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

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.

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.

Orofacial Myofunctional Therapy before and after Laser Frenectomy

What is orofacial myofunctional therapy (OMT)?

·       Orofacial myofunctional therapy (OMT) is a program of specific exercises that target the facial muscles for chewing and swallowing.  These exercises help to strengthen the tongue muscles after the frenectomy procedure. 

Why is orofacial myofunctional therapy necessary before & after laser frenectomy?

·       Karen Wuertz, D.D.S. and Brooke Pettus, COMS are authors of the article published in Laser focus in DSP, fall 2018 wrote, “The removal of oral restrictions is necessary to attain optimal orofacial function and must be combined with regular pre- and post-frenectomy orofacial myofunctional therapy (OMT).”

·       OMT helps re-educate the tongue and orofacial muscles during movement and at rest to create new neuromuscular patterns for proper oral function, including chewing, swallowing, speaking, and breathing. 5,6

5. Guilleminault C. Huang YS, Monteyrol PJ, Sato R, Quo S, Lin CH.  Critical role of myofascial reeducation in pediatric sleep-disordered breathing. Sleep Med. 2013 Jun; 14(6): 518-25.  Doi: 10,1016/j.sleep.2013.01.013.

6. Guimaraes KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2009 May 15;179 (10):962-6. Doi:10.1164/rccm.200806-981OC.

*Case example by Karen Wuertz, D.D.S. & Brooke Pettus, COMS

Patient: 29 year old female

Clinical exam & symptoms:

·       Temporomandibular Disorder (TMD) symptoms with jaw deviation, clicking/popping on the right side

·       Neck pain and frequent headaches

·       Low facial muscle tone, a short upper lip

·       Mouth breathing all night, regular night time drooling, restless sleep

·       Complained of daytime fatigue & never waking well rested

·       Frequent congestion

·       Forward head/neck and forward rolled shoulder posture

·       Tension in the neck and shoulders

·       Tongue thrust during swallowing

·       Dry, chapped lips and the habits of lip licking, cheek biting and clenching

Intraoral examination:

·       Narrow, high palate

·       Tight upper labial frenum and attached gingiva

·       Tongue is short and wide with a tight, restrictive lingual frenum

·       Range of Motion (ROM) was 28mm from tongue tip to incisive papilla

Laser Surgery:

·       CO2 laser frenectomy was performed to release lip and tongue restrictions

·       Patient was asked to lift, extend, and lateralize the tongue

·       ROM was measured at 47mm.  Patient gained 19mm in the ROM with tongue tip to incisive papilla (gum tissue between upper 2 front teeth).

Postoperative care and healing:

·       Almost immediately, patient reported less neck and shoulder tension

·       Could stand up straighter

·       Her airway felt more open when breathing

·       Able to close her mouth without straining on her upper lip

·       Able to elevate the middle and posterior portions of the tongue to the palate

·       800mg ibuprofen was taken twice the day of and once the day after

·       Soft, bland diet for 48 hours

·       Continue orofacial myofunctional therapy (OMT) regimen after the revisions

-OMT helped the patient retrain and re-pattern neuromuscular movements that had been foreign to her and helped her integrate them into her everyday life

Results:

·       Proper oral posture (tongue to palate)

·       Lip (no open mouth posture at rest)

·       Nasal breathing got increasingly easier

·       Better posture, more energy, eats less, feels rested in the morning

·       Sleeps through the night

·       Tongue thrust eliminated

·       No more night time drooling

·       Decreased in clenching and biting the sides of her tongue at night

Summary:

Optimal orofacial functions in adult patients can be achieved through laser lip and tongue frenectomy procedures and regular pre- and post-frenectomy orofacial myofunctional therapy.

*“The Importanace of Orofacial Myfunctional Therapy Before and After CO2 Laser Frenectomy in Achieving Optimal Orofacial Function” by Karen M. Wuertz, DDS, ABCDSM, ABLS, FOM, and Brooke Pettus, RDH, BSDH, COMS

Dr. Anna Lee is a general & cosmetic dentist in Glendora, CA.  Dr. Anna Lee is an experienced provider for laser frenectomy.  If you have any questions about lip and tongue ties, please visit us at www.annaleedds.com or call for a consultation at 626-335-5114.

Adult Lip and Tongue Ties

     

What is lip tie?

Lip tie is a band of thick tissue that connects the underside of the lip to the gums and restricts the normal movements of the lip.

What is tongue tie?

Tongue tie is a band of thick tissue that connects the bottom of the tongue’s tip to the floor of the mouth and restricts the normal movement of the tongue.

What are some of the problems may be caused by tongue and/lip ties?

1.      Airway obstruction

·       In his book, “Tongue Tie,” pediatric dentist, Richard Baxter, D.D.S., discusses that the tongue is held down by a tongue-tie, the tongue often falls backward during sleep and blocks the airway.

·       When the airway is blocked, the body tries to open up the airway by protruding the lower jaw and grinding teeth.  It is a body’s defense mechanism of arousing the person to breathe when the airway is obstructed. (88, 89)

88.  Kostrzewa-Janicka J, Jurkowski P, Zycinska K, Przybylowska D, Mierzwinska-Nastalska E. Sleep-Related Breathing Disorders and Buxism. Adv Exp Med Biol 2015; 873:9-14.

89.  Jokubauskas L, Baltrusaityte  A.  Relationship between obstructive sleep apnoea syndrome and sleep bruxism:  a systematic review. J  Oral Rahabil 2017; 44(2): 144-53

2.      Chewing

·       Tongue tied restricts movement and function of the tongue.

·       Tongue cannot move food from side to side for sufficient chewing, swallowing and complete digestion.

3.      Swallowing

·       The tongue assists in swallowing 1200-2000 times per day.  Tongue tied restricts swallowing which prevents saliva/food to be swallowed normally and may lead to digestive problems.

4.      Cleaning of the Mouth

·       Tongue tied restricts the tongue from lifting and sweeping the food stuck between the cheeks and teeth.  Tongue is restricted and unable to clean the back teeth and the palate.

·       Lip tied can trap food between the lip and the teeth and make it difficult to brush.

5.      Facial development

·       Tongue tied keeps the tongue in a low position, so the palate does not receive its natural resting pressure from the tongue to form a broad and flat palate. Mal-alignment and mal-occlusion of the teeth may occur and affect the facial development of the person

6.      Obstructive Sleep Apnea (OSA)

·       Dr. Baxter’s article, Tongue-Ties and Sleep Issues, published from Dental Sleep Practice in winter 2018 discusses the following:

“A tongue that is held down by a tie is unable to rest in the palate.  The only place left for the tongue to go is backward, which closes off part of the airway.”  Snoring from upper airway resistance can be a warning sign of obstructive sleep apnea (OSA) or sleep disordered breathing.

7.      Speech

·       Movement of the tongue is important for pronunciation of words and linking the words into sentences.

·       Tongue tied restricts the tongue to move freely and reach the palate to sound out letters, words, and phrases

8.      Problems with posture, neck and back pain

Tongue tied may cause the head to tilt low and forward. The poor posture affects the sternocleidomastoid muscle, trapezius muscle and surround muscles and may cause the following problems:

·       Neck and back pain

·       Headaches and migraines

·       Shoulder pain

Note: dental problems caused by lip and tongue ties are discussed in the 2-24-2019 blog

What is frenectomy?

To remove the thick band of tissues that connects to the lip or tongue.

·       Labial frenectomy (aka frenectomy of lip)

·       Lingual frenectomy (aka frenectomy of tongue)

Indications of adult frenectomy

When the lip and/tongue tied is overlooked in an infant, future health problems can occur as an adult.  Lip and/tongue tied may be the cause of one or more of the problems discussed in this blog.  Consult with your dentist or general surgeon (ENT specialist) for evaluation and diagnosis.

How is frenectomy surgical procedure performed?

·       Scissors-bleeding

·       Scalpel or sharp surgical knife-bleeding

·       Laser-minimal bleeding, faster surgical time, decreased postoperative pain, quick healing

How long will the procedure take?

·       The amount of time needed for the frenectomy procedure depends on the technique used.  The entire procedure may be 30 to 60 minutes; includes pre-treatment preparation, post treatment instructions and the actual surgical (incision) procedure may take only a few minutes.

Post treatment care after the frenectomy procedure

·       Pain-relief medication may be needed

·       Salt water rinses for the next 5 days, 2-3 times per day

·       Soft food diets for 3-5 days; avoid hard, crunchy and spicy foods

·       Gentle tooth brushing

·       Follow-up visit

Orofacial Myofunctional Therapy before and after frenectomy

·       Pre- and post-frenectomy orofacial myofunctional therapy (OMT) helps re-educate the tongue and orofacial muscles during movement and at rest to create new neuromuscular patterns for proper oral function, including chewing, swallowing, speaking, and breathing.7

7 Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Cappasso R, Kushida CA. Myofunctional Therapy to Treat Obstructive Sleep Apnea; A Systematic Review and Meta-analysis. Sleep. 2015 May 1; 38(5):669-75. Doi: 10.5665/sleep.4652

If you are suffering from any problems related to lip and/tongue ties.  Dr. Anna Lee is here to help you with the diagnosis and treatment. Dr. Anna Lee is a general & cosmetic dentist in Glendora, CA.  Dr. Anna Lee is an experienced provider for Laser lip and tongue tied frenectomy.  If you have any question about lip and tongue tied frenectomy, please visit us at www.annaleedds.com or call for a consultation at 626-335-5114.