Dry Mouth

Xerostomia or dry mouth is a condition which is often caused by the decrease in salivary production in the mouth. Often, it is a gradual occurrence of aging but can be rapidly exasperated by medications both over-the-counter and prescription. It affects millions of people and can lead to very serious dental problems for patients. Symptoms of dry mouth include:

• Dryness
• Soreness of the tongue or lips
• Difficulty swallowing
• Cracked lips
• Bad breath
• Decreased taste

Saliva is very important in overall good oral hygiene for several reasons. Firstly, it is our primary line in breaking down carbohydrates in our food and aids in swallowing our food. Second, it is a primary preventer of tooth decay. It washes food from our tooth surfaces AND contains minerals that buffer food/drink acids.

Without an adequate salivary flow many patients will develop a rapid increase in cavity formation. Sometimes this may even lead to the necessity to remove all existing teeth and leave patients in false teeth.

Aggravating factors in dry mouth include:

• Improper nutrition
• Dehydration
• Excessive consumption of diuretics (coffee, cola's)
• Excessive use of alcohol (both rinses and drinks)
• Smoking
• OTC meds such as antihistamines and decongestants
• Prescription medications such as muscle relaxants, blood pressure meds
• Hypertension
• Sjorgren's syndrome
• Chemotherapy
• Radiation therapy

What can be done for patient's suffering with dry mouth? One of the easiest ways to manage the symptoms of dry mouth is frequent drinks of water. Carry a water bottle with you at all times and keep the mouth moist. Especially when eating. Use sugar free candy to stimulate extra salivary flow. This may not work if you have a true loss of salivary gland tissue such as with radiation therapy. The use of artificial saliva substitutes is also recommended. At our office we recommend both Oasis mouth rinse/products and the use of Biotene products. Lastly, if all else fails there are medications that may be available to stimulate additional salivary production.

Sensitive Teeth:

A basic understanding of tooth structure is important to understanding some of the primary causes of tooth sensitivity. The tooth is composed of several layers of tooth structure. The outermost portion of the tooth that most people are conscious of is called the Enamel. It is crystalline in structure and serves to protect and insulate teeth. It may be thinned in patients with dental restorations, those who grind their teeth or have abraded the tooth structure, and it may be congenitally thin or malformed. The second layer of the tooth is called Dentin. Dentin is porous like a sponge. It is perforated with microscopic pores called tubules which run from the innermost portion of the tooth, the nerve, to the inside enamel layer. It is the stimulation of these tubules which cause the sensitivity most of us feel. Lastly the innermost portion of the tooth is the nerve tissue or dental pulp.

When the dentin of the tooth is stimulated there is a transmission to the dental pulp which often will then be translated as pain. What needs to be understood is the cause of this pain so that the proper treatment may be rendered.

Sensitivity can come from several sources which need to be located. Such sources include:

• Grinding of teeth (Bruxism)
• Overzealous tooth cleaning
• Abrasive diet
• Chemical erosion from acids in citrus fruits, colas, etc…
• Chipped or fractured teeth

Treatment of sensitive teeth needs to be tailored to the cause of the sensitivity. After an examination recommendation will be made including:

• Use of a soft bristled toothbrush
• Use of an electric toothbrush
• Softer diet
• Elimination or decreased use of acidic products
• Use of a desensitizing toothpaste or rinse
• Tissue grafts
• Dental restorations (fillings, crowns, sealants)

It is important that the source of the sensitivity be identified so the appropriate treatment course may be recommended. By masking symptoms with dental products or pain killers more serious problems may be masked until it would be difficult to bring a good resolution to the problem.

Our office currently recommends the use of fluoride gels and rinses and desensitizing agents when appropriately diagnosed.

Sealants:

If you where to take a close look at the chewing surface of your teeth, you would no doubt see grooves in the center portion of each tooth. These grooves will vary in individuals from being shallow to being very deep. It is these fissures and pits that will very frequently become decayed.

On a microscopic level a tooth brush bristle can only penetrate these grooves just so far. Meanwhile, the bacteria that cause tooth decay can penetrate extensively further and do their damage by excreting acid that softens the tooth and creates a cavity.

Sealants are adhesive materials that bond with tooth structure and block off bacterial access to these grooves. They act by shielding these cavity prone areas from food and the associated bacteria. It has even been proven that bacteria left under sealants will go into a state of dormancy without access to air or an energy source.

As a general recommendation we encourage parents to have their children's adult teeth sealed upon full eruption into the mouth. Sealants are not 100% effective in preventing tooth decay but go a long way to preventing unwanted and unnecessary tooth decay and the associated drilling necessary to restore these areas.

The process is often done at the hygiene appointment and consists of cleaning the fissures of the teeth, the application of an etchant and bonding agent, and the application of the sealant. It is a painless procedure that takes approximately 10 minutes to complete in most children.

Sealants are generally long lasting but if they were to come loose or be missing at a subsequent dental cleaning and examination they will be placed at no charge to the patient.

Periodontal Health:

Having healthy teeth is really only part of good oral hygiene. An often overlooked and undervalued part of your dental hygiene deals with your tooth's supporting structures. This supportive network is comprised of your gums and underlying bone. These components of your anatomy provide a barrier to bacteria and a foundation to hold your teeth in place.

We recommend to all our patients to take a good look daily at their gum tissues to note any changes in color or swellings. The tissue of the mouth should be a healthy coral pink in color. If redness and puffiness is noted you likely have gingivitis or inflammation of the gums which is a state if unhealthy that may one day turn to periodontitis. The difference between gingivitis and periodontal disease is whether there is evident bone loss. Once bone loss has occurred in the mouth it will never grow back and only in isolated incidences can new bone be "added" through surgical measures. This is why early detection and preventative measures must be taken.

Just as brushing will remove adherent material to the chewing and exposed surfaces of the tooth, flossing is necessary to remove adherent material to the more hidden areas of our mouths such as between teeth and below the gum line. Proper flossing techniques are important in this removal. Many patients believe that it is adequate to merely snap the floss down and up between teeth. This does remove trapped larger pierces of food but there is more to proper flossing. We use an analogy of drying off after bathing to help patients understand good flossing principles.

Crowns and Bridgework:

Crowns and bridgework are considered the staples of restorative care in dentistry. The difference between the two is that bridgework involves the linking or "bridging" together of multiple teeth and involves the replacement of one or several missing teeth. The primary purpose of a crown is to provide 360 degree protection of a weakened tooth. Teeth may be weakened a number of different ways including:

• Excessively large or wide restorations
• Fractures or cracks
• Missing cusps
• Tooth decay
• Root canals

When one of the above indicators is present, a crown will often be recommended to strengthen and lend support to a compromised tooth. Sometimes a weakened tooth will merely shear a wall or cusp off when a break occurs and this will require an immediate crown but sometimes a weakened tooth may split into the pulp or nerve tissue center of a tooth and this will result in the tooth's need to be removed. This reason is why preventative crown placement is sometimes recommended vs. reacting after the fact. It provides the best assurance to keeping your teeth as long as possible and often prevents the need to make a one tooth problem into a multiple tooth answer.

The process of preparing a tooth for a crown isn't all that more invasive than a typical filling or restoration. First, the tooth is anesthetized. Once the patient is comfortable then approximately 2 millimeters of tooth structure is removed circumferentially and from the chewing surface. This will allow the laboratory technician to fabricate the new tooth structure. Without adequate tooth reduction crowns will not fit in the mouth. Once the preparation is finished then a mold or impression will be taken so that a duplicate model can be made and used in the laboratory. Lastly, a temporary may be placed in the mouth to provide protection to the now slightly smaller tooth. On the next visit, crowns will typically be cemented permanently into the mouth. On multiple unit bridgework, a try-in visit is scheduled to assure that with the larger span all prepared tooth structure is covered and that there are no unnecessary pressures applied to the teeth due to the "draw" of the bridge going into the mouth. The bridge will then be returned to the lab for porcelain finishing and returned for a third visit of cementation.

Dental Implants:

Dental implants are a single tooth replacement to a single tooth problem. They are an accumulation of over 20 years of proven scientific and clinical research and are an excellent way of replacing missing teeth and also used in providing positive retention to loose fitting or poorly retained full dentures.

An implant is composed of multiple components that are worked on at different times and often in different locations. Here at Collegeville Dental we DO NOT place dental implants, we work with periodontists and oral surgeons to treatment plan the implants and then in the restoration of them. Key terminology includes:

• Dental Implant- the titanium root form that gets surgically placed below the bone
• Healing abutement- the attachement that sculpts the gum tissue from the implants top (at the bone level) to the emergence into the mouth
• Crown abutement- the attachment that gets screwed into the dental implant. It is this structure that the implant crown is made to fit to.
• Implant Crown- A crown that is fitted to the implant abutment and retained either by traditional cement or screw retained directly to the abutment.

After the decision has been made to restore a missing tooth with an implant and evaluation at the specialist the placement of the implant will be scheduled. Typically only local anesthesia is used. After an incision to show the bone, a pilot hole is drilled into the bone to make room for the implant. Then the implant is threaded into the jaw. This is similar to making a pilot hole in drywall and then tapping in a screw retainer. After this is done the healing abutment is placed and the tissue is closed. Most patients will say that this procedure is very easy to tolerate with little to no post op pain. A narcotic pain reliever may be prescribed depending on the situation.

Following the implant placement a patient may have an immediate restoration or may require a healing period. This will be dependant upon several factors including:

• A history of smoking
• The density and quality of the bone the implant was placed in
• The occlusion or bite of the patient
• Possible parafunctional habits such as tooth grinding

Once it has been determined to safely restore the implant the healing abutment is unscrewed and the abutment is selected based on the implants angle in the jaw and delivered. When in place this abutment may be shaped and then it will be molded or impressed for the final fabrication of the implant crown. Lastly, the crown will be delivered.

Multiple implants may be utilized for complete reconstruction of entire arches or for replacement of multiple missing teeth. One of the wonderful things that can be done for patients going into full dentures is the placement of several implants at critical sites to provide a firm and solid retention to these removable appliances. This will provide additional retention some denture wearer's desire or eliminate the fear of dentures falling out at inopportune times.

Removable Dentures:

As the name implies, these prosthetics are meant to come into and be taken out of a patient's mouth. They are an economical way to replace multiple areas of missing teeth or complete replacement of all the teeth in a dental arch.

The steps involved for full denture fabrication involve:

• Dental Impressions
• Bite Registration
• Teeth in wax try in for esthetics and bite verification
• Appliance Delivery.

The entire process typically takes about a month to do due to lead times needed for laboratory work.

For partial dentures or prosthetics used to replace some or most of the teeth in an arch the steps are similar and involve:

• Retention areas to be made on existing teeth and dental impressions
• Framework try in- the structure providing the clasps and foundation for the teeth
• Teeth in wax try in for esthetics and bite verification
• Appliance Delivery.

After delivery patients will need to be seen for subsequent visits to determine if there are any pressure sores and/or adjustments to the bite of the appliances.

One may expect a period of time to relearn tongue placement and phonetics. Eating may also need to be relearned as dentures are not used like our original teeth.