Written By: Dr. J. Basrai

Sedation dentistry happens when a patient is offered any type of medication which assists in relaxation or sleep, but does not include those types of procedures which require general anesthetic, for which air support and monitoring are needed. General anesthesia needs to be provided by a licensed anesthesiologist and under the care of a physician, and this is usually the case with oral surgery done through clinics and hospitals. Sedation dentistry has come very popular over the past five to ten years, as a wider variety of medications have surfaced and the demand grows for a less stressful, less painful, and more positive dental experience. Many children’s dentists have developed safe and relaxing means of taking care of their young patients without the side effects once caused by certain sedatives.

Another cause for the heightened volume of sedation dentistry these days is that while undergoing this type of procedure, the patient is able to have many issues taken care of at one time without the inconvenience, stress, and time issues caused by making several different appointments. The dentist can simply block out that one to two hour span of time, sedate the patient, and take care of multiple issues in one fair swoop. This is a big plus for everyone, and also saves money on office visits.

Many sedatives will require that the patient answer a great many questions about allergies, past health issues, or an other factors which may adversely effect him or her during sedation. This is routine, yet extremely important where these potent medications are concerned. You may be asked to provide this information at your initial consultation before the actual surgical date, giving your dentist time to find the right sedatives and pain blockers for your situation. This can be a big time saver and can also keep everyone safe when the day comes for the procedure.

There are many procedures that can be performed while the patient is under sedation. Many find that they are comfortable with sedation dentistry for such issues as fillings, root canal treatments, crowns, bridges, extractions, and repairs. It is often the case that the mere sound of the drill causes a great deal of stress in patients, making sedation a great alternative to the worry and fear caused by many procedures. Your dentist will be able to lead you through all of your options, helping you to come to a conclusion about the types of anesthesia or sedation that will work best for you.

“In a way, it’s really quite an old story, because back in the early 19th century there was a therapy called focal sepsis, and people believed that infections in the mouth caused disease in the whole body,” Watt said

“As a result, they used to take everyone’s teeth out.”

Watt said such a response was “a bit dramatic,” but his findings did suggest that twice-a-day brushing was a good idea.

Gum or periodontal disease is an infection of the tissue surrounding and supporting the teeth and is more likely to occur in people who do not brush their teeth regularly.

Heart disease is a leading killer of men and women in Europe, the U.S. and many other rich nations and together with diabetes, accounted for almost a third of all deaths around the world in 2005, according to the Worlds Health Organization.

The teeth brushing study published on Friday in the British Medical Journal was the first to investigate whether the simple number of times someone brushes their teeth daily has any bearing on the risk of heart disease.

The results showed oral health behaviors were generally good, with 62% of participants saying they visited the dental every six months and 71% reporting they brushed their teeth twice a day.

Once the data were adjusted for other known heart risk factors such as social class, obesity, smoking and family history of heart disease, those who reported less frequent teeth brushing had a 70% extra risk of heart disease compared to those who brushed twice a day.

Blood tests on those with poor oral hygiene were also positive for two factors called C-reactive protein and fibrinogen – both of which signal inflammation in the body

Source – drbicuspid.com

People who don’t brush their teeth twice a day have an increased risk of heart disease, scientists said of Friday, adding scientific weight to 19th century theories about oral health and chronic disease.

British researchers studied nearly 12,000 adults in Scotland and found those with poor oral hygiene had a 70% extra risk of heart disease compared with those who brushed twice a day and who were less likely to have unhealthy gums.

People with gum disease are more likely to develop heart disease and diabetes because inflammation in the body, including in the mouth and gums, plays a role in the build up of clogged arteries, said Richard Watt from University College London, who led the study.

The 70% extra risk compares to a 135% extra risk of heart disease in those who smoke, he said.

Although the overall risk was low — with a total of 555 heart attacks or other serious coronary problems among 11,869 people – the effect of same league,” Watt said

The study doesn’t prove that brushing your teeth leads to lower heart disease.

“But…even after controlling for all those things there is still a relationship between this very simple measure of tooth brushing and heart condition,” Watt told Reuters.

Dentists can play a potentially life-saving role for some patients by identifying those at risk for fatal heart attacks and referring them to physicians, according to a new study.

While in previous studies have theoretically studied the role of dentists in identifying cardiovascular disease (CVD), this is the first to show that screening for the disease at the dental office actually works, said lead author Michael Glick, D.M.D., professor of oral medicine at the Arizona School of Dentistry and Oral Health.

A 2005 study by Dr. Glick and his colleague Dr. Greenberg found that dentist can play an important role in identifying people in need of primary prevention strategies for CVD. The study used extracted data from the 1999-2000 National Health and Nutrition Examination Survey (NHANES) and the 2001-2002 NHANES. In a 2007 study Dr. Glick and colleagues went a step further, looking at oral health care professionals (OHCPs) as a resource for identifying patients who were unaware of their increased cardiovascular risk factors.

“OHCPs identified patients with an increased CHD [coronary heart disease] risk who could benefit from primary prevention activities,” concluded the study. “A substantial proportion of study patients who were unaware of their risk status were at an increased risk of experiencing a CHD event within 10 years.”

HeartScore System

This latest study put this knowledge to a practical test where dentists actually identified patients at risk who were later provided intervention.

Researchers looked at 200 patients – age 45 or older – in private dental practices in Sweden with no history of, or use of medications for, hypertension, hyperchloesteroiema, or diabetes. These patients had no visits to a health care professional in 12 months during which glucose levels, total cholesterol levels, or blood pressure had been assessed.

The participating dentists and staff members used a questionnaire to gather information about the patients’ weight, height, disease history, medications, smoking habits, physical activity level, and family history of CVD. They also checked the patients’ blood glucose level, total cholesterol, and blood pressure.

The dentists then used a computerized system, HeartScore, to calculate the risk of a patient dying from a cardiovascular event within a 10-year period. Designed by the European Society of Cardiology, HeartScore measures cardiovascular disease risk in persons aged 40-65 by factoring the person’s age, sex, total cholesterol level, systolic blood pressure, and smoking status.

Among the study findings:

• Twelve of the patients had HeartScores equal to or exceeding 10% – in other words, a 10% or higher risk of having a fatal cardiovascular event, such as a stroke or an MI, during the next 10 years.
• All 12 of these patients were men
• Eight of these patients were older than 65 years, and five were smokers
• Over 13% of the patients (21 men and 6 women) had a HeartScore of 5% to 9%
• No woman had a HeartScore higher than 5%

Dentists urged patients with a HeartScore of 10% or higher to seek medical advice.

Of the 12 male patients with HeartScores of 10% or higher, nine sought further evaluation by a medical care provider. Intervention was needed for six of these patients, who were given prescriptions for antihypertensive medications. Physicians for three patients were not able to confirm their risk for cardiovascular disease. Two patients did not follow the dentist’s recommendation to seek further medical evaluation, and one was only encouraged by his dentist to stop smoking.

“Oral health care professionals can identify patients who are unaware of their risk of developing serious complications as a result of CVD and who need of medical intervention,” the authors wrote.

With the increasing data on the link between oral and non-oral diseases, the possibility of chairside screening tests for diseases such as CVD and diabetes mellitus could put dentists and their staff in a key position to enhance the overall health and well being of their patients, the authors concluded.

A minority of patients with recurrent mouth sores have gluten-sensitive enteropathy, making evaluation for celiac disease appropriate in this population, according to a new study in BMC Gastroenterology.

Gluten-sensitive enteropathy, or celiac disease, is an inherited autoimmune disorder in which the lining of the small intestine is damaged from eating gluten and other proteins found in wheat, barley, rye, and possibly oats.

“It has been reported that in 5% of celiac disease patients, aphthous stomatitis may be the sole manifestations of the disease, “write Dr. Farhad Shahram, of Tehran University of Medical Sciences, Iran, and colleagues.

Aphthous stomatitis is a painful open ulcer, such as a canker sore, in the mouth that is white or yellow and surrounded by a bright red area. They tend to reappear in times of stress and are associated with viral infections, food allergies, and other conditions.

The researchers studied 247 aphthous stomatitis patients (average age, 33 years) who had at least three aphthous attacks during the year. The team measured antibodies and other immune factors associated with celiac disease, and patients with negative results were excluded.

Those with positive results underwent biopsies of the lining of the small intestine. Gluten-sensitive enteropathy was defined as a positive blood test for immune factors and abnormal biopsy results. A gluten-free diet was recommended for patients with gluten-sensitive enteropathy.

Of the 247 patients, seven patients with positive blood tests underwent upper GI endoscopy and duodenal biopsies. Endoscopic findings were compatible with gluten-sensitive enteropathy in two patients and were normal in five patients. However biopsy findings were compatible with gluten-sensitive enteropathy in all seven patients.

The patients with gluten-sensitive enteropathy were an average of 27 years old and the average duration of the disease was 4.5 years. The seven celiac disease patients had not responded to conventional mouth ulcer medications, including topical corticosteroids, tetracycline, and colchicines.

Of the seven celiac disease patients, four started a strict gluten-free diet. All showed a significant improvement within two to six months.

“Gluten-sensitive enteropathy should be considered in aphthous stomatitis patients,” the authors conclude. A lack of response to conventional treatment for could be another indicator of celiac diease risk.

BMC Gastroenterology 2009

So you think your teeth are strong. They can handle anything, right? Wrong. While you may be tempted to use your teeth as a household tool or stress relief aid, think again. You could be damaging your teeth beyond repair. The Chicago Dental Society polled its members to find out some of the worst (and wackiest) dental habits they have seen in patients.

Warning: Do not try these at home.

1. Cleaning teeth with Comet, bleach, or other household cleaners. Household cleaners are abrasive and will wear down the enamel on your teeth. Some are also toxic.
2. Chewing fingernails and toenails. Your teeth are you for chewing food and speaking only. Use a nail file or nail clippers to keep your mouth – and your feet – safe from bacteria.
3. Using “crazy glue” for loose dental work. Super-strong glue will still wear away over time. See your dentist for a long term solution to loose dental work.
4. Opening beer bottles with teeth. This can break the tooth; dig the bottle opener out of a drawer.
5. Sucking on lemons. This is sometimes done with the misguided goal to whiten teeth or freshen breath. But the acid in a lemon will break down the enamel on your teeth and cause decay.
6. Filing teeth with a nail file. Patients risk taking off too much of the tooth and damaging the tooth structure. See your dentist if the shape of your tooth doesn’t feel right.
7. Flossing with household items. Dentists have seen patients floss with random objects, including hair, needles, credit cards, paper, and rubber bands. Those things can break in your mouth and put you at your risk for injury and infection. Hard items like paperclips will wear away enamel when used repeatedly and may even break your tooth. Use only dental floss to clean between those teeth!
8. Rinsing with acidic liquids. Just like sucking on lemons, sloshing liquids such as vinegar, apple juice, and orange juice in your mouth will wear away your teeth and cause decay. Your best bet is mouthwash or fluoride rinse.
9. Extracting teeth with pliers/power tools. Leave extraction for the professionals. Doing it yourself risks infection, broken teeth and roots, and bone damage to your jaw.
10. Chewing pens. Such an oral fixation can fracture teeth, leading to otherwise unnecessary dental repairs. It can also put you at risk for ingesting ink. There are safer ways to relieve stress and fight boredom. Preserve your teeth for their real job: talking and chewing food.

Dental Dateline, July/August 2008

If you’ve always longed for straight teeth but don’t want to face the months of discomfort involved in traditional metal braces, you may be thinking of Invisalign. Patients in the Annapolis area should contact The Annapolis Center for Dental Health and Wellness, where Dr. Vernon L. Sheen, D.M.D. and his staff will tell you if the Invisalign system is right for you, and give you full details about the process and its benefits.

Straight teeth look attractive, and also improve your overall dental health and prevent future problems. Invisalign is a revolutionary process that straightens your teeth in a gentle, effective series of steps without the drawbacks of traditional metal braces. It can be used to correct common problems such as overly crowded teeth, widely spaced teeth, overbite, underbite and crossbite. Not every orthodontist can provide Invisalign treatment, as it is a specialized process requiring specific training and the completion of ongoing educational requirements.

The Invisalign process consists of a series of thermoplastic aligners made specially for you. You wear each aligner for about two weeks, and it gradually shifts your teeth into a better position. With each new aligner you will get closer to your perfect smile. The aligners are virtually invisible, and have smooth edges so they don’t irritate the inside of your mouth. They can be removed to brush and floss your teeth, eat and drink, and for special occasions. You will visit The Annapolis Center for Dental Health and Wellness regularly so that Dr. Sheen and his staff can check that your teeth are shifting in accordance with your customized treatment plan.

Patients love Invisalign because it’s comfortable and easy to live with, unlike metal braces that often cause pain and irritation. Because the aligners are easily removed, there are no issues with food stuck in the braces or gum disease caused by difficulty in brushing and flossing. What’s more, because the improvement in the position of your teeth begins very quickly, people will soon begin to notice your new smile even when you’re wearing the aligners! And you can take them off for parties and other special occasions.

Click here for more information about The Annapolis Center for Dental Health and Wellness. You can explore our site to see some amazing pictures of real patients’ dramatically transformed smiles, and contact us with your questions about Invisalign and our full range of orthodontic and cosmetic services.

Sports drinks may boost your energy, but they can also weaken your teeth, a new study shows.

The popular energy drinks sipped by many athletes to increase stamina contain levels of acid that can cause tooth erosion, hypersensitivity, and staining according to the findings of New York University dental researchers.

The beverages also can cause excessive tooth wear and may damage underlying bone like material, causing teeth to soften and weaken, the researchers say. The drinks may also possibly trigger conditions leading to severe tooth damage and loss.

The findings are being presented at the International Association for Dental Research in Miami.

“This is the first time that the critic acid in sports drinks has been linked to erosive tooth wear, “says Mark Wolff, DDS, professor and chairman of the department of cardiology and comprehensive care at New York University College of Dentistry.

He says people who use sports energy drinks for energy should not brush their teeth immediately after drinking the beverages. Softened enamel, he says, is highly susceptible to the abrasive properties of toothpaste.

To prevent tooth erosion, Wolff says:

• Drink sport drinks in moderation
• Wait at least 30 mins before brushing your teeth to allow softened enamel to reharden
• If you drink a lot of sports drinks, ask your dentist if you should use an acid-neutralizing remineralizing toothpaste to help reharden soft enamel.

The FDA has approved OraVerse, the first drug indicated for reversing the effects of local anesthesia used by dentists.

According to Novalar Pharmaceuticals, the drug company that makes OraVerse, the FDA approved OraVerse’s use in adults and children based on several clinical studies in which patients got an injection of OraVerse or a placebo after undergoing dental procedures under local anesthetics.

In the clinical studies, the patients who got OraVerse regained normal sensation in their lips faster than those who got the placebo. Within an hour after getting OraVerse, 41% of the patients had normal sensation in their lower lip. Compared with 7% of those who got the placebo. And 59% of the OraVerse patients regained normal sensation in their upper lip within an hour after getting OraVerse, compared with 12% of those who got the placebo.

A Novalar news release states that no serious side effects were seen in clinical studies; the most common side effect was pain at the injection site.

Novalar notes that although fast heart rate (tachycardia) and cardiac arrhythmia may occur when drugs like OraVerse are given intravenously, such problems are uncommon when OraVerse is injected into the gums.

OraVerse isn’t recommended for use in children younger than 6 or children under 33 pounds.

Miranda Hill

WedMD Health News

Content by OraPharma, Inc. 5/09

If you have been to a dentist recently, you’ve probably noticed something has changed. Your hygiene appointment is not just a cleaning. Today’s dental hygienists are as instrumental in diagnosing oral problems as a dentist. Recently, the American Dental Hygienists’ Association formally recognized the importance of a hygienist’s diagnosis with regards to their patients’ oral health.

During your appointment, a dental hygienist will:

• Review your medical history
• Remove the plaque and tartar from your teeth
• Do a pocket-depth check of your gums to look for signs of periodontal disease
• Take x-rays (if indicated)
• Clean, polish and floss your teeth
• Check for signs of oral cancer
• Explain how to treat or prevent any issues that seem troublesome
• Formulate a home care plan to keep your mouth healthy

In our practice, hygienists will also follow up this diagnosis with an easy home care plan for you. You may notice your mouth is a little healthier. If so, you have one important member of our dental team to thank your hygienist.

At least every six months is a good schedule to keep when you’re trying to keep your mouth in good shape. So, give us a call today—we are ready to schedule an appointment most convenient for you.