Watch Your Mouth: Part 1
For Women Only by Dr. Allyson K. Hurley, DDS, MAGD, AACD

Practicing good oral hygiene and seeing your dentist for regular check-ups is sound advice for everyone male or female, young or old. But women of all ages have particular oral health needs of which they need to be aware. The following are common issues women may experience throughout the different phases of their life, along with the oral health problems associated with them.

Puberty
When a girl reaches puberty, she experiences a surge in hormones that may cause gum tenderness, particularly when she menstruates. She may also develop mouth ulcers or lesions. Of course, this can make brushing and flossing uncomfortable or painful, which in turn may cause her not to brush and floss as thoroughly as she should, thus leading to gingivitis (inflammation of the gums) or periodontal disease.

There are several over- the- counter products, including topical applications and lozenges, which can help relieve some pain caused by gum sensitivity and mouth ulcers. In addition, warm saltwater rinses and non-alcoholic mouthwashes may help.

Bulimia
Bulimia is an eating disorder often characterized by episodes of “binge” eating followed by purging via self-induced vomiting. Although it can affect men and women of all ages, it is more prevalent in women. Bulimia can lead to the erosion of tooth enamel due to the introduction of stomach acid into the oral cavity, which results in the insides of the teeth being worn away and an increase in tooth decay. The teeth can also become very sensitive.

To address these problems, we make custom-fitted fluoride trays that allow the patient to apply fluoride to her teeth daily. We can also prescribe to such patients higher-concentration fluoride toothpaste to help prevent the devastating effects this condition can have on the teeth. The higher concentration of fluoride also seems to help decrease the tooth sensitivity that often accompanies this condition.

Pregnancy
Have you ever heard the saying that a woman loses a tooth for every child she bears? Of course, this is just an old wives’ tale. However as a result of hormonal changes, especially surges in the hormones estrogen and progesterone, pregnant women can develop several oral health problems. One of the most common is swelling of the gums, often referred to as “pregnancy gingivitis”. Pregnancy tumors, a benign but painful condition where growths form on irritated gum tissue, are another common problem. Both conditions can be reduced or eliminated by thorough, gentle brushing of the gum tissue, teeth, and tongue at least twice a day, in addition to daily flossing.

Hormonal fluctuations can also lead to an increased buildup of plaque. Combined with the sensitivity and pain caused by swollen gum tissue, which may cause women to be less thorough in their oral hygiene regimens, periodontal disease may result. Since periodontal disease is not always a painful condition it can go undetected. Periodontal disease can lead to tooth loosening, tooth loss, and infection, which may also increase a woman’s risk of having a pre-term, low-birth-weight baby. Which smoking is another risk for delivering a premature baby.

In addition, vomiting associated with morning sickness can cause erosion of the tooth enamel as stomach acid is brought into the mouth. This increases the risk of tooth erosion and cavities. Again, brushing and flossing at least twice a day, along with drinking plenty of water and using fluoride toothpaste can help protect the teeth.

Oral Contraceptives
Oral contraceptives contain progesterone or estrogen, so women using this form of birth control may experience some of the same problems as pregnant women, including gingivitis. Some studies have also found that women who use oral contraceptives are at a higher risk of developing dry sockets (a localized inflammation of the tooth socket) following a tooth extraction (in addition, certain antibiotics can negate the efficacy of oral contraceptives). If these antibiotics are prescribed for any reason, a back-up form of birth control should be used until the course of antibiotics is finished. For these reasons, it’s always a good idea for women who use oral contraceptives to let their dentists know.

Menopause
Due to further changes in hormone levels, women going through menopause often experience dry mouth. Also, many women at this phase of their lives are also on medications that can cause dry mouth as a side effect. This increases the chance of tooth decay, especially along the gum line and in between the teeth. In addition to drinking lots of water, brushing and flossing daily, and going to the dentist regularly, women with dry mouth can use a prescription fluoride toothpaste that can help prevent increased tooth sensitivity.

Osteoporosis
According to a study of 2500 postmenopausal women, low bone density (osteoporosis) led to an 86% greater risk of gum disease. Similarly, osteoporosis may also cause bone loss around the teeth. Dental x-rays can help identify potential problems before they become too serious.
For more information on women’s dental health issues visit www.AllysonHurley .com or the Academy of General Dentistry’s website at www.agd.org/consumer/oralhealthtopics.

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Garden State Woman
Watch Your Mouth: Part II
For Women Only by Dr. Allyson K. Hurley, DDS, MAGD, AACD

Seeing your dentist for regular checkups and practicing good oral hygiene is sound advice for everyone, but women of all ages have particular oral health needs. The following are common issues women may experience throughout the different phases of their life, along with the oral health problems associated with them.

Tobacco Products
The use of tobacco products, including cigarettes, snuff or “dip”, and chewing tobacco is the number one threat to teeth and gums. It is the primary cause of oral cancer, and a leading cause of periodontal disease. These products contain carcinogenic compounds, and the use of them can lead to oral cancer. Smokers are four to ten times more likely to develop oral cancer than non-smokers. Periodontal disease, a chronic infection of the gums, is seven times more likely in smokers. Smokers are at significant risk in the development and progression of this disease, which can result in tooth loss. Oral cancer, in its early stage, can be painless and difficult to detect without a thorough examination by a dental or medical professional.

Oral Piercing
As oral piercing has become more common, dentists are beginning to see the ill effects of this practice. It can trigger dangerous infections and can cause permanent nerve damage to the tongue. The “jewelry” can strike the teeth with enough force to fracture teeth, necessitating fillings, root canal treatment, crowns, and even the loss of teeth. Oral piercing can also affect taste and speech. There is research underway to determine if oral cancer can be associated with these piercings.

Periodontal Disease
Studies now confirm that people with periodontal disease are twice as likely to suffer from coronary artery disease, the nation’s leading cause of death. Bacteria in the mouth can enter the bloodstream and contribute to heart disease, clot formation, respiratory diseases, and be a serious threat to people with diabetes. Women with periodontal disease may be more likely to give birth to an underweight or pre-term baby. Oral microbes may enter the placenta, which can expose the fetus to infection. This disease can be prevented with regular brushing and flossing, proper diet, and routine professional care.

Oral Contraceptives
The hormones progesterone or estrogen are present in birth control pills and women using these products may experience gingivitis, or swelling of the gums, and tissue tenderness. Brushing and flossing, and seeing your dental professional regularly will help control these symptoms. Dry socket (a localized inflammation of the tooth socket) following tooth extraction may also occur. In addition, certain antibiotics can negate the efficacy of oral contraceptives. If antibiotics are prescribed for any reason a back-up form of birth control should be used until the course of antibiotics is finished.

Osteoporosis
In postmenopausal women low bone density (osteoporosis) leads to greater risk of gum disease. This reduction in bone mass around the teeth contributes to periodontal disease and related tooth loss. Dental x-rays can help to identify potential problems before they become too serious, so regular dental visits are of the utmost importance.

For more information on women’s dental health issues or to review Part I of this series visit www.allysonhurley.com and click on “articles.”

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Garden State Woman
Watch Your Mouth Part III
For Women Only by Dr. Allyson K. Hurley, DDS, MAGD, AACD

There is a growing awareness of medical concerns that impact women’s health, particularly their dental health. Due to longevity women are more likely to take drugs that can complicate or compromise dental treatment. In addition, women are at high risk of developing diseases such as osteoporosis, cardiovascular disease, arthritis, and diabetes, all of which are manifested in the mouth.

Autoimmune Diseases
Unfortunately women suffer high rates of autoimmune diseases, such as lupus, rheumatoid arthritis, multiple sclerosis, and Sjogren’s disease. Many of these diseases have oral indications. Sjogren’s disease can result in the destruction of the salivary glands, with subsequent dry mouth. Dry eyes are also an indication of this disease.

Xerostomia (dry mouth)
This is not a disease but is a symptom of many diseases or conditions. Cancer therapy, trauma to head and neck area, stress, or nutritional deficiencies are some of the causes. Certain medications, such as diuretics, antihistamines, tranquilizers, and blood pressure medications can cause xerostomia. The lack of saliva can result in increased decay, oral candidiasis, difficulty in swallowing food, and red and burning tissue. Patients can also have difficulty in speaking for long periods of time and there can be difficulty in wearing dental appliances. Dietary habits can be affected with resulting problems with nutrition.

It is of utmost importance that if any of these symptoms are present that women seek the attention of a dental professional. There are treatments available, which will not cure the condition, but will help the patients find relief. Topical fluoride gels, which are prescribed by your dentist, can help control decay. Drinking plenty of water and avoiding alcohol based mouth rinses may help the symptoms. Medications are also available that stimulate saliva production, as well as saliva substitutes.

Prophylactic premedication
Osteoporosis, which commonly affects women after menopause, can increase her risk for vertebral and hip fractures. This sometimes results in prosthetic replacements and due to risk of joint infections prophylactic antibiotics are usually prescribed prior to any invasive dental treatment.

A regimen of premedication may also be prescribed for patients with heart valve replacements, history of rheumatic fever, or heart murmurs. This is done to reduce risk of secondary infections from dental procedures.
Stomatitis

Stomatitis is an inflammation of the mucous lining of the mouth, which can include the cheeks, tongue, lips, and roof of the mouth. It can be a red, painful condition with swelling and bleeding. There are many causes of stomatitis. It can be caused by conditions in the mouth, such as poor oral hygiene, ill-fitting dental appliances, or by conditions that affect the entire body, such as certain diseases, allergic reactions, or medications.

Treatment is based on diagnosis by a dental professional with possible interaction with medical specialists, depending on whether or not the condition was caused from systemic disease or chronic medical problems. Good oral hygiene is fundamental. Use a soft toothbrush and floss daily. Avoid sharp foods such as chips and peanuts and also avoid tobacco and alcohol while inflammation is present. Infectious causes of stomatitis can usually be managed with medication. Regular dental checkups, good oral hygiene and good nutrition can help prevent this condition. Problems caused by systemic disease can be minimized by closely following the advice of your health care provider.

Pregnancy
As a result of hormonal changes pregnant women can develop several oral health problems. The most common is swelling of the gums, often referred to as “pregnancy gingivitis.” Pregnancy tumors, a benign but painful condition where growths form on irritated gum tissue, are another common problem. Both conditions can be reduced or eliminated by thorough, gentle brushing of gums, teeth and tongue, at least twice a day, in addition to daily flossing.

Pregnant women should avoid all drugs if possible, especially during the first trimester. After birth, if the mother is nursing, certain drugs should be avoided. Aspirin, which can trigger Reyes syndrome, some antidepressants, and tetracycline, which can stain the baby’s teeth, can be excreted in breast milk. Many other medications, including those that are used to treat candida albicans can also pass to breast milk. Nursing mothers should consult with their health care provider prior to taking any medications, even non-prescription.

Tempromandibular joint dysfunction
In the U.S. about 70% of the population has suffered from tempromandibular joint dysfunction (TMD) at some point in their lives. Clinching and grinding the teeth, usually while sleeping, can cause it. It manifests itself with pain in jaw that may radiate to the ear, headaches, clicking of the joint, and limited opening of the mouth. Occlusal splints, warm moist packs, as well as some medications can be prescribed to improve symptoms.

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