Your Dry Mouth Could be Killing Your Teeth

What do over 500 medications have in common? The medications treat various chronic problems all over the body. But they can create major problems for your teeth. Why? Because these medications reduce saliva production. They cause dry mouth.

Saliva just doesn’t make our mouths wet, it protects our teeth from bacterial attack. Good, healthy saliva acts as a buffer to neutralize acidic foods. No saliva? Your mouth’s acid level increases. The acid-loving bacteria in your mouth have a field day. Our teeth decay. And this decay is not just a nuisance, repaired by a simple filling. It can dissolve exposed roots. And sometimes it happens so fast that nothing can be done to save the tooth, and it needs to be extracted.

Dry mouth can occur as a result of some chronic diseases such a Sjogren’s syndrome. It can occur following radiation therapy to the head and mouth region as well as after chemotherapy.

So what’s the solution? If you are taking medications that are causing dry mouth, one thing you can do is to ask your physician if there is an alternative medication. Barring that, we need to do our best to keep the mouth moist and the acid reduced. A constant water bottle by your side is one solution. But even then, there is no assurance that the mouth acids will be neutralized. I have my patients rinse with baking soda rinses up to four times a day. Make a solution of 1 tablespoon of baking soda to 8 ounces of water. Rinse for 1 minute and spit out. The 8 ounces of water should last the full day.

There are artificial salivas that you can purchase from your pharmacy as well.

There is a natural sugar that actually can reverse tooth decay, xylitol. Xylitol comes as a straight granulated sugar. I recommend however that you purchase xylitol mints or xylitol gum. Make sure that the mints or gum are 100% xylitol with no other added sugars. Dissolve 5 mints a day or chew 5 pieces of gum a day spread throughout the day. You can find xylitol in health food stores and many dental offices.

An excellent rinse to help prevent dental decay is Cari-Free. It combines an acid modifier, xylitol, and modifies the bacterial imbalance in the mouth. It can be ordered on line at carefree.com

Finally, increase the frequency of your dental examinations.

Dry mouth can be devastating to your teeth. It requires a change in how you treat your mouth even if you haven’t had a decay problem in the past. Aggressive preventive care can go a long way in reducing your dental expenses as well as your chance of tooth loss.

~Dr. Lee Sheldon

Osteoporosis Meds

Osteoporosis is a mammoth problem in this country.

Ok, so there’s well-known secret that’s advertised on nearly every osteoporosis drug commercial that treats using bisphosphonates. You don’t pay attention to it until you need the service. What’s the warning? “Osteonecrosis of the jaw (ONJ), which can occur spontaneously, is generally associated with tooth extraction and/or local infection with delayed healing, and has been reported in patients taking bisphosphonates…Known risk factors for osteonecrosis of the jaw include invasive dental procedures…”

So here’s what I’ve seen in ONJ. Patients’ bone doesn’t heal properly. They are chronically sore. Little pieces of bone flake way continually for months or even years. And even when we remove the flaking bone, it still doesn’t heal well. The quality of the bone has changed. It just doesn’t act the way normal bone acts.

In an attempt to reduce the risk of oral surgery in the presence of bisphophonates, we often ask our patients to take a “drug holiday” of three months before we attempt oral surgical procedures on those patients who have been taking bisphosphonates for over three years and then delay resumption of the drug until all areas are thoroughly healed. But even when we do that, there are some patients who still have a delayed healing response.

Bisphosphonates are the most common drug used for treating osteoporosis. I won’t mention the brands here, but if you’re being treated, look at the package insert to see if that’s what you’re taking.

How do bisphosphonates work? There are two primary cells in bone metabolism. The osteoblast forms new bone. The osteoclast that takes the old bone away. A bisphosphonate stops the osteoclast from working. So that means that old bone remains and new bone is laid down on top of and around the old bone. That’s why a bone scan “looks better” after taking a bisphosphonate.

So, not only is osteoporosis a problem, but the treatment is a problem as well. And the problem is not limited only to bisphosphonate drugs. Estrogen-containing drugs have their risks as well.

Calcium has an affinity for estrogen, so the more estrogen, the more calcium. That’s good from a bone standpoint and estrogen-containing drugs do not have the same oral surgery risk that bisphosphonate drugs do. But that doesn’t mean that they don’t have a risk. Increased estrogen is associated with an increased risk of breast cancer.

So what does one do? If you’re new to my columns, my overall theme is “Do everything that you can without medication.” Because if you correct what you might be doing that’s bad for your body, the problem may resolve itself.

So, what should you do? Acid levels in the body seem to make a difference in osteoporosis and alkalizing (non-acidic) foods can make a big difference. Practically all vegetables are alkalizing as well as eggs, plain yogurt, and beans. All meat is acid-forming. A little reading will give you some dietary guidance on acid-forming and alkaline-forming foods. And there’s reasonable evidence that adding some sodium or potassium bicarbonate may help restore bone as well.

In addition, natural progesterone cream, has very beneficial effects with no reported cancer risk. A study by Dr. John Lee found that adding natural progesterone cream to an already established osteoporosis program increased bone density up to 10 percent in 6 months and 3-5 percent annually until stabilizing at the level of a 35 year old. The rest of the program included a diet rich in green vegetables, limiting meat to three times a week, and elimination of sodas, alcohol, and smoking. Along with that was 20 minutes of daily exercise, and Calcium, Vitamin D, Vitamin C, and Beta-carotene. –Alternatives, Dr. David Williams.

Yes, the drugs are there. But wouldn’t it be great if we correct the cause of the problem in the first place?



Note: Dr. Sheldon provides this for informational purposes only. Any treatment decisions should be made in consultation with your doctor.

Iodine is a Necessary Nutrient

I learn so much from my patients. And while the vast majority of my time is helping to rehabilitate very sick mouths, the fact is that a sick mouth can be an indicator of a sick body. So I was in a conversation about that very thing when a patient talked to me about iodized salt. And it was then that I knew my next column would be on iodine.

Iodine may help with baking. I’m a pretty good cook, but I don’t bake, so I can’t verify that. But I do know this: Iodine is added to table salt for health reasons. It was a government mandate in the 1920’s to add iodine to table salt because of a nationwide iodine deficiency that resulted in enlarged thyroid glands called “goiters.” People ate at home much more often, and salt had no stigma, was a commonly used condiment, and so was the best way for our government to help stop the goiter problem . And yes, the treatment of iodized table salt worked wonders to eliminate goiters.

Well, now we’ve forgotten the importance of iodine. Our use of iodized table salt decreased by 65% between 1971 and 1994 and it continues to drop. And what do you think is happening as a result? Goiters are increasing in the U.S.

You see, the thyroid gland acts as an iodine sponge, and when it doesn’t get enough iodine it gets sluggish and enlarges. And when your thyroid gets sluggish, so do you. Some of the problems associated with iodine deficiency include chronic fatigue, weight gain, low metabolism, bone loss, increased cholesterol levels, fat retention, depression, hair loss, intolerance to cold, enlarged thyroid, exhaustion, poor sex drive, poor circulation.

Other things have changed since the 1920’s. We’ve increased the amount of fluoride and chlorine in our water supplies. Both fluoride and chlorine are chemical antagonists to iodine. So we may need even more iodine now than we did then. And if you have some concerns about increased levels of radiation in our environment due to the recent Japanese nuclear disaster, one of the products of nuclear fission is radioactive iodine. Your thyroid doesn’t recognize the difference between a supplement of inorganic iodine and radioactive iodine. So if you’re iodine deficient, which many of us are, the thyroid will absorb what it can get. And radioactive iodine is not a healthy form of iodine.

At the minimum, I’d recommend buying iodized table salt and use it. Personally, I’m taking an iodine supplement. Make sure that it is the inorganic kind, the type that would be found as a supplement, not the kind that’s used as an antiseptic, which is poison.

And do some reading on the subject. Dr. Guy Abraham has made iodine his life’s work. You can find his material at www.optimox.com.

3 Good Reasons to see a Dentist BEFORE Cancer Treatment

You’ve received the news. You or a loved one needs to be treated for cancer. Now you go through the process of thinking about the treatment and the changes that you may need to make to be sure that the treatment is most effective. That may involve lifestyle and dietary improvements as well as the cancer treatment itself. One area that is often neglected but should be addressed early is the health of your mouth.

The National Institute of Health lists three reasons to see the dentist before cancer treatment.

1. 1. You’ll feel better
2. 2. You’ll help protect your teeth, gums, and bone.
3. 3. You’ll prevent needless delays and complications that can occur if infections occur after cancer treatment.

In addition to surgery, the two primary treatments for cancer are radiation and chemotherapy. Let’s look at radiation first. Radiation to the head and neck area has two potential devastating side effects.

1. Radiation to the head and neck kills the salivary glands in its field producing a dry mouth. When the mouth is dry, it becomes acidic. And an acidic mouth becomes prone to dental decay. Therefore, all decay should be diagnosed and treated before radiation therapy. In addition, a preventive protocol that might include fluoride, xylitol (sugar that helps stop tooth decay), baking soda rinses, and artificial salivas might be prescribed to help prevent decay. Intensive home care can prevent decay and the potential of tooth loss. Tooth extraction after radiation can be devastating because…

2. Radiation to the head and neck reduces the blood supply to the bone and soft tissues. If an extraction is necessary after radiation, there are increased complications from infection as the blood supply to the area is compromised. It is much less risky to have a tooth extracted before radiation therapy than afterward.

Chemotherapy has a much more generalized effect as it usually permeates the entire body. Side effects include soreness or ulcerations of the soft tissue of your mouth, dry mouth, a burning, peeling, or swelling tongue, infection, and taste changes. Oral rinses that numb the mouth may help you get through this period.

If I were diagnosed with cancer, I would get to a dentist immediately. Your dentist and oncologist will communicate together to reduce your risk during treatment. If an extraction is necessary, get it done as soon as possible before chemotherapy or radiation as adequate healing time of the extraction site is necessary before beginning radiation or chemotherapy. And your dentist will get you on a protocol to help keep you as comfortable as possible and reduce future risk of dental disease. Even if you never did it before, this is the time to keep up regular dental visits where prevention is emphasized and early diagnosis could be critical. Dental examination and treatment is a step that should not be overlooked as part of overall cancer therapy.

Braces at my Age? Yes!

Remember how you were interested in how many cavities you had when you were young (or maybe not so interested)? Now you have weathered periodontal disease, worn teeth, crowns, bridges, partials, often losing some teeth along the way. So it's not the same as it was. And just as we need to remodel our houses at times from the bottom up, we have to sometimes rebuild our bites.

As we age, the importance of comprehensive treatment planning increases. Where we were at one time accustomed to having the dentist fix one tooth at a time, that doesn't work as well as it did when we were younger because of the general deterioration that often occurs as the years pass.

In developing a comprehensive treatment plan, we often look at the changes that have occurred in tooth to tooth relationships. Teeth drift into spaces created by teeth that have been missing. So the teeth start to lean over. And just as the Leaning Tower of Pisa is not particularly stable, a slanted tooth may not be able to tolerate the generally vertical forces from chewing and the multiple forces that occur when we grind our teeth.

Sometimes teeth are never in the right position to begin with, but we live with it. The problem is that unfavorable tooth positions over time can result in loose teeth as the body can no longer bounce back from the adverse stresses that the teeth and the underlying bone can no longer tolerate.

As we age, teeth often become more crowded, particularly in the front. People often ask me why their teeth are more crowded in the front now, when they never used to. The answers are sometimes difficult to come by, but the fact is that teeth tend wo move toward the center as we age, causing crowding that we never had when we were younger.

Therefore, an important part of a comprehensive dental treatment plan is to look at these factors and make sure that our teeth are in the best possible position for appearance and for function.

If teeth are out of alignment, the treatment is now easier and quicker than ever before. You've probably seen commercials for a technique that uses a series of clear plastic trays that move teeth without anyone even seeing that your teeth are being moved. And if traditional braces are desired, there is a periodontal surgical technique that can be used at the beginning of orthodontic treatment to make the treatment up to four times faster than traditional braces called "Periodontally Assisted Osteogenic Orthodontics."

The point is clear. Proper tooth alignment can help your teeth be more comfortable and more functional. Orthodontic tooth alignment is worth assessing as part of any full dental treatment plan.

What to Look for in a Dental Exam

There is no shortage of new, innovative, dental techniques to enhance your dental experience, your ability to chew, and your smile. But today, let’s get back to basics and talk about what you should look for in a dental examination.

We grew up understanding that if there is a cavity, it needs to be fixed. This is “single-tooth” dentistry. However as we’ve grown older, we may have lost teeth, crowned teeth, broken teeth, had gum disease, gum recession, etc., etc. Changes in tooth relationships occur as a result. It’s for those reasons that our dental examinations should be more detailed. A full oral care plan should be developed even if it may be months or years before you complete the plan. A good plan can save money and help preserve your dental health.

Here’s a checklist of my recommendations:

□ A full periodontal examination including periodontal probing, gum recession, thickness of the gum tissue, and tooth mobility

□ A full dental examination which looks at tooth decay, worn fillings and crowns that may be leaking, cracks and microfractures, and loss of enamel at the gum line.

□ Full mouth dental x-rays. I want to be a bit careful here. Dental radiation for these x-rays is extremely small. However, it is still radiation. The more your disposition to dental disease, the more important x-rays become.

The three examinations above should give you and your dentist an understanding as to the long-term risk for each tooth. After all, you don’t want to spend a lot of money on a tooth that has a high risk of being lost.

□ Bite relationship. Not only should you know how your teeth line up, you should also know which teeth touch and which teeth don’t. For the most part, all teeth should touch when you close your mouth.

□ Joint and muscle assessment. Does your jaw pop or grind when you open or close your mouth. Why? And what can be done to reduce the chances of more joint damage.

□ Study models. For complex cases, impressions are made of your teeth and models of your mouth made so that your dentist can look at your mouth from every different direction.

The more complex your case, the more these diagnostic elements are important. Specialized diagnostic instruments to test the vitality of the nerve of the tooth, or specialized x-rays such as the Cone Beam CT Scan which provides a three dimensional view of your bone may also be indicated.

The relatively small cost in doing a good, careful, diagnostic evaluation can easily be saved in the treatment planning process that you and your dentist make together. A little bit of planning can go a long way toward decreasing your costs and improving your results in effective, comprehensive dental treatment.

Using Statin Drug? Look at CoQ10

From time to time, I write about nutrition in this column. Often people think that a vitamin can be used as a drug. Vitamins can be used therapeutically, but you’ll get the most out of nutrition when you eat a variety of fresh, whole foods. If you don’t get all the variety that you can get from eating whole foods, there are whole food supplements available. I recommend one to all my patients as insurance that they are getting what they need. The vitamin bottle definitely plays second fiddle to whole foods.

However, you should know about a single, and very important nutritional component, CoQ10 or Coenzyme Q10. CoQ10 is a naturally occurring compound in the body. It works in each cell to produce energy for that cell to work at an optimum level. We manufacture our own CoQ10, but as we age, we produce less and less of it. CoQ10 provides the source of energy to all of our muscles, including our heart. It, all by itself, has been shown to reduce hypertension. In fact, if you have low blood pressure, CoQ10 may be something that you don’t want to take.

CoQ10 was touted as a periodontal treatment years ago. While I never found it to be particularly effective for most periodontal patients, I did have and continue to have some amazing stories on the use of CoQ10 in my surgical patients. About 20 years ago, I had a patient who wasn’t healing well after a relatively minor periodontal surgical procedure. I told her to take CoQ10. In two days, she was nearly completely healed. Same thing happened with another patient three weeks later. CoQ10 has now become a routine part of my pre-operative instructions. And if there are times when patients might not follow this recommendation and they heal a little more slowly than they should, I reinforce the recommendation and most do better. Now this isn’t science. This isn’t a controlled study. It is an observation.

Many of us have been prescribed statin, or cholesterol-lowering, drugs. One problem with those statin drugs is that they drive our own CoQ10 out of our bodies by as much as 50%. Ever experienced leg cramping while in a statin drug? That may be due to that CoQ10 reduction. Many doctors recommend CoQ10 for their statin patients to help replenish the lost nutrient. In fact, one of the prominent pharmaceutical companies has a patent that combines their statin drug with CoQ10. Unfortunately, it hasn’t been put on the market.

There is lots of information on CoQ10 on the internet. One good source is written by a former physician astronaut, Dr. Duane Graveline. You can see his material by logging on to www.spacedoc.net.