Pregnancy and Teeth

I’m very excited to announce that my wife is pregnant with our 4^th child. She has been diagnosed previously with hyperemesis gravidarum, meaning she has horrible morning sickness and has difficulty staying out of the hospital for most of the pregnancy. So I’ve been taking care of her and haven’t posted in a few weeks. But I’ve been thinking a lot about how to take care of your teeth and gums when you’re pregnant. The last thing you want to worry about when your feeling sick and preparing for a baby is a toothache or a cavity.

Poor diet, frequent vomiting, acid reflux, and poor hygiene during pregnancy can all make the mouth more acidic and damage your enamel. Reducing the frequency and duration of acid attacks can help to prevent erosion, cavities, and sensitivity. It is important that you don’t brush your teeth until about an hour after vomiting or having something acidic to eat or drink. Instead put 1 teaspoon of baking soda in 1 cup of water and rinse to neutralize the acid. Brush at least twice daily with fluoride toothpaste and floss at least once daily to remove the plaque that causes cavities and gingivitis.

Altered hormone levels are a major factor in pregnancy associated gingivitis. If not controlled, gingivitis can lead to periodontitis, and has been linked to preterm delivery and low birth weight. In addition to brushing and flossing at home, you should have your teeth cleaned before and during pregnancy to control gingivitis.

It is highly recommended that you see a dentist before you become pregnant. Your dentist can discuss your current oral health, and you can work to control cavities and gingivitis. This reduces the likelihood that you will have problems during your pregnancy. If you are already pregnant, consult with your dentist as soon as possible. Having treatment during pregnancy is very unlikely to cause any problems but in general we avoid the following: x-rays not related to emergency treatment, elective treatment, or long appointments during the late third trimester.

Taking care of your teeth before and during pregnancy can actually help to ensure that your baby has healthy teeth. Cavities are an infectious, contagious, disease, and the most likely way a child will pick up the bacteria that cause cavities is from their mother. So one of the best birthday presents you can give your child is your own oral health.

Helpful links:

Academy of General Dentistry

American Dental Association

Cosmetic Dentistry - Jewel Fixed Her Teeth!

Jewel finally fixed her teeth. She hasn’t told us if it’s permanent or if it’s just for her new movie. If the picture didn’t have a caption, I would not have known it was her. There is a good lesson in this. Teeth play a big part in how we recognize each other. Sometimes the pursuit of “ideal” teeth just makes us less unique. There are times when I am reluctant to perform elective cosmetic services, because I feel that the result will not really be an improvement, it will just make their teeth more like their friend’s.

My personal philosophy is that elective cosmetic dentistry is appropriate when you are distracted by the look of your teeth, or when you have difficulty smiling confidently. When I examine a patient, I do not perform a smile analysis unless the patient first tells me that they are concerned with the appearance of their teeth. Otherwise the patient may leave my office feeling worse about their teeth then when they came in.

Extreme makeover shows give the impression that anyone can have a complete smile makeover that will last forever in less than a week, and everyone needs veneers on all their teeth, and it will only require that you take out a second mortgage. There are many different options for improving the look of your teeth. Some are relatively simple, non-invasive, and inexpensive. Some treatments are very invasive and may require significant time, work, and money. There are 2 questions that will determine the best treatment for your individual case, and these are the questions that you should first answer in consultation with your dentist. What do you want to accomplish? What treatments will maintain or improve the health of your teeth? This will determine what is ideal for your case. Reasonable alternatives to the ideal treatment will allow you to come close to ideal within a time frame and budget that works for you.

Some aspects of ideal treatment that are often overlooked in the race to veneers are whitening, orthodontic treatment, and periodontal treatment. Whitening is simple, non-invasive, and relatively inexpensive. It is usually best to begin any cosmetic treatment with whitening. This may be all the treatment that you need and it will increase the success of any other treatment that you have. Orthodontic treatment (braces) is time consuming but it can be critical to the success of other treatments. Neglecting orthodontic treatment increases the likelihood that you will need root canals, get cavities, and have bone loss on the restored teeth. The teeth are framed in gum tissues and periodontal treatment if often necessary to improve the health and the looks of your teeth. You don’t want to frame your beautiful new teeth in an ugly broken down frame.

Now don’t race to a mirror and pick your smile apart. Don’t pick your friends and family apart either. Try to smile as confidently as you did before you read this post (or more confidently). But if you are distracted by your smile or already have difficulty smiling confidently, talk to your dentist. With patience you can agree on a plan that will improve your smile, keep your teeth healthy, and keep some money in your wallet.

Pools and Your Teeth

My wife and kids escaping the summer heat.

A recent unpublished report details a woman who experienced significant damage to her teeth from swimming in a pool that was too acidic. The woman had a dental exam 1 week before she went on vacation to Cuba. She swam for 2 ½ hours each day for 10 days in the pool at the resort where she stayed. After returning to the US, she returned to her dentist and told him that her teeth felt strange. The dentist found that she had lost all of the enamel on her teeth and a full mouth reconstruction was required to restore the lost tooth structure.

Where I live, swimming pools are just below water and air when it comes to essentials for life. When the temperature hits 125, most people would not shy away from a pool that had more p than H. But an acidic pool could be causing irreversible damage to your teeth.

Enamel is demineralized below a pH of 5.5. Even if your pool’s pH is not that low, you add the acidity of the orange juice you had for breakfast, and the sports drink you had afterwards, and your teeth may lose a significant amount of minerals.

Your pool is one possible contributor to tooth wasting syndrome. This is a very destructive but often overlooked process that causes progressive loss of tooth structure. Other factors include clenching and grinding, reflux, and abrasion.

So start the summer off right, check your pool’s pH and talk to your dentist about keeping your teeth healthy this summer.

Brain Tumors and Dental X-rays

As if you needed another reason to hate the dentist. According to a recent study, dental x-rays are associated with an increased risk of the most common type of primary brain tumors, called meningiomas. This is a very sobering possibility and the study deserves a serious discussion. I admit my bias in analyzing this study. I recommend and take dental x-rays every day. But the study has some weaknesses that need to be recognized and targeted for further research.

The study compared a group of 1433 patients who had been diagnosed with meningioma to a group of 1350 patients who self-reported that they did not have a meningioma. This self-reporting is a problem inherent to case control studies, but especially with meningiomas, which are often asymptomatic. Previous studies have shown that asymptomatic meningiomas are almost 3 times more common than symptomatic. It’s possible that patients in the control group had meningiomas and did not know it, which would alter the results of the study.

Both groups were also asked to self-report their history of dental x-rays. Patients who had meningiomas were more likely to reports having received bitewing dental x-rays, panoramic x-rays before the age of 10, or yearly panoramic x-rays. I personally cannot remember how many and what type of x-rays I have received over the past 5 years, much less the last 20. Patient recall of x-ray history is often found to be incorrect when previous dentists are consulted. This type of study is also prone to what researchers refer to as “recall bias” where people with the disease are likely to look for a cause and over-report their history of something like dental x-rays.

Dental x-ray technology has changed significantly over the last 20 years with digital x-rays becoming much more commonplace. Digital intraoral x-rays give anywhere from 40-75% reduction in radiation dosage compared to intraoral films. In my office, we are able to reduce exposure time by about 66% using digital x-rays. The effects of x-ray radiation are dose dependent. Dosage was so neglected by the study that it actually showed that a single bitewing x-ray has a 50-100% greater risk than a full mouth series of 20 x-rays.

Please speak to your dentist about your need for dental x-rays. Most likely, he is following the recommendations of the American Dental Association for radiographic examinations, and is working to keep your radiation dosage As Low As Reasonably Achievable (ALARA). X-rays enable us to find problems earlier when they are much easier and cheaper to fix. Avoiding x-rays, when they are recommended appropriately will increase the likelihood that you will lose teeth early and spend more money at the dentist.

Additional Resources:

Cancer.org

American Dental Association

Dentistry On My Mind

I'm kind of a dental nerd.  I lay in bed at night thinking about cleaning teeth, making a crown, performing a root canal etc.  One of my favorite aspects of dentistry is the challenge of communicating with patients about treatments.  There can be many reasonable alternatives to any treatment plan and each of those options can be rather complex.  The potential expense of a treatment plan makes the decision even more difficult.

Another aspect of dentistry that is very enjoyable to me the wide range of power tools and materials involved.  There are constant innovations in tools, materials and techniques.  These innovations are accompanied by news articles and reports on television of the necessity of one and the outright dangers of another.  It can be very difficult to separate the fact from fiction.

For these reasons I decided to start a blog, with my wife's help.  I hope this will be a good resource for my patients in deciding on the treatment that is best for them, as well as the general public who might find this information useful.  Please send any questions and ideas for future posts to my email address.