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Gum Disease and Increased Link to Many Cancers

Brushing, flossing, and regular dental checkups appear to do much more than maintain a healthy smile. Now, a large prospective cohort study shows that postmenopausal women with a history of periodontal disease, including those who have never smoked, are at significantly increased overall risk for cancer as well as site-specific cancers, including lung, breast, esophageal, gallbladder, and melanoma skin cancers.

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Periodontal Disease Treatment Billings MT

Diabetes and Daily Oral Care

Diabetes can take its toll on dental health. The main reason is that diabetes is a systemic disease involving high blood sugar. The higher a person’s blood sugar, the higher risk for dental diseases and tooth decay.

Cavities and High Blood Sugar

Cavities happen when bacteria within our mouths produce acids that eat away at the enamel (enamel is the hard protective outer-coating on a tooth). These acids come from plaque, which is a sticky film produced when mouth bacteria interact with the starches and sugars from our foods and drinks. If you are diabetic and dealing with a high blood sugar level, there will be a greater supply of starches and sugars within our bodies—you will also have different requirements for diet.

The Early Stages of Gum Disease

When someone has diabetes, their bodies have a reduced ability to fight back against bacteria. When things like plaque are not removed by brushing and flossing (remember the importance of brushing twice daily and flossing once!) that plaque hardens at the gum line. This harder substance, called tartar, forms around the base of the teeth, causing the gums to swell and begin to form pockets—pockets where bacteria can creep in below the gum line and cause problems! Over time, swollen gums can begin to bleed. These initial stages, called gingivitis, are usually easy and non-invasive to treat.

Advanced Gum Disease and Diabetes

Gingivitis that is left untreated can progress to the much more severe, and much more invasive and difficult to treat, Periodontal Disease. Periodontal Disease is an infection that can destroy the soft tissues and bones within the mouth. Obviously, this is bad, because the bones and soft tissues support everything in the mouth. Overtime this breaking down causes the gums and teeth to pull away from the bone—inevitably the teeth will become loose and, possibly, fall out. Why is Periodontal Disease worse for those with diabetes? It’s because diabetes hinders a body’s ability to resist infection. Diabetes, and all systemic disease for that matter, can also hinder the body’s ability to heal. It’s so important to keep up a regular routine of oral care that includes a regular checkup with your periodontist, Dr. Manhart.

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Do Mouthwashes Work?

Do Mouthwashes Work?

Not all mouthwashes are created equal. And most mouthwashes are placed into two categories: cosmetic mouthwash and therapeutic mouthwash. Therapeutic mouthwashes are available both in the aisle at the grocery store and by prescription. Therapeutic mouthwashes help to combat bad breath, fight gingivitis, and even control plaque. But how?

The condition of having bad breath, called halitosis, is caused by several things including: food breakdown and oral disease (pervasive plaque and bacteria). Now, for a mouthwash to fight these problems, it needs to have antimicrobial ingredients. These ingredients have long names like, chlorhexidine (chlorhexidine is an active ingredient in mouthwashes given out by prescription), chlorine dioxide, and, the less chemically-sounding, essential oils (usually therapeutic mouthwashes with essential oils are found in the aisle at the grocery).

These antimicrobials have proven effective at combating halitosis. But, mouthwashes are only effective at removing plaque and bacteria from the mouth when they’re used in conjunction with brushing and flossing. It all comes back to a good quality everyday oral care routine.

Now, there are certain rules to using mouthwash. Don’t swallow it, and don’t give it to young children, even if they understand how to spit the mouthwash back out of their mouths properly. A child who swallows large amounts of mouthwash may suffer the consequences of diarrhea, vomiting, and (it’s possible in higher doses) intoxication—if your child has ingested enough mouthwash to be intoxicated, call poison control.

Now, there’s no best way to incorporate mouthwash into your daily oral care routine. If you brush first, you may want to swish out your mouth with water before you use mouthwash. Other than that, it’s personal preference. It’s most important that you are brushing at least twice every day, and flossing at least once.

If you are concerned about halitosis and what’s possibly causing it, make an appointment with Dr. Manhart. He can check for signs of oral disease—remember, it’s best to catch gum disease in its earliest stages, when it’s easily treatable—and develop an action plan to get it fixed.

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Pregnancy and Gum Disease


Gum disease is common in adults, and many people will suffer from some form of it in their lifetime; the reasons for it will vary. But did you know that a pregnant woman can contract gum disease because of the hormonal changes happening in the rest of her body? It’s true. That’s one reason why it’s especially important that pregnant women practice good quality routine oral care throughout their pregnancy.

Do you treat a pregnant woman for gum disease?

The early stages of gum disease, called gingivitis, are easy to treat. At this stage, the gums are swollen and tender. Someone practicing good quality oral care may be able to fight gum disease at these initial stages naturally: brushing and flossing regularly, and doing it well, making sure to clean all areas of the tooth; Vitamin C (which can help to combat gingivitis, and could be taken naturally through certain fruits and vegetables or supplemented) and Vitamin A, which helps the teeth and bones to grow (Vitamin A does have certain drawbacks and limits and before you take on any extra Vitamin A in supplement, consult with you doctor first); also, an at-home remedy to reduce inflammation in the mouth is to gurgle with salt water twice daily. More severe cases of gum disease will be handled on a case-by-case basis between you, your doctor, and your periodontist.

More severe cases of gum disease involve sensitive teeth, teeth that move suddenly out of place, teeth that become loose altogether, and teeth that hurt when you chew food (obviously, these symptoms could also be symptoms of other oral problems, and Dr. Manhart will be able to determine which it is). And if gum disease evolves to the more severe periodontal disease, it will become more difficult to treat. That’s why early detection is very important to a swift and non-invasive treatment. Remember it is very important to the treatment of gum disease that it’s caught in its earliest stages.

If you have any questions as to how to keep a quality oral care routine during your pregnancy call Dr. Manhart’s office today, schedule an appointment.

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Recently, the routine practice of flossing has come under fire as being a nonsensical and ineffective way to clean the space between our teeth down to the gum line. Of course, the study got a ton of press, and news outlets everywhere were running ad hoc with the story as if it were revolutionary and based entirely in fact. As the story evolved through the news outlets it grew bigger, as stories tend to do, claiming that even the federal government’s health agencies also believed flossing to be a waste of everyone’s time. But that’s not true. The federal governments health agencies, as well as the ADA (American Dental Association) all claim flossing as an important, everyday practice.

Flossing is important because it helps to remove the plaque that builds up in the spaces between our teeth. Floss, or an interdental cleaner, scrapes away the plaque that builds up there. If plaque is allowed free reign to grow rampant, then you are likely to see problems such as gum disease develop, and, if the initial stages of gum disease are not dealt with appropriately (and remember, oftentimes gum disease has very little symptom in its early stages) it will progress to the more chronic stages—periodontal disease.


Flossing Refresher

It’s important to keep the practice of flossing between our teeth routine, done once daily. To floss, simply purchase a spool—it comes in a few different sizes—strand widths—and many different flavors, and pull from the spool about eight to ten inches of floss. Wrap the tag ends of the floss around opposing fingers, keeping a few inches of open space between your hands so that you may maneuver it down into the spaces between the teeth. Then use the floss to scrub the faces of the teeth with the floss, cleaning all the areas between the teeth down to the gum line. It’s a pretty standard, simple practice, although it’s often overlooked by many in their daily oral routine.

Remember to keep flossing once every day, keep brushing twice daily, that initial prevention is the best treatment for gum disease.

Make an appointment with Dr. Manhart today for all of your oral health needs.




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Periodontal Disease and Pregnancy

Periodontal Disease and Pregnancy

During pregnancy, there’s a whole host of changes that occur within a woman’s body. Hormone’s shift and the body’s immune system goes through little quirks. Did you also know that during pregnancy a woman’s periodontal health can change, even if they keep to the strict routine of brushing twice daily and flossing once.

Periodontal Disease and Pregnancy

It’s true! there are links between periodontal disease and pregnancy (For those of you not immediately familiar, periodontal disease is a chronic condition caused by bacteria—the most severe condition of gum disease—and, if left untreated, can cause tooth loss, damage to the tissue in the mouth, and it’s even been linked to systemic diseases such as heart disease). Many woman experience what is called pregnancy gingivitis somewhere between the second and eighth months. Remember that any progression of gum disease is bad and needs to be treated.

Gum disease is progressive, and to not treat the disease could mean a progression to full-blown periodontal disease. Studies show that periodontal disease can cause premature birth, or cause an infant to be born at a dangerously low birth weight. A baby born underweight is susceptible to other bodily conditions, such as respiratory problems, and growth issues—both social and physical.

Periodontal Disease and Pregnancy

This makes it imperative during pregnancy to keep to a strict routine of oral health—remember, brush twice and floss at least once, and it may also be beneficial to use certain mouthwashes during pregnancy to ensure a clean mouth. And this oral care routine includes dental checkups with your periodontist to ensure that your mouth is staying healthy. Oftentimes gum disease can begin without a patient knowing. If a person has already been diagnosed with having periodontal disease, and is currently pregnant, that patient will need to keep up regular appointments and treatments.

Make an appointment with Dr. Manhart today, if you are pregnant, and would like a comprehensive periodontal exam. Remember it’s much easier to treat gum disease in its early stages. And remember to keep up a quality oral care routine, whether you are pregnant or not.


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A Cracked Tooth

A cracked tooth can present symptoms similar to other dental emergencies, and, in almost all cases, a cracked tooth will be painful. A common presentation of symptoms would include: it hurt while chewing, but the pain feel localized to a tooth, to a localized position on the jaw; when the chewing stops, the pain subsides or goes away completely.

Now, say you have these symptoms, and you’ve looked in the mirror to check for a line down the tooth, a fracture or crack, something noticeable, but there’s nothing there? What should you do? Obviously, if you have pain in your teeth, or localized on the jaw near your teeth, you should consult your periodontist. Not always will you see a fracture or crack on a tooth. Oftentimes, a cracked tooth could have a hairline fracture, something so small it may not even show on the X-Ray.

Causes of a cracked tooth vary, however chewing hard foods such as nuts, ice, hard candy, etc., are likely culprits. You can also damage a tooth playing sports, or maybe you’re someone who grinds their teeth; it’s possible even, when a set of teeth are not properly aligned to have bite problems that cause a cracked tooth.

You might be wondering now, just how will your cracked tooth be fixed, knowing now that even an X-Ray may not show the exact location of a fracture. There’s a few options, and they differ depending on the severity of the crack.
The simplest methods are bonding the tooth back together, sealing the crack, and, or, a root canal treatment to seal the tooth back up again. It is possible, however, that a crack be too great and the tooth should be removed, however your periodontist, Dr. Manhart, will be able to determine the best course of treatment when you visit. And if you are suffering from tooth pain, don’t let it persist, call the office immediately.
A cracked tooth is a common dental emergency, and, often, it is easily fixable, so you shouldn’t have to suffer through the tooth pain.

If you have a cracked tooth, please schedule an appointment today with your Periodontal Specialist today!


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E-Cigarettes Can Cause Gum Disease

There’s no safe alternative for tobacco, however, there’s an opinion out there that the use of e-cigarettes or vaporizers are more health conscious—there’s even advertisements claiming that it’s just a harmless vapor, nothing dangerous. Hopefully we’re seeing through those advertisements, because e-cigarettes are far from being healthy, or even safe.


For those of you who don’t know, e-cigarettes are refillable modern-looking pipe or cigarette-looking devices, that use battery power to vaporize a nicotine-type solution, which is then inhaled.

Because e-cigarettes are relatively new, there is very little, if any, standards in place to govern the substances used. Therefore, there’s no control over what the level of contaminants are—contaminants include cancer-causing carcinogens, some of which are found in products like anti-freeze, etc. Also, because e-cigarettes are new, it is impossible to know what exactly the adverse health effects of “vaping” are. However, what we know for sure is that nicotine in any dose has adverse health effects on bodies. E-cigarette companies like to state that the levels of nicotine are much lower than that from a classic tobacco cigarette, also claim that the nicotine doesn’t have the same adverse effects on a person’s health because it’s not being burnt—understand, however, that regardless of the severity of the nicotine intake, nicotine in any amount of form has a negative effect on your body, and your oral health.

E-cigarettes and oral health

Studies have shown that nicotine causes our gum tissues to recede, and these recessed pockets can become likely sights for gingivitis or the more severe periodontal disease. There’s information on the internet that vaping will benefit a person’s gum health. However, this has been shown to be false. The reasons for this myth—yes, we’re calling it a myth—are varied, but to put it simply, nicotine usage in any dosage will cause inflammation in the gum tissues. This inflammation makes the gum tissue appear healthy—vibrant pink, etc. But the problem is that the inflammation is only masking the underlying issues, and the gum tissue is, in fact, still receding from the teeth.

The signs for gum disease are the same for the person using an e-cigarette. Your gums will bleed, they will have receded from the teeth, and pockets of space will form around the base of the tooth. If you think you are suffering from gum disease, make an appointment with your periodontist immediately, as early detection is essential in a successful treatment of the disease.

If you are experiencing periodontal disease, please schedule an appointment today with your Periodontal Specialist today!






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Periodontal Disease Linked to Marijuana Use

According to the American Academy of Periodontology, The AAP, there is a link between periodontal disease and frequent marijuana use. This is an interesting find given that legal use of marijuana is proving to be ever-more topical, and with several states now decriminalizing the drug, Montana is not one of these states; here it is still very much illegal to possess or use marijuana for personal, non-medical, use.

According to the journal article, which you can find here:  https://www.perio.org/consumer/marijuana-use , frequent use of marijuana, hashish, and has oil contributed to the increased chance of periodontal disease. The study compared those who used these dugs heavily and a second group which combined subjects who didn’t use heavily and who didn’t use at all.

The indicators used to determine possible periodontal disease are the pocket gaps between the tooth and the gum tissue. Teeth should be adhered to the gums, and the gums shouldn’t easily separate away from the teeth. Unhealthy mouths, i.e. mouths with gum disease and periodontal disease, have much larger pockets between the tooth and the gum tissue. The deeper the pocket the more severe the case of periodontal disease.

Periodontal disease is caused by bacteria infiltrating these pockets below the gum line, pockets that run deep and, for the most part, are unclean-able by the average person using just a toothbrush and a strand of floss. However, Periodontal disease is still treatable, and the potential treatment depends mostly on the severity of the disease. Periodontal disease that is left unchecked for long periods of time is going to have progressed to a severe state than if the disease was treated immediately.

If you think that you have the symptoms of some form of periodontal disease, speak with your periodontist. According to the AAP, nearly one half of all adults in the United States have some form of periodontal disease, so it’s not something to be ashamed of. But, an untreated case of periodontal disease could develop into something very severe. Consider the old adage: an ounce of prevention is worth a pound of cure.

If you are experiencing periodontal disease, please schedule an appointment today with your Periodontal Specialist today!

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Do You Need Dental Implants?

We are living in the golden age of dentistry.  Dental implants have revolutionized treatment options for patients  From replacing to a single tooth to an entire set of teeth dental implants provide can patients restorations thought unimaginable little more than a decade ago.  However too much of a good thing can bring its own problems too.


While dental implants are very predictable and long lived, they are not without their own issues.  The most common problems associated with implants are with infection, bone loss and implant failure, not unlike natural teeth.  Consequently it is important to carefully consider all your options prior to committing to implant treatment.  This is particularly true if you still have have natural teeth that are planned for extraction and replacement.


Below are several concerns you should investigate prior to committing to treatment.


Are you in pain?

Often patients planned for implant treatment are having few if any symptoms.  Teeth may be planned for extraction for many legitimate reasons.  While on occasion these issues may not be evident to you, most of the time they are. If you have been told teeth need to be extracted to make way for implants yet you are unsure as to why this needs to be done, seek a second opinion.


Is the area to be restored highly esthetic?

Simply put, it can be very difficult to place an implant that is both functional and at the same time highly esthetic.  This is due to the trauma of tooth removal and the  gum tissue and bone loss that results.  Often such esthetic areas are better treated with convention prosthetics such as a bridge.


You have bone loss

Bone loss does not mean necessarily natural teeth must be removed.  Nature has been nice to us permitting the full function of most teeth even with loss of well over half of the bone support.  For most patients a modest commitment to more frequent maintenance care and these compromised teeth can last for a decade or more delaying or avoiding the need for implant treatment.  Please remember dental implants can experience bone loss as well due to the same reason as loss on natural teeth.


Does the missing tooth/teeth need replacement?

Although at first blush this may seems a somewhat silly question, it far more pertinent than many realize.  Although we all want to maintain a full dentition for our entire life, bad things happen.  Even if you manage to defeat decay and periodontal disease there are baseballs, hockey pucks, car accidents, falls and a myriad of other hazards that cause the loss of teeth.  When the inevitable happens your first consideration should be ” do I need this replaced.  While the answer to this question is fairly obvious for front teeth it may not be so for every back tooth.  For example most second and third molars doe not provide much function or chewing efficiency.  They are not seen in the Esthetic zone so often times their loss is easily accommodated.  Immediately after these teeth are removed the patient notices the change.  I always tell them to let me know how badly they are missing these teeth in 2-3 months.  The vast majority of patients find they have no desire to replace these teeth.  However, about one in ten find the change problematic and seek a restoration.
This is not the case with first molars and teeth forward.  It is here the bulk of your chewing efficiency comes from.  These teeth are also seen in the esthetic zone so there are far more compelling reasons to replace these teeth.


You smoke, Vape, or use smokeless tobacco

While tobacco use, or more accurately nicotine abuse, is not an absolute contraindication to implant placement it is a concern that must be weighed against other options.  There is no question that on average the success of implant treatment among nicotine users is lower compared to non-users.  How this plays out for a specific patient is variable.  If you use nicotine, you should consider conventional restorations first as they stand the best chance of being successful in the long term.  Consider implants only as a second option and understand you are potentially accepting more complications should you go down this path.



Beginning in the 1990’s new drugs were introduced to help manage osteoporosis.  These drugs were revolutionary.  However again nobody considered what could happen if these agents did too good of a job.  Unfortunately or some these powerful drugs can be too effective and create bone problems specifically in the jaw.  If you have been on medications for osteoporosis for more than 5 years prior to placing dental implants it may be necessary to do some blood tests to see what the condition of you bone is.  Sometimes it is necessary to discontinue these drugs for a few months to allow your bone to recover a more normal healing response before implants can be placed.   Please note, untreated osteoporosis is also a risk when it comes to dental implants.  Bone that is too hard or too soft is not a good thing.  Getting your bone density just right should be the goal of your treatment.  Then dental implants work well.


You need a root canal

The dental nerve tissue inside teeth is fragile. Every time there is damage to the tooth the nerve is damaged.  If this damage happens repeatedly or if a single event is bad enough the nerve tissue can lose its blood supply and die.  This dipoles not mean the tooth is “dead”.  All the ligaments that attach the tooth to the bone are fine and remain functional.  In such a situation a root canal is the treatment of choice.  This involves cleaning out the inside of the tooth where the nerve tissue used to be and placing a filling to keep bacteria out.  Caught and treated early root canal treated teeth can last as long or longer than dental implants.  However if the tooth dies and then goes through several cycles of acute and chronic infections, success rates for root canal therapy drop.  Interestingly implant success is lower in sites where repeated tooth infections have occurred as well underscoring the need to address such problems early on.


Reasons to consider dental implants over conventional restorations.


Decay problems

Some patients have far more problems with tooth decay than others.  This is particularly true if you you are experiencing problems with dry mouth.  Often this is a side effect of medications but can also be due to aging and disease processes.  Whatever the cause decay activity increases in adults over 50.  For patients experiencing problem with decay, as indicated by more than one decay lesion per year, Dental implants are a better choice over conventional tooth retained restorations.  Simply put, titanium and ceramic do not experience decay as the natural teeth retaining crowns and bridges do.


Restorations on teeth with severe bone loss.

A tooth with bone loss, standing on its own, may function fine for many years.  However, if that same tooth is employed to retain a large restoration, the excess load placed on this tooth may accelerate the bone loss leading to failure and loss of expensive dental work.  In such situations dental implants may be used instead of conventional bridges to distribute the load of biting away from the compromised teeth.  In some cases the natural teeth may be extracted and implants placed to optimize implant location making placement of a restoration easier and more predictable.


Long standing root canal infections

If teeth are allowed to remain with longstanding root canal infections, success rates for root canal therapy drop significantly.  While not an absolute contraindication for treatment, it is best to approach such teeth with a 2 step approach.  First the nerve chamber is cleaned and a medication is placed.  If after a few months the surrounding bone shows signs of healing the root canal procedure can be finished.  If ther is little sign of healing or pain remains persistent then extraction and bridge/implant treatment is indicated.


You can’t wear dentures or your dentures do not work well

Many patients can not wear dentures.  This can be due to anatomical problems or dentures can’t be tolerated due to instability, severe gagging or sensitivity to the materials used to make the denture.  This is a problem implants were designed to solve.  From providing an simple anchor to minimize movement to a full dentition permanent restoration that is fixed to the implants, many options exist that will make your denture more comfortable, functional or you can get away fro the concept of a removable denture altogether.  The choice is yours.


When it comes to these factors each patient is unique.  How to choose what options are best in your case requires consultation to review all options including doing no treatment.  If you are unsure how to proceed or believe you have other options that have not been fully explored, a second opinion is a good idea.


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