Today I’d like to look at a few disorders which are chronic and can cause a variety of pains or disabilities. 

Oral, dental, or craniofacial signs and symptoms play a critical role in autoimmune disorders such as Sjögren’s syndrome and in a number of similar conditions.

Sjögren’s syndrome is one of several autoimmune disorders in which the body’s own cells and tissues are mistakenly targeted for destruction by the immune system and is more prevalent among women.

The disease occurs in two forms: Primary Sjögren’s involves the salivary and lachrymal (tear) glands; Secondary Sjögren’s, where the glandular involvement is accompanied by the development of a connective tissue or collagen disease.

The glandular involvement causes a marked reduction in fluid secretion, resulting in xerostomia and xerophthalmia (dry eyes) and constant oral dryness that causes difficulty in speaking, chewing, and swallowing. There is currently no cure for Sjögren’s.

Clinically, the reduction in salivary flow changes the bacterial flora, which, in addition to the reduction in salivary protective components, increases the risk of caries and candidiasis.

Recent studies have indicated there is a reduction in masticatory function and an increased prevalence of periodontal disease.

In advanced stages the salivary glands may swell because of obstruction and infection or lymphatic infiltration.

Acute and Chronic Oral-Facial Pain

Since the nineteenth century, when two dentists, Horace Wells and Frederick Morton, demonstrated the analgesic powers of nitrous oxide and ether, oral health investigators have been recognized leaders in the field of pain management worldwide.

Their analyses of the cells, pathways, and molecules involved in the transmission of pain have given rise to a growing variety of medications, often combined with other approaches, which can control acute and chronic pain.

Atypical Facial Pain

Atypical facial pain is characterized by a continuous dull ache on one or both sides, most frequently in the region of the maxilla (the upper jaw).

The pain tends to be episodic and is aggravated by fatigue, worry, or emotional upset.

Tic Douloureux

The most frequently encountered of oral facial neuralgias is tic douloureux, or trigeminal neuralgia, a disease of unknown aetiology, affecting one, two, or all three branches of the trigeminal nerve.

The pain is highly intense, of a stabbing nature that lasts for a few seconds.

Temporomandibular Disorders

Various etiological factors, including trauma, can give rise to pain and dysfunction in the temporomandibular joint and surrounding muscles, conditions collectively called temporomandibular disorders (TMDs).

The pain may be localized or radiate to the teeth, head, ears, neck, and shoulders. Abnormal grating, clicking, or crackling sounds, known as crepitus, in the joint often accompany localized pain.

Pain is also found in response to clinical palpation of the affected structures.

I welcome anyone with firsthand experience of dealing with these disorders to get in touch and discuss how they’ve handled them in their dental practice.

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The wonders of modern medicine allow a huge variety of physical ails to be treated, and managed, which otherwise would severely limit quality of life.

Medicinal intervention comes at a cost though, in the form of side effects. These side effects don’t stop in the mouth.

For this reason today I’ll be discussing drug induced oral disorders:

Anticonvulsants, calcium channel blocking agents, and cyclosporine may all be associated with gingival enlargement. Oral contraceptives may also be a contributing factor in alterations of gingival tissues.

Treatment considerations for patients affected by drug-induced periodontal disease may include:

1.  Consultation with patient’s physician as necessary.

2.  When possible, baseline periodontal evaluation prior to initiation or modification of drug therapy.

3.  Modification of the drug regimen prescribed in consultation with the physician if gingival enlargement or other adverse drug reactions or side effects occur.

4.  Surgery as necessary to eliminate gingival enlargement. Patients should be informed that gingival enlargement may recur if drug therapy can not be modified or if adequate plaque control is not achieved and maintained.

I’d also like to mention hematologic disorders and leukemia:

Hemorrhagic gingival enlargement with or without necrosis is a common early manifestation of acute leukaemia.

Patients with chronic leukaemia may experience similar but less severe periodontal changes.

Chemotherapy or therapy associated with bone marrow transplantation may also adversely affect the gingiva, and considerations for patients with hematologic disorders and periodontal disease should include:

1.  Coordination of treatment with the patient’s physician.

2.  Minimization of sites of periodontal infection by means of appropriate periodontal therapy prior to the treatment of leukaemia and/or transplantation.

3.  Avoidance of elective periodontal therapy during periods of exacerbation of the malignancy or during active phases of chemotherapy.

4.  Consideration of antimicrobial therapy for emergency periodontal treatment when granulocyte counts are low.

5.  Monitoring for evidence of host-versus-graft disease and of drug-induced gingival overgrowth following bone marrow transplantation.

6.  Periodontal therapy, including surgery, for patients with stable, chronic leukaemia.

If you treat patients experiencing any of the symptoms mentioned in this article, Biterite would love to hear from you.

Feel free to leave a comment here or find me on social media:

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A patient managing their diabetes properly presents a much reduced risk to their own dental health

Dentists will be no stranger to how to a systemic condition can affect a patient’s overall health, and they may be familiar with how it can affect their oral health too.

Today I’m going to talk about the unique challenges presented by a patient with diabetes mellitus.

Type 1 (insulin dependent) and Type 2 (non-insulin dependent) diabetes mellitus 

Patients with undiagnosed or poorly-controlled diabetes mellitus have particular susceptibility to periodontal diseases.

On the other hand, most well-controlled diabetic patients can maintain periodontal health and should respond favourably to periodontal therapy.

Treatment considerations for patients with periodontitis associated with diabetes should include:

1.  Identification of signs and symptoms of undiagnosed or poorly controlled diabetes.

2.  Consultation with the patient’s physician as necessary.

3.  Consideration of diagnosis and duration of diabetes; level of glycemic control; medications and treatment history.

4.  Consideration of adjunctive systemic antibiotics for periodontal procedures if the diabetes is poorly controlled.

5.  Preparation to diagnose and manage medical emergencies associated with diabetes.

It’s also worth mentioning, while we’re on the subject of systemic conditions affecting the mouth, pregnancy.

Hormonal fluctuations in the female patient may alter the status of periodontal health. Such changes may occur during puberty, the menstrual cycle, pregnancy, or menopause.

Changes may also occur with the use of oral contraceptives.

The most pronounced periodontal changes occur during pregnancy and treatment considerations for pregnant patients with periodontal disease include:

1.  Consultation with the patient’s physician as necessary.

2.  Consideration of postponement of periodontal treatment during the first trimester.

3.  Performance of emergency periodontal treatment at any time during pregnancy.

4.  Consideration of deferral of periodontal surgery until after parturition.

5.  Performance of periodontal maintenance as needed.

6.  Administration of antibiotics and other drugs with caution.

7.  Use of local anaesthesia in preference to general anaesthesia or conscious sedation.

If you treat patients experiencing either of these conditions, I welcome your response to this article.

Feel free to leave a comment here or find me on social media:

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In my dedication to discussing and expanding the horizons of dental discussion, today I’d like to talk about more systemic conditions.

It’s a fact a significant portion of the population must deal with a systemic condition, and their access to dental care is as valuable as those without.

A comprehensive periodontal evaluation of your patient should be performed with regard to conditions suggestive of systemic disorders, such as:

Physical disabilities;

• Signs or symptoms of xerostomia, mucocutaneous lesions, gingival overgrowth, excessive gingival haemorrhage, or other indicators of undetected or poorly-controlled systemic disease;
• Therapeutic drug use;
• Signs or symptoms of smoking, chemical dependency, and other addictive habits;
• History of recent or chronic diseases;
• Evidence of psychological/emotional factors;
• History of familial systemic disease.

You should also request laboratory tests as appropriate and, when warranted, referral to or consultation with other health care providers should be made.

Your therapeutic goal should be to achieve a degree of periodontal health consistent with the patient’s overall health status.

Treatment outcome in the patient with contributing systemic factors may be directly affected by the control of the systemic condition.

The systemic and psychological status of the patient should be identified to reduce medical risks that may compromise or alter the periodontal treatment.

A patient with systemic conditions that contribute to progression of periodontal diseases can successfully be treated utilizing well-established periodontal treatment techniques.

You should be aware, though, the systemic/psychological status of your patient may cause a change of the therapy planned and may also have an adverse affect on the treatment outcomes.

As ever, I welcome any discussion on this topic. Feel free to leave a comment here, or get in touch on social media:

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Recently, while discussing implant treatment assessment and procedures, we looked at a problematic female patient.

Today, let’s look at a 45 year old man with a maxillary fixed partial denture which is failing. The patient expresses a desire to have a new prosthesis in the same manner as the original, but with “more teeth showing.”

A semi-professional singer, he is quite concerned about the aesthetic and phonetic outcome.

He will not tolerate a removable prosthesis, but wants a prosthetic design which closely simulates his natural teeth.

Diagnostic examination revealed that the four remaining maxillary teeth are salvageable and can be incorporated into the new prosthesis.
Although it was possible to construct a fixed partial denture on the remaining teeth, it was explained this was inadvisable with regard to long term prognosis, especially with increased tooth length.

Use of dental implants in conjunction with the remaining teeth was discussed. Available bone seemed adequate in the anterior region, but questionable in the posterior region due to the presence of large maxillary sinuses.

The mandibular fixed partial denture extends to the area of the second bicuspids, so molar occlusion was not necessary. All other factors were positive.
Implants in the anterior edentulous spaces, as well as in the posterior maxilla distal to the natural abutments were proposed. A prosthesis supported by natural abutments, as well as implant abutments, was ultimately chosen.

Contingencies and alternative treatments were discussed, and the patient elected to follow the proposed treatment plan.

The surgical phase proceeded with the placement of five implant fixtures. Six months after placement, all five implants were found to be integrated. The prosthodontic phase was completed over a three month period.

The patient was pleased with the appearance of longer teeth, and the resulting phonetics.

Biterite has a huge variety of implants available to your practice. If you’d like to discuss the possibilities for your patients, feel free to get in touch. Leave a comment here, or find me on social media:

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A face you might see while discussing implant materials and placement with a patient!

There has been much written about factors influencing the long term success of dental implants and the many variations in prosthodontic design and application. But patients don’t care about the number implant designs available.

They do not care whether implants are coated with hydroxyapatite, and nor do they care where the implants were manufactured, and possibly don’t care what the implant is made of, as long it’s durable and non-toxic.

What patients actually care about is the appearance, function, longevity and cost of implant supported prostheses.

There is great potential for patient disappointment when their dentist does not address these issues prior to initiating treatment.

A patient classification system can provide practitioners with information about the course of treatment and the expected outcomes and to arrive at a conclusion which indicates how difficult it will be to complete the final treatment plan.

Variations in individual patients and prosthetic designs indicate that experience and skill are mandatory for the dentists and technicians performing the prosthodontic phase of implant treatment.

Once you have established the complexity of the treatment plan, what follows is a discussion with the patient about whether the proposed treatment will approach their expectations.

The patient can then make an informed decision as to whether this treatment is desirable.

The initial patient examination, after determining the extent of edentulism, should always include dialogue regarding possible methods of tooth replacement.

A determination can then be made whether conventional dental prostheses or implant supported prostheses will be utilized.

While it is true that the closer implant retained prostheses approach the configuration of natural teeth, the more difficult they will be to produce. It is also true, however, that they are more likely to be accepted by the patient.

Your patients may not care about the variety of implant styles and materials available, but we know you do. We offer a huge range of solutions for implants. Get in touch for more information on our services.

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In light of recent news about the changing approach to dental care providers with HIV/AIDs being permitted to participate in care again after a long ban, I thought we could focus today on discussion immune system disorders in the patient.

Immune System Disorders

Some forms of periodontal disease may be more severe in individuals affected with immune system disorders, and patients with HIV may experience especially severe forms of periodontal disease.

Incidence of necrotizing periodontal diseases may increase in the patient with AIDS. Special considerations for immune system disorder patients with periodontal disease include:

1.  Consultation/coordination of treatment with patient’s physician as necessary.

2.  Controlling associated mucosal diseases and acute periodontal infections.

3.  If indicated, administration of systemic or local medications in a manner that avoids opportunistic infections and adverse drug interactions.

Outcome Assessment

The predictability of the outcome may be enhanced through close medical/dental coordination. Satisfactory outcome of therapy in systemic disorder patientss may include:

1.  Significant reduction of clinical signs of gingival inflammation;

2.  Reduction of probing depths;

3.  Stabilization or gain of clinical attachment;

4.  Reduction of clinically detectable plaque to a level compatible with gingival health;

5.  Control of acute symptoms.

Because of the complexity of systemic factors, it may not be possible to control periodontal diseases. A reasonable treatment objective here is to slow progression of the periodontal disease which may be characterized by:

1.  Persistent inflammation/infection of the gingival tissues;

2.  Persistent or increasing probing depths;

3.  Lack of stability of clinical attachment;

4.  Persistent clinically detectable plaque levels not compatible with gingival health;

5.  Radiographic evidence of progressive bone loss.

In patients where the periodontal condition does not resolve, additional therapy may be required as well as further evaluation of the patient’s systemic condition.

I hope this article was enlightening, especially in relation to new events. If you have any comments, or questions, about this subject get in touch. Leave your thoughts in a comment here, or find me on social media:

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