Dental Disease Can Affect Your General Health

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Dental Disease Can Affect Your General Health & Wellbeing

Over the past several years a great deal of medical and dental literature has been published associating oral infection and oral inflammation with various health problems.

It has been known for years that dental disease associated with significant chronic infection can cause problems with diabetic control. Diabetes can also contribute to periodontal disease being out of control.

More recently studies have shown a high association between chronic dental discase (periodontal disease) and heart attack and stroke. It has been said by some medical experts that inflammation is a greater risk factor for heart attack than high cholesterol. 

Periodontal Disease

CPK is a test that measures inflammation. A high CPK has been associated with many diseases. However since inflammatory diseases such as arthritis elevate CPK then it is not specifically predictive for heart attack or stroke. 

Dental disease has also been associated with low birth weight babies and respiratory disease. Teeth in poor repair or full dentures make for less effective chewing efficiency which results in choosing a diet that is softer and usually high in refined carbohydrates and sugar. 

This will contribute to an increase in body fat. We have learned that body fat, especially in the abdomen, is not just added weight (that’s bad enough) but it is actually an organ that excretes dangerous chemicals that contribute to inflammation and higher health risks of all kinds.

I believe that having a denture stabilized by 2 implants can be a life saving procedure. It has been shown that an implant supported denture functions 5 times more efficiently than a denture that is stabilized by denture adhesive. Talking about dental problems that are bad for your health, let’s talk about denture adhesives. 

Denture adhesives contain zinc a chemical that is toxic when ingested. Many denture patients need to wear adhesives. These products melt when the patient drinks hot beverages.

Of course the adhesive then runs down into the stomach. The manufacturers claim that if used in the recommended quantity the product is safe. Sadly for many patients the denture just won’t stay up so they add more and more product. 

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The temporary solution is to see your dentist as required for relining or remaking the denture. The best solution is to have implants done if possible.

Again, 6 to 8 implants will make the denture feel more like having real teeth again. If money and or bone are limited consider just 2 implants to make a big difference. 

What Health Issues Can Affect Your Dental Health?

How well diabetes is controlled is measured by the glycolated, hemoglobin value which is a measurement of how well controlled the disease is and has been over a period of time.

If your diabetes is out of control you should have only preventive and emergency care until it is under control. Specifically have non surgical periodontal treatment like scaling and home care instruction done frequently.

Practice excellent oral hygiene. Postpone elective dental surgery, that is implants and periodontal surgery. Once you are told that the disease is controlled then you may have dental surgery and implants and you will have a normal response to treatment.

Other health problems that will affect dental health are diseases that reduce the potency of the immune system. Examples are HIV, leukemia, nutritional problems and diseases requiring steroid therapy like Chrohn’s disease. Chemotherapy also reduces the effectiveness of the immune system.

Painful oral ulcerations can occur with chemotherapy making normal oral hygiene difficult. The use of a prescription mouth rinse like Oradex can help with the discomfort as well as helping to control gum disease. 

Organ transplant patients usually take a drug called Cyclosporine to prevent the organ rejection phenomena. This drug causes severe gum enlargement which will interfere with hygiene. Dilantin, which is used for seizure disorders, also causes gingival enlargement. 

Pregnancy, not a discase of course, predisposes women to gingivitis. This will only happen to women who had some degree of gingivitis before becoming pregnant. 

Increased hormone levels during pregnancy increases the number of harmful bacteria in the mouth. Pregnancy gingivitis can be avoided by achieving good periodontal health before becoming pregnant and then maintaining good dental hygiene during the pregnancy. 

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Continue to have regular dental cleanings during the pregnancy. Learn to floss your teeth daily even if you didn’t previously. The dentist will take precautions like not placing you too far back in the dental chair in the last trimester since this may cause syncope or fainting. 

Other elective treatment might need to be postponed. This does not relate to the treatment per se but to the drugs that may need to be administered like pain meds or anesthesia. On the other hand it is not safe to have a dental infection. 

Have your obstetrician and dentist consult about which drugs and procedures are safe and which are not. It is well known that consuming the antibiotic tetracycline will stain the developing teeth of the embryo. Staining only occurs to developing teeth not teeth that are already in the mouth of a child or adult.

The causes of bad breath are multifactorial. Often it is related to dental disease and poor oral hygiene. It may be related to consumption of foods like garlic and onions or smoking. 

Systemic conditions such as poorly controlled diabetes, lung disease or infected tonsils may also cause bad breath. If the problem persists after eliminating the local factors, then see you physician.

The Importance of Your Drug History (medication history)

The best advice is to tell the dentist about all medications you are taking. After all, this information is confidential. You may be taking a drug, prescribed or otherwise and not know that it could interact with some drug that the dentist is using. 

The most common example of a drug not revealed in medical history is aspirin or aspirin products. A person taking 325 mg of aspirin daily to prevent a heart attack is likely to have significant bleeding after dental surgery. 

The dentist, if aware of the aspirin use, will be prepared to deal with the bleeding. This can be done in many ways. Occasionally the medical dr will suggest stopping the aspirin 3-5 days before the surgery. 

This is done prior to a colonoscopy. It is more difficult to stop bleeding in the colon than in the mouth. The current thinking is not to stop the aspirin before most dental procedures since this may cause a rebound resulting in an intravascular clot with serious medical consequences.

Instead the dentist may modify the procedure. For example if a patient needs to have all of their teeth extracted, the dentist will do this in 4 visits instead of one visit making it casier to control bleeding. The dentist will typically suture the wound and use hemostatic agents.

Plavix (Clopidogrel) is another drug commonly prescribed for patients who have had stents placed in the coronary arteries. Clopidogrel acts like aspirin. I have found that bleeding during extractions and dental implant surgery is very moderate for patients on Plavix. 

Drugs like aspirin or Plavix must be stopped for 10 days to totally eliminate the effect of the drug.

Medication like ibuprofen also prolong bleeding after an injury or surgery. However the effects of ibuprofen or similar drugs, also called NSAIDS (non steroidal anti inflammatory drugs) are short acting and are usually gone after 24 hours. 

Similar drugs are Motrin and Aleve. A similar drug in this regard is Warfarin. 

While aspirin interferes with bleeding, Warfarin interferes with clotting. Clotting and bleeding are separate mechanisms. 

These drugs are often called blood thinners by the lay public. They do not make the blood thinner. Anticoagulant drugs simply interfere with the clotting process. If you are taking an anticoagulant your physician will prescribe a blood test monthly which measures the extent of anticoagulation. 

The therapeutic range for most patients is between 2.5 and 3.5. A higher number means a greater tendency nor to clot. This test is called an IN. This is an internationally recognized test that expresses a ratio between the patients’ clotting time to a normal clotting time. 

Another test used is called a prothrombin time test. You should have your INR done a day or two before seeing your dentist. If the IN is less chan 3.5 it will be safe to have your teeth cleaned. Routine restorative dental procedures like dental injections, fillings and caps cause little or no bleeding so the INR is less relevant. 

On the other hand dental extractions or having a periodontal surgical procedure becomes a risk for the patient on anti coagulants. 

An INR of 3.0 may be safe depending on the size of the surgical area. For example having one single rooted tooth extracted will not usually require changing your medication if your IN is 3.0 On the other hand having multiple extractions often will require a change downward in the INR and chis must be done by consultation with your cardiologist.

There are other medications that may affect your mouth. Blood pressure medications called calcium channel blockers may cause an enlargement of the gum tissue especially if gingivitis is present. This occurs in 40% of the patients taking these drugs. Procardia and Norvasc are 2 examples of chis type of medication. 

Dilantin, a drug used for seizures, also causes significantgum enlargement. Cyclosporine is a drug used for immuno suppression. 

Patients who have had organs transplanted such as a kidney or liver usually take this drug which also causes enlargement of the gum tissue. Excellent oral hygiene and excellent periodontal health will minimize the enlargement. 

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This is important since the enlarged gingiva will retain more plaque and the generalized inflamation resulting from the plaque retention may endanger the transplanted organ or contribute to other diseases. 

Patients taking birth control pills need to inform their dentist since taking an antibiotic will reduce the effectiveness of the birth control pill. Dentists often prescribe antibiotics.

Since many medications can affect your dental health it is wise to inform the dentist of any drugs you are taking whether they are prescribed or over the counter. If you take drugs like cocaine or non prescription steroids tell your dentist. 

Drugs the dentist may prescribe or procedures the dentist may do may be unsafe for you. Remember the information is confidential.

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