Oral and Dental Care for Patients with Thyroid Disease

The thyroid gland manufactures hormones that regulate the body’s metabolism. The most common thyroid problems are involved with the overproduction and underproduction of thyroid hormones. A thyroid gland that produces too much hormone is called hyperthyroidism and not enough production is called hypothyroidism.
There are dental risks treating patients with uncontrolled thyroid disease. Patients with hyperthyroidism can have elevated blood pressure and pulse. It is dangerous to perform dental procedures on patients with elevated blood pressure. Regular communication between the dentist and patients’ physician is important in helping the patients to maintain and control the thyroid disease.
Some effects of Thyroid Disease on Dental Health:

• Dry mouth

▪ decrease saliva production

▪ mouth sores, tooth decay and difficulty swallowing

• Burning Mouth Syndrome (BMS)

▪ middle-aged women or women in menopause develop BMS

▪ burning sensation on the tongue or the lips or the whole mouth

▪ bitter or metallic taste

▪ treatment for thyroid disease can improve the symptoms of BMS

Some Signs and Symptoms of Hypothyroidism on oral and dental health

• Salivary gland enlargement

• Compromised periodontium (gum infection)

• Dysgeusia (distortion of the sense of taste)

• Delayed dental eruption

• Enamel hypoplasia (thin enamel, vulnerable to dental decay)in primary and permanent dentition

• Anterior open bite (upper and lower front teeth don’t touch)

• Xerostomia (dry mouth)

• Mouth breathing

Some Signs and Symptoms of Hyperthyroidism on oral and dental health

• Increased dental decay risk

• Increased periodontal disease risk

• Burning Mouth Syndrome

• Accelerated dental eruption

• Maxillary and mandibular osteoporosis

Recommendations on treating patients with Thyroid Disease

• Regular communication between the dentist and patients physician

• Update the patient’s medical history at every dental visit

▪ patient’s medication (list of medications currently taking)

▪ blood test (thyroid) ordered by the physician

• Take blood pressure at the start and end of the dental treatment

• Patients with elevated blood pressure and pulse

▪ postpone the dental treatment

▪ use local anesthetics without epinephrine

• Patients with dry mouth

▪ xylitol products in toothpaste, mouth rinse, and chewing gum prevent tooth decay and dry mouth

• Review dental home care

• Regular dental checkups

▪ dental exams and cleanings 2 times per year

▪ x-rays as needed

• Remind the patient to follow up with their physicians

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. With proper medical and dental care, symptoms of Thyroid Disease can be monitored, maintained and well-controlled. Please call our office at 626-335-5114      to schedule a dental checkup. 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

Symptoms of Obstructive Sleep Apnea (OSA)

                                            

Are you impacted by symptoms of sleep apnea? 

Here are a list of symptoms that can impact individuals with Obstructive Sleep Apnea 

        Multiple episodes of breathing pauses, lasting for more than 10 seconds at a time (can experience up to 300 episodes per night)

·       Wake up with a choking or gasping for air sensation

·       Loud snoring

·       Wake up with a sore or dry throat in the morning

·       Wake up with morning headaches

·       Daytime sleepiness, lack of energy during the day, sleepy while driving

·       Forgetfulness, mood changes

If you have any of these symptoms, contact Glendora dentist, Dr. Anna Lee, for a free consultation for Sleep Apnea

Positive airway

Positive airway pressure devices are the most widely used treatment for Moderate and Severe Sleep Apnea. They have been endorsed by the American Academy of Sleep Medicine (AASM).  CPAP machine delivers air pressure through a mask placed over the nose during sleep.  With CPAP, the air pressure is greater than that of the surrounding air, and is just enough to keep the upper airway passages open and prevents apnea and snoring.

CPAP is the most common and reliable method of treating sleep apnea, but some people find it cumbersome and uncomfortable. There are different types of masks and it may take some time to find one that fits well, but for some it is just intolerable and it is for those patients that we have the answer.

CPAP treatment may also cause side effects in some patients.  These side effects include a dry or stuffy nose, irritated skin on the face, dry mouth and headaches.  If CPAP is not adjusted properly, patients may get stomach bloating and discomfort while wearing the mask.

Dr. Anna Lee, a dentist trained in sleep apnea, can assist you with treatment by determining if you are a candidate for an oral dental device and then creating your custom appliance for therapy.  Dr. Lee conducts a full evaluation of your teeth, mouth, and temporomandibular joint (TMJ) to ensure that your teeth and jaw structure are healthy enough to wear an oral appliance. Following the examination, you will have models of your teeth made and a follow-up appointment is scheduled to fit your custom appliance.                 

Call Dr. Anna Lee at 626-335-5114 for more information.