Effect of Various Medications on Oral Health

Many medications including some vitamins, minerals and herbal supplements can negatively effect your oral health. It is extremely important to ensure that your dentist has a recent copy of ALL medications you take so they can avoid certain side effects during your visits and treatment. I will review some drug groups and their oral side effects in this post;

Anticoagulants which are usually prescribed for preventing stroke and heart disease can prolong bleeding during and after certain treatments. Examples include aspirin, warfarin and/or heparin. The dosage of this class of drugs is usually adjusted before certain treatments and should be discussed with your dentist and physician. 

Certain medications can alter your taste and cause a metallic or bitter aftertaste. Among them are cardiovascular agents, central nervous system stimulants, non-steroidal anti-inflammatory agents, respiratory inhalants and smoking-cessation products.

Some medications have been known to cause mouth sores and/or inflammation of oral soft tissues. This list includes blood pressure control medications, immunossuppresive agents, oral contraceptives and some chemotherapy agents. Again all such prescribed meds should be discussed and included in your patient file and a special oral hygiene regimen may need to be recommended to alleviate their effects.

Anti-seizure medications such as Phenytoin, some meds prescribed after organ transplants and calcium channel blockers have been known to cause gingival hyperplasia or overgrowth of the gum tissue. Meticulous oral hygiene will keep these symptoms in check.

Some medications can cause dry mouth which in turn will damage the gum tissue and/or cause tooth decay. Also many prescribed or over-the-counter medications have a significant amount of sugar which if not properly cleaned off dental surfaces can lead to cavities or recurrent decay under existing restorations. Be especially careful with children's formulations and seek out sugar-free alternatives when possible. 

Bottom line is that unless your dentist knows about the medications that you are taking, he may not be able to control potential side effects.   

 

Dental Infections

Dental infections are not all the same and there are three basic types:

The first type is an infection inside your tooth, in the living pulp tissue. This comes from tooth decay or severe irritation such as trauma. Ordinarily, when bacteria grow in your body, your body responds by sending antibodies and white blood cells to fight the bacteria. Because of this body response, the tissue will swell as it heals. For minor infections, the antibodies and white blood cells may completely eliminate them, without the outside help of antibiotics. However, inside your tooth, this natural defense mechanism breaks down because there is no room for antibodies and white blood cells. And antibiotics are of no help here either. Therefore, when your tooth becomes infected, it will not recover, and the pulp tissue will die. The treatment for this condition is a root canal treatment, where the necrotic soft tissue inside your tooth is removed and replaced with a sealer material that keeps infection from seeping back into the tooth.

There is a second type of tooth infection which occurs in the bone around the end of the root tips. This usually occurs after the first type. You will get what is called a tooth abscess. An abscess may or may not be painful. When bacteria are in the bone, your body can fight them with antibodies and white blood cells. The problem is that there is a constant supply of new bacteria to the region from the dead pulp tissue inside your tooth. Your body may or may not be successful in containing the infected area, so an abscess can go on for years without hurting. But the risk of damage is great. The abscess can grow and spread, and it can even cause the root of your tooth to be gradually dissolved. Treatment, again, would be a root canal procedure. In some rare cases an existing root canal can fail or become reinfected. Treatment in this case would be either a re-treatment or root canal surgery(apicoectomy).

The third type is a gum infection also known as gingivitis or periodontitis. This occurs in the gum tissue and/or the bone directly below the gums. Again, your body can fight this. It can also result in an abscess. The treatment for this is very different and does not require root canal treatment. This type of dental infection requires thoroughly cleaning the root surface, removing tartar and other irritants. There are many grades and types of gum infections and specific treatment regimens depend upon the specifics of the case. A subdivision of this type would be a wisdom tooth infection, which occurs in the surrounding gum and is treated with the extraction of the wisdom tooth. 

The vast majority of these infections are avoidable and the best way to steer clear of these conditions is to visit the dentist regularly and follow recommended advice and/or treatments.             

The importance of replacing missing teeth

Throughout the course of one's life, teeth are lost for many reasons including cavities, gum disease, cracked roots and accidents. Missing teeth compromise your eating habits, speech and appearance. The loss of a front tooth will negatively affect the appearance of your smile and your self confidence. Losing a tooth in the back of your mouth can lead to numerous problems affecting your ability to chew, your ability to properly clean your teeth and the health of your remaining teeth. Replacing a lost tooth will prevent further destruction and save your remaining teeth.

The loss of a single tooth starts a chain reaction. Let's assume that a lower molar in the back has to be extracted. The tooth directly above the lost tooth is now useless, because it no longer has a lower tooth to chew against. Losing one tooth can result in the loss of the use of two teeth. 

Back teeth have a lifetime tendency to erupt (move farther into the mouth). Only the presence of a tooth to chew against keeps a back opposite tooth from erupting too far. The tooth immediately above the missing tooth has a tendency to over-erupted which will cause some of its roots to be exposed. Exposed roots do not have an enamel covering and decay much faster than the crown of the tooth. 

Now the resulting unevenness among the upper back teeth has created areas between these teeth that trap food debris. It is very difficult to keep spaces between uneven teeth clean, despite your best efforts at brushing and flossing. The accumulation of food debris and the resulting bacteria cause inflammation of the surrounding gum tissue. The inability to easily remove the trapped food debris accelerates tooth decay.

When teeth are lost, the remaining adjacent teeth are also adversely affected. These teeth have a tendency to tilt (lean over) into the space the missing tooth once occupied. They also have the potential to drift or move. Now that a tooth has been extracted, a space is left. This allows the lower molar directly behind the space to tilt and drift forward and it will tilt farther and farther over time. The upper molar no longer makes proper contact with the adjacent, erupted molar or with the tilted lower molar. This will cause the upper molar to tilt and drift backward. The bite is no longer stable. 

A tooth tilted over will develop a gum pocket along its forward root. Gum pockets are narrow, abnormal spaces or clefts that develop between the gums and the tooth root. These pockets trap food debris and bacteria. A gum pocket is a problem, because you can almost never keep it clean. The debris and bacteria that collect in a gum pocket lead to ever-worsening inflammation of the gums. When an area of the gums is constantly inflamed, as happens in a gum pocket, the bone immediately adjacent to the gum pocket also becomes inflamed. Inflamed bone softens, and slowly begins to resorb (disappear). Chronic gum inflammation and the eventual loss of underlying bone are symptoms of advanced periodontal disease. When left untreated, this condition will negatively affect your facial appearance and damage your remaining teeth.

 If missing teeth are not replaced, a chain of damaging events may occur. Over time, one missing tooth can lead to bone loss, periodontal disease and the eventual loss of remaining teeth. Replacing a lost tooth today will avoid grief and greater expense tomorrow.

Best of Yorktown 2012

Most recently at the Yorktown fall Festival, I was honored with the Best of Yorktown 2012 Award in the Doctor/Dentist/Therapist category. It is needless to say that I am extremely proud and grateful. I was especially thrilled to share this recognition with my partner/wife Lucy and our three boys who were present at the ceremony. This award reinforces one of my ideals that treating others with respect, compassion and generally doing the right thing will eventually lead to success.

12 years ago I started practicing dentistry in Yorktown Heights and a couple of years later my wife and I moved to nearby Somers. At that time I had a dream of creating an exceptional practice that is recognized as the best in our community for providing outstanding quality of care and service. Initially my vision was met with some skepticism from the status quo but with much hard work and dedication we became established as a quality family practice. Today we are much closer to our goal and we continue to grow.

For those who are not familiar with our practice, Elite Dental Studios, our main focus is to always do the right thing by our patients and to surpass all expectations all the time. We moved into our current location approximately five years ago. We have a state-of-the-art set up with all the latest equipment and materials, a comprehensive approach which has our patients best interest at heart, a relaxing and progressive decor and an exceptionally well-trained staff and associates. We are experts in many of today's most popular restorative and cosmetic procedures.            

Please feel free to contact us with any dental concerns and/or inquiries:

Main website:  http://www.elitedentalstudiosny.com/

My blog:  http://www.elitedentalstudiosny.blogspot.com/

Facebook page:   https://www.facebook.com/elitedentalstudios

Twitter:  https://twitter.com/ashkhorramdds

Phone #: 914-245-7575

Lastly I would like to thank my amazing wife and partner Lucy who manages our whole operation and stood by my side through the years, my excellent staff who help make it all happen and most importantly all our loyal patients and friends whose support means the world to me!  

In good health- 

Dr. Ash Khorram        

Back to School Dental Tips

It is that time of year again when students of all ages are going back to school. It is important to remember that in addition to the recommended supplies, a healthy mouth is also a necessity.

According to the American Dental Association, a dental examination is as important as immunizations and booster shots and should be a regular part of back-to-school preparations. Statistics from the Centers for Disease Control and Prevention say that tooth decay affects U.S. children more than any other chronic infectious disease and 19 percent of children ages 2 to 19 years old have untreated decay. Dental pain or disease can lead to difficulty in eating, speaking, playing and learning as well as millions of hours of missed school.

Students' back-to-school checklist:

-Regular clinical and radiographic dental examinations to diagnose, treat and/or prevent dental problems are always important. In school guardians and teachers may not always realize there's a dental problem, so a regular checkup before school is especially important. Your dentist may suggest fluoride treatments or sealants to prevent decay and can diagnose and treat dental problems such as decay to save your child discomfort and lost attendance.

-A regular hygiene program including brushing with fluoride toothpaste and flossing. Visit the dental care section when you're out shopping for school supplies. If parents buy several toothbrushes they could have their child change to a new one every three months or so, or after an illness. If it's hard to remember when to change a brush, you could try to change it every time report cards come out. Ask your dentist for a recommendation on how often to change toothbrushes and other hygiene tips.

-A tooth healthy diet plan. Include portable healthy lunch items and snacks in your child's sack lunch, including grains, milk, cheese, raw vegetables, yogurt or fruit. If your child eats in the school cafeteria, review healthy, balanced food choices with him/her before the first day of school. It is always a good idea to reduce sugary foods and soft drinks as excessive sugar can not only cause dental decay, but is also unhealthy for a young person's overall health.

-Wearing a properly fitted mouth guard while participating in organized sports, PE classes or playground activities.

Good luck to all the kids who are headed back to school and remember if you take care of  your teeth now, they will return the favor for a lifetime!

Worn Teeth

Under normal circumstances a layer of enamel covers your teeth. This enamel is very hard and protects the tooth from daily wear and tear. 

However your tooth enamel may be worn away in several ways:

Attrition

Attrition is the gradual loss of enamel through "wear". A small amount of attrition may be caused by normal speaking and eating, but this typically doesn't produce excessive wear. More extreme cases of attrition are typically caused by bruxism, the grinding or clenching of teeth against each other. Bruxism typically occurs at night while the patient sleeps, so often the patient is unaware of the grinding or enamel loss. The first line of defense against bruxism is a night guard.  

Abrasion

Abrasion is the wearing away of tooth enamel by a foreign object. Common causes of abrasion are:

Brushing too hard - When using a soft bristle tooth brush, it isn't necessary to press hard. The soft bristles will bend into all desired positions with minimum pressure. 

Unnatural biting habits - Fingernail biting, chewing on pens or pencils, holding needles or pins between the teeth, etc.
Oral jewelry - Patients with pierced lips and/or tongue often wear away the enamel on adjacent teeth 

Erosion

Erosion is the chemical wear of tooth enamel. Typically this kind of wear is caused by an acid. Citric acid is one of the most common agents. Citrus fruit (lemons, limes, oranges, grapefruit) contain citric acid, as do most soft drinks and citrus juices. Some candies also contain citric acid. Many soft drinks contain additional harmful acids. Coffee and tea also contain corrosive acids. Bulimic individuals (people who intentionally and repeatedly induce vomiting) also expose their teeth to very strong stomach acids.

Occasional exposure to most dietary acids is rarely a problem, but repeated exposure to high levels of these acids can cause premature wear. Some common habits to avoid are:

 -Regularly sucking on lemons or limes

 -Regularly eating or sucking on candies, especially "sour" candies as they often contain sugar and citric acid!

 -Drinking several soft drinks daily, even "diet" soft drinks

 -Drinking several cups of coffee or glasses of tea daily

Even if you only occasionally eat or drink highly acidic foods, it's a good idea to at least rinse your mouth with fresh water when you are finished. This is to reduce the amount of time that your teeth are exposed to the acids.

Our fifth year anniversary at new location!

Recently we celebrated our fifth year anniversary at our new location. The festivities included wine-tasting and various food items with many of our patients and friends. Here is an excerpt of my speech from that night:  

Hello everyone!

12 years ago I bought an existing dental practice in Yorktown Heights. Having worked as an associate in some private practices in New York City and Westchester County, my dream of owning my own dental practice came true!

7 years later as my lease in the commerce building was coming to an end, Lucy and I looked for a property to buy and found this building. Much hard work allowed us to convert it into a state-of-the-art dental practice and we’ve been here ever since.

Here at Elite Dental Studios we are a family practice and treat the whole family with lots of emphasis on quality of care! I am a Prosthodontist, which is an ADA recognized specialty in conventional and implant supported tooth replacement and tooth restoration.We are also experts in many of today’s popular cosmetic procedures. I am proud to say that in the 12 years of practicing in Yorktown Heights, our commitment to the health of our patients has remained strong and quality of care has always been a first priority.

Over many years our practice has flourished and I’ve had the honor of meeting and serving so many good people in our community. However,  I do realize that we could not have done it alone and tonight is about appreciating all those who helped us along the way.

Firstly I would like to acknowledge my awesome staff, whose dedication and professionalism is a big part of what we do;

Lisa Piciocchi is our amazing full time hygienist! She is a superb clinician with great attention to detail.

Kim Salveggi is our part time hygienist and also an awesome clinician!

Erin Murphy is our treatment coordinator and receptionist. She is always on the ball and ready for just about anything that she encounters and always with lots of professionalism.

Debra Kane is one of our assistants and also part of the front desk crew. She is compassionate and caring and assists our part-time endodontist (root canal specialist) and periodontist (surgeon/gum specialist).

Barbara Balchunas is our other assistant and usually works with myself. She is very positive and very good at making personal connections with our patients.

Alida Palevik is the newest member of the team with much enthusiasm. She is learning the ropes quickly.

And last but not least Lucy Landolfi-Khorram is my partner and practice administrator who’s been in the dental field as long as I have. She is extremely bright and in tune with all aspects of the practice. Somehow she is able to pull it all together and always with a smile on her face!

So thank you all…..I really couldn’t do it without you!

 

I would also like to thank all of our wonderful patients who honor us by putting their trust in our hands. You all make doing what I love even more enjoyable. Thank you for your loyalty through all the years!

I am a big believer in small businesses being the back bone of our local economy. We have had the support of so many local businesses in our community and I am grateful for that.

Lastly I would like to thank the Yorktown Chamber of Commerce for their support and their dedication to furthering all small businesses in our community!