Contrary to what many denture-wearers believe, dentures require regular maintenance, including relines, repairs, and replacement. In fact, the average denture should be relined every two to three years and replaced every five to seven years for the most optimal fitting prosthesis. There are many reasons for this maintenance interval and for regular dental examinations, whether or not the patient perceives any problem.

Bone Changes and the Need for Denture Relines

The first problem has to do with the basic function of the bone surrounding natural teeth. Natural teeth are held in their sockets by thousands of “cables”, called the periodontal ligament that tug and pull on the supporting bone during function. The bone is designed to be strengthened and stimulated in this manner. When the teeth are removed, the bone no longer has appropriate stimulation, and shrinkage occurs unless it is directly loaded again with dental implants. Bone atrophy is accelerated by inappropriate forces caused by loose and ill-fitting dentures.

Relining, or replacing the tissue surface of the denture, helps preserve bone by adapting dentures to the gums as they shrink, but it is only helpful for dentures that are otherwise in good condition, which includes a proper bite relationship. Relining also helps to encourage health of the soft tissues because the denture plastic is porous and becomes heavily laden with bacteria and yeast over time. Relining refreshes the tissue surface of dentures with new acrylic. Sometimes a more advanced type of relining, called rebasing, is the treatment of choice when all of the pink portion of a denture is in poor condition and needs to be replaced.

New dentures should be made when relining or rebasing of dentures can no longer re-establish proper fit and function. Often this is obvious by wear or fracture of the denture teeth. When dentures contribute to headaches or when the patient’s face begins to look “collapsed” or “old”, the need for new dentures is likely.

Lastly, but certainly not of least importance, denture wearers need to stay current with regular dental examinations for inspection of not only the dentures but the tissue for pre-cancerous lesions. Since most people feel they do not need to go to the dentist once they have dentures, many early pre-cancerous lesions are missed.

Everyone is at risk for oral cancer, whether they have teeth or not. In fact, the constant “trauma” and lack of blood circulation caused by chronic denture wear increases the risk for oral cancer development. For this reason alone, annual dental examinations are recommended for denture wearers.

Many patients with older dentures report their dentures fit fine. You can relate this to the fit of shoes. Shoes get broken in over time and seem comfortable. However, the fact is, over time shoes lose their ability to provide proper support. Even though they may be comfortable, they may be causing other problems due to this lack of support.

If you are a denture wearer and have not seen a dentist in a year or more, it’s time to consider a dental visit. Learn about how your dentures are fitting and whether relining or replacing them makes sense. For most, it is also never too late to consider the benefits of dental implants to help preserve bone and secure dentures in place.

Do you have any problems with dental decay (cavities), gum recession, and/or dental erosion (the chemical breakdown of tooth structure)? These dental issues are complicated multifactorial diseases of epidemic levels affecting both children and adults. A healthy mouth sometimes requires more than brushing, flossing, and “fillings”. With current scientific evidence and new technologies, patients and practitioners need to begin to look at these problems not just from a drilling and filling approach, but also from a medical (preventive/therapeutic) approach. There are over 19,000 different bacteria that have been found in mouths and every person has about 1,000 different types. Not all of them cause decay, but many of them have also been found to grow on artery walls. The medical/dental systemic connection is real and we must pay more attention to it.

Remineralization and pH Control Before Another Filling

Why the increase in decay? Most of it has to do with dietary trends. We snack more, eat more sugar/carbs, drink more soda, have more gastric reflux, take more mouth-drying medications, etc. Dental caries (decay) is a pH specific disease. The right bacteria, plus sugar, create acid which breaks down the enamel of the teeth. Add an already acidic environment and it is even worse. In most cases it is a preventable disease. And don’t think that just because you don’t eat “sugar” that you are safe. If you are getting decay, something is causing it. The problem is that changing behavior can be very hard to do. It is time for the dental professional to take a different approach when treating this disease. More focus needs to be shifted to prevention of decay rather just treating it. Filling teeth is treating the result of the disease but does nothing to prevent it. The dentist needs to take a more active role in assessing individual’s risk factors. In the dental world this is referred to as CAMBRA, which stands for Caries Management By Risk Assessment. Based on assessing an individual’s risk factors such as quality of home care, quality of salivary flow, medication issues, and dietary issues, a caries-preventive strategy can be established. There are many new products on the horizon to help combat and virtually eliminate this disease. However, dentists must take some responsibility and be open to a different management of this disease. They must also be able to motivate people to change habits, which can be challenging. The bottom line is that if you want to be decay-free, you can be. For those at higher risk, there are some great products currently available from a company called Carifree. Everything from new toothpastes and gels with ions in them to rebuild tooth structure, sprays to neutralize pH, and probiotics are on their way. Right now you can use things like the sweetener replacement Xylitol, which by itself is cavity-fighting, but also works synergistically with fluoride. Prescription level toothpastes are also available and there is strong research for the topical application of fluoride varnish, the same stuff the kids get, for adults. The evidence is very clear – this is a preventable disease. Next time you go to the dentist and find out you have a new cavity, stop blaming the dentist or yourself, and ask to get a specific protocol for prevention of this disease based on your specific risk factors. You may also want to mention Carifree products to your dentist in case they have not heard of this company. Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

If all dental offices do the same thing – treat teeth – why are there so many variables between different offices?

How a Dentist’s Preferences Shape the Treatment Plan

Each office takes on the characteristics of the practitioner who owns it.  The personality of the owner is probably the key to how that office “feels” when you walk in the door.  Some practices may feel “clinical and efficient”, while others feel somewhat more home spun and laid back.  The dentist’s personality is reflected in his or her treatment preferences as well.  The fact that different dentists will suggest different plans to treat your condition does not necessarily mean that one plan is better than another. Most dentists will suggest what they feel to be the best plan for any given patient.  The differences between the treatment suggested by one dentist over another reflects that dentist’s preferences based on his or her experience. Thus, differing treatment plans do not necessarily reflect any deficiency in either dentist’s judgment. All dentists who have graduated from an accredited dental school should be technically competent to perform any procedure that they personally feel comfortable performing.  But it is important to remember that each one is an individual, and no two dentists can perform exactly the same technical procedure in exactly the same way.  As a matter of fact, no single dentist can perform exactly the same procedure exactly the same way twice in a row!  How well your filling turns out depends as much on how wide you can open your mouth as it does on the technical qualifications and skills of the dentist himself or herself. There is also no dentist who can perform all procedures for every patient at their highest level. While many patients like a one-stop-shop for their dental needs, it is sometimes in the best interest of the patient to be treated by a specialist for a particular problem. The dentist and patient should discuss this, especially for more complex issues. It is also important to remember that there are numerous ways to treat the same situation. The dentist needs to tailor treatment plans for each patient’s specific circumstances.  For example, finances are one of those circumstances, and since different treatment plans can vary a great deal in cost, it is important for the dentist to be able to discuss finances. The best treatment plan for any patient is one that meets the needs of the patient from a clinical perspective, and that they are aware of and comfortable with financially. Think of treatment plans like various models of cars offered by different dealers.  All of the models are new, have warranties and will work well out of the lot.  The higher end models, however, have some advantages not found in the less expensive models.  Some options add years to the life of the car. Some add to the appearance and enjoyment of driving it.  Dental treatment plans are like that too.  Saving a badly damaged tooth with a root canal and a crown will most likely preserve it for a long time, but it has a price attached to it. The patient may opt for a much less expensive extraction instead. A dentist should be able to explain the advantages and disadvantages of the various options, and allow the patient to make the decision. Over the years I have developed great respect for all members of the dental office team.  There is no greater reward than to be part of a profession that seeks to improve people’s lives. Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

The Connection Between Diabetes and Gum Disease

With more than 24 million diabetics and 57 million pre-diabetics in the United States, nearly a quarter of the nation’s population, there are a lot of people affected by diabetes. The prevalence of diabetes will increase by 54% to more than 54.9 million Americans between 2015 and 2030; annual deaths attributed to diabetes will climb by 38% to 385,800. In addition, the most up to date research shows the connection between dental health and diabetes has never been more critical. As an indication of our general health, the rapidly rising rate of diabetes should be ringing alarm bells everywhere. The litany of health implications from diabetes is a long and grisly list. It is the sixth leading cause of death in the U.S. That is probably vastly understated because as many as 65% of deaths from diabetes are attributed to heart attack and stroke. People with diabetes have about twice the overall risk of death as those who don’t have the disease. Complications from diabetes cuts years off productive lives and interfere with the quality of those lives through a host of debilitating health effects. Heart disease and stroke rates are as much as four times higher among diabetics. Nearly three-quarters of diabetics have high blood pressure. Each year, diabetes causes blindness in as many as 24,000 Americans. It is the leading cause of kidney failure, nervous system disease, amputations – the list goes on. This isn’t meant to be a scare tactic. These are simply the facts and, yes, they are sobering. But if you have diabetes or are pre-diabetic, you may want to brace yourself. Because we are going to talk straight about oral health and diabetes, two diseases that can twist each other into a tight downward spiral of amplifying negative health effects. Unless they are halted by your physician and your dentist working in tandem as a health care team, together with your commitment to hold up your end of the bargain, these effects can continue to compound. The facts about the connections between oral health and diabetes are even more alarming than those about diabetes alone. Here are just a few: Diabetics are twice as likely to develop gum disease. This is especially true if your diabetes is not under control. The gum disease then worsens your diabetes through an automatic response that your body uses to fight the infection. People with gum disease are 270% more likely to suffer a heart attack than those with healthy gums. People who have diabetes and severe gum disease have a premature death rate nearly eight times higher than those who do not have periodontal disease. Those who have gum disease and diabetes together are more than three times more likely to die of combined heart and kidney failure. In people who have type 2 diabetes, gum disease is a predictor of end-stage kidney disease. In people who have pre-diabetes – blood glucose levels that are higher than normal but not in the diabetic range – gum disease makes it more likely that they will become diabetic. Once established in a person who has diabetes, the chronic infection that causes gum disease makes it more difficult to control diabetes, and increases damage and complications in blood vessel disease. Aggressive population health measures, including increased availability of diabetes prevention programs, could help millions of adults prevent or delay the progression to type 2 diabetes, thereby helping turn around these dire projections.