Do you have that "Long in the tooth look?"

Posted by Dr. Edward Magida | Filed under , , ,

Have you ever seen someone smile and it seems that their teeth are really long? You know what I mean. The teeth look like the teeth of a snarling dog, at least 50% longer than what they should be. Well, before you sign them up with Barnum and Bailey, you should realize that the teeth really haven't grown longer. Rather the gums have shortened. This can happen for many reasons. Because the gums no longer cover the roots of the persons' teeth, like they did years ago, the teeth appear longer. Many people have this condition called "gum recession". When it occurs in the front of the mouth, it can really make a persons smile seem older. When it occurs on the back teeth, it does not have that aging effect, but there are still problems that can develop. When the gums recede and the roots of the teeth are now exposed, the teeth can become more prone to tooth decay, due to the root surface not having any enamel on it. The exposed roots can also become more sensitive to hot and/or cold temperatures more easily.

How do your gums recede?. Healthy gum tissue attaches to the teeth near the bottom of the enamel part of the tooth. The gum tissue completely covers the necks of the teeth. There are certain instances when the gums pull away from the necks of the teeth. This condition is called recession, and it can happen in the following ways:

The most common way is for the gums to actually be worn away, because the person brushes their teeth incorrectly and/or too hard. You should only use a soft toothbrush to clean your teeth. Leave your medium and hard toothbrushes out of your bathroom. Perhaps your tool box is the correct place for them, to help clean your tools. Never use a front to back sawing motion to brush as it could harm the delicate gum tissues.

Gum, or periodontal disease, can also be a cause of gum recession. This disease causes the bone to shrink around the teeth. The gums can also shrink and pull away from the teeth.

Smokers tend to have more gum disease since the smoke causes the gums to not maintain their strength and attachment to the teeth.

Oral jewelry, such as a tongue bar, can rub away the gums from the necks of the teeth.

If you find yourself in the same boat as millions of others, that is with recession, what should be done? Well, many times nothing needs to be done. If the recession is not too bad, you just want to not cause any more recession.. Many times all this means is a change in the way you brush your teeth. Obviously cutting down or eliminating smoking will also help. While you're at it, keep the hardware, meaning your tongue piercings, on the shelf. Metal does not belong in a persons' mouth, period. If you have receding gums and do not have sensitivity to hot, cold or sweet things, that's great. As long as the recession stays in check you do not have to do anything.

However, if temperature and /or sweet things cause pain to your teeth, or if your dentist tells you that you are now starting to get cavities around the necks of the teeth (which used to be covered by the gums), then you might want to do some things.

Using a prescription strength fluoride toothpaste or mouthrinse is one way to combat the pain that develops in the teeth. The fluoride helps to stop the pain caused by temperature. It will also help prevent the occurrence of root cavities, which can happen because the now uncovered roots do not have any enamel protection like the rest of the tooth.

You can also use one of the "desensitizing type" toothpastes that have been formulated to stop the pain and sensitivity from developing.

Lastly, if your recession is rather severe and your teeth look funny because a lot of gum is missing, your dentist might suggest getting a "gum graft". This is a procedure where gum tissue from another part of your mouth is put in the areas where it is missing. Since it is your own tissue it should attach itself in the new area and replace the gum tissue you lost. After a few weeks the gum tissue in the new area blends in with the old gum and your smile looks younger because you are not " so long in the tooth" anymore.

The dentist's role in eating disorder therapy

Posted by Dr. Edward Magida | Filed under , , , , , , , ,

Read any women's magazine these days and sooner or later you will encounter an article about eating disorders. Eating disorders are more widespread than ever and getting worse every year.

Often it is a dentist who is the first health professional to recognize the problem.

Dental complications of anorexia and bulimia vary in complexity depending upon the length and severity of the eating disorder and may include the following:

Enamel erosion, called "perimylolosis," is the most common problem and is caused by chronic exposure of enamel to hydrochloric acid of the purge cycle. The most common area involved are the back surfaces of the upper front teeth, but all teeth can be affected. The front teeth over time may appear shorter because the thin edges wear away first and eventually, even when a person closes their teeth together, the front teeth no longer touch.

Over time, the back teeth may become affected as their cusp tips, the pointy areas that grind the food, become rounded off.

Erosion can be accelerated by excessive toothbrushing, especially right after purging when the enamel has been softened and is more susceptible to mechanical wear.

Cavities, caused by the intake of the high caloric foods during the binge cycle and compounded by eroded and weakened enamel.

Hypersensitivity to hot, cold and sweets due to exposure of the dentin, which is the layer of tooth structure under the enamel that is in direct connection with the nerve of the tooth.

Apparent "eruption" of amalgam (silver) fillings, which happens as the enamel around the fillings erodes and makes the fillings seem to grow out of the tooth.

Salivary abnormalities, inducing enlarged parotid glands and reduced flow of salvia, causing "dry mouth" (xerostomia). If the patient is receiving treatment for depression, antidepressant drugs may exacerbate the problem.

Increased risk of gum disease related to reduced salivary flow, nutritional deficiencies, and trauma to the soft tissue in the mouth.

A patient with an eating disorder must be open and honest when it comes to answering questions about their problems. The dentist must be made aware of the person's medical history, nutritional status, previous dental treatment, extent of the binge/purge cycle and whether the person is currently in therapy, The dentist may request permission to consult with the therapist to discuss dental treatment objective, medications and issues of compliance and progress. As in any such situation, confidentiality is strictly adhered to.

Dental care for the eating disorder patient does not deviate markedly from any other patient, and includes:

Emergency treatment and pain management, thorough tooth cleaning and/or periodontal therapy, basic restorative care to restore tooth function, re-evaluation prior to cosmetic or complex treatment.

Extensive oral rehabilitation and elective cosmetic treatment should be delayed until the eating disorder had been controlled.

Cosmetic bonding, porcelain laminate veneers, porcelain crowns and bridges, as well as orthodontic treatment to correct color contour bite and spacing problems are often a powerful motivating factor in a patient's recovery.

By working closely with the psychotherapist and other members of the health professional team, the dentist can help in the intervention, treatment recovery and continued health of the eating disorder patient.