If there is a link between oral and systemic health, does this mean there’s a link between medications and the oral cavity as well? As it turns out, yes! Let’s discuss the systemic implications of antibiotics and how they can affect the teeth long after the course has been finished.

What are antibiotics and why do people take them?

Antibiotics are taken for bacterial infections like strep throat or UTI’s ^[1]. These are infections that are caused by an overgrowth of bacteria. Antibiotics work by killing off these bacteria or preventing them from multiplying. While antibiotics are useful in treating bacterial infections and quickly bring relief, they are not useful for viral infections like herpes or the flu.

Do antibiotics always affect teeth?

While antibiotics can affect your teeth, it doesn’t mean that they necessarily will. In fact, there is a good chance that you will take an antibiotic at some time in your life without any kind of complication. Effects of antibiotics on teeth are mostly dependent on two different factors: 1.) how long the antibiotic was/is taken and 2.) age.

What are the effects of antibiotics in children vs adults?

Fun fact, teeth begin to develop in utero at about 6 weeks ^[2]. Since the development process begins so early, it can be easily disrupted by genetics, drug/alcohol use of the mother, and medications. Tetracycline is one of the antibiotics most associated with developmental disturbances of the teeth ^[3]. It is a broad-spectrum antibacterial drug that is used to treat many infectious diseases. When taken during pregnancy, it causes permanent discoloration to the teeth. Tetracycline staining often appears brownish- gray or sometimes has a bluish hue. Tetracycline staining can affect adults as well, but this is typically only in adults who take it for long periods of time. Amoxicillin ingestion while baby is in utero is associated with developmental enamel defects that appear as spotted white flecks, possibly due to hypo- mineralization of the enamel ^[2].

Are developmental tooth defects from antibiotics permanent?

Unfortunately, if the development process of teeth is disturbed when in utero, the effects are permanent. Developmental disturbances occur on a cellular level which then go on to affect the rest of the developing teeth. If teeth are affected by tetracycline staining and appear bluish gray, bleaching will not do anything to whiten them since the staining is within the tooth as opposed to on the tooth like coffee or red wine. The same goes for Amoxicillin and its areas of hypo-mineralization. For developmental stains like these, one might consider veneers or crowns as aesthetic options.
Developmental anomalies of the teeth are not uncommon. Teeth form very early in life and the development process can be easily disturbed. While developmental disturbances are permanent, dentistry is always evolving and affords many options for aesthetics.

Esmy Ornelas

Esmy Ornelas is a registered Dental Hygienist, writer, educator, and consultant with 10 years of experience in dentistry. She is passionate about education, empowering hygienists to advance their careers in and out of the operatory, and about community. She has written for RDH Magazine, the RDH Graduate, and is a full-time professor of Dental Hygiene and Assisting at Rose State College in Oklahoma.

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1. Centers for Disease Control and Prevention. (2021, October 6). Antibiotic use questions and answers. Centers for Disease Control and Prevention. https://www.cdc.gov/antibiotic-use/q-a.html
2. Hong, L., Levy, S. M., Warren, J. J., & Broffitt, B. (2011). Amoxicillin use during early childhood and fluorosis of later developing Tooth Zones. Journal of public health dentistry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4556648/
3. Prachi, J., & Manu, R. (n.d.). Embryology, teeth – statpearls – NCBI bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK560515/
   .

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Cancer. It’s one of the scariest words anyone can hear at a healthcare visit. You may not know that it’s something your dental hygienist should be checking for at every visit. Keep reading for practical advice and information about why this important piece of your dental health care should never be overlooked.

How common is oral cancer?

Oral Cancer is the 13th most common type of cancer worldwide, according to the World Health Organization ^[3]. It makes up just over two percent of all cancers ^[2]. While this may seem like a relatively small percentage, oral cancer has a serious impact on those who have it. In 2020, 177,757 people died worldwide of oral cancer ^[3]. Certain risk factors increase the chances of developing oral cancer. People who smoke are at a much higher risk than those who do not ^[1]. Alcohol consumption also increases the risk, and those who drink heavily are at a higher risk than casual drinkers ^[1]. Tobacco and alcohol consumed together provide a synergistic effect, meaning that those who smoke and drink are at an exponentially higher risk of developing oral cancer ^[1]. Other types of tobacco, including chewing tobacco, snuff, and pipes also increase the risk ^[1]. HPV is also a big contributing factor, as is excess sun exposure . ^[1]

What happens during an oral cancer screening?

During an oral cancer screening, your dental hygienist will begin with an extra-oral exam. They will palpate your face, head, and neck with their gloved hands. They may ask you to turn your head to the side or tip your chin up and down. They will feel underneath your chin, behind your ears, and at the base of your skull. They will also have you open and close your mouth as they feel your jaw joint. They will feel your trachea and thyroid, and check for any abnormal lymph nodes. Next, the hygienist will begin the intra-oral portion of the exam. They will palpate your lips, cheeks, palate, and the floor of your mouth. They will stretch your cheeks slightly to get a good field of vision. They will have you stick your tongue out so they can check the sides of it, because this is one of the most common areas for oral cancer to occur. Oral cancer screenings are comfortable to receive and take only a few minutes.

Should I ask for an oral cancer screening?

Many dental hygienists already incorporate oral cancer screenings into preventive dental care appointments. However, if you aren’t sure if you are receiving this screening, ask them! Registered dental hygienists receive in-depth training during their formal education about how to screen for and detect abnormal findings that can indicate cancer and other serious conditions. If your hygienist is not performing screenings at every visit, you should absolutely ask them to. It could mean the difference between life and death. You can also ask your hygienist to show you some techniques you can use at home to perform self-screenings. While self-screenings are valuable, it’s important to keep in mind that they are not a substitute for professional screenings.

What happens if my hygienist finds something?

The first thing your dental hygienist will do if they find something suspicious during your screening is notify the dentist. The dentist will evaluate the area and determine if the finding is truly abnormal. Then, they will decide if a biopsy needs to be performed, or if a referral to a specialist is necessary. If they refer you to see a specialist, such as an oral surgeon, it is critical that you follow through and see them. While it may seem scary to seek more information, when oral cancer is caught early, it has much better outcomes.

Rachel Stroble

Rachel Stroble is a researcher, professor of dental hygiene at Rose State College in Oklahoma, and registered dental hygienist with 10 years of experience in dentistry. She supports education in the classroom with her own students, in the professional community through the development and presentation of continuing education courses, and you may have seen her articles in RDH Magazine, Today’s RDH, and the Oklahoma Dental Association Journal.

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1. American Cancer Society. (2021, March 23). Risk factors for oral cavity and oropharyngeal cancers. https://www.cancer.org/cancer/types/oral-cavity-and-oropharyngeal-cancer/causes-risks-prevention/risk-factors.html
2. World Cancer Research Foundation. (2022, March 23). Worldwide cancer data. https://www.wcrf.org/cancer-trends/worldwide-cancer-data/
3. World Health Organization. (2023, March 14). Oral health. https://www.who.int/news-room/fact-sheets/detail/oral-health#:~:text=Globally%2C%20an%20estimated%202%20billion,from%20caries%20of%20primary%20teeth.

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It’s the most wonderful time of the year… flu season! Let’s talk about some ways to stay healthy this holiday season so you can spread love and not germs.

How do colds, flus & other illnesses spread?

The truth is germs are everywhere and spread very easily. With the common cold, many catch it by not washing their hands after touching doorknobs in public places. The fecal-oral route is one of the easiest ways to get sick. If you’re in a public place, always wash your hands or use sanitizer after touching the doorknobs in the bathrooms. Some people do not wash their hands after using the lavatory and transfer bacteria to the doorknob. If someone comes along and touches it after they do and then proceeds to rub their eyes or eat, they are encountering the bacteria.

The flu spreads a little differently. Experts say flu viruses spread mainly by droplets created when people with the flu cough, sneeze, or talk ^[1]. When in proximity with someone who sneezes or coughs, these droplets can land in the noses or mouths of people who are nearby or potentially be inhaled into the lungs ^[1]. While the flu virus can still be spread by contact with contaminated surfaces or people who are sick, it is less likely than the spread through droplets.

How can we help kids (and ourselves) stay healthy this winter?

One of the easiest ways to stay healthy this winter is also one of the simplest, wash your hands! When? All the time. Especially when out in public during the holiday season as crowds are significantly bigger and more germs are being spread. When you wash your hands, be sure to lather up the soap and scrub in between your fingers as this is one of the most common areas bacteria is missed. If you can’t wash your hands, use hand sanitizer.

In addition, take your vitamins and manage your stress! Shopping, traveling, and family can be major stressors during the holidays. Keep your immune system strong by drinking lots of fluids, getting rest, and eating a few vegetables here and there.

How does cold weather affect the sinuses?

While we tend to think of flus and colds during the holiday season, the sinuses are also affected. This is because the dry winter air dries out the mucus membrane which is one of our body’s natural defenses (mucus traps bacteria). Along with your vitamins, consider taking an oral probiotic. Oral probiotics have been shown to decrease the bacteria in the nose and upper respiratory tract ^[2], which will decrease sinus infections.

The holiday season is upon us and while it’s filled with holiday treats and time with loved ones, it can also be a time of germ spreading, decreased immunity, and getting sick. Stay healthy this winter by washing your hands, taking an oral probiotic with your Christmas cookies, and finding some time to rest among the hustle and bustle of the holidays.

Esmy Ornelas

Esmy Ornelas is a registered Dental Hygienist, writer, educator, and consultant with 10 years of experience in dentistry. She is passionate about education, empowering hygienists to advance their careers in and out of the operatory, and about community. She has written for RDH Magazine, the RDH Graduate, and is a full-time professor of Dental Hygiene and Assisting at Rose State College in Oklahoma.

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1. Centers for Disease Control and Prevention. (2022, September 20). How flu spreads. Centers for Disease Control and Prevention. https://www.cdc.gov/flu/about/disease/spread.htm
2. Ulrich Glück, Jan-Olaf Gebbers, Ingested probiotics reduce nasal colonization with pathogenic bacteria (Staphylococcus aureus, Streptococcus pneumoniae, and β-hemolytic streptococci), The American Journal of Clinical Nutrition, Volume 77, Issue 2, Pages 517–520, https://doi.org/10.1093/ajcn/77.2.517

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I woke up in a hurry like most mornings to get ready for work, kissed my husband goodbye, and headed out the door. About two hours later, I got an SOS call from him. “Babe, I woke up with a huge knot on the side of my neck. It hurts to swallow. I’m scared.”

That was the phone call that changed another aspect of my life. You see, my husband was critically injured in the line of duty several years ago, which resulted in a kidney-pancreas organ transplant. He ended up having to have the transplant kidney removed 7 years later. Before that incident, he had been a smokeless tobacco user for about 20 years. As a current dialysis patient along with past immunosuppression medication use from the transplant, his physician assumed he had a systemic infection but knew lymphoma was a possibility. As a dental hygienist, I thought maybe he might have a nasty abscess. So, while his physician started antibiotics, I had him come into the office for radiographs and an oral cancer screening. No abnormalities were seen that day. Not even a week later, he was diagnosed with Squamous Cell Carcinoma of the Left tonsil confirmed via biopsy. The cause was immunosuppression, HPV 16+, and prior smokeless tobacco use. As a hygienist, I felt like I failed. However, instead of focusing on the negative, I threw myself into learning all I could to help my husband through this diagnosis. I had to be a better advocate for not only him but for my patients, to make sure I was doing my due diligence in educating them on the risks, symptoms, and treatments of oral cancer. In addition, I had to make both the extra and intraoral cancer screenings a priority at every appointment with my patients as well as educate them about the human papillomavirus.

Risk factors and symptoms

As an organ transplant recipient, you are made abundantly aware of the statement, “It is not a matter of if you get cancer, but when”. Taking immunosuppressive medications is known to increase your chances of getting cancer. Most often it is a skin cancer, so imagine our surprise to learn he had oral cancer. As a hygienist, I have been taught the risk factors and pathology but I still had much to learn. Such as, did you know that one does not have to have any known risk factors to have oral cancer? Cancer is non-biased, but when one thinks of oral cancer they often relate it to tobacco. It turns out, tobacco and heavy alcohol use, immunosuppression, family history, and the human papillomavirus (HPV) are all risk factors. The high-risk strains HPV16 and HPV18 are the main strains which contribute to oral cancer and it is more common in men vs women over the age of 40 ^[1].

When oral cancer is caught early, there are successful outcomes. Hence, it’s essential to know the symptoms could include ulcers and persistent sores that do not heal within two weeks, an enlarged lymph node of the cervical chain of the neck, pain, unexplained weight loss, fatigue, and difficulty swallowing or speaking. As oral cancer progresses symptoms could also include bleeding, pain, or numbness in the mouth and loose teeth ^[2]. The rule of thumb is if you see or feel something suspicious and it does not heal or go away in two weeks let your medical provider know. In my husband’s case, we let his physician know right away due to the size of the enlarged lymph node and pain.

Oral Cancer screening

At every comprehensive exam, it is required to conduct an oral cancer screening, but what about conducting a screening at your follow-up or future dental cleaning appointments? Your dental hygienist and dentist should be providing a thorough extraoral and intraoral examination at least twice a year. During the screening, one should expect both an extraoral and intraoral examination. During the intraoral exam, all areas of the tongue, tissue, salivary glands, tonsils, and back of the throat are viewed. We are looking for a white or red patch of the gums, tongue, tonsil, or lining of the mouth, a hard-painless lump in the cheek, near the retromolar pads or the front teeth, irregular color or growth of tissue, or an open sore that does not go away ^[2]. The extraoral exam should include palpation of your jaw, throat, neck, and back of your head to evaluate any enlarged lymph nodes or cysts.

Did you know you could screen yourself for oral cancer at home? As a woman, we are told to self-examine ourselves for breast cancer. All individuals are told to look out for abnormal moles, and skin tags for skin cancer. So why are we not looking in our mouths for signs, or abnormalities that could be cancer? The best way to evaluate yourself at home is to look in the mirror for any changes to the skin and palpate the throat, the sides of your neck and the back of your head, including behind the ears. Then take a small flashlight and look in your mouth at both sides of the tongue, and the back of the throat. Keep in mind there are abnormal structures in the mouth that are harmless, such as tori and geographic tongue.

You have oral cancer, what now?

Talk to your medical and dental provider. Your radiation oncologist should inquire about your last dental exam, which is necessary before starting treatment should one’s oral cancer treatment plan include chemotherapy and radiation. Do you have any infections, decay, or gum disease? All crucial questions are due to the damaging effects radiation will have on the oral cavity. The truth is radiation burns! It damages the tissue to eradicate the cancer leaving painful sores, mucositis, and severe xerostomia which may lead to the patient having a feeding tube placed due to the pain experienced when eating. In worst-case scenarios, symptoms can result in future gross caries and osteonecrosis. Your dental provider can prepare you by providing any necessary restorative treatment, extractions, prescription fluoride toothpaste, and magic mouthwash. In addition, your dental hygienist can go over your home care plan which may include the fabrication of fluoride trays, and recommending xerostomia products in the form of gums, rinses, sprays, and gels to alleviate your symptoms.

Every cancer experience is different and may require less or more support. My husband is an oral cancer survivor with residual effects from radiation exposure including short episodes of paralysis to the left side of his tongue. There were plenty of times when he wanted to end treatment due to the pain. Fluoride trays had been made but the types of gel attempted for use were irritating to his tissues and due to his severe xerostomia, he could not take the pain. Therefore, other products were given to attempt to alleviate those symptoms. I say this because it will take some trial and error to get your overall care plan right but following the steps below were taken for his case. His care plan included brushing more frequently, rinsing his mouth every 4 to 6 hours with a non-hydrogen or non alcohol mouth rinse, using magic mouth rinse when necessary, and moisturizing lips with Aquaphor or Vaseline. It is important to note there is a waiting period before applying a chap-stick before radiation therapy^[3]. Avoiding spicy foods, citrus, tobacco, and alcohol is also necessary to avoid additional discomfort with radiation therapy.
Catching oral cancer early has a high cure rate. Knowing what to look for and knowing how to care for your symptoms is imperative to one’s success in completing treatment. If diagnosed with oral cancer there will be help along the way. You got this!

Chassidy Cassady

I have been in the dental industry for over a decade now and I still the love the profession! I love patient education and advocacy . Therefore, I will always continue to learn and grow. Not only is it a joy to change someones life, it is so rewarding to see the confidence it can give someone. Besides being a RDH, I enjoy time at home with my husband and fur-babies as well as writing, reading and traveling when able.

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1. www.ncbi.nlm.nih.gov/pmc/articles/PMC4107541/
2. www.nidcr.nih.giv/health-info/oral-cancer
3. www.mskcc.org/cancer-care/patient-education/mouth-care-during-your-treatment

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When you think of mouthguards, you may think of appliances that help to prevent the wear and tear that can happen to the teeth at night when you clench and grind , or you may think of the guards that professional athletes wear to protect their teeth from incoming hockey pucks, elbows, or basketballs. One thing you may not know is that sports mouth guards do more than protect athletes’ smiles; they help to protect their brains as well.

What is the origin of sports mouth guards?

Sports mouth guards have been around for more than a century. The first sport to require mouthguards was boxing in the 1920’s ^[4]. Even though this type of protective equipment is becoming increasingly more common, it is still optional in many sports, despite the risk the athletes endure if they choose to not wear them.

How do mouth guards protect the teeth?

Healthy children’s teeth help to ensure a good developmental pathway for the formation and eruption of healthy adult teeth. Childhood and adolescent dental health can set the stage for lifelong oral health… or the lack thereof. Dental sports injuries comprise up to 40% of children’s injuries ^[4]. The good news is that there is something we can do about that. Sports guards protect teeth from being chipped, broken, or even avulsed (knocked out) during sporting activities.

Who should wear sports guards?

Any person participating in sports with a high risk of dental or brain injury should wear a mouth guard ^{[2, 4]}. A few examples of this type of sport would include basketball, baseball, rugby, soccer, football, and martial arts. Whether the athlete is 5 years old or 85 years old, injury knows no age limit. Everyone should aim to protect their oral health.

But…how is the brain involved?

When an athlete receives a hit to the head, the teeth rattle together, creating a secondary blow that reverberates throughout the skull and the brain. By placing a quality cushioning layer between the teeth (i.e., a mouth guard), the secondary shock wave can be substantially reduced or eliminated. Studies show that proper use of a mouth guard during impact sports can reduce the incidence of concussion ^[3] The more we learn about the long-term effects of concussions on the brain, the clearer the importance of protecting our brains becomes.
Concussions can lead to traumatic brain injury. In 2019, a shocking 15% of the entire high school student population in the United States reported concussions related to recreational events within the preceding 12 months ^[1]

What to look for in a sports mouth guard

Some mouth guards are better than others! While purchasing an off-the-shelf guard will provide some protection, it’s important to note that not one size fits all. An athlete should shop for a mouth guard like they shop for a well-fitting pair of shoes.Even among members of the same team, the needs are different. To receive the biggest benefit, all athletes alike should seek out a custom-fit mouth guard.Custom-fit guards will offer the most comfort, safety, and accommodation of oral anatomy, such as arch size and muscle attachments.Different materials and fabrication techniques can be used to meet the needs of each person ^[5]

Rachel Stroble

Rachel Stroble is a researcher, professor of dental hygiene at Rose State College in Oklahoma, and registered dental hygienist with 10 years of experience in dentistry. She supports education in the classroom with her own students, in the professional community through the development and presentation of continuing education courses, and you may have seen her articles in RDH Magazine, Today’s RDH, and the Oklahoma Dental Association Journal.

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1. Centers for Disease Control and Prevention. (2022, December 15). Traumatic brain injury and concussion.
   https://www.cdc.gov/traumaticbraininjury/index.html
2. Knapik, J. J., Hoedebecke, B. L., Rogers, G. G., Sharp, M. A., & Marshall, S. W. (2019). Effectiveness of mouthguards for the prevention of orofacial injuries and concussions in sports: Systematic review and meta-analysis. Sports Medicine, 49(8), 1217–1232.
   https://doi.org/10.1007/s40279-019-01121-w
3. Ono, Y., Tanaka, Y., Sako, K., Tanaka, M., & Fujimoto, J. (2020). Association between sports-related concussion and mouthguard use among college sports players: A case-control study based on propensity score matching. International Journal of Environmental Research and Public Health, 17(12), 4493. https://doi.org/10.3390/ijerph17124493
4. Parker, K., Marlow, B., Patel, N., & Gill, D. S. (2017). A review of mouthguards:Effectiveness, types, characteristics and indications for use. British Dental Journal, 222(8), 629–633. https://doi.org/10.1038/sj.bdj.2017.365
5. Roberts, H. W., (2023). Sports mouthguard overview: Materials, fabrication techniques, existing standards, and future research needs. Dental Traumatology, 39(2), 101–108. https://doi.org/10.1111/edt.12809

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Did you know that prolonged high fever damages teeth? This is particularly true for children. Read on to learn more about the link between childhood illness and lifelong dental issues.

How does fever affect the body overall?

The human body generally maintains a stable temperature of 98.6 degrees Fahrenheit. A high fever is generally considered to be 102 degrees Fahrenheit or greater for children, or 103 degrees Fahrenheit or higher for adults ^[2]. When someone gets sick, their body works to fight illness by increasing their internal temperature. Fever often causes aching muscles and joints, and chills. During a febrile state (fever), the body’s metabolism speeds up and uses its own proteins as an energy source ^[6]. This is a shift from the body’s typical use of glucose, the sugar normally found in the blood. There is also an increased need for oxygen and a higher heart rate ^[6]. Prolonged fever can damage critical organs including the brain, heart, and kidneys ^[6]. What’s more, fever can damage teeth!

Who is most at risk for dental problems due to fever?

Children are at the highest risk of damage to teeth due to fever. Before teeth erupt, they slowly form inside the jaw bone in specialized capsules of tissue also known as tooth buds. Children under 12 have teeth that have not come in yet, so they have tooth buds inside the jaw bone where there is a possibility that the formation of the teeth can be disrupted.

How does fever damage teeth?

Teeth are formed through an amazing process that happens inside the bone. There are various different types of special cells that build the teeth layer by layer before they erupt. When the intricate tooth development process is disturbed, the enamel may suffer. When this happens, teeth erupt as rough, pitted, and discolored ^[1].

How does childhood fever cause dental problems in adulthood?

Even though fever damages teeth before they erupt, weak enamel comes with lifelong consequences. These teeth are at a higher risk of dental disease. Poorly formed enamel is not as strong as healthy enamel. Roughness and pitting in teeth cause them to retain more plaque because bacteria have more places to hide and attach. This makes it more difficult to effectively keep the oral cavity clean. Increased plaque retention results in more acid attack on the enamel, which causes an increased risk of dental decay ^[5]. Plaque also contains bacteria that are responsible for gum disease ^[5].

How can I protect my child’s teeth?

If your child has a fever, call a physician to see if a visit to the doctor’s office is needed, or if over the counter fever-reducing medications should be administered. Common fever-reducing medications are acetaminophen and ibuprofen. It is critical that you follow correct dosing instructions since children do not need adult-sized dosages. Too much of certain medications can cause serious damage to the liver ^[3]. Some children may not be able to take these medications, so be sure to follow your doctor’s guidance. Never give aspirin to a child or adolescent, as it increases the risk of Reye syndrome, a serious condition that can cause brain damage or even death ^[4]

Rachel Stroble

Rachel Stroble is a researcher, professor of dental hygiene at Rose State College in Oklahoma, and registered dental hygienist with 10 years of experience in dentistry. She supports education in the classroom with her own students, in the professional community through the development and presentation of continuing education courses, and you may have seen her articles in RDH Magazine, Today’s RDH, and the Oklahoma Dental Association Journal.

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1. Fatturi, A. L., Wambier, L. M., Chibinski, A. C., Assunção, L. R. da S., Brancher, J. A., Reis, A., & Souza, J. F. (2019). A systematic review and meta‐analysis of systemic exposure associated with molar incisor hypomineralization. Community Dentistry and Oral Epidemiology, 47(5), 407–415. https://doi.org/10.1111/cdoe.12467
2. Mayo Clinic. (n.d.) Fever. https://www.mayoclinic.org/diseases-conditions/fever/symptoms-causes/syc-20352759#:~:text=a%20preexisting%20illness.-,Adults,Severe%20headache
3. Normandin, P. A., Benotti, S. A., & Mullins, M. A. (2020). Hidden Danger: Pediatric Acetaminophen Overdose Unintentional and Intentional Emergencies. Journal of Emergency Nursing, 46(6), 914–922. https://doi.org/10.1016/j.jen.2020.06.015
4. Schror, K. (2007). Aspirin and Reye Syndrome: A Review of the Evidence. Paediatric Drugs, 9(3), 195–204. https://doi.org/10.2165/00148581-200709030-00008
5. Scharnow, A. M., Solinski, A. E., & Wuest, W. M. (2019). Targeting S. mutans biofilms: A perspective on preventing dental caries. MedChemComm, 10(7), 1057–1067. https://doi.org/10.1039/c9md00015a
6. Swetha Balli; K. R. Shumway; S. S. (2022). Physiology, Fever. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK562334/

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Some say the eyes are the window to the soul. But did you know your nails are a window to your health? The human body gives us lots of signals as to what it needs, if we only know where to look. Your nails are one of the key signposts we can use to help us understand our own health.

Your nails are an indicator of your nutrition

There are certain signs in your nails to look for that can indicate that you have a nutritional deficiency. For instance, nails that appear particularly pale are a sign that you are lacking in iron^[5]. White bands that cross the nails can signify calcium or zinc deficiency ^[5] your nails are soft and often separating (flaking), you might be lacking adequate magnesium in your diet ^[5]. Soft nails can also be related to low levels of vitamins A and D ^[5]. If you’ve noticed dark red or brown lines that look like splinters under your nails, you may be lacking in vitamin C, or you could be suffering from something much more serious, like kidney disease ^[3][5].

Your nails can alert you to other health problems

Certain nail conditions can alert you to very serious health circumstances. Nail clubbing is usually evidence of serious lung conditions such as COPD or heart conditions like congestive heart failure ^[2]. Dry, brittle nails can be a sign of thyroid disease ^[1]. If your nails appear yellow, it could be due to nicotine staining if you smoke, nail fungus, or even lung disease or diabetes ^[6]. Blue-tinted nails indicate an immediately urgent situation—low oxygen ^[6]. This can occur for many reasons, such as asthma or COPD, but can occur in anyone and should be taken very seriously.

Biting your nails is worse than you think

If your mother told you to stop biting your nails as a kid, she knew what she was talking about! Nail biting is often seen as an annoying habit that leaves nails and cuticles looking ragged. However, nail biting is also quite unsanitary. Throughout the day we touch many germy surfaces: cell phones, elevator buttons, pens, and much more. When people chew their nails, they are taking all of those collected germs and introducing them into their mouths. Many types of illnesses can be transmitted this way, such as the flu, a cold, or something more serious. Even more alarmingly, nail biting can transmit parasitic pinworm infections ^[4]!

Additionally, nail biting and cuticle chewing can lead to infection of the hands. When skin is nipped or torn with the teeth, an open wound (though it may be small) is created, and bacteria and other microbes are introduced into it. Human mouths contain many varieties of bacteria, in addition to the bacteria that are on the outer surface of the adjacent skin. When infection occurs, swelling, redness, and tenderness will result.

Nail biting affects your oral health too

The community of microbes that live in your mouth is known as the oral microbiome. Your microbiome plays a huge role in your overall and oral health. By putting germy fingers in your mouth, you run the risk of introducing specific types of bad bacteria into your oral microbiome, like those that are responsible for cavities and gum disease. Additionally, nail biting can cause trauma to your gums, and can even lead to an infection of the traumatized area. In closing, there are many reasons to work on breaking this damaging habit!

Rachel Stroble

Rachel Stroble is a researcher, professor of dental hygiene at Rose State College in Oklahoma, and registered dental hygienist with 10 years of experience in dentistry. She supports education in the classroom with her own students, in the professional community through the development and presentation of continuing education courses, and you may have seen her articles in RDH Magazine, Today’s RDH, and the Oklahoma Dental Association Journal.

View My Profile Contact Rachel

1. American Academy of Dermatology Association. (n.d.). Thyroid disease: a checklist of skin, hair, and nail changes. https://www.aad.org/public/diseases/a-z/thyroid-disease-skin-changes
2. Burcovschii S. & Aboeed A. (2019, April 11). Nail clubbing. In StatPearls. StatPearls Publishing. https://europepmc.org/article/nbk/nbk539713
3. Cleveland Clinic. (2022, June 25). Splinter Hemorrhages. https://my.clevelandclinic.org/health/diseases/23341-splinter-hemorrhage
4. New York State Department of Health (2011, October). Pinworm infection. https://www.health.ny.gov/diseases/communicable/pinworm/fact_sheet.htm
5. Seshadri, D. & De, D. (2012). Nails in nutritional deficiencies. Indian Journal of Dermatology, Venereology, and Leprology, 78(3), 237–241. https://doi.org/10.4103/0378-6323.95437
6. WebMD. (2022, April 26). Slideshow: What Your Nails Say About Your Health. https://www.webmd.com/skin-problems-and-treatments/ss/slideshow-nails-and-health

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“It’s raining, it’s pouring. The old man is snoring. And he couldn’t get up in the morning.”- Mother Goose

That nursery rhyme may seem innocent enough, however it sounds as if the poor old man may have possibly suffered from sleep apnea. This disorder affects as many as 22 million Americans alone.

What is obstructive sleep apnea?

Obstructive sleep apnea is the most common, often undiagnosed sleep-related disorder that occurs when you have abnormal reductions in your breathing while you are sleeping.^[1] This is a serious disorder as it may cause you to stop breathing for 20 to 30 seconds numerous times throughout the night, on average 5 times per hour.^[1][2] These disruptions can not only reduce the quality of your restful phases of sleep, but can also lead to potentially serious health conditions if left untreated.^[3]

Sleep & obstructive sleep apnea

Obstructive sleep apnea occurs when the upper airway is blocked or constricted while the individual is sleeping, preventing air from passing through normally and contributing to a buildup of carbon dioxide.^[1][5][6] The person suffering from this disorder awakens due to the blocked airway, gasps for air or takes deep breaths and is often heard snorting or choking.^[1] If this disorder is left untreated it increases the individuals risk to diseases such as heart disease, stroke, diabetes, headache syndromes, high blood pressure, congestive heart failure, and can cause heart rhythm problems.^[3][5] Obstructive sleep apnea may also be the cause for job impairment, work-related accidents, motor vehicle crashes, as well as poor school performance in children and adolescents. ^[5]

Symptoms of sleep apnea

• Loud snoring that is often accompanied with grasping, snorting, or choking sounds.^[1][2]
• Restless sleep that has you kicking, thrashing, jerking often accompanied with periods of insomnia throughout the night.^[1][2]
• Irritability, frustration, or difficulty focusing. (1).^[1]
• Dry mouth or a sore throat upon awakening.^[1][5]
• Excessive tiredness, daytime sleepiness, or fatigue.^[1][2][5]
• Headaches.^[5]
• Sexual dysfunction or decreased libido.^[6]
• Bad breath that won’t go away.^[4]
• High blood pressure.^[6]

Risk Factors

• Age: Sleep apnea can occur at any age even amongst infants and children, however the risk increases with age throughout adulthood especially amongst people over the age of forty. ^[1][5]
• Body weight: Research has shown a correlation between individuals who have a higher body mass index, are overweight, or are obese.^[1][3]
• Sleeping position: People who sleep on their back are more prone to the disorder due to how the sleeping position affects the airways shape and positioning of the tissue supporting the airway.^[1]
• Medications: Chronic prolonged use of opioid drugs and some prescription medications increase one’s risk.
• Structural Abnormalities: Individuals who have large necks, enlarged tonsils, small jaw with an overbite, or nasal obstruction have and increased risk.^[5]
• Smoking.^[6]
• A family history of sleep apnea.^[6]
• Asthma.^[6]

Treatment:

One of the most common ways to treat obstructive sleep apnea is to sleep with a CPAP (continuous positive airway pressure) machine and mask.(1) The machine keeps the airway open and delivers constant steady pressure to help you breathe while you sleep.^[1]

Your dentist might discuss with you the option of getting a custom-fitted oral appliance therapy made. Dental appliances help prevent the tongue from blocking the throat and can advance the lower jaw forward, thus helping to keep the airway open while sleeping.^[5]

Surgery might be suggested that removes excess tissue in the throat and expands the airway.^[1] This might prove helpful to individuals who have tissue that is obstructing their airway. Another option it to have a surgical treatment that implants a device that stimulated a nerve to help control your breathing.^[1][5] Other surgery options are to repair abnormalities that cause obstructions when you breath, removal of adenoids and tonsils, or repairing the defects in facial structures.^[3]

Many have found that making lifestyle changes such as: losing weight, exercising regularly, alternating sleep positions, and reducing alcohol consumption has helped them to manage their symptoms.^[5]

It is important to discuss any symptoms you have with your medical doctor or your dentists so that you can avoid the risk of major health problems.^[3] They will probably recommend a sleep study that will determine your breathing patterns and help the doctor develop a customized treatment plan for you to treat and manage your condition.^[3]

Kari Carter-Cherelus

Kari Carter-Cherelus RDH, DA is a registered Dental Hygienist, writer, consultant, coach, international keynote speaker, with 23 years of experience in dentistry. She is passionate about helping others recover from burnout, improving organization’s work culture, and helping her clients to improve their mindset. She authored the book The Ultimate Guide For Dental Hygienist Burnout, and has written for RDH Graduate, RDH Magazine, and Inside Dental Hygiene.

View My Profile Contact Kari

References

1. Sleep Foundation. https://www.sleepfoundation.org/sleep-apnea
2. John Hopkins Medicine. 4 Signs You Might Have Sleep Apnea. https://www.hopkinsmedicine.org/health/wellness-and-prevention/4-signs-you-might-have-sleep-apnea
3. John Hopkins Medicine. Obstructive Sleep Apnea. https://www.hopkinsmedicine.org/health/conditions-and-diseases/obstructive-sleep-apnea
4. Mayo Clinic. CPAP machines: Tips for avoiding 10 common problems. 2021, October 27. ://www.mayoclinic.org/diseases-conditions/sleep-apnea/in-depth/cpap/art-20044164
5. Cleveland Clinic. Oral Appliance Therapy for Obstructive Sleep Apnea. https://my.clevelandclinic.org/health/treatments/21129-oral-appliance-therapy-for-sleep-apnea
6. Mayo Clinic. 2021, October 27. Sleep Apnea. ://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090

The post Sleep Apnea: Causes, symptoms and treatments appeared first on Smile Brilliant.

The mouth is the entry point to the body. Though commonly treated separately by medical & dental providers, there is actually a clear link between the two systems: oral health influencing overall (systemic) health and vice versa. In fact, early signs of systemic diseases are often detected first by dental providers at routine exams.

The mouth is connected to the rest of the body!

While this may seem obvious, you would be surprised how often dental professionals hear patients say things like “Why do you need to know about my medications (or heart health, etc.), I’m just here for a cleaning!” In fact, the mouth plays a very important role in the overall health of the body. Likewise, it is critical for your dental health providers to know your health conditions in order to provide safe health care.

Oral health serves as an indicator for overall health

Dental hygienists and other dental providers are on the front lines for detecting unsuspected health conditions in their patients. For instance, signs of diabetes, pregnancy, or even cancer may be detected in the mouth first, before other diagnostic methods have identified them.

Dental disease can cause systemic disease

This is key. Studies have shown that dental disease such as periodontitis, also known as gum disease, can increase the risk of other very serious systemic diseases, such as heart disease, stroke, and diabetes. Newer evidence even suggests that chronic periodontitis even plays a role in a debilitating, currently incurable, and sometimes fatal disease: Alzheimer’s^[1]. Periodontal disease increases inflammation in the body. Furthermore, the bad bacteria cause periodontal disease can enter the bloodstream and travel to other parts of the body. Periodontal pathogens have been found in arterial plaques associated with heart disease, as well as in the brains of patients with Alzheimer’s disease ^[1][4]. Additionally, people with periodontal disease are at higher risk of developing diabetes. If someone has uncontrolled periodontal disease, it makes their diabetes more difficult to control ^[3]. Likewise, if someone has uncontrolled diabetes, they will have a more difficult time getting their periodontal disease under control. This is due to delayed wound healing caused by diabetes, as well as the increased levels of sugar in the blood, which bacteria all over the body feed upon.

Systemic diseases often have oral manifestations

Some people think they are going to the dentist only to have their teeth “scraped” or polished. However, through thorough examination, your dental hygienist or dentist may see red flags that point to other undiagnosed systemic conditions. Cancer or other masses in the body may be detectable through changes in consistency, color, or appearance of the oral tissues, eyes, face, or neck ^[2]. When a patient’s gums don’t heal as expected after a procedure, it may be a sign of diabetes. Ulcerations in the mouth could point to undiagnosed gastrointestinal issues, such as Crohn’s disease. Viral, bacterial, and fungal illnesses may also be seen in the mouth. Autoimmune diseases such as lupus or rheumatoid arthritis may inhibit salivary flow, which increases the risk of cavities. Dental providers may even be able to identify nutritional deficiencies by looking in your mouth ^[2]!

Taking care of your mouth is part of taking care of your whole body

By performing good oral hygiene at home and seeing your dental care team at the recommended time interval, you are not only helping to keep your smile in top condition. These oral care visits are essential to maintaining oral health and supporting your whole-body health as well. You can help to lower your body’s inflammatory load and keep disease causing bacteria at bay. You can also rely on your dental health provider to serve as a crucial part of your medical care! They may be the first defense in detecting very serious systemic conditions ^[2].

Rachel Stroble

Rachel Stroble is a researcher, professor of dental hygiene at Rose State College in Oklahoma, and registered dental hygienist with 10 years of experience in dentistry. She supports education in the classroom with her own students, in the professional community through the development and presentation of continuing education courses, and you may have seen her articles in RDH Magazine, Today’s RDH, and the Oklahoma Dental Association Journal.

View My Profile Contact Rachel

References

1. Dioguardi, M., Crincoli, V., Laino, L., Alovisi, M., Sovereto, D., Mastrangelo, F., Russo, L. L., & Muzio, L. L. (2020). The role of periodontitis and periodontal bacteria in the onset and progression of Alzheimer’s disease: A systematic review. Journal of Clinical Medicine, 9(2), 495. https://doi.org/10.3390/jcm9020495
2. Porter, S., Mercadante, V. & Fedele, S. Oral manifestations of systemic disease. (2017). British Dental Journal 223, 683–691. https://doi.org/10.1038/sj.bdj.2017.884
3. Preshaw, P., Bissett, S. (2019) Periodontitis and diabetes. British Dental Journal 227, 577–584. https://doi.org/10.1038/s41415-019-0794-5
4. Sanz, M., Marco del Castillo, A., Jepsen, S., Gonzalez-Juanatey, J., D’Aiuto, F., Bouchard, P., Chapple, I., Dietrich, T., Gotsman, I., Graziani, F., Herrera, D., Loos, B., Madianos, P., Michel, J., Perel, P., Pieske, B., Shapira, L., Shechter, M., Tonetti, M., … Wimmer, G. (2020). Periodontitis and cardiovascular diseases: Consensus report. Journal of Clinical Periodontology, 47(3), 268–288. https://doi.org/10.1111/jcpe.1318

The post The oral-systemic connection: how oral health influences overall health appeared first on Smile Brilliant.

Most kids get an ear infection in their first few years because their immune system is just developing. For some, ear infections become chronic & require antibiotics, which can actually disrupt the natural bacterial balance of the nose & sinuses, leaving the child more at risk for future infections. Find out an easy way to intervene at home to stop this cycle.

What is an ear infection?

Ear infections are prevalent in children; however, there are three different types of ear infections, which can be confusing.

Acute otitis media (AOM) is the term for middle ear infections.^[1][9] Acute otitis media is one of the most common illnesses evaluated by pediatricians and is often related to a current or recent upper viral respiratory tract infection, also known as a common cold. (1,8) About 50% of all children will have at least one ear infection by the time they reach their second birthday.^[1]

Otitis media with effusion (OME) occurs when fluid in the middle ear space is not infected, and this type of ear infection does not require antibiotics. ^[1][8] OME, or “glue ear,” is when fluid is in the middle ear without acute infection symptoms that can cause temporary hearing loss and has been identified as a principal cause of balance instabilities and vertigo in children.^[1][2][8]

Otitis externa is an infection of the space outside of the eardrum and involves the ear canal. Sometimes, this condition is known as swimmer’s ear.^[1][3][8] The most common cause of acute otitis externa is a bacterial infection, which may be associated with allergies, eczema, and psoriasis.^[3] Oral antibiotics have not been proven beneficial, and their inappropriate use will increase resistance among common otitis externa pathogens.^[3]

Ear infection symptoms

Chronic ear infections should not be ignored because they can lead to serious health conditions.

Some of the most common symptoms of an ear infection are pain, fever, difficulty hearing, and pressure inside the ear. Children may start to pull at their ears, lose their balance, and experience a reduction in energy. Chronic ear infections begin as acute infections that leave a hole in your ear that never heals, allowing bacteria to worsen the condition. Other complications of chronic ear infections include an eardrum to burst, headaches, dizziness, or ringing in the ears (tinnitus).

One rare disorder of chronic ear infections is palatal myoclonus, a rhythmic, involuntary, jerking movement of the soft palate.^[4][5][6] This condition means the muscle in the back of the throat constantly twitches, sometimes with an audible clicking noise. The only treatment options provided were surgically cutting the muscle, placing Botox injections, or leaving it as is.

People with chronic ear infections can develop a cholesteatoma in the middle ear. A cholesteatoma is a growth that looks like skin and isn’t cancerous. Still, it increases your risk of having serious complications such as hearing loss that doesn’t get better, infections in other parts of your ear, the bones of your skull, or your brain, or damage to the nerve that controls movements in your face.^[7]

Ear anatomy and how it affects chronic ear infection sufferers

The inner ear is significant for hearing and balance, and chronic infection of the tonsils or adenoids can also lead to more ear infections. Your tonsils are two lymph nodes and are an important part of your immune system, helping fight off infection. Enlarged tonsils, a common cause of ear infections, occur when bacteria or viruses get trapped in the tonsils and enter the middle ear through the eustachian tube, causing inflammation and pain.

Why do kids get ear infections more than adults?

Chronic ear infections are a common problem for children but can also occur in adults. Children get ear infections more than adults because their immune systems are underdeveloped. Five out of six children will have at least one ear infection by their third birthday.^[8]

Typical treatments for kids’ ear infections?

Treatment for chronic ear infections should be individualized. Antibiotics only work against bacteria, so they can’t help with viral infections like the common cold and flu. Most ear infections can be treated with over-the-counter pain-relieving medications, rest, and extra fluids to allow your immune system to fight the infection because most ear infections only last a few days. However, children who develop problems with chronic ear infections may require surgical repair.

Probiotics can help to disrupt the cycle of ear infections

Like every parent or guardian, we do our best to protect our children from getting sick and being in pain. Oral probiotics, healthy bacteria, are one of the effective treatments for ear infections. A study testing the effectiveness of probiotics showed that taking probiotics decreased the number of children acquiring other infections or having to take antibiotics for any infection.^[9] Antibiotics kill both good and bad bacteria, and overuse can lead to antibiotic resistance. Adding probiotics to your daily regimen, in addition to proper hand hygiene, will help reduce your chances of acquiring an infection.

Lacy Walker

LACY WALKER, RDH, BS, CDA, FAAOSH - dental hygienist, speaker, owner of Shared Hygiene, LLC, & writer w/ 25 years of experience in the dental field working in a psychiatric hospital, cosmetic, restorative, DSO, and periodontal practices. Lacy is the CE Director for A Tale of Two Hygienists podcast & Public Relations Chair for the AADH. She has a passion for the oral-systemic connection & is published in DACE, RDH Magazine, & DrBicuspid. Lacy is an approved provider of CE credits through AADH.

View My Profile Contact Lacy

References

1. Paul CR, Moreno MA. Acute Otitis Media. JAMA Pediatr. 2020;174(3):308. doi:10.1001/jamapediatrics.2019.5664
2. Sabir, O. A., Johnson, E. G., Hafiz, A. E., Nelson, R. N., Hudlikar, M., Sheth, I., & Daher, N. S. (2021). Chronic Effects of Pediatric Ear Infections on Postural Stability. International journal of pediatrics, 2021, 6688991. https://doi.org/10.1155/2021/6688991
3. Medina-Blasini Y, Sharman T. Otitis Externa. [Updated 2022 Aug 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556055/
4. Palatal Myoclonus. (n.d.). Science Direct. https://www.sciencedirect.com/topics/medicine-and-dentistry/palatal-myoclonus
5. Kim JS, Caplan LR. Verterobasilar disease. In: Grotta JC, Albers GW, Broderick JP, et al, eds. Stroke: Pathophysiology, Diagnosis, and Management. 6th ed. Philadelphia, PA: Elsevier; 2016:chap 26
6. Walker, Lacy. (2020, Jan 14). Why you need to know about palatal myoclonus. DrBicuspid. https://www.drbicuspid.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=325748
7. The Manual’s Editorial Staff. Content last modified Sep 2022.Chronic Ear Infection (Chronic Otitis Media). https://www.msdmanuals.com/home/quick-facts-ear,-nose,-and-throat-disorders/middle-ear-disorders/chronic-ear-infection-chronic-otitis-media
8. National Institute on Deafness and Other Communication Disorders. (Last Updated Date: March 16, 2022). Ear Infections in Children. https://www.nidcd.nih.gov/health/ear-infections-children
9. Scott, A. M., Clark, J., Julien, B., Islam, F., Roos, K., Grimwood, K., Little, P., & Del Mar, C. B. (2019). Probiotics for preventing acute otitis media in children. The Cochrane database of systematic reviews, 6(6), CD012941. https://doi.org/10.1002/14651858.CD012941.pub2

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