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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 should be able to 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 contact us 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.”

Is having good oral hygiene important to kissing? Who’s better to answer that question than Vivica A. Fox? Among her other achievements, the versatile actress won the “Best Kiss” honor at the MTV Movie Awards, for a memorable scene with Will Smith in the 1996 blockbuster Independence Day. When Dear Doctor magazine asked her, Ms. Fox said that proper oral hygiene was indeed essential. Actually, she said:

“Ooooh, yes, yes, yes, Honey, ’cause Baby, if you kiss somebody with a dragon mouth, my God, it’s the worst experience ever as an actor to try to act like you enjoy it!”

And even if you’re not on stage, it’s no fun to kiss someone whose oral hygiene isn’t what it should be. So what’s the best way to step up your game? Here’s how Vivica does it:

“I visit my dentist every three months and get my teeth cleaned, I floss, I brush, I just spent two hundred bucks on an electronic toothbrush — I’m into dental hygiene for sure.”

Well, we might add that you don’t need to spend tons of money on a toothbrush — after all, it’s not the brush that keeps your mouth healthy, but the hand that holds it. And not everyone needs to come in as often every three months. But her tips are generally right on.

For proper at-home oral care, nothing beats brushing twice a day for two minutes each time, and flossing once a day. Brushing removes the sticky, bacteria-laden plaque that clings to your teeth and causes tooth decay and gum disease — not to mention malodorous breath. Don’t forget to brush your tongue as well — it can also harbor those bad-breath bacteria.

While brushing is effective, it can’t reach the tiny spaces in between teeth and under gums where plaque bacteria can hide. But floss can: That’s what makes it so important to getting your mouth really clean.

Finally, regular professional checkups and cleanings are an essential part of good oral hygiene. Why? Because even the most dutiful brushing and flossing can’t remove the hardened coating called tartar that eventually forms on tooth surfaces. Only a trained health care provider with the right dental tools can! And when you come in for a routine office visit, you’ll also get a thorough checkup that can detect tooth decay, gum disease, and other threats to your oral health.

Bad breath isn’t just a turn-off for kissing — It can indicate a possible problem in your mouth. So listen to what award-winning kisser Vivica Fox says: Paying attention to your oral hygiene can really pay off! For more information, contact us or schedule an appointment for a consultation. You can read the entire interview with Vivica A. Fox in Dear Doctor’s latest issue.

There are a lot of opportunities to have your blood pressure checked: your doctor’s office, of course; your local pharmacy; health fairs; and the dentist’s office. The last one might surprise you, but blood pressure monitoring before a dental examination or office visit has become quite routine.

Why all this attention to blood pressure? Because chronic high blood pressure (hypertension) is a major cause for cardiovascular disease (CVD), a family of life-threatening conditions that affects 80 million people in the United States. And, you may not even be aware you have it.

That’s why avenues for blood pressure screening are on the rise, and the dental office is a prime opportunity. Since you see us regularly for cleanings and checkups (you do, don’t you?), there’s a good chance we might help you become aware you have a problem if we perform blood pressure readings.

One study published by the Journal of the American Dental Association, for example, followed a group of dental patients with no previous risk factors of CVD, and who had not seen a doctor in the previous twelve months. Through blood pressure screening at their dental visits, 17% discovered they had high blood pressure and at risk for a cardiovascular event.

Your blood pressure can also have an effect on your oral health, especially if you’re taking medication to control it. Some medications can cause reduced saliva flow, which could drastically increase your chances of developing tooth decay or periodontal (gum) disease. We would also need to exercise care during dental procedures with certain local anesthetics: some may cause both your pulse and blood pressure to rise.

Although we’re primarily focused on your dental care, we also know it’s only one aspect of your overall health. By simply including blood pressure checks during your checkup, we may help you identify a problem before it causes you greater health problems in the future.

If you would like more information on blood pressure and dental health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Monitoring Blood Pressure.”

Many people have questions about the proper use of antibiotics — especially today, as the overuse of these medications has become a concern. It isn’t necessary for most people to take antibiotics before having a dental procedure. But for a few — notably, those with particular heart conditions and, in some cases, joint replacements — pre-medication is advisable. The question may be even more confusing now, because the standard recommendations have recently changed — so let’s try and sort things out.

First, why would anyone need antibiotics before dental treatment? Essentially, it’s because of the chance that an open wound could allow bacteria from the mouth to enter the bloodstream. For people in good health, the body is capable of quickly containing and neutralizing the bacterial exposure. But people with some types of heart disease, heart transplants, and/or total joint replacements have a greater likelihood of developing a bacterial infection, which can be dangerous — or even life-threatening. The same may be true of people whose immune systems are compromised.

At one time, people with a broad range of heart problems and artificial joints were advised to pre-medicate; today, new research indicates that fewer people need to take this step. Antibiotics are currently recommended before dental procedures if you have:

• An artificial heart valve, or a heart valve repaired with artificial material
• A history of endocarditis
• A heart transplant with abnormal heart valve function
• Cyanotic congenital heart disease (a birth defect where blood oxygen levels are lower than normal) that hasn’t been fully repaired — including children with surgical shunts and conduits
• A congenital heart defect that has been completely repaired with artificial material or with a device — but only for the first six months after the repair procedure
• Repaired congenital heart disease with residual defects, such as leakage or abnormal flow

In addition, not everyone who has an artificial joint needs antibiotic premedication. Instead, your health care providers will rely on your individual medical history to determine whether this step is required in your situation. However, having a compromised immune system (due to diabetes, cancer, arthritis, chemotherapy and other factors) is still an indication that antibiotics may be needed.

The question of whether or not to pre-medicate is an important one — so it’s vital that you share all relevant medical information with your doctors and dentists, and make sure everyone is in the loop. That way, the best decisions can be made regarding your treatment.

If you have questions about premedication before dental treatment, please contact us or schedule an appointment for a consultation.

Growing up with a dentist stepdad, Cheryl Burke of Dancing with the Stars heard a lot over the years about the importance of good oral hygiene — in particular, the benefits of using dental floss.

“My dad would say, ‘make sure you floss,’ but I never really listened to him. I was very, very stubborn,” Cheryl told Dear Doctor magazine recently in an exclusive interview. Cheryl admits this stubbornness took its toll, in the form of tooth decay. “I definitely had my share of cavities,” Cheryl recalled.

Cavities can form when food particles, particularly sugar and carbohydrates, are not effectively cleaned from the spaces between teeth. These particles are then broken down by bacteria naturally present in the mouth, resulting in the production of acids that attack the tooth enamel.

When she reached her twenties, Cheryl decided she really needed to step up her oral hygiene and cultivate an asset so important to a professional dancer: a beautiful smile. And once she did, cavities became a distant memory.

“I think when you do floss frequently, it helps to reduce the chances of getting cavities,” Cheryl said. “It took me a while to figure it out.” Now Cheryl flosses after every meal. “I carry floss with me wherever I go. I have no shame busting out my floss in the middle of a restaurant!” She declared.

Dental decay is actually a worldwide epidemic, especially among kids. Untreated, it can lead to pain, tooth loss, and, because it is an infectious disease, it may even have more serious systemic (whole body) health consequences. The good thing is that it is entirely preventable through good oral hygiene at home and regular professional cleanings here at the office.

If it has been a while since you or your children have seen us for a cleaning and check-up, or you just want to learn more about preventing tooth decay, please contact us to schedule an appointment for a consultation. If you would like to read Dear Doctor’s entire interview with Cheryl Burke, please see “Cheryl Burke.” Dear Doctor also has more on “Tooth Decay: The World’s Oldest & Most Widespread Disease.”

The next time you’re visiting Boston, why not make time for a stroll in the city’s renowned public garden? It’s got a little something for everyone: acres of greenhouses and formal plantings, a picturesque pond where you can go for a paddle in swan-shaped boats, and the first (and perhaps the only) statue dedicated to an anesthetic gas.

Yes, the Ether Monument (also called “The Good Samaritan”) is a vaguely Moorish-looking sculpture that commemorates the first use of anesthetic in a medical procedure. This ground-breaking event took place at nearby Massachusetts General Hospital in 1846. But if it seems that perhaps the park designers were feeling a bit light-headed when they commissioned this statue* then just think of what it would have been like to have a tooth drilled without it!

Today, of course, ether is no longer used for anesthesia; that’s because medical science has developed far better ways to make sure you don’t feel pain when you’re having a procedure. However, we do still use a gas for people who need a little more help relaxing during dental treatment. It’s called nitrous oxide, but sometimes goes by the nickname “laughing gas.”

This sweet-smelling gas, mixed with oxygen, is often administered in a process called inhalation conscious sedation. It doesn’t put you to sleep — you can still follow directions and respond to verbal cues — but it makes you very comfortable, and may even induce a slightly euphoric feeling, which wears off quickly when the gas is stopped. That’s what makes it ideal for some dental procedures: It’s quite effective for people who might otherwise have a great deal of dental anxiety, yet it’s quick, easy and safe to administer — and you can usually drive yourself home afterward.

Sometimes, however, you may need even more relaxation — for example, if you’re having multiple wisdom teeth extracted. In this case, it may be best to use intravenous (IV) conscious sedation. Here, the precise amount of medication you need is delivered directly into your bloodstream via a tiny needle. As with nitrous oxide, you’ll remain conscious the whole time, but you won’t feel any pain — and afterward, you probably won’t remember a thing.

Sedation dentistry has come a long way since the days of ether… but making sure you don’t feel pain or anxiety remains a critical part of what we do. Before a procedure, we’ll talk to you about what type of anesthesia is best — and if you have any questions or concerns, we’ll work with you to make sure you have the best experience possible. If you would like more information about sedation dentistry or relieving dental anxiety, call our office for a consultation. You can learn more in the Dear Doctor magazine articles “Oral Sedation Dentistry” and “Sedation Dentistry For Kids.”

That “squeaky clean” feeling on your teeth might be the most noticeable result of a professional cleaning performed by a dental hygienist. Rest assured, though, there’s more to it — regular professional cleanings yield long-term benefits to your oral health.

A basic procedure known as coronal cleaning removes plaque (bacteria and leftover food deposits) on the crowns, the visible portion of the teeth. If you are showing signs or are at risk for gum disease (a bacterial infection of the gum tissue) your hygienist may also initiate cleaning below the gum line with a procedure called scaling. This common technique removes plaque and tartar (hard deposits) above and below the gum line using either a traditional set of hand instruments (known as curettes) or an ultrasonic scaler, a device that uses vibrations from ultrasonic frequencies and water to remove plaque and tartar.

Root planing takes the cleaning even deeper, using curettes to remove plaque and tartar adhering to tooth roots. This is typically necessary for patients with advanced gum disease, and may need to be repeated over a number of visits as inflammation subsides.

Polishing is another common hygienic procedure performed both above and below the gum line. It’s the procedure you most associate with that feeling of smoothness after a cleaning. The hygienist will typically apply to the teeth polishing paste held in a small rubber cup attached to a motorized device. As the motor rapidly rotates the rubber cup, the paste works into the teeth to remove surface stains and bacterial plaque. While it’s considered a cosmetic procedure, it’s more accurately defined as a prophylaxis, a dental term derived from the Greek meaning to guard or prevent beforehand.

Professional cleaning performed by a dental hygienist is only one half of an overall hygiene plan; the other half is your own daily habit of brushing and flossing. Both your daily hygiene and regular dental checkups and cleanings will go a long way toward preserving your teeth as they were meant to be — for a lifetime.

If you would like more information on teeth polishing, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Teeth Polishing.”

Chewing tobacco is a known cause of oral cancer, yet many a Major League Baseball player has been seen walking onto the field with a round tin visibly poking out of his back pocket. That was before this year. Recognizing the influence big-leaguers have on their young fans, MLB players agreed to a new contract that limits their use of chewing tobacco and their ability to carry it around their fans. The 2012 season is the first to be played under the new rules, which were championed by Baseball Commissioner Bud Selig.

One player who used smokeless tobacco heavily is Baseball Hall of Famer Tony Gwynn. The former Padres slugger earlier this year endured 14 hours of surgery to remove a cancerous growth from the inside of his right cheek and graft a nerve from his shoulder to replace a facial nerve damaged by the tumor. This was Gwynn’s second cancer surgery in less than two years.

When it comes to oral cancer, the importance of early detection can’t be stressed enough. Unfortunately, this form of cancer is not usually detected until a late stage so the overall survival rate is poor, with only 58% surviving five years after treatment. Yet when oral cancer is detected while a lesion is small, survival rate exceeds 80%. That’s why an oral cancer screening is always part of your dental check-up or regular cleaning appointment at this office.

During this screening we will examine your face, neck, lips, mouth, tongue and the back of your throat for any suspicious lesions (sores or ulcers) or lumps. Of course, if you notice any unusual lesions, or color changes (white or red patches), anywhere in your mouth that do not heal within two-three weeks, please come in to see us as soon as possible. And if you need help kicking a tobacco habit, we can advise you on how to get it.

If you would like more information about oral cancer, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine article “Oral Cancer.”

Ninety percent of people have noticed bleeding from their gums when they brush or floss their teeth at some time or other. You may wonder if this is a result of brushing too hard — but that’s not usually the case.

If your gums don’t hurt — even if they bleed easily — you may think the bleeding is normal, nothing to worry about, or you’re brushing too hard.

Bleeding from your gums is not normal!

It is an early warning sign of gum disease. In fact ten percent of those who start with bleeding gums go on to develop serious periodontal disease affecting the support for the teeth leading to tooth loss.

Then why do my gums bleed?

The way you brush your teeth is indeed a factor! Bacteria that normally reside in the mouth (in fact you need them to stay healthy) collect along the gum line in a biofilm. When the biofilm is not removed effectively on a daily basis, over time the gums become inflamed and bleed when touched. Other signs of inflamed gums — gingivitis — are redness and swelling, and even recession.

SO — the problem is not that you are brushing too hard, but that you are not brushing and/or flossing effectively. Both are important.

Three ways to stop bleeding gums before they lead to serious problems

1. It all starts with brushing your teeth correctly at the gum line. Use a soft multi-tufted toothbrush. Hold it in the gum line and wiggle it gently until the tooth surfaces feel clean to your tongue — just like when you’ve had a professional cleaning. It doesn’t take force, be gentle.
2. It’s just as important to remove biofilm from between the teeth where the toothbrush won’t reach. If you are having difficulty flossing, we’ve got some easy demonstrations and instructional tips.
3. Remember, as we say, “It’s not the brush, it’s the hand that holds it.”

Contact us today to schedule an appointment or to discuss your questions about bleeding gums. Bring your toothbrush and floss with you to our office and ask us to demonstrate proper oral hygiene techniques. You can also learn more by reading the Dear Doctor magazine article “Bleeding Gums: A very important warning sign of gum disease.”

Statistically speaking, Americans can expect to enjoy a longer life today than at any time in the past. A recent U.S. government interagency study indicated that our oldest citizens are also generally getting healthier and doing better economically. Yet, along with an increased lifespan comes the possibility that at some future time, you or a loved one may undergo treatment for cancer.

There’s good news here too: According to the National Cancer Institute, a branch of the National Institutes of Health, both the rate of cancer incidence and the death rate from the disease have been steadily declining. It’s true that cancer treatments may cause a variety of oral health problems. But did you know that there are some measures you can take to minimize the discomfort and possible complications from these lifesaving therapies?

Chemotherapy and radiation, two common treatments, work by attacking cancerous cells. However, they can affect normal cells too — including the cells lining the mouth, and the salivary glands. This sometimes results in mouth sores, a dry mouth, and an increased risk of developing dental diseases like tooth decay.

What should you do if you or someone you love needs cancer treatments? The best outcomes can be obtained by a dose of prevention when possible, and by taking a team approach to the treatment.

Oral side effects may be worse if the mouth isn’t healthy prior to cancer treatment. So, if there’s time, have necessary dental procedures done before treatment begins. During and after cancer therapy, dental surgery should be limited if possible. The first step is to get a complete dental examination, and to develop a treatment plan. It’s vitally important to coordinate any dental treatments with an oncologist (cancer specialist).

There are also things a patient can do to help control unpleasant oral side effects. Removing the bacteria that cause tooth decay is more essential now than ever. In addition to thorough brushing, an antibacterial rinse or fluoride gel may be prescribed. To combat the symptoms of dry mouth, it’s important to drink plenty of fluids. Chewing gum with Xylitol, or using a mouth rinse or a prescription medication may also be recommended.

It’s essential for those having cancer treatment to understand and follow the recommendations of their dentist and doctor. These include taking steps to reduce the chance of complications, and recognizing the warning signs that may indicate a problem.

If you would like more information about cancer treatment and oral health, please contact us or schedule an appointment to discuss your treatment options. You can learn more in the Dear Doctor magazine article “Oral Health During Cancer Treatment.”