Periodontal Disease Billings MT – Page 2 – Periodontal Specialist of Montana

May 13 6

Temporomandibular Joint Disorders (TMD, TMJ)

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TMJ, which is short for temporomandibular joint and muscle disorders—we’ll simply refer to it as TMJ from here on out, is a condition that can cause pain and or improper function of the muscles, which control the jawbone. For most people this isn’t a serious problem, although it can be more serious for some, while merely an annoyance for others. Often pain from TMJ is temporary, although it can continually occur in cycles.

Several different things could cause TMJ disorders. Firstly, TMJ is caused by trauma to the jaw. But often TMJ just appears even if no trauma has occurred. It’s possible that oral disorders such as an overbite or other alignment issues can cause TMJ. Even orthodontic braces can cause TMJ to occur.

There are several symptoms that a person has TMJ: a radiating pain in the jaw or in the neck or the face, or, more obviously, in the jaw; if the jaw muscles feel overly tight; if the jaw is locked, or a person’s ability to move the jaw is limited—this could also be a symptom of a worse condition and treatment should be sought immediately; there’s a pain at the jaw when a person opens or closes their mouths and with the pain is a clicking feeling or sound; if a person’s teeth suddenly change, and the rows of teeth fit differently. These symptoms could all be signs of other oral issues, so it’s important to not jump to conclusions if you’re suffering from one or more of these symptoms. But, how will you know? It’s important if you’re suffering from any of these symptoms to consult your periodontist.

Treatments for TMJ vary with severity. For some, simple jaw-stretching exercises could relieve the pain, while others may require pain medications to subside the insistent cycles of pain. Anti-inflammatories and muscle relaxants can be used for worse case scenarios.

If you believe that you have TMJ disorder, it’s important to not immediately panic—remember the discomfort in your face or jaw could be from anything besides TMJ like, for instance, a sinus infection which is easily treatable. If you are suffering from TMJ please visit Periodontal Specialists of Montana today!

Mar 16 13

The Benefits of Technology in Dentistry

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Planmeca Promax 3D

From tablet computers to smart phones, Google to Uber, there is no question that our daily lives have been more than reshaped by technology. Some of these changes have been truly beneficial while some have been more a case of technology for technologies sake alone. Dentistry has not been left out of this revolution. Over the last 15 years technology has redefined many aspect of dentistry as well.

Nowhere in dentistry has these technological changes been more evident than in the case of X-rays. We are all acquainted with the standard drill of holding x-ray film in the mouth while an X-ray machine exposes the film or sensor. This is an inconvenience for most of us and quite literally a real pain for others. Jaw anatomy is not always conducive for comfortable placement of the film or sensor, not to mention the problem with gag reflexes. Over the past 20 years technology has replaced the use of traditional X-ray film with digital substitutes but the practice of placing something in t the mouth to capture the image has remained the same.

Extra-oral X-rays, those taken with the film outside of the mouth have been in existence for decades as well. These too have become digitized and capable of conveying more information including three-dimensional CT X-rays that have been a boon to implant dentistry. Again these technologies have been digital modifications to what we already doing rather than being a revolution in how we obtain information.

Recently these worlds of intra-oral and extra-oral X-rays have started to merge. Planmeca, a medical equipment company from Finland recently released its new series of Dental CT X-ray units that is capable of obtaining intraoral, extra-oral and 3-D CT dental X-ray images all using a sensor that goes around the patient’s head. The most important aspect of this advance is not just that the days of placing a sensor in the mouth to get X-ray images is coming to an end but that all of this is being accomplished with dramatically reduced exposure to X-rays as well.

The new Planmeca Promax is equipped with an ultralow dose HD setting that can produce a full 3D image with less radiation than an X-ray series taken with conventional sensors. It can also produce regular 2D images with less radiation than two regular intraoral X-rays. In addition to a faster and more comfortable experience for patients, this also means better and more complete information for diagnosis with reduced need for follow up up X-rays and less overall radiation exposure.

Please schedule an appointment today with Dr. Marnhart for all of your periodontal needs!

Feb 16 22

The Wide-Ranging Role of the Microbiome: “We Are What We Eat”

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It is well known that the gut serves as the largest immune system in the body. Recent research, however, has extended our understanding to the

links between the immune system and the host microbiome, as well as the subsequent effect this may have on a broader range of disease activities. The focus of this paper is on how exactly existing diet and potential modifications to it may influence these effects.

The Real Risk of Artificial Sweeteners

While many understand the role of excess sugar increasing the risk for diabetes, it will come as a surprise to most that so do artificial sweeteners. Experiments with both mice and people indicate that artificial sweeteners can actually induce glucose intolerance (a pre-diabetic state) via alterations in the gut microbiome. The bacteria that are responsible are the same group that causes periodontal disease.

Asthma and Allergies

In the past several decades, there has been a dramatic increase in chronic inflammatory diseases, such as asthma and allergies. The association between asthma and the immune cell regulation by the microbiome is particularly striking.

The Western diet leads to an altered microbiome that increases symptoms of Asthma and the frequency of allergies. Again bacterial digestion of certain fibers produce compounds that turn down immune system stimulation and helps prevent problems with “leaky gut”.

The diseases mentioned here are very commonly treated with medications; in most cases powerful medications. Given this new information we need to also start considering diet as a potential adjunctive, if not primary, treatment for many of these diseases. Our drugs are minimally effective if we keep feeding the problem with inappropriate diets.

Excerpted from Medscape 10/15/15

Original article by David A Johnson, MD

Professor of Medicine, Chief Gastroenterology

Eastern Virginia Medical School, Nofolk VA

Feb 16 20

Maximum, Not Snapshot, BMI Is Best Predictor of Mortality

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Pam Harrison January 12, 2016

Capturing an individual’s weight at a single “snapshot” in time significantly and consistently underestimates mortality risk attributable to obesity because it fails to factor in high-risk, illness-related weight loss in the formerly obese, new research indicates.

The work shows that past obesity is a marker for higher death rates in the same way that former smoking can be, say the researchers.

“It’s not the case that intentional weight loss raises your risk for death,” investigator Andrew Stokes, PhD, Boston University School of Public Health, Massachusetts, told Medscape Medical News. “Rather, we found that weight losers as a group are at higher risk of dying because of illness-associated weight loss.”

“By using maximum body mass index [BMI], we were able to distinguish between low-risk individuals whose weight never exceeded the normal-weight category and higher-risk individuals who were formerly overweight or obese. This simple step shows that obesity is more dangerous than is commonly appreciated.”

The study was published online January 4 in the Proceedings of the National Academy of Sciences.

Use Maximum Lifetime BMI for Highest Mortality Risk

Together with Samuel Preston, PhD, University of Pennsylvania, Philadelphia, Dr Stokes examined the association between excess weight and mortality using data from the 1988–2010 National Health and Nutrition Examination Surveys (NHANES) that were linked to death records through 2011.

A key independent variable in their analysis was lifetime maximum BMI, based on a question in NHANES that asks respondents to recall their maximum lifetime weight, excluding weight during pregnancy. The sample was restricted to adults between 50 and 74 years of age at the time of the survey.

In total, 39% of NHANEs participants who had previously been in a higher BMI weight category had migrated down into the normal-weight category over time.

As Drs Stokes and Preston point out, this is a large volume of individuals and this downward flow from higher BMI classes to the normal-weight category clearly has the capacity to change survival outcomes of the normal-weight class.

They then compared the effect on all-cause mortality risk of using participants’ BMI at the time of the survey only (model 1) with the effect that maximum lifetime BMI had on all-cause mortality risk (model 2)

“In both models, each higher BMI category above the normal-weight category carried with it succeedingly higher mortality,” they point out.

“However, the degree of excess mortality associated with a particular BMI category was higher when that category referred to maximum weight rather than survey weight.”

When maximum weight was used instead of the one-time snapshot of participants’ BMI, the risks associated with overweight increased from 10% to 19% while for those in obese class I, mortality risk increased from 47% to 65% and for those in obese class II, mortality risk increased from 72% to 149%.

Hazard Ratios for All-Cause Mortality According to BMI at Survey vs Maximum Lifetime BMI
BMI category	Model 1: Survey BMI (Estimated HR)	Model 2: Maximum lifetime BMI (Estimated HR)
Normal weight	1.00	1.00
Overweight	1.10	1.19
Obese class 1 (30-34.9 kg/m2)	1.47	1.65
Obese class II (≥35 kg/m2)	1.72	2.49
Further Findings: Consider Past Weight The authors also calculated hazard ratios for mortality using two other models that combined data on weight at the time of the survey and maximum weight. In these, they differentiated between individuals who were at their maximum weight at the time of survey and those who were below their maximum weight at the time of survey. Results showed that people who lost weight were at a greater risk of dying than those who remained in the higher weight class they had previously occupied. Drs Stokes and Preston also examined the prevalence of diabetes and cardiovascular disease among participants. For both conditions, people who had moved to a lower BMI class had a higher prevalence of both diseases than those who remained in a higher BMI class. “The high prevalence of both diabetes and CVD among people moving to lower BMI classes demonstrates that weight loss is often associated with illness,” the authors emphasize. “An analogy to smoking makes it clear why it’s important to consider past as well as present weight when studying the effects of obesity on mortality,” Dr. Stokes explained. “If you were to compare smokers and nonsmokers, you might arrive at the conclusion that smoking is beneficial and the reason is that the nonsmoking group may include a large number of former smokers whose mortality risk is elevated,” he added. To avoid this bias, Dr. Stokes points out that studies investigating the effects of smoking on death rates have long distinguished between nonsmokers who never smoked and former smokers (nonsmokers who smoked in the past and quit). “Surprisingly, this distinction is rarely made in studies on obesity,” he observed. “And as a result, the effects of obesity on mortality have been consistently underestimated.” Neither Dr Stokes nor Dr Preston had relevant financial relationships. Proc Natl Acad Sci USA. Published online January 4, 2016. Abstract

Oct 16 92

Bacteria in Our Mouths That Causes Tooth Decay

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There are thousands of different types of bacteria that live within our mouths. Our tongues, gums, and teeth are loaded with them. Most bacteria within our bodies are very helpful, but some bacteria can cause our bodies problems. For instance, some types of bacteria that live in our mouths can cause tooth decay. Tooth decay happens when the bacteria in our mouths use the sugars in the foods that we eat, producing in an acid that can cause a cavity within a tooth. The bacteria can use sugars and also starches to produce acid. While it is widely regarded that foods such as candy and sugary drinks such as soda, juice and milk cause cavities, foods such as breads and pastas, which contain starches, also help the bacteria to produce acids.

A cavity develops through the constant exposure to acid. These prolonged exposures break down the enamel, removing its minerals; a small white spot on the tooth is evidence that this has occurred. Following an acid attack the enamel can harden again, by using minerals from saliva and fluoride. However if the acid attacks are too frequent or prolonged, decay can result.

Fluoride is very important to preventing tooth decay, because it can stop decay from progressing, but, also, fluoride can reverse or stop an early decay of the tooth. Fluoride is in our toothpastes and even in most community water supplies. Most bottled waters do not contain enough fluoride to prevent tooth decay, so if a person only drinks bottled water, fluoride should be supplemented in other ways.

Diet is very important to the prevention of tooth decay. Eat and drink sugary foods and drinks on special occasions. Try not to snack all day long; enamel needs some time to repair itself between meals. Do not eat or drink anything that contains sugar, after you have brushed your teeth for the night. Bacteria will have ample time to convert those sugars to acids while you sleep. Also, make sure to brush your teeth at least twice a day, and brush with fluoride toothpaste.

For more information on tooth decay and other dental related issues, please contact Healthy Gums Montana.

Oct 13 65

Procedure Focused versus Problem Focused Dentistry

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The first decision you must make is what dentist you are going to see. While individual practitioners have their specific approach to treatment, the fundamental issue for you is the choice between the Procedure Focused practices versus a Problem Focused office. Procedure focused offices tend to look at individual tooth problems, i.e drill and fill. You have pain from a particular tooth, the dentist treats that particular issue with minimal regard for other issues you may be unaware of. For many people the course of dental diseases is protracted over many years. This fact allows you to get away with a procedure focus for a while. However, this approach will often lead to more work needing to be redone in the future.

Problem focused practices (sometimes called Holistic practices) take into account the overall dental and medical conditions as well as potential future dental problems as part of making treatment decisions for the immediate concerns. This approach emphasizes the treatment and control of dental disease and the overall function of the dentition. Such an approach tends to address more than your immediate perceived problems but leads to more predictable restorations and avoidance of large-scale failures. Such practices emphasize a long term Doctor/Patient relationship compared to the episodic relationship of Procedure Focused practices based on emergent dental problems. This approach focus’ on the establishment and maintenance of dental health.

Is one approach better?
That depends on many factors. If your needs are minimal, procedure focused practices are very efficient in treating the few isolated concerns you may have. However in the early stages, most dental disease has minimal symptoms so patients are usually in a bad position to assess their needs. Waiting for symptoms such as pain and swelling means problems have progressed much further than they should have and treatment will be far more complicated.

Patients with several different dental problems tend to do better with Problem Focused practitioners. In this setting finding treatment solutions that achieve a harmony in addressing the multiple concerns is best. As we get older the complications from the accumulation of multiple past dental procedures tends to magnify. In adults the need to view cases in the entirety is essential to achieve the highest levels of success.

By their very nature, some dental specialties are more procedure oriented. Orthodontists, Oral Surgeons and Endodontists are specialty-trained dentists that are seen only when specific procedures are needed. Once the specific treatment is completed you return full time to your general dentist to continue care. Periodontists, Pedodontists, Prosthodontists tend to have longer-term relationships with their patients due to nature of the problems they deal with. You may still see your general dentist as part of your care as well.

Oct 04 46

What exactly are teeth?

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Sounds like a stupid question right? Nobody asks that question about hearts and livers. However few of us are really acquainted with this part of our bodies. This is in-part because the dental or stomatognathic system works well with few disruptions for most of our lives. This reliability also leads to the cultural view of what happens when the system goes on the fritz. Dental pain is one of the most debilitating pains a human being can experience. Prior to modern times, tooth pain had been represented in poems stories, art, and sculpture. We do not see the same for hip or knee pain.

Lets get acquainted
Teeth are one of the most amazing parts of the human body. They are composed of 3 specific hard tissues, Enamel, dentin and cementum. These occur nowhere else in the body. Dentin and cementum are related to bone but have a higher proportion of hard stuff (calcium and phosphorus) compared to bone. Enamel on the other hand is nearly pure mineral. So much so that for years nobody could figure out how it actually was made. Recently it has been shown that enamel is actually the original Nano-tech material. Once again millennia ago biology figured out how to do something that we humans are just beginning to understand.

Teeth are constructed similar to the windshield on your car and much for the same purpose: to limit breakage. Enamel is very hard second only to diamond. The problem with hard things is they tend to be brittle. If teeth were made only of enamel they would shatter. The dentin is the plastic layer, which can absorb the impact from biting, protecting the enamel from breakage. Enamel and dentin when formed correctly are capable of providing a lifetime of function.’

In order to function, teeth have to be attached to the jawbone. Teeth are not fused to the bone. They sit in a ligamentous joint that acts as a shock absorber. These ligaments insert into a specialized layer of the jawbone called the cribiform plate or bundle bone. This bone only forms in response to tooth development. This structure including the root, ligaments and bone that supports the teeth is referred to as the periodontal ligament or PDL for short.

Dentin and enamel, being much harder than bone, do not provide an adequate surface for ligaments from the bone to attach to the root: enter cementum. This third hard tissue is a layer of bone like tissue fused to the dentin of the root that provides attachment for the periodontal ligaments that attach to the bone. Teeth are not fused to the bone. They sit in a ligamentous joint that acts as a shock absorber. These ligaments insert into a specialized layer of the jawbone called the cribiform plate or bundle bone. This bone only forms in response to tooth development. This structure including the root, ligaments and bone that supports the teeth is referred to as the periodontal ligament or PDL for short.

The pulp:
Our lives may have been easier if dental pulp tissue did not exist. Dental pulp, also called the dental nerve is actually a neurovascular bundle consisting of and arteriole, vein and nerve tissue. This structure is left over from tooth development. This tissue supplies blood to the cells responsible for supplying nutrients and oxygen to the cells that produce the dentin. This process continues at a slow rate throughout our lives. The dental nerve actually serve a purpose in that it helps us sense how hard we are biting. This is one of the reasons why teeth lacking a living nerve are more likely to break.

The downside of having this nerve tissue inside teeth is pain. Unfortunately the only type of nerve receptor in the pulp are for pain. Not only are they pain nerves but they are slow reacting fibers. This means that it takes a lot of stimulation to get them to send messages but once they start they keep going which is the aspect that lends the special character to dental pain.

The Jaw bones
The jaw bones and other facial bones as well differ form the rest of the bones in the body.

Dec 08 78

The Diseases: Decay, Occlusion/TMJ and Periodontal disease

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First a definition:
Disease: disease is a particular abnormal condition, a disorder of a structure or function that affects part or all of an organism. It may be caused by factors originally from an external source, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune diseases. Diseases usually affect people not only physically, but also emotionally, as contracting and living with a disease can alter one’s perspective on life, and one’s personality.

In our every day lives we do not often consider dental disease to be the same as Medical diseases. This is false. In fact dental diseases are the most common diseases that affect people.

Decay
Dental decay or caries (caries is Latin for “rottenness), also known as cavities, is a breakdown of teeth due to acids produced by bacteria that live on and around the teeth. In a sense, teeth are essentially a form of limestone. If you have ever put an acid like vinegar or lemon juice on limestone the solution will bubble and fize. This action is the result of the acids eating away the calcium/phosphate structure of the rock. The same happens to teeth.

Where do acids come from?
Regarding decay, the acids come from the bacteria in the mouth fermenting residual sugars left over in your mouth after you eat. This fermentation produces acids that are held close to the tooth surface. The more sugar you eat and the more frequently you eat or drink the more opportunity the bacteria have to produce acids.

They are what you eat…Not all bacteria are equal.
The bacterial in your mouth is past on to you by your parents as is most of the bacteria that live on and around you. If you routinely eat a diet that has a high amount of refined carbohydrates the bacterial will shift to include more of the most efficient fermenters, which equals more acids and higher risk for decay. If you limit simple sugars in your diet the bacteria will shift away from this group. This is one reason why two people with equally poor oral hygiene can have very different decay rates.

Dietary and stomach acids can play a role in amplifying the effects of bacterial action. Just as acids produced by bacteria, acids in foods and drink also dissolve and weaken tooth structure. Most often damage from these agents affects the smooth surfaces of teeth. Bacterial activity affects the grooves and other surfaces where bacteria can hide.

Teeth are bathed in saliva and have a coating of bacteria on them (biofilm) that continually forms, almost from the moment they are cleaned. The minerals in the hard tissues of the teeth (enamel, dentin and cementum) are constantly undergoing processes of demineralization and remineralisation. Dental caries results when the demineralization rate is faster than the remineralisation and there is net mineral loss. This happens when there is an ecologic shift within the dental biofilm, from a balanced population of micro-organisms to a population that produce acids and can survive in an acid environment.[5] This shift to a cariogenic microbiological population (one which causes caries) is driven by (eaten) sugars. So, bacteria break down the hard tissues of the teeth (enamel, dentin and cementum) by making acid from food debris or sugar on the tooth surface.[6] Simple sugars in food are these bacteria’s primary energy source and thus a diet high in simple sugar is a risk factor.[6] Risk factors include conditions that result in less saliva such as: diabetes mellitus, Sjogren’s syndrome and some medications.[6] Medications that decrease saliva production include antihistamines and antidepressants among others.[6] Caries are also associated with poverty, poor cleaning of the mouth, and receding gums resulting in exposure of the roots of the teeth.[2][7]

Prevention includes: regular cleaning of the teeth, a diet low in sugar and small amounts of fluoride.[4][6] Brushing the teeth two times per day and flossing between the teeth once a day is recommended by many.[2][6] Fluoride may be from water, salt or toothpaste among other sources.[4] Treating a mother’s dental caries may decrease the risk in her children by decreasing the numbers of certain bacteria.[6] Screening can result in earlier detection.[2] Depending on the extent of destruction, various treatments can be used to restore the tooth to proper function or the tooth may be removed.[2] There is no known method to grow back large amounts of tooth.[8] The availability of treatment is often poor in the developing world.[4] Paracetamol (acetaminophen) or ibuprofen may be taken for pain.[2]

Worldwide, approximately 2.43 billion people (36% of the population) have dental caries in their permanent teeth.[9] The World Health Organizations estimates that nearly all adults have dental caries at some point in time.[4] In baby teeth it affects about 620 million people or 9% of the population.[9] They have become more common in both children and adults in recent years.[10] The disease is most common in the developed world and less common in the developing world due to greater simple sugar consumption.[2]

Oct 04 57

Gum Disease

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Gum Disease is a common ailment afflicting good oral Health. The most common form of gum disease is gingivitis. The harmful effects of gingivitis are rarely felt by the person who has them, although if gingivitis remains untreated, it can lead to the much more severe periodontitis. Gingivitis can be caused by a multitude of factors such as diabetes, smoking, stress, inadequate nutrition, and even puberty. While poor oral health is a primary cause of gingivitis, it is not always the only factor. When a person is suffering from gingivitis, his gums will become red and swollen, and may even bleed from contact with foods, or a scrubbing from a toothbrush. After gingivitis is located, a professional cleaning of the teeth and gums followed by the use of an oral rinse in the home will most likely treat gingivitis.

Periodontitis is caused when plaque grows below the gum line, and the toxins from the plaque enflame the gum tissue and, eventually if left untreated, the enflamed gum tissue will separate from the teeth. Periodontitis can occur in adults and children, and it can be brought on by untreated gingivitis, or if a person is chronically unhealthy, genetically predisposed to the disease, or suffering from a systemic disease such as heart disease, diabetes, and respiratory disease. Periodontitis has an array of treatments based upon severity that begin with non- surgical treatments and end at plastic surgery. Periodontists are trained to treat the effects of periodontal disease, and have undergone three additional years of specialized training to learn to treat it.

To help prevent Periodontal Disease, a person should perform the daily habits of good, quality oral health such as brushing ones teeth and flossing. Also, remember that a good diet helps your body to stay healthy, and areas like your mouth benefit from a good diet as much as anywhere else. Also, if you are a smoker or if you use chewing tobacco, it will give you another reason to add to the long list of reasons why you should quit. Remember, while some people may not be able to prevent Periodontal disease, many people can help to prevent the disease by simply living healthy.

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