Living with HIV includes Keeping a Close Watch on Your Oral Health

We've come a long way since the early 1980s when we first identified the HIV virus. Although approximately 35 million people worldwide (including a million Americans) now have the virus, many are living relatively long and normal lives thanks to advanced antiretroviral drugs.

Still, HIV patients must remain vigilant about their health, especially their oral health. In fact, problems with the teeth, gums and other oral structures could be a sign the virus has or is moving into the full disease stage, acquired immunodeficiency syndrome (AIDS). That's why you or a loved one with the virus should maintain regular dental checkups or see your dentist when you notice any oral abnormalities.

One of the most common conditions among HIV-positive patients is a fungal infection called candidiasis (or "thrush"). It may appear first as deep cracks at the corners of the mouth and then appear on the tongue and roof of the mouth as red lesions. The infection may also cause creamy, white patches that leave a reddened or bleeding surface when wiped.

HIV-positive patients may also suffer from reduced salivary flow. Because saliva helps neutralize excess mouth acid after we eat as well as limit bacterial growth, its absence significantly increases the risk of dental disease. One of the most prominent for HIV-positive patients is periodontal (gum) disease, a bacterial infection normally caused by dental plaque.

While gum disease is prevalent among people in general, one particular form is of grave concern to HIV-positive patients. Necrotizing ulcerative periodontitis (NUP) is characterized by spontaneous gum bleeding, ulcerations and a foul odor. The disease itself can cause loosening and eventually loss of teeth, but it's also notable as a sign of a patient's deteriorating immune system. The patient should not only undergo dental treatment (including antibiotics), but also see their primary care physician for updates in treating and managing their overall symptoms.

Above all, HIV-positive patients must be extra diligent about oral hygiene, including daily brushing and flossing. Your dentist may also recommend other measures like saliva stimulators or chlorhexidine mouthrinses to reduce the growth of disease-causing bacteria. Together, you can reduce the effects of HIV-induced teeth and gum problems for a healthier mouth and better quality of life.

If you would like more information on oral care for HIV-AIDS patients, please visit our website at www.myparkdental.com, or contact us here, or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article "HIV-AIDS & Oral Health."

Treating a Young, Permanent Tooth Requires a Different Approach

Soon after the primary (baby) teeth begin to give way, the teeth a child will have the rest of their lives start erupting into the mouth. But while they're permanent, they're not as strong and developed as they will be in adulthood.

That's why we treat young permanent teeth differently from older adult teeth. For example, a decayed adult tooth may need a root canal treatment; but this standard treatment would often be the wrong choice for a child's tooth.

The reason why involves the pulp, the innermost layer of a tooth, which plays a critical role in early development. Young permanent teeth continue to grow in sync with the jaws and facial structure. Most of this growth is in the dentin, the layer between the enamel and pulp, which increases proportionally to the other layers as the tooth matures. The pulp generates this new dentin.

A root canal treatment completely removes the diseased tissue of the pulp. This isn't a major issue for a mature tooth because it no longer needs to generate more dentin. But it can have long-term consequences for an immature tooth whose growth may become stunted and the roots not fully formed. The tooth may thus become brittle and darkened, and might eventually require removal.

Because of these potential consequences, a root canal treatment is a last resort for a young permanent tooth. But there are modified alternatives, depending on the degree of pulp exposure or infection. For example, if the pulp is intact, we may be able to remove as much soft decayed dentin as we can, place an antibacterial agent and then fill the tooth to seal it without disturbing the pulp. If the pulp is partially affected, we can remove that part and place substances that encourage dentin growth and repair.

Our main goal is to treat a young tooth with as little contact with the pulp as possible, so as not to diminish its capacity to generate new dentin. Avoiding a full root canal treatment if at all possible by using these and other techniques will help ensure the tooth continues to develop to full maturity.

If you would like more information on dental care for children, please visit our website at www.myparkdental.com, or contact us here, or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article "Saving New Permanent Teeth after Injury."

Composite Resin Could Transform Your Tooth's Appearance in Just one Visit

You've suddenly noticed one of your teeth looks and feels uneven, and it may even appear chipped. To make matters worse it's right in front in the "smile zone" - when you smile, everyone else will notice it too. You want to have it repaired.

So, what will it be - a porcelain veneer or crown? Maybe neither: after examining it, your dentist may recommend another option you might even be able to undergo that very day - and walk out with a restored tooth.

This technique uses dental materials called composite resins. These are blends of materials that can mimic the color and texture of tooth structure while also possessing the necessary strength to endure forces generated by biting and chewing. A good part of that strength comes from the way we're able to bond the material to both the tooth's outer enamel and underlying dentin, which together make up the main body of tooth structure. In skilled, artistic hands composite resins can be used effectively in a number of situations to restore a tooth to normal appearance.

While veneers or crowns also produce excellent results in this regard, they require a fair amount of tooth alteration to accommodate them. Your dentist will also need an outside dental laboratory to fabricate them, a procedure that could take several weeks. In contrast, a composite resin restoration usually requires much less tooth preparation and can be performed in the dental office in just one visit.

Composite resins won't work in every situation - the better approach could in fact be a veneer or crown. But for slight chips or other minor defects, composite resin could transform your tooth's appearance dramatically.

To see if composite resin is a viable restoration option for your tooth, visit your dentist for a complete dental examination. It's quite possible you'll leave with a more attractive tooth and a more confident smile.

If you would like more information on restorations using composite resins, please visit our website at www.myparkdental.com, or contact us here, or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article "Artistic Repair of Front Teeth with Composite Resin."

Gum Disease can Prevent Your Gums from Protecting Your Teeth

Your mouth is a lot like the Wild West - home to millions of bacteria and other microbes, some of which are definitely not "the good guys." But your teeth are well-protected from these hostile forces and their acidic waste products: with enamel shielding the visible part of your tooth, your gums protect the parts you can't see.

As effective as they are, though, your gums aren't invincible: their greatest threat is periodontal (gum) disease. This bacterial infection arises from plaque, a thin film of bacteria and food particles accumulating on teeth due to inadequate brushing and flossing.

The infected tissues soon become inflamed (red and swollen), a natural defensive response from the immune system. The longer they're inflamed, however, the more likely they'll begin detaching from the teeth. The gums may eventually shrink back or recede from the teeth, often causing them to appear "longer" because more of the tooth is now exposed to view.

Gum recession doesn't bode well for your teeth's survival: the exposed tooth and underlying bone can become even more susceptible to infection and damage. In the end, you could lose your tooth and portions of the supporting bone.

Treatment depends on the severity of the gum recession. In mild to moderate cases, we may only need to perform the standard gum disease treatment of removing plaque and calculus from all gum and tooth surfaces (including below the gum line) with special instruments. This helps reduce the infection and allow the gums to heal and re-establish attachment with the tooth. In more advanced cases, though, the recession may be so extensive we'll need to graft donor tissue to the area using one of a variety of surgical techniques.

Although the right treatment plan can help restore your gum health, there's another approach that's even better - preventing gum disease in the first place. You can reduce your disease risk by practicing daily brushing and flossing and visiting your dentist regularly or when you see symptoms like gum swelling or bleeding. Taking care of your gums won't just save your smile - it might also save your teeth.

If you would like more information on diagnosing and treating gum disease, please visit our website at www.myparkdental.com, or contact us here, or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article "Gum Recession."