The Scary Side of Candy

Halloween is just a few days away and you know what that means- candy galore! As a dentist, candy is not the best choice for your teeth. However, I love these sweet treats just as much as most kids do! A few things to keep in mind while enjoying your trick-or-treating goodies are:

• Avoid or limit candy such as caramels, candy corn, jelly beans, and taffy. These particular candies are extra sticky, making it hard for saliva to wash away the sugar.


• Give your kids sugar free gum to chew. Not only does sugar-free gum help prevent cavities, it also helps neutralize the effects of sugar from the candy and therefore, it combats the bacteria in plaque that causes cavities.


• After enjoying candy make sure to brush and floss your teeth. Cavities occur not from the sugar in the candy but from the bacteria which feeds on sugars that are not removed from your teeth when you brush and floss.


• Believe it or not, pixie sticks are some of the safest Halloween treats out there.
  Pixie Stix are typically poured directly onto the tongue, avoiding chewing and your teeth altogether. They are then quickly consumed and out of the mouth before any major damage can been done. So while it may not make sense, those sacks of sugar may be the best candy for your teeth.


• Stay away from the sour stuff! According to WebMD, "Dentists’ worst nightmare: ultra-sour, ultra-sticky, ultra-sugary kids’ candies such as Warheads and Toxic Waste. Even sour gummy vitamins can be culprits. 'These sour candies, when tested, have a really low pH, nearing battery acid,' says Robyn Loewen, DDS, a fellow in the American Academy of Pediatric Dentistry and a diplomate of the American Board of Pediatric Dentistry. 'I liken it to an ice cube that’s been left on the counter. It melts the tooth. To make matters worse, children’s tooth enamel isn’t mature until a decade after their teeth erupt, Loewen says. Because it’s softer, it’s more susceptible to the acid.'"

After helping your kiddos sort through their goodies, let them enjoy some of their treats, but all at one time. It is better to let them have several pieces at once and then put the candy away and brush their teeth rather than allow them to spread it out over time and let the sugar stay on their teeth and in their little mouths. Come up with a plan about how many pieces they can have a day after Halloween and maybe even consider donating some to a local charity.

Halloween is such a fun time and we want you and your kiddos to enjoy every minute of it. Just be careful with the kind of candy they are eating and how long their splurges last! I know my girls will be focused on Skittles and lollipops, their favorites!

Happy Halloween! Dr. Wade

New Links in the Oral-Systemic Connection

Another great article to share from this month's addition of Inside Dentistry. -Jill


Current research shows that the role of periodontal disease may have even more of an impact on overall health than previously thought.

By Allison M. DiMatteo, BA, MPS

Since Inside Dentistry launched its first issue in 2005, its publishers, editors, and staff have continued to conscientiously cover ongoing research associating conditions in the oral cavity with systemic effects throughout the body. Much has been learned since then regarding the link between periodontal pathogens and diseases affecting the heart, lungs, blood sugar levels, pregnancy, and other areas remote from the mouth. Once considered separate from the body, the oral environment is gaining acceptance as a reflection of an individual’s overall health.
“We are learning more and more about how the mouth is connected to the rest of the body,” says Donald S. Clem, DDS. “Therefore, it is crucial that as dental professionals we understand that periodontal disease may have a broader significance to overall health than previously believed.”

For example, Clem notes that current research makes it evident that respiratory disease must be added to the growing list of systemic, inflammatory disease states that may be impacted by periodontal disease. Other research points to possible links between gum disease and anemia, suggesting that proteins produced as a result of chronic periodontitis negatively react with the blood and decrease red blood cell production.1 Different studies suggest that women with tooth loss caused by gum disease may experience higher incidences of breast cancer.2 Poor oral care also has been associated with memory loss and dementia, with researchers determining that study participants with the least number of natural teeth were at higher risk of memory loss and early onset Alzheimer’s disease.3 While the nature of these associations has been hypothesized, further research is needed to clarify and validate the association, as well as more clearly determine causality.

“The emerging concept of systems biology fundamentally states that no part of our body is in isolation,” notes David T.W. Wong, DMD, DMSc. “All parts are connected, despite the fact that we do not yet have readily the mechanistic underpinnings. The fact that we have been able to harness and develop salivary biomarker panels for systemic diseases including pancreatic, breast, and lung cancers substantiates this central concept.”

The significance of oral and systemic associations is significant not only to quality of health issues, but also quality of life issues. For example, burning mouth syndrome—which research suggests may be linked to systemic conditions—affects quality of life, not life or death, for 5% of the population, explains Gary D. Klasser, DMD. “The more the association between systemic conditions and the oral environment is brought to both the public’s attention and politician’s attention, hopefully more money for more research will be devoted to this particular aspect,” Klasser hopes. “As it relates to burning mouth syndrome, the more that individuals write about this particular subject, the greater the potential for funding availability and more research, because it is very difficult, if not impossible, to do research without funding.”

This month, Inside Dentistry presents updates and current research initiatives underway to further the healthcare profession’s understanding of the connection between oral and systemic diseases. Our experts this month are those conducting the research themselves, or who have served as a conduit to disseminate and help apply that research within the dental profession. For their time and passionate dedication to pursuing a greater understanding of the association between oral and systemic conditions, we extend our sincere gratitude.

Conclusion:
According to Clem, it is no longer good enough to “watch a couple of trouble spots.” Rather, controlling periodontal disease will become an integral part of controlling a patient’s overall inflammatory burden, he says.“Our patients are not healthy unless they are periodontally healthy,” Clem notes. “I think the most important issue or message here is that although in the past dentists focused on saving teeth and keeping them healthy, today we now have a broader dimension for why it is more important to maintain a healthy mouth,” Bissada explains. “If you have an inflammatory condition, which the most popular example here is periodontal disease, it puts the individual at a higher risk for a more serious systemic problem, whether it’s heart problems, diabetes, or rheumatoid arthritis. As we take care of the mouth, not only do we save teeth, which is a very good objective, but we also protect our general health.”

Bissada’s current research involving links between prostatitis and periodontitis is similar to previous research he and his associates conducted on rheumatoid arthritis, in which patients with rheumatoid arthritis were treated for periodontal disease by eliminating the inflammation. The signs of very severe rheumatoid arthritis in those patients were reduced to a significant level, he says. They are repeating the process relative to the prostate.

Brown believes that dental researchers should partner with health economists to increase the speed at which their field moves forward, since they have content, clinical expertise, and drive the research agenda. Health economists have a technical toolbox unrivaled in the social sciences and can use this toolbox to help push the research agenda established by dental researchers forward at much faster pace than would otherwise be possible, he adds.

“While the mechanistic rationale for salivary biomarkers for oral diseases are well in place, the rationale for systemic diseases is not. It is in this light that the scientific community must engage in collaborative efforts to study, determine, and establish the scientific underpinning of systemic disease detection in saliva,” Wong emphasizes. “It is only when the scientific connectivity and the definitive clinical validation of salivary biomarkers for a systemic disease combine that the credibility of salivary diagnostics for systemic diseases will be acceptable by the scientific communities.”

Burning Mouth Syndrome Linked to Menopause

I found this article in Inside Dentistry October 2011 and thought it was too good not to share!

Burning Mouth Syndrome Linked to Menopause
By Gary D. Klasser, DMD

According to our recently published study in the May/June issue of General Dentistry, burning mouth syndrome (BMS) may be related to nerve damage during menopause. The study indicated that nearly 5% of Americans experience the symptoms of BMS, a burning sensation on the roof of the mouth and the tongue, and that menopausal and post-menopausal women are most likely to be affected 7:1. We attributed this statistic to the fact that hormonal changes during menopause can result in BMS and also affect pain perception in women.

Due to the lack of physical symptoms, many study participants suffered from BMS for many years without being diagnosed. The most startling fact revealed in the research is the time lag for these individuals who suffer with burning mouth syndrome between the initial onset of a burning sensation in their mouths to the time it was definitively diagnosed, which was a mean of 41 months. Considering these individuals saw multiple healthcare practitioners, were prescribed medications—some appropriate for the treatment of burning mouth syndrome and some totally inappropriate—you can understand the frustration they must have been feeling with the healthcare community.

Certainly BMS is a diagnosis of exclusion. People present with oral burning sensations, and it is up to the practitioner to determine why they have them. First, local factors must be ruled out, then systemic factors, and, finally, potentially psychological factors and maybe certain selective medications that may be implicated in causing burning mouth. Once all of those factors are ruled out, then a diagnosis of primary BMS—for which no etiological reason is found—can be made. A diagnosis of secondary BMS is attributed to when there is an etiological reason for the burning, such as systemic factors like menopause.

We do not know what causes BMS, but we do have some theories that might explain why individuals have it. One of the startling facts that we see in BMS is that it seems to be a female-dominated condition. The ratio of women to men suffering from BMS can be anywhere from 7:1. It also seems to be a perimenopausal disorder, where most of the individuals who complain about BMS seem to be in the age range of 3 years prior to menopause, up to 12 years post-menopause. So clearly there is a menopausal component to this.

It seems that BMS may follow damage to taste, suggesting a taste/BMS interaction. Anything that causes damage to taste may in fact cause BMS and one of the potential factors damaging taste is a decrease in estrogen levels, which is associated with menopause. Taste is served by three cranial nerves (ie, 7, 9, and 10), and if there is some taste damage in those nerves, that sometimes can precipitate a loss of inhibition in cranial nerve 5, which is important for a pain sensation. So, the mechanism for BMS may very well be a neuropathic condition caused by miscommunication between the nerves and brain that results in a failure to turn off the oral pain receptors. Because the receptors do not turn off, BMS sufferers experience a burning sensation, a dry and gritty feeling in the mouth, and a change in taste.

We’re still in our infancy in understanding this syndrome. We label anybody who fits the criteria of what one considers primary burning mouth syndrome, but there are several subgroups of BMS and several theories as to why somebody has it. What is needed is a very large database to start phasing out the various categories of the subgroups in the field of BMS in order to understand the etiology and pathophysiological processes that do not fit the overall domain of BMS but maybe explain the different subcategories. If we can explain the different subcategories, then maybe we can begin targeting our interventions, rather than using a shotgun approach.