We'd like to share this article regarding the current struggle between "expert opinion" and "evidence-based science" and how FLOSSING got thrown under the bus, due to this controversy

SundayReview

Flossing and the Art of Scientific Investigation

Gray Matter

By JAMIE HOLMES NOV. 25, 2016

It’s bad enough that expertise is under attack these days from populist political movements that dismiss specialist opinion as just another establishment ruse. But lately expertise is being criticized from another direction, too — from would-be defenders of science.

Consider the recent controversy over flossing. In August, a widely read Associated Press report suggested that, contrary to the advice of dentists everywhere, flossing didn’t necessarily foster good oral health. The report looked at 25 studies that had generally compared toothbrushing and flossing with toothbrushing alone and concluded that the evidence for the benefits of            flossing was weak.

In response, the Department of Health and Human services, the American Dental Association and the Academy of General Dentistry reaffirmed the importance of interdental cleaning. But confusion persists: A lot of people now mistakenly think that “science” doesn’t support flossing.

What explains this confusion? Misconceptions about the relation between scientific research, evidence and expertise.

In the case of flossing’s benefits, the supposedly weak evidence cited by The Associated Press was the absence of support in the form of definitive randomized controlled trials, the so-called gold standard for scientific research. Why was there so little of this support? Because the kind of long-term randomized controlled trial needed to properly evaluate flossing is hardly, if ever, conducted — because such studies are hard to implement. For one thing, it’s unlikely that an Institutional Review Board would approve as ethical a trial in which, for example, people don’t floss for three years. It’s considered unethical to run randomized controlled trials without genuine uncertainty among experts regarding what works.And dentists know from a range of evidence, including clinical experience, that interdental cleaning is critical to oral health and that flossing, properly done, works. Yet the notion has taken hold that such expertise is fatally subjective and that only randomized controlled trials provide real knowledge.

The opposition between randomized controlled trials and expert opinion was fueled by the rise in the 1990s of the evidence-based medicine movement, which placed such trials atop a hierarchy of scientific methods, with expert opinion situated at the bottom. The doctor David Sackett, a father of the movement, once wrote that “progress towards the truth is impaired in the presence of an expert.”

But while all doctors agree about the importance of gauging the quality of evidence, many feel that a hierarchy of methods is simplistic. As the doctor Mark Tonelli has argued, distinct forms of knowledge can’t be judged by the same standards: what a patient prefers on the basis of personal experience; what a doctor thinks on the basis of clinical experience; and what clinical research has discovered — each of these is valuable in its own way. While scientists concur that randomized trials are ideal for evaluating the average effects of treatments, such precision isn’t necessary when the benefits are obvious or clear from other data.

Clinical expertise and rigorous evaluation also differ in their utility at different stages of scientific inquiry. For discovery and explanation, as the clinical epidemiologist Jan Vandenbroucke has argued, practitioners’ instincts, observations and case studies are most useful, whereas randomized controlled trials are least useful. Expertise and systematic evaluation are partners, not rivals.

Distrusting expertise makes it easy to confuse an absence of randomized evaluations with an absence of knowledge. And this leads to the false belief that knowledge of what works in social policy, education or fighting terrorism can come only from randomized evaluations. But by that logic (as a spoof scientific article claimed), we don’t know if parachutes really work because we have no randomized controlled trials of them.

Antagonism toward expertise can also waste time and effort by spurring researchers to test the efficacy of things we already know work. In the field of international development, for example, a recent study investigated the relationship between prescription glasses and school performance. A randomly selected group of Chinese children with poor eyesight were given glasses … and subsequently got better grades. Imagine: Kids who could see did better in school!

The cult of randomized controlled trials also neglects a rich body of potential hypotheses. In the field of talk therapy, for example, many psychologists believe that dismissing a century of clinical observation and knowledge as anecdotal, as research-driven schools like cognitive behavioral therapy have sometimes done, has weakened the bonds between clinical discovery and scholarly evaluation. The psychiatrist Drew Westen says the field is too often testing “uninformed hunches,” rather than ideas that therapists have developed over years of actual practice.

Experiments, of course, are invaluable and have, in the past, shown the consensus opinion of experts to be wrong. But those who fetishize this methodology, as the flossing example shows, can also impair progress toward the truth. A strong demand for evidence is a good thing. But nurturing a more nuanced view of expertise should be part of that demand.

Jamie Holmes, a fellow at New America, is the author of “Nonsense: The Power of Not Knowing.”

Men's Periodontal Health, Men have higher risk than women for gum disease and complications that can result in cancer, heart disease and more!

Don't ignore your gums, guys

Shorter life spans. Greater risk for heart attacks. Higher rates of cancer. As if men don’t
have it tough enough, studies report that periodontal disease is more prevalent and severe in males
than in females. In fact, the January, 1999 Journal of Periodontology reports that at the very least,
34 percent of the U.S. male population age 30 to 54 has periodontitis, compared to 23 percent of females.

Part of the reason for this is attributed to poorer oral hygiene among males than females. Further
reasoning for the gender difference remains unclear, but may have something to do with a protective
effect of female hormones.

So why should men be concerned? First of all, periodontal disease is a major cause of tooth loss in adults. After age 65, almost 25 percent of men have no remaining natural teeth. However, don’t think tooth loss is a problem you won’t face until old age. Tooth loss due to periodontal disease can strike people in their 30's and younger.

And maybe more importantly, the pool of research linking periodontal disease to far more serious health threats, such as heart disease, respiratory disease and diabetes, continues to grow.

One study found that people with advanced periodontal disease are 4.5 times more likely to have a chronic respiratory disease. Another study found that people with periodontal disease may have nearly twice the risk of having a fatal heart attack as those without periodontal disease. While periodontal disease cannot always be avoided, proper oral hygiene is the best means of prevention.

• Daily flossing breaks up the bacterial colonies between teeth, and proper brushing prevents plaque buildup.
• Professional cleanings at least twice a year are necessary to remove calculus from places     your toothbrush and floss may have missed.
• And, because there are often no symptoms of the disease in its early stages, a trip to a periodontist can determine if you have periodontal disease

Just for men

Face your fears According to a 1999 AAP online poll, 47 percent of periodontists say that their male patients are more often fearful of periodontal treatment, while only 11 percent find their female patients to be the more fearful gender. Share your anxiety with your dentist, periodontist and their staffs. They are prepared to help. The survey also revealed that the top origins of dental fear are family and friends or a personal bad experience more than 10 years ago. Realize that advances in the ability to treat periodontal conditions in a comfortable way have come a long way in recent years.

Chew on this

Smokeless tobacco products such as snuff and chewing tobacco increase your risk for oral
cancer. In fact, oral mucosal lesions are found in 50 to 60 percent of smokeless tobacco users.
And, smokeless tobacco use has been associated with more severe and rapidly progressing periodontal disease.

Don’t skip the trip

Dental care utilization rates are lower among men than women. According to a 1997 American
Dental Association/Gallup phone survey, one in four men reported they hadn’t visited a dentist in the
past year. In addition, a study in the June, 1999 Journal of Periodontology found that well over half
of males under age 40 who have undergone nonsurgical periodontal treatment are likely to drop out
of periodontal maintenance therapy. Periodontal diseases are chronic diseases, and without this
careful, ongoing treatment, disease can and often does recur.

Make it a mate ritual

One study, which examined 58 elderly couples, found that long-married partners had strikingly similar tooth-care habits. So men may want to begin flossing with their significant others before bed as part of their evening ritual. Good oral care will help ward off periodontal disease and tooth loss.

Peace and Thanks to All Americans, Enjoy your family, friends and give thanks to your country for the holidays are upon us!

After the Election, a Thanksgiving to Unite Us

By 

MELANIE KIRKPATRICK (WSJ)

Nov. 17, 2016 7:08 p.m. ET

Election Day has come and gone, and after one of the most divisive campaigns in memory, “healing” seems to be the word of the hour. What better time to begin than Thanksgiving, which Benjamin Franklin called a day of “public Felicity” to give thanks for our “full enjoyment of Liberty, civil and religious.” Thanksgiving, our nation’s oldest tradition, is a moment to focus on our blessings as Americans, on what unites us, not on what divides us.

Such was the case in 1863, when Abraham Lincoln called for a national Thanksgiving celebration. He did so at the urging of a farsighted magazine editor who believed that a Thanksgiving celebration would have a “deep moral influence” on the American character, helping to bring together the country, which was divided over the issue of slavery. Lincoln’s 1863 proclamation was the first in the unbroken string of annual Thanksgiving proclamations by every subsequent president. It is regarded as the beginning of our modern Thanksgiving holiday.

Lincoln’s call for a national Thanksgiving was different from the thanksgivings he orJefferson Davis, the president of the Confederacy, had called in the early years of the Civil War to express gratitude to God for specific Union or Confederate military victories. Rather, in 1863 Lincoln asked Americans to give thanks for the nation’s general blessings. It was the first time since George Washington led the country that a president proclaimed a day of general Thanksgiving. 

The opening sentence of Lincoln’s proclamation set the tone: “The year that is drawing toward its close has been filled with the blessings of fruitful fields and healthful skies,” he wrote. This was an astonishing way to characterize the year 1863, when death, suffering and grief were ever present. At the Battle of Gettysburg, which had taken place in July, the Union lost 27% of its fighting men and the Confederacy lost 37%. Yet amid this human suffering, Lincoln cataloged the blessings for which Americans could be grateful. Even “in the midst of a civil war of unequaled magnitude and severity,” he wrote, the nation remained at peace with foreign countries, its borders were expanding, its population was growing, and its farms, industries and mines were producing.

Lincoln spoke not as commander in chief of the Union forces but as president of the entire nation, North and South. He made no reference to victories or losses or rebels or enemies. Instead, the president spoke of “the whole American people.” He called on every American to celebrate Thanksgiving “with one heart and one voice.”

To understand how Lincoln came to believe in the healing power of a national Thanksgiving, it is necessary to examine the remarkable life of the woman who made it happen. She used her position as editor of the most popular magazine of the pre-Civil War era to conduct a decadeslong campaign for a countrywide Thanksgiving holiday. She is often called the godmother of Thanksgiving. Her name was Sarah Josepha Hale.

Hale’s story is a classic American saga of how one enterprising, hardworking individual with a good idea can have an impact in an open, democratic society. In this case, a penniless young widow from New Hampshire—subject to all the limitations attached to such a station in life in the early 19th century—rose to become the editor of the most widely circulated magazine of her era, Godey’s Lady’s Book.

As editor—or “editress,” as she preferred to be addressed—Hale set out to publish American authors writing on American themes. This approach contrasted with that of other magazines of the day, which typically reprinted articles pirated from English publications. Hale lined up American writers such as Harriet Beecher Stowe, Nathaniel Hawthorne, Washington Irving and Edgar Allan Poe. Her interest in culture extended to everyday aspects of American life—food, fashion, manners, child rearing and running a household.

Thanksgiving Day, a homegrown holiday, fit into Hale’s mission of focusing on Americana. She saw it as a patriotic occasion along with the Fourth of July and Washington’s Birthday. Thanks in part to Hale’s campaign, by the time the Civil War began nearly every state marked its own Thanksgiving Day on dates ranging from September to December. Her goal was to have it established as a national holiday and observed on a uniform date throughout the country. George Washington had selected the last Thursday in November as the date of the first national Thanksgiving in 1789, so that was the date she chose.

Hale helped consolidate popular support for a national Thanksgiving by publishing editorials making the case for the holiday, fiction and poems set around Thanksgiving Day, and recipes for traditional Thanksgiving dishes such as roast turkey and pumpkin pie. Her hope wasn’t simply to see Americans feast on the same foods on the same day, but she was shrewd enough to realize that the culinary appeal of Thanksgiving was another selling point for her vision of a shared celebration.

Meanwhile, she conducted a letter-writing campaign, soliciting support for her project from presidents, governors, congressmen and other influential Americans. On Sept. 28, 1863, Hale sent a letter to Lincoln. The subject she wished to lay out before the president, she wrote, “is to have the day of our annual Thanksgiving made a National and fixed Union Festival.” The editor asked the president to “appeal to the Governors of all the States” to follow suit. “Thus the great Union Festival of America would be established.” The result, as we know, was Lincoln’s decision to declare a national day of Thanksgiving.

In his 1863 proclamation, Lincoln reminded Americans that the Civil War would eventually end. He asked them to look beyond the current horrors to a better day, when the country “is permitted to expect continuance of years with large increase of freedom.”

Lincoln’s Thanksgiving proclamation was profoundly hopeful, reminding the American people of the nation’s capacity for renewal. It’s a message that resonates today.

Ms. Kirkpatrick is the Journal’s acting editorial features editor. This essay is adapted from her book, “Thanksgiving: The Holiday at the Heart of the American Experience,” just out from Encounter Books.

Your Child's Oral Health

Brushing Up on Oral Health: Never Too Early to Start

As the American Academy of Pediatrics (AAP) and other children's organizations report, tooth decay(also called early childhood caries, or ECC) is the most common chronic children's disease in the country. As a result, it is very important that parents work with their pediatrician to establish good oral health care from the first weeks of their baby's life. Although most of us think of dental care in relation to our own dentists, parents will be working closely with their pediatrician even earlier than with a dentist.

Since pediatricians see young infants and children frequently for preventive health care visits, they are in an excellent position to identify children at risk for dental health problems, coordinate appropriate care and parent education, and refer affected and high-risk children to pediatric dentists.

The Centers for Disease Control and Prevention (CDC) has stated that dental caries is five times more common than asthma and seven times more common than hay fever in children. More than 40 percent of children have tooth decay by the time they reach kindergarten. Children with dental caries in their baby teeth are at much greater risk for cavities in their adult teeth.

Health care professionals know that tooth decay is a disease that is, by and large, preventable. Because of how it is caused and when it begins, however, steps to prevent it ideally should begin prenatally with pregnant women and continue with the mother and young child, beginning when the infant is approximately 6 months of age. Pediatricians have become increasingly aware that their own proactive efforts to provide education and good oral health screenings can help prevent needless tooth decay in infants.

For parents who wish to establish good dental health for their infants, the following general guidelines may be of help:

• Fluoride and Your Child: Fluoride is a naturally occurring mineral that is found in many foods, and it also is added to the drinking water in some cities and towns. It can benefit dental health by strengthening the tooth enamel, making it more resistant to acid attacks that can cause tooth decay. It also reduces the ability of plaque bacteria to produce acid. Check with your local water utility agency to find out if your water has fluoride in it. If it doesn't, ask your doctor if you should get a prescription for fluoride drops or chewable tablets for your child.                                                                          
• Check and Clean Your Baby's Teeth:                                                                           
  
  Healthy teeth should be all one color. If you see spots or stains on the teeth, take your baby to your dentist. As soon as your child has a tooth begin to use a smear (size of a grain of rice) of fluoride toothpaste. Clean the teeth at least twice a day. It's best to clean them right after breakfast and before bedtime. Once your child turns 3 you can begin to use a pea-sized amount of fluoride toothpaste. When your child is able, teach him to spit out the excess toothpaste, but don't rinse with water. As your child gets older let her use her own toothbrush. It is best if you put the toothpaste on the toothbrush until your child is about age 6. Until children are 7 or 8 years old, you will need to help them brush. Try brushing their teeth first and then letting them finish.
• Feed Your Baby Healthy Food: Choose drinks and foods that do not have a lot of sugar in them. Give your child fruits and vegetables instead of candy and cookies. Be careful with dried fruits, such as raisins, since they easily stick to the grooves of the teeth and can cause cavities if not thoroughly brushed off the teeth.
• Prevent Tooth Decay: Do not put your baby to bed with a bottle at night or at naptime. (If you do put your baby to bed with a bottle, fill it only with water). Milk, formula, juices and other sweet drinks, such as soda, all have sugar in them. Sucking on a bottle filled with liquids that have sugar in them can cause tooth decay. During the day, do not give your baby a bottle filled with sweet drinks to use like a pacifier. If your baby uses a pacifier, do not dip it in anything sweet like sugar or honey. Near his first birthday, you should teach your child to drink from a cup instead of a bottle.
• Talk With Your Pediatrician About Making a Dental Home: Since your pediatrician will be seeing your baby from the first days and weeks of life, plan to discuss when and how you should later develop a "dental home"—a dentist who can give consistent, high-quality, professional care—just as you have a "medical home" with your pediatrician. Usually, your dentist will want to see a child by his first birthday or within six months of the first tooth's emergence. At this first visit, your dentist can easily check your child's teeth and determine the frequency of future dental checkups.

Last Updated

 

10/3/2014

Source

 

Adapted from Healthy Children Magazine, Winter 2007

The information contained on this post should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

UNDERSTANDING DENTAL INSURANCE

Feeling “antsy” about your dental plan?

Sorting through the complexities of insurance plans can be difficult.  However, ultimately, patients are responsible for knowing what their coverage is. Plan sponsors (usually the employer) are required to provide booklets detailing what is and what is not covered. The intent of all dental insurance is the same: to help pay a portion of the cost of dental care.
Virtually all plans limit the yearly dollar amount that will be paid.
Basically, three types of dental benefit plans exist: traditional, direct reimbursement and managed care.

Traditional or “fee-for-service” plans allow patients to seek care from the general dentist or specialist of their choice. Traditional plans provide benefits based upon either a fee schedule or a percentage of what the insurer determines to be usual, customary and reasonable (UCR) fees. Typically, most periodontal services are reimbursed at 80% of the UCR fee. In addition, patients may be responsible for the difference between the UCR fee and the dental office’s regular fee.

In a direct reimbursement plan, the patient pays the dental bill and submits the receipt to the employer for reimbursement. There are no restrictions other than the limitation on the total dollar amount that will be paid.

Managed care plans restrict your choice of dentists. They will only pay maximum benefits if the services are provided by a dentist in their plan. Like traditional plans, they limit the type and frequency of care and require the patient to pay the difference between the covered
amount and the dentist’s fee.

With all types of plans, it is important to evaluate other plan components, such as deductibles (the amount you pay personally before the dental insurance plan kicks in); copayments (your share of the financial responsibility for a specific dental service); limitations (such as waiting periods before coverage begins); exclusions (treatments not covered such as implants or preexisting conditions); and annual or lifetime maximum benefit (dollar limit of the insurer’s financial responsibility).

If a plan doesn’t cover a procedure that is recommended by your dentist, this does not mean the treatment isn’t needed. It just means the plan doesn’t cover it. Periodontal disease is a chronic disease that must be monitored closely. Talk with your dentist and periodontist about the treatment you need and ask about financing options. If you value oral health and keeping your teeth, the fact that your plan does not cover your treatment should not stop you from going ahead with that treatment.

Common questions answered

What should I do if I have a concern or complaint about my dental plan? 
Dental benefit plans are the result of a contract between your employer and the insurance company. Limitations in coverage are the result of the financial commitment your employer has agreed to make and the benefits the insurance company will offer in exchange for that commitment. Your dentist often cannot answer specific questions about your dental benefit or predict what your level of coverage will be because plans vary according to these contracts. Therefore, your concerns should be directed to your employer (usually the human resource department or benefits manager).

Can I refer myself to a periodontist?
Under traditional plans, you can see the dental specialist of your choice. Managed care
plans are based on a “gatekeeper” model so you may need to be referred by your general dentist in order to receive coverage for specialty treatment. In some plans, there are economic drawbacks for the general dentist to refer patients to specialists. Check to see if your access to specialty care will be restricted when evaluating plans.

What happens if my periodontist is not listed under my managed care plan? 
Check to see if the plan has a “freedom of choice” or “point-of-service” option. These
enable you to seek care from a practitioner of your choice. Under most plans, you will not receive full benefits if you select a practitioner not associated with the plan. Of course, you can always go to the dentist of your choice if you are willing to pay yourself.

Periodontal Health and the Battle of the Sexes

MEN vs WOMEN:  GENDER AND ORAL HEALTH

Periodontal disease and its associated complications affect both men and women, so it’s important that both sexes are doing everything they can to maintain their periodontal health. However, Research published in the Journal of Periodontology suggests that women are more proactive in maintaining healthy teeth and gums than men. In fact, the study found that women are almost twice as likely to have received a regular dental check-up in the past year, and women in the study also had better
indicators of periodontal health, including lower incidence of dental plaque than men.

Overall, the study suggested that women have a better understanding of oral health, as well as a more positive attitude towards dental visits. This understanding is important for women, as hormonal fluctuations throughout a woman’s life may affect her periodontal health and, therefore, overall health. Certain life stages may increase women’s susceptibility to periodontal disease, which may require special attention:

• Puberty: Studies show that elevated hormone levels may cause an increase in gum sensitivity and lead to a greater inflammatory reaction, which can cause gums to become swollen, turn red, and feel
tender.

• Menstruation: During menstruation, some women may experience menstruation gingivitis, which may
cause gum bleeding, redness, or swelling of the gums between the teeth.

• Menopause: Hormonal changes may cause women to experience discomfort in their mouths, including pain, burning sensations in the gum tissue, or mouth sores.

Men have special periodontal health considerations, as well. A June 2008 Lancet Oncology study found that men with periodontal disease may be more likely to develop kidney cancer, pancreatic cancer, and blood cancers. Periodontal disease has also been linked to higher risk of developing prostate cancer.

Both men and women should strive for periodontal health by brushing twice each day, flossing
at least once each day, and seeing a dental professional, such as a periodontist, regularly.
Additionally, it’s a good idea to get a comprehensive periodontal evaluation every year. A dental
professional, such as a periodontist, can conduct this exam to assess your periodontal
disease status.

Oral Health Survey: Men vs. Women

A recent survey conducted by the American Academy of Periodontology found some
interesting results including:

• Women are 26 percent more likely than men to floss on a daily basis.

• 74 percent of women would be embarrassed by a missing tooth (a possible consequence of
periodontal disease), compared to 57 percent of men.

• Women are almost twice as likely to notice missing teeth on another person than men.

• 44 percent of women are aware that periodontists can help
contribute to overall good health,
compared to 33 percent of men.

Helping you put on your best smile; here's how it's done!!!!

Create a Beautiful Smile with Periodontal Plastic Surgery

A confident, beautiful smile is one of the first things people notice about your face. If you’re not happy with your smile, a periodontist can help! Just as cosmetic surgery has been helping people improve their appearance, several periodontal plastic surgery procedures are available to help enhance the aesthetics of your teeth and gums.

Here are some examples of popular procedures:

Crown Lengthening

Crown lengthening is a procedure to remove excess gum tissue, exposing more of the “crown” of the tooth. This procedure is for patients who feel their teeth are too short or their gum line is uneven. The gum line is then sculpted to create the right proportion between gum tissue and tooth surface. This can be done to just one tooth, or to enhance your entire smile.

Dental Implants

A dental implant is an artificial tooth root placed in the jaw to hold a replacement tooth or bridge in
place, or to provide support for a denture. Dental implants are the answer for many people with
missing or damaged teeth- implants look and feel just like your own teeth!

Root Coverage

During a root coverage procedure, gum tissue from your palate is used to cover the exposed tooth roots. These procedures are used to cover roots, develop gum tissue where needed, or to make dental implants look more natural. In some cases, this procedure can cover exposed roots to protect them from decay or prepare your teeth for orthodontic treatment. Your tooth sensitivity may be reduced as well, and your smile may also improve!

Before

Ridge Augmentation

Ridge augmentation procedures are used to correct irregularities in the jawbone where your natural teeth are missing. They are also used to prevent the jawbone from collapsing after a tooth extraction, and help to even out dental implants that may seem too long compared to the rest of your teeth.

After

Pocket Depth Reduction

Deep pockets caused by periodontal disease can be corrected through pocket depth reduction. This
procedure is used to clean the pockets and secure the gum tissue in its original place. Reducing pocket depth and eliminating existing bacteria are important to prevent damage caused by the progression of periodontal disease and to help maintain your healthy smile.

Combination Procedures

Sometimes you may need a few of these procedures to build the framework for your perfect smile.
Often, periodontal plastic surgery is used to lay the foundation for further cosmetic enhancements,
such as orthodontics and veneers. A combination of periodontal procedures can result in a beautiful
new smile and improved periodontal health- your keys to smiling, eating, and speaking with comfort and confidence.

Pregnancy and Periodontal Disease

Pregnancy and Periodontal Disease

There used to be an old wives’ tale that said “A tooth is lost for every child.” While it may seem far fetched, it may actually be based loosely on fact. Your teeth and gums can be affected by
pregnancy, just like other areas of your body.

Most commonly, pregnant women can develop gingivitis, or pregnancy gingivitis, beginning in
the second or third month and can increase in severity through the eighth month of pregnancy. During this time, some women notice
swelling, bleeding, redness, or tenderness in the gum tissue.

In some cases, gums swollen by pregnancy gingivitis can react strongly to local irritants and form a large lump. These growths, called pregnancy tumors, are not cancerous and are generally painless. They usually disappear
after pregnancy, but some may require removal by a dental professional, such as a periodontist. The best way to avoid periodontal conditions
associated with pregnancy is to begin with healthy gums. If you are thinking about becoming pregnant, you should visit your
dentist or periodontist for a comprehensive periodontal evaluation.

If you are pregnant, or planning to become pregnant, you need to know that your periodontal health
may affect the pregnancy and ultimately the health of your baby. Pregnant women who experience
periodontal disease during their pregnancies may be twice as likely to develop preeclampsia, which is
characterized by high blood pressure and the presence of protein in the urine. It can put you
and your baby at risk for severe complications.

Additionally, studies have suggested that women who experience periodontal disease during pregnancy may be at risk of having a premature or low birth weight baby. The good news is
that researchers are making strides to find out exactly how periodontal disease affects pregnancy outcomes. Some studies have suggested that treating periodontitis during pregnancy may reduce the risks of a preterm birth. Preventing gum problems from developing during the stresses of pregnancy also appears to be important in improving the health of mother and baby.

If you are already pregnant and have been diagnosed with periodontal disease, treatment by
your dental professional may reduce your chances of having a preterm, low birth weight baby.
Talk to your dentist or periodontist for more information. If you’re considering pregnancy, it’s a good
idea to include a periodontal evaluation as part of your prenatal care. A healthy mouth can help
give you, and your baby, something to smile about!

Infertility Treatment

Researchers have found that women undergoing infertility treatment and who are subjected
to ovulation induction for more than three menstrual cycles had higher levels of gingival inflammation and bleeding. More studies are needed to examine the impact of infertility treatments on periodontal health. Until more information is known, meticulous at-home oral care
including routine tooth brushing and flossing and regular cleanings by a dental professional is a practical approach while receiving infertility treatment.

Remember to Visit Your Dentist/Periodontist Regurlarly

Your Annual Comprehensive Periodontal Evaluation (CPE)

You already know that visiting your dental professional regularly for a check-up and cleaning is an essential part of keeping your oral health at its best. However, these visits may not specifically look for signs of periodontal disease.

The American Academy of Periodontology (AAP) recommends that you receive a comprehensive periodontal evaluation, or CPE, annually to determine if you have or if you are at risk for periodontal disease. By assessing your periodontal health yearly, you and your dental professional will know how healthy your teeth and gums are, and will be better able to assess if you need additional treatment.

Your CPE can be performed at your regular yearly check-up by a member of the dental team, including a general dentist, registered dental hygienist, or periodontist.

Your dental professional will assess these six areas during your CPE:

1. Your Teeth: Your dental professional will examine your teeth and any restorations you might have, including dental fillings, dental implants, crowns, and dentures. During the examination of your teeth, he or she will note the position of the teeth and their closeness to one another.

2. Your Plaque: The amount and location of any plaque and/or tartar will be assessed

3. Your Gums: An instrument called a dental probe will be inserted into the space between your tooth and gums to measure the depth of your gum pockets and to see how well your gums attach to your teeth. Any bleeding that occurs during the probing process, as well as any inflammation of your gums, will also be recorded.

4. Your Bite: Your dental professional will then observe your bite, also known as occlusion. While you bite down, your dental professional will look to see how your teeth fit together and for any signs of tooth movement or loose teeth. This is important because moving or loose teeth can be a sign of periodontal disease.

5. Your Bone Structure: Your dental professional will examine the bone in and around your mouth since it can be affected by periodontal disease. X-rays may be taken to help evaluate the quality of bone in your upper and lower jaw areas and to determine if any bone loss has occurred.

6. Your Risk Factors: You will be asked about a variety of risk factors for periodontal disease, including age, tobacco use, if anyone else in your family has periodontal disease, or if you have another systemic condition that may be linked to periodontal disease, such as diabetes or cardiovascular disease.

When your dental professional has finished your comprehensive periodontal evaluation, he or she will discuss the findings with you and explain if any treatment is needed. This is a good time to ask any questions you may have about the evaluation, findings, or anything else regarding your oral health.

In addition to brushing twice each day, flossing at least once each day, and seeing your dental professional for regular cleanings, receiving your annual CPE is an essential part of your oral health routine.

Protecting Your Teeth May Protect Your Health

PROTECT YOUR TEETH AND GUMS WITH THESE ORAL HEALTH TIPS AND RESOURCES

Good oral health not only protects the integrity of your teeth and gums but also ensures that your smile remains bright for years to come. Even if you brush and floss regularly, however, there are still some oral health concerns that you may end up facing. Whether a result of your lifestyle or your genetic endowment, these issues may be worrying and unpleasant, but they can all be addressed and managed.

INSIDE YOUR TEETH

To understand the problems you may face with your teeth, it is important to first understand what your teeth are made of. At the very center of the tooth lies a cavity filled with nerves, blood vessels and other soft tissues. This is called the dental pulp. Surrounding the dental pulp is surrounded a hard yellowish material called dentin. Covering the dentin below the level of the gums is a layer of hard tissue called cementum, while above the gum line the dentin is covered by the hard, smooth, white outer layer of the tooth: the enamel. Each tooth sits in a space in the jaw bone supported by ligaments and surrounded by the soft gingiva or gum tissue.

Each part of the tooth is vital to good dental health and a problem with any one part will usually lead to trouble for other parts of the tooth.

BAD BREATH

Bad breath or halitosis can be a very embarrassing and concerning condition. Though bad breath can occasionally be the result of more serious non-dental conditions such as:

• Diabetes mellitus (acetone scent)
• Kidney failure (fishy smell)
• Liver failure
• Metabolic disorders (fishy smell)
• Lung or sinus infections

More frequently, however, halitosis is a side effect of other dental conditions. The smell itself is usually produced by the bacteria cells in plaque which produce odorous sulfur compounds. Since the tongue is very rough, it can be a site of food and bacteria accumulation. This collection of bacteria and its fuel--food debris--can result in large outputs of sulfur compounds which drive bad breath.

Bad breath can also be be caused by oral infection, cracks or chips in the teeth that gather extra bacteria, as well as periodontitis which can create hard to reach homes for sulfur producing bacteria. Fortunately, all of these conditions are treatable and halitosis has a high treatment success rate.

After you have confirmed with a doctor that there is not a more serious internal cause for your bad breath, a visit to your dentist is the next step. Your dentist can test the severity of your bad breath issue before treating any oral infections, cavities, and periodontitis. Your dental hygienist can then help you develop an effective oral health program (including specialized toothpastes and mouth rinses) that will help reduce oral bacteria and prevent recurrence of your halitosis problem.

DRY MOUTH

Dry mouth is associated with a wide range of symptoms and causes and can lead to an increase in gingivitis, periodontitis, cavities, and other forms of oral disease. Fortunately, dry mouth (xerostomia) can be managed.

Signs of dry mouth include:

• Frequent thirst
• Impaired taste
• Difficulty speaking
• Dry burning sensation on the surfaces of the mouth
• Difficulty eating (dry foods)
• Difficulty wearing dentures
• Dry lips, cracking lips and corners of the mouth

These symptoms can be the result of natural aging, rheumatoid conditions, immune conditions, hormonal disorders, neurological disorders, longterm use of liquid and soft diets, radiation therapy, and any number of pharmaceuticals including decongestants, diuretics, antidepressants and a variety of others.

Unfortunately there is no straightforward cure for dry mouth but there are treatment options. The easiest way to reduce dry mouth is by drinking more water and keeping water with you throughout the day and night. Whenever you feel any dryness, just take a sip. Chewing sugarless gum can also help stimulate the salivary glands, while avoiding tobacco, alcohol, and sugary foods helps to prevent dryness. In some cases, using a saliva substitute (found in most pharmacies) may be the best treatment, allowing you to adjust your saliva levels artificially.

While treating dry mouth, it is also important to remember that the reduction in saliva (your body's natural oral rinse) can lead to increased plaque deposits, gum disease, and cavities. Thus, your oral hygiene plan deserves additional attention, and it becomes even more critical to use fluoridated toothpaste to protect your teeth.

TOOTH SENSITIVITY

If eating ice-cream or drinking a hot latte is a source of agony to you, you may have tooth sensitivity. When teeth are damaged by physical trauma, teeth grinding, or cavities, or when the gums begin to recede in association with gum damage, the sensitive dentin and root surfaces can be exposed. These surfaces, when they come in contact with extreme temperatures, large differences in acidity, or even sugar, can cause sudden, intense, shooting pain in the teeth and jaws.

Chronic teeth grinding (bruxism), a lost crown or filling, cracked or chipped teeth, aggressive tooth brushing, gum disease, and periodontitis induced gum recession are the primary causes of tooth sensitivity. Unfortunately, with the exception of replacing a lost filling, most of these conditions are not reversible, but a good system of oral care can help reduce tooth sensitivity despite the exposure of sensitive surfaces.

In the case of severe sensitivity, dentists may use white fillings, fluoride varnish, or dentin sealer to cover the exposed root or dentin. If, however, you do not wish to undergo such procedures, there are some simple at-home solutions as well. First and foremost, you should maintain good oral health and hygiene using fluoridated rinses or toothpastes and a soft bristled toothbrush which will prevent further gum abrasions. Avoiding acidic foods which can erode enamel over time can also help prevent an increase in sensitivity.

Finally, there are many desensitizing toothpastes on the market which can actively reduce sensitivity. You many even want to spread a thin layer on the exposed roots and leaving it overnight. You may also need to try several different brands before you find the one that's right for you, but once you find one that works, you must keep using it or risk a return in sensitivity. The toothpaste is not curing your tooth sensitivity, it is merely managing it.

If your tooth sensitivity is connected to bruxism or tooth grinding, wearing a night mouth guard will prevent further erosion of tooth enamel, thus preventing an increase in sensitivity.

GINGIVITIS AND PERIDONTITIS

Healthy gums are usually light pink or coral, composed of firm orange peel textured tissues, and fitted closely to the teeth, following their contours and forming a scalloped edge. In this healthy state, gums will not bleed or cause discomfort during your daily oral hygiene routine, and there will be no visible redness or swelling. When plaque or tartar is allowed to accumulate along the gum line, however, these healthy tissues can become inflamed and painful. This development is called gingivitis.

Gingivitis is usually indicated by red, swollen gums and bleeding during flowing and brushing. It is at this point that oral hygiene intervention can completely reverse the damage, but continued neglect can lead to the development of periodontitis. At the gingivitis stage, the gums are irritated, but the bone beneath them has not started to erode and there is no real lasting damage.

Once gum disease progresses to periodontitis, treatment is vital, but a full reversal of symptoms may be impossible as the bone around the teeth begins to degrade. In addition to the inflammation and bleeding seen in gingivitis, warning signs of periodontitis include:

• Gums pulling away from teeth
• Infection and pus around the teeth and gums
• Loose or separating permanent teeth
• Changes in your bite or the fit of a partial denture
• Bad breath
• Itchiness

In the first stages of periodontitis, plaque and tartar appears below the gum line, the ligaments around the teeth degrade and the gums begin to separate from the teeth leaving a gap for more plaque and tartar to form. At this stage, professional plaque removal (scaling) and an active improvement in oral hygiene practices can prevent further degradation and maintain healthy gums and teeth. Unfortunately, the ligament structure will not recover and the teeth will always be more vulnerable to gum diseases.

At later stages of periodontal disease, the ligaments have broken down, and the bone surrounding the teeth begins to degrade as well, pulling the gums far from the teeth. At this point, tooth sensitivity is common and swelling is severe. If left untreated, the condition may progress to the point that teeth are no longer fully supported in the mouth and must be removed to protect your overall oral health.

Regular visits to your dental hygienist and frequent self-checks can help catch and treat gum disease before it reaches irreversible levels. The best way to protect your gum health, however, is the maintenance of an effective oral health plan including regular brushing and flossing, use of a fluoridated toothpaste, and in some cases use of specialized mouth rinses.

PREGNANCY GINGIVITIS

Starting in the second month of pregnancy and continuing for as many as six months after delivery, many pregnant women experience a sudden increase in gum swelling and redness. The hormones involved in pregnancy make the body more sensitive to the irritation of plaque near the gums. If, however, the plaque is removed regularly, the increased sensitivity will not lead to gingivitis all on its own. Just as with non-pregnancy gingivitis, the best prevention (and cure) is good oral hygiene. If you are concerned about the effectiveness of your oral hygiene routine, it's always a good idea to visit a dental hygienist and get professional advice.

CAVITIES

In addition to gum health, good oral hygiene can help prevent tooth damage in the form of cavities. When bacteria are allowed to remain on your teeth over time, particularly in the spaces between teeth, their chemical output gradually eats away at the tooth enamel. Low salivary flow, consumption of sticky sugary foods, and large gaps between eating sugary foods and cleaning the teeth, can all increase the likelihood of cavity formation. The natural strength, shape, and positioning of your teeth may also affect your risk of cavities.

Especially if you have a family history of weak enamel and frequent cavities, oral hygiene products containing fluoride will help to strengthen the tooth, harden your enamel, and even rebuild the tooth at the early stages of cavity formation. In combination with reducing problem foods such as candy and sticky starches like chips, and ensuring regular plaque removal, fluoride can help you maintain healthy cavity free teeth.

TOOTH GRINDING

Even with excellent oral hygiene, you may still face other dental concerns. Affecting 8-20% of the adult population (Lavigne et al., 2008), bruxism or teeth grinding can lead to a range of problems including tooth sensitivity, jaw pain, enamel erosion, and even the cracking and chipping of teeth. Most severe teeth grinding occurs during sleep and so can be very hard to diagnose until it reaches such severity that your partner can hear you grinding, or that you begin to suffer from pain, migraines, and visible tooth degradation.

The cause of bruxism is still unclear but stress seems to play a role in the severity and frequency of episodes. Thus, stress reduction and behavioral change therapies may be helpful in reducing the impact of bruxism. Ultimately, however, there is no certain cure so most dentists will recommend the use of a custom dental night guard. These guards fit closely to your teeth and protect them from the erosion and pressure resulting from grinding. 

SPORTS AND MOUTHGUARDS

Physical trauma through sporting activities can not only lead to bruises and broken bones, but can also cause dental injuries which are unsightly, painful, and expensive to repair. In any contact sport, a mouthguard and a helmet should be worn as default.

Mouth guards for sport come in a variety of forms from the often large and clumsy (but cheapest) stock mouthguard, to boil and bite guards which allow a better fit through softening and molding to the teeth, and finally to custom mouth guards fitted precisely to your unique bite by dentists. A custom mouth guard will offer the best fit and protection without inhibiting breathing or speech, but they do tend to be more expensive than other options. Regardless of cost, the most important features of a mouth guard are:

• Complete and durable protection for all your teeth
• A good fit which ensures the guard won't fall out if you get hit
• No interference with breathing or speaking
• Comfortable

Once you've chosen a mouth guard that works for you, you can extend its lifespan by rinsing it in cold water after each use, occasionally cleaning it with soap and water, storing the guard in a closed container filled with water, and carefully watching for any signs of tearing or damage. As soon as you identify damage on the guard, it's time to replace it to ensure the best protection of your teeth.

ORTHODONTICS (BRACES)

In the quest for the perfect smile, many people choose orthodontics or braces to correct their tooth alignment and bite. Though typically chosen for aesthetic reasons, braces can also help to treat or prevent impaired chewing, speech problems, abnormal facial muscle function and swallowing patterns, and susceptibility to cavities, all of which are associated with misaligned teeth and bite patterns.

Because orthodontics work gradually, you may have to wear them for several years. Your dentist may be able to fit you with clear or white braces rather than the traditional silver apparatus, but if you are choosing to wear braces, your dental hygiene become more important than ever. Braces leave lots of hard to reach places that can collect food and plaque, so it is best for orthodontics wearers to brush after every meal and make use of smaller interdental brushes to reach around and behind the wires and bands of the braces. Mouth rinses and special flossing tools can also help remove plaque and food debris. Additionally, wearers should avoid sticky or hard to chew foods that can not only stick in the teeth and lead to cavities, but which may also stick to and bend or break the wires of the braces.

Orthodontic appliances like braces can do a lot to improve your smile, but they also increase the risk of plaque and tartar build-up. If you are going to be wearing braces, especially over a long period of time, you will need to be extra diligent in your oral hygiene practices.

DENTURES

If you wear dentures, it is important that they fit well so that you can eat and talk comfortably and that they are kept clean to prevent gum damage, mouth odor, and irritation or infection. To maintain clean, comfortable, stain free teeth you should rinse the denture under water after every meal, brush the denture with water and denture paste (or a mildly abrasive toothpaste) at least before bed but ideally after every meal, and soak the denture daily in a denture solvent such as Efferdent or Polident.

When cleaning your denture it is important to work lightly with a soft brush to prevent scratching or breaking--never use sharp tools to scrape off deposits, take it to your dentist for cleaning instead. You may want to work over a sink filled with water and with a towel in the bottom to cushion the denture if it is dropped. While cleaning, it is also important to avoid hot water and to always submerge the appliance in cool water when it is out of your mouth. Both of these practices protect the fit of the denture.

Even maintaining the original fit of your denture, the shape of your jaw changes with age so you may end up with ill-fitting dentures no matter how well you care for them. In you are noticing problems chewing or speaking, redness and inflammation in your mouth, discomfort, cracks around the corners of your mouth or chronic cheek biting, it may be time to return to your dental professional and arrange a refitting.

While you are wearing dentures, you must also be sure to give your gums the care that they deserve. Dentures should be taken out overnight or left out of the mouth for 6-8 hours each day allowing your gums to breathe. Your gums will also require daily cleaning with a soft toothbrush or cloth to remove debris and stimulate blood flow. You can further massage your gums using your thumb and index finger to lightly press and stroke the ridge of the gum. Like your gums, any remaining natural teeth also require care. Brush and floss them regularly and thoroughly and you may be able to extend their lives significantly.

TOOTH BLEACHING

In our image obsessed society, it is easy to feel self-conscious about your teeth if they are stained or yellowed. These stains can be internal as a result of injury to the tooth or certain medications, or external as a result of food and drink or smoking habits. Internal stains are very difficult to remove and even bleaching may not get rid of them. External stains, however, are receptive to bleaching and can be removed and prevented by good oral hygiene habits.

In order to determine what sort of stains you are facing and whether or not profession or home bleaching is right for you, you may wish to visit your dentist or dental hygienist. Dental professionals can help you reach your whiteness goals without damaging your teeth or gums with careless or overzealous bleaching. If you decide to bleach at home, be sure to follow all instructions carefully and contact your dental professional if you experience any lasting or severe side-effects.

SMOKING AND ORAL HEALTH

Smoking and other tobacco use is not only damaging to your lungs, but also causes a diversity of oral health concerns. Some of the potential problems are:

• Tar deposits and staining of teeth
• Inflamed roof of mouth and palate
• Delayed gum healing
• Increased gum disease
• Bad breath
• Black hairy tongue
• Oral lesions
• Gum recession
• Oral cancer

The most severe of these effects is oral cancer which in 75% of cases is directly associated with tobacco and alcohol use. Your risk of all of these symptoms can however be reduced by tobacco use cessation. Even after years of smoking, within 10 years of not smoking, oral cancer risks return to normal levels. There are many stop-smoking aids available from nicotine gum and patches to support groups and aversion therapy. If you are ready to stop using nicotine, a dental or health professional can help you choose an effective way to quit.

ORAL CANCER

Like skin cancer, if oral cancers are caught early, they can often be removed with limited damage to your overall health. Because your dentist can't check your mouth everyday, you may want to begin performing self-checks. Be aware of the appearance and feel of your oral cavity and be particularly conscious or any swellings, lumps, or growths in the mouth or neck, discolored patches in the mouth, repeated bleeding from the mouth or throat, and any difficulty in chewing or swallowing. If you have any concerning signs or any sore that doesn't heal within two weeks, you should visit your dentist or physician to have the sore or growth checked and biopsied as needed.

To perform a full oral cancer self check you will need to:

• Examine your head and neck visually looking for any sores, moles, discoloration, or asymmetry
• Press the skin along your neck feeling for any tenderness or bumps
• Visually examine the inside of your lips for discoloration or sores
• Run your thumb and forefinger along your lips pressing and feeling for any lumps or tenderness
• Visually examine the inside of your cheek, pulling it outwards with your fingers
• Press and feel along the cheek for any bumps
• Tilt your head back with a wide open mouth and look for any lumps or sores on the roof of your mouth
• Stick out your tongue and visually examine all surfaces of the tongue for sores or discoloration
• Press and feel along the underside of the tongue for bumps or swelling.

If you have any concerns it is always better to see a health professional and have it checked.

GET STARTED WITH HEALTHY TEETH AND GUMS

A healthy mouth is vital for comfortable eating and speaking, and for maintaining good self-esteem. Though there are many potential oral health concerns, most of them can be prevented or managed by good consistent oral hygiene practices such as twice-daily brushing with fluoride toothpaste and regular flossing. Dental professionals can treat oral health issues and can help you set up good oral health habits, but ultimately prevention starts with you making good choices in food and drink consumption and dental care.

REFERENCES

Lavigne, G.J., Khoury, S., Abe, S., Yamaguchi, Y., Raphael, K. (2008). Bruxism physiology and pahtology: An overview for clinicians. Journal of Oral Rehabilitation, 35, 476-494.