• A travel bottle of mouthwash (try to stick with natural mouth rinses without alcohol)
• Stim-u-dents (little toothpicks)
• Floss holders and pocket flossers (disposible)
• Travel toothbrush/paste
• Travel proxy brushes
• Sugarless chewing gum

These are just a few things to consider to enhance your daily oral hygiene regimen. There are many other tricks a person can use. We have listed the most common handy tools. Do you have any other tricks you use on a daily basis for your oral care? Feel free to send us an e- mail and let us know. We will share tricks on our next follow up article.

• Sweets contain sugar, which can cause tooth decay, gingivitis, and bad breath if left on the teeth, tongue, or gums. Alcohol can cause bad breath and dry mouth. If used in excess, it too can cause decreased immune responses. This can directly affect the gums and teeth and the rest of your body, as well.
• Spicy foods can cause bad breath. However, some spicy foods contain important nutrients and vitamins. Just remember to brush well after eating spicy dishes.
• Holiday vegetarian dishes can be healthier choices, and can provide a boost to your immune system. This can also be a plus for the health of your gums.
• Holidays can be stressful. We know that stress plays a considerable role in the risk of gum disease. Overeating and excessive drinking is also common at this time of year. Combining all of the above can adversely affect the gums and teeth.

Also keep in mind that keeping up with your oral hygiene routine is important particularly during this time of year when we all eat and drink too much. Daily brushing and flossing can keep your gums, teeth, and oral tissues healthy. It is also advisable to brush your tongue twice a day to keep the bacteria to a minimum and keeping your breath healthy.

Be mindful of everything you are eating and drinking during the holidays and how it may affect your teeth, gums, breath, and your health overall.

What are your favorite holiday drinks and foods?

1. Meet the dentist or periodontist first for a consultation, to discuss your needs and the way the treatment will be performed. This way you can feel comfortable, confident, and reassured that you will be in good hands. If not possible, move on to another professional.
2. You can request to speak to other patients of the practice to see what their experiences have been. Be sure to call more than one patient to verify consistency. Our practice’s new periodontal patients have this opportunity available to them at their first visit and all the information is kept confidential.
3. Ask the dentist or periodontist if you could have anti-anxiety medication prior to your visit. You might have to be driven or escorted to the office if given oral medications. You could also ask about having nitrous oxide (laughing gas) for the visit as well. In this case, you can drive yourself.
4. Practice breathing and relaxation techniques while at the dentist or periodontist’s office.
5. Bring an mp3 player, or have music playing to relax you while having the dental work. This really helps.
6. Once you have done your research on the dentist or periodontist you have chosen, trust your decision. Try not to consult a million other people because ultimately you might develop even more anxiety.

Do you have anxiety about getting oral exams? How do you cope?

Other possible causes might be:

• Fungal infection or Thrush. This can be caused by yeast or Candida Albicans. This condition can be treated with anti-fungal creams and ointments, some of which are available over the counter and some by prescription. Ask your pharmacist or doctor. Additionally, to correctly diagnose this condition, your doctor might have to do a smear of the area and see under a microscope what organisms are present.
• Viral / Herpes Simplex. This is usually unilateral (on one side) and is recurrent. But don’t be fooled, it can also be on both sides. The area should be checked and a smear taken to see if viral particles are present. Many options including antiviral creams or oral anti-viral medications that can be given to treat this condition and prevent recurrence.
• If the lesions remain crusted, this could also be indicative of a bacterial infection such as staphylococcus aureus, which can be treated with antibiotic creams. We don’t want this type of bacteria to spread around the body. These lesions can also be spread between partners, sharing towels and the spread of bodily fluids.

The bottom line: Have the area around the corners of the mouth checked to see if this is a fungal, viral or bacterial infection. After a precise diagnosis is obtained, then the correct treatment can instituted rather than trying to guess randomly how to cure the cracks on the sides of the mouth.

Let’s review some of the more common myths — starting with that chewing gum question:

• Chewing gum is bad for you. Although it can be (if it contains sugar, which can cause tooth decay), the movement of the upper and lower jaws during chewing is actually good exercise for the muscles of mastication. And chewing gum actually works to cleanse the mouth and stimulate salivary flow. Stick to sugar free chewing gum without artificial ingredients, if possible.
• A cleaning once a year is enough. In my experience as a periodontist, most of my patients over the last 26 years needed to have their teeth cleaned an average of 3-4 times a year. This is critically important to maintain good oral health.
• Dental X-ray exposure will cause damage and possibly cancer. In the last decade, with the introduction of digital X-rays, the risk to patients from exposure to dental X-rays is insignificant. Even the older technology (traditional X-rays with a higher exposure rate) has never been shown to have any associations to any harmful systemic diseases or illnesses. The American Dental Association has made recommendations on how often a full mouth series of X-rays should be taken. Routine X-rays are safe. However, if you are pregnant please let your dentist or periodontist know.
• Bleeding gums are normal. This couldn’t be further from the truth. Bleeding gums can be a sign of gum disease, or potentially a more serious systemic disease. We also know that gum disease is caused by “bad bacteria” or infection in the mouth. Bacteria and infection can potentially spread to other parts of the body if not controlled with better oral hygiene and treatment by a dentist or periodontist.
• Dental insurance covers everything. For those who have dental insurance, you already know that it usually covers only a portion of the total costs of care. The exception might be HMO plans. However, each plan is different and has its own rules. Check with your employer about the type of plan you have, and be prepared for the actual restrictions and benefits of your dental insurance.

There are many more oral care myths out there. Is there anything you’ve heard that’s made you wonder if it’s really true?

There has been a debate raging in the dental community about the pros and cons of fluoride usage.

The pros include:

• Prevention of tooth and root decay
• Anti-bacterial action against some forms of gum disease, in conjunction with daily oral hygiene and visits to your dentist or periodontist
• Alleviating symptoms of tooth or exposed root sensitivity
• Controlling bad breath
• Easy application with toothpastes, gels, and rinses

The cons include:

• Possible concern with over dosage of fluoride (the combination of water, drops, pastes, rinses, pills, etc.)
• Some professionals believe that fluoride can be toxic (This has not been proven.)
• Concern about the levels of fluoride in community drinking water
• Possible systemic effects not yet seen in the population

In our own 26-year-old periodontal practice, we will often suggest the use of non-dietary sources of fluoride, including gels, rinses, and pastes. This has been a recommended part of all our patients’ daily oral hygiene regimens.

Does your daily oral care routine include fluoride in any form? What do you think about the current fluoride debate?

In the last few years, scientific studies have shown connections and strong links between gum disease and the risk of heart disease or stroke. Other medical conditions that have been linked to gum disease include obesity, diabetes, kidney disease, lung disease, and other systemic illnesses. A connection that might surprise you — even premature births have been linked to untreated gum disease.

Besides gum disease, there are other oral health conditions that can affect your overall health. Tooth decay, if not treated promptly, can lead to infections in the nerves of the teeth. Neglected and infected teeth — or wisdom teeth that need to be extracted — can also cause severe infections in the mouth. These infections can then spread into the bones and the bloodstream, and potentially cause a variety of harmful medical conditions.

Your oral health can also have an effect on your partner. Dental studies have shown that the “bad bacteria” that cause gum disease can potentially be spread from one partner to another, by kissing and sharing saliva.

So be sure to keep up with your oral health routines and visit your dentist or periodontist regularly. You’re doing more than just maintaining a nice smile. You’re defending your health, by and large.

Are you surprised to hear some of the connections I mentioned? Have poor oral conditions affected your greater health in any way?

Below are some common clues and what they might mean:

• Bleeding or red swollen gums is a classic sign of gum disease or possibly a manifestation of a systemic illness.
• Receding gums is another sign of gum disease and/or perhaps a result of incorrect or destructive brushing habits
• Yellow teeth can be caused by staining, poor oral hygiene, smoking, or ingestion of certain medications
• Dark marks on teeth can possibly be an indicator of dental decay, staining (eg. coffee and tea), embedded food particles, or smoking remnants.
• White spots on the tongue, cheek, lips, gums can be a sign of pathology (abnormal tissue) which could be caused by a virus, bacteria, irritation or other possible sources that need to be evaluated promptly by a dental professional.
• Swollen lips, gums can be a sign of an active infection, allergy or other systemic problem.
• Crooked teeth, can be a sign of malocclusion (bad bite), which if left uncorrected, can lead to possible periodontal (gum) trauma.
• Dry mouth can be a side effect of medications, dehydration, or possibly a systemic disease.

It’s important to keep in mind, though, that while what we see in the mirror can give us some clues, it doesn’t tell us the whole story. I recommend that people always follow up their self- exams with a visit to their Dentist or Periodontist.

What about you — anything concerning you when you see your teeth in the mirror?

• Detailed Results of Nutrition Survey

More than half of the 135 periodontists polled report that either they or their staffs talk to patients on a regular basis about the role of good nutrition in maintaining good oral health. “I tell them that a well balanced diet is important for the body and subsequently the mouth’s health,” said one responding periodontist. “I inform my patients that vitamin C is important for tissue health and calcium is important for bone health.”

The majority of periodontists recommend calcium supplements and multivitamins for patients who are not getting adequate amounts from their diet. Many patients seem to listen to this advice. In a separate poll of consumers visiting the AAP’s Web site, nearly 57 percent of 477 respondents said they have tried improving their diet to help improve periodontal health.

“Research has proven that people who consume inadequate amounts of calcium and vitamin C have higher rates of periodontal disease,” said Michael McGuire, D.D.S., president of the AAP. “However, many other nutrients likely play a role in maintaining good periodontal health too.”

Conversely, some foods are best avoided to maintain good periodontal health. The top culprit chosen by periodontists was popcorn, because the husks can get caught in between the teeth and gums and cause abscesses.

A referral to a periodontist in your area and free brochure samples are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for periodontists—specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontists are also dentistry’s experts in the treatment of oral inflammation. They receive three additional years of specialized training following dental school, and periodontics is one of the nine dental specialties recognized by the American Dental Association. The AAP has 8,000 members worldwide.

Researchers examined 20 individuals with chronic periodontitis. In 13 of the 20 patients, bacterial pathogens most frequently found in severe chronic periodontitis were also found in atherosclerotic plaque of coronary vessels. In 10 cases, those species of bacteria were also present in atherosclerotic plaque and in subgingival plaque”. (Atherosclerosis is a multistage process set in motion when cells lining the arteries are damaged as a result of high blood pressure, smoking, toxic substances and other agents.)

“We found that patients with periodontal pathogens detected in atherosclerotic plaque had four millimeters or greater of deep periodontal pockets and a significantly higher bleeding index,” said study author Dr. Maciej Zaremba. “This supports the possibility that bacteria associated with periodontitis can permeate into coronary vessels.”

“Since periodontal and cardiovascular diseases have several common risk factors, more studies are needed to evaluate the strength of association between the two diseases,” said Dr. Preston D. Miller, DDS, and AAP president. “It is very important for people to talk to their dentist or periodontist about their periodontal health and their at-home oral hygiene routine to prevent periodontal disease and maybe even coronary artery disease.”

According to the American Heart Association, coronary heart disease is the number one single cause of death in the United States. Knowledge of the risk factors and possible links to coronary heart disease, such as periodontal disease is the first step towards preventing it. To find out if you are at risk for periodontal disease, please visit the AAP’s Web site and take a free risk assessment test.

A referral to a periodontist in your area and free brochure samples including ones titled Periodontal Diseases: What You Need to Know and Ask Your Periodontist about Periodontal Disease and Heart Disease are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for periodontists—specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontists are also dentistry’s experts in the treatment of oral inflammation. They receive three additional years of specialized training following dental school, and periodontics is one of the nine dental specialties recognized by the American Dental Association. The AAP has 8,000 members worldwide.