Toothfully Blog

I have many patients (many are teachers!) who grind or clench their teeth at night and complain of jaw pain and muscle soreness in the morning. Well, recently I have been having symptoms myself with clenching. My jaws have been popping on opening wide, and sometimes my facial muscles are so tight I can't open wide to bite a sandwich. You'd think I'd know how to treat myself right? Sad to say, I didn't wear my night guard regularly and the pain continued. When you clench your teeth in your sleep, apparently you can generate 300 lbs of force on them. With a night guard, you are still clenching, but it's not teeth-on-teeth, and the force is not as strong (maybe 100 lbs). The grinding & clenching can also wear down your teeth over time, possibly breaking/ chipping them in the future. The most helpful treatment for me was massaging the TMJs for a few minutes each day, and wearing the night guard every night. Now there's new treatment modality on the horizon- Botox injection directly in the clenching muscles. The thinking is that the Botox will stop the contraction of the muscles, hence no clenching. And it'll make you look younger! Joking aside, this treatment is still in its infancy, and there's not enough data to support it yet. I imagine it's costly and needs to be repeated every few months. Will it make you less efficient at eating since your chewing/ clenching muscles will be contracting less? Stay tuned to find out.  More info here.

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New studies have found another link of gum disease to a systemic disease- this time it's dementia. Chronic periodontitis (inflammation of the gums from bacterial infection) has been linked to increased risk of dementia and Alzheimer's. A study in South Korea of 50,000+ people found that those who received a diagnosis of chronic periodontitis have a 6% higher risk of developing dementia than those who didn't have gum disease. The findings doesn't prove periodontitis cause dementia, only that they are linked. A possible explanation is that chronic gum inflammation can promote systemic inflammation, especially in the brain tissue. Or possibly the oral bacteria can pass through the blood-brain area to cause damage to the brain itself. Those dangerous oral bacteria can sure wreck havoc on all parts of your body- heart, brain, fetus (mothers with gum disease are at risk for low term weight babies). Everyone, brush and floss your teeth!  More info here.

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Sores in the Mouth

I get a fair number of patients complaining of sores in their mouth, so here's a list of some common lesions found intra-orally.

Canker Sores

Also known as apthous ulcers, these are probably the most common ones seen. They appear as small, flat sores inside the mouth such as the palate, the inside cheek area and by the gums. Unlike cold sores, they don't appear by the lips' outside region and are not contagious. They tend to be round or oval, white or light yellow center, with a red border. They can be quite painful, and usually go away after a few days to a couple of weeks.

Causes can include food irritation (hot pizza, sharp tortilla chips), trauma (cheek biting or dental work), toothpastes and mouthrinses containing sodium lauryl sulfate (SLS), reactions to foods (spicy food, coffee, chocolate (that's a bummer!)), and stress. 

Anyone can get canker sores, but they occur more commonly in teens and young adults, and more in females. For those who get them repeatedly, it could be hereditary- check your family history.

There's no definitive treatment for canker sores. You can rinse with warm salt water to promote healing of the tissue. Some people like using Orajel, which is a numbing gel that numbs the pain for 15 minutes. I've read an article that claims eating yogurt daily decreases the recurrence thanks to the help of the good bacteria (probiotics). Watch what you eat (avoid spicy, salty and acidic foods), and try to reduce your stress.

Cold Sores

Also known as fever blisters, they are common viral infections. They occur around the outer lips in small clusters that blister and crust, then heal without a scar after a couple of weeks. Cold sores are contagious, and are caused by a herpes virus (HSV-1). You may feel a tingling or itching around your lips before the sores appear,

Cold sores are most contagious when when oozing blisters are present, so don't share utensils, food or drinks. Once you've had an episode, it can be re-triggered in the same area by sun exposure, fever, stress, and hormonal changes.

You can use Abreva cream (buy over the counter) to help speed up healing of the sores, or use anti-viral medicine like Zovira and Valtrex (both prescription) to help shorten the course of the sores, most effective when taken within the first 48 hours of the outbreak.

Leukoplakia

Leukoplakia are thickened white patches that cannot be rubbed off that appears on the gums, the inside of the cheek, the floor of the mouth and sometimes the tongue. It is caused by irritation from tobacco- smoked or chewed. It can also be caused by irritation from rough edges like broken teeth, ill-fitting dentures or partials. These lesions go away once the offending factors are fixed or tobacco use is stopped.

Most leukoplakia are harmless (non-cancerous), though lesions at the floor of the mouth may be associated with the beginning of cancer (those usually needs biopsy to confirm). White lesions with red patch inside may also indicate pre-cancer. Let me know if you have lesions in the mouth that haven't resolved after 2 weeks, or are getting bigger.

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I'm sure you are well aware of the correlation between gum disease and systematic health problems such as heart disease. One theory is that the bacteria from gum inflammation enter the blood vessels and attach to fatty deposits, causing blood clots and stroke or heart attacks. Now there is more correlation linking gum disease to diabetes and kidney disease and obesity. Those with diabetes and kidney disease tend to be immuno-compromised and have dry mouths. Dry mouth can lead to more plaque & tartar buildup on teeth, and therefore more gingival inflammation. Those with obesity have more inflammatory factors released by the fat cells, which means the body is in constant low grade inflammation, which can lead to progression of gum disease, diabetes and heart disease. More research are showing at the cellular level the inflammation factors can add up and wreak havoc on your body. It's a circular pattern that link all these conditions and factors. This is why we emphasize regular cleanings, good hygiene- not just to preserve your teeth for the rest of your life, but also to maintain a healthy body. For more info about obesity and perio disease, click here.

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There's a great new development in dental numbing, a least favorite part of dental procedures. Most patients do not enjoy the needle injection. Now there is a new kind of anesthesia administered via intra-nasal spray, similar to flu vaccine done by nose spray. This method only works for the 10 upper front teeth, and doesn't apply for lower teeth needing work. A syringe of the anesthetic is sprayed into the nostril two times, with waiting time of 10-15 minutes for the anesthetic to become fully effective. It is indicated for adults and children weighing 90 lbs or more. I am sure they'll come out with lower dosage for younger children soon. It is not recommended for patients with uncontrolled hypertension or thyroid disease, or those taking tricyclic antidepressants. As usual, there are pros and cons with any medicine, but this looks to be a promising new modality of treatment that many will welcome. For more info click here.

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