Posts for: January, 2020
Say “bacteria,” especially in the same sentence with “disease” or “infection,” and you may trigger an immediate stampede for the hand sanitizer. The last thing most people want is to come in contact with these “menacing” microorganisms.
If that describes you, however, you’re too late. If you’re of adult age, there are already 100 trillion of these single-celled organisms in and on your body, outnumbering your own cells 10 to 1. But don’t panic: Of these 10,000-plus species only a handful can cause you harm—most are either harmless or beneficial, including in your mouth.
Thanks to recent research, we know quite a bit about the different kinds of bacteria in the mouth and what they’re doing. We’ve also learned that the mouth’s microbiome (the interactive environment of microscopic organisms in a particular location) develops over time, especially during our formative years. New mothers, for example, pass on hundreds of beneficial species of bacteria to their babies via their breast milk.
As our exposure to different bacteria grows, our immune system is also developing—not only fighting bacteria that pose a threat, but also learning to recognize benevolent species. All these factors over time result in a sophisticated, interrelated bacterial environment unique to every individual.
Of course, it isn’t all sweetness and light in this microscopic world. The few harmful oral bacteria, especially those that trigger tooth decay or periodontal (gum) disease, can cause enormous, irreparable damage to the teeth and gums. It’s our goal as dentists to treat these diseases and, when necessary, fight against harmful microorganisms with antibacterial agents and antibiotics.
But our growing knowledge of this “secret world” of bacteria is now influencing how we approach dental treatment. A generalized application of antibiotics, for example, could harm beneficial bacteria as well as harmful ones. In trying to do good we may run the risk of disrupting the mouth’s microbiome balance—with adverse results on a patient’s long-term oral health.
The treatment strategies of the future will take this into account. While stopping dental disease will remain the top priority, the treatments of the future will seek to do it without harming the delicate balance of the mouth’s microbiome.
If you would like more information on the role of bacteria in oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “New Research Show Bacteria Essential to Health.”
Just like adults, teenagers experience chipped, stained or disfigured teeth. And during a life stage where issues with appearance can be acutely painful, these defects call out for a solution.
And, there is one: porcelain veneers. These thin wafers of custom-made porcelain are bonded to the front of teeth to cover dental flaws. They’re one of the least invasive—and most affordable—methods for smile enhancement.
There is one caveat, though: The affected teeth will most likely need alteration. Veneers can look bulky when bonded directly to teeth, so we compensate for this by removing some of the surface enamel. This changes the tooth permanently, to the point that it will always require a veneer or some other form of restoration.
But although this may be a minor issue for an adult, it could pose a problem for a teenager. That’s because the pulp, the innermost layer of a tooth containing nerves and blood vessels, is larger in a younger adolescent tooth than in an older adult tooth. Because of its size, it’s closer to the tooth’s surface. During enamel reduction for veneers on a young tooth, this could lead to inadvertent nerve damage. If that happens, the tooth may need a root canal treatment to preserve it.
If the adolescent tooth needing a “facelift” has already been root canaled or sustained significant structural damage, then altering it for veneers may not be too concerning. Likewise, if the teeth are smaller than normal, the bulkiness of a veneer may actually improve appearance and not require alteration. We’ll need to examine a young patient first before making any recommendations.
There are also alternatives to veneers for improving smile appearance. Enamel staining could be enhanced temporarily with teeth whitening. Small chips can be repaired with bonded dental material, or in skilled hands be used to “build” a veneer one layer at a time with no enamel reduction. Although not as durable as regular veneers, these bonding techniques could buy time until the tooth is more mature for veneers.
Whichever path we take, there are effective ways to transform a teenager’s flawed tooth. And that can make for an even better smile.
If you would like more information on dental restorations for teenagers, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Veneers for Teenagers.”
During your latest dental cleaning and checkup, your dentist notices a skin rash around your mouth. You sigh—it’s been going on for some time. And every ointment you’ve tried doesn’t help.
You may have peri-oral dermatitis, a type of skin rash dentists sometime notice during dental treatment. It doesn’t occur often—usually in only 1% of the population—but when it does, it can be resistant to common over-the-counter ointments.
That’s because peri-oral dermatitis is somewhat different from other facial rashes. Often mistaken as acne, the rash can appear as small red bumps, blisters or pus-filled pimples most often around the mouth (but not on the lips), nostrils or even the eyes. Sometimes the rash can sting, itch or burn.
People with peri-oral dermatitis often try medicated ointments to treat it. Many of these contain steroids that work well on other skin conditions; however, they can have an opposite effect on peri-oral dermatitis.
Because the steroids cause a constriction in the tiny blood vessels of the skin, the rash may first appear to be fading. This is short-lived, though, as the rash soon returns with a vengeance. Prolonged steroid applications can also thin the affected skin, making it more susceptible to infection and resistant to healing.
Peri-oral dermatitis requires a different treatment approach. The first step is to stop using any kind of steroidal cream, as well as moisturizers, ointments and both prescription and non-prescription medications. Instead, you should only use a mild soap to wash your face.
You may find the rash looking worse for a few days but be patient and continue to avoid ointments or creams. Your healthcare provider may also prescribe oral antibiotics, usually of the tetracycline family. It may take several weeks of antibiotic treatment until the skin noticeably clears up.
For most people, this approach puts their rash into permanent remission. Some, though, may see a reoccurrence, in which case it’s usually best to repeat treatment. With a little patience and care, though, you’ll finally see this persistent rash fade away.