We've all had them — tiny sores that pop up seemingly out of nowhere under the tongue or the inside of the cheek. They're named aphthous ulcers, but are more commonly known as canker sores. For some people, they can be a recurring irritation.
Round with a yellow-gray center surrounded by reddened skin, aphthous ulcers seem to coincide with periods of anxiety or stress, or as a result of some minor trauma. Many people will feel a tingling or painful sensation a few hours or days before the ulcers appear. Once they appear they usually persist for a week to ten days before finally drying and healing. In the meantime they can be painful, especially while eating or drinking.
One form known as recurrent aphthous stomatitis (RAS) affects about a quarter of the population with outbreaks of multiple ulcers that occur regularly. RAS ulcers are usually one centimeter or more in size — the larger the sore the more painful they tend to be.
There are ways to ease the discomfort of an ulcer outbreak and help hasten their healing. A number of over-the-counter products can be used in minor cases to numb the area temporarily and cover it to facilitate healing. We can also apply steroids or inject other medications for more severe cases. You may also find curbing your eating of certain foods like tomato sauce, citrus or spicy dishes can help.
For the most part aphthous ulcers aren't dangerous. In some situations, though, you should seek dental or medical evaluation: a sore that doesn't heal within two weeks; increases in severity, frequency or duration of ulcers; or when you don't seem to ever be without an ulcer in your mouth. We may need to perform tests, including tissue biopsy, to make sure there aren't any underlying systemic conditions causing the ulcers.
More than likely, though, you'll only need relief from the aggravation caused by aphthous ulcers. Among the many remedies, there's one right for you.
If you would like more information on aphthous ulcers or other mouth sores, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Mouth Sores.”
If we could go back in time, we all probably have a few things we wish we could change. Recently, Dr. Travis Stork, emergency room physician and host of the syndicated TV show The Doctors, shared one of his do-over dreams with Dear Doctor magazine: “If I [could have] gone back and told myself as a teenager what to do, I would have worn a mouthguard, not only to protect my teeth but also to help potentially reduce risk of concussion.”
What prompted this wish? The fact that as a teenage basketball player, Stork received an elbow to the mouth that caused his two front teeth to be knocked out of place. The teeth were put back in position, but they soon became darker and began to hurt. Eventually, both were successfully restored with dental crowns. Still, it was a painful (and costly) injury — and one that could have been avoided.
You might not realize it, but when it comes to dental injuries, basketball ranks among the riskier sports. Yet it’s far from the only one. In fact, according to the American Dental Association (ADA), there are some two dozen others — including baseball, hockey, surfing and bicycling — that carry a heightened risk of dental injury. Whenever you’re playing those sports, the ADA recommends you wear a high-quality mouth guard.
Mouthguards have come a long way since they were introduced as protective equipment for boxers in the early 1900’s. Today, three different types are widely available: stock “off-the-shelf” types that come in just a few sizes; mouth-formed “boil-and-bite” types that you adapt to the general contours of your mouth; and custom-made high-quality mouthguards that are made just for you at the dental office.
Of all three types, the dentist-made mouthguards are consistently found to be the most comfortable and best-fitting, and the ones that offer your teeth the greatest protection. What’s more, recent studies suggest that custom-fabricated mouthguards can provide an additional defense against concussion — in fact, they are twice as effective as the other types. That’s why you’ll see more and more professional athletes (and plenty of amateurs as well) sporting custom-made mouthguards at games and practices.
“I would have saved myself a lot of dental heartache if I had worn a mouthguard,” noted Dr. Stork. So take his advice: Wear a mouthguard whenever you play sports — unless you’d like to meet him (or one of his medical colleagues) in a professional capacity…
Most people associate bacteria with disease and ill health. But the real story about the trillions of microscopic organisms now living in and on your body is a bit more complicated. With recent advances in genetic code research scientists are learning that many of these microorganisms you’re hosting are actually beneficial for you — including your teeth and gums.
Beginning at birth and throughout your lifetime you are continually developing a distinct microbiome — actual communities of bacteria and other microorganisms that inhabit your body. As your microbiome develops it helps train your immune system to distinguish between “good” bacteria that help with digestion and other bodily processes and “bad” bacteria that cause disease.Â And it continually adapts to changes in what we eat, the pets we acquire or the drugs we take.
But lifestyle choices like diet can also have a detrimental effect, causing harmful bacteria to become dominant. This seems to be the case with Streptococcus mutans, the bacterial strain most associated with tooth decay. Scientists have analyzed biofilm (plaque deposits on teeth) from the pre-industrial era before 1900 and compared it with modern biofilm samples. They’ve found Streptococcus mutans levels to be much higher in modern biofilm, which they directly attribute to the modern Western diet.
As we gain a better understanding of these findings and of the role of bacteria in our lives, it could change many health recommendations not only about diet but about medications too. In the fight against disease, for example, we’ve used antibiotics to eradicate infection-causing microorganisms, but with a broad destructive ability that can also kill many beneficial strains of bacteria. It’s hoped as our knowledge grows we’ll be able to create newer drugs that more narrowly target harmful microorganisms while not affecting beneficial ones.
There’s a new appreciation emerging for bacteria’s role in our lives. As a result efforts to rebalance a person’s microbiome when they become sick may eventually become a critical element in healthcare treatment strategies. The benefits of this strategy for health, including for our teeth and gums, could be quite impressive.
If you would like more information on the role of bacteria in oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “New Research Shows Bacteria Essential to Health.”
A recent episode of “America’s Got Talent” featured an engaging 93-year-old strongman called The Mighty Atom Jr. The mature muscleman’s stunt: moving a full-sized car (laden with his octogenarian “kid brother,” his brother’s wife, plus Atom’s “lady friend”) using just his teeth. Grinning for host Howie Mandel, Atom proudly told the TV audience that his teeth were all his own; then he grasped a leather strap in his mouth, and successfully pulled the car from a standstill.
We’re pleased to see that the Atom has kept his natural teeth in good shape: He must have found time for brushing and flossing in between stunts. Needless to say, his “talent” isn’t one we’d recommend trying at home. But aside from pulling vehicles, teeth can also be chipped or fractured by more mundane (yet still risky) activities — playing sports, nibbling on pencils, or biting too hard on ice. What can you do if that happens to your teeth?
Fortunately, we have a number of ways to repair cracked or chipped teeth. One of the easiest and fastest is cosmetic bonding with tooth-colored resins. Bonding can be used to fill in small chips, cracks and discolorations in the teeth. The bonding material is a high-tech mixture of plastic and glass components that’s extremely lifelike, and can last for several years. Plus, it’s a procedure that can be done right in the office, with minimal preparation or discomfort. However, it may not be suitable for larger chips, and it isn’t the longest-lasting type of restoration.
When more of the tooth structure is missing, a crown (or cap) might be needed to restore the tooth’s appearance and function. This involves creating a replacement for the entire visible part of the tooth in a dental lab — or in some cases, right in the office. It typically involves making a model of the damaged tooth and its neighbors, then fabricating a replica, which will fit perfectly into the bite. Finally, the replacement crown is permanently cemented to the damaged tooth. A crown replacement can last for many years if the tooth’s roots are in good shape. But what if the roots have been dislodged?
In some cases it’s possible to re-implant a tooth that has been knocked out — especially if it has been carefully preserved, and receives immediate professional attention. But if a tooth can’t be saved (due to a deeply fractured root, for example) a dental implant offers today’s best option for tooth replacement. This procedure has a success rate of over 95 percent, and gives you a natural looking replacement tooth that can last for the rest of your life.
So what have we learned? If you take care of your teeth, like strongman Atom, they can last a long time — but if you need to move your car, go get the keys.
If you would like more information about tooth restoration, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine article “Crowns & Bridgework.”
A half million people are diagnosed every year with oral cancer. While other cancers are more prevalent, oral cancer is among the most dangerous with only a fifty percent five-year survival rate.
A major reason for this low rate is because this fast growing cancer is difficult to detect early — diagnosis comes far too often after the disease has already well advanced. In an effort to detect cancer earlier many dentists visually screen for oral abnormalities during checkups, especially patients over fifty, tobacco or heavy alcohol users, patients with a family history of cancer or a medical history of exposure to the sexually transmitted human papilloma virus, HPV-16.
If they detect an abnormality, the dentist often refers the patient to an oral surgeon or other specialist for a possible biopsy. In this procedure the surgeon removes a sample of the abnormal tissue, which is then examined microscopically for cancer cells. A biopsy remains the most effective way to diagnose oral cancer.
Because of the disease's aggressive nature, many dentists lean to the side of caution when referring patients for biopsy. As a result 90% of oral biopsies reveal no cancer. Reducing the number of biopsy referrals is highly desirable, especially for the patient undergoing the procedure. Tissue samples tend to be large to ensure complete detection of any cancer cells. Depending on the size and location of the sample, there may be a risk for loss of function or disfigurement.
A new screening tool using a sample of a patient's saliva could help reduce the number of biopsy referrals. Besides DNA, saliva also contains dormant genes called biomarkers that activate in response to the presence of a specific disease. This particular saliva test identifies those biomarkers for oral cancer if they're present.
A sample with a low score of biomarkers indicates no cancer present (with a statistical confidence of 99%). A medium or high score indicates cancer may be present, but only a biopsy can determine for sure. Using this test, dentists might be able to reduce the number of biopsy referrals and instead be able to employ watchful waiting in certain cases. Because of its simplicity and non-invasiveness, saliva screening could help identify oral cancer earlier.
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