While there are several causes for dental anxiety, research indicates that the most common cause is direct experiences the person has had in the past.  My own 25 years of treating patients with dental anxieties bears this out.  In fact, my own experiences as a child patient support this! 

I recently saw a patient who had awful dental experiences as a child.  As we discussed her experiences further, she came to realize that in her case, it wasn’t the treatment itself that created her anxiety but HOW she was treated by the dentist and staff.

Research indicates that while an upcoming dental procedure can cause anxiety, the manner of the dentist and staff is very important.  Dentists who were considered impersonal, uncaring, uninterested or “cold” were found to produce high dental anxiety among patients even if the dental procedure was not painful.

For this reason, choosing a dentist can be a daunting task.  How do you know that the dentist you choose will be receptive to your concerns?

Our dental practice has evolved into one that caters to those persons with significant concerns regarding dental care.  It initially started with anxious patients entering our practice by chance but as our reputation for success has spread, we now have therapists who refer their patients directly to our office.

I don’t see our approach to patient care as some sort of magic trick.  It simply begins with taking the time upfront to listen to our patients’ concerns and developing trusting adult-to-adult relationships.  I like how one patient described our office as a “safe” place.

While real and sincere “TLC” is important, I would be remiss if I didn’t touch on technology.  It is wonderful how dentistry has changed and improved over the years.  Technology allows us to do great dentistry in a comfortable and more efficient manner.

Lastly, I am supported by what I honestly feel is the best staff around.  They have a caring, empathic nature which adds to our success and the betterment of our patients’ health and well-being.

It’s no wonder that we have many patients who state that they are no longer afraid to come to the dentist.  It’s awesome!

mercury amalgam fillings

Every once in a while, I have a patient ask me if they should have all of their amalgams (dental mercury fillings) replaced.

Dental amalgam is an alloy made up of liquid mercury and a powdered mixture of silver, tin and copper.  Most of the filling composition is elemental mercury (approximately 50%).  This type of mercury releases mercury vapor and has been the cause for concern with amalgam fillings.  It was first used in the 19^th century in France.  For many years it was the dental material of choice because of its strength, workability and low cost. 

Over the years, there have been claims that the mercury in dental amalgam leaches out, enters the body and contributes to a wide variety of ailments such as depression, epilepsy, multiple sclerosis, lupus, leukemia and more.  While dental amalgam does release mercury, in the words of 16th century Swiss physician Paracelsus, “The dose makes the poison.”

According to Dr. Rod Mackert, professor of dental materials at the Medical College of Georgia School of Dentistry Department of Oral Rehabilitation, “a person would need between 265 and 310 amalgam fillings before even slight symptoms of mercury toxicity could be felt.”  A person with seven fillings, which is average, absorbs only about one microgram of mercury daily. About six micrograms are already absorbed daily from food, water and air, according to the Environmental Protection Agency. 

In other words, people are exposed to more total mercury from food, water and air than from the minuscule amounts of mercury vapor generated from amalgam fillings.  The American Dental Association (ADA) continues to support the use of amalgam as “a safe restorative option for both children and adults.”  In 2009, the U.S. Food and Drug Administration (FDA) deemed amalgam fillings a “safe and effective treatment option for the general population.”  

Granted, in Europe, Denmark and Sweden have completely banned the use of dental amalgam.  Germany and Norway have restricted its use.  Note that this is not because of safety concerns for amalgam itself but as a very small part of an overall effort to decrease environmental levels of mercury.  In fact, the European Union also continues to support amalgam as a safe restorative material.

Still, the reality is that amalgam use in both the United States and Europe continues to decrease.  Look for my next article where I will tell you why I haven’t placed a dental amalgam in over 15 years.

While there are numerous causes of headaches, few people make the connection that teeth grinding can cause headaches, specifically muscle tension headaches.  

Many times, it comes down to an unbalanced bite or one that is not in harmony with the proper position of the jaw joints (TMJ).  This misalignment causes the jaw muscles to become hyperactive and just like any other muscle that is overworked, they eventually become fatigued and sore.  The result is that we complain of a headache. 

It takes a trained dentist to determine if in fact the bite is in harmony with the jaw joints or it is not. 

It may have everything or nothing to do with how your teeth look.  I’ve seen what appeared to be a rather nice smile but the bite was off by a mile… without the patient even realizing it. 

Interestingly enough, headaches are just one of many signs and symptoms of a bad bite.  Other signs include worn teeth, loose teeth, chipped teeth or even teeth that have moved over time.  I have even seen patients with sensitive teeth who thought they needed a root canal, only to find that their bite was the culprit.  The bite was adjusted and the pain went away. 

For many patients the key is in balancing the bite with the proper position of the jaw joints.  There are several ways to do this depending on the severity of the bite discrepancy.  Only a comprehensive bite analysis will reveal the best route to take. 

Patients can typically find some relief with custom made bite guards.  However, it is important to note that these bite guards must be fitted properly or they can cause more harm than good.  And regardless, even a custom-made bite guard won’t correct the underlying problem.  In fact problems can still worsen. 

The first step in correcting the problem is a comprehensive examination and bite analysis by a dentist trained in this discipline to determine if indeed an unbalanced bite may be causing headaches.

There’s no escaping the fact that the health of your mouth affects the health of your entire body.  As my staff and I have professed to our patients, research indeed indicates a link between dental disease and your systemic health and in particular four of the top ten leading causes for death according to the Centers for Disease Control.  These include heart disease, stroke, diabetes and Alzheimer’s disease. 

Your mouth houses a lot of bacteria, which cause cavities and periodontal (gum) disease.  If you have inadequate dental health, the gum around each tooth can be weakened and thinned, thus allowing bacteria to seep from the mouth and into your body.  The bacteria then settles in susceptible areas of the body including your heart and blood vessels and leads to what can be pretty major problems.

 Woman’s Day is but one of several magazines that have had articles on this important topic.  Some of our new patients are coming to us specifically because of concerns they have for their overall health and not just their dental health.  

For example, we have known for many years that diabetics are three times more susceptible to periodontal (gum) disease.  But research is now showing that periodontal (gum) disease increases one’s susceptibility to diabetes!  It’s a vicious cycle. 

We pay particular attention to the “oral-systemic connection” and when red flags come up regarding a patient’s periodontal (gum) health, we may bring the patient’s physician into the loop just to make sure there aren’t any other systemic problems going on. 

So when you are brushing and flossing, you are not only saving your teeth, you may very well be saving your life!

But as usual, it’s only when someone famous gets a disease that the world finally notices. 

While most Americans probably never even heard of this type of cancer, the reality of it is that the incidence of this disease is growing at an alarming rate. 

According to the American Cancer Society, oral cancer occurs about as frequently as leukemia.  More people die of oral cancer than from melanoma or cervical cancer. 

According to the American Dental Association, the incidence of oral cancer in the under-40 population has grown almost five-fold, with many patients with no known risk factor.

 Going back to my dental school days (more years ago than I care to admit), we had always thought that it was the people who either smoked too much or drank too much alcohol who got oral cancer.  As a side note, Michael Douglas apparently indulged in both smoking and drinking.

 Today, research is showing us that the increase in the disease may be attributable to the human papillomavirus (HPV).  In fact, according to the Centers for Disease Control (CDC), 25% of mouth and 35% of throat cancers may be linked to HPV.  And although the topic may be uncomfortable, what you might not realize is that HPV is a sexually-transmitted virus.  In fact, according to the Centers for Diseased Control (CDC), HPV is the most common sexually transmitted virus in the United States.

 According to Brian Hill, the executive director of the Oral Cancer Foundation “Social and sexual behaviors have changed.  Oral sex is more common.  The virus is spreading, especially among young people because sexual contact is more common, that this virus is not only ubiquitous in our society, but the mechanism of transfer is simple.”

 But still, 25% of those who develop oral cancer do not use tobacco or alcohol and have no other lifestyle risk factors.

 What makes this disease so dangerous is that unless someone (like your dentist) is actually examining and looking for it, oral cancer often goes unnoticed until the later stages.  Why?  Because often there are no symptoms in the early stages.

 Sadly, according to a study by the CDC in 2008, less than 30% of adults aged 18 years orolder had ever had an oral cancer examination. 

 Finding these abnormalities early strongly improves prognosis.  It is the key to success.  In our office, not only do we perform oral cancer screenings on each adult patient, we also use a specialized rinse and light that makes abnormal tissue stand out.  It’s called Vizilite Plus and you can find more information on it at www.vizilite.com.  It’s painless, fast and may save your life.

 Let me leave you with this:  Only 57% of all diagnosed oral cancer patients will be alive five years after their diagnosis.  I strongly believe that this is because of delayed diagnosis.  Make sure you have an oral cancer screening when you visit your dentist!

Let’s see if you remember some of your high school chemistry.  pH is the measure of acidity or basicity of a solution.  Pure water is neutral and has a pH of 7.0.  Solutions with a pH less than 7.0 are considered acidic.  Solutions with a pH higher than 7.0 are considered basic or alkaline. 

The lower the number the more acidic a solution is.  The important thing to understand here is that when the pH of a solution on a tooth surface is less than 5.5, tooth surface damage occurs. 

Gatorade, for example, has a pH of 3.3.  In fact, research by a British dentist, Dr. Milosevic, found the pH levels of sports drinks ranged from approximately 4.5 to 2.4. 

Why do sports drinks have such a high acid content to begin with?  My understanding is that the acidity improves the taste and increases the shelf life of the products. 

But the acid components are just one part of the equation.  Sports drinks can also have a rather high amount of refined sugar.  Any beverage that has high acid content can weaken the enamel.  Sugar can worsen the situation by encouraging bacterial growth.  So acid is bad, sugar is bad and many of these sports drinks have both.  Together, they cause tooth decay. 

Realize that there are a lot of liquids that we consume that contain acid – sodas, sports drinks, wine.  So why aren’t everyone’s teeth just rotting away?  Your saliva contains minerals that naturally re-mineralize or re-harden teeth after they have been exposed to acid solutions.  But in the presence of a significant exposure to acid, there is only so much repair that saliva can do. 

Fortunately, there are sports drinks out there that don’t have so much sugar and aren’t so acidic.  One that I have personally used is HEED made by Hammer Nutrition.  This company has been around since 1987, developing a wide range of nutrition products for the endurance athlete. 

For sweeteners, HEED contains Xylitol and Stevia, which are both healthier alternatives to the refined sugars and/or artificial sweeteners found in most sports drinks.  In addition, HEED doesn’t contain the high amounts of citric acid found in most sports drinks.  The result of these modifications, according to Steve Born at Hammer Nutrition, is that the pH of HEED is 7.04 – almost neutral.   Pretty impressive. 

So what exactly is Xylitol and Stevia?  Xylitol and Stevia are both natural sweeteners.  Xylitol can be found in a variety of fibrous fruits and vegetables.  The human body even naturally produces some Xylitol via normal metabolic processes.  Stevia comes from a plant found in subtropical and tropical Central and South America.

From a dental standpoint, Xylitol and Stevia are very “tooth-friendly”.  Remember, bacteria in the mouth love refined sugars.  They metabolize it to create acids that cause cavities.  On the other hand, oral bacteria are unable to ferment Xylitol and Stevia. 

The result is that the number of cavity-causing bacteria is remarkably reduced, no acid is created, and thus no cavities are formed. 

“Tooth-friendly” sports drinks can be found in almost any triathlon, running and cycling store. But for those people who continue to drink sports drinks that are high in refined sugar and acid components, There are things you can do to at least reduce their risk of damaging your teeth. 

First, use the sports drink for its intended purpose during and after extended exercise, training or competition, and not as an everyday beverage. Second, one of the most important factors is how long one holds the liquid in their mouth.  The longer the drink sits in the mouth, the more damage it will cause. Third, there are some toothpastes on the market that are designed to re-mineralize teeth that have been exposed to liquids that contain acid such as wine, soda and sports drinks.Lastly, research suggests that brushing your teeth immediately after consuming a sports beverage can actually make tooth erosion matters worse. 

 Better to rinse with water to dilute the acid and then wait 30 minutes before brushing your teeth to allow softened enamel to naturally re-harden via the minerals in saliva.

Q: Dr. Van Gurp, I understand that today’s focus is on hormones and women’s oral health.

Dr. Van Gurp: Women have an increased propensity for oral health problems because of the hormonal changes that take place throughout their lives.

In general, these hormonal changes affect both the blood supply to the gum tissue and the body’s response to the toxins (poisons) that result from plaque build up.  As a consequence of these changes, women are more susceptible to the development of periodontal disease at certain stages of their lives, as well as to other oral health problems.

Q: Are there specific times in a woman’s life that one should be particularly concerned about these hormonal changes and their dental health?

Dr. Van Gurp: Actually, it is not confined to one specific point in time but more like several situations in the course of a woman’s life where there is an increased sensitivity to oral health problems.  They are: puberty, the monthly menstrual cycle, during the use of oral contraceptives, pregnancy and relative to menopause.

Q: Let’s hit this one at a time.  Tell me first about the effects of puberty.

Dr. Van Gurp: The body’s production of the hormones estrogen and progesterone increases dramatically during puberty.

The result of this can be an increase in blood flow to the gums.  It can also alter the manner in which the gum tissue reacts to bacterial plaque.  So what one might notice is gum tissue that is more red, tender and swollen.  And you are more likely going to see bleeding of the gums during brushing and flossing.

The presence of plaque on the teeth can worsen this response. This underscores the importance of good brushing and flossing habits learned at an early age, combined with periodic dental visits and cleanings. The tendency for inflammation and swelling associated with puberty appears to decrease as a young woman gets older.

Q: Let’s move on to the monthly menstrual cycle.  What kind of oral health concerns do you have there?

Dr. Van Gurp: Hormonal fluctuations during the monthly menstrual cycle can have a significant effect on the oral cavity.  Usually, these changes take place a few days prior to menstruation when progesterone levels are high.

Q: What does the progesterone do to the gums?

Dr. Van Gurp: Progesterone causes dilation of blood vessels, which in turn results in inflammation and thus obstructs the normal repair mechanisms of the gums.  So as with the puberty signs above, one finds red, swollen and tender gums that may bleed easily.  Note that if there is pre-existing periodontal disease present, these changes can be severe.

Q: What if the condition does doesn’t get better?

Dr. Van Gurp: If the condition doesn’t resolve soon after menstruation, you may want to consult your dentist.  Women that experience changes in their gums during their menstrual cycle may be more susceptible to a condition called Rapid Progressive Periodontitis.  This rather aggressive form of periodontal (gum) disease can cause rapid bone loss around the teeth.

Q: Are there other problems aside from periodontal disease that can occur during the menstrual cycle?

Dr. Van Gurp: A few days prior to the menstrual cycle, some women may develop cold sores on the lips or aphthous ulcers on the soft tissue inside the mouth.  Both of these will typically heal themselves within a few weeks.  During that two week period, topical ointments can be applied to relieve the discomfort.

Some women may also notice swelling of the salivary glands – in particular the parotid gland on the cheeks.  If the swelling is related to the hormonal changes experienced during the menstrual cycle, the changes are temporary and should be reversed within a few days.

The key to resolving the gum disease-related changes is good oral hygiene to remove any plaque that is present on the teeth.

Q: How do birth control pills affect a woman’s dental health?

Dr. Van Gurp: Women who take certain oral contraceptives that contain progesterone may experience inflamed gum tissue due to the body’s exaggerated reaction to toxins produced by bacterial plaque.  These changes are most pronounced during the first few months of taking birth control pills.

As a side note, women who take oral contraceptives should also bear in mind that antibiotics can reduce the effectiveness of birth control pills.

Q: I am seeing a pattern here.  Increased levels of certain hormones and in particular progesterone can lead to inflammation, the body’s exaggerated response to the toxins or poisons produced by plaque on the teeth and gums.  The result may be significant gum disease.

Dr. Van Gurp: That is correct.  And this also holds true during pregnancy when there are significantly elevated levels of estrogen and progesterone. I cannot emphasize enough the importance of good oral hygiene during pregnancy. In the presence of plaque, women who are pregnant are more prone to gum inflammation and periodontal disease. This appears to be more likely during the second through eight month of pregnancy.

In addition, studies show that women with periodontal disease may be at risk for pre-term, low birth-weight babies.

Q: What kind of oral changes take place due to menopause?

Dr. Van Gurp: There are a number of changes that can take place in the mouth as a result of menopause.  As estrogen levels decrease during menopause, women can find themselves at a greater risk for osteoporosis and periodontal disease that includes bone loss from around the teeth.

Jaw bones exhibiting osteoporosis may be unsuitable for dental implants and/or conventional prosthetic devices.  Other oral changes include altered taste, a burning sensation in the mouth and an increased sensitivity to hot and cold foods and drinks.

In addition, women might find that they do not produce as much saliva in their mouths as they did prior to menopause.  The result is a dry mouth, which in turn can lead to periodontal disease and dental decay because insufficient saliva is available to cleanse the mouth by neutralizing the acids and toxins produced by bacterial plaque on the teeth.

Preventing or at least decreasing the likelihood of the dental problems discussed above comes down to good oral hygiene – brushing and flossing.  See a dentist on a regular basis for cleaning and exams. And watch your diet. Eat a well balanced diet and avoid sugary snacks.

Q: I think that most parents recognize that fluoride is a proven means to protect the dental health of children primarily by making teeth more resistant to cavities. But today, you wanted to talk about how fluoride can benefit adults as well.

Dr. Van Gurp: That’s right. Research now indicates that everyone – children and adults – can benefit from fluoride.

Q: Now, when you talk about fluoride, are you focusing on fluoride in our community water supply, in toothpaste or are you talking about additional supplementation?

Dr. Van Gurp: It depends. For the healthy individual without a history of or any current dental problems, fluoridated water and toothpaste may be enough. But for the dental patient who has issues with cavities, sensitive teeth and/or gum disease, fluoride supplementation may be prudent.

Q: Most everyone knows that fluoride helps to prevent cavities in younger children because their teeth are still forming. How does fluoride help the adult patient whose teeth are already formed?

Dr. Van Gurp: The positive effects of fluoride against cavities in adults are twofold. First, topically, in areas where a cavity is just starting to form, fluoride can cause re-mineralization or repair of the tooth. It may prevent the cavity from getting bigger or even reverse the process.

Secondly, systemic fluoride in one’s saliva provides a reservoir of fluoride that can infiltrate the tooth surface to prevent the formation of cavities.

Additionally, no other agents have been so thoroughly reviewed and found safe and effective for the prevention of tooth decay.

Q: What if I already have caps or crowns on my teeth? Don’t crowns protect my teeth from new cavities?

Dr. Van Gurp: A common misconception. Even if you have crowns on some or all of your teeth, cavities can still form at the margin of the crown — where the crown meets the tooth.
And recurring decay on teeth that are supporting a crown or a bridge threatens the entire restoration and can require costly replacement. Fluoride can help to protect these critical areas and help protect the investment that patients have already made in crowns and bridges.

Q: What about the roots of the teeth? Are they more or less susceptible to cavities?

Dr. Van Gurp: When it comes to protection from cavities in adults, we have to take into account that a lot of adults have gum recession, where the gum has pulled away from the teeth thus exposing the roots.

This can be a problem in two significant ways. First, the roots are not nearly as mineralized as the natural crowns of the teeth. In other words, the roots are not as strong and are more susceptible to cavities. Thus, cavities on a root surface may progress rapidly. As with the crowns of the teeth, fluoride can also be incorporated into the roots of the teeth, making them stronger and more resistant to decay.

Q: How does fluoride help those people with sensitive teeth?

Dr. Van Gurp: That’s the second issue related to gum recession. Exposed roots can be very sensitive, particularly to cold. Microscopically, think of the roots as being porous with channels or tubules that lead to the nerve of the tooth. Studies show that by regularly treating these areas with stannous fluoride, the pores of the tubules are filled with fluoride ions.
The fluoride that does penetrate the pores (tubules) serves as a catalyst that helps build strong and resistant mineral in dentin root surfaces and within the tubules. That serves to block or inhibit the stimuli from reaching the nerves and causing sensitivity.

Q: I thought that fluoride would only help with the teeth. How can it help someone who has gum disease?

Dr. Van Gurp: Studies, even dating back to the mid 1980’s, show that fluoride supplementation can decrease the levels of bacteria that cause not only cavities but also gum disease.
Fluoride does so by altering bacterial metabolism at low concentrations and actually killing the bacteria at high concentrations.

Q: What kind of fluoride supplementation are you recommending? Can an adult basically use the same type of fluoride as children?

Dr. Van Gurp: Remember that for all patients, I recommend using a fluoride containing toothpaste recommended by the American Dental Association. Fluoride in one’s drinking water is also a plus. But for those who qualify, I do recommend fluoride supplementation.

As for using the same type of fluoride in adults as one would use for children, not necessarily.

For children, since we are focusing for the most part on cavity prevention, we have the option to use stannous fluoride, sodium fluoride or sodium monofluorophosphate. These are all indicated for tooth decay.

For adults, we only use stannous fluoride, because it is the only one of the three fluorides above that help to treat all three problems we discussed – cavities, sensitive teeth and gum disease.

In treating adults, we recommend a two-prong approach. At hygiene appointments, we do a treatment that involves a higher concentration of fluoride. This may involve a swish or the application of a fluoride varnish. This acts as an initial boost.

For many of our patients, we then recommend the use of a fluoride rinse on a daily basis. This is more the maintenance phase, which keeps the fluoride levels up. This rinse also provides antimicrobial activity for up to 8 hours.

Q: This sounds like the triple force for fluoride as it can be a benefit for those patients who are concerned about any or all three of the problems you’ve discussed –cavities, gum disease and sensitive teeth.

Dr. Van Gurp: That’s right.

Dr. Richard Van Gurp, a Charlotte area dentist and regional leader in Dental Care and Technology, maintains a general dental practice in Charlotte, North Carolina at the Belle Grove Office Park at the Arboretum. He can be contacted at 704-542-2884.