Below is a great article we found on Inside Dentistry about probiotics in dentistry. Dr. Dahlkemper is using this new form of treatment in her office to help alleviate patients prone to infection in the gums and teeth. It's easy to use, simply dissolve the pill on your tongue like a mint once a day! To find out more about its use in our office go to http://www.mycharlestonscdentist.com/Evora-Pro-Biotic.asp.

November 1st - 4th Annual Candy Buy Back - Save your candy after trick-or-treating and we will buy it back from you and donate it to our Troops Overseas - 3:30 - 6PM at the office!

November 3rd - Light the Night Walk for the Lymphoma & Leukemia Society - 7PM at the Mt. Pleasant Waterfront Park

Cracked Tooth Syndrome

Gum disease---or periodontal disease---is an infection of the bone and gum tissues caused by an accumulation of plaque and bacteria. Many symptoms of gum disease do not appear (or asymptomatic) until advanced stages of the disease, but indications may include persistent bad breath odor, sores or pus in between teeth, loose teeth or separation and movement in your regular bite, swollen gums, and bleeding when brushing or flossing. Although surgery is one option for combating gum disease, non-surgical treatments can be employed to help fight periodontal disease, such as Scaling and Root Planning (SRP).

SRP can be done in your general dentist's office by the hygienist and can save you thousands of dollars. However, gum disease is NOT curable, but can be maintained and its affects can be stopped and somewhat reversed. It is because of this reason that it is important that after your SRP procedure(s) that you see your dentist every 2-4 months for periodontal (gum) maintenance depending on the severity of the infection.   

Why can't I have a normal cleaning as opposed to an SRP?

Since gum disease is a chronic disease (meaning it gets worse over time) the bone and its ligaments around the teeth begin to deteriorate as the bacterial infection gets worse and worse. As the bone and ligaments deteriorate your teeth become loose and can start to shift, thus causing movement in your bite and eventually leading to tooth loss. A regular healthy mouth cleaning (prophy) does not address the infection, it is purely a preventive procedure and since you already have the infection you are then beyond preventive care. It's kind of like having a dirty car and polishing the car before it is clean. All you are doing is polishing the dirty onto the car and allowing the dirt to do more damage. 

Can I have a relapse of infection? If so, what do I do?

Yes, every patient with gum disease can relapse, because the disease is NON-CURABLE. Many patients have the initial SRP procedure and then quit treatment thinking they are cured; however, should a patient fail to maintain their gum maintenance the infection can return and should the infection come back worse surgery might be the next option. Sometimes when caught early enough the patient can be stabilized with another round of SRPs, but must maintain the gum maintenance appointments required to keep the infection at bay. 

Can't I just take an antibiotic to cure it?

Unfortunately, there is no antibiotic available to cure this disease. Scientists are unable to pin-point the direct cause of gum disease, therefore they are having a hard time developing an antibiotic cure-all. They have, however, developed an antibiotic called Arestin that when placed during the SRP procedure can help fight the bacterial infection that an SRP might leave behind.

So if you are experiencing any of the following symptoms:

·     persistent bad breath odor,

·     sores or pus in between teeth,

·     loose teeth or separation and movement in your regular bite,

·     swollen gums, and/or

·     bleeding when brushing or flossing.

Call our office today for a complete comprehensive exam and x-ray!

843-884-6166

Why is pH so important?

pH is a measure of acidity.  The lower the pH, the more acidic something is, and the higher the pH, the more alkaline something is.  The pH scale goes from 1-14, 1 being the most acidic, 14 being the most alkaline, and 7 being neutral (like most water).

For years we have focused on the role of sugar in causing cavities.  While we know that sugar feeds the bacteria that produce acids, which in turn causes cavities, it is a prolonged acidic oral pH that is responsible for promoting these cavity-causing bacteria, and an acidic pH that is responsible for the demineralization of the enamel required for cavities to occur.

It breaks down like this. . .

Prolonged low pH in the mouth = overgrowth of cavity causing bacteria = death of healthy bacteria = cavity infection = CAVITY 

If you want to stop the end result in this chain, you have to intercept the lowering of the pH, which you can do either by avoiding acidic and sugary food/drink and/or by using alkaline and neutralizing dental products.

Conversely, if we can keep the pH of the mouth neutral between meals, we can maintain health.  If the caries infection already exists, we can use alkaline pH products to promote the re-growth of healthy bacteria.

Advice from Dr. Dahlkemper

Limit not only sugary/carbohydrate containing items in your diet, but also even non-sugar containing acidic beverages (i.e. diet soda, coffee, tea, sparkling water, alcohol, sports drinks, energy drinks).  It is these items in the diet that can cause intense or long-lasting acidic pH in the mouth that then causes healthy bacteria to die and cavity-causing bacteria to thrive, thus leading to a caries infection. If you decide to drink any of these types of drinks brush or swish with water immediately after.

• Drink more water! Water is a natural pH stabilizer for your mouth.
• Brush and floss before you go to sleep. This prevents food from being broken down and used to feed the cavity-causing bacteria allowing them to work double-time on your teeth while you are sleeping and your mouth is at its most vulnerable.
• Have your teeth cleaned every 3-4 months a year along with a periodic dental exam and bitewing x-rays 2 times a year. That old adage: “Visit the dentist 2 times a year” is outdated and never clinically proven to be effective in helping stop infection.
• Consider the acidity (pH) of the dental products you are using.  Do they neutralize your mouth?  Know your pH.  Don't just brush and floss. . . neutralize!

pH and cavities

• Studies have shown that a prolonged acidic (low pH) oral environment can cause an overgrowth of acidic bacteria
• Acidic bacteria cause tooth decay
• Keeping a neutral or alkaline pH in the mouth can prevent acidic bacterial growth
• New dental products with alkaline pH, xylitol, and fluoride are now available

Oral Health has been Associated with Some Respiratory Diseases

Respiratory diseases account for one in six deaths in the United States, making them collectively the third most common killer of Americans.¹ A growing body of research has established an association between oral health and some respiratory diseases. Three systematic literature reviews in recent years suggest that the oral cavity may provide a reservoir for pulmonary pathogens.^2-4 Furthermore, all three reviews concluded that oral hygiene procedures lower the risk of lung disease among elderly institutionalized individuals. One review presented evidence of the highest rating (I-A) in support of oropharyngeal decontamination to reduce the occurrence or progression of respiratory diseases.² Another review pointed to strong evidence that mechanical oral hygiene decreases mortality risk from pneumonia; indeed approximately one in 10 cases of death from pneumonia among dependent elderly patients may be prevented by such measures.⁴ The third review suggested that oral interventions may lower the incidence of respiratory diseases among the institutionalized elderly at highest risk.³

Although the link has not been proven to be causal, there are two mechanisms that could explain such a relationship. First, dental plaque biofilm harbors both periodontal and pulmonary pathogens.1 That is of particular importance for patients in intensive care who are mechanically ventilated. Mechanical ventilation has a strong association with pneumonia, and recent work has demonstrated that bacterial isolates from dental plaque are genetically indistinguishable from those cultured from bronchoalveolar lavage of ventilated patients.5 Secondly, enzymes associated with periodontal disease and the pathogens that cause it may facilitate adherence of respiratory pathogens to airways while also destroying protective salivary pellicles, in turn reducing non-specific host defense mechanisms.2 In addition, cytokines released from the periodontium and carried with aspirated saliva of high-risk patients could upregulate expression of mucosal surface adhesion receptors, further potentiating pathogen colonization.2

Oral Hygiene for At-Risk Patients

Specific interventions shown to reduce nosocomial respiratory tract infections include frequent tooth brushing and the preoperative use of 0.12% or 0.2% chlorhexidine mouthrinse or gel.4 This illustrates the potential for elevated dental hygiene care to reduce the frequency of respiratory infections among patients most at risk for respiratory diseases. Such patients at risk, including smokers and patients with current acute or chronic respiratory conditions such as chronic obstructive pulmonary disease (COPD), should be considered for more frequent and intensive dental hygiene care. Other important risk factors for respiratory disease, particularly pneumonia, include female gender, advanced age, other diseases (i.e., diabetes or congestive heart failure), and immune suppression (i.e., among people with HIV or undergoing cancer therapy).1 It is worth noting that smoking is a risk factor common to both COPD and periodontitis.6

It has been established that oral hygiene intervention significantly reduces the occurrence of pneumonia in institutionalized subjects.2,3 Thus, dental hygienists who complete a thorough oral health assessment of their patients most at risk for respiratory diseases are well positioned to identify and address threats to good oral health, and potentially to reduce both the initiation and severity of common respiratory infections.1 Heightened oral hygiene care involving higher frequency visits is therefore warranted for at-risk patients. However, because aspiration of bacteria-bearing particulates from the mouth is especially dangerous in this group, procedures may need to be tailored. For example, debridement with ultrasonic instrumentation should be accompanied by high volume evacuation.6

Teamwork

The association between oral and respiratory health is another example of how dental care may effectively extend well beyond the mouth. It shows how critical a role dental hygienists may play beyond their traditional arena of care by working with caregivers, nurses, and other healthcare professionals to increase not only oral health, but general health as well.1

References

1. Gluch JI. Exploring the connection. The relationship between respiratory diseases and oral health. Dimensions Dent Hyg 2009;7(10):54-57.
2. Azarpazhooh A, Leake JL. Systematic review of the association between respiratory diseases and oral health. J Periodontol 2006;77(9):1465- 1482.
3. Scannapieco FA, Bush RB, Paju S. Associations between periodontal disease and risk for nosocomial bacterial pneumonia and chronic obstructive pulmonary disease. A systematic review. Ann Periodontol 2003;8(1):54-69.
4. Sjogren P, Nilsson E, Forsell M, Johansson O, Hoogstraate J. A systematic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: effect estimates and methodological quality of randomized controlled trials. J Am Geriatr Soc 2008;56(11):2124-2130.
5. Heo SM, Haase EM, Lesse AJ, Gill SR, Scannapieco FA. Genetic relationships between respiratory pathogens isolated from dental plaque and bronchoalveolar lavage fluid from patients in the intensive care unit undergoing mechanical ventilation. Clin Infect Dis 2008;47(12):1562-1570.
6. Agado B, Bowen DM. Does the link between COPD and periodontitis affect dental hygiene treatment? Access 2009;23(4):19-21.

What is Diagnodent?

Diagnodent is a non-invasive, painless tool used for detecting tooth decay that is not yet visible and would otherwise be undiagnosed by conventional methods alone. Leaders in the field of dental research agree that, when used by themselves, the traditional methods of detecting tooth decay are inadequate and outdated for modern dentistry. With the flouridation of water and improved oral hygiene standards, the very nature of tooth decay has changed. Due to these factors, most of our patients have harder and more resistant tooth enamel, which can conceal even aggressive decay if it is under the tooth surface.

How Does Diagnodent Work?

Diagnodent works by scanning your teeth to measure fluorescence within your tooth structure. Healthy teeth will have little or no fluorescence. Teeth that have decay present will have higher levels of fluorescence, which are proportionate to how extensive the decay is. Diagnodent translates these fluorescence readings into a digital numeric output. Also, these changes in fluorescence and numeric value are emitted as an audio signal which signals the presence of decay as it goes up in tone.

Q: Does it hurt?

A: No! DIAGNOdent is completely painless. It’s energy level similar to that of a laser pointer, the laser beam is harmless to surrounding tissues.

Q: What are the shortcomings of the traditional dental techniques like probing and x-ray imaging?

A: Believe it or not, as much as 50% of tooth decay may go undetected by traditional dental methods of probing and other diagnostic techniques.

Q: How long has this technology been around?

A: While the device has been in use in Europe for several years, the FDA has recently approved the use of the cavity-detecting laser for use by dentists in the U.S.

Q: Where does most tooth decay start today?

A: Today most tooth decay starts in the hard-to-see valleys and canyon-like anatomy of the tooth surface.

Q: Why are these pit and valley cavities more important to detect today than in the past?

A: In the past tooth decay predominated in between teeth. With the widespread use of fluoride, the very nature of tooth decay has changed. The outer surfaces of teeth are strengthened and more resistant. Today the pit and valley cavities are more prevalent than cavities in between teeth.

Q: Why can’t traditional methods like x-rays see these pit and valley cavities?

A: Pit and valley cavities are traditionally the most difficult to detect using x-rays due to the direction the images are taken from. Images are taken from the side of the tooth, which essentially hides the cavity from the dentists view.

Q: If DIAGNOdent is good at finding pit and fissure cavities do I still need x-rays?

A: Yes, x-ray imaging is an indispensable diagnostic tool for dentistry. X-rays and DIAGNOdent complement each other. X-rays are good at finding cavities in between teeth and on the roots. DIAGNOdent is good at find cavities on the tooth’s biting surface.

Q: If you can’t see it with your naked eye then why should one be concerned?

A: An almost undetectable area of decay can aggressively penetrate inward towards the soft surfaces of the tooth and literally destroy the tooth from the inside out. This can happen before a cavity is even visible to the naked eye.

Q: Why can’t traditional methods like the dental probe find these pit and valley cavities?

A: This type of decay can make diagnosis with traditional methods difficult because the outer tooth surface often appears to be intact and the probe may be too large to detect the cavity.

Q: How does DIAGNOdent work?

A: DIAGNOdent is first calibrated to your unique tooth structure by scanning a cleaned tooth surface with a harmless laser beam. After calibration a team member will gently scan your teeth. A small countertop unit emits an audio signal and registers a digital read-out, which identifies cavities developing below the surface - the higher the amount of fluorescence detected by the machine, the greater the degree of decay within the tooth.

Q: What is the benefit to me?

A: Because the decay is detected earlier, the number of dental procedures - and hence, the cost - can often be reduced. It’s a great way to keep little problems from becoming big problems.

Q: How long does the DIAGNOdent process take?

A: A few minutes are all it takes to scan your entire mouth.

Q: How much does it cost?

A: Dr. Thurman uses the DIAGNOdent laser as a routine part of exams and there is no additional fee associated with the scan.

Q: What is the DIAGNOdent actually measuring?

A: The DIAGNOdent measures laser fluorescence within the tooth structure. As the incident laser light is propagated into the site, two-way handpiece optics allows the unit to simultaneously quantify the reflected laser light energy. At the specific wavelength that the DIAGNOdent laser operates, clean healthy tooth structure exhibits little or no fluorescence, resulting in very low scale readings on the display. However, carious tooth structure will exhibit fluorescence, proportionate to the degree of caries, resulting in elevated scale readings on the display.

Q: Can DIAGNOdent read caries under an existing amalgam?

A: If there is caries at the margin, it will give an accurate reading; however if the caries is under the floor of the amalgam the reading will not be accurate.

Q: Can DIAGNOdent be used on both primary and permanent teeth?

A: Studies have shown the unit is equally accurate in both primary and permanent teeth.

Q: As the device is a laser, is protective eye wear required?

A: No. The device is harmless when used as directed.

ViziLite Plus as part of a comprehensive oral screening

Oral cancer is one of the most curable diseases when it's caught early. That's why the ViziLite Plus exam has been developed. ViziLite Plus uses technology that has proven successful in identifying soft tissue abnormalities in other areas of the body. A ViziLite Plus exam is particularly important if you are at increased risk for developing oral cancer.

The ViziLite Plus exam can help your dentist or hygienist identify abnormal tissue, that might develop into oral cancer.

An annual ViziLite Plus exam, in combination with a regular visual examination, provides a comprehensive oral screening procedure for patients at increased risk for oral cancer. The ViziLite Plus exam is painless and fast, and could help save your life.

ViziLite Plus is performed immediately following yearly visual examinations.

Importance of Early Detection

Early detection is the key to reducing the devastating impact of oral cancer on victims and their families. Annual oral cancer screening of patients at increased risk for oral cancer, patients age 18 and older, and tobacco users of any age, is the only way to achieve the early detection of oral cancer necessary to reduce the death rate of oral cancer - a death rate that has remained unchanged for more than 40 years.

Doesn't my dentist already do a cancer screening?

Yes, your dentist does check your neck and oral tissues for lumps, red or white patches or recurring sore areas. But typically, these techniques catch cancer at very advanced stages and mortality drops dramatically. Early detection is key to a successful treatment. With Vizilite Plus Dr. Dahlkemper can detect early stages of cancer more easily and should be checked yearly.

Did you know that Charleston County has one of the highest percentage of Oral Cancer Cases in SC?

An estimated 28,000 new cases of oral cancer and 7,200 deaths from these cancers occurred in the United States in 2004. The age-adjusted incidence was more than twice as high among men than among women, as was the mortality rate. More than 40% of persons diagnosed with oral cancer die within five years of diagnosis.

More than 90% of oral cancers can be attributed to tobacco use, alcohol use, and both tobacco and alcohol use. Sun exposure can also be a risk factor for oral cancer. Low consumption of fruit and some types of human papilloma virus infections have also been implicated.

Oral cancer is the 9th most common cancer in South Carolina, with 2,897 oral cancers diagnosed between 1996 and 2001 (or about 480 new cases per year). South Carolina ranks 2nd in the nation for deaths from oral cancer. The majority (70%) of oral cancers occurred in males, with black males having the highest incidence. There are three counties in South Carolina (Charleston, Georgetown, and Richland) with oral cancer rates higher than the state average.