To smile or not to smile

Dr. Karen Teston and other local experts on oral hygiene and your overall health

Some folks are afraid of pain.  Some know they haven’t done a good job of taking care of their teeth, and don’t want to be lectured.  Still others lack cash.  Whatever the reason, many avoid the dentist until an emergency arises.  By that time, however, what may have been a small problem may be a large one.  “Avoiding the dentist can have serious consequences,” observes Dr. Karen R. Teston, a board-certified psychiatrist at Watson Clinic South in Lakeland and a Polk County Medical Association member.

Ultimately, you can’t separate your oral health from your overall health.  “Your teeth and mouth and saliva are the first link in the line of digestion,” explains Dr. Steven D. Reddick, a Lake Wales general/implant/cosmetic dentist.  “It can affect your overall quality of life.  What I tell everybody is it affects the way you look.  You use those teeth every day.”

Preventing Serious Dental Problems

Seeing a dentist only when there is a dental emergency means more aggravation.  “If you wait until you have pain . . . you will have an advanced, extensive and probably expensive problem to fix,” Dr. Reddick says.  “We catch problems when they’re small.”

About half of the children between 12 and 15 in the United States have experienced tooth decay; one-fourth of adults 65 and older have lost all of their teeth, the Centers for Disease Control and Prevention (CDC) reports.  Advanced gum disease afflicts four to 12 percent of the adult population; half of the cases are attributed to cigarette smoking.  Recent studies link gum disease with heart disease, stroke, diabetes, and premature, low-weight births, according to CDC officials.  More than 7,800 die of mouth and throat (pharyngeal) cancers each year.

Dental problems can be costly.  Americans spent an estimated $108 billion in dental services in 2010, the CDC reports.  Yet, oral health problems are preventable.

Keeping mouths healthy involves regular brushing and flossing, a healthy diet, and biannual dentist visits.  Brushing every four to six hours removes plaque, a film on your teeth created by bacteria.  Flossing allows you to remove plaque you can’t reach with your brush.  Bacteria and plaque together produce an acid that causes cavities.  It’s best to keep plaque off your teeth.  “It’s the plaque that initiates tooth decay and gum problems,” Dr. Reddick says.

When problems occur, they develop without causing pain.  “You won’t know you have a cavity, you won’t know you have a periodontal pocket [associated with gum disease], unless it’s diagnosed for you,” Dr. Reddick points out.

Preventing Self-Esteem & Anxiety Problems

Those with dental problems are affected in several different ways.  Self esteem and confidence levels may drop.  People may become self-conscious.  “The social, psychological, and even financial consequences of having crooked, uneven, absent, discolored or obviously decayed teeth can be enormous,” Dr. Teston explains.  “If that sounds overly dramatic, just check out the array of ‘tooth whitening’ products next time you visit a grocery store.”

While it’s common to have some anxiety about visiting the dentist, some people have phobias that cause them to avoid regular dental care.  “Fortunately, we know how to help many patients overcome their dental fear, anxieties, and avoidance.  Many dental offices now employ techniques such as soothing music, and calming surroundings, to lower patient anxiety,” Dr. Teston says.

Cognitive behavioral therapy can help those with specific dental phobias.  “Briefly, this technique involves helping the patient identify and correct any misinformation in a patient’s thinking (For example, ‘any dentist that I visit will criticize me for the condition of my teeth’), and then coaching the patient through steps needed to allow them to complete a dental visit,” she says.  To desensitize the patient, they may make an appointment just to become familiar with the routine.

Problems Extending Beyond the Mouth

Physiological implications extend beyond the mouth.  Those with moderate to severe gum disease will have elevated levels of C-reactive protein, indicating a higher risk of cardiovascular disease, Dr. Reddick says.  “It’s a blood marker,” he elaborates.  “It means you have some inflammatory process going on in your body.”

Gum disease starts with gingivitis, which causes red and puffy gums, and leads to periodontitis, when the gum and bone supporting teeth detach and recede.

He explains diabetics will have better oral and overall health by controlling their sugar levels.  Some infections in the mouth can affect surgical patients, including those with heart and joint surgeries, so antibiotics may be administered to avoid spreading infection through the bloodstream.

In general, keeping teeth properly aligned will avoid potential problems.  Sometimes braces are required; sometimes wisdom teeth are removed because patients’ jaws are not long enough for teeth to be in proper alignment, Dr. Reddick observes.

While infections usually are localized in the mouth, on rare occasions they can spread and become life threatening, especially when the infection is in the lower molars, he says.

When teeth become infected, loose or painful, they may be removed and replaced with dentures.  Though the patient can eat well, look good and chew at acceptable levels, they usually process food about half as well as those with healthy teeth.  “That doesn’t mean they can’t eat well.  It takes them longer to eat.  Usually they have boundaries they stay in: What foods work well, which foods they would chew at home but they may not chew in public,” he explains.  Efficiency improves with dental implants, but it varies based on individual circumstances.

Amalgam fillings made with mercury were the standard years ago, but now many dentists offer tooth-colored composites.  “It [amalgam] is a stable compound,”says Dr. Reddick,adding it is no more dangerous than eating fish or breathing air.  Still, some have become concerned about potential mercury toxicity.  “People want pretty.  They are concerned about it,” he says.  “The composite materials have gotten to the point that they’re good.”

Preventing Problems before They Start

Good dental habits begin in childhood, and Dr. Kenny Nguyen, a pediatrician and Polk County Medical Association member, is doing his part to put children on the right path.  Believing healthy children’s teeth lay the foundation for health in adulthood, he checks for cavities, swollen gums and infection as part of awell child visit at Winter Haven’s Bond Clinic.  One out of two times he finds it.  “I try to make a difference in kids’ oral health.  I do that every single time,” Dr. Nguyen says.

Oral health issues can affect children’s eating, speaking, and learning.  Dental sealants can be used to fill natural crevices in the teeth, preventing decay.  Dr. Nguyen can treat an abscess with antibiotics, but refers to pediatric dentists for the underlying cavity.  “The problem is we don’t have a lot of pediatric dentists,” he says.  “Some of them are not taking Medicaid.”

Dr. Nguyen was trained to check children’s teeth while he was a student at Case Western University School of Medicine in Cleveland, Ohio.  “My mentor always reminded me to talk to parents about oral health,” says Dr. Nguyen, who did his residency at Metro Health Medical Center.  “I think more pediatricians pay attention to kids’ teeth nowadays,” because proper care and prevention is key to a healthy smile for life.



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