchers from The Children's Hospital, Harvard Medical School, Departments of Pediatrics and Preventive Medicine, Mount Sinai School of Medicine, New York, and Columbia University College of Dental Medicine, New York set out to evaluate the BPA content of dental materials and find ways to manage BPA exposures.

The authors stress that dental materials present a far smaller and much less frequent exposure to BPA than other sources might, such as plastic food-storage containers, the linings of metal food cans, and some water bottles.

Reducing exposure to BPS is important for health, especially after prior research had discovered that BPA can pose health risks from its endocrine-disrupting, estrogen-like properties.
,br> The researchers learned, form a literature review, that BPA is released form dental resins through saliva enzymes. Up to 3 hours after resin placement, BPA can be detected in saliva.

We do not know how much of the BPA in the saliva is absorbed by the child's body, the investigators say.

In a press release, the American Academy of Pediatrics writes:

Dental products that contain the bisphenol A derivative glycidyl dimethacrylate (bis-GMA) are less likely to be converted to BPA and have less estrogenic properties than those containing bisphenol A dimethacrylate (bis-DMA), and the authors suggest the more commonly used bis-GMA resins should be the preferred choice.

The authors say the important moment of BPA exposure for the child is during the placement of material in his/her mouth, and immediately afterwards.

The scientists suggest rubbing the material with pumice to remove the top liquefied layer of sealants. Saliva levels of BPA were also found to drop significantly if children rinsed their mouth for about 30 seconds after application of the sealant.

The authors believe that because of the substantial benefits the sealants provide, when weighed against the brief exposure to BPA, they should continue to be used in pediatric dentistry.

Manufacturers should be encouraged to develop materials with less estrogenic potential, the authors wrote. Whenever possible their use should be kept to a minimum during pregnancy, they added.

"Bisphenol A and Related Compounds in Dental Materials"

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Dental Hygiene Self Care Techniques

Basic Dental Hygiene And Regular Check Ups Can Help Prevent Tooth Decay and Gum Disease

Basic Hygiene

Seeing your dentist for a check up twice a year can greatly reduce the risk of gum disease, tooth decay or bad breath. This is why in all of our medical packages we include a free dental check-up upon request. Many people choose to ignore this advice and only visit the dentist once a problem occurs. A simple check up and a professional clean is all it takes to help keep your mouth hygienic and to spot problems before they become excruciatingly painful. Daily brushing is not enough, and deep cleaning to get those hard to reach areas should be done by a dentist despite any feelings you may have about going to the clinic.

The dentist will begin by scraping the mineral build up on your teeth known as plaque, they will then floss to remove any build up between the teeth. The dentist will use a polishing compound and apply fluoride to help fight tooth decay and finish off the cleaning process. Cleaning is usually painless and takes about 20 minutes however if you haven’t been to the dentist for a while be prepared to sit for a while longer whilst they clean parts of your teeth you didn’t know you had!

Your dentist may ask to take x-rays of your teeth. This only takes a few minutes and is completely painless, you will be expected to bite down on a small piece of plastic whilst the dentist aligns the machine to take several different pictures of your teeth.
If your dentist sees fit, they may apply a sealant on the chewing surface of your teeth. This will prevent bacteria and food getting stuck in the rough parts of your teeth, it will also protect your teeth from plaque and help prevent tooth decay.

Your dentist may ask about you diet and the foods you eat as this can affect your dental health. They may also talk about your cleaning and flossing habits and whether or not you should change them. If you have active cavities your dentist will recommend dental treatment, which can be carried out right away or scheduled for appointment. If your teeth and gums are health you will be advised to keep your brushing and flossing habits.

Tooth Decay

Tooth decay is the process that results in what is know as a cavity. It occurs when bacteria in the mouth create acids that eat away at the tooth, this can lead to infection and tooth loss and can be extremely painful.

The plaque which is always forming on our teeth contains bacteria, it’s these bacteria that feed on the sugars in our mouth making acids which attack the teeth for up to 20 minutes after eating, over a period of time these acids destroy the tooth enamel and cause tooth decay.
A cavity has no real symptoms until its too late, this is why it’s important to have your teeth checked regularly. Once you have a cavity or tooth decay you may experience painful tooth aches until the cavity is attended to.

If you have been diagnosed with a cavity the treatment may vary depending on how bad it is. Slight tooth decay can be reversed by using fluoride, mild tooth decay will be treated by filling the cavities with another substance (fillings), for more severe tooth decay you may need a crown or root canal and for even more extreme cases, the dentist may remove the tooth.

Bad Breath

Stores are packed full of mouthwashes, mints and gum that are supposed to control bad breath or halitosis. These products may work, but only temporarily and they may less effective in controlling bad breath than simply keeping your mouth clean. Certain foods, habits or health conditions can be the cause of bad breath and in many cases you can prevent bad breath with proper dental hygiene. If self care techniques don’t solve the problem a visit to your dentist or doctor may help determine the cause of bad breath.

Food

The breakdown of food in your mouth can cause a bad odor. Eating foods with volatile oils is another source of bad breath. After these foods are digested the pungent oils are absorbed into your bloodstream and can carry into to the lungs giving off bad breath until the food is eliminated from your body.

Dental Hygiene

Poor dental hygiene can lead to bad breath. If brushing and flossing is not carried out daily, food particles can stay in the mouth collecting bacteria and emitting hydrogen sulfur vapors. If plaque is not scraped away it can build up between your teeth and gums, this to too can be lead to bad breath.

Disease

Chronic lung infections and abscesses can also produce very foul smelling breath. Other illnesses can also cause a distinctive smell, kidney failure can cause a urine-like odor and liver failure can cause an odor described as fishy. People with diabetes often have a fruity breath odor and the chronic reflux of stomach acids (gastroesophageal reflux disease, or GERD ) or a slight protrusion of the stomach into the chest cavity (hiatal hernia) can also produce bad breath.

Mouth, Nose and Throat Conditions

Nasal discharge from the back of the nose into the throat can cause mouth odor. A sinus infection or something that is lodged in the nose can cause a persistent nasal discharge which creates the foul smelling odor. Strep Throat, Tonsillitis and mononucleosis can also cause bad breath until the infection clears. Bronchitis and other respiratory infections in which odorous sputum is coughed up is another source.

Self Care Techniques

Some simple self care techniques to help combat bad breath, tooth decay and disease include:

• Brushing your teeth after you eat – to help combat acids that attack your teeth.
• Floss at least once a day – to remove food particles and plaque between your teeth.
• Brush your tongue – to remove dead cells, bacteria and food debris.
• Drink plenty of water – to keep your mouth moist and stimulate saliva that helps protect your mouth.
• Use a new tooth brush – it’s good practice to change your toothbrush regularly for hygiene reasons.
• Clean your dentures – if you wear a bridge, partial or complete dentures, clean at least once a day.

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Paper Clips For Root Canals Lands Dentist In Jail

When dentists do a root canal they are supposed to use steel posts, and definitely not paper clips. A dentist from Massachusetts has just received a 1-year prison sentence at the Bristol County House of Correction, for using paper clips for just such procedures - he had faced charges of assault and battery, as well as defrauding Medicaid to the tune of $130,000, and intimidating a witness.

Dr. Michael Clair, according to prosecutors, in an effort to reduce costs, would use parts of paper clips for root canals. A number of patients developed a range of problems, including infections.

When Brenda Almeida's son underwent a root canal in 2005, his tooth went black and had to be taken out. Almeida claims her other two children received substandard dental treatment from Dr. Clair.

Almeida is annoyed, because she feels Clair got off lightly with a 1-year jail sentence.

After Judge Richard Moses passed sentence, Almeida said:

"He put my kids in pain for months ...
I hope he rots there."

The prosecutors had requested a five-to-seven year sentence. After the sentence was imposed, the prosecutors, as well as the defense team, refused to comment.

The judge said that certain mitigating factors were taken into account before passing sentence. These included the ex-dentist's lack of criminal record, some mental health issues, plus that fact that he fully accepted responsibility for what he had done.

A request from the prosecutors that Clair stay away from his victims, as well as seven working colleagues, was granted by Judge Moses. Apparently, his former staff members were and are concerned for their own safety.

Of the 2.5 year sentence, all but one year was suspended. Clair will have to complete five years of probation after leaving prison.

At the end of the sentencing, Clair said:

"Thank you, your honor, for
your consideration."

Clair lost his Massachusetts dental practice license in 2006. He is now banned from practicing dentistry anywhere in the USA.

Even though Clair was suspended by Medicaid in 2002, claims filed by him continued from August 2004 to June 2005 - he used other dentists name when completing the form, all colleagues in his practice.

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New Treatment For Receding Gums: No Pain, Lots Of Gain

Tufts dental researchers conducted a three-year follow-up study that examined the stability of a treatment option for receding gums and found that complete root coverage the goal of the surgery had been maintained. This specific tissue regeneration application, developed at Tufts, reduces the considerable pain and recovery time of gum grafting surgery. The case study of six patients is published in the July 2009 issue of the Journal of Periodontology.

"Patients have a less invasive treatment option for receding gums and we now have evidence to support the stability of this relatively painless procedure. Instead of leaving the dental office with stitches in the roof of their mouth, a patient leaves with a small bandage on the arm that can be removed in an hour," said Terrence Griffin, DMD, associate professor, chair of the department of periodontology, and director of postdoctoral periodontology at Tufts University School of Dental Medicine in Boston.

"One of our previous research studies showed that all of the post-operative bleeding and most of the post-operative pain were related to the gum tissue removed from the roof of the mouth for use as a graft," he continued.

Traditional gum grafting surgery requires surgically excising tissue from the roof of the mouth (the palate) to replace the gum tissue lost around the teeth.

Unfortunately, removing tissue from the roof of the mouth extends recovery time and is a major source of patients' discomfort or pain. According to the American Academy of Periodontology, periodontal disease is the primary cause of tooth loss in adults aged 35 and older. Periodontal disease includes gum recession, also called gingival recession, which can result in tooth root decay and tooth loss.

The new tissue regeneration application from Tufts uses platelet concentrate gel applied to a collagen membrane as the graft instead of using tissue from the roof of the mouth. The graft is soaked in the patient's platelets, using blood drawn in the same visit. Placed over the receding tooth root, the graft is then surgically secured.

In order to examine three-year efficacy of the treatment, measurements were taken from six patients in the gum recession area at baseline, 6, and 36 months after surgery. At six months, 24 out of 37 teeth from the six patients had complete root coverage (65 percent). At 36 months, 21 out of 37 teeth from the six patients had complete root coverage (57 percent). The authors said that the recession over three years was minimal and that the results are comparable to traditional gum grafting surgery.

"Our previous research determined that pain and discomfort were barriers to receiving traditional gum grafting surgery.* We have also shown previously that this treatment for gum recession results in proper coverage of the tooth root, better esthetics than those found with traditional gum grafting surgery, and enhanced patient satisfaction with the results," said co-author Wai Cheung, DMD, MS, assistant professor in the department of periodontology at Tufts University School of Dental Medicine.

Over the last decade, Griffin and his colleagues, including Cheung, have studied alternatives to traditional gum grafting surgery and have more than 20 publications on the topic.

"Gum disease affects most American adults and research is linking periodontal disease to other health problems, including heart disease. Encouraging patients to undergo surgery to fix receding gums can be difficult because the mere thought of this dental surgery is often associated with considerable pain. This treatment, while only marginally more expensive for the patient, is more time-consuming and technically more difficult for us but the end result improved esthetics, reduced pain, and, most importantly, improved oral health for the patient make it a valuable and important alternative," said Griffin.

Griffin TJ, Cheung WS. Journal of Periodontology. 2009. (July); 80 (7): 1192-1199. "Guided tissue regeneration-based root coverage with a platelet concentrate graft: A 3-year follow-up case series." Published online July 1, 2009, doi: 10.1902/jop.2009.080609

Griffin TJ, Cheung WS, Zavras AI, and Damoulis PD. Journal of Periodontology. 2006. (December); 77(12): 2070-2079. "Postoperative complications following gingival augmentation procedures."

Cheung WS, Griffin TJ. Journal of Periodontology. 2004. (December); 75 (12): 1678-1687. "A comparative study of root coverage with connective tissue and platelet concentrate grafts: 8-month results."

About Tufts University School of Dental Medicine

Founded in 1868, Tufts University School of Dental Medicine (TUSDM) is committed to leadership in education, patient care, research and community service. Students obtain an interdisciplinary education, integrated with medicine, with access to training in dental specialties. Clinics managed at TUSDM provide quality comprehensive care to more than 18,000 diverse individuals annually, including those requiring special needs. Nationally and internationally, the School promotes health and educational programs and researches new procedures, materials and technologies to improve oral health.

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What Is A Dental Abscess? What Causes Dental Abscesses?

A dental abscess, or tooth abscess, is an accumulation of pus that forms inside the teeth or gums. The abscess typically originates from a bacterial infection, often one that has accumulated in the soft pulp of the tooth.

Bacteria exist in plaque, a by-product of food, saliva and bacteria in the mouth which sticks to the teeth and damages them, as well as the gums. If the plaque is not removed by regular and proper tooth brushing and flossing the bacteria may spread within the soft tissue inside the tooth or gums, eventually resulting in an abscess.

There are 3 types of dental abscess:

Gingival abscess - the abscess is only in the gum tissue and does not affect the tooth or the periodontal ligament.

Periodontal abscess - this abscess starts in the supporting bone tissue structures of the teeth.

Periapical abscess - this abscess commences in the soft pulp of the tooth.

According to Medilexicon's medical dictionary:

• A gingival abscess is "an abscess confined to the gingival soft tissue."
• A periodontal abscess is "an alveolar abscess or a lateral periodontal abscess."
• A periapical abscess is "an alveolar abscess localized around the apex of a tooth root."

A dental abscess usually requires treatment; otherwise it can worsen and result in the destruction of bone tissue.

What are the signs and symptoms of a dental abscess?

A symptom is something the patient feels and reports, while a sign is something other people, including a doctor or nurse may detect. For example, pain may be a symptom while a rash may be a sign. Signs and symptoms of a dental abscess may include:

Pain - the main symptom. This may be a throbbing pain, and is often intense. The pain usually starts suddenly, and becomes more intense over the subsequent hours or days. In some cases the pain may radiate to the ear, jawbone and neck.

• Pain in the affected area when biting
• Touching the affected area may be painful
• Sensitivity to cold or hot food and liquids
• A foul taste in the patient's mouth
• Fever
• General malaise (the patient feels generally unwell)
• Trismus - the patient finds it harder to open his/her mouth
• Dysphagia - swallowing difficulties
• Insomnia

What causes a dental abscess?

A dental abscess in most cases is a complication of a dental infection. Bacteria, often bacteria present in plaque, infect and make their way into a tooth.

Periapical abscess

Bacteria enter the tooth through tiny holes caused by tooth decay (caries) that form in the tooth enamel (hard outer layer of the tooth). The caries eventually break down the softer layer of tissue under the enamel, called dentine. If the decay continues, the hole will eventually penetrate the soft inner pulp of the tooth - infection of the pulp is called pulpitis.

As the pulpitis progresses the bacteria make their way to the bone that surrounds and supports the tooth, called the alveolar bone, and a periapical abscess is formed.

Periodontal abscess

When bacteria which are present in plaque infect the gums the patient has periodontitis. The gums become inflamed, which can make the periodontal ligament (tissue surrounding the root of the tooth) separate from the base of the tooth. A periodontal pocket, a tiny gap, is formed when the periodontal ligament separates from the root. The pocket gets dirty easily and is very hard to keep clean. As bacteria build up in the periodontal pocket, periodontal abscess is formed.

Patients can develop periodontal abscesses as a result of a dental procedure which accidentally resulted in periodontal pockets. Also, the use of antibiotics in untreated periodontitis, which can mask the symptoms of an abscess, can result in a periodontal abscess. Sometimes gum damage can lead to periodontal abscesses, even if no periodontitis is present.

What should I do if I have dental abscess symptoms?

Any person with symptoms linked to a dental abscess should see a dentist immediately. Dental abscesses are easily diagnosed by a qualified dentist. In the UK the National Health Service (NHS) advises people to visit either their usual registered dentist, a local Dental Access Centre, or the emergency department of their local general hospital.

People who have swallowing and/or breathing problems should go straight to the emergency department of their local hospital.

If for some reason you cannot get to a dentist immediately you could visit your GP (general practitioner, primary care physician). A GP cannot treat an abscess, but he/she may prescribe medication and advise on self-care and pain management, and is also likely to know the fastest way of getting emergency treatment, if required.

What is the treatment for a dental abscess?

The only person who can effectively treat a dental abscess is a dentist. Treatment may involve typical dental procedures, and in some occasional surgery.

Incision - the abscess needs to be cut out (incised) and the pus, which contains bacteria, drained away. The patient will be given a local anesthetic.

Treating a periapical abscess - root canal treatment will be used to remove the abscess. A drill is used to bore a hole into the dead tooth so that the pus can come out. Any damaged tissue will be removed from the pulp. A root filling is then inserted into the space to prevent subsequent infections.

Treating a periodontal abscess - the abscess will be drained and the periodontal pocket cleaned. The surfaces of the root of the tooth will then be smoothed out by scaling and smoothing (planing) below the gum line. This helps the tooth heal and prevents further infections from occurring.

Surgery for dental abscesses

Patients with a periapical abscess and a recurring infection may need to have diseased tissue surgically removed. This will be done by an oral surgeon.

Patients with a periodontal abscess and a recurring infection may have to have their gum tissue reshaped and the periodontal pocket removed. This procedure will be performed by an oral surgeon.

If the dental abscess recurs, even after surgery, the tooth may be extracted (taken out).

Treatment for pain

OTC (over-the-counter, no prescription required) painkillers (analgesics) may help reduce the pain while the patient is waiting for treatment. It is important to follow the information on the packet carefully. Painkillers are only there for pain reduction, they cannot replace the visit to a dentist.

Aspirin, ibuprofen or Tylenol (parecetamol) are effective painkillers. However, some are unsuitable for certain types of patients (read below):

• Ibuprofen and asthma - if you are asthmatic do not take ibuprofen.
• Ibuprofen and stomach ulcers - do not take ibuprofen if you have, or ever had stomach ulcers.
• Aspirin and children - do not give aspirin to children under 16 years of age.
• Aspirin and pregnancy and breastfeeding - do not take aspirin if you are pregnant or breastfeeding.

Things you can do yourself

• Avoid cold foods and drinks
• Avoid hot foods and drinks
• Moderately cool foods, chewed on the "good" side of your mouth will probably be less painful
• Do not floss around the affected area
• Use a very soft toothbrush

Antibiotics - these may be prescribed to prevent the infection from spreading, and may be taken together with painkillers. Examples of antibiotics include amoxicillin or metronidazole. In no way should antibiotics be seen as a way of substituting treatment with a dentist, or postponing treatment.

What are the complications of a dental abscess?

In the vast majority of cases, complications only occur if the abscess is left untreated. However, complications can occur, even after seemingly effective treatment, but this is very rare. Possible complications include:

Dental cysts - a fluid-filled cavity may develop at the bottom of the root of the tooth if the abscess is not treated. This is called a dental cyst. There is a significant risk that the cyst will become infected. If this happens the patient will need antibiotics, and possibly surgery.

Osteomyelitis - the bacteria in the abscess gets into the bloodstream and infects the bone. The patient will experience an elevated body temperature, severe pain in the affected bone, and possibly nausea. Typically, the affected bone will be near the site of the abscess; however, as it may have spread into the bloodstream any bone in the body may be affected. Treatment involves either oral or intravenous antibiotics.

Cavernous sinus thrombosis - the spread of bacteria causes a blood clot to form at the cavernous sinus - a large vein at the base of the brain. Cavernous sinus thrombosis is treated with antibiotics, and sometimes surgery to drain the sinus. In some cases the condition can be fatal. This is a very rare complication.

Ludwig's angina - this is an infection of the floor of the mouth when the dental abscess bacteria spread. There is swelling and intense pain under the tongue and in the neck. In severe cases the patient may find it hard to breathe. Ludwig's angina is a potentially fatal condition. Patients are treated with antibiotics. In severe cases a tracheostomy (procedure to open the airway) is performed if there are breathing problems.

Maxillary sinusitis - the bacteria spread into small spaces behind the cheeckbones, called the maxillary sinuses. This is not a serious condition, but can be painful, and the patient may develop a fever and have tender cheeks. Sometimes the conditions resolves on its own. Depending on the severity, the doctor may prescribe antibiotics.

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What Is Fluoride? What Does Fluoride Do?

Fluoride is a chemical ion of the element fluorine (from the Latin fluo meaning "to flow"), in that fluoride has one extra electron that gives it a negative charge. Fluoride is found naturally in water, foods, soil, and several minerals such as fluorite and fluorapatite. However, it is also synthesized in laboratories where it may be added to drinking water or used in a variety of chemical products.

Fluoride is most commonly associated with dental hygiene products and tooth protection. Most people are exposed to fluoride through treated drinking water or products such as toothpaste and mouthwash.

What does fluoride do?

Fluoride protects teeth from decay and cavities in two ways. When bacteria in the mouth combine with sugars, acid is produced that can erode tooth enamel and damage teeth. Fluoride can protect teeth from demineralization that is caused by the acid. If teeth have already been damaged by acid, fluoride accumulates in the demineralized areas and begins strengthening the enamel - a process called remineralization. Fluoride is very useful for preventing cavities and strengthening teeth, but its effectiveness is thwarted if a cavity has already formed.

How is fluoride obtained?

Fluoride may be ingested or applied topically. If foods containing fluoride (such as meat, fish, eggs, and tea leaves) are consumed, then fluoride enters the bloodstream and is eventually absorbed by the teeth and bones. Many communities add fluoride to the drinking water to ensure that the recommended levels are obtained.

Fluoride can also be applied directly to teeth by a professional in a dental office. The teeth will readily absorb topical fluoride treatments, and the chemical will remain in the mouth for several hours. Less thorough topical fluoride treatments may also be applied at home using products such as toothpaste, mouthwash or mouth rinse, fluoride gels, or fluoride supplements.

Who needs fluoride?

Many governmental health agencies recommend that both children and adults receive some level of fluoride. Children need fluoride to protect their permanent teeth as they are forming. Adults need fluoride so that they can continue to protect teeth against tooth decay. Several groups of people could benefit especially from fluoride treatments because they have a higher risk of tooth decay. This includes people who have:

• A history of cavities or tooth decay
• No or little access to dentists
• Poor dental hygiene
• Diets with high amounts of sugars or carbohydrates
• Snacking habits
• Braces, crowns, bridges, and other teeth restoration procedures
• A lack of saliva or dry mouth

Is fluoride safe?

When used properly, fluoride is usually considered a safe and effective tool to prevent tooth decay. However, high levels of fluoride exposure for extended periods of time may result in harm. For example, dental fluorosis - a discoloration of tooth enamel - may occur if a person is exposed to too much fluoride. In addition, it is possible for a lifetime of exposure to high fluoride levels to lead to bone weakening and skeletal fluorosis (joint stiffness and pain).

More extreme, toxic effects and even death may result if someone consumes too much fluoride. Fluoride overdose is possible, for example, if a small child consumes an entire tube of tooth paste. Symptoms include nausea, vomiting blood, diarrhea, stomach pain, salivation, watery eyes, general weakness, shallow breathing, faintness, tiredness, and convulsions.

Why is fluoride controversial?

Although scientific research has supported the benefits of fluoride treatment in preventing tooth decay, many people question its safety and effectiveness. Several interest groups cite recent increases in dental fluorosis and fluoride levels in water that exceed optimal levels in calling for an end to fluoridated drinking water. They deem fluoride treatments unnecessary and less useful and more dangerous than originally thought.

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