As seen in the November 2008 issue of Indianapolis Woman magazine HEALTHY MOUTH Brushing and flossing HEALTHY LIFE effectively to improve your overall health

Back To Basics: Cleft and : : Are you brushing One woman’s amazing Know the correctly? transformation Signs

Presented by Table of Contents Give Yourself a Reason to Smile Letter from Dr. Judy Monroe ...... 2 The Health Connection...... 2 A healthy smile tells the world all about us — how we feel, how we Keep Your Winning Smile...... 3 look, how we care for ourselves and how healthy we are. A person who From Soda Pop to Mouth Guards ...... 3 has bad breath and missing or decayed teeth, often associated with Back to Basics...... 4 poor oral health, may feel ashamed and lack the confidence to excel at The Life of a Toothbrush ...... 4 work or at school. Imagine not being able to chew your food or being The Truth About Whitening ...... 5 in constant pain and not being able to concentrate on work or school. Dental X-rays...... 5 Poor oral health can negatively impact not only our physical health but You May Be Surprised ...... 6 also our social and emotional well-being. Mouth Guards ...... 6 AUnfortunately, periodontal or gum disease is very common. Members of racial and The Gender Effect ...... 7 ethnic minority groups experience a disproportionate level of oral health problems, such as Osteoporosis ...... gum disease. Those who suffer the worst oral health are people with low incomes, children 7 and seniors in particular. Individuals who are medically compromised or who have disabilities It’s Never Too Early ...... 8 are at greater risk for oral diseases, and in turn, oral diseases further jeopardize their health. Cleft Lip and Palate ...... 8 The good news is there are steps you can take to have a healthier mouth. Some things you Harmful Habits? ...... 9 can do to prevent gum disease: brush your teeth with fluoride toothpaste at least twice a day, Your Questions Answered...... 9 floss every day, visit the dentist routinely for a checkup and professional , eat a Disparities in Oral Health ...... 10 well-balanced diet and don’t use tobacco products. Going For It...... 10-11 I hope that by reading this insert you will better understand the important role a healthy Did You Know...... 10-11 smile and good oral health play in ensuring a good quality of life. For most people, maintaining Diversity in ...... 11 good oral health and preventing the problems associated with an unhealthy smile are easy, do Dental Implants ...... 12 not take much time, and are inexpensive. Prevention is the key to a healthy smile, so practice Medications and Your Mouth ...... 12 basic oral health habits every day, and make sure your children are adopting these habits as a One Step At A Time ...... 13 way of life. And don’t forget to smile! Crowns ...... 13 Oral Cancer...... 14 Bleeding ...... 14-15 Oral Cancer: Know The Signs ...... 14 Quiz Answers ...... 14-15 Oral Conditions...... 15 Judy Monroe, M.D. Resources...... 16 State Health Commissioner Thank You to Our Sponsors ...... 16

The Health Connection We’ve known for a long time that bacterial Taking a new view of the importance of dental health plaque on teeth causes gum disease, and . More recently it is by Dr. Michael J. Kowolik, Associate Dean for Graduate Education, suggested these conditions may affect other Professor of Periodontology, Indiana University School of Dentistry Dr. Michael J. Kowolik areas of our health: coronary heart disease; Believe it or not, dental care dates back to physician, John Hunter, was drummed out of a pre-term, low birth weight babies; stroke; chest primitive times. Toothpicks and floss have been conference of the American Dental Association. infections; diabetes; and even some cancers. found in the teeth of prehistoric human beings. He had accused the dental profession of not There are certainly biological mechanisms Innovations in oral health are available that addressing the overall health of its patients and that could be responsible. Many studies on not only add to our health but can enhance instead focusing on the mechanical aspects of these connections have been conducted. Some our appearance. The connection between oral the art. He was a man before his time. experts feel the relationship between oral health and overall health is becoming a part of The approach to medicine and dentistry health and overall health is confirmed; the discussion to promote healthy dental always undergoes change. With an emphasis on others are more cautious. Until the results habits and regular visits to your dentist. “evidence-based” clinical practice, we have of research are more conclusive, there is no This is not entirely a new development. started to unravel many medical mysteries. One doubt that practicing good oral hygiene Until the last 10 to 15 years, it was the techni- of these is whether infection or inflammation continues to be the best way to help maintain a cal advances in dentistry that took center stage. in the mouth can influence organs and tissues healthy mouth. And, if it helps the rest of Nearly 100 years ago the prominent English in other parts of the body. your body too, then it’s a bonus.

Healthy Mouth 2 Healthy Life Keep Your Winning Smile Know oral health basics for all stages of life

Your smile is often the first thing people Dentures: Artificial teeth on a model notice. To keep that winning smile, take time made to sit directly on the gums. Dentures from your busy lifestyle to visit your dentist can be complete or partial depending on and develop healthier habits to maintain how many teeth are missing. your oral health. Endodontics: A dental specialty that It goes beyond looks. The health of your focuses on treating the nerves and roots of teeth. mouth often reflects your body’s overall health. Gingivitis: A type of gum disease that Other diseases and health conditions, such as causes red and swollen gums that bleed Yheart disease, osteoporosis, diabetes, pregnancy easily. Gingivitis is caused by the buildup of and birth can be linked to oral health. plaque and food particles in the mouth. Stay healthier; know these oral health Impacted : A tooth that lies Periodontitis: A serious type of basics. Then read the following pages to beneath the gum, under bone or soft tissue, gum disease that can occur from untreated ensure you keep healthier teeth and gums, usually under another tooth. Impacted gingivitis. fresher breath — and a healthier you. teeth are not likely to grow out on their Plaque: A substance that collects on the Baby bottle mouth (syndrome): own. surface of teeth. Plaque contains bacteria Decayed baby teeth caused by taking a nap Implant: Support for a bridge or denture. that can lead to if it is not or going to bed at night with a bottle of milk Implants are surgically placed into bone. removed by daily brushing and flossing. or juice. (Plain water is better for bedtime.) Inlay: A solid filling (usually gold) that Prosthodontics: A branch of dentistry Bleaching: A technique used to whiten covers a missing portion of a tooth. focused on the replacement of missing teeth stained teeth. Orthodontics: A dental specialty that using bridges or dentures. Bridge: A tooth replacement used when focuses on straightening teeth or jaws by Root canal: The removal of the only a few teeth are missing. using braces or surgery. nerve tissue and blood vessels inside a Caries: Tooth decay. Another word for Pedodontics: A branch of dentistry tooth that have been damaged by injury cavity. focused on treating children. or decay. Crown/cap: An artificial tooth covering Periodontics: A dental specialty that Tooth implant: Artificial tooth made of porcelain or metal that protects treats the gums, tissue and bone surrounding replacement for a lost tooth surgically placed decayed or damaged teeth. teeth. into bone.

From Soda Pop to Mouth Guards What do you really know? (Answers on Page 15) You may no longer have your wisdom teeth, but you still can take this simple quiz to find out just how much you know about oral health. And to fill in the gaps of your knowledge, read the following articles on preventative care, dental procedures and dental disease — and become more oral health-wise. 1. You should replace your toothbrush once every six months. True False 2. Half of all cases of periodontal disease in the United States are associated with cigarette smoking. True False 3. You should talk to your dentist before using any teeth-whitening or bleaching procedures. True False 4. It is better to sip a soft drink slowly throughout the day rather than all at once. True False 5. The element found in drinking water that helps protect and strengthen teeth is magnesium. True False 6. Chewing sugarless gum that contains xylitol will help protect your teeth from cavities. True False 7. You do not need to worry about your infant’s oral health until their baby teeth come in. True False 8. A lack of folic acid during pregnancy is associated with cleft palate, the most common birth defect in the United States. True False 9. It is important to wear a mouth guard while playing sports. True False 10. It is normal for gums to bleed while brushing and flossing. True False

Healthy Mouth 3 Healthy Life Back to Basics Are you getting them right? by Rita Hope RDH, MS, LCSW, State Dental Hygienist, Indiana State Department of Health

Brushing drop down to begin the lower left gum area by Chances are you can improve the molars and roll up to the teeth. Always your technique. Americans begin on the gums and end on the teeth. When brush their teeth an average of you approach the front teeth, turn the brush only 30 seconds — not nearly lengthwise to reach more gum area and brush long enough time to use the each tooth by itself to the count of 7. lower left to lower right. Finish by “wiping” the proper technique. Brush your > Move to the upper left inside of the backside of the last molars in all four quadrants. teeth in a consistent pattern mouth, drop to the lower left side, moving to Having a routine prevents missing an area. Rita Hope each day, morning and night, to the center teeth and ending at the lower right > Wrap middle fingers with 15 to 18 improve your smile and prevent gum disease. molar area inside of the mouth. Finish by gen- inches of floss, grasping the middle of the floss tly brushing the tongue, which harbors bacteria between your index fingers and thumbs and An effective way to brush that may cause dental disease or bad breath. slide a clean section at each crevice, with one > Hold the toothbrush in your right hand > Rolling the bristles down on the upper middle finger taking up the “used” portion. — or left, if left-handed. Bristles should be teeth and up on the lower teeth massages and > Place the floss at an angle to the first pointed toward the ceiling. Top with a small firms the gum tissue, and helps reduce crevice and slide gently between the teeth dollop of toothpaste. pocketing areas for plaque to hibernate. The and “shoeshine” the sides of the teeth in the > Begin in the right upper arch of your “rolling” direction prevents , which space leaning to the left tooth and then to teeth in the back and move it back and forth tends to happen with sideways scrubbing. the right tooth. Picture a “C” as you on the chewing surface to the count of 7. manipulate to the right and to the left. Make sure you get the inner and outer surfaces. Flossing > Lasso the last tooth in each quadrant. Repeat on the upper left side. You only need to floss the teeth you want Make a loop of floss and ‘wipe’ the molars’ > Next, turn the bristles toward the floor to keep. Flossing is key to getting rid of debris backsides. Never jam the floss into any crevice. and begin scrubbing the lower left side chewing missed by the toothbrush that lurks between You may bleed at first but daily flossing surfaces and end at the lower right chewing the teeth or at the backs of the last teeth. firms the tissue and less bleeding will occur. surfaces. This distributes the paste to all four Flossing cleans the teeth and makes the If bleeding persists after a week, see your quadrants of the mouth as well as scrubs the tooth surfaces slippery to prevent plaque hygienist or the dentist for a diagnosis. chewing surfaces, where most plaque lives. attachment. Rinsing the mouth with water Once the routine is down, it takes less > Go back to the upper right molar teeth, after eating or drinking also prevents plaque than 30 seconds to floss. cheek area, with bristles toward the ceiling in a attachment but is not a substitute for flossing. 45-degree angle; roll the bristles down over Floss daily. The best time of the day to Bad breath gums and teeth 7 times, move the brush to the floss is right after dinner. You may be too Bad breath or halitosis usually is caused next set of teeth and repeat 7 times and so on. sleepy to brush and floss first thing in the by certain foods, such as garlic, but also may > As you move to the front of the mouth morning or before going to bed, so save that stem from medical problems like post nasal your hand and toothbrush handle changes time for the toothbrush alone. drip, diabetes, stomach disorders or poor direction, but always begin on the gums and oral hygiene. Find the culprit and take the end after brushing the tooth area to the count Effectively flossing steps to correct the problem. of 7. If you have heavy plaque, count to 10. > Follow the same pattern every day, The main idea is to reduce plaque or food > Next, point bristles toward the floor and beginning upper right to upper left and then particles caught between the teeth. are great, but the effects are short lived. Sugarless gum or mints also are The Life of a Toothbrush temporary fixes. Simply rinsing with water Three to four months is a normal lifespan for a toothbrush. after eating can rid the mouth of potential It’s time to change toothbrushes when the bristles fan out or odor-causing debris. Routine brushing and after a bout with a cold or flu. Never share toothbrush holders flossing should keep bad breath at bay. with family members. After rinsing thoroughly, store your If it continues to be a problem, talk to your toothbrush in a separate area so the bristles have time to dry out. dentist. He or she can help determine the causes and suggest proper treatment so you can have cleaner, fresher breath.

Healthy Mouth 4 Healthy Life The Truth About Whitening Be careful about what you use Dental X-rays to get that Hollywood smile Vital tools to maintain your oral health by Mariquita “Kit” M. Palanca-Beveridge, by Gail F. Williamson, RDH, MS, Professor of Dental Diagnostic Sciences, Department of DDS, Preferred Dental Care, P.C. Oral Pathology, Medicine and Radiology, Indiana University School of Dentistry

t is the hottest craze in Women often express concerns about result in a tooth abscess, town. People want to have radiation from dental X-rays, particularly which is painful and Ithat attractive “Hollywood” during pregnancy. The amount of exposure usually requires root smile. The good news is there is minimal, especially with the advent of canal treatment. Decay Mariquita Palanca- are various ways available to get Beveridge, DDS digital imaging. Digital X-rays significantly between the teeth can be those brilliant white teeth. The reduce the amount of exposure needed to viewed in dental X-rays to bad news? There are so many products available capture the image. An added bonus is that determine the extent of that claim to whiten teeth that consumers the image is displayed on a monitor for you decay and involvement don’t know what to believe. and your dentist to discuss. of the nerve for proper Google the words “teeth” and “whitening,”W Gail F. Williamson The dentist may provide lead shields for treatment. (See figure 1.) and you’ll get more than 5 million Web sites. extra protection during X-ray procedures. When evaluating gum or periodontal Unfortunately, consumers often proceed with Lead shields are strongly recommended for disease, X-rays allow evaluation of the treatment without first consulting a dentist. children, women of childbearing age and amount and quality of the bone present, They rely merely on marketing information and pregnant women. reveal the status of supporting structures and the latest word on the street. X-rays are like picture illustrations that view tartar deposits. Periodontal disease has There are many good over-the-counter your dentist uses to determine problems and been associated with a variety of health whiteners, but there also are “questionable” decide proper treatment. They also are a conditions such as cardiovascular disease, ones. Products with the ADA seal of approval resource that can help you understand preterm births and diabetes. Early diagnosis are considered safer since they have been tested. necessary dental care. and treatment is important to both your In-office whiteners utilize more effective Dental X-rays, or radiographs, are an dental health and your overall health. and reliable prescription-strength medication. essential tool used to evaluate your teeth and There are many other situations in which However, be careful in selecting which material supporting structures. Dentists depend on X-rays are necessary. Root curvature or other to use and, more importantly, when it would be X-rays to provide information about the conditions such as missing, extra or impacted advisable to use a whitening agent safely. underlying tissues in the mouth and to reveal teeth are important findings that affect Studies show that truly effective whiteners conditions that may be suspected but not treatment. (See figure 2.) have side effects, namely tooth sensitivity, as well seen clinically. X-rays provide important information for as gum tissue chemical burns, according to X-rays are used to evaluate more common proper diagnosis and treatment. Without X- the Journal of the American Dental Association. diseases, such as tooth abscesses, decay and rays, the dentist would be working blind and Using effective whitening agents on teeth gum disease. Infection of the nerve may might not be able to provide proper care. with pre-existing damage may result in more serious problems to the teeth and gums. This can require more costly and time-consuming procedures to correct. Your dentist can advise as to which whitening agent would be most appropriate for your situation and expectations. Before deciding to whiten your teeth, undergo a thorough dental examination. People who have damaged teeth may not have pain or sensitivity. This can mislead people to believe they have healthy mouths. It is important to Figure 1 Figure 2 have a dentist diagnose any pre-existing problems. Take appropriate precautions to Figure 1: This bitewing X-ray was taken to Figure 2: Some people develop extra teeth. avoid complications prior to whitening teeth. view decay, which is the dark area identified by This X-ray shows two extra premolar or So do yourself a favor and see a dentist the arrow. The first molar tooth has a very large biscuspid teeth impacted between the normal first before whitening. Keep your smile cavity, which extends to the nerve of the tooth. premolar teeth. healthy!

Healthy Mouth 5 Healthy Life Mouth Guards The device provides a cushion of protection between you and injury by M. Kent Smith, DDS, R.Ph., Director of Oral Health, Indiana State Department of Health

emember the old saying “An Rounce of preven- tion is worth a pound of cure”? This holds true You May Be Surprised with preventing mouth injury from physical M. Kent Smith, DDS Try these food and drink options for healthier smiles and bodies activity. Imagine what it would be like if you by Hannah Maxey, R.D.H. and Tonya Stewart, DDS, Director, Dental Services, lost one or two front teeth. It would not Marion County Health Department only be expensive to repair and painful, but eating, talking, smiling and your self-esteem Want to have a healthier smile and help can hinder the ability to heal, thus exacerbating all could be negatively affected. prevent certain health conditions, such as the periodontal disease and creating a Dental injuries due to participating in osteoporosis, heart disease and diabetes? vicious cycle. sports and other activities can be minimized Eat a healthy, balanced diet, and drink water Orally, beneficial beverages include water by the use of a properly fitted mouth guard along with some milk. and milk. Daily intake of water — eight or or mouth protector. You may have seen A healthly diet is low in sugar, fats and salt, more glasses per day for women — helps these in contact sports such as football, and includes plenty of fresh fruits, vegetables reduce cavities and gum disease by removing boxing or hockey. Mouth guards help and lean meats. Along with good oral food, sugars and from teeth, cushion blows that might cause injuries to Whygiene practices, a healthful diet helps to gums, tongues and cheeks. the , tongue, face, jaw or teeth. prevent tooth decay, gum disease, Though milk and fruit juices are more There are three main types of mouth and systemic conditions. healthful than sodas, many people assume guards: Dairy products, such as milk, yogurt and milk and natural fruit juices don’t cause > The ready-made mouth guard cheese are beneficial to healthy smiles and cavities. Actually, all drinks that contain sugar > The mouth-formed or boil-and-bite bodies because they provide calcium. tend to produce plaque, whether it is refined mouth guard Calcium aids in the development of teeth sugar from sodas and juices or naturally > The custom-made mouth guard and bones during childhood and strengthens occurring sugars found in fruit juices and The first two are available at many bones, such as our jawbones, during adult milk. sporting good stores, and the custom-made years. Maintaining a daily intake of calcium Early childhood caries, ECC or “baby bottle mouth guard is available from your dentist. — three servings per day — helps in preventing decay,” almost always is a result of constantly All of these devices provide protection, but periodontal disease as well as other diseases feeding from or sleeping with a bottle filled they vary in comfort and cost. such as osteoporosis. with milk or juice. In ECC, children suffer The most effective mouth guard is tear- Be aware that diets high in sugar, sodium with rampant cavities. To alleviate EEC, resistant, resilient and comfortable. It and fats can lead to poor smiles and health babies should be given bottles of water should be easy to clean, durable and fit problems. In addition to causing cavities in between meals and at bedtime instead of properly. A mouth guard that does not fit teeth, these diets often lack necessary milk or juice. Sodas can cause rampant decay properly can cause irritation to the gums or nutrients for good health. Increased risk of too, typically along the gum line, but it can other areas of the mouth. A properly fitted periodontal disease is possible because the be beneficial to drink water following sodas mouth guard will not interfere with your body is not as effective at fighting infections. to help remove any remaining sugars. speech or breathing. Periodontal disease also may be a contribut- Healthy and cavity-free smiles are promoted If you or your children participate in any ing factor in heart disease and diabetes. The and maintained by drinking plenty of water recreational activities that might pose a risk bacteria from gum infections can get into and, in moderation, enjoying milk, fruit of injury to the mouth, consider wearing a the blood stream, flow to and affect the juices and sodas. Also, maintain a healthy mouth guard. See your dentist for advice on heart. Gum infections may exacerbate diabetes diet. It adds to the benefits of good oral the type of mouth guard that is best for you. because infections can affect the stability of health, you’ll feel better — and your smile Your smile says a lot about you, so do blood sugar levels. Uncontrolled diabetes and body will thank you. everything you can to protect it!

Healthy Mouth 6 Healthy Life Osteoporosis Discuss the potential consequences with your dentist by Gregory E. Phillips, DDS, MSD, Diplomate, American Board of Periodontology; Fellow, International Team for Implantology

steoporosis, or thin- ning of the bones, is Oa condition that affects both genders but is more common in women. It has been estimated that more Gregory E. Phillips, DDS than 44 million people in the United States older than 50 are at risk for fractures due to osteoporosis and low bone mass. It also increas- es the chances for periodontal, or gum disease. The Gender Effect If you have osteoporosis, your doctor may Tobacco negatively impacts women more so than men have prescribed a bisphosphonate medication. The use of bisphosphonate medications has by Laura Romito, DDS, MS, Clinical Associate Professor, Director, Nicotine Program been linked to “” or Department of Oral Biology, Indiana University School of Dentistry ONJ, which literally means dead bone. When it comes to smoking, women and Neck: Feel along the Following an oral surgical procedure, such as men are not created equal. Osteoporosis is sides and front of your neck a tooth extraction, the area does not heal more common in women than in men, and to identify tenderness or and a portion of the jawbone is exposed, prone tobacco contributes to the development of lumps. to infection and often painful (see figure 1). osteoporosis by decreasing bone density and Lips: Inspect the The vast majority of cases of ONJ have reducing calcium absorption. inside of your lips for occurred in patients who have received the Not surprisingly, the alveolar bone support- sores or changes. high potency bisphosphonate medications ing the teeth can be affected. Tobacco smoke Use your thumb and Laura Romito, DDS for the treatment of bone cancer. However, Walso has harmful effects on the gums, forefinger to feel lips for changes in texture. ONJ has also been reported in patients that increasing the risk for periodontal disease Cheeks: Look for color changes. Feel have taken the medication for osteoporosis. and tooth loss. each cheek for lumps or tenderness. Not everyone who takes an oral bisphos- One of the most tragic consequences of Roof of the mouth: With head tilted phonate and needs a tooth removed develop tobacco use is the development of cancer in back and mouth open, look for lumps or ONJ. To help prevent periodontal disease the gums, tongue, lips and mouth, but the unusual coloration. and ONJ, If you have taken bisphosphonate initial signs may appear harmless. Oral Floor of the mouth and tongue: medications, schedule a dental evaluation as cancer signs and symptoms include: Stick out your tongue and look at the top soon as possible to determine the overall health > a painless swelling surface for changes in color or texture. Move of your teeth and gums. > hardness or lump in the mouth or neck the tongue left, right and up to examine all If bisphosphonate medication is prescribed > red or white patches in the mouth tongue surfaces and the floor of your as part of your osteoporosis therapy, any > bleeding mouth. dental treatment can be safely performed > numbness Women who currently use tobacco or during the first three years of drug therapy To minimize the risk of developing oral have in the past should visit their dentist when the risk of developing ONJ is minimal. cancer, women should take steps now to quit regularly so problems can be detected early Once the teeth and gums are healthy, simple, using all forms of tobacco. Women currently and treated promptly. routine dental care can maintain your oral using tobacco should perform regular oral In order to have a healthy mouth and a health without risk of developing ONJ. self-exams at home. After brushing, use a healthy body, the best decision is to abstain mirror and examine your: from tobacco. Fortunately, there are many Head and neck: Look for any lumps resources available for smoking cessation. If or swellings that are only on one side of your you smoke, talk to your health care provider face. or dentist about cessation programs in your Face: Look for any color or size changes, area or call (800) QUIT-NOW to get the Figure 1 sores, moles or growths. help you need.

Healthy Mouth 7 Healthy Life Cleft Lip and Palate Major surgical advancements are promising in correcting birth defects by Ronald R. Hathaway, DDS, Director, Craniofacial Center It’s Never Too Early Peyton Manning Children’s Hospital at St. Vincent The time is now to care for your children’s oral health by Caroline W. Derrow, DDS, Pediatric Dentist, Auburn Pediatric Dentistry left lip and palate are the Dentists strive to make each child’s first affect the developing Cmost common dental visit a good and memorable one. permanent teeth. Early birth defects in the With your help, your children can develop a care is essential for a United States. These lifelong interest in maintaining their oral health. lifetime of good dental defects affect the upper health for your child. lip and roof of the Ronald Hathaway, DDS The ABCs of brushing mouth. Tissue that Good oral hygiene starts at birth. Wipe Going to the forms the roof of the mouth and upper the gums after every feeding. Wrap a dentist Caroline W. Derrow, DDS lip don’t join before birth and result in Dwashcloth or cotton gauze around your Your child’s first visit should be made by one or both of these abnormalities. The index finger and wipe off the gums. Use the at least age 1 as recommended by the American problem can range from a small notch in same wiping pattern each time to ensure Academy of Pediatric Dentistry, the American the lip to a large gap or groove that runs consistency. Eventually, your child will open Dental Association and the American into the roof of the mouth and nose. after every feeding expecting a cleaning, so Academy of Pediatrics. This visit provides a vital This can affect the way a child’s face that once he or she is older, brushing after opportunity to begin preventative oral health looks and can lead to problems with eating every meal will come more naturally. habits and reduce the risk of getting cavities. and talking, ear infections and other Brush once the first teeth erupt –– a soft It’s important to establish a dental home. Your health issues. All infants, children and infant toothbrush is recommended with child then will be treated in a familiar place adults with facial growth problems non-fluoride toothpaste. Use a very small with all the needed medical forms on record should receive high quality medical and amount of toothpaste. Apply it across the for routine care, or in case of an emergency. dental care from routine orthodontics to width instead of the length of the bristles. With a positive attitude, you can make the craniofacial surgery as appropriate. Change your child’s toothpaste once he or first visit to the dentist enjoyable. Talk to your Treatment usually involves surgery to she is old enough to spit out the toothpaste child about how the dentist is there to help close the lip and palate. Doctors often do and not swallow it. Toothpaste containing and answer any questions. Avoid using words this surgery in several stages. The first fluoride is then recommended. that might cause unnecessary fear, such as surgery typically is done during the baby’s needle, pull, drill or hurt. Pediatric dental first year. The results of such treatment Baby teeth offices specialize in making your child’s oral include improved facial appearance, Primary teeth, or baby teeth, are health experience effective and comfortable. better speech and hearing, proper chewing important for proper chewing and eating. Your child can sit in your lap for the first and swallowing function, better oral They also provide space for permanent visit. Even though all of the teeth may not be hygiene and improved self esteem. teeth, guiding them into the correct position, present, it’s important to assess the eruption Fortunately, with medical and dental and permit normal development of the jaws of the teeth, development of the jaw, advances, outcomes for children born and muscles. Primary teeth also affect the nutrition and fluoride. with cleft lip and palate and others with development of speech and add to an The visit should include a comprehensive facial birth problems are now quite attractive appearance. exam, teeth cleaning and fluoride application, promising. Though the front four teeth last until age and digital X-rays depending on need. You See page 13 for amazing before and after 6 or 7, the back teeth — cuspids and molars — may discuss topics, such as finger sucking and photos of one Hoosier woman born with a aren’t replaced until age 11 to 13. Neglected grinding. A tour of the office can help your cleft lip and palate who is now proud to cavities frequently lead to problems, which child feel at home during routine visits. show off her smile.

Healthy Mouth 8 Healthy Life Harmful Habits? Deciding when to put an end to thumb sucking and pacifier use by Judith R. Chin, DDS, MS, Associate Professor, Department of Pediatric Dentistry, Indiana University School of Dentistry

As a mother, you may be worried about by age 4 will help to prevent future problems pacifiers for bedtime use only. your child’s thumb, finger or pacifier sucking with the correct growth of the jaws, mouth Cut a small hole in the top of the habit and wonder if it is harmful. and teeth. pacifier. This creates a different feel that Rest assured it is normal for infants and Pacifiers can affect the teeth in the same most children do not like. Make sure young children to put things in their mouths way as sucking fingers and thumbs. that your child does not bite off and suck on things. It may make your child However, it is often an easier habit pieces though as it may cause a feel safe and happy. It also may help soothe to break. An individualized approach choking hazard. your child in stressful situations. for each child is needed when Talk to your child about AUsually, children stop these habits on their evaluating his or her particular stopping and set a date. You can own when they are 2 to 4 years old. Children habits and stage of development. make it a positive thing by having need to stop using a pacifier or sucking their Tips to break the habit: the “Binky Fairy” come get the thumb before the adult front teeth come in, > Children often suck their pacifier to give to a new baby and Judith R. Chin, DDS which usually happens around age 6. Stopping thumbs or rely on a pacifier when leave some “Big Kid” toys for your needing comfort or feeling insecure or tired. growing toddler. When appropriate, some of these needs can > For a thumb or finger habit you can try be addressed in other ways. several methods: > Notice when and where thumb sucking Place a stretchable glove or sock or pacifier use occurs. Divert your child’s on the hand attention by offering an alternative. Cover the finger with an adhesive > For an older child, involve him or her bandage. in choosing the method of stopping. Talk to your pediatrician and dentist > For a pacifier consider one of these about this issue and other concerns. They methods: may offer other creative ideas for breaking Make it a special treat by limiting the habit when the time is right. Your Questions Answered Q-and-A with Joan E. Kowolik, BDS, LDS, RCS, Director, Pre-doctoral Pediatric Dentistry, Indiana University School of Dentistry

Q: How can my children and I using a soft cloth to begin with and then a also important to never put avoid getting cavities? Is it possible? soft baby toothbrush once the baby can sit with anything but milk or water in A: It doesn’t take an advanced degree or support. Keep in mind that the mouth needs the bottle. training to prevent cavities, just regular and to be cleaned even after nursing on breast milk. sustained oral health home care. Q: Do I have to forbid Q: Where does the baby get the all candy? Joan E. Kowolik, BDS Q: What exactly is good oral germs that cause cavities? A: Absolutely not! Candy, soda pop and health home care? A: We all have them so they generally come sweet foods are a part of life and should not A: Brush and floss your teeth regularly, from adult caregivers: Mom, Dad, Grandma, be banned. Sugary foods should only be each morning and night before bed, and limit the sitter, anyone who feeds or kisses the baby. consumed in moderation and at times when sugary foods. The key is consistently doing That is why it is important for the adults to the mouth can be cleaned. Sweet things these things in an effective manner. have healthy mouths and no cavities. eaten only as part of or after a meal have little bad effect if the teeth are brushed soon Q: When should I begin tooth Q: Should I put my baby to bed after. It is also better for your child’s health brushing? with a bottle? if they do not eat sugary foods between A: The best time to start is when you are A: Giving your child a bottle in bed is meals. Eating candy and drinking pop in just a baby. Cleaning the mouth should advised only if the bottle has water in it. the car is much more damaging. As a parent, begin when the baby is very young, even Sipping milk all the time may cause cavities you should set the example. It is easier to before any teeth have erupted. Every time to form because it contains natural sugars. set up good habits when your child is the baby is fed the mouth should be cleaned To protect your children’s oral health, it is young.

Healthy Mouth 9 Healthy Life Going For It Barbara Fuentes Smith realizes her Disparities in Oral Health dream to become a dentist Oral health is essential to everyone’s general health and well-being. by Deb Wezensky Unfortunately, significant oral health disparities persist in the United States largely due to complicated cultural, economic and social love of science and an processes that ultimately affect access to effective dental health care. orthodontist’s genuine Minorities experience numerous barriers to preventive dental care A and professional care including lack of insurance, lack of access including an unmet need for inspired Barbara Fuentes Smith mentors and promotion of preventative care, discrimination, language to become a dentist with a barriers and lack of culturally sensitive dental care. private practice. “I went into The consequences of poor oral health and the lack of or inadequate dentistry to help people. If it O Barbara Fuentes Smith, DDS dental care often result in pain and infection, missed work and school, takes me an hour to do the speech and eating dysfunction, distraction from normal lifestyles, risks right thing, it takes me an hour,” she says. to overall health and worsening of medical conditions. Fuentes Smith says she’s also committed Nancy Jewell Some of the more alarming disparities include: to educating her patients so their overall dental > In Indiana, African Americans and Hispanics were more likely to report tooth loss health improves. compared to Whites. From a traditional home in Mexico City, > Hispanics and African Americans have experienced a higher incidence of tooth decay, her parents had not anticipated her desire to periodontal disease and bone loss than Whites. be career oriented as opposed to a homemaker. > Hispanic children are 2.5 times more likely and African-American children are 1.5 Still, her father encouraged her to be the best times more likely to have tooth decay than are White children. at whatever she wanted to be. > A larger portion of elderly African Americans have periodontal disease compared to elders Her father taught her to treat others the of all racial populations regardless of social-economic status. way she wanted to be treated and always to > African-American men have higher rates of oral cancer and poorer survival rates strive to do the right thing. Growing up, her than other men. orthodontist modeled a wonderful patient- > African Americans with oral cancer are less likely to survive five years after the disease is doctor relationship. “He always treated me as detected compared to Whites. if I was special, and he helped me get a much > Fewer Hispanics have dental insurance than African Americans and Whites. nicer smile,” she says. It was a precious gift The Indiana Minority Health Coalition is a nonprofit organization whose vision is to ensure that Fuentes Smith now passes on to her patients. no ethnic/minority child, adolescent or adult will experience preventable health conditions at any She worked hard earning her dental degree greater rate than non-minorities. We are constantly challenged to find ways to assist with the in Mexico at the Universidad Intercontinental. elimination of racial and ethnic disparities. We utilize our broad-based network of affiliate agencies A dentist in her native country for six years, she across the state of Indiana to assist with this task. Collectively, we hope to make a difference. turned her sights on continuing her education You can encourage others to get the preventative dental care and treatment they need by with a master’s degree in the United States. telling them about the health care resources on page 16. Some community resources for The road to success was challenging. “You reduced cost dental care include HealthNet Dental, Indiana University School of Dentistry really have to know what you want and you and Marion County Health Department. really have to work hard,” she says. Before being admitted to college in the United States, she had to pass the Test of English as a Foreign Language exam (TOEFL). During Nancy Jewell English as a Second Language classes, she President and CEO met John Smith, her husband of 20 years. Indiana Minority Health Coalition Her decision to return to school was a wise

Did You Know? > The community water fluoridation program began more than 60 years ago in Community water fluoridation Grand Rapids, Michigan. by Daniel S. Cain, BS, REHS, Director of > Community water fluoridation has Water Fluoridation, ISDH been named by the Centers for Disease Control > Fluoride is a natural element found in and Prevention as one of the 10 great public the environment that can reduce the risk of health achievements of the 20th century. Daniel S. Cain tooth decay. > Over 4.3 million Hoosiers drink opti-

Healthy Mouth 10 Healthy Life one. However, moving away from her tight- knit family –– to an entirely different culture in Indiana –– and attending classes as a new mother took courage and persistence, along with her husband’s unwavering support. Fuentes Smith balanced baby, books and being a wife with patience and flexibility. Time was an issue. Money was tight. And not having English as her native language added another demanding facet to daily life. Being culturally different set her apart. At times, she felt she didn’t belong. Her different standing in her coursework also kept her from being more integrated with her fellow students. That experience and her desire to help others, motivates Fuentes Smith to also teach at the Diversity in Dentistry Indiana University School of Dentistry. Explore opportunities to positively impact others Some of her minority students also experience a sense of “standing alone,” she adds. by Traci Adams-Wilson, Coordinator of Diversity Support Services, “On the other hand, being a minority student Indiana University School of Dentistry Traci Adams-Wilson today may actually help you to be accepted Looking for a career in a people-oriented necessary for the development of a competitive in schools, as well as alternative scholarship workplace that provides a valuable service to application when the time comes to apply and loan opportunities. Here there is so others? Your goals may be realized in the for dental school. much opportunity. I went to school on loans.” dental field. The IU School of Dentistry in There are some barriers that may keep her “Dentistry provides flexibility, lots of Indianapolis is actively recruiting students to fellow Latinos from getting proper dental opportunities and variety,” says Dr. LaQuia fill the growing needs for dental professionals. care. Some Hispanics may not be at ease Walker, who chose dentistry as a career. “It’s The Urban Pre Dental Club has been with English-speaking health care providers. great if you want a family. Each day is different, created with specific activities geared toward There often is a lack of education about and you are not tied to a pager.” minority students. Each month, members the value of routine preventative care. The result L The dental industry is rapidly growing have the opportunity to participate in dental- is an association of dental care with pain and with a need for dentists, orthodontists and related hands-on activities. Personal career unpleasantness. Lack of dental insurance professional dental support staff. There is a development advice is provided through coverage often means care is not affordable. great need for more dental practitioners in discussions with dental practitioners, partic- The goal of some minority dental students is Indiana. In many places, dentists are retiring ipation in mock interviews, personal statement to go back and improve the dental health in faster than new practitioners can be trained. writing assistance and other application- their communities by bridging cultural gaps. There is an even greater need for under- related activities. Students in the club also “If you are in the chemistry lab and you like represented minority dentists, defined as have the opportunity to network with other it … then college classes in biochemistry, Black/African American, Latino/Hispanic and dental students, faculty and staff, as well as biology and math will be interesting,” an American Indian by the American Dental future classmates and colleagues. aptitude Fuentes Smith says is very important Education Association. This year the IU School of Dentistry and for dental school. “You also need to like to work Cristina Lara, a fourth-year dental Latina the Metropolitan Indianapolis-Central Indiana with your hands, be ethical and have good student at Indiana University School of Area Health Education Center launched people skills. You have to like to help people,” Dentistry says she went into the field Dental Summer Institute: Indianapolis, a she adds. “And you can not stop learning new “because the country is becoming more weeklong experience developed for high school techniques, materials and equipment.” diverse, and people feel more comfortable and college students interested in exploring going to a health care practitioner who dentistry. Interested students from three shares a common culture.” states experienced dental tool use, chairside mally fluoridated water. The Centers for Disease Her future plans include having a practice in observations with real patients and gained a Control and Prevention recognizes Indiana for the Philadelphia area where she will be able sense of what dental school is actually like. providing 95 percent of the total public water to provide dental services to members of her Interested in exploring a career in dentistry? supply population with fluoridated water. community. For more information, contact Traci > Indiana has 89 community public water Lara suggests shadowing a dentist in your Adams-Wilson at [email protected] or log systems that serve about 328,000 Hoosiers. The community if you are interested in dentistry. on www.iusd.iupui.edu. systems contain naturally occurring fluoride She also advises high school students to For more information, log on to the at levels recommended by the CDC. take AP courses in the sciences and join science American Dental Education Association’s clubs to begin building the foundation Web site at www.adea.org.

Healthy Mouth 11 Healthy Life Medications and Your Mouth Some may adversely affect oral health by Amy Sutton Peak, PharmD, Director of Drug Information Services, Butler University

any of us take one kind of Mmedicine or another to treat a health condition. Unfortunately, Dental Implants some medications that treat one problem may actually For a smile that looks and feels natural cause another. Amy Sutton Peak, PharmD by Denise Flanagan, DDS, Oral and Maxillofacial Surgeon A common oral side effect of medications is dry mouth, which can Have you lost at anchored into the jaw. The difference is be caused by more than 500 medications. least one permanent that the implant is made of titanium –– the Persistent dry mouth may be linked to cavities tooth to an accident? same well-accepted material used by surgeons and infections and should not be ignored. Experienced gum dis- for artificial joints. Medications causing dry mouth include drugs ease, a failed root canal for overactive bladder, allergies, Parkinson’s or tooth decay? You are The process disease, and sleep aids and antidepressants. not alone. Sixty-nine A team approach that involves you, the Though less common, some medications Denise Flanagan, DDS percent of adults ages patient, a restorative dentist and an oral cause gum overgrowth. This adverse effect often 35 to 44 share someH of these same oral and maxillofacial surgeon is critical when is associated with three drugs: phenytoin, used health issues. There are solutions to getting dental implants. to treat seizures; cyclosporine, often used in improve your oral health. First, the surgeon surgically places the transplant patients; and nifedipine, typically There are plenty of reasons to replace a implant in the jaw with the top of the used for blood pressure or heart conditions. missing tooth. A missing tooth can affect implant slightly above the tops of the bone. Those with gum overgrowth need to work with your bite, speech and eating choices. As A screw is inserted into the implant to their dentist and the physician prescribing the you rely more on your remaining teeth, protect it and keep the tissue from growing medication to determine treatment. you increase the chance they will wear out over the implant. This procedure, as well as Some medications can cause discoloration prematurely or be damaged or lost. There the recovery, is similar to or easier than the of the teeth or mouth. Certain antibiotics are is also a risk of extra pressure on and tooth extraction process. known for causing teeth discoloration in young discomfort in the jaw joints due to the Time is allowed for bone to heal and children or pregnant women. This permanent changing relationship of the teeth. grow around the dental implant. During discoloration typically is not improved by Twenty years ago, these patients would the second step, a support post, or abutment, bleaching. Anti-malarial agents and other drugs have had no alternative but to get a fixed is placed on the implant. In the final step, may cause discoloration. Unlike the permanent bridge or removable denture to restore the dentist makes a custom artificial tooth, teeth discoloration seen with , their ability to eat, speak clearly and smile. called a “dental crown,” of a size, shape, these tongue discolorations often disappear However, fixed bridges and removable color and fit that will blend with the other shortly after stopping the medication. dentures are not the perfect solution and teeth. Once completed, the crown is Share these side effects with your dentist and often bring with them a number of other attached to the implant post. If all of your health care provider so the most appropriate problems. The good news is that there is teeth are missing, a variety of treatment plan of treatment can be followed. This helps another solution — implants. options are available to support the ensure a healthy mouth and a healthy body. replacement teeth. More like your natural teeth Good candidates for implants are those A natural tooth consists of a root and a in good health and with healthy gums and crown. If you compare natural teeth to adequate bone to support an implant. If implant supported replacement teeth, you think implants might be right for you, you’ll see they have the same basic parts. schedule a consultation with an oral and Both have a crown, the visible part used to maxillofacial surgeon who can perform an Left: Tooth discoloration caused by tetracy- cline use when the patient was 3 years old. chew food. Both have a root that holds the exam and determine if you are a good Right: Gingival hyperplasia (gum overgrowth) tooth securely under the gum and is candidate for dental implants. caused by phenytoin.

Healthy Mouth 12 Healthy Life Crowns New technology can make restoration more convenient by William C. Tellman, DDS, Castleton One Step at a Time Cosmetic and Family Dentistry Romesha Thomas faces the challenges of a cleft palate and lip dvances in the by Deb Wezensky field of dentistry The birth of a new baby is often met with A have made some anticipation, joy and maybe even a little fear. dental repairs, such as This was indeed true of Romesha Thomas’ crowns, less time-consum- birth. Her mother, Rita, initially agonized over ing and more aesthetically the challenges facing her newborn because she appealing. was born with a cleft palate and cleft lip. A crown or cap is an William Tellman, DDS But with the help and support of her own artificial covering placed mother and maternal grandparents, Surgeries and orthodontic treatments trans- over existing teeth that need to be repaired. Romesha always got the extra attention and formed the appearance of Romesha Thomas, Teeth may need crowns as a result of T who was born with a cleft palate and lip. continued expert medical care she required. fractures, cracks, large restorations and root From the moment she cried from hunger, canal treatment to correct the bite, or to Romesha and her mom shared a special just fall into place –– things will go better,” make teeth look more natural. bond brought about by facing adversity she recalls. “Dr. Hathaway has done an Crowns are made with a variety of durable together — and overcoming it. amazing job in always keeping me positive.” dental materials. They usually contain some Romesha’s cleft lip and palate meant she In addition to her surgeries, Romesha type of metal, such as gold, silver or copper. had difficulty drinking from a traditional went to speech therapy in elementary school Sometimes they are made of porcelain or a bottle. The opening into her mouth from to help her pronounce the “s” sound properly. combination of porcelain and metal. her nose caused a leak of air that prevented “I remember I did really well in class,” she A crown restores a tooth to its original effective suction. To be sure her baby received reflects. It is through a team of health care shape and improves its strength and the right amount of nourishment, Rita fed her professionals that her health and appearance appearance. Recent improvements in dental with a specially designed bottle and nipple have been transformed over time. materials allow dentists to place porcelain that allowed milk to flow more freely. Final steps in the late teenage years crowns that are functional, natural-looking Initially, Romesha was fitted with a included a surgical advancement of her top and cosmetically appealing. prosthetic device called an obturator made jaw by Dr. Jeff Buttrum, an oral and max- Porcelain crowns are used primarily for to fit the roof of her mouth to cover the gap illofacial surgeon of the same craniofacial restoring teeth toward the front of the mouth, during the first months of life. This procedure team and a final lip revision again by Sadove. due to their ability to match the looks of helped her to feed by preventing the milk After her most recent surgeries, Romesha is a natural teeth. Gold crowns usually are placed from coming out through the open nasal quietly confident, attractive young woman who only on the back teeth. They are potentially passage. The lip was closed surgically at 3 appreciates the quality of care she received. the strongest type of crown. They are placed months and the roof, or palate, of her mouth “Today I have straighter teeth, my bottom in areas of the mouth where the most was surgically closed at 14 months. jaw is more aligned with my top jaw so that my chewing takes place and are very durable. Dr. A. Michael Sadove, a craniofacial plastic teeth fit better, and the way my lips look makes Among the most impressive technological surgeon with the cleft palate program of the me very happy,” she says. “I’ve been given a advances in the past few years is the CAD/ Peyton Manning Children’s Hospital, saw totally whole new look. Since I’ve had braces, CAM technology, or computer aided design/ Romesha for these early procedures. Over the my smile has changed ... I feel more confident.” manufacturing technology. It allows a dentist years, Romesha’s family made the trek from Fort Because of her experiences, she is now a to custom-create ceramic restorations at the Wayne to Indianapolis to confer with Dr. self-assured 18-year-old woman who truly rate of about one hour per tooth. Multiple Ronald Hathaway, a craniofacial orthodontist knows the value of family and friends. “My restorations that once required weeks can be and director of the Craniofacial Center, Peyton mom’s best friend and Grandma were here in completed in a single office visit. Manning Children’s Hospital at St. Vincent. Indy during my last surgery. They helped out Using a digital impression of your teeth, Hathaway performed several procedures to as much as they could,” she says. the technology allows dental experts to design modify her facial and dental structures as she Romesha advises others faced with and create a restoration that matches the matured. Special medical care was needed physical adversities to “remember you are exact shade of your surrounding teeth. as her mouth, teeth and jaw developed over not different from anyone else. Just because I By the time you leave the dental office, time. Romesha found it helpful when had a cleft palate and lip didn’t mean I your new restorations will be permanently Hathaway counseled her to be “patient, and couldn’t feel confident about myself. We are bonded into place, giving you the confidence remember that, step by step, everything will all beautiful people.” only a flawless smile can bring.

Healthy Mouth 13 Healthy Life Oral Cancer Bleeding Gums Keep this silent killer quiet — reduce your risks The problem may be “just the tip of the iceberg” by Thomas McLellan, DDS, Director of Professional Services at Delta Dental of Michigan, by Burton Largura, DDS, MSD, Ohio, Tennessee, Illinois and Indiana Peridontist, Indiana Health Oral cancer isn’t something that comes to infrequently and do not Centers-Kokomo mind when people name common types of smoke. Recent studies cancer. Yet, according to the Oral Cancer have dentists and doctors ant to keep your teeth healthy Foundation, about 34,000 Americans are worried because they show and avoid the need to be fitted diagnosed with oral cancer, and more than there is a growing risk of Wfor dentures or implants? Be 8,000 die annually. oral cancer in women, proactive by taking care of your mouth, teeth There also is a growing trend of women including those who don’t and gums. Brushing and flossing twice daily Thomas McLellan, DDS getting oral cancer. Several decades ago, about drink or smoke. can help keep your mouth disease free. Oone woman would get oral cancer for every 10 There also appears to be a connection Periodontal disease is the No. 1 cause men who got it. Today, it’s one woman for between the Human Papillomavirus (HPV) of tooth loss in adults, according to an every two men, according to the U.S. Centers and oral cancer. Women who have HPV American Dental Association/Colgate survey. for Disease Control and Prevention. The should tell their dentist and request an oral Your annual dental exam involves an five-year survival rate is 57 percent and has cancer exam. Women who don’t know evaluation for tooth decay, and the health not gotten better in more than 40 years. their HPV status should talk to their doctor of your gums and supporting tissues. Those who have oral cancer can have a about it at their next annual exam. This Periodontal or gum diseases, including poor quality of life due to damage caused to common infection often does not have any gingivitis and periodontitis, are serious their face and neck. The cancer and the symptoms. infections that when left untreated can damage it causes can affect how people speak, There is some good news. Advances in lead to tooth loss. eat and breathe. science and technology, such as the new Gingivitis, the mildest form of gum Making more people aware of the disease OralCDx BrushTest™, are used to spot oral disease, affects just over half of the U.S. can help with early detection, which is the cancer in its earliest stages or when cells population. Gums that are red, swollen and key to boosting the survival rate to as high as appear abnormal but are not yet cancerous. bleed easily are classic signs of gingivitis. 81 percent. With earlier detection, dentists can provide There can be very little to no discomfort. Using alcohol, tobacco or smokeless the care to their patients to fight oral cancer Gingivitis often is caused by inadequate tobacco really increases the danger of getting before it has a chance to kill. oral hygiene — flossing and brushing — oral cancer. However, more than 25 percent For more information about oral cancer, but can be reversed easily by professional of all oral cancer occurs in people who drink log on www.deltadentalin.com. treatment and improved homecare.

Oral Cancer: Know the Signs Quiz Answers: arly detection of oral cancer through > Tiny marks resembling canker sores that (From Page 3) preventative dental care is the key to last longer than two weeks 1. False. Toothbrushes should be Esurvival. Whether you believe you have > Sores that bleed and don’t heal (in later replaced every three to four months. A worn any of the risk factors for getting oral cancer, it stages) toothbrush will not do as good a job of is important to always be on the lookout for Oral cancer exams are quick and painless. cleaning your teeth. (When the bristles fan early signs of the disease, including: A dentist or dental hygienist can examine out or if you get a cold, it’s time to change.) > Non-healing red or white spots that your neck, head, mouth, gums, throat and 2. True. Cigarette smoking is associated appear on the gums, cheeks or under the tongue tongue looking for signs. If a dentist finds an with half of all the cases of periodontal > Swelling of the tongue or throat unexplained red or white spot, he or she can disease in the United States. > A lump in the mouth or neck use the OralCDx BrushTest™. This procedure 3. True. Effective whitening agents can > Pain or difficulty with swallowing or spots oral cancer in its earliest stages or cause serious problems in teeth and gums chewing when cells appear abnormal but are not yet with preexisting damage. > Numbness in the mouth cancerous. It is used to collect cell samples 4. False. It is better to drink a can of > Vocal hoarseness that lasts for an extended for further study. soda with a meal rather than sip throughout time (Source: Delta Dental) the day because your teeth are exposed to high acid levels for a shorter period of time.

Healthy Mouth 14 Healthy Life Periodontitis is a very serious form of gum disease that progresses from untreated gingivitis. Bacterial plaque moves below the gumline and releases chemical toxins that destroy the tissue and bone surrounding teeth. The gums become loose and separate from the teeth, causing a pocket to develop, which then harbors more infection. As the disease progresses, destruction occurs to the bone and tissue, leading to further damage, painful infections, loose teeth and eventual tooth loss. In many cases, only mild symp- Oral Conditions Susan Zunt, DDS toms of discomfort are noted until more advanced stages of the disease are present. Dry mouth and burning mouth disorder can be troublesome The damage to both tissue and bone by Susan Zunt, DDS, MS, Professor and Chair, Oral Pathology, Medicine and often is impacted by the immune system. Radiology, Indiana University School of Dentistry As the immune response is activated by foreign bacteria and their by-products, the Not feeling like smiling, eating or talking > Use over-the-counter products to increase body’s own immune cells, white blood due to a less than healthy mouth? You aren’t mouth comfort after consulting your dentist. cells, lymphocytes and antibodies destroy alone. Work with your health care team to > Chew sugarless gum with Xylitol. host tissues in their attempt to defend the diagnose your health issue and put that smile > Avoid tobacco; it dries the mouth and body from these foreign invaders. back on your face. increases the risk of gum disease and oral cancer. Additional factors, such as smoking > Limit alcohol. It is drying and increases tobacco and suffering from a systemic Dry mouth the risk of oral cancer if used with tobacco. disease such as diabetes, can compound Your mouth seems dry all the time. You > Use a cool air humidifier by your bed. the effects of periodontitis. Nhave burning sensations inside your mouth Diabetes, if not well managed, weakens or on your tongue. Your lips are chapped and Burning mouth disorder the body’s immune system and can allow dry. You may get frequent mouth sores. Eating Burning mouth disorder is a chronic pain more pervasive and damaging periodontal dry, rough, salty, sweet, acidic, hot or spicy syndrome affecting 2 percent to 3 percent of infections to occur. It is important to see your foods is difficult. You keep water with you adults and is more common in women. It physician and dentist for comprehensive constantly. You wake up with your tongue typically affects about 14 percent of post- health checkups to prevent this very stuck to the top of your mouth. Speaking menopausal women. unpleasant but preventable health problem and swallowing are difficult. The causes are unknown, but BMD may from occurring. You may have dry mouth due to decreased follow a viral infection, traumatic injury or salivary gland function. Having a dry mouth stressful event. The burning sensation can increases the risk of developing dental decay be over the entire inside of the mouth or 5. False. The element found in drinking or cavities due to bacterial infection. isolated to the top of the tongue, lips and water to protect teeth is fluoride. Some medications, especially those used for front roof of the mouth. 6. True. Not only does this help dislodge anxiety, depression, hypertension, allergies, Symptoms can appear gradually, but about some of the food stuck to your teeth, it also colds and pain, can cause dry mouth. People 35 percent of patients report sudden onset. increases saliva flow to help buffer acids. with diabetes, an autoimmune disease, Often the intensity worsens during the day and 7. False. Oral care should begin at birth. rheumatoid arthritis, and autoimmune reaches the maximum in the evening. Many A baby’s gums should be wiped after every thyroiditis also may suffer from this condition. people experience altered or bad taste such as feeding with a washcloth or cotton gauze. Radiation therapy to the head and neck can metallic, bitter, intense sweet/sour or are super- 8. True. Cleft lip and palate is the most destroy salivary glands that lead to dry mouth. tasters with increased numbers of taste buds on common birth defect in the United States There are simple tests your dentist or the front of the tongue. Decreased salivation has and may be associated with a lack of folate. physician can perform for an accurate diagnosis been found in 20 percent of patients. 9. True. Wearing a mouth guard while and treatment. To alleviate dry mouth: Unfortunately, there is no specific test for playing sports protects your mouth and > Stay hydrated. Sip eight to 10 8-ounce BMD. Blood tests often are done, and the teeth from accidents that may result in glasses of water daily. dentist or physician makes the diagnosis by cracked, broken or lost teeth. > Avoid acidic beverages, including ruling out other known causes of oral burning. 10. False. Bleeding gums could be a flavored water and colas. There is no one treatment for BMD. sign of gingivitis or periodontitis, two > Use a fluoride toothpaste. There are Be sure to see your dentist or physician to common forms of periodontal disease. special toothpastes for dry mouth. accurately identify and treat BMD.

Healthy Mouth 15 Healthy Life Resources Academy of General Dentistry provides a dental directory, HealthNet Community Health Centers provide health as well as information on oral health. Call (888) AGD-DENT (243- and dental care services at reduced costs. Dental care can be provided 3368) or log on www.agd.org. at the following centers: Martindale-Brightwood Health and Dental Center, (317) 782-2128; People’s Health & Dental Center, (317) American Dental Association, the world’s largest dental 782-2126, and Southeast Health & Dental Center, (317) 782-2126. association, provides invaluable oral health news and information. Log on www.ada.org. Hoosier Healthwise provides low-cost or free health and dental insurance to eligible children and families. Call (800) 889-9949 American Dental Hygienist Association provides or log on www.in.gov/fssa/ompp/2848.htm. prevention education and materials on better oral health, tobacco cessation and school lesson plans. Log on www.adha.org. Indiana Dental Association provides information on finding a dentist in your area and learning more about basic oral health. Call American Academy of Periodontology provides (317) 634-2610, (800) 562-5646 or log on www.indental.org. information on finding a periodontist in your area, as well as information on periodontal health. Log on www.perio.org. Indiana State Department of Health has an oral health program that is working towards better oral health for all Hoosiers. Connect2Help provides information and referrals for dental Call the Indiana State Department of Health Family Helpline at care in central Indiana counties. Call 211, (317) 926-4357 or log on (800) 433-0746 or log on www.in.gov/isdh/18695.htm. www.connect2help.org. Indiana University School of Dentistry offers adult, Centers for Disease Control and Prevention provides pediatric and orthodontic services provided by dental students. Call a variety of oral health information and recommended guidelines. (317) 274-7957 or log on www.iusd.iupui.edu. Log on www.cdc.gov/oralhealth. Marion County Health Department provides several Delta Dental of Indiana, Michigan and Ohio — with its dental services, including clinics and a traveling Smile Mobile. Call affiliates in Illinois and Tennessee — make up one of the largest (317) 221-2329 or log on www.mchd.com/dh.htm. dental plan administrators in the nation. In 2007, the enterprise paid out nearly $1.8 billion for dental care for more than 7.6 Simple Steps to Better Dental Health provides information million enrollees. For more information on oral cancer, log on on preventing problems, understanding conditions and exploring www.deltadentalin.com. treatments. Log on www.simplestepsdental.com.

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This project is funded by the CDC PHHS Block Grant award number B01DP009019-08. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.

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Healthy Mouth 16 Healthy Life