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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.

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

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.

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

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: 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.

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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.