What to do if a tooth is chipped, partially dislodged or completely knocked out:

• If you break or chip a tooth, keep the pieces and rinse with some warm water. Once any bleeding stops, apply a  cold pack or ice to the area and see your dentist as soon as possible. It may or may not be possible to reattach the pieces, but bring them with you to your appointment just in case.

• If your tooth becomes partly dislodged,  put a cold pack or ice on the area to decrease swelling. Go to your dentist as soon as possible.

• If a  tooth becomes completely dislodged, find the tooth (if possible)  and pick it up by the crown end, not the root. Rinse the tooth under running water but do not scrub it as it is important  to preserve any tissue fragments. Teeth that have been knocked out have the best chance to be saved if they are put back in place within an hour of the accident. Try to put the tooth back in place (be sure that it is facing the correct way) but don’t force it. If you can’t reinsert the tooth, place it in a small container of milk, or water with a pinch of salt. Seek dental care as soon as possible.

Wanting to support the  sufferers, families and friends of cancer victims as well as the behind the scenes research, Clare Dental decided to enter a team into the 2012 Relay For Life. Weeks of decorating, banner making, outfit sewing, tooth moulding and planning all took place, whilst at the same time raising vital funds for the Cancer Council.  Being a non-government funded body, the Cancer Council relies on such events to help minimise the effect of Cancer on Australian communities.

Taking out the trophy for ‘Best Banner”, the Clare Dental Tooth Fairies had a night to remember! With one in two Australians being diagnosed of some form of Cancer in their life time, this disease will either affect you or someone you know and love. So why not dig deep and help out those in need?!

In 2014, the Clare Dental Tooth Fairies will venture back to the local oval for another day of running, walking, fun and games. We hope to see you all there!

For more information on how to donate or join a team, please visit the Cancer Council website:    http://www.relayforlife.org.au/

Hypertension is the term used to describe high blood pressure (Medline Plus 2011).

In today’s society, high blood pressure is the most common problem managed by general practitioners. The prevalence of hypertension indicates that 3.7 million Australians over the age of 25 have high blood pressure, or are on medication for the condition, which is 32% of men and 27% of women (AIHW 2011). One third of individuals affected by the disease are unaware of its presence, hence why hypertension is referred to as the ’silent killer’ due to its asymptomatic manner (Little 1997).

What is Blood Pressure?

Blood pressure is a measurement of the force against the walls of the arteries as the heart contracts and pumps blood around the body (Tortora & Derrickson 2009). Blood pressure readings are given as two measurements; systolic and diastolic pressure. Systolic pressure corresponds to the pressure in the arteries when the heart contracts and pumps blood forward into the arteries. Diastolic pressure represents the pressure in the arteries as the heart relaxes after contracting and as it fills up with blood again (MedicineNet.com 2011).

Symptoms of Hypertension

For most individuals there are no symptoms of hypertension and most cases are found out when visiting a health care provider. Due to there being no symptoms, most patients will not know they have high blood pressure and can develop heart disease and kidney problems without knowing so straight away (Medline Plus 2011).

Patients with severe hypertension, known as ‘Malignant Hypertension’ can often experience:

- Severe headaches

- Nausea/Vomiting

- Confusion

- Changes in vision

- Nosebleeds

- Chest Pains (PubMed Health 2011 & AIHW 2011).

Effects on Oral Health

Often medications that are used to treat hypertension (anti-hypertensive medications) can have effects on the oral environment. Some may cause patients to experience dry mouth, also known as Xerostomia (Colgate 2011). Xerostomia may result in gingivitis, periodontal disease or due to erosion, loss of tooth structure (Bartels C, 2000). Overtime if left untreated, Xerostomia will lower the pH within the oral cavity, which will increase the development of plaque and therefor dental caries (Bartels C, 2000).

An altered sense of taste (Dysgeusia) is another effect hypertension medications may have on the oral cavity as well as some others may make patients more likely to faint when raised in a dental chair too quickly, which is a reaction known as Orthostatic Hypotension (Colgate 2011).

Gingival overgrowth (Gingival Hyperplasia) is another possible side-effect of medications used to treat high blood pressure, for example, Calcium channel blockers can often have this effect (Colgate 2011). Some patients will have to undergo gingival surgery to remove some of the gingiva, but quite often it will just grow back. The gingiva are very difficult to look after when experiencing this overgrowth, as plaque can easily get trapped underneath and as they are often quite sore, it is difficult to brush and therefore maintain good oral health (Colgate 2011).

Example of drymouth (Xerostomia):

Examples of gingival hyperplasia:

At the Dentist

Patients with high blood pressure should have their dentist check their blood pressure at each visit. Depending on how high the blood pressure is, how well it is controlled and whether the patient has any other medical conditions, the dentist can decide whether or not it is safe for non-emergency treatment to be completed (Colgate 2011).

Most people suffering from hypertension can safely take anti-anxiety medications, such as Nitrous Oxide or Valium, and can also safely receive local anaesthetics for dental procedures. It is extremely important that dental professionals know which medications a patient with hypertension is on at every dental visit (Colgate 2011).

There are two main ways that a Stroke can occur.

Ischaemic stroke (blocked artery)

The most common form of Stroke is known as an Ischaemic Stroke (Brain Foundation, 2011). This occurs from a blockage in the artery that is carrying blood to part of the brain. Blockages can occur in two ways; either by a blot cot that has formed somewhere else in the body that travels to the brain where it is too large to pass through the arteries, this is known as Embolic Stroke or by Thrombotic Stroke which is caused by build-up of cholesterol ‘plaque’ that narrows the size of the artery (Stroke Foundation, 2007). If blood supply to any part of the brain ceases for more than a few minutes, that specific part of the brain stops functioning and brain tissue begins to die. (Brain Foundation, 2011). As a result, if the blockage is not cleared, the whole part of the brain that the particular artery supplies, may die. This is often called brain infarction (Brain Foundation, 2011).

Haemorrhagic stroke (bleed in the brain)

Also known as cerebral haemorrhage, this kind of Stroke occurs a result of a blood vessel rupturing within the brain or into the space around the brain (Brain Foundation, 2011). Due to the high pressure inside the artery, as it bursts, it also tears the brain tissue, resulting in a large clot that ultimately puts pressure on the brain and can cause brain death. (Brain Foundation, 2011).

Symptoms of Stroke

Everyone is affected differently; however symptoms of stroke usually come on very suddenly. (Brain Foundation, 2011). Common warning signs include sudden numbness of the face, arm or leg on one side of the body, dizziness , loss of balance, confusion, trouble communicating and walking, blurred vision and headaches (Brain Foundation, 2011 & Stroke Association, 2011). Some people affected my symptoms such as nausea, vomiting, drowsiness or seizures, although such symptoms are rarer (Brain Foundation, 2011).

In 2006, a campaign to increase awareness of the common warning signs of Stroke was established to help prevent delayed reaction and improve the outcomes of sufferers (Stroke Foundation, 2011). This is known as FAST, referring to the face, the arms, speech and time (Stroke Foundation, 2011). This campaign aims to teach people in the general community to act fast if they witness signs and symptoms such as, a drooped face, inability to lift arms and or slurred speech (Stroke Foundation, 2011).

Effects on Oral Health

The after effects of a Stroke can be both challenging and demanding for patients in regards to the whole body but in particular, the health and maintenance of the oral cavity.

One of the general health effects of a Stroke is paralysis on one side of the body (Colgate, 2011). Paralysis is defined as being “an impairment or loss of the motor function of the nerves, causing immobility” (Anderson J, 2007, pg. 762). Such impairment could lead to a number of issues including, not being able to brush the teeth efficiently on the effected side, difficulties with rinsing of the mouth and not realising when food is left in the oral cavity (Colgate, 2011). If not monitored, this could ultimately lead to caries, gingivitis and or periodontal disease; however there are options available such as electric toothbrushes, floss holders and large interdental brushes to prevent such outcomes.

Certain medications that are prescribed to Stroke victims can lead to a dry mouth, known as Xerostomia (Brady, M et.al, 2007). Side effects include a constant sore throat, difficulty communicating, impaired swallowing and dry nasal passages (Bartels C, 2000). Three out of ten patients with Xerostomia will result in gingivitis, periodontal disease or loss of tooth structure by erosion (Bartels C, 2000). If left untreated, Xerostomia will lower the pH within the mouth and increase the development of plaque and therefore dental caries (Bartels C, 2000). Treatment options include saliva substitutes such as GC Dry Mouth Gel or certain types of tablets that increase the quantity of saliva. Blood thinning medications can effect certain dental procedures including extractions and deep scaling (Colgate, 2011). Such medications may need to be stopped prior to these types of treatments and it is therefore vital that Stroke victims give oral health care providers up to date and accurate medical histories.

Another oral health effect of Stroke is ulcers of the mouth (Brady, M et.al, 2007). Although most ulcers are harmless and clear up by themselves, there can be a number of complications is left untreated including bacterial infection, inflammation of the mouth (cellulitis) or development of an abscess.

Denture Stomatitis is s fungal/yeast disease that leads to infection in the mouth (Better Health Victorian Government, 2011). The wearing of dentures may be compromised as a result of a Stroke and many dentures need to be adjusted in such circumstances (Colgate, 2011 & (Brady, M et.al, 2007). Denture Stomatitis can be caused by inadequately cleaned or ill-fitting dentures and such disease may need medication to rectify.

Here are some importnant tips on how you can reduce your risk of being one of those people.

Smoking - If you are a smoker, talk to your dentist or doctor today about how this habbit not only effects your geneeral health but also your oral health. It might be enough to help you quit.

Alcohol - Drinking more than four standard drinks a day increases your risk of oral cancer so be sure to drink in moderation.

Sun Exposure – As most people are aware, exposure to the sun for long periods can increase your risk of cancer.Don’t forget to apply sunscrren to your lips, avoid being outdoors in the middle of the day when the UV rays are at thier highest and always wear a hat.

Diet – Consuming a diet low in vegetables increases your risk of oral cancer. Ensure you eat plenty of fruit and vegetables high in antioxidants, as a  minimum of eight serves per week compared to three serves will decrease your risk of oral cancer by 50%.

Human Papilloma Virus (HPV) – Oral cancer can be linked to HPV, a virus that is known to cause warts on the genital regions and cervical cancer. New research suggestes that HPV that is spread from the genital areas to the oral cavity can increase the risk of oral cancer. Speak to your GP today about getting vaccinated against HPV and if you notice a change in your lips or mouth, such as a spot or sore, seek the help of a dentist as soon as possible.

Regualr Dental Visits – The first person to usually detect oral cancer is your dentist. Therfore increasing your visits could save your life!

For more infomration, please visit the Australian Dental Association website.

Inside Dental Assisting

May/June 2011, Volume 7, Issue 3                                                                         

Published by AEGIS Communications

Xerostomia

The Prevalent Dry Mouth Syndrome

Xerostomia, commonly called dry mouth, is a condition of oral dryness. In many, but not all cases, it is caused by reduced or absent saliva flow due to impaired salivary gland function. While oral dryness may not sound serious, xerostomia can in fact be a contributing factor in a number of oral health problems, including increased risk of plaque, tooth demineralization, dental caries, dental erosion, oral yeast infections, and ulcers of the tongue.^1,2

Saliva: A Quick Review

Saliva is secreted from the parotid, submaxillary, sublingual and minor mucous glands of the mouth. Healthy saliva is viscous, clear, and watery. It contains two types of protein secretions: a serous secretion that contains the digestive enzyme ptyalin, and a mucous secretion that contains a lubricating fluid called mucin. Saliva also contains potassium, bicarbonate, chloride, and sodium ions that help remineralize teeth, as well as a number of antimicrobial agents, such as lysozymes, lactoferrins, and immunoglobins.^3,4

Salivary function is mediated primarily by receptors that are located in the salivary glands (Figure 1). When these receptors are stimulated, flow of saliva increases.⁴ Many of the medications that have been linked to xerostomia hinder function of these receptors, reducing salivary production and volume.

Common Causes of Xerostomia

Medications/Medical Treatments

More than 400 commonly prescribed drugs in the United States can cause xerostomia.^3,5 Some medications—such as sedatives, antidepressants, antihistamines, opiates, antipsychotics, anti-Parkinson agents, and antianxiety agents—interfere with the function of salivary gland receptors, reducing salivary production and volume.^3,5

Others, such as antihypertensives and diuretics, interfere with the body’s salt, water, and electrolyte balance. This changes the composition of saliva so it contains less of the lubricating agent mucin, as well as low concentrations of ions needed in remineralization. Polypharmacy—taking multiple medications everyday—has also been associated with dry mouth, with the risk being the highest when more than three different drugs are taken daily.^3,5

Cancer treatments, such as chemotherapy, or radiotherapy to the head and neck, can also cause dry mouth if the treatment has affected salivary glands. Sometimes affected salivary glands maintain some functional ability, but sometimes cancer treatments can destroy them completely.⁶

Systemic Diseases and Other Health Conditions

A number of systemic diseases have been linked to impairments in saliva secretion or compositional changes in saliva. These include autoimmune diseases such as Sjögren’s syndrome, rheumatoid arthritis, autoimmune thyroiditis, and systemic lupus erythematosus; chronic infections such as hepatitis C virus (HCV) and human immunodeficiency virus (HIV); and hormonal conditions such as diabetes or menopause.^3,7

Other conditions that have been implicated in dry mouth include eating disorders such as bulimia or anorexia nervosa; neurological disorders such as depression, bipolar disorder, Bell’s palsy, or cerebral palsy; and local salivary diseases such as salivary gland cancer, salivary duct stones, or salivary gland infections.^3,7 Chronic use of alcohol and other drugs, such as cannabis and methamphetamines, have also been linked to xerostomia.^3,7-9

Who Is Most at Risk?

The elderly tend to be most at risk for dry mouth. This isn’t because age itself causes the condition, but rather because this age group is more likely to have systemic diseases and health conditions linked to xerostomia. The elderly are also more likely to be taking medications, and engaged in polypharmacy.³

Particular attention should also be paid to women between the ages of 40 and 60, since they are undergoing hormonal changes as they transition to menopause that affect salivary gland function, inducing dry mouth.¹⁰ This group is also most at risk for the autoimmune condition Sjögren’s syndrome (SS), the most common disease that causes xerostomia. In SS, the body’s immune system attacks secretory glands (such as the salivary glands and tear glands), so they lose their ability to produce sufficient lubricating fluid. This causes dryness of all mucosal linings of the body, including the mouth, eyes, and digestive tract.^3,7,11

Medications to Help Patients Manage Dry Mouth

While the ideal scenario is one in which you could help a patient identify the underlying cause of dry mouth and take steps to minimize the cause, this may not always be possible. In addition to helping patients manage their symptoms with the tips recommended above, some may benefit from medications that substitute saliva or increase salivary flow.

Over-the-counter saliva substitutes are products that mimic saliva to replace moisture, and make the mouth feel more lubricated. Many are also formulated to supply calcium, phosphate, and fluoride ions, to counteract the demineralization and increased caries risk that accompanies dry mouth. Studies have found that they also help decrease plaque levels, and reduce gingivitis and oral yeast infection risk.¹³ These come in the form of sprays, lozenges, or mouthwashes.

Another type of medication that may help some patients with dry mouth—depending on if their salivary glands are still able to function—is a salivary stimulant. These include over-the-counter lozenges and tablets; and prescription medications, such as pilocarpine and cevimeline, which activate the receptors to increase saliva production.¹⁴

References

1. Fox PC. Xerostomia: recognition and management. Dent Assist. 2008;77(5):44-48.

2. Guggenheimer J, Moore PA. Xerostomia: etiology, recognition and management. J Am Dent Assoc. 2003;134(1):61-69.

3. Fejerskov O, Kidd E, eds. Dental Caries: The Disease and Its Clinical Management. 2nd ed. 2008; Oxford, United Kingdom: Blackwell Munksgaard.

4. Du Toit DF, Nortje C. Salivary glands: applied anatomy and clinical correlates. SADJ. 2004;59(2):65-74.

5. Sreenby LM, Schwartz SS. A reference guide to drugs and dry mouth–2nd edition. Gerodontology. 1997;14(1):33-37.

6. Jensen SB, Pedersen AM, Vissink A, et al. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life. Support Cancer Care. 2010;18(8):1039-1060.

7. von Bültzingslöwen I, Sollecito TP, Fox PC, et al. Salivary dysfunction associated with systemic diseases: systematic review and clinical management recommendations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103(Suppl 1):S57.e1-15.

8. Versteeg PA, Slot DE, van Velden U, van der Weijden GA. Effect of cannabis usage on the oral environment: a review. Int J Dent Hyg. 2008;6(4):315-320.

9. Hamamoto DT, Rhodus NL. Methamphetamine abuse and dentistry. Oral Dis. 2009;15(1):27-37.

10. Agha-Hosseini F, Mirzaii-Dizgah I, Mirjalili N. Relationship of stimulated whole saliva cortisol level with the severity of a feeling of dry mouth in menopausal women. Gerodontology. 2010;15: Epub ahead of print.

11. Pedersen AM, Bardow A, Nauntofte B. Salivary changes and dental caries as potential oral markers of autoimmune salivary gland dysfunction in primary Sjogren’s syndrome. BMC Clin Pathol. 2005;5(1):4.

12. National Institute of Dental and Craniofacial Research. National Institutes of Health. Dry Mouth. Available at: http://www.nidcr.nih.gov/OralHealth/Topics/DryMouth/DryMouth.htm. Accessed February 1, 2011.

13. Montaldo L, Montaldo P, Papa A, et al. Effects of saliva substitutes on oral status in patients with Type 2 diabetes. Diabet Med. 2010;27(11):1280-1283.

14. Wick JY. Xerostomia: causes and treatment. Consult Pharm. 2007;22(12):985-992.

If your expenses in a financial year exceed $2000  and you are an Australian tax payer, then you are able to claim the rebate.

The rebate amount is currently 20% of the excess over $2000. Payments for dental services and treatments can be added to other general medical expenses,  increasing your entitlement.

Example: If your total medical and dental expenses are $4000.00  then you would be entitled to a 20% rebate of $500.00

(Remember to keep all reciepts and take along to your accountant at the end of the finanical year)

Sporting accidents are one of the most common causes of dental injury. Every year thousands of people, including young children, are treated for dental injuries that could have been prevented or  at least minimised by wearing a custom-fitted mouthguard.

It doesn’t matter what type of sport you are playing, you should always wear a protective mouth guard, even during training sessions.

With the upcoming football and netball seasons fastly approaching, now is the time to get your mouth guard. All it takes is one simple appointment where a mould is taken of your upper teeth. This mould is then sent to a specialist laboratory where a custom fitted mouth guard is made in a colour of your choice.

If you already have a mouth guard, we recommend that you have it assessed every 12 months by your dentist to ensure that it has optimal fit and protection.

Mouth guards should be stored in a rigid container and kept away from heat. Ensure your mouth guard is rinsed after each use and stored correctly to improve its longevity.

So why spend the money on a custom fitted mouth guard when you can get one cheaper over the counter at a chemist you may be asking. Over-the-counter mouthguards provide inadequate protection against dental injuries, and the potentially significant costs associated with dental injuries means investing in a custom-fitted mouthguard is worthwhile.

For more information please visit the website below or to make an appointment call Clare Dental on 08 8842 29999

http://www.mouthguardawareness.info/about.htm

1. Distract them - Consider a battery powered brush, which adds novelty to cleaning thier teeth.

2. Entertain them – Sing nursery rhymes or play a favourite song while you help them brush thier teeth.

3. Bribe them – Offer a rewrad every time your toddler allows you to brush their teeth for two full minutes. (This should not be food, but could simply be a visit to the park)

4. Lead by example – Encourage your child to practise teeth cleaning (under your supervision) to install good oral hygiene habits from an early age. Use a combination of ’show and tell’ methods.For example, you could brush your teeth as your child imitates you; then next time, tell your child how to brush while you watch.

5. Dazzle them – Make brushing and flossing as much fun as you can to avoid any negative association or resistance.

6. – Tell them you do it – Children tend to imitate their parents behaviours. If oral hygiene and dental care are important to you, they will be important to your child. Talk to your child about the importance of healthy teeth. A child who undertsnads that teeth have to last a lifetime is more likely to take care of them. Visit your dentist regularly to maintain your own oral health, which will in turn benefit your child.

Issue #5,  Smile Magazine