Search for tag: "dentistry"

Interviewer: Gum disease. The other dental disease you should be concerned about especially if you're an adult. We'll talk about that next, on The Scope.

Announcer: Health tips, medical news, research and more for a happier, healthier life. From the University of Utah Health Sciences, this is The Scope.

Interviewer: Dr. David Okano is a periodontist with 30 years of experience and currently an assistant professor at the University of Utah School of Dentistry. And it seems like when you talk about teeth the big star is cavities. You've got be careful and watch out and do all the prevention for cavities. But gum disease can be devastating, especially if you're an adult.

Dr. Okano: Gum disease is another dental disease that is really of concern. In fact, is considered to be the seventh most common disease in the world, even bypassing diabetes. Gum disease is a problem in which the bone support, the roots of your teeth become affected. And you lose bone support. Ultimately that could lead to loose teeth. And eventually tooth loss.

Interviewer: And how prevalent is it?

Dr. Okano: Well a recent study from the NIH indicated that nearly 50% of adults will have some amount of bone loss. So anywhere from 70 to 90% of adults would likely have a form of gum disease.

Interviewer: So it's you and me in this room right now. That means that likely.

Dr. Okano: Yes.

Interviewer: Do you have gum disease?

Dr. Okano: Yes, I do.

Interviewer: Okay. Maybe I'm lucky then.

Dr. Okano: Okay.

Interviewer: Maybe I'm the one that doesn't.

Dr. Okano: One of the problems of gum disease is there aren't a lot of symptoms that would give you a clue that anything is developing. My problem with gum disease is receding gums. That's a classic symptom of gum disease. And it's not just brushing your gums too hard with your toothbrush. It could be a symptom of an underlying bone loss problem that could lead to major concerns in your adult life.

Interviewer: So when you talk about gum disease. I hear gum disease and then I hear bone loss which kind of confuses me a little bit. Does that confuse most people?

Dr. Okano: Sure. Gum disease is somewhat of a generic term to indicate that your gums are affected and the support of your teeth is. Bone loss is the real problem because there are different forms of gum disease. Some can be as simple as receding gums from possibly brushing your gums too hard to significant infections that are destroying the bone support and causing you to lose teeth. More cases of tooth loss after the age of 35 are due to loss of bone with gum disease than due to tooth decay.

Interviewer: So I can understand how my gums can be receding and lead to the bone loss. What are some other ways that that bone loss can occur and is there anything that I do about it?

Dr. Okano: Sure. The most important thing you can do to prevent or minimize considerations of gum disease is to practice good oral hygiene. That means brushing your teeth at least twice a day and flossing on a daily basis. In terms of treating and preventing gum disease, flossing is probably more important than tooth brushing.

Interviewer: And how often should I be flossing? I'm sure that's a question you get a lot.

Dr. Okano: That's a great question. And you're not alone. You should floss on a daily basis.

Interviewer: All right.

Dr. Okano: What are the realities? Less than a quarter of the population flosses on a daily basis.

Interviewer: Yeah. And what is that doing to prevent the bone loss?

Dr. Okano: What brushing and flossing will do is the oral hygiene techniques will remove the bacterial plaque. Basically, gum disease is an infection your gums that responds to the germs in your mouth. We all can associate sugar intake to tooth decay. But sugar may not have anything to do with gum disease. It all has to do with germs in your mouth that will collect below the gum line and create an inflammatory response that will eventually erodes away the bone.

Interviewer: You have me terrified. I mean other than brushing and flossing is there anything I should be doing?

Dr. Okano: It would be real important to see your dental office. See them for regular preventive cleanings. Have them evaluate. There is a very specific periodontal examination to check for gum disease to see if you in fact have it. And what can be done about it.

Interviewer: Is that something my regular dentist could do? Or do I need to see a periodontist?

Dr. Okano: Well, your general dentist can most certainly help with the initial diagnosis, perhaps even the initial treatment. Your dental hygienist is a key person to help you with the recognition of gum disease and the treatment.

Interviewer: And they would inform me if I did indeed have indications of that?

Dr. Okano: They would. Be certain to ask them if you do in fact have some gum disease because it really is a silent disease in the early stages of development.

Interviewer: Is there anything that we left out? Anything you feel compelled to say?

Dr. Okano: Well it's such a rampant problem that it wouldn't be unusual for an average adult to have some form of gum disease. One of the cardinal signs would be bleeding gums. Many people think that "I just brush my gums too hard and they bled." No. That could in fact be a symptom of a developing gum disease problem.

Interviewer: Is that the main symptom?

Dr. Okano: That would be one of the very early symptoms and easily recognizable. So if your gums bleed, have it checked out with your dental professional.

Interviewer: And it is something that can be fixed?

Dr. Okano: It can be treated. And what we're trying to do with periodontal disease is to try to control it. It is a chronic inflammatory disease. It's treated much like diabetes. In terms of we control it. We don't cure diabetes, we don't cure blood pressure, arthritis. But we can control those long chronic inflammatory diseases quite well. So it can be controlled. And if it can be controlled with enough bone levels remaining, you should be able to have a healthy set of teeth for the rest of your life.

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Interviewer: Fluoride in your drinking water. Is it bad? We're going to find out the real deal next on The Scope.

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Interviewer: There are some people that say fluoride is bad for us as humans and it shouldn't be in our toothpaste or in our water. Now, the thing that I struggle with, is that if it was really that dangerous, why would we still be doing it? And I wanted to find out from an expert. Dr. David Okano is a periodontist with 30 years of experience and is currently an assistant professor at University of Utah School of Dentistry. So help me sort through this. Have you had to have this conversation with a patient that is very concerned about the fluoride in the water or their toothpaste and being poison the body?

Dr. Okano: That's a question that all dentists are asked about on a regular basis, dental hygienists also. We've known for over 50 years that fluoride has a very beneficial effect to the developing tooth and the areas that had naturally-occurring fluoride were areas where it was found that they had very strong teeth, very few cavities, very few fillings were necessary in those areas. And as a result of those regions having naturally-occurring fluoride, teeth were very strong. It was found that by adding fluoride into the municipal water supply, that the developing tooth in children, in the child, could then benefit by becoming stronger and much less susceptible to tooth decay.

Interviewer: So there's research that shows this?

Dr. Okano: Absolutely. At a very small amount, the fluoride is very beneficial. And that's when you get your best benefit from fluoride in water is if you're a child with a developing tooth that will become strong for the rest of their adult life.

Interviewer: Okay. So when you go on the Internet and you do some research on fluoride in water and you find those there are those that are against it, they say that it is poisonous, they point to the back of the toothpaste tube and it says don't swallow because there is fluoride. They point to a study from the Harvard School of Public Health that talks about how it can cause a reduction in IQ points. Help me sort through . . . that doesn't feel right. Help me sort through what's going on here.

Dr. Okano: You're correct. "That doesn't feel right," is a good way to say that. The studies have indicated a lot of bias in many instances. The sample sizes have been of concern. Really, the locations where these studies have been conducted we really can't relate to the American system. So the fluorides we have known at a very low concentration . . . in fact, the American dental association has reduced the amount of concentration that's recommended in drinking water for fluoride. Too much of anything is not good.

We have chlorine added to the municipal water supply already. Too much chlorine there can be a real problem, and has been in some cases, but there are a lot of safeguards in the water systems to prevent excessive amounts of fluoride from accidentally being placed into your water supply.

Interviewer: From what I understand, that's what a lot of these studies are talking about, are locations where it was a large amount, beyond what was safe.

Dr. Okano: That is correct.

Interviewer: And we have a very good idea, based on research, what is safe.

Dr. Okano: Yes, very much so. We have 50 years of data showing the benefits of fluoride. And if you look at the children, especially in communities that do not have fluoride, and the challenges they have with tooth decay, and the concerns they develop because of their fears of dentistry, and you look at other children who do not have decay and what great experiences they have in the dental setting, it's remarkable what the benefit of fluoride has been for those 50 years.

Interviewer: And I think a lot of times when you look at a lot of things in life, it's risk-benefit. It's that risk-benefit balance.

Dr. Okano: Absolutely. The benefits are substantial for having fluoride in your water supply. My daughter is a Ph.D. candidate in public health and she has mentioned to me that fluoridation in water has been one of the top five community health benefits in public health, the first being indoor plumbing, the second being antibiotics for infectious disease, and I believe she told me fluoride in the water supply was the number three best benefit that has ever been done for public health.

Interviewer: That's pretty good for fluoride. That's quite a list, indoor plumbing and antibiotics, right, and fluoride is number three. In good company. So if you've had conversations with patients before that have raised concerns, generally, after they have the talk that we just had, does it kind of alleviate those?

Dr. Okano: Generally speaking, it does. They recognize the fluoride that's been placed into the municipal water supply or the fluoride in your toothpaste is of such low concentration that it's not dangerous and the benefits are great. Nonetheless, there are some folks who do not believe in it and they are skeptics for the rest of their lives. But we can't convince those folks. But for the masses, where so many people have benefited, people understand the benefits of fluoride to their dental health.

Interviewer: And I think the interesting thing that you said is that it's a naturally-occurring element or chemical in a lot of water and it hasn't affected us. It's just those high concentrations that, really, you've got to watch out for.

Dr. Okano: That is correct.

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updated: December 7, 2018
originally published: July 13, 2016

Interviewer: You have a sensitive tooth. What could it be? Well, we're going to try to narrow that down for you next on The Scope.

Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Dr. David Okano is an assistant professor at the University of Utah School of Dentistry and it's probably a common thing that people come to dentists for. "I've got a sensitive tooth, what could it be?" And I understand it could be a lot of things.

Dr. Okano: It most certainly could, Scott. The sensitive tooth indicates that the nerve inside your tooth is responding to some type of stimulus on the surface. That could be either a cold sensitivity, could be hot sensitivity, could be sweet sensitivity.

Interviewer: And do those different sensitivities mean different problems?

Dr. Okano: They absolutely would.

Interviewer: Oh, okay.

Dr. Okano: Correct. Cold sensitivity is not unusual. People will have receding gums, which causes the root to become exposed. The enamel, which is the crown, does not have nerves on the surface, but the root, basically, does have some sensitivity on the surface. So when your root becomes exposed, for example, through recession, it could be cold sensitive.

Interviewer: Okay. And then what about a sweet sensitive?

Dr. Okano: Same thing, it could be sweet sensitivity on an exposed root surface. But it could also be the beginning stages of a tooth decay problem. In other words, a cavity.

Interviewer: Okay. And then what about the hot sensitivity?

Dr. Okano: Hot sensitivity is a little bit more of a concern. Hot sensitivity could indicate the nerve inside the tooth is starting to go bad, that one of the symptoms of a nerve before it ultimately dies and becomes an abscessed tooth is it goes through a period of hypersensitivity of which hot sensitivity is usually not a good sign. Particularly if it lingers.

Interviewer: But generally, cold or sweet wouldn't bother that particular problem?

Dr. Okano: They both could.

Interviewer: Okay. But . . .

Dr. Okano: Depending on . . .

Interviewer: But if it's something hot, then, really, you need to see a dentist.

Dr. Okano: Yes, actually, for any of the sensitivities, I'd recommend that you see a dentist because cold could be something very early in development. Cold, sweet, and hot could be something very late in the development that would perhaps require root canal treatment.

Interviewer: Okay. What are some other causes of tooth sensitivity?

Dr. Okano: Toothpastes, believe it or not.

Interviewer: Oh, okay.

Dr. Okano: Some of these sensitivity toothpastes are great for treating sensitive teeth, but we also know that toothpastes that are formulated for whitening can be abrasive. Smokers' toothpastes are very abrasive. That's how they remove stains, but it can also cause some sensitivity on exposed root surfaces.

Interviewer: All right. In that case, probably discontinue use, I'd imagine.

Dr. Okano: That would be the best recommendation and, again, see your dentist for further follow-up to see if it indicates something a little bit more serious.

Interviewer: So for any of these sensitivities, it could affect just one tooth or is it going to affect all the teeth?

Dr. Okano: It could do either of what you just mentioned. For example, an area of gum recession with an exposed root surface, it may be localized to that tooth. On the other hand, you could have generalized periodontal disease with a lot of bone loss with a lot of gum recession, which would be the symptom of that generalized bone loss and you could have sensitivity throughout the mouth.

Interviewer: Gotcha. Are there other causes of sensitivity? You've given us some of the first ones you'd look at.

Dr. Okano: Sure. The sensitivity we've just been describing relates to exposed root surfaces. You could also have some sore gums that could be a discomfort to the mouth. And sore gums could certainly be related to periodontal disease, another type of dental disease besides tooth decay.

Interviewer: Is there anything else we need to know about this topic or have we covered it?

Dr. Okano: Well, the lack of symptoms doesn't mean everything is okay. So certainly, see your dentist for preventive treatments and regular examinations to be sure your teeth and gums are healthy. But at the first sign of a symptom, I would certainly share that with your dentist at the next appointment.

Interviewer: All right. Sounds good. How far, usually, after you start noticing symptoms has the disease, or whatever the issue might be, progressed?

Dr. Okano: That can be highly variable. It could be a very early stage consideration with dental problems that would cause symptoms. On the other hand, with some of the dental diseases, you may not have a lot of symptoms until it is very advanced and sometimes even too late, where nothing can be done. So the severity of symptoms can be really variable as it relates to the severity of the underlying dental problem.

Interviewer: So if I'm hearing you correctly, if somebody has any sort of tooth or gum or any sort of sensitivity, odds are it's not going to go away.

Dr. Okano: That is correct.

Interviewer: Yeah, and you should go see a dentist right away to prevent further damage.

Dr. Okano: Especially in the early stages. The dental problems, quite often, will not manifest themselves to you as a patient until they're very advanced and sometimes that could even be too late to do any dental treatment. And there's a possibility you could lose the tooth even though you did not have symptoms.

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Dr. Jones: There are some conditions that are more common in women, medical problems that can lead to problems with oral health. Today we're going to talk about eating behaviors and eating disorders and oral health in women on The Scope.

Announcer: Covering all aspects of women's health. This is the Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Well, I have a disclosure here on The Scope. My mother's pregnancy with me was diagnosed by a dentist. My mother was a dental hygienist, had perfect oral health, she brushed and flossed, and her teeth got all puffy and they bled. The dentist that she went to see said, "Oh, madam. I think it's not me that you should be seeing, but my partner down the hall who's the obstetrician." She didn't even know she was pregnant.

There are conditions more common in women in pregnancy, and today we're talking about eating disorders, which are more common in women that can change oral health. In the studio today, we have Dr. Lea Erickson, who's the Associate Dean for Student Life at our dental school. She has been an expert on the consequences of eating disorders in primarily women because women have more eating disorders than men, and their oral health. Welcome to the studio, Dr. Erickson.

Dr. Erickson: Thank you for the invitation.

Dr. Jones: So let's talk a little bit about eating disorders in women. I think of eating disorders in two forms, which are sometimes combined. There's anorexia where people just don't eat, and then there's bulimia where women make themselves throw up, and sometimes women have both. Can you talk about anorexia and oral health?

Dr. Erickson: So there aren't really any clearly defined links between oral health and anorexia in the absence of bulimia. It's logical to assume that the lack of adequate intake is going to have an impact on the quality . . . I mean, we know it has an impact on the quality of the bone and certainly it's reasonable to assume that it has an impact on the quality of the bone that's supporting the teeth. There's really no long-term evidence showing that.

Dr. Jones: But sometimes women, when they have an eating disorder, eat certain kinds of foods exclusively. So they'll eat more sour things or they may choose to drink more sodas that are sugar-free and not so much other things. Are there any kinds of foods that might be habitually used in people who are trying to decrease their calories that might be bad for your mouth?

Dr. Erickson: So all of the sugar-free sodas, all the diet sodas, really any fruit that's highly acidic, vegetables that are acidic are going to dissolve tooth structure. So potentially, those who have such a limited diet that their diet coke all day long, diet soda all day long are probably dissolving tooth structure.

Dr. Jones: Right. Well, in women with eating disorders, bulimia or forced vomiting is actually often associated with anorexia, and there are people who don't lose a lot of weight but have bulimia alone. Let's talk about forced vomiting and how that might affect oral health.

Dr. Erickson: The acid in the stomach that they're vomiting is constantly bathing the teeth and will dissolve the enamel and ultimately the dentin. So the teeth will become thinner and thinner from usually on the pallet side and these eventually dissolve away.

Dr. Jones: The pallet side, meaning on the inside where the tongue is . . .

Dr. Erickson: Correct.

Dr. Jones: . . . or sort of like that. Well, how about the way people make themselves throw up? Some women can just make themselves throw up by thinking about it. But quite often, young women are sticking their fingers down their throat. Does that affect their oral health?

Dr. Erickson: Sticking the fingers down the throat probably doesn't affect the oral health, although there can be some scarring on the pallet from it. Very often there's scarring on the fingers where the teeth are impacting them.

Dr. Jones: Oh, okay. Well, the other thing is that women who have bulimia are not often forthcoming about their problem. They're addicted to their vomiting. They realize that they have a problem. But they're often not telling either their parents, their family, their friends and certainly not their dentist. What might be the first sign that someone might have this problem?

Dr. Erickson: Very often, the dentist is going to be the first one to see evidence of this and it will be the thinning of the teeth. Usually the upper front teeth on the inside, they'll become thinner. The enamel will dissolve away. The teeth will become shortened. So really, the dentist can play an important role in identifying the problem.

Dr. Jones: I think the issue for women who are suffering with bulimia is recognizing that this is a disease. There are medical interventions that can help, as well as psychological interventions, and there are consequences whether or not it has to do with weight loss or whether women are just vomiting to try to maintain their weight. But there are significant consequences to their health and their oral health.

Dr. Erickson: The consequences can be phenomenal. I saw cases where the teeth were literally dissolved almost to the gum line.

Dr. Jones: Oh, no.

Dr. Erickson: So a disease that started with a teenager who wanted to be a cheerleader and so she started vomiting in an attempt to control her weight, and as you mentioned it is an addiction and continued until literally the teeth were short and black in the front. So devastating effects.

Dr. Jones: It's devastating, particularly for a young woman whose self-image was already in jeopardy leading to the efforts to maintain her weight and becoming bulimic, and now having a lifelong teeth presentation problem.

Dr. Erickson: Yeah. Then, she really does have a lifelong dental disability as a result of the bulimia.

Dr. Jones: When we're talking about bulimics, I think about something that starts young as kind of a fad. Girls do it together. You're talking about long-term effects on the teeth. Is this something that you might see if a young woman goes through kind of a fad stage where she's bulimic for maybe six months or a year? Or is this something, the kinds of changes that you've described, do they take a really long time?

Dr. Erickson: We're not going to see this, usually, until somebody's been vomiting, usually multiple times a day for a significant period of time.

Dr. Jones: Does that mean a year? Or how long is a significant period of time?

Dr. Erickson: The patients that I saw that had a substantial amount of damage had, most of them, been vomiting four or five times a day for seven to 10 years.

Dr. Jones: Right. Being honest and helping your clinician take the best care of you and your dentist take the best care of you is going to help you, if you suffer from these issues, when you finally recover, have the mouth that you want when this is all over.

Dr. Erickson: And certainly, talking with your dentist frankly and asking your dentist to help you find the resources to get the help that you need.

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Dr. Jones: Dry Mouth. Well, I have this problem and it makes me drink more and it's worse at night, so then I have to get up and go to the bathroom more.

What is this all about? This is Dr. Kirtly Jones from the Department of Obstetrics and Gynecology here at the University of Utah Health Care and we're talking about dry mouth on The Scope. And boy is my mouth dry.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Today in the studio, we're going to be talking with Dr. Lea Erickson, who is the Associate Dean for Student Life at our dental school here. And she is an expert on the issue of the older mouth, and that doesn't tell you how old I am, but about dry mouth in specifics. Welcome to The Scope studio, Dr. Erickson.

Dr. Erickson: Thanks for the invitation.

Dr. Jones: Sure. So let's talk about women's mouths with respect to dry mouth. So is it frequent? How often does it happen for women?

Dr. Erickson: So dry mouth is really common among older people, not necessarily always older people, but see it much more commonly; it's usually associated with the use of medications. There are also some autoimmune diseases like Sjrogen's syndrome, again more common in women, that will have a dry mouth. A dry mouth can be really devastating for the patient having, or the individual having it. It's uncomfortable. One of the common complaints is I can't lick a stamp, I can't eat a cracker, I have to have liquids with my food, I have to have sauces on my food so it really can affect quality of life.

Dr. Jones: Does it affect your sense of taste as well or does it just dry mouth?

Dr. Erickson: Oh, it absolutely affects the sense of taste. Food needs to be in solution to be tasted and so if it isn't in solution then the taste buds don't affect it, don't get it, and so people with dry mouth have much less pleasure in eating as well as just not tasting it.

Dr. Jones: Well, we know that people when they get embarrassed or when people are giving a talk, there's always a glass of water for them. So dry mouth can be an acute response to nervousness or stress. And we know that there are some medications that make us get rid of fluid, like high blood pressure medications. So aside from diuretics, what other kinds of medications can lead to dry mouth?

Dr. Erickson: The list of medications, I think the last time I saw it, said 400 medications that cause dry mouth.

Dr. Jones: Oh, that many? Okay. Good.

Dr. Erickson: So any of the drugs that treat depression, again commonly used on adult patients. Pain medications are the worst so any of the narcotics.

Dr. Jones: Narcotic pain medications.

Dr. Erickson: Absolutely.

Dr. Jones: And then so if we have people that need their medications or need their blood pressure or their anti-depressants, what kinds of things do we do for people?

Dr. Erickson: So, what we need to do is either anything that will stimulate salivary flow, so you . . .

Dr. Jones: Ooh, thinking about pizza does that for me.

Dr. Erickson: Ahh, well, you know, thinking about food will

Dr. Jones: Or lemons

Dr. Erickson: . . . do it.

Dr. Jones: Thinking about lemons. I'm thinking about lemons right now and that's doing it for me.

Dr. Erickson: So, thinking is always a little bit useful, but most people are not going to walk around thinking about lemons and pizza. However, putting a sugar-free lemon candy in your mouth will stimulate salivary flow and keep it coming and not contribute to tooth decay.

Dr. Erickson: Putting some gum in your mouth. Cinnamon's my favorite. Cinnamon can be irritating in a dry mouth, but whatever flavor does it for you. The citrus flavored gums will do a wonderful job of stimulating salivary flow. And then you've got your natural saliva.

Dr. Jones: Is there some way of making . . . is there a medication that makes more saliva?

Dr. Erickson: There are two medications that are available. They both were tested on either patients who've had cancer therapy, radiation to the glands, or have Sjrogren's syndrome, but are often used for medication-induced dry mouth. Salogen, pilocarpine is one and cymatidine is the other one. They're not used terribly commonly because they also have side effects of making people sweat. So they're less convenient, but among the very, very dry mouth, they're very effective and very helpful.

Dr. Jones: So you have dry mouth, you say, "Well," you see everybody walking around with a bottle of water anyway. Now it's so acceptable to take your bottle of water with you. What are the side effects or what are the long-term risks of having a dry mouth?

Dr. Erickson: So the water puts the moisture in your mouth, helps your comfort, but does not have an effect on the health of the teeth.

Dr. Jones: Oh, so saliva has more in it than just water, huh?

Dr. Erickson: Absolutely.

Dr. Jones: Oh, tell us about that.

Dr. Erickson: It has anti-microbials, it has ions in it that remineralize the teeth. So the teeth are in a constant flow of losing calcium and phosphate and regaining it. So they demineralize and remineralize and it's a constant flow back and forth. Without saliva, it tends to be just a flow outwards and makes the teeth at very, very high risk for aggressive tooth decay that goes rapidly.

Dr. Jones: Oh. Well, that's something new for me because I figured that it was just dry and now I think of saliva as being really an important part of my mouth's health.

Dr. Erickson: It's absolutely a critical bodily fluid that has huge really therapeutic or functional benefits for the mouth.

Dr. Jones: So do you think the average family doc or nurse practitioner knows about treatment? Let's say . . . women might not even talk to their doctor about treatment cause they think it's common, but if they do . . . should women who's got this problem, should they go to their doctor? Should they talk to their dentist? Should they talk to everybody, their best friend?

Dr. Erickson: Well, they probably should at least talk to their physician and their dentist about it. The physician in terms of are there some alternatives to the medications that might have less of an effect, but absolutely talk to the dentist, get a prescription for a high concentrated fluoride dentifrice to use that will help to increase the remineralization.

Dr. Jones: Is that a toothpaste you're talking about, the dentifrice thing?

Dr. Erickson: Yes, toothpaste, sorry. Yes, it's a 1.1% neutral sodium fluoride, it requires a prescription, a number of brands. And really, most dentists manage to carry it in the office and have it available.

Dr. Jones: So and so brushing and flossing's more important in an effort to try to prevent tooth decay.

Dr. Erickson: Yes, and the patients that have good salivary flow can get away with doing less . . . well, get away with being a little more cavalier about their oral health care. Somebody with a dry mouth has to do such an excellent job of cleaning that they leave no plaque.

Dr. Jones: Okay. All you flossers and all you brushers who are of a certain age, if you have dry mouth, you should be talking with your clinician about causes that might be changeable if it's your prescriptions, about new therapies that might be helpful for you, but get your teeth checked out and keep them healthy and strong.

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Dr. Jones: We all know that women's mouths are different than men's. They move more, and they wear lipstick. But inside the lipstick, there are important differences. This is Dr. Kirtly Jones from Obstetrics and Gynecology at University Health Care and we are talking about women and oral health today on The Scope.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Women's hormones are different than men's. Women get pregnant. Women go through menopause. And some autoimmune diseases are more common in women than men. Of course, these are only a few of the differences between men and women. But all of these factors can affect teeth and the skin inside your mouth called the oral mucosa. Let's think a little more about how these factors affect women's oral health and what should we do about it.

One, boys and girls go through puberty, but the estrogen and progesterone that are part of puberty in girls causes increased blood flow to the oral mucosa. This may cause swelling and greater reaction to irritation caused by food particles. An 11-year-old girl can have perfectly fine teeth and gums even though she is not religious about brushing and flossing. After puberty, though, these bad dental habits may lead to swollen and bleeding gums. Hormones may also cause changes in the normal bacteria in the mouth.

So what to do? At the time that kids are the least likely to listen to you, you need to tell them about brushing and flossing. You might remind them that the red, swollen gums are unattractive and can cause bad breath. That might get their attention and it might get your girl on the program. If your daughter hasn't been to the dentist or the hygienist recently, maybe puberty is a good time to get a checkup.

Two, the same changes in the gums that happen in puberty can be exacerbated in the menstrual cycle. So some women notice more gum swelling in certain times of their cycle and some viruses like oral herpes or other oral ulcers may be more common just before the period. These actually may be flattened out in women who use hormonal birth control because it blocks the ups and downs of hormones, but that's just a little aside.

Three, pregnancy and the high estrogen hormones that causes even more swelling of the gums and bleeding gums is caused by gingivitis and it happens in about 60 to 75% of pregnant women. For some women the food they eat as part of their food cravings like sweets and ice cream before bedtime, and not brushing and flossing before you go to bed, can lead to changes in their oral health. Brushing and flossing are even more important in pregnancy as gingivitis and poor oral health causes inflammation throughout the body and is associated with an increased risk of preterm birth. I know, the last thing you want to do before you go to bed is belly up your big tummy to the sink, and brush and floss, but you have to go for it. And if the problem is more than you can handle, you should see your dentist.

Four, menopause is when the ovaries stop making so many hormones so your mouth should get better, right? Well, at menopause women suffer more than men of the same age from something called xerostomia; starts with an X as in xeriscape or dry gardening. The fancy word xerostomia means dry mouth. This can be just annoying or it can cause a burning sensation, a loss of taste, as well as needing to drink fluids all the time with the consequent potty trips. If this is happening to you, it may just be menopause, or it can be a number of other diseases including diabetes, or it could be your medications.

Talk with your clinician and your dentist about it. There are some simple things to help: avoid alcohol, caffeine, sodas, alcohol-based mouthwashes. There are some treatments your dentist can suggest, but it is important that you brush and floss regularly because having less moisture in your mouth means your teeth and gums aren't naturally rinsed as often. Sugarless lozenges that stimulate the salivary glands can be helpful.

Lastly, there are some autoimmune diseases that are more common in women than men that can affect the skin of the mouth. Sjogren's syndrome specifically causes dry eyes and dry mouth. This disease is more common as women age so it's hard for you to know what might be going on if you're suffering from dry eyes and dry mouth, both of which are more common after menopause. So you should bring up your symptoms with your clinician and they can help figure it out and give you some tips.

So ladies, watch that pretty mouth, take care of yourself and stay tuned as we'll be talking more about women and dental health in the future Scope radio sessions.

Announcer: thescoperadio.com is University of Utah Health Sciences radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com.

Interviewer: How do I know if my headache is caused by a mouth-jaw issue? That's next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: Dr. Gary Lowder is a practicing dentist and a professor, both at the University of Utah School of Dentistry. He's got 30 years of TMJ experience and he's seen a lot of cases of people coming in with headaches asking, "Is this a mouth-jaw issue?" Headaches are so common nowadays and can be caused by so many different things, how do you know if it's caused by a mouth-jaw issue? Is there any kind of one-tell that you look for?

Dr. Lowder: Well first of all, in my practice I like to know if a patient has been to their physician or their ENT to find out if there's any underlying infection that might be contributing to the headaches. A lot of patients will say that they have migraines, but in fact they're really just severe muscle tension-type headaches.

So what we do is we will often use a technique called Spray and Stretch, where we use a vapocoolant spray on the muscle areas of the face to see if there is a diminishing of the pain. If we can get headache to respond to that kind of a test, then it usually indicates that it could be related more to muscle irritability, muscle tension, or another term is called Trismus, and that gives me encouragement that this is something that can be treated because it's more of a muscle tension-type headache than a true migraine-type headache.

Interviewer: And we're talking about tense muscles in the jaw and the mouth area?

Dr. Lowder: Yes.

Interviewer: Does that cover the neck area as well what you do, or is that different?

Dr. Lowder: It also covers the neck area. A simple test to know why is if you look up toward the ceiling and tap your teeth together, the bite will feel different that if you look down toward the floor and tap your teeth together. And the neck muscles actually determine head position.

If the head position is altered by tension in those muscles, it can alter your bite, which in term can trigger clenching and/or bruxism, and you can either get headaches toward the end of the day or when awakening in the morning. Often morning headaches are due to the fact that the individual is clenching their teeth throughout the night.

Another sign that could help you understand if you're clenching or grinding is look at your teeth in the mirror and see if you see any signs of wear. The canine teeth or the cuspids just to the sides of the incisors, should have nice points on them. If those points are missing and they're flattened, that means that you have been doing some grinding and abrading of your tooth structure and it can be a factor in headaches.

Again, not all headaches are related to teeth and occlusion, but if it's been ruled out that you have migraines or some other systemic reason for a headache, then we need to suspect that maybe the occlusion is a factor.

Interviewer: So what are some common issues that might be causing my headaches? So TMJ would be one of them, grinding your teeth sounds like another. Are there any other ones?

Dr. Lowder: Well, stress is probably the number one culprit. And stress happens for good reasons and negative reasons. For instance, Christmas can be very stressful to some people, and so can birthdays and weddings. And so a promotion at work, increased responsibilities, can cause us to start grinding or clenching our teeth, and that usually can create tension-type headaches over time.

Interviewer: What can I do about it if I have headaches that are being caused by my muscles and my jaws and my mouth?

Dr. Lowder: I'd like to say, "Just take a deep breath and relax," but that doesn't always work. I think it is good though to evaluate the stress in your life, both physical and emotional stress and determine if there's a more healthy way to deal with them. Stress management counseling is a good idea. Considering your daily activities, is there anything that you're doing that puts more strain on the muscles of your neck and shoulders than the body is able to tolerate?

The position you're in, if you're at a computer all day, can make a difference in how those muscles feel, which can in turn, create muscle tension-type headaches. Physical therapy is beneficial in those cases, ice packs, good quality exercises, routines that can help strengthen those muscles are also beneficial.

If you feel like you're clenching or grinding your teeth and doing it habitually or waking up having these symptoms, some form of protective mouth wear can be beneficial. And those are called dental splints or mouth guard that helps to take the stress off of the teeth and distribute it over the plastic, protecting the teeth and relaxing the muscles associated with your jaw.

Interviewer: That's interesting. So a lot of headaches can start from there but it sounds like there's some hope for people if that's where their headaches are starting.

Dr. Lowder: There definitely is. It's worth investigating because you don't have to suffer with a headache if it's coming from muscle tension in that area. It's also important to know that in some cases of temporal-mandibular disorder, there is clicking and popping that occurs inside the joints just in front of the ear. If it's non-painful we often do not treat that, it's very common. And if it's non-painful or if it doesn't limit your jaw function, then we don't usually treat it. When it becomes painful then the patient should seek help to try and alleviate the problem as soon as possible so that further breakdown in the form of osteoarthritic remodeling isn't occurring.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at the scoperadio.com.

updated: December 19, 2018
originally published: May 27, 2015

Interviewer: Why does my jaw pop, and do I need to do something about that? That's coming up next, on The Scope.

Announcer: Health information from experts, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: Dr. Gary Lowder is a practicing dentist and a professor at the University of Utah School of Dentistry and has 30 years of TMJ experience to boot. The question that I would imagine you get a lot is: "My jaw pops. Is that something I should worry about?" What's the answer to that?

Dr. Lowder: There are actually two kinds of popping that patients report. One is when they're almost at their widest opening, like when you when you yawn. This type of popping is more of a subluxation where the lower jaw bone passes over a ridge in the upper jaw bone, and that's a normal occurrence caused by just a hyperextended lower jaw.

The other type of popping is the one that's more concerning, and it involves the displacement of the cartilage-like disc which is inside the joint. This type of popping occurs usually quietly when you're closing. The disc will slip forward of the lower jaw bone. Then when you go to open again, there will be a louder pop or crack that happens when the disc repositions itself onto the condyle of the lower jaw.

Interviewer: So, talking or chewing, is that when this happens?

Dr. Lowder: Yes. It can happen

Interviewer: And even just opening your mouth.

Dr. Lowder: It can even be bothersome to other people at the table where you're eating. They can hear it, and they'll wonder what's going on, and that's usually because that disc is dislocating on closure and then reducing back to normal position on opening. If it's painful, it's usually painful because the ligament that controls the disc is being stretched, or the muscles that control the jaw movement are also being affected by that dysfunction.

Interviewer: So, if it's painful, is that something to be concerned about, and if it's not painful, as long as my dinner mates can handle the noise, its okay? Or should I have them both looked at?

Dr. Lowder: I think if it's painful, it should definitely be addressed. One thing that you could try if it's a new episode, and it's never happened before, is just reduce your jaw function. Go to a softer diet. If you catch yourself clenching, try to relax the jaw and maintain a lips together, teeth apart posture.

Interviewer: But what if I like a good steak? Is there any way you can fix it, or am I just going to have to live with this jaw popping then?

Dr. Lowder: Depends on how good the steak is.

Interviewer: Sure.

Dr. Lowder: If you get the tender cuts of meat and cut it in smaller pieces

Interviewer: All right.

Dr. Lowder: ...you'll learn what to tolerate, but you have to go by what your jaw will tolerate. If there's a food that you're eating that causes your jaw to hurt, you need to avoid that food in that form, at least until your jaw's starting to feel more relaxed.

An injury to the jaw can create these popping and clicking episodes, and if it's the first event, I usually tell patients to give it at least two to three weeks to see if it will resolve on its own. And with a softer diet, they may find that things get back to normal again. If that doesn't happen, then you should go in and see your dentist and find out if there's something more that needs to be done.

Interviewer: Could long-term damage be caused if I don't do something about it?

Dr. Lowder: It can, especially if there is pain. It usually signals strain to the muscles or an inflammatory condition which can eventually lead to some arthritic degeneration in the joint, and then that starts to limit function and creates changes in your bite. So it needs to be addressed under those circumstances.

Interviewer: So if I understand correctly, if I start developing a popping in my jaw, and it's painful, back off on what I'm eating, eat some softer foods for a couple of weeks, and if it still continues, that would be the time to see my dentist, or should I go in right away?

Dr. Lowder: I think if it's a first episode that has never happened before, then it's valid to wait two or three weeks just to see if it will go away on its own. If it were to reoccur in another month, then there's something going on that your body's trying to signal to you that the stresses in those areas are exceeding its ability to recover.

Interviewer: And then what will you do to fix that?

Dr. Lowder: What I usually do is to initiate use of an inter-oral appliance that we call a dental splint, and it creates a buffer for the jaw and the teeth to function to. It needs to be adjusted properly so that it is maximum stability, and it doesn't create a new problem for the muscles and joints to deal with. But if it is adjusted properly, it will often relieve the muscle strain and also decompress the joint tissues so that the inflammation has a chance to resolve. I think the real key here is if you have jaw issues that are painful, it is worth going and getting an evaluation by a qualified dentist who can manage TMJ-type issues so they don't cause worse problems later.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: June 1, 2018
originally published: May 20, 2015

Interviewer: TMJ, what causes it, how awful it is, and what you can do about it.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: Dr. Gary Lowder is a practicing dentist at the University of Utah School of Dentistry and also a professor there as well. And more importantly he has 30 years of TMJ experience. So, Dr. Lowder, tell me about TMJ.

Interviewer: Making dental visits easier for children with autism. We'll examine that next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: It can be stressful enough going to the dentist in the best of circumstances, but for children with autism, the sights and the sound sand the smells can speak overwhelming. Dr. James Bekker is with University of Utah School of Dentistry and he's going to give us some tips to make it an easier experience. So first of all is it pretty common for reactions to be pretty extreme or is the range pretty broad?

Dr. Bekker: There is a broad range, but every child with autism is different. There's such a spectrum and for parents that deal with this on a regular basis they know that there child has very specific things that they respond to and a positive way and in a negative way. So coming to the dentist can be made so much easier if the dentist beforehand can identify what makes the child happy and what scares the child.

Interviewer: So a conversation with the parents sounds like it's a good idea.

Dr. Bekker: Right.

Interviewer: Tell your dentist those things.

Dr. Bekker: Right. So we have a packet that parents can fill out ahead of time where we'll talk about their child that we talked about their likes, their dislikes, the triggers what makes them anxious, what is their happy place, what makes them comply with what you need to do as a physician or a doctor. You do that ahead of time and find out a little bit more about the child so when the child comes to your office you have already set up the situation that the things that make that child respond in a positive way or there.

I've had a child that love vacuuming, I've had a child that love playing with water, whatever it is that they like, you key in on that and then when they come in you are right on their level, you are relate into them, you know who they are, you know what they like and you take away some of that strangeness and some of that fear right off the bat. That makes the child much more comfortable but it really makes the parents more comfortable.

Interviewer: Yeah. There's probably nothing worst than bringing your child to the dentist and then having them scream or react negatively like that.

Dr. Bekker: Right, and if the parents sees that you kind of know what you're doing, that you've been down this road before with other children and you're keying in on what is good for their child it really helps them relax. You also schedule in your office at a time when . . . Parents are sometimes nervous about, if I bring my child to this office are the other children going to look, are they going to be afraid of my child, will my child have a negative interaction in the waiting room? And if you schedule it so that that waiting situation or that reception goes smoothly and you're prepared for the child ahead of time.

Maybe you don't have other patients scheduled at that time and you can focus just on that one child. You get them in, you get treatment and analysis and diagnosis done quickly and then they can be on their way. You don't have the anxiety of sitting and waiting in an office.

Interviewer: Yeah, sure. So those are couple of really good ideas of what a parent can communicate to a dentist, let them know that they have an autistic child and could you do these things. What are some other things a parent could do before that visit to maybe. . . Is there anyway you can prepare a child with autism for that by talking to them?

Dr. Bekker: Yes, and some of the things that apply to all children will apply specifically to children with autism. If a child picks up that a parent is really nervous about a situation, then the child will be more nervous. If the parent can be relax about the situation, the child is more relaxed. The parent can use terms that are positive terms. They can talk along the lines of this will be fun, this will be easy, this will be quick, he's really nice, or she's my friend. Those kinds of positive terms about the experience are really helpful ahead of time.

If the parent is saying things like he won't hurt you, I won't let her take you away, then the child's anxiousness is elevated. And every child is that way.

Interviewer: Yeah. Interesting. So is there something that a parent with an autistic child should look for when choosing a dentist?

Dr. Bekker: You need to have someone who has experience. You can go on their website and for the most part you may want to try and find a pediatric dentist and that's a specialty in dentistry where they go two extra years and do a residency in pediatric dentistry and they are more attune to the needs of special needs children. There are many general dentists in the community that have experience with special needs, but you need to do a little bit more homework to find out who those are.

Interviewer: Yeah. What are some of the things that you're doing here at the University of Utah School of Dentistry because this is a brand new facility. I understand you have some rooms that are kind of specially built for this. Explain that a little bit.

Dr. Bekker: We do. We have some areas that are child friendly, we have a special waiting room and I guess we don't call them waiting rooms, we call them reception rooms because we hope that nobody ever has to wait. We have this special reception area, we have a special clinic for pediatric patients and patients with special needs where we have TV monitors on the ceiling and you have all different kinds of movies or Discovery Channel, whatever the child likes to watch available. We found that the TV is one of the best anesthetics that we have.

Interviewer: Is it really. It works for most.

Dr. Bekker: It works for most and we also have treatment areas that are completely private so that the child and the parents can be somewhere away from the hustle and bustle of the other parts of the clinic.

Interviewer: That will probably helps a lot to cut down on a lot of that input.

Dr. Bekker: It does, especially with children in the autism spectrum, noises are big issue. And things that they don't understand that makes scary noises can really set them off. So if you can have a quiet or calmer place it really helps.

Interviewer: So that's really got a help with all that external stimulation that can be troublesome sometimes with autistic individuals.

Dr. Bekker: It really does.

Interviewer: What about smells and lighting, do those types of things cause problems generally or not so often?

Dr. Bekker: Smells do to some degree but lighting especially does with children in the autism spectrum. We can have the room darkened. In the new technology a lot of what we do in our diagnosis treatment planning and actual treatment, is with magnifying scopes that have an LED light right on them and it just zooms in on the area of treatment and the whole rest of the room can be darkened.

Interviewer: So any final thoughts or final tips for a parent with an autistic child that would help them through this experience?

Dr. Bekker: I think the most important thing is don't be afraid. Find a good pediatric dentist, find a good situation that is ready for your child because it can be a great experience. I've been doing this for many years and I have children with autism that love to come to the dentist. I have children with autism that don't particularly like it, but they do it and that's really important. Having that good oral health piece is so much more important than staying away just because you're afraid of the situation.

Announcer: TheScopeRadio.com is University of Utah Health Sciences radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Interviewer: You've been told by your dentist that you have impacted wisdom teeth and they need to come out. Is that the case and is there a way that it could be a little easier? We'll talk about that next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: I think my guests would agree that nobody looks forward to having their wisdom teeth pulled. But there could be an easier way than what you're aware of. We're with Dr. Bryce Williams. He's an oral surgeon in the Ear, Nose and Throat department at the University of Utah Health Care. Boy that's a tough thing isn't it? Is there anything more painful than having your wisdom teeth pulled?

Dr. Williams: It's certainly not the most exciting thing to have to look forward to. But it is kind of a rite of passage into adulthood.

Interviewer: Yes, so let's talk about why somebody should and the importance of it. And then we're going to talk about what you can do to make the experience a little bit better. So first of all, wisdom teeth. Why would somebody want to have them pulled? And is it important?

Dr. Williams: Wisdom teeth in the majority of people cause a problem because there's not enough room in the mouth for them to come in. So removing them early on in life is important because taking them out as you're older is more difficult; the bone is harder, you may have other health problems as you get older, and the roots are longer.

Interviewer: So get them out while you're young and healthy. Is this a preventative thing? This is before you see any evidence of impacted teeth?

Dr. Williams: Right. There's a lot of evidence to show that having the wisdom teeth taken out before the age of 25, you get a better outcome and you avoid long term complications.

Interviewer: And is that something everybody should do?

Dr. Williams: It's not for everybody. But the vast majority of people should at least get a dental x-ray to check out and see where those teeth are and to see if they're going to cause a problem.

Interviewer: And the dentist could figure that out for them?

Dr. Williams: Absolutely.

Interviewer: Okay, and then at that point the dentist says okay, you probably should have these pulled out. What then?

Dr. Williams: Yes a general dentist is able to remove your wisdom teeth. The difference between a general dentist and an oral surgeon is the oral surgeon is trained to remove the wisdom teeth using IV sedation.

Interviewer: Okay. And a dentist can't?

Dr. Williams: Oral surgeons typically do a deeper level of sedation and know how to do it safely. That way you can go completely to sleep and not remember any of the procedure, wake up when it's all done, and go home and have a somewhat good memory of the event.

Interviewer: As opposed to being awake the whole time and watching the thing.

Dr. Williams: Right. Exactly.

Interviewer: So only oral surgeons can do IV sedation which sounds like a huge benefit. What are some of the other benefits of having perhaps an oral surgeon do it over a general dentist?

Dr. Williams: So the core of an oral surgeon's training is four to six years after dental school. And the core of that is in removal of wisdom teeth. So we see a lot more cases, we do a lot more difficult cases, we're trained to do them with IV sedation. As a general dentist's bread and butter is fillings and crowns, an oral surgeon's core is the removal of wisdom teeth. So we feel very comfortable with it.

Interviewer: Yes, so that's what you do. You see a lot of it. You do a lot of them.

Dr. Williams: Exactly. And I think that helps translate into a quicker recovery for the patient, kind of a smoother procedure, and all of that.

Interviewer: Yes, and plus you don't have to be awake for it.

Dr. Williams: Exactly.

Interviewer: If somebody has any questions what can they do?

Dr. Williams: You can search for me on the university website, Bryce Williams, DDS. You can find more information about wisdom tooth removal and IV sedation, and my contact information is on there as well.

Interviewer: Final thoughts?

Dr. Williams: You should go to your dentist every six months for routine checkups and cleanings. Your dentist can take x-rays and diagnose you with impacted wisdom teeth. If you do need to have your wisdom teeth removed keep in mind that there is a nicer way to do it with IV sedation.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: November 7, 2018
originally published: August 8, 2014

Interviewer: Do mouth guards really make a difference for your kids teeth? We'll find out next on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope. Interviewer: We're with Dr. Bryce Williams he's an oral surgeon in the Ear, Nose and Throat Department of the University Utah Hospital. Mouth guards and kids, let's talk about that for a second, do you recommend kids wear them, I think I know the answer it seems like an obvious one to me.

Dr. Bryce Williams: If you ask any dentist, oral surgeon they'll say yes. Not wearing a mouth guard you're at twice the risk for an injury to a tooth or to your jaw and then someone who's wearing a mouth guard.

Interviewer: Two times? And those types of injuries, give me how significant that is, what I mean is at the end of the day.

Dr. Bryce Williams: Well it could range all the way from breaking off a small part of usually it's a front tooth which for most people that's pretty significant, as far as cosmetically, to actually a fracture of the upper and lower jaws which can require some kind of major surgery.

Interviewer: Really, wow. So mouth guards what types of sports should the kids be wearing them in?

Dr. Bryce Williams: Really any sport, where any kind of contact sport are in any sport where there's a risk of falling. So football, hockey, certainly skiing, playing tackle football.

Interviewer: Skiing really? Interesting. Tackle football keep going with your list.

Dr. Bryce Williams: Tackle football

Interviewer: I'd imagine soccer

Dr. Bryce Williams: Soccer for sure.

Dr. Bryce Williams: A ball in the face, that's no fun.

Interviewer: Is there a sport in particular that's really notorious for injuries?

Dr. Bryce Williams: I think in football is pretty well guarded even in the full face mask on but I think that - and even baseball as well. I've seen several injuries from a ball or from a bat in people playing baseball.

Interviewer: So I understand how the mouth guard might protect my teeth but how's it is protecting my jaw?

Dr. Bryce Williams: It protects your jaw by allowing the teeth to come together when you get hit. And having the teeth together when you get hit, protects the jaw as well.

Interviewer: Alright. What about you see the helmets with the jaw guard on them?

Dr. Bryce Williams: Yeah I see more and more of those when I go up skiing and I don't think there's any literature as far as those are concerned at this point but I think it's probably good idea especially people that are skiing very fast and doing very tricky maneuvers. Certainly it can help to protect your lower jaw.

Interviewer: Do you ever find yourself in a situation where you just want to scream? You just want to say put a mouth guard in.

Dr. Bryce Williams: You always see a teen age kid with perfectly white teeth come in and they been playing tackle football in the park with their friends and they've broken two of their front teeth and they're very distressed and in those situations I just want to take them by the shoulders and say wear a mouth guard next time. Especially, after you get fixed.

Interviewer: What age should kids start wearing mouth guards?

Dr. Bryce Williams: Most dramatic event start to happen when kids are playing sports. So typically between ages 8 and 10 years old. Sometimes it's difficult for a general dentist to make a mouth guard fit a patient choose teeth are erupting and changing all the time. In those cases, it's fine to go to the store and buy a store-bought mouth guard to wearing and change every so often when the mouse grows or changes or a new tooth comes in.

Interviewer: So is one type of mouth guard better than another type of mouth guard?

Dr. Bryce Williams: I think with mouth guards there's several different types, you can buy the kind at the store that you can boiling water and adapt to your teeth. I think those are very good but the best kind of mouth guard you can get is one that's custom- made by your dentist and the reason those are better is they adapt to your teeth. They're fit to the relationships of your jaw and they're less likely come out while you're playing sports or other activities.

Interviewer: What's one of those cost, roughly?

Dr. Bryce Williams: It depends on the dentist but sometimes it's covered by insurance.

Interviewer: Oh really?

Dr. Bryce Williams: So sometimes you don't have to pay very much at all.

Interviewer: No excuses.

Dr. Bryce Williams: No excuses.

Interviewer: No excuses to mess up those teeth.

Dr. Bryce Williams: Absolutely.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope. University of Utah Health Sciences Radio.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to the Scope.

Interviewer: Dr. Bryce Williams is an oral surgeon at the University of Utah Hospital. As an oral surgeon, tell me about the effects of smoking and chewing tobacco on the teeth.

Dr. Bryce Williams: That's a good question. Smoking for the oral cavity causes a lot of different changes. Primarily, it causes a dry mouth. Not having that saliva in there to protect your teeth and your gums will cause a plaque build-up on the teeth and then slowly over time you can get cavities in your teeth that cause infection and need to be removed. The other obvious changes that happen with smoking in particular are the risks of getting oral cancer. Sometimes it doesn't always show up in the obvious place. It can kind of hide behind the tongue or further down the throat. It can make it very tricky for the otolaryngologist or the oral surgeon to find those areas of concern. With chewing tobacco, there's not necessarily a higher risk of oral cancer with chewing tobacco. That's never been proven. However, chewing tobacco does damage the gums around the teeth. It can cause recession of the gums and damage to the roots of the teeth, which require removal. Sometimes that's very difficult to repair so the teeth have to be removed.

Interviewer: Out of all the things that we're putting in our mouth and that we're doing to ourselves, would you say smoking and chewing tobacco are a couple of the worst things you can do for your teeth?

Dr. Bryce Williams: I think smoking and chewing tobacco are definitely terrible for the world cavity. Something else that's not typically thought of as been awful for the mouth are sweets and those kinds of things. Especially suckers and lozenges that have sugar in them. Those can have similar effects to chewing tobacco, causing recession of the gums and cavities in the teeth. Those work kind of slower over time but they can have a devastating effect on the teeth and gums.

Interviewer: Interesting. What about chewing ice? Is that bad for me?

Dr. Bryce Williams: Chewing ice can be bad for you as well, especially if you have a lot of fillings in your mouth. The fillings tend to weaken the teeth. If you take a nice crunch down on a piece of that ice, it can fracture that tooth and then you need some expensive dental work.

Interviewer: What about opening things with your mouth? You know, clamping down on a package of whatever and opening it up. Is that bad? I've heard it is.

Dr. Bryce Williams: It's always impressive to see someone open a bottle with their teeth.

Interviewer: Have you actually seen that?

Dr. Bryce Williams: Many times. I've never seen a tooth actually break.

Interviewer: That doesn't sound smart.

Dr. Bryce Williams: It does not sound smart, no. I'm sure the day will come when I will see someone and I'll give them a talking to.

Interviewer: What about other packaging, like, plastic bags of candy or whatever?

Dr. Bryce Williams: I'd say save your teeth for the food so you'll have your teeth long-termed to chew the food with.

Announcer: We're your daily dose of science, conversation, medicine. This is the Scope. The University of Utah Health Science's Radio.

Okay, it's time for another edition of ER or Not with Dr. Troy Madsen, Emergency Physician at the University of Utah Medical Center. This is where you get to learn whether you should go to the ER or not for various ailments.

It's a Sunday morning and I have this killer toothache. ER or not?

Dr. Madsen: That's a great question because a lot of people make the decision to go to the ER, especially at the University of Utah, because for some reason a lot of people think we have dentists in the ER, but unfortunately we do not.

As an emergency physician I'm not trained, it's just not part of what I do to pull a tooth if you've got a severe cavity. So if you've got a toothache, as long as you can control the pain at home, I would say don't go to the ER.

If it's something where the pain is so severe, you just cannot get it under control, you can come to the ER. Just keep in mind we won't be able to do a whole lot more than maybe put you on some antibiotics to cool down that infection in your tooth, get you some pain medication, get you feeling a little better. But the bottom line is, you will need to see a dentist for that.

Interviewer: What if it's an abscessed tooth and you feel it like looks really ugly in there?'

Dr. Madsen: If you're at a point where it's not just tooth pain but you've got a lot of swelling on the side of your face, if it's extending down into your neck, certainly if it's causing any trouble breathing, absolutely go to the ER. That's a situation where we need to see you emergently.

Interviewer: All right, what about for the tooth pain? If it was just the pain could you go to emergency care?

Dr. Madsen: Sure, yes if you could get into an urgent care. A Sunday morning you're going to have a tough time obviously seeing your dentist, but at least if you can go to an urgent care they can give you everything that we would do in the ER.

updated: August 27, 2021
originally published: September 24, 2013