PAINFUL SORES IN THE MOUTH

Sores in the mouth that last more than three weeks without healing should be evaluated by a dentist or oral surgeon.  Period.  Most non-cancerous sores should heal within a three-week time frame.  There are two main groups of painful ulcerous lesions that form in the mouth.  The first type is known as canker sores or recurrent aphthous ulcers.  They are small whitish oblong sores.  The second is cold sores or herpes simplex (type 1).  These are viral lesions that are painful fluid-filled blisters and are extremely contagious.  Both sores form ulcerous lesions that can be found at a single location or in groups.  The differentiating factor is where the lesion is located.  Canker sores form in the soft tissues not supported by underlying bone, such as the tongue, cheek and vestibule of the mouth.  Cold sores typically form on tissue over bone such as the roof of your mouth and the gum tissue up to a half inch below where your teeth enter the gums.  However, they can also be found around the surrounding  lip surfaces.

Now let's look at how these two uniquely different sores are treated.  Cold sores are viral lesions and can be treated with both topical and systemic corticosteriods.  Since they are contagious, it is prudent that the lesions are treated in a timely fashion and are not able to spread.  Both physicians or dentists can diagnose and prescribe this medication.  Canker sores, on the other hand, are treated using over the counter medications.  Examples of these products are:  Kanca, Orabase B, Vitamin B12 and Anbesol.  Although these medications will not expedite the healing of the lesions, they will numb them and make it more comfortable to eat and talk.

I STILL HAVE MY BABY TOOTH AS AN ADULT

I bet you didn't know that five percent of adults are congenitally missing one or more permanent teeth.  So this condition is not as rare as one might think.  In my practice it is very prevalent; I see it all the time.  The causes of this phenomenon vary; however, there is a strong genetic predisposition to congenitally missing teeth.  I see patterns of this condition from parents to children and on down to their grandparents.

In most cases the baby tooth can stay anchored in your jaw decades longer than it was designed for.  I have patients in their sixties and seventies that still have functioning baby teeth!!!  Many individuals, however, lose their baby teeth as an adult much earlier in their lives.  This is due to poor hygiene practices.  Poor hygiene soon leads to large fillings in these teeth and they soon disintegrate or become loose.  The bottom line:  REMEMBER TO BRUSH AND FLOSS THIS TOOTH faithfully, as the enamel in a baby tooth is thinner and weaker than that of a permanent tooth.

If you do lose your primary tooth it is usually replaced with a dental implant and crown or a bridge, which is permanently anchored to the two teeth adjacent to the lost primary tooth space.

ADULT BRACES WITH CROWNS

Many adults believe they're not candidates for braces because they have crowned teeth in their mouth.  This simply isn't so anymore.  Conventional braces, that is, braces with brackets and archwires bonded onto natural teeth enamel, can now be bonded to porcelain surfaces.  Therefore, crowned teeth can move and straighten just as predictably as natural teeth.  There is an alternative method to straighten teeth that doesn't involve wires or bonding brackets to teeth.   This revolutionary method is known as Invisalign, which utilizes a series of crystal clear, comfortable and virtually invisible retainers or aligners.  You wear each retainer for two weeks while it gently moves each tooth into position and then replace it with the next sequential aligner until the teeth are straight.  No bonding brackets to teeth are needed!

Don't let your crowns stop you from having the beautiful smile of your dreams.  It's never too late for a beautiful smile.  The advances in cosmetic dentistry are truly amazing!!!

TEETH GRINDING IN ADULTS

I deal with this problem almost every day with patients.  When you wake up with a stiff, tired, achy jaw that gets better as the day goes on, you most likely are grinding your teeth during the night. Grinding at night, also known as bruxism, is a habit of tightly squeezing your top and bottom teeth together while at the same time sliding them back and forth over each other.  Clenching, on the other hand, is when you squeeze your teeth tightly together only, without sliding them back and forth on each other.  Bruxism can happen at any age to children or adults.  Many children do this at an early age but outgrow the habit.  Fortunately, when they do grind it is on their primary or baby teeth which will be lost anyway,

People who suffer from bruxism may have the following symptoms:  (1)  Facial pain.  Grinding your teeth back and forth under high pressure will cause the muscles in your jaw and neck to contract and release 75% more than in normal use.  This lends to lactic acid building up in your muscles, resulting in spasm.  (2)  Worn, broken and cracked teeth and fillings.  Studies show that the pressure on your teeth during grinding is five times higher than the pressure from normal chewing.  This extra force is pulverizing your teeth.  Studies indicate that those who grind their teeth experience up to 80 times the normal wear per day compared with those who don't.  (3)  Loose teeth.  If left untreated, this powerful force of rocking your teeth back and forth will loosen your teeth in the jaw.  (4)  Headaches and/or earaches from spasming muscles.  (5)  Cold sensitivity and/or sore teeth when chewing.  The first symptom of an injured or inflamed nerve inside a tooth is cold sensitivity.  This will be resolved if the forces on teeth are eliminated.

So what causes bruxism?  Why do some individuals grind and others don't?  One of the major causes of bruxism is stress.  Bruxism can be a neuro-muscular reaction to stress.  We don't know the full process, but if you go to bed with undue stress, there is a good chance you will grind your teeth for a portion of the night.  Studies indicate it is during the deep REM part of your sleeping pattern that bruxism occurs.  Abnormal biting, where teeth don't close correctly, can also lead to bruxism, as the body will try and grind the teeth down until it feels proper.

Bruxism is primarily treated with an acrylic nightguard that is worn while you sleep.  This nightguard slips over either the upper or lower teeth, preventing the teeth from touching.  It protects teeth and prevents them from wearing down.  When a dentist fabricates this nightguard, he or she will adjust it so all teeth slide evenly over each other like a skating rink.  The once tense muscles will begin to relax and muscle fatigue will be eliminated.

ENAMEL LOSS

What the heck is enamel, anyways?  Enamel is the thin, translucent, hard outer layer of the teeth that protects them from the daily stress of chewing, biting and grinding; temperature of hot and cold foods and drinks; and erosive acids.  Despite being the strongest material in your body, a variety of factors can cause enamel erosion or loss of enamel.  Loss of enamel increases teeth sensitivity, exposes stains on teeth, increases vulnerability to cavities and decay, and creates rough and irregular teeth edges and dents on teeth surfaces.

Enamel loss is primarily caused by erosive acids that wear away enamel over time.  Excessive consumption of soft drinks, which contain high amounts of phosphoric and citric acids, and other acidic drinks and foods such as fruit drinks and sour foods or candies, is the leading cause of acid-related enamel loss.  Coke, for example, contains citric and phosphoric acids.  Frequent consumption of medicines and supplements containing high acid content, including aspirin, antihistamines and vitamin C supplements also cause enamel loss.

Environmental factors in the mouth, or the physical wear and tear from daily friction and stress on the teeth, are another contributing factor of enamel loss.  Environmental causes of enamel loss include friction from clenching or grinding your teeth, especially during sleep, and wear and tear from brushing your teeth too hard, improper flossing, biting hard objects or chewing tobacco.

Low saliva production is also another cause of enamel loss.  Saliva strengthens both your teeth and their enamel by coating them with calcium and other strengthening minerals.  Saliva also protects against enamel loss by diluting and washing away erosive acids and other wastes left over from foods and drinks and also by producing substances that fight against mouth bacteria and disease that can cause enamel loss.  While a healthy amount of saliva production can protect enamel from erosive effects of acidic foods and drinks, excessive consumption of acidic foods and drinks decreases saliva production and saliva's ability to strengthen teeth and enamel.  Excessive plaque can also contribute to enamel loss, so regular brushing, flossing, dental checkups and cleanings are essential!!!  Toothpastes with fluoride in them can strengthen and remineralize slight to moderate enamel breakdown; a great way to protect your enamel!

HELP, MY TONGUE IS BURNING!!!

This painful condition is called burning mouth.  This is a painful sensation felt in almost all the areas of the tongue.  Usually the burning sensation worsens as the day progresses.  Some of my patients experience a tingling or numb sensation in their mouth or on the tip of the tongue.  Some experience dry mouth, increased thirst, a general soreness in the mouth and a bitter or metallic taste in the mouth.  Other names are scalded mouth syndrome, burning tongue syndrome, burning lips syndrome, glossodynia and stomatodynia.  Burning tongue basically affects the tongue, gums, lips, inside of the cheeks, roof of the mouth and other areas of the mouth.  Sometimes people affected with burning tongue lose their sense of taste temporarily.  Some causes of burning tongue are:  hormonal abnormalities, diabetes, menopause, medications, tobacco use, and the list goes on and on.

Now the most important part of this week's subject.  What should people do who are experiencing this very bothersome syndrome?  Unfortunately, there's no one sure way to treat burning mouth syndrome.  Good solid research on how to treat it is lacking.  Your treatment depends solely on your individual symptoms.  We also need to take into consideration any underlying conditions that may be causing your discomfort.

Obviously, replacing poorly fitting dentures or correcting a vitamin deficiency may help.  If you are lucky enough to pinpoint the cause and can get it treated, your burning mouth syndrome symptoms should improve.

If your cause can't be found, treatment can be extremely challenging.  Unfortunately, there's no known cure for the syndrome.  So, like many medical conditions, practitioners are left with controlling the symptoms.  Treatment options could include:  saliva replacement products, medications that block nerve pain, certain antidepressants, cognitive behavioral therapy, specific oral rinses or lidocaine, capsaicin (a pain reliever made from chili peppers).

DENTURE AND PARTIAL UPGRADES

Over a period of time, your denture will need to be relined or rebased.  I will discuss these procedures below.  In general, a full denture (which replaces all your teeth) or partial (which hooks onto at least a couple remaining teeth) will remain functional for a period of approximately seven to ten years.  At that time, they should be evaluated for possible replacement.

Let's take a look at why dentures and partials loosen with time,.  First, when teeth are lost, jawbone starts to melt away or atrophy, leaving a gap or space under your partial or denture.  When the jawbone is no longer directly stimulated by the chewing pressure a tooth provides to the bone, the bone, as a result, atrophies.  As the bone atrophies, the space under your denture and partial cause it to shift and become loose.  Extra food will also pack into this newly created space.

As long as the space isn't too large, it can be filled in with new acrylic (a process called a reline).  When the space gets excessive a denture may need rebasing.  Rebasing means making a new plastic base while keeping the existing denture teeth.   On the other hand, when the denture teeth become worn, a new denture or partial should be made.

As a side note, I highly recommend people with full dentures have an oral cancer evaluation once a year.  Sores, irritations and new found red or white lesions under dentures that don't heal should be evaluated by a dentist.