We’ve come a long way since the early 1980s when we first identified the HIV virus. Although approximately 35 million people worldwide (including a million Americans) now have the virus, many are living relatively long and normal lives thanks to advanced antiretroviral drugs.
Still, HIV patients must remain vigilant about their health, especially their oral health. In fact, problems with the teeth, gums and other oral structures could be a sign the virus has or is moving into the full disease stage, acquired immunodeficiency syndrome (AIDS). That’s why you or a loved one with the virus should maintain regular dental checkups or see your dentist when you notice any oral abnormalities.
One of the most common conditions among HIV-positive patients is a fungal infection called candidiasis (or “thrush”). It may appear first as deep cracks at the corners of the mouth and then appear on the tongue and roof of the mouth as red lesions. The infection may also cause creamy, white patches that leave a reddened or bleeding surface when wiped.
HIV-positive patients may also suffer from reduced salivary flow. Because saliva helps neutralize excess mouth acid after we eat as well as limit bacterial growth, its absence significantly increases the risk of dental disease. One of the most prominent for HIV-positive patients is periodontal (gum) disease, a bacterial infection normally caused by dental plaque.
While gum disease is prevalent among people in general, one particular form is of grave concern to HIV-positive patients. Necrotizing ulcerative periodontitis (NUP) is characterized by spontaneous gum bleeding, ulcerations and a foul odor. The disease itself can cause loosening and eventually loss of teeth, but it’s also notable as a sign of a patient’s deteriorating immune system. The patient should not only undergo dental treatment (including antibiotics), but also see their primary care physician for updates in treating and managing their overall symptoms.
Above all, HIV-positive patients must be extra diligent about oral hygiene, including daily brushing and flossing. Your dentist may also recommend other measures like saliva stimulators or chlorhexidine mouthrinses to reduce the growth of disease-causing bacteria. Together, you should be able to reduce the effects of HIV-induced teeth and gum problems for a healthier mouth and better quality of life.
If you would like more information on oral care for HIV-AIDS patients, 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 “HIV-AIDS & Oral Health.”
If your child begins complaining of tooth pain without an accompanying fever or facial swelling, it’s likely not an emergency. Still, you should have us check it—and the sooner the better if the pain persists or keeps your child up at night. There are a number of possible causes, any of which if untreated could be detrimental to their dental health.
Before coming in, though, you can do a cursory check of your child’s mouth to see if you notice any abnormalities. The most common cause for a toothache is tooth decay, which you might be able to see evidence of in the form of cavities or brown spots on the tooth’s biting surfaces. If you notice swollen or reddened gums around a tooth, this could be a possible sign of a localized area of infection known as an abscess. You should also ask your child if they fell or were hit in the mouth and look for any signs of an injury.
If you don’t see anything unusual, there may be another cause—stuck food like popcorn or candy lodged and exerting painful pressure on the gum tissue or tooth. You may be able to intervene in this case: gently floss around the affected tooth to try to dislodge any food particles. The pain may ease if you’re able to remove any. Even so, if you see abnormalities in the mouth or the pain doesn’t subside, you should definitely plan to come in for an examination.
In the meantime, you can help ease discomfort with a child-appropriate dose of ibuprofen or acetaminophen. An ice pack against the outside jaw may also help, but be careful not to apply ice directly to the skin. And under no circumstances rub aspirin or other painkiller directly on the gums—like ice, these products can burn the skin. If these efforts don’t help you should try to see us the same day or first thing the next morning for advanced treatment.
The main thing is not to panic. Knowing what to look for and when to see us will help ensure your child’s tooth pain will be cared for promptly.
If you would like more information on handling dental issues with your child, 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 “A Child’s Toothache.”
When they’re introducing a new movie, actors often take a moment to pay tribute to the people who helped make it happen — like, you know, their dentists. At least that’s what Charlize Theron did at the premiere of her new spy thriller, Atomic Blonde.
"I just want to take a quick moment to thank my dentists," she told a Los Angeles audience as they waited for the film to roll. "I don’t even know if they’re here, but I just want to say thank you."
Why did the starring actress/producer give a shout-out to her dental team? It seems she trained and fought so hard in the action sequences that she actually cracked two teeth!
“I had severe tooth pain, which I never had in my entire life,” Theron told an interviewer from Variety. At first, she thought it was a cavity — but later, she found out it was more serious: One tooth needed a root canal, and the other had to be extracted and replaced with a dental implant — but first, a bone grafting procedure was needed. “I had to put a donor bone in [the jaw] to heal,” she noted, “and then I had another surgery to put a metal screw in there.”
Although it might sound like the kind of treatment only an action hero would need, bone grafting is now a routine part of many dental implant procedures. The reason is that without a sufficient volume of good-quality bone, implant placement is difficult or impossible. That’s because the screw-like implant must be firmly joined with the jawbone, so it can support the replacement tooth.
Fortunately, dentists have a way to help your body build new bone: A relatively small amount of bone material can be placed in the missing tooth’s socket in a procedure called bone grafting. This may come from your own body or, more likely, it may be processed bone material from a laboratory. The donor material can be from a human, animal or synthetic source, but because of stringent processing techniques, the material is safe for human use. Once it is put in place your body takes over, using the grafted material as a scaffold on which to build new bone cells. If jawbone volume is insufficient for implants, it can often be restored to a viable point in a few months.
Better yet, when grafting material is placed in the tooth socket immediately after extraction, it can keep most of the bone loss from occurring in the first place, enabling an implant to be placed as soon as possible — even before the end of a movie’s shooting schedule.
Will Atomic Blonde prove to be an action-movie classic? Only time will tell. But one thing’s for sure: When Charlize Theron walks down the red carpet, she won’t have to worry about a gap in her smile.
If you have questions about bone grafting or dental implants, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Dental Implant Surgery” and “Immediate Dental Implant.”
While out with friends one evening, you take a bite of ice cream. Suddenly, pain shoots through your teeth. It only lasts a second, but it's enough to ruin your good time.
This could be tooth sensitivity, a painful reaction to hot or cold foods. It often occurs when the enamel in prolonged contact with acid has eroded. Acid is a waste product of bacteria found in plaque, a thin film of food particles that builds up on tooth surfaces due to inadequate brushing and flossing. Enamel normally mutes temperature or pressure sensation to the underlying dentin layer and nerves. Loss of enamel exposes the dentin and nerves to the full brunt of these sensations.
Sensitivity can also happen if your gums have shrunk back (receded) and exposed dentin below the enamel. Although over-aggressive brushing can often cause it, gum recession also happens because of periodontal (gum) disease, a bacterial infection also arising from plaque.
The best way to avoid tooth sensitivity is to prevent enamel erosion or gum recession in the first place. Removing accumulated plaque through daily brushing and flossing is perhaps the most essential part of prevention, along with a nutritious diet low in sugar and regular dental cleanings and checkups.
It's also important to treat any dental disease that does occur despite your best hygiene efforts. Gum disease requires aggressive plaque removal, especially around the roots. While receded gum tissues often rebound after treatment, you may need gum grafting surgery to restore lost tissues if the gums have receded more deeply. For enamel erosion and any resulting decay you may need a filling, root canal treatment or a crown, depending on the depth and volume of structural damage.
While you're being treated you can also gain some relief from ongoing sensitivity by using a toothpaste with potassium nitrate or similar products designed to desensitize the dentin. Fluoride, a known enamel strengthener, has also been shown to reduce sensitivity. We can apply topical fluoride directly to tooth surfaces in the form of gels or varnishes.
Don't suffer through bouts of tooth sensitivity any more than you must. Visit us for a full exam and begin treatment to relieve you of the pain and stress.
If you would like more information on the causes and treatment of tooth sensitivity, 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 “Treatment of Tooth Sensitivity.”
Although distressing to many parents, infants and toddlers sucking their thumb is a common if not universal habit. Most children phase out of it by around age 4, usually with no ill effects. But thumb-sucking continuing into late childhood could prove problematic for a child’s bite.
Thumb sucking is related to how young children swallow. All babies are born with what is called an infantile swallowing pattern, in which they thrust their tongues forward while swallowing to ensure their lips seal around a breast or bottle nipple when they nurse. Thumb-sucking mimics this action, which most experts believe serves as a source of comfort when they’re not nursing.
Around 3 or 4, their swallowing transitions to a permanent adult swallowing pattern: the tip of the tongue now positions itself against the back of the top front teeth (you can notice it yourself when you swallow). This is also when thumb sucking normally fades.
If a child, however, has problems transitioning to an adult pattern, they may continue to thrust their tongue forward and/or prolong their thumb-sucking habit. Either can put undue pressure on the front teeth causing them to move and develop too far forward. This can create what’s known as an open bite: a slight gap still remains between the upper and lower teeth when the jaws are shut rather than the normal overlapping of the upper teeth over the lower.
While we can orthodontically treat an open bite, we can minimize the extent of any treatments if we detect the problem early and intervene with therapies to correct an abnormal swallowing pattern or prolonged thumb sucking. For the former we can assist a child in performing certain exercises that help retrain oral and facial muscles to encourage a proper swallowing pattern. This may also help diminish thumb sucking, but we may in addition need to use positive reinforcement techniques to further discourage the habit.
To stay ahead of possible problems with thumb sucking or the swallowing pattern you should begin regularly taking them to the dentist around their first birthday. It’s also a good idea to have an orthodontic evaluation around age 6 for any emerging bite problems. Taking these positive steps could help you avoid undue concern over this common habit.
If you would like more information on managing your child’s thumb-sucking habit, 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 “How Thumb Sucking Affects the Bite.”
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