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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Over the years there has been a rise in the usage of electronic cigarettes also known as “e-cigs,” “vapes,’ “e-hookahs, “vape pens,” and “electronic nicotine delivery systems (ENDS.)”^[2] The devices can look like traditional cigarettes, cigars, or pipes or they can be more unconventional in their design and resemble USB flash drives, pens, or something that is less detectable.^[2] This can be concerning as many youths could be potentially damaging their health while their caregivers are completely unaware.

The rise of underage use

It has been reported by various news outlets that there has been widespread usage of vapes by youths in schools in classrooms and bathrooms.^[8] The popularity amongst youth is attributed by researchers to the sweet flavoring that many companies incorporate into the vapor that is inhaled. Many youths believe that vaping is less harmful than smoking cigarettes. Vapes can also be less expensive than traditional cigarettes overtime which is more economical for the younger population.^[3][8] The U.S. Food and Drug Administration (FDA) prohibited the sale of prefilled cartridge e-cigarettes in any flavor other than tobacco or menthol, on January 2, 2020 unless authorized by FDA. Restricting harmful marketing tactics that were directed at young ones was instituted as well so as to help decrease the usage of these products by youths which was on the rise.^[8]

Oral health implications

Most popular reports tend to focus on the potential dangers using electronic cigarettes can have on one’s heart and lungs.^[1] The rise of vaping has lead to an outbreak of lung injuries and deaths that have been attributed to the individuals vaping habits.^[3] Research also shows that there is a negative correlation with the use of e-cigarettes and poor oral health.^[1] Nicotine in any form whether it is smoked or vaped restricts the blood flow to the gums.This restriction increases one’s risk to periodontal (gum) disease, inflammation, tooth cavities, and oral cancer.^[1]

Why vaping is not actually a safer alternative

Some e-cigarette users may have turned to vaping because they considered it a safer alternative to using traditional cigarettes. Research however, shows that the nicotine delivery and emission of some e-cigarettes is comparable to those from traditional cigarettes.^[6] E-cigarettes use a battery that heats up the liquid called “e-juice” into an aerosol that is inhaled by users. Some users think the steam from the vape pens are harmless water vapor when in actuality they can contain the following chemicals: nicotine, propylene glycol, formaldehyde, acetaldehyde, acrolein, dactyl, dtiethylene glycol, cadmium, benzene, heavy metals, and ultra fine particles that can be inhaled deep into the lungs.^[5][6] Many of these chemicals are considered to be cancer causing carcinogens that are also linked to causing lung disease, are weed killers, are used in explosives, or are used in antifreeze.The chemicals found in e-cigarettes increases an individual’s risk to gum disease, cavities, and oral cancer.^[1]

Gum disease & your health

The gums are the foundation of your mouth and aid in supporting your teeth and protecting the roots of your teeth. They provide a protective barrier between harmful oral bacteria that can affect our overall health and wellness. When someone has gum disease their gums are compromised. The gums aren’t able to protect the mouth from harmful bacteria due to being infected and inflamed. From the moment that the vapor from the e-cigarettes enter your body from the mouth, the toxic cocktail of chemicals begin to inflict damage.^[1] Nicotine in any form, whether it is vaped, smoked, or chewed restricts the blood flow to the gums and contribute to gum (periodontal) disease. Vaping can cause mouth and throat irritation, and cause the gums to become tender, swollen, and red.^[4] If the fluid in the vape contains nicotine, then there is an increased risk of teeth stains and discoloration, teeth grinding, and receding gums. Individuals with gum disease have an increased risk of having cardiovascular disease, diabetes, chronic respiratory disease, pregnancy complications, dementia, and cancer.^[6]

The time to quit is now

Quitting the use of tobacco can be difficult if you try to do it without the help of a healthcare professional. Often users relapse as tobacco dependence is a difficult habit to break. Talking with a healthcare provider can increase your chances of being successful. Your provider might counsel you and recommend cessation medications that are approved by the US Food and Drug Administration that are evidenced based treatments. Your health is worth all the effort that you make to maintain a healthy lifestyle and move towards having overall health and wellness.

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.

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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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What is gingivitis?

Gingivitis is inflammation of the gums that can be caused by several factors, including poor dental hygiene, diet, hormones, and certain medications. If gingivitis is untreated, it can progress to more severe gum disease, periodontal disease, and bone loss. The condition is isolated to the soft-tissue area of the gingival epithelium and connective tissue. ^[1]

Gingivitis is a less serious form of periodontal disease and is a common condition affecting the gums. Gingivitis can be caused by a build-up of plaque leading to inflammation, redness, and bleeding gums, which is the most typical cause of gingivitis. Plaque is a biofilm that accumulates on the tooth surface and contains many bacteria. Leaving gingivitis untreated can progress to periodontitis, a more serious form of gum disease.

Periodontitis is when the periodontal condition has progressed beyond gingivitis into a chronic, destructive, and irreversible inflammatory disease state. If left untreated, bone loss and further destruction of the supporting tissue surrounding the tooth can become damaged, resulting in tooth loss and bad breath, and may complicate other systemic conditions.

Genetics, environmental, and behavioral factors are involved in the development of the disease, the exposure of susceptible individuals to its initiation, and the speed of progression. ^[2] Strong contributing factors to periodontal disease include smoking, diabetes mellitus, metabolic syndrome, and obesity.^[2]

The oral microbiome

The oral microbiome is defined as a collection of microorganisms that reside in the oral cavity. Oral bacteria can populate the human mouth as early as the day you are born. If these bacteria are imbalanced, the harmful bacteria can grow and cause destruction to your teeth and gums, leading to cavities and gum disease.

Common causes typically associated with gingivitis

Diet

An individual’s diet plays a significant role in their oral health, and what you eat directly impacts your oral health. Gingivitis may occur due to a vitamin C deficiency.^[1] A balanced diet rich in nutrients helps to keep teeth and gums healthy. On the other hand, sugary and acidic foods can influence a person’s oral environment making it more susceptible to tooth decay and gum disease. Be mindful of your dietary habits to maintain good oral and systemic health.

Hormones

Hormones play an essential role in oral health. Fluctuations in hormone levels can cause changes in the mouth, such as increased sensitivity or dryness. During adolescence, gingivitis appears earlier in girls (eleven to thirteen years) than in boys (thirteen to fourteen years).^[1]

During pregnancy, it has been suggested that estrogen levels determine the severity of gingival inflammation created against the biofilm at the gingival margin.^[1] Maintaining good oral health will reduce the risk of adverse pregnancy outcomes.

Oral pH

Saliva plays an essential role in oral health by washing away food particles and bacteria, influencing tartar formation and gum disease, and keeping the mouth hydrated. Saliva has a normal pH range of 6.2-7.6, with 6.7 being the average pH.^[3]. Healthy saliva contains basic compounds that neutralize acids produced by plaque bacteria.

Pathogens

Salivary diagnostics are a non-invasive way to determine if harmful pathogens are present. Many studies have observed that periodontal pathogens grow at particular pH environments.^[4]

Medications

Certain medications can also affect oral health. Several drugs prescribed for systemic conditions can cause drug-induced gingivitis as a side effect, such as phenytoin (used for epileptic seizures), calcium channel blockers (used for angina and high blood pressure), anticoagulants, and fibrinolytic agents, oral contraceptive agents, protease inhibitors, vitamin A and analogs.^[1]

Gingival Hyperplasia (Enlargement)

Drug-induced gingival overgrowth (DIGO), also referred to as drug-induced gingival enlargement, is noted as a side-effect of certain medications given for non-dental uses where the gums are not the intended target.^[1][5]

Gingivitis Prevention

The best way to prevent gingival inflammation is to perform beneficial oral hygiene practices including brushing and cleaning in between the teeth, eating a healthy diet, and avoiding tobacco and vaping products. Continuous collaboration and communication with your primary care physician and dental healthcare professionals will help prevent gingivitis.

If you’re concerned about how hormones, your daily oral hygiene practices, pathogens, diet, or medications may be impacting your oral health, speak to your dentist and healthcare provider for a more holistic approach to your oral-systemic health.

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.

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1. Rathee M, Jain P. Gingivitis. [Updated 2022 Jun 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557422/
   
2. Könönen, Eija, Mervi Gursoy, and Ulvi Kahraman Gursoy. 2019. “Periodontitis: A Multifaceted Disease of Tooth-Supporting Tissues” Journal of Clinical Medicine 8, no. 8: 1135. https://doi.org/10.3390/jcm8081135
3. Baliga, S., Muglikar, S., & Kale, R. (2013). Salivary pH: A diagnostic biomarker. Journal of Indian Society of Periodontology, 17(4), 461–465. https://doi.org/10.4103/0972-124X.118317
4. Koppolu P, Sirisha S, Penala S, et al. Correlation of Blood and Salivary pH Levels in Healthy, Gingivitis, and Periodontitis Patients before and after Non-Surgical Periodontal Therapy. Diagnostics (Basel). 2022;12(1):97. Published 2022 Jan 3. doi:10.3390/diagnostics12010097
5. Tungare S, Paranjpe AG. Drug Induced Gingival Overgrowth. [Updated 2022 Sep 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538518/

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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.

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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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While dental cleanings make your teeth whiter and brighter, there is more that goes into a dental cleaning than you might expect. Before you arrive, your dental hygienist reviews your dental chart and medical history. Once you arrive to your appointment, they may check your blood pressure and other vitals. They may also perform a head and neck exam, which helps to detect many types of conditions that can affect your whole body, such as cancer or thyroid disease. Your hygienist takes measurements of your gums that help them to determine if you have periodontal disease, and if so, to what extent. All of this happens before any of the cleaning actually begins!

Dental cleanings treat disease or help to prevent it

Dental professionals commonly use the phrase “dental cleaning” with their patients, but there are actually different types of dental cleanings. Some types are preventive in nature, such as a dental prophylaxis. Others even treat disease, such as non-surgical periodontal therapy. There are also types that help to maintain stability in oral condition, such as periodontal maintenance. So, when your dental healthcare provider says something about a dental cleaning, they are actually referring to a procedure that is specialized to your needs, not just a one-size-fits-all appointment.

Dental cleanings are more than just polishing

Many people think that polishing is the dental cleaning. Polishing removes plaque buildup and stains. Most of what can be accomplished by polishing can actually be done with a regular toothbrush and toothpaste. However, the most important part of the actual removal of build up on the teeth is scaling. During scaling, dental hygienists use hand instruments or an ultrasonic scaler (or most commonly, a combination of the two) to remove calculus from the teeth. You may be more familiar with the term tartar, which is the older terminology for calculus. Removal of calculus is very important for maintenance of health and prevention of disease because it harbors toxins and microbes, including disease-causing bacteria ^[2].

Dental cleanings are essential to whole-body health

Periodontal disease, also known as gum disease, has been scientifically linked to serious systemic diseases, including heart disease, diabetes, and rheumatoid arthritis ^[3]. The bad bacteria that cause periodontal disease have been found in the arterial plaques in people with heart disease, as well as in the brains of people with Alzheimer’s ^[1][3]! Also, increased inflammation in the mouth leads to more inflammation throughout the body ^[3]. The mouth is connected to the rest of the body, and any illness that impacts the mouth can have an effect on overall health. Just as your hands, eyes, and heart are part of your body, so is your mouth!

Different people need dental cleanings at different time intervals

Your dental hygienist will make a specific recommendation for how often you should receive dental care. They will consider how much inflammation you have, how quickly you accumulate calculus, your homecare habits, your systemic risk factors, and many other elements. Common recommendations are three, four, and six months. Many people need care more often than dental insurance will cover. Keep in mind that your hygienist is making their recommendations based on your individual needs, whereas your insurance benefits are pre-set, regardless of your oral health. If you are having a hard time affording the dental care you need, talk with your dental team to explore solutions. They may offer a discount plan, or may be able to refer you to lower cost clinics, such as a dental or dental hygiene school.

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 Academy of Periodontology. (2019, January 28). Periodontal Disease Bacteria Linked to Alzheimer’s Disease https://www.perio.org/press-release/periodontal-disease-bacteria-linked-to-alzheimers-disease/
2. Kamath, D. G., & Umesh Nayak, S. (2014). Detection, removal and prevention of calculus: Literature review. The Saudi Dental Journal, 26(1), 7–13. https://doi.org/10.1016/j.sdentj.2013.12.003
3. Lim, G., Janu, U., Chiou, L.-L., Gandhi, K. K., Palomo, L., & John, V. (2020). Periodontal health and systemic conditions. Dentistry Journal, 8(4), 130. http://dx.doi.org/10.3390/dj8040130

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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

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