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teethlove them or lose them
ADVERTISING FEATUREPublished Friday September 27, 2013
Teeth: Love them or lose them2
From the PresidentThe 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
suffi cient 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 fl uoridated water, desist from
smoking, moderate your alcohol intake and
make sensible decisions to minimise the
risk of physical trauma.
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.
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.
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.
To locate an ADAWA dentist in your area
visit www.ada.org.au.
Remember, dental care today...
savings tomorrow.
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 signifi cant in promoting a child’s general health, it infl uences a child’s risk of early childhood caries. This infl uence begins in pregnancy and remains important throughout early childhood.
During pregnancy the foetus develops a sense of fl avour 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 fl avour preferences can be modifi ed 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 artifi cial 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 fi rst trimester of pregnancy, but calcifi cation 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 defi ciency, preterm birth, as well as a child’s poor health and nutrition within the fi rst 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 signifi cantly 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
ContentsRole of maternal
nutrition on early
childhood caries2
Baby teeth care 2
Dental treatment for
the very young3
Treatment of early
childhood caries5
Growing Up Smiling
program6
Effective use of
fl uoride in different
age groups6
Why straighten teeth? 7
The use of
mouthguards in sport7
What to watch out for
in dental cover7
Dental erosion 8
Black front tooth 10
Eat right to smile
bright11
Grinding the night
away: possible health
outcomes11
Home dental care -
tips for proper teeth
and gum care12
Diabetes and oral
health13
Dental treatment of
the elderly13
Dry mouth 14
The use of implants
in dentistry14
Tobacco and alcohol
dangers15
Oral cancer 15
Editor: Louise Allan
Design: Michelle Nunn
Advertising: Eithne Healy 9482 3559
3
Baby teeth careWhat 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 refi ned sugars, performing adequate tooth
cleaning and visiting a dentist regularly.
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.
Tooth cleaning: Tooth cleaning should be
started as soon as the teeth erupt. A fl annel
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.
Visiting a dentist: A child should visit a
dentist by one year of age, or when their
fi rst 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
Dental treatment for the very youngKids feel more confi dent 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 fi rst birthday can give your child a head start to lifelong oral health. At these fi rst visits your dentist can assess your child's caries risk profi le 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 fi llings. Sometimes though tooth decay may have progressed to the point where fi llings, cappings,
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
UPPER TEETH
Central Incisor 8-12 months 6-7 years
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
LOWER TEETH
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
Baby Teeth Chart
Even badly broken teeth can be fi xed.The goal of dental treatment of the very young is healthy, comfortable, functional, and beautiful teeth.
Advertisement
B right Smiles, Bright Futures™ (BSBF) is an established oral health education program to help children understand the importance of brushing twice
a day and taking responsibility for their own dental health from an early age. BSBF gives teachers, parents and children the tools they need to make good oral health a permanent part of their lives. With focus on prevention, the program builds self-esteem and teaches the practices that create lifelong oral health habits.
This engaging, activity-based program is a curriculum linked primary school resource. The free BSBF Kit identifies key learning areas and outcomes, and is flexible, so can be adapted to individual classroom needs. The DVD features two cartoon dentists, Dr. Rabbit and Dr. Brushwell, who have mentored a group of children to become Tooth Defender superheroes. Together, the team undergoes a mission to protect tooth city from the sticky, sugary villain called Placulus.
BSBF inspires kids to take control of their own oral health. Its messages of empowerment enable children not only to understand “what” to do to take care of their teeth and gums, but the “why” behind the messages.
In this way, BSBF equips them to become lifelong Tooth Defenders. Over the next two years, BSBF aims to educate another one million more Australian children.
bright futuresBright smiles
● Dr Rabbit & the Legend of Tooth Kingdom DVD / CD ● How to Brush Poster ● Comprehensive Teachers’ Guide ● Stickers (80 per kit) ● Calendar ● Parent take-home brochures (32 per kit) ● 32 brushes and toothpaste
Each FREE Bright Smiles, Bright Futures Kit includes: FUN FROM CLASSROOM TO BATHROOM
Early education is the key to improving dental health for the next generations. This is how the Colgate Bright Smiles, Bright Futures program has already taught more than 4 million Australian children how to look after their teeth.
The [Bright Smiles, Bright Futures] Kit is amazing. It’s cross-curricular. It’s comprehensive. It’s fun. Children all around the world are learning about how to look after their teeth.Glynis Cardy, teacher, Hampton Park Public School, WA
TEACHERS & PARENTS, GET INVOLVED! Go to healthyteethforlife.com.au
5
Treatment of early childhood cariesTreatment of childhood caries starts with understanding – what it is and how it develops. Dental caries is the most common infectiousdisease 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 fl uids 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 fi llings, crowns
and tooth extraction.
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, fi llings, crowns and extraction may be
needed.
The most common form of ECC is decay
between molar teeth where toothbrush
bristles can’t reach. It is as important to fl oss
between baby teeth as it is to brush them.
Very early decay can be treated with careful
cleaning and remineralisation, however
once cavities form, fi llings are needed.
ECC in all its forms is mostly preventable by
early identifi cation of ‘at risk’ children.
There are three main approaches:
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 diffi cult to avoid; it is
better for Mum and Dad to have healthy
teeth than avoid kisses!
2. Care for teeth early. New parents should
take their baby for a dental check soon
after eruption of the fi rst tooth and
defi nitely by 12 months of age. This
allows identifi cation of ‘at risk’ children
but importantly provides education
on brushing and fl ossing, adjunctive
preventive therapies and dietary advice.
Where ECC Is identifi ed, early treatment
can prevent signifi cant 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
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.
Figure 7: Restored cavity allowing
easier fl ossing.
EXAMPLESOF EARLY CHILDHOODCARIES AND RESTOREDTEETH
Teeth: Love them or lose them6
Growing Up Smiling programHaving 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 fi ve 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 fl uoride 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 fi ve 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 Benefi t 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 fi nalised 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
Figure 2: Decay on lower back baby
teeth. Photos: P Arrow.
Figure 1: Decay on upper front
baby teeth.
Effective use of fl uoride in different age groupsSince discovering the ability of fl uoride ion to prevent decay progression and protect tooth enamel surfaces, scientists and health organisations have implemented a myriad of modalities for delivering its benefi ts to people of all ages and socio-demographic status. Below are the majority of these modalities:
Water Fluoridation describes the controlled adjustment of fl uoride levels in community water supplies and was fi rst 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 fl uoridation 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 fl uoridation 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 fl uoridated toothpastes is an effective way to prevent tooth decay across all age groups with an additive preventive effect when used with fl uoridated water. To reduce the incidence of enamel fl uorosis 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-fl uoridated water areas may be prescribed individually tailored preventive regimens by their oral health professional for the use of high fl uoride toothpastes, fl uoride 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 1ARCPOH. The use of fl uorides in Australia: Guidelines; Aus Dent J. 2006;51(2):195-199Armfi eld JM. Public Water fl uoridation 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 fi rst 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
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 growingchild 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 self-
confi dence. 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 diffi cult 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.
Prevention of damage to front teeth: Severely protruding teeth do increase the
risk of trauma from sporting and
daily activities.
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.
There is nothing more distressing to a child
and parent than having their front teeth
damaged.
Tooth wear: It is claimed that some bad
bites lead to clenching, grinding, and
excessive wear and/or uneven wear of the
teeth.
Gum damage: In some bites, the teeth can
damage the gum of the opposing teeth.
For example, in cases with a large over bite,
the lower front teeth can bite into the gum
behind the upper front teeth.
This may lead to loosening and movement
of the teeth and eventually may lead to
tooth loss.
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.
Speech: Some people have diffi culty
speaking properly because of alignment
problems with their teeth and jaws.
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.
Dr Mithran Goonewardene,
Orthodontist
The use of mouthguards in sportPrevention 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.
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-fi tted 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 fi t. They have a
loose fi t 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
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 fi t
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
Stock mouthguards. Boil and bite mouthguards.Custom-constructed mouthguards.
What to watch out for in dental coverWhen it comes to dental cover, it is very important to consider your annual fi nancial limits.
A low annual fi nancial 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 diffi cult 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 fi nancial limits on all our extras
covers. Plus, our general dental treatment
is unlimited.”
At HIF, you’ll get access to the maximum
annual fi nancial limit under extras covers
after only fi ve years.
“Across the myriad of extras covers in
the market you’ll fi nd 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 fi nancial 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 specifi ed
rebate amounts based on a proportion
of the average charge for each dental
treatment. Other funds provide a fl at
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 fl at 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 fi nancial limits are generally lower
and a fi nancial 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 fi nancial 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 fi tted
mouthguards”, Mr Gibson said.
“Dental health is directly linked to our
general health and that’s why we fi nancially
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 benefi t you the
most when you are in that situation.
Teeth: Love them or lose them8
Dental erosionDental 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.
It is important to determine what the cause of the erosion is for each person based on their specifi c 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
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.
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.
Are you at risk of dental erosion?External sources1. 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.
Internal sources1. 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 refl ux.
4. Pregnancy: Vomiting
Internal sources are the most diffi cult
to control and may require referral to
medical specialists capable of dealing
with the origins of the problems if at
all possible.
What does erosion look and feel like on teeth?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.
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.
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 fi llings 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 People1. 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 fl uoride 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 fl uoride treatments and fl uoride
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 fi llings 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
Saliva provides a protective protein coating over the teeth called a pellicle and loss of this coating can make the teeth more susceptible.
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Teeth: Love them or lose them10
Black front toothDiscoloured 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
specifi c 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 diffi cult 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 fi rst 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 fi rst 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 diffi cult
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
Figure 3: Extrinsic discolouration of the
two front teeth due to fl uorosis (excess
fl uoride during tooth development).
Figure 4: The same teeth as in Figure 3
following enamel microabrasion treatment
by a dentist.
EXAMPLES OF DISCOLOURATION
Figure 2: The same tooth as in Figure 1
following internal bleaching treatment by
a dentist.
Figure 1: Intrinsic discolouration of a front
tooth that had been traumatised.
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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 stabilised stannous fl uoride to form a barrier against damaging acids to protect teeth against enamel wear.
A clinical study showed up to 42 per cent reduction in enamel loss versus ordinary fl uoride toothpaste after 15 days of use.*
Oral-B Pro-Health has also been proven to protect against cavities, gingivitis, plaque, sensitivity, tartar, whitening and breath. For more information log on to oralb.com.au.Oral-B Pro-Health is now available in Australia from all major supermarkets and pharmacies. *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.
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11
Grinding the night away: possible health outcomesA lot of people are not aware that they grind or clench their teeth when they are either awake or asleep. The scientifi c 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).
Scientifi c 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 fi llings leading to signifi cant 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 fi t 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.
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
Eat right to smile brightGuidelines for diet and nutrition that improve oral health.
1. Eat fi bre and whole grains dailyHigh fi bre foods encourage saliva fl ow
which helps protect teeth. Wholegrain
foods are important for bones, teeth and
gums. Options for incorporating fi bre into
your diet are bananas, apples, oranges,
peanuts and almonds.
2. Drink lots of waterWater 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 mealsSaliva 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 foodsDental 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 refi ned sugarsNatural sugars are better for your health
and teeth than refi ned 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 fl ow. 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 fi llings.
9. Good nutrition is essential for gum healthEating 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
Figure 1: Worn and fractured
incisal edges.
Figure 2: Night guard or occlusal splint.
Teeth: Love them or lose them12
A B
Home dental care - tips for proper teeth and gum careA 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.
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”).
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.
All the fi llings 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.
If you want to stop tooth and gum disease
you need to keep these areas clear of the
debris and germs that cause damage.
So how should this be done? Most people own a toothbrush but do you use it effectively?
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.
Avoid brushing the gums otherwise this
can cause damage, such as recession or
scratching and ulceration.
Massaging the gums does not provide any
extra benefi t.
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 fl oss to wipe the tooth
surface. These will have a greater benefi t
with the back teeth than the front.
Dr Keith Gale, Periodontist
E F
C D
When using a toothbrush remember to clean not only your teeth but, more importantly, between your teeth.
po a y, be eeyour teeth.
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 fl uoride toothpaste.
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13
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 infl amed 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, fl ossing
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 fl ossing 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 benefi t.
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
Dental treatment of the elderlyThe 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.
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.
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 diffi cult to eat, swallow, taste and speak.
What to do
• Use an artifi cial 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 proneto decay.
• Root surfaces can decay at a rapid rate.
What to do
• Visit your dentist or dental hygienist regularly.
• If you are identifi ed as a high-risk patient for root surface decay, your dental professional may provide a preventive fl uoride treatment at the dental clinic. They may also recommend the use of high fl uoride mouth rinse or paste at home.
• Make changes to your diet to reduce sugar intake.
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 fl uoride 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 fl oss 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
Brush your teeth twice a day with a fl uoride toothpaste, especially at bedtime.
Figure 3: Before treatment.
Figure 1: Before treatment.
Figure 4: After treatment.
Figure 2: After treatment.
Teeth: Love them or lose them14
The use of implants in dentistryDental implants can be described as artifi cial tooth roots made out of titanium that are placed into the jawbone to replace missing natural teeth.
The artifi cial 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 suffi cient strength to support
an artifi cial 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 scientifi c research.
Dental implant therapy involves a surgical
stage, where the implant is placed into the
jawbone, and a restorative stage, where
an artifi cial tooth or crown is securely
attached to the implant. Compared to
other methods of replacing missing teeth,
dental implants offer a signifi cant advantage
because damage to adjacent teeth can
be avoided. Unlike natural teeth, implants
cannot decay. However if not brushed and
fl ossed 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 signifi cant advantages over
previous methods of tooth replacement.
A/Prof Dax Calder, Periodontist
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 voicecomplain 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 hay-
fever 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 auto-
immune condition linked to rheumatoid
arthritis, lupus and Hashimoto’s Disease.
Dry mouth may be the fi rst 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 fl uid 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
fi rst 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 diffi culty
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
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.
These repair processes become ineffi cient
when saliva production is reduced, leading
to increased risk of tooth decay and tooth
loss. New cavities or the need to replace
recent fi llings 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 grape-
seed 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 effi cient means of
stimulating saliva.
Anyone with a dry mouth should see a
dentist regularly so that problems resulting
from hyposalivation may be identifi ed and
appropriate management initiated.
Dr Gareth Davies, Oral Medicine -
The University of Western Australia
For some people, having a dry mouth is not a transient problem, but something that persists and may be permanent, 24 hours per day.
15
Tobacco and alcohol dangersSmoking 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 signifi cantly 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 non-
smokers. 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 fi ve 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 modifi cation, 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, identifi ed anywhere in
the mouth, be checked if it persists for more
than two weeks (Figure 4).
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 identifi ed. 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
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.
Figure 2: Oral cancer affecting the
mucous membrane of the tongue.
Figure 1: Oral cancer affecting the
mucous membrane of the inside of the
cheek.
Oral cancerOral cancer in western society represents between three and fi ve 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 fi ve years after diagnosis. This fi gure 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 non-healing 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 defi ciencies, chronic irritation, poor oral hygiene, betel nut chewing and chronic infection with the fungus Candida albicans. The dietary defi ciencies include iron defi ciency, and defi ciencies 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 work-up. 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 fi rst 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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