Is Morning Sickness Ruining Your Teeth?

Is Morning Sickness Ruining Your Teeth?

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What is Morning Sickness?

Morning sickness is a commonly used term to describe the nausea and vomiting that affects many women during pregnancy.  It’s a bit of a misnomer, as most women who experience this phenomenon say it actually happens throughout the entire day and not just in the mornings.  Morning sickness affects between 70-85 percent of pregnant women!  While most women experience morning sickness in the first 16-20 weeks of pregnancy, some of the unlucky ones have symptoms throughout the entire pregnancy. 

Morning sickness affects a person’s ability to work, perform necessary tasks around the home, and/or care for children or other dependents in the household.  Many women state that morning sickness forced them to reveal their pregnancy earlier than they would have preferred. 

How Does Morning Sickness Affect My Teeth?

The reason morning sickness is damaging to teeth is that the nausea and vomiting brings acid from the stomach up into the mouth.  Healthy stomachs are filled with acid, which breaks down food as an important part of the digestion process.  However, that acid is supposed to stay in the stomach.  Stomach acid has a pH of 1.5-3.5. 

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In contrast, a healthy mouth has a pH that is slightly above neutral, in the range of 7.1-7.5.  Teeth can stay strong at this pH.  The enamel covering our teeth begins to weaken when the pH drops to 5.5 or below.

 

When someone vomits, the acid in the stomach is pulled up the esophagus and into the mouth.  This stomach acid is far below the pH threshold for enamel damage.  When the mouth is subjected to this strong acid with such a low pH repeatedly, the enamel is weakened and may begin to erode. 

Enamel erosion is the gradual degradation of the enamel surface of teeth caused by exposure to acids.  This includes any acid, like sodas, lemon juice, and any carbonated drink.  Because stomach acid is more acidic than these things, it can cause more damage in a shorter amount of time.  The photos below show examples of severe enamel erosion.  The enamel becomes thinner and is even missing in some areas.  On front teeth, this can cause the teeth to appear translucent or “see-through”.  On back teeth, the enamel can erode away from a filling, leaving the filling taller than the tooth surface. 

Because enamel is a tooth’s defense against decay, anything that weakens enamel makes a tooth more likely to get a cavity.  Loss of enamel also causes tooth sensitivity. 

  

How Do I Protect My Teeth From Morning Sickness?

There are several steps you can take to protect your teeth if you are suffering from morning sickness.

 

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  1. After vomiting, do not immediately brush your teeth. Rinse your mouth thoroughly with water, wait 30 minutes and then brush.

  2. Use an over-the-counter mouthrinse that contains fluoride before bed each night. Fluoride can strengthen the enamel and protect it against acid.

  3. Chew sugar-free gum throughout the day. This stimulates your natural saliva production, which raises the pH in your mouth.

  4. See your dentist. If you are suffering from morning sickness, let Dr. Aanenson and Dr. Kuiper know. They can assess your risk for enamel erosion and make specific recommendations for you.

 

What Else Can Cause Acid Erosion of Teeth?

GERD – Severe acid reflux can keep the pH in the mouth much lower than normal.

Bulimia – As with morning sickness, consistent vomiting causes enamel erosion.

Lemon juice cleanses – Lemon juice is as acidic as stomach acid and should never touch the teeth.

Are You Suffering With Morning Sickness?

Call our office at 605-925-4999 (Freeman) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell! They can help you manage the risks associated with morning sickness and help you protect your teeth.

Hormone-Induced Gingivitis

Hormone-Induced Gingivitis

What is hormone-induced gingivitis?

Hormone-induced gingivitis is a type of gingivitis that occurs specifically during changes in hormonal levels .  It is a very common condition that we see frequently in our office.  Hormone-induced gingivitis causes a patient to have gums that are swollen, red, tender, and bleed easily.   The tenderness and bleeding often make oral hygiene routines uncomfortable, and patients sometimes avoid proper brushing and flossing techniques because it hurts.  Healthy, natural gum tissues are light pink, relatively flat and tightly adhered to the teeth.  The appearance of bright red, puffy gums is unsightly, giving a diseased look to the mouth, and may cause embarrassment. 

What causes hormone-induced gingivitis?  

The name says it all: it is induced by hormones.  Rapid swings in hormone levels (most notably estrogen, progesterone, and chorionic gonadotropin) can have a profound effect on gum tissues.  Research has shown that these hormone levels cause two important changes to occur:

  1. Hormone changes affect the tiny blood vessels in the gum tissue, increasing the blood flow in this area (which can cause swelling) and changing the permeability of the blood vessels (which makes the tissue bleed more easily).

  2. Hormone changes also affect the types of bacteria present in gum tissues. Research shows that gum tissues in patients with hormone changes such as pregnancy or taking birth control pills have more dangerous bacteria than patients without hormone changes. By “more dangerous”, we mean stronger and more likely to cause gum disease.


Who is at risk for hormone-induced gingivitis?  

Hormone-induced gingivitis is common in children going through puberty, both girls and boys.  It is also prevalent in women at various stages of hormone changes, including menstrual cycles, the use of birth control pills, pregnancy, and menopause.  This higher risk for gum disease makes oral hygiene even more important than it already is.  People with poor oral hygiene are more likely to experience hormone-induced gingivitis than those with good plaque control and consistent oral hygiene habits.  People who have infrequent and inconsistent dental cleanings are also at an increased risk.

 

What can you do about hormone-induced gingivitis?

 

  • Practice perfect oral hygiene. Do not miss a single day of flossing! Use an electric toothbrush; they are shown to effectively remove more plaque than a manual toothbrush.

  • Add a mouthwash to your oral hygiene routine, and use it twice daily. In addition to an over-the-counter alcohol-free mouthwash, you can swish with warm salt water throughout the day. Some patients require a prescription mouthwash to get the inflammation under control.

  • Stay on schedule with professional dental cleanings. Your dental hygienist is able to remove bacterial buildup from areas you might be missing, even with good oral hygiene.

  • Consider increasing the frequency of professional dental cleanings. Many of our patients with severe gingivitis during puberty or pregnancy have their teeth cleaned every 3 months, instead of every 6 months. This reduces the severity of gingivitis by reducing the amount of bacterial buildup accumulated between cleanings.

  • Talk to Dr. Jason, Dr. Alex or Dr. Serena about other recommendations they may have to improve your gingivitis. There are many additional oral hygiene products available to help reduce gum inflammation. They will determine which one will be most beneficial for your unique situation.

 

Think you or your child may have hormone-induced gingivitis?

Call our office at 605-925-4999 (Freeman) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!

Radiation Safety

Radiation Safety

We are often asked by our patients about the safety of dental x-rays.  Many people are concerned about the radiation they are exposed to when diagnostic x-rays are taken.  Since exact measurements are difficult to obtain, this article will use averages and comparisons to help you understand the radiation dose you receive from dental x-rays.

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Understanding Dose from X-rays

A set of four bitewing x-rays, which is typically taken once per year, delivers an average effective dose of 0.005 milliSievert (mSv). Effective dose is not measured. Effective dose is calculated by taking the dose delivered to the specific organs exposed during an x-ray and accounting for the sensitivity of the tissues exposed. Those values are then summed over all of the tissues in the human body to calculate an effective dose, which allows us to compare doses delivered in different ways to one another.

Comparing the dose from a set of four bite-wings to other doses we are exposed to daily is a useful way to understand dental x-ray doses in context. In the graphic below, dental bitewing x-ray dose is shown in comparison to other medical exposures and different sources of naturally occurring background radiation. Naturally occurring background radiation is exposure that each of us gets every day, and some of us more than others depending on the location in the world in which we live. In the chart below, the average US doses are shown. The total US average natural background dose from all sources per year is right around 3 mSv, or 600 times greater than the dose from one set of four dental bitewing x-rays, so you would nearly need to have bitewing x-rays twice a day for a year to equal the dose you receive annually just from living on the planet.

Risk from Dental Exposures

What most people worry about when they hear the word “radiation” is whether or not it can cause cancer.  The likelihood of an adverse effect (cancer) given an exposure to radioactivity is also known as risk. The delivery of radiation dose to the head and neck area during a dental x-ray does come with some associated risk.  According to the World Health Organization (WHO)’s publication, Communicating radiation risks in paediatric imaging: Information to support healthcare discussions about benefit and risk, the increased risk of cancer incidence from various types of diagnostic x-rays can be compared with baseline lifetime cancer risk.  This publication focused on risk to children because: “children are more vulnerable than adults to the development of certain cancer types, and have longer lifespans to develop long-term radiation-induced health effects.” Basically, kids are more susceptible than adults to cancer from radiation because they will live longer from time at exposure than their adult counterparts and their bodies are still growing and developing, so their organs are more vulnerable to exposure.  WHO’s studies showed that the increase in cancer incidence, or risk, for children aged 1-10 years from dental x-rays is <1 in 500,000.  That risk would be even lower in an adult. Levels of risk are generally considered to be “acceptable” among agencies that regulate radiation exposures to the public if they are in the range of 1 in 10,000 to 1 in 1,000,000. The cancer incidence risk from dental x-rays to children reported by WHO falls directly in this range of acceptable risk.

Benefit

The benefit of dental bitewing x-rays is the early detection of multiple types of oral disease, including cavities, gum and bone infections, and oral cancer.  As with any disease, the earlier it is detected, the less invasive treatment can be and the better the long-term prognosis.  The risk of these diseases going undetected is the progression of disease, spread of infection, loss of teeth, loss of bone in the jaws, and in severe cases even death.

Risk vs. Benefit

Due to the prevalence of oral diseases and the risks associated with those diseases, it is the opinion of our practice, as well as that of the American Dental Association, that the benefits of early detection with diagnostic x-ray imaging far outweigh the risks associated with the x-rays.  The risk of adverse consequences from undetected dental and oral diseases is significantly greater than the risk of increased cancer incidence due to dental x-rays.  Because each patient has different risk factors, the number of x-rays and the frequency at which they are taken can vary widely and is always determined on a case-by-case basis with the utmost respect for balancing patient concerns with positive outcomes.  For example, a patient with a higher risk for cavities or periodontal disease would benefit from more frequent dental x-rays than a patient who has a very low risk for either cavities or periodontal disease.  The more aggressive a dental condition is, the more frequently dental x-rays are needed to provide the best preventive and interceptive dental care.

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X-rays and Pregnancy

The American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women reaffirmed its committee opinion in 2015: “Patients often need reassurance that prevention, diagnosis, and treatment of oral conditions, including dental X-rays (with shielding of the abdomen and thyroid) … [is] safe during pregnancy.”  Dr. Jason, Dr. Alex and Dr. Serena typically postpone any dental x-rays during a patient’s pregnancy until after the baby is born unless the patient has a very high risk for disease, which could affect the patient’s overall health and that of the pregnancy.

 

Concerned about Radiation from Dental X-rays?

The number and type of dental x-rays taken on every patient is customized for his or her specific needs.  Call our office at 605-925-4999 (Freeman) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!