If you have noticed white spots or enamel pitting on your teeth, something in your diet may be the cause. If accompanied by other general symptoms, these dental problems may stem from a possible intolerance to gluten.
Gluten is a protein found in grains like wheat, barley or oats. Some people (an estimated one in 130 Americans) have a condition called Celiac Disease (CD) in which their immune system mistakenly treats gluten as a threat and initiates an attack of antibodies (individual proteins made by the immune system to target and kill specific foreign substances) against it. Tiny hair-like structures in the small intestine called cilia that aid in nutrient absorption may be destroyed in the process. As a result, the body can't properly absorb nutrients.
CD can be difficult to diagnose because its symptoms resemble other conditions like Irritable Bowel Syndrome. Typically, though, CD causes digestive issues like diarrhea, bloating and stomach aches, as well as fatigue, growth abnormalities and vitamin deficiencies. In the mouth, the most common symptoms are enamel defects like spotting and pitting. Patients may also lose a portion of their enamel in the grooves of the central incisors where the enamel may appear chalky or opaque rather than shiny, evidence of a condition called decalcification. CD may also cause canker sores.
Determining if you have CD is a two-step process. You must first undergo a blood test to see if antibodies are present for gluten. If the test returns positive confirming you have CD, the next step is a biopsy in which a small amount of intestinal tissue is removed and analyzed. This measures the degree of damage to the stomach lining, which will indicate whether or not you should remove foods containing gluten from your diet.
While research is ongoing to develop counteracting medications, removing gluten from your diet remains the most effective treatment for CD. Enamel defects caused by CD can also be treated with fluoride toothpastes and other aids to foster re-mineralization (restoring calcium and other mineral content to the enamel), and with cosmetic techniques to reduce any discoloration effect. CD patients should continue with normal oral hygiene efforts, with one exception: hygiene products (including polishing pastes and fluoride gels used in professional cleanings) should be gluten-free.
If you would like more information on how gluten may affect your oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Gluten & Dental Problems.”
Clenching, or grinding of your teeth (also known as bruxing) are common habits. Biting forces are normally small, gentle, fleeting and very frequent throughout the day. In fact, it's the normal stimulus necessary to keep your teeth and jawbone healthy. When you clench or grind your teeth you apply forces up to ten times normal (in the 200 lb range). And it's not just the force, it's the duration and frequency with which they're applied. High forces lasting for seconds or minutes, frequently exerted, can affect some or all of the masticatory system. This includes the teeth, jaws, jaw joints and muscles, causing aching jaws, headaches, earaches, neck and even backaches; and the teeth themselves causing excessive wear, fractures, or even loose teeth.
Why does grinding occur? Habitual grinding is most frequently a reaction to stress. Sometimes abnormalities in your bite or malocclusion (“mal” – bad; “occlusion” – bite) can trigger clenching or grinding. It is normal for children to sometimes grind their teeth when new teeth are coming in, but it may be indications of stress too. You may be grinding your teeth subconsciously in your sleep, but it may be so loud as to awaken your sleeping partner. Or our office may be the first to suspect it during a dental exam because of the apparent signs of change to muscles, joints and teeth especially abnormal tooth wear.
What can be done about teeth grinding or bruxing? If you are symptomatic, having pain, muscle, joint or tooth soreness, the first step is to get you comfortable. Generally, a mild non-steroidal anti-inflammatory medication (aspirin, ibuprofen) and muscle relaxants will help in addition to moist heat and mild jaw exercises. Stress management is also helpful. To prevent further damage, we may recommend a bite guard made of wear-resistant plastic that fits over the biting surfaces of your upper teeth. These customized unobtrusive appliances when properly fitted and adjusted stop clenching and grinding activity, or at least the damage they can do. A bite guard can be worn day or night especially during stressful periods.
Do you clench your jaw or grind your teeth? Bite your nails? Chew on pencils or toothpicks? Or, heaven forbid, unscrew hard-to-open bottle caps using your precious pearly whites?
Over time, habits such as these — referred to in dentistry as “parafunctional” (para – outside; functional – normal) or beyond the range of what nature intended — can inflict excessive wear and tear on your teeth. Besides the impact damaged teeth can have on your smile, so called “tooth to tooth” and “tooth to foreign object” behaviors can cause physical problems, such as jaw joint and muscle pain, headaches, earaches, and even neck and back pain.
Parafunctional behaviors exert an abnormal amount of force on your teeth — up to 10 times the amount used for biting and chewing. Tooth grinding or “bruxism” (from the Greek word brykein – “gnash the teeth”) is particularly detrimental and is commonly seen in individuals who are experiencing a stressful time in their life. Some medications can also trigger it. Since bruxism often occurs while people sleep, it's possible to be unaware of it unless a partner comments (it can be noisy!) or a dental professional points out the tell-tale signs of wear.
To counter the adverse effects of nocturnal tooth grinding our office can create a customized night or occlusal (bite) guard. Typically fashioned from a hard, clear “processed acrylic” (wear-resistant plastic), this type of guard is amazingly inconspicuous. It is made to fit over the biting surfaces of the upper teeth only and is thinner than a dime. When it is worn, the lower teeth easily glide over the upper teeth rather than chomping into and gnashing with them, which minimizes the likelihood of erosion, chipping and uneven or excessive wear of the biting surface of the teeth. The guard is so unobtrusive, that some people even wear it as they go about their daily activities.
Remember: In addition to proper dental hygiene, you can help keep your teeth healthy by using them wisely!
If you would like more information about parafunctional habits like bruxism and ways to protect your teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Stress & Tooth Habits” and “How And Why Teeth Wear.”
You use toothpaste every day — don't you? But how much do you really know about what's inside the tube: namely, the white, sticky stuff that keeps your teeth clean and your breath fresh? Take this True/False quiz and find out!
True of false: Powdered charcoal, brick dust and crushed bones were once ingredients in toothpaste. TRUE
Many years ago, these gritty abrasive materials were used to make toothpaste. Today, abrasives are still used — but they're much gentler. Compounds like hydrated silica or alumina, calcium carbonate, and dicalcium phosphate have proven effective at cleaning and polishing tooth surfaces without damaging the enamel.
True of false: Fluoride was first introduced into toothpaste in 1955. FALSE
Arguably toothpaste's most important ingredient, fluoride was used as early as 1914. But its mass-marketing debut came with the Crest brand in the mid-1950s. Today, no toothpaste without fluoride can receive the American Dental Association's Seal of Approval. That's because it has been shown to strengthen tooth enamel and help prevent tooth decay.
True of false: Detergent is a common ingredient of toothpaste. TRUE
But it isn't the same kind you do laundry with. Detergents — also called surfactants, because they act on the surfaces of liquids — help to loosen and break down deposits on your teeth, which can then be rinsed away. Like other health and beauty products, many toothpastes use a gentle detergent, derived from coconut or palm kernel oil, called sodium lauryl sulfate.
True of false: Whitening toothpastes work, to some degree, on all stains. FALSE
Whether the whitening agents in toothpaste will work for you depends on why your teeth don't look white in the first place. The abrasives and enzymes in these toothpastes can help remove “extrinsic” stains: those on the surface of your teeth. But for “intrinsic” stains — that is, internal discoloration — they probably won't help. In that case, you may need to get professional bleaching treatments.
True of false: Toothpastes made for sensitive teeth have substances that block pain transmission. TRUE
Potassium nitrate and strontium chloride can block the sensation of pain that may occur when dentin — the material that makes up most of the inside of teeth, and is normally covered by enamel — becomes exposed. Fluoride, too, helps reduce sensitivity. But the benefits of reduced tooth sensitivity may take a few weeks to really be felt.
If you have questions about toothpastes or oral hygiene, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine article “Toothpaste — What's In It?”
Congratulations! In a few months, you're expecting a new baby... but, in the mean time, your body is adjusting to nausea, weight gain, food cravings, and a hundred other changes. Is this really the time to worry about your teeth and gums?
Yes and no — don't worry, but do be aware of a few basic facts about your oral health and your pregnancy, and how they affect each other.
Being pregnant may make your teeth and gums more sensitive. It also puts you at greater risk for some periodontal diseases, like pregnancy gingivitis (“gingival” – gum tissue; “itis” – inflammation of) and benign growths on the gum called “pregnancy tumors.” You may think these problems are just uncomfortable, but you should really have them evaluated as soon as they develop. Why?
Once upon a time, it was believed that periodontal (gum) diseases just affected the mouth. Today, we think these diseases and their associated bacteria may be involved with the whole body, playing a role in cardiovascular ailments, heart attacks, strokes, diabetes, and other illnesses.
What's more, recent studies suggest that these oral bacteria may be able to cross the placenta, stimulating an inflammatory response that may lead to preterm delivery. Babies who are born pre-term often have low birth weight, and are at greater risk for a number of health complications. That's one reason why maintaining good oral health is so important to expectant moms.
So, what should you do? First of all, keep in mind that maintaining your own general and dental health is the best thing you can do for your developing baby. Eat a balanced diet, keep up healthy habits — like limiting sugary between-meal snacks and brushing regularly — and don't put off visiting your dentist to get your dental cleanings. Those cleanings and a thorough evaluation can set your mind at ease and give your baby the best chance at a healthy start.
If you would like more information about pregnancy and oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Pregnancy and Oral Health,” and “Expectant Mothers.”