Oral Health Care of Our Aging Population – Dentist Sandy Springs

Two important oral health care concerns emerging in the United States are disparities in the oral disease burden and the inability of certain segments of the population to access oral health care.[1] Older Americans are becoming a larger segment of our population and suffer disproportionately from oral diseases, with the problem being particularly acute for individuals in long term care facilities. Population projections for the United States indicate that the elderly will constitute an increasing percentage of the population as we proceed into the 21st century. In 2001, the population of the United States was almost 278 million, and 12.6% of the population was 65 years of age or older. By 2015, the population is expected to increase to 312 million (3.08 million in 2010) and 14.7% of the population will be aged 65 years or older. In 2030, which is within the practice lives of students currently enrolled in dental schools, the population will have increased to more than 350 million, and 20% of the population—1 of every 5 members of the US society—will be 65 years of age or older. This large segment of our population is further compounded by the elderly population continuing to become increasingly diverse in terms of race, ethnicity, financial resources, and living conditions.[2]

The challenges faced by both the dental profession and the nation as a whole regarding provision of oral health care services to older adults were the subject of a recent report prepared by Oral Health America.[3] All 50 states were surveyed to determine the level of Medicaid coverage for dental services, and the report concludes that financing oral health care services for the elderly will be a major challenge to our future. Medicare does not provide any coverage for dental services, and only 1 of 5 Americans aged 75 years or older has any type of private dental insurance. Given our current economic circumstances it will be highly unlikely that our government resources will be adequate to gear up for the impending problem of oral health for the elderly.

The elderly suffer from chronic disorders that can directly or indirectly affect oral health, including autoimmune disorders such as pemphigus and pemphigoid.[4] They generally require multiple medications, and common side effects of the more than 500 medications used to treat their overall health issues usually reduce salivary flow.[5] Usually the reduction in saliva can adversely affect their quality of life, the ability to chew, and lead to significant problems of the teeth and their supporting structures.

The elderly may also have difficulty performing routine oral hygiene procedures because of physical limitations, such as Parkinson’s or rheumatoid arthritis. In addition, oral infection is now recognized as a risk factor for a number of systemic diseases, including cardiovascular diseases, cerebrovascular diseases, diabetes, mellitus, and respiratory disorders. Also, it is important to note that once people have lost their teeth and are using complete dentures, their oral health needs do not decrease. Our jaws are not static and may continue to resorb over time. Besides the continued resorption of bone, improperly fitted dentures can adversely affect chewing, leading to poor nutrition. In addition, those without teeth remain susceptible to oral cancer, mucosal diseases, and alterations in salivary gland function. 

So for the vast majority of seniors who will reside in a long term care facility, financing of oral health care services will be a formidable challenge. Given that medicare does not provide coverage for routine dental services including exams, and in the absence of private insurance or personal resources, a large portion of this group will not be able to afford any dental services whatsoever, let alone the most appropriate treatments. Clearly, there must be a response to the increasing oral health concerns of the elderly who present with special needs, especially those who are homebound or living in long term facilities burdened with other chronic disorders. 

While effective preventive measures exist for younger populations (water fluoridation, dental sealants and parents), no preventive measures have been devised to address the expected increase in oral health needs of the aging population. And the need for a coordinated effort to address the oral health care needs of the elderly suggested by demographic trends and epidemiological data necessitates our planning for what might be considered a crisis or at least a paradigm shift in oral health care delivery for the elderly. Such a plan must consider contributions from the dental profession, possibly through the efforts of the American Dental Association (ADA) and its state and local associations; the dental schools, with involvement of the American Dental Education Association; federal, state, and local health authorities; and assistance from national organizations and foundations that focus on health care. The dental profession has an opportunity to take a leadership role in the delivery of health care services to the seniors who have contributed so vitally to our society’s well-being and who deserve to be treated with the best oral health care we have to offer. 

Dr. Scheinfeld is a prosthodontist specializing in geriatric care.

Novy Scheinfeld, DDS, PC                                                                                          

290 Carpenter Drive, 200A

Atlanta (Sandy Springs), GA 30328

404-256-3620

www.rightsmilecenter.com

info@rightsmilecenter.com

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[1] Oral Health in America: A Report of the Surgeon General. Rockville, Md: National Institute of Dental and Craniofacial Research; 2000.

[2] Wikipedia and 2010 Census.                                                                                

[3] A State of Decay: The Oral Health of Older Americans. Chicago, Ill: Oral Health America; 2003:1–8.

[4] Stoopler ET, Sollecito TP, De Ross SS. Desquamative gingivitis: early presenting system of mucocutaneous disease. Quintessence Int.2003;34:582–586.

[5] Fox PC, Eversole LR. Diseases of the salivary glands. In: Silverman S, Eversole LR, Truelove EL, eds. Essentials of Oral Medicine. Ontario, Canada: BC Decker; 2002:260–276.

Teeth Whitening - Dentist Sandy Springs

More and more the aesthetics of teeth are of great importance to patients, including tooth color.  The color of teeth is influenced by a combination of their natural color and the presence of any external stains that may form on the tooth surface.   The type of natural stain and initial tooth color can play a significant role in the ultimate outcome of teeth whitening.  Where oral health care used to be the primary role of a dentist, in the past 10 years the importance of teeth whitening has seen a dramatic rise in the number of tooth whitening products and procedures to come onto the marketplace.  Not only has the relationship of the dentist and patient changed, but the demand by the consumer for cookie cutter results to esthetic dentistry is supplanting the traditional approach to oral health care.

There are a number of approaches to measuring tooth color changes following tooth whitening; each with their own advantages and disadvantages; and given the consumer’s demand for continued esthetic emphasis, tooth whitening continues to demand further research and perfection.  The key factors that affect tooth whitening efficacy by peroxide containing products are a function of peroxide concentration, light exposure and the allocation of application time.  In general, higher concentrations of peroxide provide results faster than lower concentrations. And what appears to be a demand for immediate gratification by the consumer apparently drives the need to develop systems that deliver higher concentrations of peroxide in shorter application time periods.

Your smile is the first thing people notice. And our goal is to help you smile, but we want to make sure it's the right smile, one that's natural and comfortable for you.  If  stained teeth are "hiding" the real you, it's time for what is commonly referred to as a smile make over. It is understood that a beautiful smile can brighten your lifestyle every day, both professionally and socially.  And unlike plastic surgery, teeth whitening isn't a major operation.  Imagine coming in for a single appointment or two and emerging with the smile you've always wanted. The results are immediate and dramatic. There are many ways you can receive a youthful, attractive, natural looking smile.

You can be assured that as a prosthodontist, I understand the functional mechanics as well as the cosmetic artistry needed to evaluate and create the right smile for you. Your goals for achieving the smile you want and the dental health you need are my first priority in our Sandy Springs office.

Novy Scheinfeld, DDS, PC

290 Carpenter Drive, 200A

Atlanta (Sandy Springs), GA 30328

404-256-3620

info@rightsmilecenter.com

www.rightsmilecenter.com

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Teeth Grinding - Dentist Sandy Springs

Most people probably grind and clench their teeth from time to time. But occasional teeth grinding does not usually cause harm. It’s when teeth grinding occurs on a regular basis the teeth can be damaged and other oral health complications can arise.

Why Do People Grind Their Teeth?[1]

Although teeth grinding can be caused by stress and anxiety, it often occurs during sleep and is more likely caused by an abnormal bite, missing or crooked teeth.

How Do I Find Out if I Grind My Teeth?

Because grinding often occurs during sleep, most people are unaware that they grind their teeth. However, a dull, constant headache or sore jaw is a telltale symptom of bruxism. Many times people learn that they grind their teeth by their loved one who hears the grinding at night.

If you suspect you may be grinding your teeth, talk to your dentist.  He or she can examine your mouth and jaw for signs of bruxism, such as jaw tenderness and abnormalities in your teeth.

Why Is Teeth Grinding Harmful?

In some cases, chronic teeth grinding can result in a fracturing, loosening, or loss of teeth. The chronic grinding may wear their teeth down to stumps. When these events happen, bridges, crowns, root canals, implants, partial dentures, and even complete dentures may be needed.

Not only can severe grinding damage teeth and result in tooth loss, it can also affect your jaws, result in hearing loss, cause or worsen TMD/TMJ, and even change the appearance of your face.

What Can I Do to Stop Grinding My Teeth?

Your dentist can fit you with a mouth guard to protect your teeth from grinding during sleep.

If stress is causing you to grind your teeth, ask your doctor or dentist about options to reduce your stress.  Attending stress counseling, starting an exercise program, seeing a physical therapist, or obtaining a prescription for anti-anxiety or muscle relaxants are among some of the options that may be offered.

Other tips to help you stop teeth grinding include:[2]

·        Avoid or cut back on foods and drinks that contain caffeine, such as colas, chocolate, coffee and so-called energy drinks.

·        Avoid alcohol. Grinding tends to intensify after alcohol consumption.

·        Do not chew on objects that are not food. So avoid, finger nails, pencils and pens. Also avoid chewing gum as it allows your jaw muscles to get used to clenching and may tend to make you more likely to grind your teeth.

·        Train yourself not to clench or grind your teeth. If you notice that you clench or grind during the day, position the tip of your tongue between your teeth. This practice trains your jaw muscles to relax.

·        Relax your jaw muscles at night by holding a warm washcloth against your cheek in front of your earlobe.

Novy Scheinfeld, DDS, PC

290 Carpenter Drive, 200A

Atlanta (Sandy Springs), GA 30328

404-256-3620

www.rightsmilecenter.com

info@rightsmilecenter.com

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[1] Webmd was utilized as a source.

[2] Ibid.

Dental Advice for Moms-To-Be – Dentist Sandy Springs

Expecting a baby is a very exciting time, and you're already on the right path if you’re staying on top of your dental health. With the proper dental care measures, you'll increase your chances of having a smoother pregnancy, full-term delivery and healthy baby.

If you're planning to get pregnant, consider having your teeth cleaned and any restorative dental treatment done first. If you are already pregnant, be sure to tell your dentist before getting any work done. You should also have a dental checkup at least once during the pregnancy. Although dental cleanings aren't harmful, it's recommended that expecting mothers get them done during the second trimester to reduce the risk of complications.

According to the American Dental Association (ADA), it's best to postpone dental work during the first and third trimesters as well, as these are critical periods for the baby's development. Your dentist will let you know what dental treatments can be performed during the second trimester, but more complicated procedures will probably be postponed, if possible. Unnecessary treatments, such as cosmetic dental work, should be avoided altogether.

If you do have an unexpected dental problem or emergency, make an appointment with your dentist as soon as you can. Your dentist will look for signs of infection and determine the need for treatment. Dental X-rays are usually avoided during pregnancy, but if photos are necessary, your dentist will take extra precautions to protect your baby.

Just as dental health is connected to your overall health, dental care is important to the health of your unborn baby. It's extremely important to take care of your teeth during pregnancy, as some dental problems can increase the risk of complications.

The best advice is to make sure your dentist is part of your baby’s pre-natal care team from the beginning.  If we can answer any questions or concerns please feel free to contact us.

Novy Scheinfeld, DDS, PC

290 Carpenter Drive, 200A

Atlanta (Sandy Springs), GA 30328

404-256-3620

www.rightsmilecenter.com

info@rightsmilecenter.com

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Women and Oral Health – Dentist Sandy Springs

As a woman, you know that your health needs are unique, including your oral health needs. And because your needs are unique, you need to take extra care of yourself.  While women tend to take better care of their oral health than men do, women's oral health is not significantly better than men's.  This is because hormonal fluctuations throughout a woman's life can affect many tissues, including gum tissue.  These fluctuations occur when you mature and change, as you do during puberty or menopause, or other times when you have special health needs, such as menstruation and particularly during pregnancy.

According to the Journal of Periodontology[1] at least 23 percent of women between the ages 30 to 54 have periodontitis.[2]  And, 44 percent of women ages 55 to 90 who still have their teeth have periodontitis.  Yet many women do not realize they have it until it reaches an advanced state, which is why regular hygiene check-ups are so important.

Stages of your life - steps to protect your oral health.

Puberty - an increased level of sex hormones, such as progesterone and possibly estrogen, causes increased blood circulation to the gums. This may cause an increase in the gum's sensitivity and lead to a greater reaction to any irritation, including food particles and plaque. Signs to look for in your teenage daughter are swollen, red and/or tender gums.[3]

It is particularly important during this time in your daughter’s life to make sure she follows a good at-home oral hygiene regimen, including regular brushing and flossing, and regular dental care. In some cases, a dental professional may recommend periodontal therapy to help prevent damage to the tissues and bone surrounding the teeth.[4]

Menstruation – can result in menstruation gingivitis.  Women with this condition may experience bleeding gums, bright red and swollen gums and sores on the inside of the cheek. Menstruation gingivitis typically occurs right before a woman's period and clears up once her period has started.  Sometimes it occurs concurrent with stressful situations and menstruation.

Pregnancy - increase gingivitis or pregnancy gingivitis beginning in the second or third month of pregnancy that increases in severity throughout the eighth month. During this time, some women may notice swelling, bleeding, redness or tenderness in the gum tissue.[5] As a result of varying hormone levels, between 50%-70% of women will develop gingivitis sometime during their pregnancy - a condition called pregnancy gingivitis.[6] In some cases, gums swollen by pregnancy gingivitis can react strongly to irritants and form large lumps. These growths, called pregnancy tumors, are not cancerous and generally painless.

Studies have shown a possible relationship between periodontal disease and pre-term, low-birth-weight babies. Any infection, including periodontal infection, is cause for concern during pregnancy. In fact, pregnant women who have periodontal disease may be more likely to have a baby that is born too early and too small!

To prevent pregnancy gingivitis it's especially important to practice good oral hygiene habits, which include brushing at least twice a day, flossing once a day, and using an antimicrobial mouth rinse. If you are due for a professional cleaning, don't skip it simply because you are pregnant.  Now more than ever, professional dental cleanings are particularly important.

Oral contraceptives – while women are taking drugs to help treat periodontal disease, such as antibiotics, may lessen the effect of an oral contraceptive.  So be sure and consult your dentist about all the medications you are taking.

Menopause and Post-Menopause – not surprising given all the changes happening within your body, but you may experience changes in your mouth as well.  You may notice discomfort such as dry mouth, pain and burning sensations in the gum tissue and altered taste, particularly to salt and pepper.

In addition, menopausal gingivostomatitis affects a small percentage of women. Gums that look dry or shiny or bleed easily and range from abnormally pale to deep red may indicate this condition. Most women find that estrogen supplements help to relieve these symptoms.[7]

Bone loss is potentially associated with both periodontal disease and osteoporosis. Women considering Hormone Replacement Therapy (HRT) to help fight osteoporosis should note that this may help protect their teeth and your jawbone as well as other parts of the body.

What Should You Do?

See a dental professional for cleaning at least twice a year – you need to monitor your oral health.

If referred, see a periodontist in your area. Problems may include: Bleeding gums during brushing, red, swollen or tender gums.   Other issues such as persistent bad breath or pus between the teeth and gums.  If you’re a denture wearer a change in the fit of your dentures may occur.

Keep your dentist informed about any medications you are taking and any changes in your health history.

Brush and floss properly every day.  Review your techniques with a dental professional.

If there any questions that you might have, please call us to discuss them.

Novy Scheinfeld, DDS, PC

290 Carpenter Drive, 200A

Atlanta (Sandy Springs), GA 30328

404-256-3620

www.rightsmilecenter.com

info@rightsmilecenter.com

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[1] January 1999 issue of the Journal of Periodontology

[2] Periodontitis is an advanced state of periodontal disease in which there is active destruction of the periodontal supporting tissues.

[3] Women and Gum Disease: http://www.perio.org/consumer/women.htm.

[4] Ibid.

[5] Ibid.

[6] WebMd. Pregnancy Gingivitis and Pregnancy Tumors.

[7] Women and Gums: American Academy of Periodontology Journal. http://www.perio.org/consumer/women.htm.

Mouthwash and Oral Cancer – Dentist Sandy Springs

There appears to be controversy over whether mouthwash containing alcohol may be related to oral cancer.  This controversy arises out the studies that show a link between oral cancer and the consumption alcohol.  By extension, if drinking alcohol may cause cancer than so should alcohol based mouthwash.  Michael Douglas is the most recent case in point.  He has been reported to be a heavy smoker and imbibe alcohol on what is rumored to be frequent in occasions.  The problem is there are no conclusive studies and at this time there appears to be insufficient evidence to alter the ADA’s approval of mouthwash containing alcohol as an effective method for the prevention and reduction of gingivitis and plaque.  The ADA Council on Scientific Affairs awarded the ADA Seal of Acceptance to alcohol based mouthwashes after a thorough review of data on their safety and effectiveness.

Of all the studies published on this topic, beginning in 1979, four studies reported some positive results while five found no association. (citations omitted)  What we know is that none of the criteria for causality have been fulfilled by the published studies so far.  The International Agency for Research on Cancer, an extension of the World Health Organization, now identifies the consumption of ethanol in alcoholic beverages as a carcinogenic risk.[1] Alcohol abuse is associated with cancers of the mouth, pharynx, larynx and esophagus. Ibid.  However, the reason for this association is not fully understood – it may be due to a direct effect of alcohol on these tissue.[2]  Because of the conflicting studies and endorsements I could advise you to keep using alcohol formulated mouth rinses.  But if you are concerned and wish to stay on the safe side of the debate, there are non-alcohol based mouth rinses available that appear to be effective in the prevention of gingivitis and plaque.

Our job is to try and educate you on the contemporary issues we face in addressing your oral health and if there are any questions you would like to pose, please feel free to contact us for a free consultation.

Novy Scheinfeld, DDS, PC

290 Carpenter Drive, 200A

Atlanta (Sandy Springs), GA 30328

404-256-3620

info@rightsmilecenter.com

www.rightsmilecenter.com

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[1] International Agency for Research on Cancer. IARC monographs on the evaluation of carcinogenic risks to humans. Volume 96. Alcoholic beverage consumption and ethyl carbamate (urethane). Lyon, France: 6-13 February 2007.

[2] Lachenmeier DW. Safety evaluation of topical applications of ethanol on the skin and inside the oral cavity. J Occup Med Toxicol 2008;3:26.