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!

FAQ's for New Moms

FAQ's for New Moms

 When do the teeth break through the gums (erupt)?

Normal eruption of the first tooth is generally around 6-7 months of age +/- 6 months.  This means that it is normal for a baby to be born with teeth (6 months old minus 6 months = birth) or to have no teeth until they are 1 yr old (6 months old plus 6 months = 1 yr old).  You can see that “normal” encompasses a pretty wide range.  If your baby’s first tooth is later than the average, you can expect them to also lose teeth later than most of their peers.  This is still considered normal. 

Teething: What can be done, and when will it end? 

Teething causes intermittent discomfort, irritability and excessive salivation as new teeth are erupting in your baby’s mouth.  It can be managed with over-the-counter analgesics, such as Tylenol Infants’ Drops, or allowing the baby to chew on a soft, chilled teething ring.  Use of teething gels containing topical anesthetics such as benzocaine is NOT recommended due to potential toxicity of these products in infants.  Teething happens intermittently as teeth are erupting, so you may notice that it is off-and-on until the child is around 2 years of age or until all the teeth have erupted.

When should I start cleaning my baby’s teeth? 

As soon as a tooth appears!  The American Association of Pediatric Dentistry recommends that you use a smear of fluoridated toothpaste on a soft, infant-sized toothbrush twice a day.

Wait a minute! I thought I wasn’t supposed to use fluoride until the child is old enough to not swallow it? 

Yes, that used to be the case.  However, the recommendations were changed due to research showing that the benefits of fluoride, preventing devastating dental disease, far outweigh the risks.  Fluoride has been deemed safe and effective by both the American Dental Association and the American Association of Pediatric Dentists.  It should always be stored out of the reach of young children and should be used under adult supervision for children under age 5.

What kind of toothbrush should I use? 

There are many products available to clean your baby’s teeth.  You may have to try out a few different types to see which you like the best.  As the teeth first erupt, a soft wet washcloth is adequate to remove the soft buildup that accumulates on the teeth and gums.  There is a type of “toothbrush” for infants that includes a sleeve that fits over the parent’s finger with small rubbery bristles to clean the teeth.  An infant toothbrush is simply much smaller in size with very soft bristles.  Do not ever use a medium or hard toothbrush on your baby!

What about baby bottles or sippy cups? 

Baby bottles are a great way to nourish your child.  Once your child has moved on to a sippy cup and is no longer receiving all of his or her nutrition via bottle, the sippy cup should contain only water.  Anything else that your child sips throughout the day and/or night can greatly increase his risk for tooth decay.  A common cause of cavities in very young children is having a bottle or sippy cup in bed with milk or juice.

What about pacifiers and thumb-sucking? 

These habits constitute a behavior known as non-nutritive sucking because it stems from the sucking reflex babies have and does not provide any nutrition.  Pacifiers and thumb-sucking are a common method very young children use to self-soothe.  Please read our earlier blog on pacifiers and thumb-sucking below to learn more about these habits.

When should my baby visit a dentist?

The American Association of Pediatric Dentists recommends that every child should see a dentist by his or her first birthday or when the first tooth comes into the mouth.  This will enable the dentist to give you, the parent, valuable information and education regarding how best to care for your child’s teeth.  It will also familiarize your child with the dental office.  You will be shown how to properly clean your child’s teeth and given tips on how to best accomplish this as your child grows and becomes more mobile.

 Do you have other questions about your baby’s teeth?

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!

Back To School

back_to_school_1622789_1280.jpg

Back to School

For many people, this time of year is more than just back to school.  It is back to daily and weekly routines, back to bedtimes and alarm clocks, and back to good habits that may have gone by the wayside in the easygoing days of summer.  Add this to your list of daily activities as you get back into the swing of things: taking great care of your teeth!  There are many things involved in pursuing a healthy mouth.  Here are some tips to getting that oral hygiene routine back on track.

 Brushing

  • In order to properly remove plaque (the soft, sticky substance that causes cavities and gum disease), it is necessary to brush your teeth twice a day with a soft or extra-soft bristled toothbrush.

  • The most commonly missed area in brushing is at the gumline, so make sure the bristles of your toothbrush are gently touching the gums as you brush.

  • Check the bristles of your toothbrush often. The American Dental Association recommends replacing toothbrushes every 3-4 months or sooner if bristles are splayed and worn (like the photo shows). A worn toothbrush cannot do a thorough job of cleaning teeth.

  • Please remember: never share a toothbrush with anyone, especially your child.

  • If you or your child is sick with any type of infection, replace your toothbrush or run it through your dishwasher’s “Sanitize” cycle.

  • Supervise your children’s brushing. They should only be brushing their own teeth if they can tie their shoelaces or write their name in cursive. Otherwise, you should still be brushing their teeth for them.

 Flossing

Brushing alone cannot quite get the job done when it comes to removing all of the plaque from your teeth.  The nooks and crannies between your teeth are havens for clumps of bacteria where even the best brusher is not able to reach.  Flossing removes this plaque and reduces your risk for cavities and gum disease.  When you skip flossing, you miss over 35% of the surface of a tooth.  Studies have shown that flossing every day can prolong your life by six years.  

Because flossing is a more difficult skill to master, you should floss your children’s teeth until they show they can properly do it on their own.  The easiest way to floss your child’s teeth is to sit on a bed or the floor, and have the child lay down with his head in your lap.  Have the child tilt his head up so that you can look straight down into his mouth.  This gives you the simplest access for flossing (also good for brushing).  The earlier you start this process, the easier it is to accomplish. 

 Preventive Dental Care

  • Professional cleanings – So let’s say you’re not a perfect brusher and flosser; no one is. We all have areas that we may miss with our toothbrush or floss. What happens when sticky, soft plaque is not removed from our teeth? In 24 hours, it begins to harden into tartar (also called calculus). Once it has hardened, it cannot be cleaned off with a toothbrush or floss. It has to be removed by your dentist or dental hygienist. Tartar buildup that is not removed on a regular basis leads to painful, chronic conditions that require more extensive and more expensive dental treatment.

  • Dental evaluation and x-rays – A dental evaluation by your dentist can uncover problems that can be treated in the early stages, when damage is minimal and restorations may be small. Dental x-rays show how the teeth are developing and hidden decay that develops between the teeth. X-rays also allow us to monitor the jawbones for any changes, including cancer or abnormal growths. These important steps, taken on a regular basis, can help prevent painful, chronic conditions and save money. Untreated tooth decay is a serious infectious disease for which there is no immunization.

  • Fluoride application – Cavities used to be a fact of life. Over the past few decades, one thing has been responsible for a dramatic reduction in the prevalence of cavities: fluoride. The U.S. Centers for Disease Control says that water fluoridation is “one of 10 great public health achievements of the 20th century”. Fluoride in your water supply is integrated into children’s teeth as they are forming, adding strength and cavity resistance to their enamel. Teeth can also be strengthened and protected with topical fluoride. Topical fluoride includes many products you may already use at home (toothpaste, mouthwash and gel), and it can be professionally applied in your dentist’s office. Your need for professional fluoride treatment should be assessed by your dentist and is based on your cavity risk level.

  • Sealants – Another common area that toothbrush bristles miss is the deep pits and grooves on the biting surfaces of your back teeth. These types of cavities can be prevented by applying dental sealants over the pits and grooves. A dental sealant is a thin coating that goes on in a liquid form, flowing into the pits and grooves and then hardening to form a smooth, flat surface that prevents the accumulation of bacteria and food particles. Sealants are most effective when applied as soon as a back tooth enters the mouth.

 

If you missed getting in to our office this summer for your preventive care, take a look at your school calendar.  School holidays are busy in our office, and appointments go quickly! Pick the next school holiday for your dental visits and call us today to get on the books for the day you want!  

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.

Risk_Perspective_7_31_17__01.jpg

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.

pregnant.jpg

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!

What Does it Mean to be High Risk for Cavities?

What does it mean to be high risk for cavities?

What is a cavity? 

A cavity is the destruction of tooth structure caused by a combination of bacteria, sugar and acid.  When bacteria in the mouth digests sugar, acid is produced.  The acid destroys enamel, just like it etches glass, and this process is called demineralization.  Once a cavity has grown through the outer layer of enamel, it cannot be reversed.

 What are the different types of cavities?

Cavities can form on any surface of the tooth, including the pits and fissures on the biting surface, smooth surfaces and any exposed root.  Pit & fissure cavities are the type that can be prevented by placing dental sealants before a cavity has formed.  Smooth surface cavities, most commonly in between the teeth, are discovered with bitewing x-rays, typically taken by your dentist once a year.  Root cavities can be seen on visual examination, or on an x-ray if they are large.

 

 How do cavities happen?

 Four things are required for a cavity to form: 1) acid,  2) sugar, 3) bacteria, and 4) time.  The bacteria present in the mouth thrive on simple carbohydrates, the sugars in most crackers, cookies, candy, soda, sports drinks, and most juices.  The more bacteria you have in your mouth, the more likely you are to get a cavity.  This factor emphasizes the importance of daily home care and regular dental cleanings.  The more sugar your teeth are exposed to, the more likely you are to get a cavity.  This factor emphasizes the importance of your diet.  The longer your teeth are exposed to sugar or acid, the more likely you are to get a cavity.  This factor emphasizes the importance of your habits (i.e. sipping on sugary or acidic beverages for long periods of time).  The more acidic your mouth is, the more likely you are to get a cavity. This factor also emphasizes the importance of diet, specifically acidic beverages like sparkling water, sports drinks, juices, and sodas.

 

What does it mean to be high risk? 

There are multiple factors that can make you high risk.  You may present with one or more of these factors:

·       Poor plaque control
·       High risk diet
·       Multiple existing restorations (like fillings or crowns)
·       Fractured teeth
·       Decreased salivary flow or dry mouth
·       Systemic condition
·       Active decay
·       Unsealed grooves and pits
·       In orthodontic treatment, either braces or Invisalign

 What can I do about it? 

By altering the four factors in the diagram, you can reduce your cavity risk.

  1. Acid – Reduce your intake of acidic foods & drinks (this includes DIET SODAS, coffee and tea), drink plenty of water, use sugar-free gum or mints to stimulate salivary flow, and control any acid reflux problems. Neutralizing the pH in your mouth may involve using recommended mouthrinses or gels.

  2. Sugar – Limit sugar intake, especially in between meals. Cut back on sodas, sweetened coffee or tea, sports drinks, or juices. Don’t chew sugar-containing gum, mints or other hard candy.

  3. Bacteria – Reduce the bacterial levels in your mouth by having your teeth professionally cleaned on a regular basis, and performing good oral hygiene at home. FLOSS!

  4. Time – Limit the length of time that your teeth are exposed to acid or sugar. Sipping on an acidic or sugary beverage is one of the most common causes of cavities. You may only drink one soda per day, but if you sip on it for several hours, you are increasing your cavity risk exponentially.

 

What if I don’t do anything?

Untreated cavities expand toward the nerve inside the tooth.  Large cavities can cause nerve irritation and sensitivity to hot and cold.  If the cavity reaches the nerve, causing it to become infected with the cavity’s bacteria, a severe infection and toothache can ensue. Not all tooth infections hurt, so evaluation of teeth with dental x-rays is important!   Tooth infections can extend through the root and into the surrounding jaw structures, and worst-case scenario, end in death by closing off the airway or spreading into the brain.

 

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!