While most dental problems are caused by disease or trauma, sometimes the root problem is psychological. Such is the case with bulimia nervosa, an eating disorder that could contribute to dental erosion.
Dental erosion is the loss of mineral structure from tooth enamel caused by elevated levels of acid in the mouth, which can increase the risk for decay and eventual tooth loss. While elevated acid levels are usually related to inadequate oral hygiene or over-consumption of acidic foods and beverages, the practice of self-induced vomiting after food binging by bulimic patients may also cause it. Some of the strong stomach acid brought up by vomiting may remain in the mouth afterward, which can be particularly damaging to tooth enamel.
It’s often possible to detect bulimia-related erosion during dental exams. The bottom teeth are often shielded by the tongue during vomiting, so erosion may be more pronounced on the unshielded upper front teeth. The salivary glands may become enlarged, giving a puffy appearance to the sides of the face below the ears. The back of the mouth can also appear red and swollen from the use of fingers or objects to induce vomiting.
Self-induced vomiting may not be the only cause for dental erosion for bulimics. Because the disorder causes an unhealthy focus on body image, bulimics may become obsessed with oral hygiene and go overboard with brushing and flossing. Aggressive brushing (especially just after throwing up when the tooth enamel may be softened) can also damage enamel and gum tissue.
Treatment must involve both a short — and long-term approach. Besides immediate treatment for dental erosion, a bulimic patient can minimize the effect of acid after vomiting by not brushing immediately but rinsing instead with water, mixed possibly with a little baking soda to help neutralize the acid. In the long-term, though, the eating disorder itself must be addressed. Your family doctor is an excellent starting point; you can also gain a great deal of information, both about eating disorders and treatment referrals, from the National Eating Disorders Association at their website, www.nationaleatingdisorders.org.
The effects of bulimia are devastating to mental and physical well-being, and no less to dental health. The sooner the disorder can be treated the better the person’s chance of restoring health to their mind, body — and mouth.
If you would like more information on the effect of eating disorders on oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Bulimia, Anorexia & Oral Health.”
One of the key elements in a child’s development is their first set of teeth. Although primary (“baby”) teeth last only a few years, they’re critically important for enabling a child to eat solid foods, speak and smile.
But they also provide one more important benefit—they hold the space in the jaw reserved for the permanent teeth developing just under the gums until they erupt. But if a child loses a primary tooth prematurely because of disease or injury, other teeth may drift into the vacant space and crowd it out for the intended permanent tooth. It may then come in misaligned or remain stuck within the gums (impaction).
To avoid this, we try to treat and preserve a diseased primary tooth if at all practical. For a primary molar, one of the large teeth in the back of the mouth, this might include capping it with a stainless steel crown.
Why a metal crown? Primary molars normally don’t fall out until around ages 10-12, so it may be years for a younger child before their permanent molars erupt. All during that time these particular teeth will encounter heavier biting forces than teeth in the front.
A steel crown is often the best solution for a molar given their longer lifespans and encountered biting forces. The crown’s metal construction can stand up to these forces while still protecting the tooth from re-infection from decay. And because molars are typically outside of the “smile zone” occupied by more visible front teeth, the crown’s metal appearance isn’t usually an aesthetic issue.
Crowning a molar usually takes one visit, a dentist typically performing the procedure with local anesthesia and possibly a mild sedative like nitrous oxide gas (“laughing gas”). After removing any decayed structure from the tooth, the dentist will then fit a pre-formed crown over the remaining structure, sized and shaped to match the original tooth as close as possible.
A stainless steel crown is a cost-effective way to added needed years to a primary molar that could otherwise be lost prematurely. Preserving it may help a child avoid bite problems and expensive future treatments.
If you would like more information on dental care for primary teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Stainless Steel Crowns for Kids: A Safe and Effective Way to Restore Primary Molars.”
Dr. McGlennen: Tell me how you use OralDNA® salivary diagnostics.
Richard Zbaraschuk, DDS: For each patient we utilize chairside microscopy. When I see mature biofilms and/or Fn (Fusobacterium nucleatum), yeast, white blood cells (WBC), or spirochetes with the aid of the microscope, or the patient has consistent bleeding upon probing, I’ll make the recommendation of OralDNA® testing. All new patients are given the MyPerioPath® brochure so they know all the options for testing that our office provides. Once I have results, I’m able to better customize the treatment and protocols specific to the individual patient.
Dr. McGlennen: What are the biggest benefits to using salivary diagnostics?
Richard Zbaraschuk, DDS: We perform Alert 2™ on almost every patient. This test includes MyPerioPath®, giving the patient a non-biased, reproducible lab test with a metric for further improvement on the bacterial profile. The MyPerioID® IL-6 portion of the Alert 2™ lets us and patients be aware when we need to be more assertive with homecare and treatment, especially when the MyPerioID® IL-6 is reported as high risk or they have pathogens present that put them at risk for activity if their homecare or systemic health decreases.
Dr. McGlennen: What is your favorite part of the MyPerioPath® results? Why?
Richard Zbaraschuk, DDS: My favorite parts are the added systemic effects portion of the report, the color bar graph and graphics. It really does make an impact to the patients with the color system for the pathogens. I have not had a patient who reads about the pathogens and the systemic risks and does not want to follow through with treatment.
Dr. McGlennen: How do your patients respond to this technology? What is their number one question?
Richard Zbaraschuk, DDS: They respond well, especially as there is more media coverage out there about salivary testing and its uses for risk identification of other types of diseases. The question I get most often is regarding cost/insurance coverage and regarding accuracy of the results.
Dr. McGlennen: What is your biggest challenge? How do you overcome that obstacle?
Richard Zbaraschuk, DDS: Cost is the big challenge. We overcome that by utilizing microscopy. When the patient can see what their biofilm looks like and watch organisms moving around on the screen, this makes a significant impact to testing and case acceptance. The other is talking about any other family history of chronic diseases and their risk factors with untreated periodontal disease. The value of knowing and making informed decisions about health empowers the patient to choose health.
Dr. McGlennen: If a new OralDNA® provider were to ask you for advice, what would be your best tip?
Richard Zbaraschuk, DDS: I would recommend that before talking with patients that the provider test the entire staff and make it a yearly part of their care. Once everyone accepts that the goal is to maintain health, not treat disease, it becomes easier to address with patients. Having your staff on-board is essential to acceptance. As a provider, I now rely on the test results, along with traditional clinical evaluations, to form my treatment plans and allow that metric to guide protocols.
Dr. McGlennen: Where do you see salivary diagnostics in 3-5 years? 10 years? What would be the impact on your practice/patients?
Richard Zbaraschuk, DDS: The changes in the last 10 years in salivary diagnostics have been incredible. It is hard to imagine how more can be done. I would love to see point of contact results not only for the tests currently available but for screening and diagnostics for other chronic systemic diseases. There would be a greater impact to patients allowing them to be truly prevention oriented, maintaining and choosing health.
**To learn more about becoming an OralDNA Provider: Text "OralDNA" to 71441**
If you think “vaping” electronic cigarettes (e-cigarettes for short) is healthier for your teeth and gums than smoking cigarettes, you might be disappointed with the latest research. A number of studies seem to indicate e-cigarettes could be just as damaging to your mouth as traditional cigarettes.
An e-cigarette is a device containing a chamber for liquids and a means to heat the liquid into a vapor. The user then inhales or “vapes” the vapor, which contains nicotine and flavorings. The heat also pressurizes the vapor causing it to expel as an aerosol into the mouth.
Researchers have found the ingredients and aerosol effect could lead to potential health problems. An Ohio State University researcher found that vaping disrupted the normal balance of microorganisms in the mouth known as the oral microbiome. This imbalance could make it easier for disease-causing bacteria to proliferate, particularly those most responsible for periodontal (gum) disease.
Another study coming out of the University of Rochester and Stony Brook University in New York detected cell damage in gum tissue caused by e-cigarette vapor similar to that caused by regular cigarette smoke. Some of this damage seemed to result from the flavoring agents used in the e-cigarette liquid, as well as nicotine.
Another study from Quebec, Canada appears to concur with the New York study. These researchers found the damage caused by e-cigarette vapor might substantially increase the rate of cell death in oral tissues by as much as 50% over a short period of time. This kind of damage can lead to higher risks of dental diseases like gum disease or tooth decay.
While we don’t know the long-term effect of using e-cigarettes on both oral and general health, these studies are alarming: They seem to show vaping may cause some of the same problems as smoking. With the jury still out, the prudent thing to do is limit or avoid vaping altogether to protect your mouth from these unhealthy outcomes.
This tooth replacement may be backed by science, but there is also an art to placing and restoring a tooth with a dental implant. Today, many adults are turning to our Sequim, WA, dentist, Dr. Richard Zbaraschuk, for implants, as this treatment it is the closest thing you can come to the functionality and look of natural teeth. Read on to learn more!
Who can benefit from dental implants?
Most healthy adults who are missing one or more teeth can benefit from getting dental implants to fill those gaps and restore their smiles. Of course, there are several factors that will help our Sequim, WA, restorative dentist determine whether implants are right for them. Some of these factors include,
- Maintaining good oral hygiene
- Having an otherwise healthy smile
- Having a strong jawbone that can support an implant
- Having good general and oral health
- Age (implants aren’t ideal for children and young teens)
- Current lifestyle
- Pregnancy (or planning on becoming pregnant)
When you come in for a consultation, we will examine your mouth and perform an x-ray screening to check the health of the gums, teeth, and jawbone, so as to determine whether implants are right for you. While implants can be a great way to replace missing teeth, this doesn’t necessarily mean that they are the best choice for you.
Certain health problems could affect your candidacy, so it’s important that you share your detailed medical history with your dentist during your consultation so we can determine the idea approach to restoring your smile.
The Installation Procedure
To install implants, surgery is necessary, but don't worry—the procedure is minor and can be performed right here in our office under local anesthesia. Furthermore, placement usually doesn’t take longer than one hour, although this depends on the number of implants being placed and the location of placement.
The Recovery Period
Getting a dental implant takes time, especially if you are receiving multiple implants. Following the initial procedure, it will take up to 6 months for the implant to fuse together with the jawbone, and we must wait for this fusion to take place before placing the dental crown. If you’re looking for a faster way to replace your missing teeth, then you may want to discuss other options with us, however, implants often remain the ideal solution due to their reliable functionality, great look, and natural feel.
Interested? Contact Us
Are you interested in getting dental implants in Sequim, WA? If so, then it’s the perfect time to schedule your consultation here at Zbaraschuk Dental Care. Don’t let tooth loss win—dial (360) 683-3626 today!
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