Love them or lose them

teeth
ADVERTISING FEATURE
Published Friday September 27, 2013
love them or lose them
2
Teeth: Love them or lose them
Contents
From the President
Role of maternal
nutrition on early
childhood caries
2
Baby teeth care
2
Dental treatment for
the very young
3
Treatment of early
childhood caries
5
Growing Up Smiling
program
6
Effective use of
fluoride in different
age groups
6
Why straighten teeth?
7
The use of
mouthguards in sport
7
What to watch out for
in dental cover
7
Dental erosion
8
Black front tooth
10
Eat right to smile
bright
11
Grinding the night
away: possible health
outcomes
Home dental care tips for proper teeth
and gum care
11
12
Diabetes and oral
health
13
Dental treatment of
the elderly
13
Dry mouth
14
The use of implants
in dentistry
14
Tobacco and alcohol
dangers
15
Oral cancer
15
Editor: Louise Allan
Design: Michelle Nunn
Advertising: Eithne Healy 9482 3559
The Australian Dental Association’s Western Australian branch (ADAWA), in collaboration with
our generous sponsors, Colgate Palmolive, Oral B and HIF have much pleasure in presenting
our Preventive Dentistry magazine entitled Teeth: Love Them or Lose Them. The contributors are
all respected members of the dental profession in WA, broadly representative of private general
practice and specialist dentistry, WA Public Health dentistry and The University of Western Australia.
Preventive dentistry is based on procedures
and life practices everybody engages in,
in their daily lives, complemented by the
education and care provided by your dental
health professional that hopefully prevents
the beginning or progression of a wide
range of oral diseases.
It is never too early or too late to practice
good oral hygiene and sensible preventive
behaviour that will not only improve your oral
health, but your overall health and well-being
and importantly prove very cost effective.
Every day far too many Australians of
all ages and from all walks of life suffer
unnecessarily from the effects of oral pain
and discomfort that often results in many
days off school and missed work time.
We want to explain some of the most
common oral diseases such as dental
caries (tooth decay), dental erosion,
periodontal (gum) disease, oral cancer,
dry mouth and dental trauma and the
relationship with the rest of your body.
Hopefully you will be empowered with
sufficient understanding to motivate yourself
and your loved ones in wanting to improve
your personal oral hygiene practices,
re-evaluate and improve your diet and
nutrition, drink fluoridated water, desist from
smoking, moderate your alcohol intake and
make sensible decisions to minimise the
risk of physical trauma.
Not all aspects of preventive dentistry could
be covered in this magazine, however
for further explanation or information on
the content contained in this magazine or
any aspect of dentistry, please make an
appointment with your dentist.
With the assistance of your dental health
professional you can maintain a healthy
mouth for your lifetime and learn to love
your teeth rather than lose them. If by some
misfortune you lose a tooth, all is not lost.
Modern technology is available to replace
the tooth that can look and feel as good as
the original.
To locate an ADAWA dentist in your area
visit www.ada.org.au.
Remember, dental care today...
savings tomorrow.
Our three sponsors are all committed to
preventive dentistry. I encourage you to
purchase their products and actively seek
them out for further product information.
Dr David Hallett
President, Australian Dental
Association (WA Branch) Inc
Role of maternal nutrition on early childhood caries
The role of maternal nutrition is not only significant in promoting a child’s general health, it
influences a child’s risk of early childhood caries. This influence begins in pregnancy and remains
important throughout early childhood.
During pregnancy the foetus develops
a sense of flavour preferences from
the fourth month, when taste buds and
taste receptor cells develop.
Flavours such as sweet, salty, umami
(savoury), bitter and sour have a strong
innate component. Sweet, salty and
umami are innately preferred but bitter
and sour are innately rejected.
These innate flavour preferences can
be modified by maternal nutrition
during pregnancy, and whilst bottle
or breastfeeding.
Mothers who consume more sugar are
likely to have children who prefer sweet
foods and beverages, thus increasing
the child’s risk of dental caries. It is
therefore encouraged that mothers limit
their sugar intake (including artificial
sweeteners) from the fourth month
of pregnancy and increase green
vegetable consumption to increase the
likelihood of vegetables becoming more
palatable to their infant.
Enamel defects in the primary dentition
are formed before tooth eruption
and affect about 25 per cent of
Australian children.
Teeth start to calcify within the
first trimester of pregnancy, but
calcification is not complete until one
to 12 months after birth. Teeth affected
with enamel defects are even more
susceptible to dental caries. The cause
of enamel defects is largely unknown,
but poor maternal nutrition, drug
and alcohol use, obesity, poor health
during pregnancy, maternal vitamin D
deficiency, preterm birth,
as well as a child’s poor health and
nutrition within the first year of life,
have been implicated.
It is therefore important to strive for good
maternal health and nutrition during
pregnancy to hopefully reduce the risk of
a child developing enamel defects.
During pregnancy it is important that
pregnant mothers have good oral health,
free of dental caries and gum disease.
A combination of snacking, a diet high in
sugar and poor oral hygiene will increase
a mother’s risk of dental caries.
A mother with dental caries will have
the bacteria Mutans Streptococci,
which can transfer to their baby by
kissing and sharing spoons, even
before the baby gets teeth.
This transmission significantly
increases the risk of the child
developing dental caries.
A child’s dietary preferences and habits
are formed from an early age and are
often modelled from their mother’s
dietary preferences and habits.
If a mother has a good diet during
pregnancy and while their child is
young, the child is more likely to also
have a good diet and is less likely to
develop early childhood caries.
Dr Vanessa William, Paediatric Dentist
3
Baby teeth care
Baby Teeth Chart
UPPER TEETH
What are baby teeth and why are they important?
“Baby teeth”, also known as “primary teeth”
or “deciduous teeth”, erupt (come through the
gum) and exfoliate (fall out) during childhood.
These teeth play an important role in the
growth and development of the jaws, as well
as in chewing, speech and appearance.
Tooth decay in baby teeth can cause pain
and infection and is linked to decay in the
adult teeth.
Infection of a baby tooth can cause harm to
the adult tooth developing under the gum
and loss of a baby tooth (especially back
molars) can cause problems with spacing for
the adult teeth.
On average, when do baby teeth erupt
(come through the gum) and exfoliate
(fall out)?
See chart opposite.
How can I care for my child’s teeth?
Baby teeth are prone to decay as soon as they
erupt. You can reduce the risk of tooth decay
by having a healthy diet, reducing exposure
to refined sugars, performing adequate tooth
cleaning and visiting a dentist regularly.
Central Incisor
8-12 months
6-7 years
Diet: Sugars cause tooth decay. The amount
and frequency of sugar should be limited in
your child’s diet. Milk and water are the best
drinks for children’s teeth, however milk given
in bottles overnight increases the risk of
tooth decay.
Lateral Incisor
9-13 months
7-8 years
Canine
16-22 months
10-12 years
First Molar
13-19 months
9-11 years
Second Molar
23-31 months
10-12 years
Tooth cleaning: Tooth cleaning should be
started as soon as the teeth erupt. A flannel
or soft toothbrush should be used morning
and night to wipe the teeth clean. The
Australian Dental Association recommends
using a smear of children’s toothpaste from
eighteen months of age.
Second Molar
25-33 months
10-12 years
First Molar
14-18 months
9-11 years
Canine
17-23 months
9-12 years
Lateral Incisor
10-16 months
7-8 years
Central Incisor
6-10 months
6-7 years
Visiting a dentist: A child should visit a
dentist by one year of age, or when their
first teeth erupt. A dentist will check for early
signs of decay and provide preventive dental
advice. Regular dental visits are important for
monitoring jaw growth and development, and
maintaining your child’s dental health.
Dr Rebecca Williams,
Paediatric Dentist
LOWER TEETH
Dental treatment for the very young
Kids feel more confident in familiar surroundings, so it makes
sense to establish a Dental Home for your child when they are
very young, and to develop an ongoing relationship with a caring
dental clinic, so that your child grows up with a positive attitude
to dental care.
No child is "too young" to visit the
dentist, and a "well baby" dental
checkup around the first birthday
can give your child a head start to
lifelong oral health.
At these first visits your dentist can
assess your child's caries risk profile
and help develop an individually
tailored program of preventive dental
care. While some kids are ready to
climb on the big dental chair, other
kids prefer to have their dental
check-up from the security of mum
or dad's lap.
Despite improvements in the oral
health of children, tooth decay is
still the most common childhood
disease, affecting one in every
two preschool aged children. The
risk of oral disease is even higher
for disadvantaged groups in our
community, particularly indigenous
Australians, immigrants, low income
families, and children with chronic
medical issues.
If there are already signs of early
dental disease, an appropriate
minimum intervention program can
be developed to control and limit
the dental disease, often without the
need for fillings. Sometimes though
tooth decay may have progressed
to the point where fillings, cappings,
Even badly broken teeth can be fixed.
or even extractions are required.
Special techniques are often required
to successfully complete the
necessary dental treatment.
Despite the advances in dental
treatment, there is no magic wand!
Many adults are anxious about
dental treatment and say this stems
from their childhood experiences.
When it is anticipated that a lot of
dental treatment will be required, or
the dental treatment will be complex,
we will consider doing that treatment
under general anaesthetic with a “day
stay” in hospital.
If left untreated, most dental
problems tend to deteriorate, and
can lead to pain, altered function,
facial infections, and undesirable
tooth loss.
The earlier dental treatment is
completed, the more successful it
will be.
Maintaining the health of a young
child's teeth is very important for
proper chewing and eating, guiding
the future adult teeth into the correct
position, for normal speech, and for
your child’s appearance.
Dr John Winters,
Paediatric Dentist
The goal of dental treatment of the very
young is healthy, comfortable, functional,
and beautiful teeth.
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B
right Smiles, Bright Futures™ (BSBF)
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This engaging, activity-based program is a
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Together, the team undergoes a mission to
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BSBF inspires kids to take control of their
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The [Bright Smiles, Bright Futures] Kit is amazing.
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FUN FROM CLASSROOM TO BATHROOM
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5
Treatment of early childhood caries
Treatment of childhood caries starts with understanding – what it is and how it develops. Dental caries is the most common infectious
disease in children, caused by bacteria forming dental plaque.
The bacteria use sugars for energy creating
an acid that dissolves enamel leading to
decay. These bacteria arrive by mother
to child transmission during infancy,
occasionally before teeth erupt. This decay
is termed Early Childhood Caries (ECC) in
young children. Not everyone gets decay
but for children who are ‘at risk’, ECC
can be a painful and debilitating disease.
Symptoms include discoloured front teeth,
avoiding solid foods, disturbed sleep and
failure to thrive.
One form of ECC, sometimes called nursing
or bottle tooth decay primarily affects upper
incisors and the biting surface of molar
teeth. Teeth can decay quickly as they
emerge into the mouth, parents describing
they “came through that way”. Frequent
intake of fluids other than water during night
and day sleep provides the sugars.
Ideal treatment is prevention, cleaning
baby’s teeth as soon as they erupt
and avoiding frequent exposures.
Remineralisation treatment is possible with
early diagnosis. Late diagnosis requires
restoration, under general anesthesia in
young children, including fillings, crowns
and tooth extraction.
Very early decay can be treated with careful
cleaning and remineralisation, however
once cavities form, fillings are needed.
ECC in all its forms is mostly preventable by
early identification of ‘at risk’ children.
There are three main approaches:
Hypoplasia associated ECC is secondary to
developmental defects. These defects are
common and can be detected early. Simple
preventive measures including sealing
the defect can avoid considerable tooth
breakdown. When decayed defects are
large, fillings, crowns and extraction may be
needed.
1. Avoiding bacteria transfer. It is very
important that both parents have healthy
teeth; unhealthy mouths put babies at
great risk. New and planning parents
should see their dental care professionals
and ensure they have good oral health.
In reality transfer is difficult to avoid; it is
better for Mum and Dad to have healthy
teeth than avoid kisses!
The most common form of ECC is decay
between molar teeth where toothbrush
bristles can’t reach. It is as important to floss
between baby teeth as it is to brush them.
2. Care for teeth early. New parents should
take their baby for a dental check soon
after eruption of the first tooth and
definitely by 12 months of age. This
Figure 1: Early childhood caries associated
with frequent nursing.
Figure 3: Decayed defect.
Figure 5: Early decay seen as dark spots
between teeth may only be
detected by dental radiographs.
Figure 2: Restored dentition.
Figure 4: Restored defect.
Figure 6: Dental decay between
molar teeth.
allows identification of ‘at risk’ children
but importantly provides education
on brushing and flossing, adjunctive
preventive therapies and dietary advice.
Where ECC Is identified, early treatment
can prevent significant disease.
3. Avoiding decay promoting diets.
a. Avoid putting your baby to sleep with
a bottle and reduce nighttime ad
libitum breastfeeding once teeth erupt.
b. Have only water available during
sleep times.
c. Provide healthy snacks and drinks.
d. Be aware of ‘hidden sugars’.
For more advice, see your Oral Health Care
Provider or Community Child Health Nurse.
Dr Tim Johnston,
Paediatric Dentist
EXAMPLES
OF EARLY
CHILDHOOD
CARIES AND
RESTORED
TEETH
Figure 7: Restored cavity allowing
easier flossing.
6
Teeth: Love them or lose them
Effective use of fluoride in
different age groups
Since discovering the ability of fluoride ion to prevent decay
progression and protect tooth enamel surfaces, scientists and
health organisations have implemented a myriad of modalities
for delivering its benefits to people of all ages and sociodemographic status. Below are the majority of these modalities:
Growing Up Smiling program
Having a healthy mouth is important for overall health and wellbeing.
Poor oral health impacts the individual, families and the community.
For example, while the rate of tooth decay
among children has declined over the last
30 years, it is still five times more common
than asthma, and among young children,
dental problems is the third most common
reason for children being admitted to a
hospital for a preventable health condition.
Some simple things that parents can do to
prevent dental decay in children include:
•
Encourage twice-a-day brushing of
teeth with fluoride toothpaste;
•
Provide water to drink when thirsty, and
•
Reduce how much, and how often,
sugary foods and drinks are consumed.
Parents of WA children who need dental
treatment can use the available government
dental services through the School Dental
Service (SDS) and General Government
Dental Clinics (GDC) or see their own
private dental care provider.
The SDS clinics are co-located within
selected local primary schools throughout
the state and GDCs are located in
metropolitan and country centres (see www.
dental.wa.gov.au/clinics/locate.php for clinic
locations).
The SDS provides free comprehensive
general dental treatment to children aged
5-16 years attending a Department of
Education recognised educational institution.
Children younger than five years of age
whose parents possess a current Health
Care or Pension Concession Card (child’s
name must appear on the Concession card)
can be provided with subsidised dental care
at the GDC.
A new Commonwealth dental program
entitled Growing Up Smiling (GUS), due to
commence in 2014, is a scheme to support
the dental care of children for families who
receive Family Tax Benefit A.
Eligible children aged 2 to 17 years, will have
access to $1000 worth of limited dental care
over two years. The School Dental Service,
Government dental clinics or private dental
practitioners are able to provide dental
services under the GUS program.
For your nearest School Dental Service or
Government Dental Clinic visit the website
or telephone 9313 0555. Details of how
GUS will operate are still to be finalised by
the Commonwealth Government.
For further information on GUS, the
following website may assist:
www.health.gov.au/internet/main/
publishing.nsf/Content/growupsmiling.
Dr Martin Glick,
Public Health Dentistry
Water Fluoridation describes the
controlled adjustment of fluoride
levels in community water supplies
and was first introduced in 1945
to the supply in Grand Rapids,
Michigan, USA.
It is universally acknowledged
by health organisations such
as NH&MRC, WHO, CDC and
the ADA’s, to name a few, that
community water fluoridation is very
safe, effective and the most socially
equitable modality for reducing the
prevalence of tooth decay across all
ages and social groups.
Regulation and implementation
of water fluoridation in Western
Australia commenced in 1968,
seeing around 92 per cent of the
population covered by this water
supply today.
Self Use Fluoride Products
comprise toothpastes, gels and
rinses. Regular, controlled use
of fluoridated toothpastes is an
effective way to prevent tooth
decay across all age groups with an
additive preventive effect when used
with fluoridated water.
To reduce the incidence of enamel
fluorosis in developing teeth it is
recommended that children use
toothpaste under adult supervision
and assistance, in controlled
quantities and in respect to stage
of dental development (see table
below).
Patients diagnosed at high risk
for dental decay, and/or living in
non-fluoridated water areas may
be prescribed individually tailored
preventive regimens by their oral
health professional for the use of
high fluoride toothpastes, fluoride
gels and rinses.
Best practice experience for healthy
outcomes always favours regular,
bi-annual attendance by patients
for check-ups with their oral health
professionals.
REFERENCES:
Walsh et.al. Fluoride toothpastes of different
concentrations for preventing dental caries
in children and adolescents (Review):
Cochrane Collaboration, 2010; Issue 1
ARCPOH. The use of fluorides in Australia:
Guidelines; Aus Dent J. 2006;51(2):195-199
Armfield JM. Public Water fluoridation and
dental health in New South Wales; ANZJ
Pub Health. 2005;29(5): 477 – 483
Dr John Camacho,
Paediatric Dentist
AGE
TOOTHBRUSHING REGIMEN
6mo – 18mo
Adult assisted brushing commencing at
eruption of first tooth
NO TOOTHPASTE
18mo - 6yrs
‘Childrens’ toothpaste – 0.4-0.55 mg/g
Fluoride (image 1)
Smear/small pea size,
Adult assisted brushing,
Spitting toothpaste out, No rinsing,
Twice daily
6 years+
‘Standard’ toothpaste - 1 mg/g Fluoride
(image 2)
Smear/small pea size,
Adult assisted brushing up to 8
years old, Spitting toothpaste out,
No rinsing, Twice daily
IMAGE 1
Figure 1: Decay on upper front
baby teeth.
Figure 2: Decay on lower back baby
teeth. Photos: P Arrow.
IMAGE 2
7
Why straighten teeth?
Many adolescents and adults have orthodontic treatment to improve the appearance, health and function of their teeth. If a growing
child has an orthodontic problem, it is important to have a thorough assessment by a Specialist Orthodontist, recognised by the Dental
Board of Australia.
The orthodontist has had three years
of additional training in a university
environment and is well equipped to offer
advice regarding the need for treatment and
more importantly, the appropriate timing
for treatment.
There are many orthodontic problems which
should be treated while the child is growing
to ensure that the treatment is effective and
quick. There are many reasons why you
may consider orthodontic treatment:
Appearance: People are very aware of
how teeth look and an attractive smile can
play an important role in enhancing selfconfidence. These days, with good oral
hygiene and regular dental care, your teeth
should last a lifetime - wouldn’t it be nice if
they looked good too?
Hygiene: It’s more difficult to clean
your teeth when they are crowded and
overlapping. Inadequate cleaning is a major
factor in tooth decay, gum disease and
eventual tooth loss. Whilst it is possible to
keep even the most crooked teeth clean,
having your teeth straightened will make it
easier for you to look after them.
For example, in cases with a large over bite,
the lower front teeth can bite into the gum
behind the upper front teeth.
Prevention of damage to front teeth:
Severely protruding teeth do increase the
risk of trauma from sporting and
daily activities.
This may lead to loosening and movement
of the teeth and eventually may lead to
tooth loss.
It may be important to reduce the extent of
the protrusion in a timely manner with either
a plate or braces, as broken and damaged
front teeth require complex management to
keep in the mouth for a lifetime.
If these types of bites are not addressed
at an early stage, the effects may often be
irreversible and this may leave the child with
long term management issues.
Jaw joint problems: It is claimed that
some bad bites stress the jaw joint causing
damage and pain in and around the joint.
There is nothing more distressing to a child
and parent than having their front teeth
damaged.
Speech: Some people have difficulty
speaking properly because of alignment
problems with their teeth and jaws.
Tooth wear: It is claimed that some bad
bites lead to clenching, grinding, and
excessive wear and/or uneven wear of the
teeth.
If you are concerned about the arrangement
of your child’s teeth, it is important to
consult a specialist orthodontist who is best
equipped to give you an opinion.
Gum damage: In some bites, the teeth can
damage the gum of the opposing teeth.
Dr Mithran Goonewardene,
Orthodontist
The use of mouthguards in sport
What to watch out for in dental cover
Prevention of dental trauma and other sporting injuries has
become an even more important issue due to an increased
popularity of contact and non-contact sport and combined with
children participating in sport at a young age.
When it comes to dental cover, it is very important to consider
your annual financial limits.
Dental injuries are the most common
type of orofacial injury sustained during
participation in sport. One of the most
cost-effective ways to protect teeth is
to wear a custom-fitted mouthguard. It
is widely thought mouthguards provide
protection against oral trauma and their
use at all levels of sport is encouraged.
There are three types of mouthguards:
Stock mouthguards:
Stock mouthguards are available from
pharmacies and sport stores. They are
a bulky gutter of rigid plastic available in
various sizes; some designs are cut in
order to allow them to fit. They have a
loose fit and rely upon a constant biting
force to hold them in position. They interfere
with speech and breathing and are a
potential airway hazard.
Boil and Bite mouthguards:
Boil and Bite mouthguards are also
Stock mouthguards.
available at pharmacies and sport stores.
They are made of a thermoplastic material
which when heated in hot water are
moulded to the athlete’s mouth.
Due to their low temperature of formation
they continue to deform so their fit
becomes loose over time. Therefore, the
protection offered is rather limited.
Custom-constructed mouthguards:
Custom-constructed mouthguards offer
the athlete the greatest form of protection.
They are made of a thermoplastic material
that is vacuum and heat formed over a
model of the athlete’s teeth.
Laboratory tests show they offer a
greater level of protection than boil and
bite mouthguards and are the type
recommended to patients.
Dr Mark Foster, General Dentist
Boil and bite mouthguards.
Custom-constructed
mouthguards.
A low annual financial limit may restrict the
amount of dental work you can afford in a
calendar year and you can’t always plan
your treatment, as it is difficult to expect
the unexpected.
It’s important to take notice of what the
limits are for your length of membership
and how long it will take you to get to the
maximum annual limits.
“We don’t plan to have dental problems”, HIF
Managing Director Graeme Gibson said.
“That’s why at HIF we have very generous
annual financial limits on all our extras
covers. Plus, our general dental treatment
is unlimited.”
At HIF, you’ll get access to the maximum
annual financial limit under extras covers
after only five years.
“Across the myriad of extras covers in
the market you’ll find some with so-called
preferred or participating provider schemes
or arrangements (i.e. contracted provider),
and you’ll see a great deal of variation
in annual financial limits, sub-limits and
the structure and amount of rebates,” Mr
Gibson said.
“Extras covers vary in terms of how rebates
are structured. Some funds have specified
rebate amounts based on a proportion
of the average charge for each dental
treatment. Other funds provide a flat
percentage of the amount of the bill – for
example they may be 50 per cent of each
bill until the annual limit is reached.”
Mr Gibson said although the flat percentage
sounded attractive, he warned of the
potential downfalls.
“Often it will only apply if a contracted
provider is used. So you might get caught
out if you use your own (i.e. non-contracted)
dentist,” he said.
“Annual financial limits are generally lower
and a financial limit may also apply to
general dental category of treatment which
can really restrict the amount of dental
treatment you can afford in a calendar year.”
Mr Gibson said funds which paid a
percentage back of the bill included it as
part of the overall annual financial limit
whereas HIF rebates have no limit on
general dental treatments.
“We provide up to 100 per cent
rebate for the most popular preventive
treatments, like examinations, plaque
removal, remineralisation and even fitted
mouthguards”, Mr Gibson said.
“Dental health is directly linked to our
general health and that’s why we financially
encourage, and encourage in other ways,
our members to be proactive toward
preventative dental treatment.”
Mr Gibson said do your sums and work
out what is the best cover for your personal
situation and your budget.
Work out which plan will benefit you the
most when you are in that situation.
8
Teeth: Love them or lose them
What does erosion look and feel
like on teeth?
Dental erosion
Dental erosion is a chemical process which permanently
destroys the hard tissues of teeth. It is not related to dental
decay (bacterial action), but is caused by the effects of
acids in the mouth which can come from different sources,
both internal and external.
Immediately after exposure to oral acids,
you can feel a change in the surface texture
of the teeth from smooth and slippery to
roughened or even gritty with chewing. This
returns to a more normal feel after some
time, once saliva has had a chance to
reverse some of the effects.
It is important to determine what
the cause of the erosion is for each
person based on their specific
medical and dental histories.
What type of acid exposure is it,
how often does it occur, how long
is the acid in contact with the
If the erosion rate exceeds saliva’s
neutralising effects, a loss of tooth structure
results. This eventually becomes obvious
by its appearance and feel. Sometimes the
enamel can become very smooth.
Saliva provides
a protective
protein coating
over the teeth
called a pellicle
and loss of this
coating can make
the teeth more
susceptible.
teeth and does anything make
it worse?
In all cases, a chemical imbalance
develops, overwhelming the
natural defences that the body
has in place to protect the teeth.
The enamel is ultimately
eroded, eventually exposing the
underlying sensitive dentine.
Saliva has an acid neutralising
(buffering) effect, so any condition
causing a dry mouth may make
the mouth more prone to erosion.
Saliva also provides a protective
protein coating over the teeth
called a pellicle and loss of this
coating can make the teeth more
susceptible.
Visually you may see thinning of the teeth,
a change in colour (yellow tinge), rounding
of tooth form, smoothing of the enamel,
depression in the surface of the tooth into
dentine (this can be sensitive) and elevation
of the edges of fillings above the tooth line.
Enamel can be lost from the neck of the
teeth revealing sensitive dentine and root
edges. Sensitivity may also become
a problem.
Prevention and Management in
Susceptible People
1. Diagnose and treat any medical
conditions or disease.
2. Avoid the cause of the acid attacks,
change lifestyle and avoid foods or
drinks known to cause problems.
3. Immediately after an acid event, wash
out your mouth with water, milk or an
antacid to dilute and neutralise the acid.
If available, high fluoride mouth washes
or toothpaste can remineralise the tooth.
4. Take acidic foods with main meals only,
reducing the number of acid attacks.
5. Avoid brushing your teeth for around
30 minutes after the event allowing the
saliva time to remineralise the teeth.
6. Avoid using hard tooth brushes or
abrasive tooth pastes as the enamel is
softened after an acid attack.
7. Drink acidic liquids using a straw. Take
Vitamin C as a tablet.
8. Topical fluoride treatments and fluoride
mouthwashes can help.
9. Ongoing monitoring of erosive effects by
the dentist.
10. Covering sensitive tooth structure can
be achieved by dentists using resin
coatings or fillings if needed.
11. Protective night guards used to reduce
tooth wear on acid affected teeth.
Fluoride solutions could be incorporated
into this.
Regular dental recalls are essential to
monitor and react to unfavourable changes.
Dr Garry Ecker, Prosthodontist
Are you at risk of
dental erosion?
External sources
1. Diet: Avoid a high intake of citric
acids, fruit juices, soft drinks
(carbonated), vinegar based foods
or known acidic foods, even some
sports drinks.
2. Medicines: Vitamin C, aspirin, some
mouthwashes. Anticholinergic drugs
can dry up saliva.
3. Chemicals: Alcohol causing vomiting,
some recreational drug effects.
4. Local environments:
Battery acids, wine tasters,
excessively chlorinated pools.
Figure 1a: Severe dental erosion
from bulimia.
Figure 2: Rounding of teeth and extreme
chemical polishing of enamel.
Figure 4a: Severe erosion and
tooth wear.
Figure 1b: Severe dental erosion
from bulimia.
Figure 3: Severe erosion from
anorexia nervosa.
Figure 4b: Severe erosion and
tooth wear.
Internal sources
1. Physical defects: Hiatus hernias and
other disorders of the throat.
2. Psychological problems:
Anorexia, bulimia, severe stress and
severe alcoholism.
3. Medications and Treatments:
Some chemotherapy, radiation
treatments, oral steroids or
medications causing gastric reflux.
4. Pregnancy: Vomiting
Internal sources are the most difficult
to control and may require referral to
medical specialists capable of dealing
with the origins of the problems if at
all possible.
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10
Teeth: Love them or lose them
Black front tooth
Discoloured teeth can be unsightly and it also usually means the tooth either has, or has had, a problem. There are many causes of
tooth discolourations – such as developmental, environmental, trauma to the tooth, disease in the tooth, systemic diseases, medicines,
food, drinks or habits.
Each cause results in a different type of
discolouration and each type requires
specific treatment. Hence, it is essential that
a dentist thoroughly examines discoloured
teeth to determine the cause, type and
appropriate treatment.
Discolourations can be intrinsic or extrinsic
in nature. There are many intrinsic stains
and these involve the dentine (the inner
layer of the tooth).
Treatment will vary depending on the cause.
If many teeth are discoloured, the cause is
likely to be developmental, environmental or
due to systemic diseases or medicines taken
during tooth development. Multiple teeth
with intrinsic discolourations are difficult to
manage and may require porcelain veneers
or crowns to cover the teeth.
If only one or two teeth are discoloured,
then this is usually due to trauma or disease
in the tooth (for example, infection). These
teeth can usually be managed relatively
easily by internal bleaching.
The tooth will first require root canal
treatment to remove the diseased pulp or
infection from the tooth, and to protect
the tooth root during bleaching. Internal
bleaching must be done by your dentist.
A bleaching compound is placed inside the
tooth to bleach the discoloured dentine.
Extrinsic discolourations involve the tooth
surface or the enamel (the outer layer of the
tooth). Most extrinsic stains involve all or
many teeth, not just one or two teeth. Many
external stains are due to food, drinks,
smoking or other habits.
Changing habits and avoiding food and
drinks that stain teeth is essential to
maintain the natural tooth colour. Most
extrinsic stains can be easily removed by
your dentist using hand, sonic or ultrasonic
scaling devices and polishing techniques.
Some teeth may need external bleaching
(whitening) – however, consult your
dentist first to determine why the teeth are
discoloured and what the best treatment is.
Extrinsic stains that are in the enamel and
not just on the tooth surface are usually
developmental in origin and can be difficult
to remove. The dentist may need to use
special techniques (for example, enamel
microabrasion) or restorations such as
porcelain veneers or crowns to cover
the discolouration.
It is important to realise that teeth become
yellower as you age – this is normal.
Teeth are not “white” and when they are too
white, they do not look natural. The most
natural colour of your teeth is when their
colour is similar to the whites of your eyes
– then the teeth do not “stand out” when
others look at you.
By Winthrop Professor Paul V
Abbott, School of Dentistry, The
University of Western Australia
EXAMPLES OF
DISCOLOURATION
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all the areas that dentists check most. With its stabilised stannous
fluoride formula, Oral-B Pro-Health is able to deliver all-around
protection in one single toothpaste, including enamel protection.
Enamel is the hardest substance in
the human body, but daily exposure
to fruit and other acidic foods can
wear away at this protective coating.
New Oral B Pro Health toothpaste’s
breakthrough formula contains
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a barrier against damaging acids to
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A clinical study showed up to 42
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versus ordinary fluoride toothpaste
after 15 days of use.*
Oral-B Pro-Health has also been
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*Hooper SM, Newcombe GR, Faller R, et al.
The protective effects of toothpaste against
erosion by orange juice: studies in situ and in
vitro. J Dent. 2007; 35:476-481.
Always read the label. Use only as directed.
If symptoms persist, see your healthcare
professional.
ASMI 22663-0813
Figure 1: Intrinsic discolouration of a front
tooth that had been traumatised.
Figure 2: The same tooth as in Figure 1
following internal bleaching treatment by
a dentist.
Figure 3: Extrinsic discolouration of the
two front teeth due to fluorosis (excess
fluoride during tooth development).
Figure 4: The same teeth as in Figure 3
following enamel microabrasion treatment
by a dentist.
11
Eat right to smile bright
Guidelines for diet and nutrition that improve oral health.
1. Eat fibre and whole grains daily
High fibre foods encourage saliva flow
which helps protect teeth. Wholegrain
foods are important for bones, teeth and
gums. Options for incorporating fibre into
your diet are bananas, apples, oranges,
peanuts and almonds.
2. Drink lots of water
Water is important for your body and
your teeth. Water helps wash away
food particles. Fluoride in water helps to
reduce caries risk.
3. Avoid snacking between meals
Saliva takes around 20-30 minutes after
a meal to start protecting your teeth.
Aiming for three meals a day, without
snacking, provides the much needed
time for saliva to repair teeth.
4. Limit acidic drinks and foods
Dental erosion is the softening and
subsequent wearing away of the tooth
surface. It is caused by exposure to acids
found in soft drinks, sports drinks and citrus
juices, citrus fruits and pickled foods.
5. Limit foods high in refined sugars
Natural sugars are better for your health
and teeth than refined sugars. Try to stay
away from snacks such as lollies and
sweets on a regular basis.
6. Enjoy calcium rich foods
Calcium is needed for strong and healthy
teeth. Cheese has been shown to help
prevent tooth decay. Other sources of
calcium are yoghurt, broccoli,
and almonds.
7. Chew sugar free gum
Chewing gum has a cleansing effect and
increases saliva flow. Chewing xylitol gum
has been shown to decrease the amount
of bacteria in the mouth and help buffer
the teeth against the effects of acid.
8. Be careful with hard foods
Biting on hard lollies and ice cubes can
break teeth and fillings.
9. Good nutrition is essential for
gum health
Eating a well-balanced diet helps
resist gum disease and oral soft tissue
infections. Malnutrition can exacerbate
periodontal diseases.
10. Limit tobacco and alcohol
Tobacco, alcohol and coffee can lead to
staining of teeth and certain chemicals
can cause wear of teeth. Tobacco use
also increases the risk of oral cancers.
Dr Marilyn Lobo, Paediatric Dentist
Grinding the night away: possible health outcomes
A lot of people are not aware that they grind or clench their teeth when they are either awake or
asleep. The scientific term to describe this is “bruxism”. Sleep bruxism is a sleep related movement
disorder experienced by approximately 12-20 per cent of children and 5-8 per cent of adults.
Most people will have periods during
their life when they will have sleep
bruxism. Previously, the cause of
sleep bruxism was thought to be a
mismatch between the upper and
lower teeth (malocclusion).
Scientific evidence debunked this
theory. It has been noted that there is
an association between sleep bruxism
and nicotine, caffeine and alcohol
use. Also it is more common if people
are anxious, performance driven or
stressed.
Sleep bruxism is sometimes related
to snoring and sleep apnoea and may
actually help open the airway during
obstruction while asleep. Despite
all the associations, we still do not
know why some people brux and why
others do not.
Teeth grinding and clenching can
generate 40kg of force and hence chip
or fracture teeth and fillings leading to
significant discomfort. Sleep bruxism
may also increase the mobility of teeth
by aggravating gum disease.
After a night of bruxing, it is not
uncommon for individuals to wake
up with jaw pain, jaw clicking and
limited mouth opening. Studies have
reported between 20-30 per cent
of individuals with sleep bruxism
complain of jaw pain,especially in the
morning. At present, treatment for
jaw pain from sleep bruxism include
limiting jaw use, pain medications,
muscle relaxants, physiotherapy and
dental splint (dental guard).
There are a variety of dental splints
used to treat disorders other than
sleep bruxism. Also, not all dental
splints marketed for treating sleep
bruxism have been shown to work.
For the best advice about whether
a dental splint is needed, it is
recommended you consult your
dentist to diagnose and if required
custom design, fabricate and fit the
splint. Ongoing consultation with a
dentist is required to monitor treatment
success and potential complications
such as bite changes.
Potential future treatments include
medical devices worn to bed that
reduce bruxism by mild electrical
impulses to the jaw muscles.
Also certain medications such as
blood pressure and mood-altering
medications have been shown
to reduce bruxism. A novel use
botulinum toxin injection (Botox) is
for the treatment of sleep bruxism;
however more rigorous studies are
necessary prior to routine use.
Perhaps the most frustrating
consequence of sleep bruxism is jaw
pain and headache. Some two-thirds
of bruxing patients report headache
related to jaw muscle pain (temporal
headache), tension-type headache
and occasionally morning migraine.
Treatment is focused on minimising
bruxism at night.
Figure 1: Worn and fractured
incisal edges.
If you or your partner brux while
asleep, suffer from jaw pain or
experience morning headache, you
should contact your dentist to discuss
these symptoms. Early diagnosis and
treatment can limit unnecessary pain
and damage to teeth.
Clin A/Prof Ramesh
Balasubramaniam, Orofacial Pain –
The University of Western Australia
Figure 2: Night guard or occlusal splint.
12
Teeth: Love them or lose them
Home dental care - tips for
proper teeth and gum care
A
A dental health professional (dentist, dental hygienist or therapist)
is the best person to tell you how to look after your teeth and
gums. They are able to examine your mouth in detail and give
advice that is unique to your mouth. However if you are unable to
visit such a person here are some basic tips.
B
How would you like your teeth to look – A,
B or C?
Most people would choose “A”. Image “B”
is of someone who didn’t care and “C” is
of somebody who has made an expensive,
belated effort to care about their mouth.
There are two common dental diseases
caused by germs growing on the teeth:
tooth decay (seen in “B”) and gum disease
(one of the effects - gum recession - is seen
in image “C”).
C
The most common site for tooth decay
and gum disease to occur is between the
teeth. In the pictures below “D” looks at the
biting surfaces of the upper teeth in a clean
healthy mouth and “E” in a mouth that had
to be repaired because of tooth decay.
D
All the fillings that have been done involve
the tooth surfaces between teeth (where
the teeth touch each other). It is therefore
very important to be aware that these are
the danger areas for problems to occur.
Avoid brushing the gums otherwise this
can cause damage, such as recession or
scratching and ulceration.
Massaging the gums does not provide any
extra benefit.
Look at image F The shape of the teeth
and the way they touch creates a 'V'
shaped space which on the palate side
(the larger yellow triangles) is greater than
the cheek or lip side (the smaller green
triangles) and so has a larger area for
germs and food to collect.
It is very important to keep these areas
clean if you want to keep your teeth and
gums healthy.
Other cleaning gadgets or aids one can
use to clean between teeth are interproxil
brushes and dental floss to wipe the tooth
surface. These will have a greater benefit
with the back teeth than the front.
Dr Keith Gale, Periodontist
If you want to stop tooth and gum disease
you need to keep these areas clear of the
debris and germs that cause damage.
E
So how should this be done? Most people
own a toothbrush but do you use it
effectively?
F
When using a toothbrush remember
to clean not only your teeth but, more
importantly, between your teeth.
You can do this if you use a mirror and
check that you place the toothbrush
along the gum line with the bristles angled
between the teeth.
The movement is usually in a small
horizontal direction, almost wiggling
the bristles between the teeth. It is also
important to clean along the gum line.
FIGHTS UP TO
90% MORE
PLAQUE GERMS
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1
FOR 12 HOURS
SUPERIOR* PROTECTION
F O R A HEALTHY MOUTH
Always read the label. Use only as directed. See your dentist if symptoms persist.
1) Fine, et al. (2006). Journal of the American Dental Association, 137: 1406-1413; funded by
Colgate-Palmolive Co, New York. *vs ordinary fluoride toothpaste.
When using
a toothbrush
remember to clean
not only your
teeth but, more
po a y, be
ee
importantly,
between
your teeth.
13
Dental treatment of the elderly
The ageing population has more teeth and a stronger desire to
retain them than their previous generations. Many of the elderly
today have a fairly intact dentition.
Figure 1: Before treatment.
Figure 2: After treatment.
A healthy mouth whatever your age
is a current goal shared by both
dentists and their patients. Age has an
effect on our whole body. This is also
true for our teeth, gums and mouth.
Dental problems are among the most
common health problems experienced
by older adults.
In fact people over 65 with natural
teeth have more tooth decay than any
other age group.
The dental profession is a strong
advocate for preventive dentistry. By
adopting healthy oral habits at home,
making smart choices about diet and
seeking regular dental care, teeth can
last a lifetime.
Visiting your dentist regularly can help
prevent more serious health problems.
Figure 3: Before treatment.
Figure 4: After treatment.
Diabetes and oral health
Diabetes and gum disease often go hand in hand and the bad
news is that gum disease can cause teeth to become loose and
even fall out if left untreated. People with diabetes are prone to
infections and the mouth is no exception.
Apart from increased risk of gum disease,
decay and fungal infections can also be
a particular problem for diabetics. Unless
dental cleaning is super good, bacteria
will stay on the teeth to form plaque which
causes inflamed swollen gums and leads
to bone loss.
Plaque is the cause of gum (periodontal)
disease so it is essential to keep the teeth
as clean as possible for a healthy mouth.
If your gums bleed when brushing, flossing
or after eating, if there is bad breath,
shrinking gums, tooth sensitivity, food
packing or loose teeth then it is likely you
have gum disease. You need help and
fast, even if you are not diabetic. Diabetes
however, makes gum disease three times
as likely and more aggressive, often with a
more severe response to plaque.
Damage to the bone around the teeth from
gum disease is irreversible so it is critical not
to ignore bleeding gums. The good news is
that help is simple and easy to access.
A dentist, hygienist or specialist periodontist
can carefully remove the bacterial plaque
and tartar from parts of the teeth which
cannot be reached by simply cleaning at
home. With proper treatment the gums
stop bleeding and heal rapidly.
Coaching from the dental team in
brushing and flossing techniques will
help keep teeth clean and the gums
healthy in between visits for professional
maintenance cleaning.
Quitting smoking is also essential for
maintaining your teeth and oral health, as
well as helping manage diabetes.
If you are diabetic, keeping good control
of blood sugar is vital to decreasing the
severity of any gum disease. In turn,
healthy gums help maintain good blood
sugar levels.
The connection between the two diseases
is strong and it is important not to ignore
either, even though there may be no pain
or severe symptoms. A healthy mouth is
essential to a healthy body and you do not
have to be a diabetic to get that benefit.
There is no question that patients with
diabetes should be seen by the dental
team as part of their annual cycle of
care alongside physicians, optometrists,
dieticians, podiatrists and exercise
physiologists.
Dr Jane McCarthy, Periodontist
Current medical research frequently
suggests that an unhealthy mouth
may worsen serious medical
conditions such as diabetes, heart
disease and stroke.
What special oral health issues
should seniors be aware of ?
Dry Mouth
• A dry mouth is caused by a lack of
saliva. It is a common condition and
may be caused by medications and
certain medical conditions.
• Saliva is the body’s defence against
tooth decay. A lack of saliva can
contribute to an increase in both
tooth decay and gum problems.
• With a dry mouth it may be difficult
to eat, swallow, taste and speak.
What to do
• Use an artificial saliva replacement
product.
• Chew sugarless gum.
• Drink plenty of water during a meal.
• Avoid drinks with caffeine, as
caffeine can dry out the mouth.
• Never change or reduce any
medications without consulting
with your doctor.
• It is important NOT to suck sugary
sweets or consume sugary drinks to
relieve the feeling of a dry mouth.
Root Surface Decay
• As we age our gums can recede,
leaving areas of exposed root
surfaces, which have no protective
enamel. These areas are prone
to decay.
• Root surfaces can decay at a
rapid rate.
What to do
• Visit your dentist or dental hygienist
regularly.
• If you are identified as a high-risk
patient for root surface decay, your
dental professional may provide
a preventive fluoride treatment at
the dental clinic. They may also
recommend the use of high fluoride
mouth rinse or paste at home.
• Make changes to your diet to
reduce sugar intake.
Brush your
teeth twice a
day with a fluoride
toothpaste,
especially at
bedtime.
Periodontal (Gum) Disease
If teeth are not properly cleaned,
plaque builds up and if left too long
it will form a hard damaging covering
called calculus or scale that brushing
doesn’t remove.
The gums will become red and
swollen and will bleed easily. If a
dentist or dental hygienist does not
professionally clean the teeth at this
stage, the surrounding gum and
supporting bone will be destroyed.
If left untreated over a period of time
further bone loss will occur and teeth
can become loose and may have to
be removed.
What to do
• Brush your teeth twice a day with
a fluoride toothpaste, especially at
bedtime.
• If you have trouble brushing
thoroughly, an electric toothbrush
may be easier to use, and is often
more effective. Ask your dentist or
hygienist to demonstrate a suitable
brush.
• Use floss and any other special
cleaning aids recommended to you
by your dental professional at least
once each day.
Regardless of your age, you can
keep your gums and teeth healthy by
following the above daily care and
seeing your dentist or hygienist for
regular care.
Dr Peter Duke, General Dentist
14
Teeth: Love them or lose them
Dry mouth
You have probably never heard anyone describe the sensation of having a wet mouth, but it is not unusual to hear a croaking voice
complain of being dry.
All of us have experienced a dry mouth
following exertion, often on a hot summer’s
day in Perth or while travelling on an
aeroplane. For most of us, the dry-mouth
is transient and we take it to be a sign of
thirst. After drinking a glass of water our
mouths soon return to feeling comfortable
and we forget the unpleasant feeling of
the dry-mouth. We take for granted the
moisture in our mouths.
For some people, having a dry mouth is
not a transient problem, but something
that persists and may be permanent, 24
hours per day. These individuals suffer with
hyposalivation, a reduction in the saliva that
moistens the mouth. The most extreme is
where no saliva is produced at all.
Whereas an absolutely dry mouth is
unusual, hyposalivation is very common
and has a number of causes. It may be
caused by drugs and medications. These
range from common over the counter items
such as anti-histamines, used to treat hayfever and allergies, to codeine-containing
compound analgesics used for minor pain.
Prescription medications including those
used in management of depression and
other psychological conditions and arthritis
medications may lead to dry mouth.
Chemotherapy agents, strong painkillers
and diuretics may reduce saliva production.
Salivation often returns to normal when
the causative drug is withdrawn; however
effects may be long-lasting. Changing to
a similar medication of the same type may
improve the dryness.
Radiation therapy used to treat cancers
of the head and neck often causes
permanent, problematic dry mouth.
Radiation destroys cancer cells but also
damages normal tissues close to the site of
the tumour. Salivary glands are particularly
sensitive to radiation and damage is
frequently permanent.
Dry mouth may result from disease
processes in the salivary glands themselves
such as Sjogren’s Syndrome, an autoimmune condition linked to rheumatoid
arthritis, lupus and Hashimoto’s Disease.
Dry mouth may be the first sign of Sjogrens
Syndrome. Mouth breathing, following nasal
obstruction, sinusitis or allergy dries out the
mouth; particularly at night. Habits such as
smoking and even moderate alcohol intake
or caffeine consumption reduce saliva.
Illicit drugs such as heroin, amphetamines,
marijuana and cocaine are well known
causes of dry mouth.
Dryness associated with diabetes is very
common. Diabetes is linked with thirst and
increased fluid intake. In Type-2 diabetes, a
disease that may develop over many years,
dry mouth is a common complaint.
In cases of Glucose Intolerance or
‘borderline diabetes’, dry mouth may be the
first symptom.
Not only is the volume of saliva production
reduced by medication or radiation damage
but the biochemical components of saliva
are also altered. As well as causing difficulty
in talking, chewing and swallowing, dry
mouth can result in more severe problems
ranging from increased risk of oral infection,
production of salivary stones and especially
tooth decay.
Surfaces of teeth are constantly worn
through biting and chewing, eroded by
For some people,
having a dry mouth
is not a transient
problem, but
something that
persists and may be
permanent, 24 hours
per day.
acids in food and drink and attacked by
chemicals produced by bacteria in dental
plaque. Saliva lubricates the mouth during
eating; contains enzymes and antibodies
that defend against plaque bacteria and
repairs microscopic damage to teeth
following chemical damage by acids in
food, drinks or plaque bacteria.
The use of implants in dentistry
Dental implants can be described as artificial tooth roots made out of titanium that are placed into
the jawbone to replace missing natural teeth.
The artificial teeth or crowns attached to
dental implants are designed to closely
mimic the look and function of real teeth.
Titanium is a unique material that provides
not only sufficient strength to support
an artificial tooth or crown, but is also
biocompatible allowing incorporation
into the jawbone without any risk of
rejection. This process is referred to as
Osseointegration and is supported by more
than 50 years of scientific research.
Dental implant therapy involves a surgical
stage, where the implant is placed into the
jawbone, and a restorative stage, where
an artificial tooth or crown is securely
attached to the implant. Compared to
other methods of replacing missing teeth,
dental implants offer a significant advantage
because damage to adjacent teeth can
be avoided. Unlike natural teeth, implants
cannot decay. However if not brushed and
flossed regularly, gum disease (periodontitis)
resulting in bone loss around the implant
surface may still occur.
In WA today, it is the General Dental
Practitioner who will usually attach crowns
to implants for the replacement of single
missing teeth. The surgical stage of
placing the implant into the jawbone is
in most cases performed by a Specialist
Periodontist or Oral Surgeon. In more
complex cases, these specialists may
also be required to carry out bone grafting
or bone regeneration techniques. A
Prosthodontist is another key Specialist
who may be involved in the restoration of
dental implants – particularly in situations
where a patient has multiple adjacent
missing teeth. The restoration of multiple
missing teeth is commonly described as
an Implant-Supported Bridge. In some
situations a bridge will span an entire jaw of
missing teeth (usually supported by four to
six implants).
For patients who have lost all of their
teeth in either one or both jaws, dental
implant treatment has resulted in dramatic
improvements in the quality of life,
particularly for those who have suffered
with loose and painful dentures, whilst for
patients who have lost single teeth, implants
can offer significant advantages over
previous methods of tooth replacement.
A/Prof Dax Calder, Periodontist
These repair processes become inefficient
when saliva production is reduced, leading
to increased risk of tooth decay and tooth
loss. New cavities or the need to replace
recent fillings may be signs of a dry mouth.
Dentists take a patient’s complaints of
a dry mouth seriously. The reasons for
the dryness need to be investigated.
Sometimes serious underlying medical
conditions are diagnosed.
Management of dry mouth involves
addressing the underlying cause, preventing
damage to teeth and other structures,
treating infections and relieving patient
symptoms.
A number of proprietary products for
dry mouth relief are on the market. Oral
lubricants are effective, but are expensive
for long-term, daily use and many patients
resort to light cooking oils such as grapeseed or olive oil. Sipping water provides
poor relief from dry mouth symptoms as
water does not have the slippery, greasy
characteristics of saliva. Chewing gum
is probably the most efficient means of
stimulating saliva.
Anyone with a dry mouth should see a
dentist regularly so that problems resulting
from hyposalivation may be identified and
appropriate management initiated.
Dr Gareth Davies, Oral Medicine The University of Western Australia
15
Tobacco and alcohol dangers
Smoking and alcohol misuse constitute two main risk factors for
oral cancer, the majority of which are squamous cell carcinomas.
Oral cancer is a disease which can affect
any intraoral site and in Australia, every
year, about 2500 new cases are diagnosed
(Figures 1-3). Oral cancer is more common
in men than women, with the majority of
cases occurring after the 5th decade of
life, although about six per cent occur
in individuals less than 40 years of age.
Sadly, on average, only about half of those
individuals survive, and of those that do,
many endure significantly compromised
life quality as the disease and its treatment
affect the most basic oral functions which
are often taken for granted, such as the
ability to eat and speak.
Tobacco smoke contains more than 60
cancer causing products and current
smokers are 3.5 times more likely to
develop oral cancer compared with nonsmokers. Ethanol and water are the main
components of most alcoholic drinks.
Ethanol is damaging to the oral mucous
membranes. Acetaldehyde, a product of
ethanol metabolism, is responsible for the
oral carcinogenic effect of ethanol. Some
alcoholic beverages, such as whisky, may
contain additional carcinogenic agents.
Consumption of as little as one standard
alcoholic drink per day is associated with
an increase in oral cancer risk. Individuals
who consume five standard drinks per day
are more than three times more likely to
develop oral cancer. Importantly, oral cancer
risk is multiplicative for the combined use of
alcohol and tobacco.
Fortunately, for many individuals, oral
cancer is a preventable disease. In fact, the
majority of oral cancers can be prevented
through lifestyle modification, involving
cessation of tobacco and moderation of
alcohol use.
Oral cancer can present in many different
ways, including as a red or a white patch,
an ulcer or a lump and can occur anywhere
in the mouth. The earlier the diagnosis is
made, the higher the chance of cure is, with
better life quality. It is therefore paramount
that any abnormality, identified anywhere in
the mouth, be checked if it persists for more
than two weeks (Figure 4).
Figure 1: Oral cancer affecting the
mucous membrane of the inside of the
cheek.
Figure 2: Oral cancer affecting the
mucous membrane of the tongue.
Figure 3: Oral cancer affecting the
mucous membrane of the palate.
Figure 4: This small gum ulcer is an
example of a very early mouth cancer.
Dentists are well trained in recognising oral
mucosal abnormalities and are well placed
amongst the health care professionals in
being able to identify oral cancers correctly.
Dentists should therefore be consulted
whenever persistent mouth abnormalities
are identified. It is important to note also
that because in the early stages oral
cancers can be painless, and can occur
in areas which are not easily visualised
without the appropriate equipment, regular
oral examinations by dentists, on at least
an annual basis, particularly of individuals
at high risk of oral cancer, can prove to be
life-saving.
A/Prof Agnieszka Frydrych, Oral
Medicine - The University of
Western Australia
Oral cancer
Oral cancer in western society represents between three and five per cent of all cancers. However, on a global scale, it is the sixth
most common cancer. This form of cancer occurs in people of late middle age.
The Amercian Oral Cancer Foundation
reports that just over half of people
diagnosed with mouth cancer will be
alive five years after diagnosis. This
figure is worse than that for cervical
cancer, cancer of the testes, thyroid
cancer and Hodgkin’s lymphoma.
The appearance of the lesions of
oral cancer can vary from crusting,
scaly lesions on the lower lip, to nonhealing ulcers or velvety red patches
in the mouth.
Equally, the occurrence of numbness
or altered sensation in the lips, or the
presence of a tooth which has rapidly
become loose, can indicate the
presence of a cancer.
As a rough guide, any mouth ulcer
which has not healed in a fortnight
should be treated as a cancer until
proven otherwise. It is a common
belief that all mouth cancers are
painful from early on. This is not
true; pain is a late feature of these
cancers and only becomes apparent
in advanced cases.
It is probably for this reason that
mouth cancers diagnosed by dentists
have a better prognosis because they
perform regular checkups and will
pick the cancers up early.
Unlike lung cancer there is no
clear cause for mouth cancer. A
number of factors are linked with a
higher chance of developing mouth
cancer. These include smoking,
alcohol (including alcohol containing
mouthwashes), dietary deficiencies,
chronic irritation, poor oral hygiene,
betel nut chewing and chronic
infection with the fungus Candida
albicans. The dietary deficiencies
include iron deficiency, and
deficiencies in vitamins C and E, both
of which are antioxidants.
More recently it has been found that
infections with certain strains of
human papilloma (wart) virus give rise
to mouth cancer. It seems that this
cause of mouth cancer is sexually
transmitted and, in people under the
age of 50, is becoming the major
cause of this form of cancer.
Unfortunately, in some instances,
mouth cancer will develop in people
who have no known risk factors.
Treatment for oral cancer can
involve surgery and radiotherapy
alone or in combination. In addition,
chemotherapy can also be employed.
Because many oral cancers are
diagnosed at an advanced stage,
the surgery can be debilitating and
interfere with functions such as eating
and speech.
If radiotherapy is involved in
the treatment, then a team of
appropriately trained dentists must
conduct a pre-radiotherapy workup. This involves assessing the teeth
and extracting any teeth in the direct
path of the radiation beam and any
teeth which cannot be guaranteed
for the life of the patient. This is
because radiotherapy affects the
ability of the jaws to respond to
trauma, meaning that the bone can
die off and result in the condition
known as osteoradionecrosis. In
Western Australia any extractions after
radiotherapy could require hyperbaric
oxygen therapy, which involves thirty
“dives” prior to surgery and 10 after.
Another side effect of the radiotherapy
is xerostomia, or dry mouth.
Obviously the best way to deal
with oral cancer is to prevent it
from occurring in the first place.
Drinking alcohol and smoking has
a multiplicative effect on increasing
the risk of developing oral cancer. A
healthy diet is also important.
Dr Nick Boyd - The University of
Western Australia
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