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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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