Oral and dental care for patients with Parkinson’s Disease

Parkinson’s disease is a movement disorder that affects the motor functions, balance, coordination and the ability to perform common daily activities. Parkinson’s disease occurs when nerve cells in the area of the brain that controls movement become impaired and/or died. The symptoms of Parkinson’s disease begin gradual and get worse over time. Symptoms may include tremor, stiffness of the limbs, slowness of movement, impaired balance, difficulty swallowing, chewing and others. Maintaining good oral and dental care is a challenge for people with Parkinson’s disease. 

Most people with Parkinson’s disease are about age 60, but there is 5-10% of people have the disease before the age of 50. Both men and women can have Parkinson’s disease. There is no medical test to detect the disease, so it can be difficult to diagnose accurately. 

Parkinson’s disease (PD) symptoms can affect the mouth; teeth, gums, and the jaw.     

      Some symptoms can cause oral and dental health problems

• Tremor-make it hard for the hand to brush and floss the teeth
• Drooling (excessive saliva)-can cause fungal infection at the corners of the mouth. 
• Dysphagia (difficulty swallowing)-can cause choking during a dental procedure
• Dry mouth increases the risk of dental decay

Tips to maintain oral and dental health

• Use electric toothbrushes-they are easier to hold and have a rotating head that can assist in finer movements associated with tooth brushing
• Toothbrushes with a bigger grip are easier to hold (adaptive grip aids to make tooth brushing easier)
• Brush right after every meal
• Avoid mouthwashes-can be a choking hazard
• Stay hydrated
• Avoid products that include alcohol (make dry mouth conditions worse)
• Eat and drink in an upright position
• Take small bites and sips
• Avoid talking when eating
• After eating a meal or snack, check the inside of the cheeks for any food pocketing (avoid bacteria staying in the mouth)
• Visit your dentist regularly (at least once every 6 months)

Tips to improve dental visits

• Inform the dental office of your Parkinson’s disease symptoms. This will help the dentist and staff provide better treatment
• Schedule short dental appointments
• Plan and schedule dental appointments about 60 to 90 minutes after taking medication
• Review the details of your overall health and the medications you take with the dentist & staff
• Ask the dentist to adjust the dental chair that is comfortable for you
• Consider replacing broken old fillings, crowns and bridges, and ill-fitting dentures during the early stages of Parkinson’s disease. Dental visits may become more difficult as Parkinson’s disease progresses.

An estimated 1 million Americans are living with Parkinson’s disease. There are ongoing researches on Parkinson’s disease. Currently, there is no cure. It is possible to have a good to a great quality of life living with Parkinson’s disease. Working with your medical doctor and following recommended therapies are important in successfully treating the symptoms.

Seeing your dentist regularly will help to maintain your oral and dental health. Dr. Lee is a general & cosmetic dentist in Glendora, CA. She is experienced in all phases of dentistry. She treats patients of all ages. With proper medical and dental care, symptoms of Parkinson’s disease can be treated and controlled. Call our office for a dental exam at 626-335-5114 or visit us at www.annaleedds.com

Why should you clean your tongue?

A good oral care regimen consists of brushing your teeth twice a day with fluoride toothpaste and floss daily. Brushing your tongue is also very important as part of your daily dental care regimen. The American Dental Association (ADA) suggests the use of tongue cleaners to scrape away excess plaque and odor-causing bacteria on the tongue after brushing your teeth. 

Why should you clean your tongue?

The tongue has a rough surface that is full of peaks and troughs that are the perfect place to harbor plaque and odor-causing bacteria. Bacteria on the tongue can easily transfer to the teeth and cause damage as well as creating bad breath. Excess plaque and odor-causing bacteria on the tongue is one of the leading causes of bad breath. 

How to clean your tongue?

• Use of a toothbrush brushing the tongue is about removing the bacteria at both the front and the back of the tongue
• Put a small amount of toothpaste on the toothbrush bristle, start at the back of the tongue and work forward toward the tip of the tongue
• Brush the entire top surface of the tongue 
• Use gentle pressure. Stop if it irritates the tongue
• Rinse your mouth with water and mouth wash
• Clean the toothbrush after cleaning the tongue

*some toothbrushes have a built-in tongue cleaner on the back of the brush head.

1. Tongue scraper-it is made of soft, flexible plastic and it gently peels the thin mucus based layer of debris from the tongue

• Rinse the tongue scraper under clean water (moist)
• Stick your tongue out
• Begin gently scraping your tongue from the back of the tongue towards the tip of the tongue with gentle pressure
• Rinse the tongue scraper after each use to remove the bacteria
• Rinse your mouth with water and mouth wash

How often to clean your tongue?

• Each time you brush and floss your teeth 
• At a minimum, clean your tongue in the morning and the evening before bedtime
• Clean your tongue if you have dry mouth or notice a foul taste in the mouth

Benefits of cleaning your tongue

• A clean tongue can also improve your sense of taste. Bacteria and food debris can coat the tongue after eating, which can clog the taste buds and leave a metallic taste in your mouth. A study published in the Journal of Clinical Periodontology found that cleaning away the bacteria on the tongue improves the taste sensation. 
• According to the National Institutes of Health, cleaning the tongue with a tongue scraper reduces the foul-smelling volatile sulfur compounds on the tongue that cause bad breath.

Dr. Anna Lee is a general & cosmetic dentist in Glendora, CA. She is experienced in all phases of dentistry. She treats patients of all ages. If you have bad breath, don’t’ wait and call our office for a dental and oral evaluation. With proper dental care, you can enjoy fresh breath and good oral health.  Call our office at 626-335-5114 or visit us at www.annaleedds.com

Dental and oral care for Diabetic Patients

An estimated 30.3 million Americans live with diagnosed diabetes. Approximately 1.7 million new cases are diagnosed each year and 8.1 million people live with diabetes and don’t even know they have it. Having good oral and dental care is essential for patients with diabetes. Research suggests people with diabetes are at higher risks of oral and dental problems, such as periodontal disease, oral infections, tooth decay, delayed healing of oral sores, and other problems. Medically, patients with diabetes are at higher risks of problems with the eyes, nerves, kidney, heart and other parts of the body.

What is diabetes?  Diabetes affects the body’s ability to process sugar. 

• Type 1 diabetes is a chronic condition in which the pancreas produces little or no insulin. Insulin is a hormone needed to allow sugar (glucose) to enter cells to produce energy.
• Type 2 diabetes is the most common type of diabetes and it is a disease that occurs when your blood glucose (blood sugar) is too high. 

Symptoms of untreated diabetes affect oral and dental health

• Dry mouth (less production of saliva)
• Higher risk of dental decay due to less saliva in the mouth
• Inflamed and bleeding gums
• Problems of tasting foods
• Delayed wound healing in the mouth
• Susceptible to infections inside of the mouth

Periodontal disease and diabetes

Periodontal disease is the most common dental disease affecting patients with diabetes. Diabetic patients have poor blood sugar control, and it causes the patients to be more susceptible to oral infections and gum diseases.

*July 2013 issue of JADA (Journal of American Dental Association) wrote findings on the latest research into how gum disease could affect diabetes. 

They found that, compared with those with healthy gums, people with severe gum disease:

• Have higher long-term blood sugar levels (A1c);
• Might be at a higher risk of developing type 2 diabetes;
• Maybe at a higher risk of developing pregnancy diabetes;
• Have a harder time controlling their type 2 diabetes;
• Are at a higher risk of experiencing harm to eyes and kidney, as well as heart attack and stroke if they have diabetes

*JADA 144 (7) http://jada.ada.org July 2013

 Diabetes and oral health issues

• According to the American Diabetes Association, diabetic patients are more likely to suffer from dry mouth and/ or to develop a fungal infection in the mouth
• Dry mouth can be a side effect of medications patients take to control diabetes. Dry mouth increases the chance of developing oral infection and/ or dental decay
• High blood sugar levels and high sugar levels in the saliva create an ideal environment for plaque to grow. Excess plaque increases the risks of oral infection and periodontal disease 
• inflammation, sensitivity, and irritation along the gums 
• taste buds do not work as well
• wounds or mouth sores may have delayed healing

Dental health care/Dental considerations for people with diabetes

• Best time to receive dental care is morning appointment because blood glucose levels tend to be under better control at this time of the day
• Dental procedures should be as short and as stress-free as possible
• Dentists and staff are trained to work with diabetic patients. The dental office should have a protocol for managing diabetic patients
• Coordination with the patient’s physician may be needed to determine the patient’s health status and determine whether the dental treatment can be safely and effectively performed
• Elective dental treatment may need to be delayed until the diabetes is considered stable
• Review the patient’s medical history, medications, take vital signs, and oral evaluation

Recommendation of dental treatment for diabetic patients

• Oral examination and teeth cleaning 2x/year. Your dentist may recommend more than 2 cleanings per year depending upon your periodontal condition
• Patients with diabetes may benefit from periodontal therapy (scaling and root planning) in conjunction with good oral health maintenance at home

Everyday dental care tips

• Keep blood sugar as close to normal as possible
• Reduce sugars and starches from your diet, eat healthy foods and exercise regularly
• If you have dry mouth, try a mouthwash without alcohol
• Brush your teeth at least 2x/day. Brush your teeth after every meal. Wait at least 30 minutes after eating before brushing to protect any tooth enamel that’s been softened by the acid in the food
• Use a toothbrush with soft bristles. Use fluoridated toothpaste.
• Floss at least once a day 
• Rinse daily with an antiseptic mouth wash
• Treat dental infections immediately. 
• Provide your medical and oral health history to both your medical and dental care providers
• Quit smoking

Medical complications of Patients with Diabetes

Diabetic patients with elevated levels of blood glucose (blood sugar) can increase the incidence and severity of complications such as heart disease, stroke, kidney disease, blindness, amputations, and other medical problems. 

Dr. Anna Lee is a general & cosmetic dentist in Glendora, CA. She is experienced in all phases of dentistry. She treats patients of all ages. If you are pre-diabetic or have been diagnosed with diabetes, don’t wait and call our office for a dental and oral evaluation. With proper medical and dental care, both diabetes and periodontal disease can be treated and be well under control. Call our office at 626-335-5114 or visit us at www.annaleedds.com

Oral Health for Older Patients

The demographic of older adults, 65 years of age and older is growing and likely will be an increasingly large part of many dental practices in the coming years. People are living longer; the average life expectancy for Americans is 78.7 years.  Many older patients take prescription medications for their medical conditions.  People want to save their teeth as long as they can to improve and sustain the quality of their life. 

Oral health impacts the health of the rest of the body and it is true that the condition of the health also impacts your oral health.

Here are some reasons that older patients’ dental care is so important:

Heart Disease

·       Studies have shown that maintaining good oral hygiene is a powerful weapon against heart attacks, strokes, other heart disease conditions

·       According to the American Academy of Periodontology (AAP), patients with periodontal disease are twice (2x) more likely to have heart disease

Diabetes

·       According to the American Diabetes Association, diabetes occurs when the body’s blood glucose exceeds normal level

·       Type 2 Diabetes is more common in older adults

·       Type 2 diabetics are at greater risk for periodontal disease.  High blood sugar can lead to gum infection and tooth loss

Dry Mouth-lack of production of saliva in the mouth

·       Dry mouth can be a side effect of taking prescription and over the counter medications

·       Dry mouth can be a side effect of cancer treatment that use radiation to the head and neck area

·       Tooth and root decay are common with dry mouth condition

·       Gum infection and periodontal disease

Gum Disease

·       Gum tissues surrounding teeth become infected due to build up of plaque

·       Gum disease is one of the reasons people have tooth loss

·       Studies show that 68% of those 65 years or older Americans have periodontal disease. It can destroy gums, bone, and ligaments that support teeth

·       Gum disease may be related to the cause of some health problems; heart disease, diabetes, pneumonia, and other health issues

Denture-Induced Stomatitis

·       Inflammation of the gum tissues under an ill-fitting denture

·       Inflammation of the gum tissues due to poor oral hygiene

Some Dental Health Risks in Older Patients

·       Tooth Decay-according to the Center for Disease Control (CDC), about 96% of the adults aged 65 and older have had at least one cavity previously.  About 20% currently have untreated tooth decay.

·       Root decay- gum tissues recede and root surfaces become exposed and susceptible to root decay and may lead to tooth loss

·       Dry Mouth-reduced saliva production in the mouth may be caused by medications as well as cancer treatment that use radiation to the heads and neck areas.  Dry mouth increases tooth and root decay

·       Gum Disease-Untreated gum disease (inflammation of gum tissue and bone loss) would lead to tooth loss

Here are some expert tips from the American Dental Association that are good guideline to follow:

·       Brush 2x per day with a toothbrush, use fluoride-containing toothpaste and floss daily

·       Rinse with an antiseptic mouthwash once or twice per day

·       If you wear full or partial dentures, remember to clean them daily

·       Take the dentures out of the mouth for at least 4 hours every day, and it is best to remove them at night

·       Drink water-it helps to prevent tooth decay

·       Quit smoking-increases problems with gum disease, tooth decay and tooth loss

·       Visit the dentist on a regular schedule, every 6 months, for a complete dental check-up, cleaning and oral exam

·       Eat a healthy, well-balanced diet

Dr. Anna Lee is a general & cosmetic dentist in Glendora, CA.  She is experienced in all phases of dentistry.  She treats patients of all ages.  If you have not had a dental check up for a while, it is time to call for a dental examination now.   Call our office at 626-335-5114 for a dental appointment or visit us at www.annaleedds.com

What is Vaping?

    

Vaping means smoking an e-cigarette.  E-cigarettes are battery-powered devices that deliver cigarettes electronically and in an array of flavors and vapors.  The 3 most common ingredients in e-cigarettes are propylene glycol, vegetable glycerin, and nicotine.  These are harmful ingredients that may cause harm to your health and your dental health.  Center of Disease Control (CDC) reports that there is an increase of e-cigarette use, especially among kids; an increase of 78% among high school students and an increase of 49% among the middle school students between 2017 and 2018.  This is a big concern and more studies are needed to find out the effects of long term exposure to e-cigarettes.

Health risks of Vaping
Nicotine is delivered through vaping.  Nicotine is an addictive substance that is also a carcinogen, and it is known to cause cancer.  Nicotine can cause tumor growth in the following:
Lung cancer
Gastrointestinal cancer
Pancreatic cancer
Breast cancer
Some early studies show data that vaping may cause bodily harm:
Impacts the health of the lungs and DNA
Damages the blood cells
Increases the risk of heart disease
Weakens the immune system
Dental health risks of Vaping
The 3 most common ingredients in e-cigarettes are propylene glycol, vegetable glycerin, and nicotine.
Oral tissues exposed to a mixture of propylene glycol and flavoring ingredients in e-cigarettes can lead to dry mouth.
Research shows when teeth are exposed to a mix of vegetable glycerin and flavoring ingredients, teeth have four times more bacteria than teeth that have not been exposed to e-cigarettes.
Vaping can cause deterioration of tooth enamel, cavities, periodontal disease, gum recession, tooth loss, and other dental health problems.
White spots on the teeth-these are decalcifications that show the beginning of enamel softening
Red or white patches on the gums or the inside of the cheek.  They can be precancerous cells and sometimes they do become cancer cells.
Oral thrush-white patches on the tongue or mouth or redness inside the mouth. This can be a sign of thrush.

Vaping increases the risk of periodontal disease. These are some of the symptoms to look out for:
Ongoing bad breath (halitosis)
Red, puffy, bleeding gums
Receding gums
Tender or swollen gums
Teeth mobility

Minimize the risk of developing dental problems
Stop vaping
Brush with fluoridated toothpaste at least twice per day.  Wait 20 minutes before brushing your teeth after vaping
Floss daily
Avoid dry mouth, drink water often.  Use a moisturizing mouth spray containing xylitol, which helps to stimulate saliva production.
See the dentist every 4 to 6 months for check-up and cleaning.
Researches

The increased number of people vaping as an alternative to traditional cigarette smoking is a growing concern.  More studies are being done now to find out the health and dental health risks of vaping.     Food and Drug Administration (FDA) asked the National Academies of Sciences, Engineering, and Medicine (NASEM) to report on the potential public health consequences of vaping. NASEM researchers were unable to find any link between e-cigarette use and periodontal disease.  They provided limited evidence that e-cigarette aerosol can cause cell damage in oral tissue.
More researches are needed to find out the long term health and dental health impacts of vaping and e-cigarettes. 

Dr. Anna Lee is a general & cosmetic dentist in Glendora, CA.  She is experienced in all phases of dentistry.  She treats patients of all ages.  If you notice any of the symptoms of periodontal disease, call our office for a dental checkup.  Call our office at 626-335-5114 for a dental appointment or visit us at www.annaleedds.com.

What is Burning Mouth Syndrome (BMS)?

                         

Burning mouth syndrome (BMS) is known as "burning tongue (or lips) syndrome."  It is a chronic dental condition that is often described as a burning sensation felt on the tongue, lips, cheeks, the roof of the mouth and the back of the mouth or throat.  For some patients, the discomfort is constant that lasts for months or years, while others may suffer from occasional discomfort.  The intensity of discomfort varies from person to person because the syndrome affects everyone differently.  BMS affects both men and women, but it seems to be more common in women during or after menopause.

The exact cause of BMS is unclear and is still being researched.  Dentists and physicians work together may recommend medications and treatment plans to provide relief of symptoms.
Signs & symptoms of BMS
Burning sensation on the tongue, lips, cheeks, the roof of the mouth, back of the mouth or throat
Dry or sore mouth
Tingling or numb sensation throughout the mouth and tongue
A bitter or metallic taste
Causes of BMS

The possible causes of BMS are many and complex.  Many patients have multiple causes.
Dry mouth
-use of certain medications for treating high blood pressure, Sjogren's syndrome (an autoimmune disease), antidepressants and other medications may cause dry mouth
Oral conditions
-oral yeast infection (thrush) is a common cause of a burning mouth
-geographic tongue causes dry mouth, sore, patchy tongue
Irritating dentures
-materials used to fabricate dentures may cause allergy reaction in some patients
-dentures may place stress on some muscles and tissues of the mouth
Oral habits
-tongue thrusting
-teeth grinding (bruxism) can irritate the mouth
-excessive brushing of the tongue
-allergic reactions to the ingredients in the toothpaste or mouthwash

Other medical and health conditions have been linked to burning mouth syndrome:
Nutritional deficiency-vitamin B, iron, zinc
Endocrine disorders-diabetes, hypothyroidism
Hormonal imbalances in women during and after menopause
Reflux of stomach acid (gastroesophageal reflux disease)-the sour or bitter-tasting fluid that enters the mouth from the upper gastrointestinal (GI) tract may cause irritation and pain in the mouth
Neuropathy-damage to nerves that control taste and pain in the tongue may cause a burning sensation in the mouth
Allergy-allergic reactions to foods, food flavorings, food additives, dyes or other substances
Psychological problems-depression and anxiety may contribute to the development of BMS
Treatment of burning mouth syndrome
Identifying all the causes is important for the dentist and physician to develop a treatment plan to treat the patient.
Dry mouth-the dentist may advise that you drink more fluids or may suggest saliva replacement products
Oral thrush-treat with oral antifungal medications
Irritating dentures-polish sharp edges of broken partials/dentures, replace broken teeth and make sure the dentures fit well in the mouth
Oral habits-wear a night guard for teeth grinding at night
Eliminate the use of mouthwash, tobacco, acidic liquids (fruit juice), soda, coffee for 2 WEEKS, and see if there is any improvement.

If the dentist determines that no oral conditions are causing the burning sensation in the mouth, consult with the physician.  The physician may order blood tests to look for other medical and health conditions that may be the cause of the burning sensation.
Helpful Tips to soothe the burning sensation
Chew sugarless gum
Sip water or suck on ice chips
Avoid alcohol, tobacco products, smoking cigarettes
Avoid hot or spicy foods
Avoid acidic foods (citrus foods and juices)

Dr. Anna Lee is a general & cosmetic dentist in Glendora, CA.  She is experienced in all phases of dentistry.  She treats patients of all ages.  If you have symptoms of Burning Mouth Syndrome, call our office for a dental checkup.  Call our office at 626-335-5114 for a dental appointment or visit us at     www.annaleedds.com.

Is Bad Breath Impacting You?

Bad breath is also known as halitosis. It is described as a foul smell and an unpleasant odor. Bad breath is caused primarily by bacteria and food particles that become trapped in the oral cavity and emit an unpleasant odor. Almost everyone experiences bad breath one time or another, whether it is after a meal filled with onions or morning breath when you get up in the morning. According to Harvard Medical School, 30% of the population struggles with some degree of bad breath daily. Bad breath may result from oral problems and poor dental hygiene habits, medical problems, types of foods we eat, unhealthy lifestyle habits and other factors.

                                                    

    Some Causes of Bad Breath

Oral problems and poor dental hygiene habits

• Poor oral hygiene; not brushing and flossing daily
• Food particles remain in the mouth, promoting bacterial growth between teeth, around the gums and on the tongue
• Bacteria on the tongue
• Odor-causing bacteria and food particles may cause bad breath if dentures are not properly cleaned
• Gum infection caused by periodontal disease
• Infection in the mouth results from the growth of bacteria. Teeth, gums, bone and surrounding tissues of the mouth can all become infected by different groups of bacteria that vary in smell. Many of these bacteria produce a foul smell that alters taste sensation and cause bad breath.
• Yeast infection caused by ill-fitting dentures
• Dental cavities

Medical problems and Bad Breath

• Respiratory tract infections: bronchitis, pneumonia, chronic sinus infection, post nasal drip
• Diabetes
• Chronic acid reflux (GERD)
• Liver or kidney problems
• Dry mouth: saliva is produced to moisten the mouth. It neutralizes acids produced by plaque and wash away dead cells accumulate on the tongue, gums, and cheeks. If not removed, these cells decompose and can cause bad breath.
• Dry mouth may be a side effect of medications
• Dry mouth is caused by salivary gland problems
• Dry mouth is caused by mouth breathing

Types of foods we eat and Bad Breath

• Garlic, onions, spices, and coffee can cause bad breath diet is high in protein and sugar associated with bad breath

Unhealthy lifestyle habits and Bad Breath

• Smoking and use of tobacco products
• Poor oral hygiene habits

Other factors and Bad Breath

• Metabolic disorders can cause a distinctive breath odor as a result of chemicals they produce
• Chronic Acid Reflux (GERD)
•  

                                             Treatment of Bad Breath

The American Dental Association (ADA) recommends the followings:

• Brush 2x/day with a fluoride-containing toothpaste
• Floss between teeth daily 
• Use an antibacterial mouth rinse
• Brush the tongue to remove bacteria that contribute to oral odors (especially in the back of the tongue)
• Remove dentures or removable dentures at night and brush them with a denture cleanser before replacing them the next morning
• Chew sugar-free gum or suck on sugar-free candies to stimulate salivary flow
• Talk to your dentist about your concerns:
• A thorough health history
• List of medications and supplements you are taking
• Determine the cause of bad breath: oral cause or medical cause
•  

                                    Some Prevention of Bad Breath

• Practice good oral hygiene: brush 2x/day, floss daily, use an antibacterial mouth rinse, clean the tongue
• Drink sufficient amount of water daily (6 to 8-ounce glasses)
• Chew sugarless gum can stimulate saliva production
• Quit smoking and avoid tobacco products
• Adjust the diet: onions, garlic, spices, sugary foods, protein, and coffee can cause bad breath
• Regular dental visit and dental cleaning with your dentist and dental hygienist
•  

In most cases, your dentist can treat the cause of bad breath. If your dentist determines that bad breath is not caused by oral problems, you may be referred to your physician to determine the odor source and treatment. 

Dr. Anna Lee is a general & cosmetic dentist in Glendora, CA. She is experienced in all phases of dentistry. She treats patients of all ages. If you notice that you have bad breath, don’t hesitate to call for a dental examination. Bad breath problems can be treated, so you can smile, talk and get close to your loved ones with confidence without being embarrassed about your breath. Call our office at 626-335-5114 or visit us at www.annaleedds.com.