When Stress Takes a Toll on Your Teeth

With economic pressures affecting millions of Americans, dentists may have noticed a drop in patients opting for a brighter smile, but they are seeing another phenomenon: a rise in the number of teeth grinders.

"I'm seeing a lot more people that are anxious, stressed out and very concerned about their financial futures and they're taking it out on their teeth," said Dr. Steven Butensky, a dentist with a specialty in prosthodontics (aesthetic, implant and reconstructive dentistry) in Manhattan.

One of his patients lost hundreds of thousands of dollars invested with Bernard L. Madoff. Another reported that he had lost a job with a seven-figure salary. A third, a single mother with a floral design business on Long Island, said she was working twice as hard for half as much.

"All three are grinders, directly affected by what's going on out there," Dr. Butensky said, gesturing outside his Midtown office window.

Dr. Robert Rawdin, another Manhattan dentist with a specialty in prosthodontics, said he had seen 20 to 25 percent more patients with teeth grinding symptoms in the last year. And in San Diego, Dr. Gerald McCracken said that over the last 18 months his number of cases had more than doubled. They, along with other dentists interviewed for this article, chalk it up to the economy.

"We're finding in a lot of double-income families, we have the people who have lost jobs and are worried, and then we have the spouse, who still has the job, with the added pressure and uncertainty," Dr. McCracken said. "This can cause some real grinding at night."

With or without economic hardship, 10 to 15 percent of adult Americans moderately to severely grind their teeth, according to Dr. Matthew Messina, a dentist in Cleveland and a consumer adviser for the American Dental Association.

Because it is a subconscious muscle activity, most grinders grind without realizing it, until a symptom such as a fragmented tooth or facial soreness occurs.

While many experts believe that genetics may play a role in bruxism (or teeth grinding), stress has long been known to set off clenching and grinding in some people, Dr. Messina said. "Recession breeds stress and our body responds to stressful events so in times like these, the incidence of bruxism goes up," he said, adding that over the last year or so he had heard from dentists around the country who had seen an uptick in patients with bruxism while also complaining about financial stress. In his own practice, he said he had treated twice as many cases in the last year than in the year before.

"Stress, whether it's real or perceived, causes flight-or-fight hormones to release in the body," he said. "Those released stress hormones mobilize energy, causing isometric activity, which is muscle movement, because that built-up energy has to be released in some way."

The most expensive option for rebuilding teeth damaged by grinding is with veneers, but this year, dentists say that many of their bruxism patients are requesting one of the least costly treatments: a night guard, also known as an occlusal splint. Manufacturers said sales of these devices had gone up. "Our night guard sales have increased 15 percent over the prior year," said Greg Pelissier, a manager at Glidewell Laboratories, a maker of custom restorative, reconstructive and cosmetic dental products based in Newport Beach, Calif.

New drugstore products have also come to market, including a disposable night guard, Grind-No-More (about $30 for 14 guards). Its makers hope it will appeal to on-again-off-again grinders.

Stan Goff, executive editor of Dental Products Report, a monthly publication, wrote in an e-mail message that all this teeth grinding "may be playing a role in the introduction of several new products designed to not only prevent bruxism, but to help fight against tooth sensitivity" and other conditions that are aggravated by grinding.

While experts believe bruxism is not a dental disorder per se, but rather originates in the central nervous system, the condition can greatly affect the teeth and the entire craniofacial structure.

"Normally, we exert about 20 to 30 pounds per square inch on our back molars when we chew," Dr. Rawdin said. "But teeth grinders, especially at night without restraint, can exert up to as much as 200 pounds per square inch on their teeth."

Some nocturnal grinders will grind up to 40 minutes of every hour of sleep. The relentless wear and tear can quickly erode enamel (10 times faster than that of nongrinders), fracture teeth, affect bite and damage the temporomandibular joint at the hinge of the jaw, and the masseter muscle, which controls the jaws. Jaw and face pain, as well as earaches and headaches, may also occur.

"I kind of thought I was going crazy," said Adrienne Lee Kornstein, 48, a patient of Dr. Butensky, whose floral design business in Jericho, N.Y., has suffered because of the economy. "A tooth broke for what seemed like no reason, and by the time I got to Dr. Butensky, I'd been to my physician, other dentists, even a dermatologist to try to get relief from migraines and facial pain I was taking painkillers for. I had no idea I was grinding or that grinding your teeth could even lead to all that."

The most common treatment for the disorder is to wear a night guard, which may not only alleviate grinding but, in some cases, train someone to stop grinding altogether.

Fitted in the dentist's office, a custom guard is usually a clear, hard plastic device that runs over the top or lower teeth from front to back and prevents the top and bottom molars from making contact. Although not cheap (the price can range from $350 to $1,000), most dentists prefer a custom guard to over-the-counter guards, which are usually made of softer material and can encourage chewing and exacerbate masseter muscle activity.

There are also smaller prefabricated splints that a dentist can customize. These are generally cheaper than the fitted full arch guards and require fewer adjustments. But some dentists argue they are not as effective as the full arch guards.

Many teeth grinders interviewed said they would not go to bed without their night guards.

"Sometimes I wake up in the middle of the night and having my guard in makes me more aware if I'm tensing my body or gripping my jaw, and I can just take a moment to relax," said Alisa Fastenberg, 50, a graphic designer in Manhattan.

Other treatments for teeth grinding include acupuncture, medical massage, hypnosis and Botox injections into the masseter muscle to relax the muscle enough to stop it from going into spasms without changing one's chewing function.

"Grinding is like body building," said Dr. Alexander Rivkin, a head and neck surgeon at Westside Aesthetics in Los Angeles, who has also seen an increase in grinding-related cases this past year. "The constant workout of the masseter muscle, the largest in the head, builds up that muscle and that can cause a lot of pain, not to mention make the face appear more square."

He added, "For, I'd say, 85 percent of the people who come to me complaining about headaches, jaw soreness and pain, Botox injections into the masseter muscle on both sides of the face is the answer."

But even something as simple as taking time before bed to de-stress has been known to help.

"Good sleep hygiene goes a long way to keeping the mind relaxed and the jaws from starting to smack together," said Dr. McCracken, who has studied the relation of sleep to teeth grinding. "We know that the stress center of the brain is directly next to the part of the brain that controls teeth grinding. We're not sure how it relates to the disorder, but it's intriguing. Lately, I even tell my patients, before they go to bed, not to watch the news."

By: CAMILLE SWEENEY

Why It's So Hard to Tell Which Tooth Has the Ache

When it comes to a toothache, the brain doesn't discriminate. A new imaging study shows that to the brain, a painful upper tooth feels a lot like a painful lower tooth. The results, which will be published in the journal Pain, help explain why patients are notoriously bad at pinpointing a toothache.

For the most part, humans are exquisitely tuned to pain. The brain can immediately distinguish between a splinter in the index finger and a paper cut on the thumb, even though the digits are next-door neighbors. But in the mouth this can be more difficult, depending where and how intense the ache is.

"We don't know much about tooth pain," comments dentist and neuroscientist Alexandre DaSilva of the University of Michigan in Ann Arbor, who was not part of the new research. The new study is one of the first to address the puzzle of toothache localization, he says.

In the study, researchers led by Clemens Forster of the University of Erlangen-Nuremberg in Germany analyzed brain activity in healthy - and brave - volunteers as they experienced tooth pain. The researchers delivered short electrical pulses to either the upper left canine tooth (the pointy one) or the lower left canine tooth in the subjects. These bursts of electrical stimulation produced a painful sensation similar to that felt when biting into an ice cube, Forster says, and were tuned such that the subject always rated the pain to be about 60 percent, with 100 percent being the worst pain imaginable.

To see how the brain responds to pain emanating from different teeth, the researchers used fMRI to monitor changes in activity when the upper tooth or the lower tooth was zapped. "At the beginning, we expected a good difference, but that was not the case," Forster says.

Many brain regions responded to top and bottom tooth pain - carried by signals from two distinct branches of a fiber called the trigeminal nerve - in the same way. The V2 branch carries pain signals from the upper jaw, and the V3 branch carries pain signals from the lower jaw.

In particular, the researchers found that regions in the cerebral cortex, including the somatosensory cortex, the insular cortex and the cingulate cortex, all behaved similarly for both toothaches. These brain regions are known to play important roles in the pain projection system, yet none showed major differences between the two toothaches. "The activation was more or less the same," Forster says, although he adds that their experiments might have missed subtle differences that could account for why some tooth pain can be localized.

Because the same regions were active in both toothaches, the brain - and the person - couldn't tell where the pain was coming from. "Dentists should be aware that patients aren't always able to locate the pain," Forster says. "There are physiological and anatomical reasons for that."

DaSilva agrees that the brain's inability to tell top-tooth pain from bottom-tooth pain "pairs really well with what we see in the clinic."

Understanding the pathway from tooth to brain may help researchers devise better treatments for acute tooth pain, such as cavities or infections, and more-chronic conditions, DaSilva says. One such condition is phantom pain that persists in the mouth after a tooth has been removed.

By, Laura Sanders, Science News

Tongue Piercings Associated With Gap Between Teeth

'Playing' with a pierced tongue stud could lead to a gap between the front teeth - according to a new study. The Research, which was carried out at the University at Buffalo in New York, suggested that tongue piercings could be a major cause of unnecessary orthodontic issues. 

The report claimed that those with tongue piercings were likely to push the metal stud up against their teeth and consequently cause gaps and other problems to arise. 

Chief Executive of the British Dental Health Foundation, Dr Nigel Carter, said the study highlighted the risks that tongue piercings have on oral health. 

Dr Carter said: "It's certainly something to think about before going out to get a tongue piercing. The temptation of playing with the stud in the mouth would be very high and in time this could lead to hundreds of dollars worth of corrective treatment. 

"The results of this study stress the risks that are associated with tongue piercings. As well as causing an apparent gap, oral piercings can also lead to chipped teeth and infection. 

"In order to avoid such health problems in the future, along with the spiralling costs of any related treatment, I would advise people to stay clear of tongue piercings." 

Lead author of the study, Sawsan Tabbaa, said that 'force, over time, moves teeth' and that the results are caused by people playing with their studs crop up in a 'very high percent of the cases'. 

A professor of orthodontics at the University at Buffalo School Of Dental Medicine, Tabbaa, explained that tooth damage was common in both past and current case studies. 

The current study featured a 26 year-old female patient and showed that a space between the upper front teeth had appeared during a period of seven years, as the metal bar was pushed against and between the teeth. 

The patient provided researchers with photographs to show that she had no diastema before having her tongue pierced. It was strongly thought that positioning of the tongue stud between the maxillary central incisors caused the midline space between the front teeth. 

The only solution was for the patient to wear braces for an extensive period of time. 

The author concluded that tongue piercings could result in serious injuries, not just to teeth but said they have also been associated with hemorrhages, infections, trauma to the gums and, in the worst cases, brain abscesses. 

The results of the study were published in the Journal of Clinical Orthodontics. 

Source: British Dental Health Foundation 

Can Green Tea Strengthen Teeth?

Researchers suspect antimicrobial molecules contained within green tea helps preserve teeth (as long as you don't add sugar).

• People aged 40-64 who drank one cup of green tea a day were less likely to lose teeth.
• Drinking unsweetened coffee had no effect on keeping teeth.
• Antimicrobial molecules called catechins may account for green tea's benefits.

A cup of green tea a day may keep the dentist away.

That's the finding of new research published in Preventive Medicine. The findings show that drinking at least one cup of green tea a day increases the odds of keeping your teeth as you age.

The researchers suspect that antimicrobial molecules called catechins present in green tea and in lesser amounts in oolong tea provide the benefit. But be careful if you like your tea with sugar: sweetener may negate the effect, the team found.

"Green tea may have bacteriocidal effects, which would affect teeth, but only if you drink it without sugar," said Alfredo Morabia, of Columbia University in New York and editor of Preventive Medicine, who wrote an editorial accompanying the new research.

"They also reported that drinking sweet coffee was actually deleterious," he added. "Coffee alone had no problem, but sweet coffee would actually make you lose your teeth."

Yasushi Koyama of the Tohoku University Graduate School of Medicine and colleagues looked at more than 25,000 Japanese men and women between age 40 and 64 in making the determination.

They found that men who drank at least one cup of tea a day were 19 percent less likely to have fewer than 20 teeth (a full set including wisdom teeth is 32) than those who did not drink green tea. Tea-drinking women had 13 percent lower odds.

One possible explanation for the benefits of tea drinking is that warm drinks wash out your mouth. But coffee, which also provides a mouth rinse, had no benefit, suggesting something else is going on.

Catechins have been shown to kill mouth bacteria associated with tooth decay and gum disease, so the researchers suspect this is what gives green tea its dental benefits.

"Previous research has indicated that regular consumption of green tea may lead to a lower instance of periodontal disease, a leading cause of tooth loss in adults," said Samuel Low of the University of Florida College of Dentistry and President of the American Academy of Periodontology in a statement to Discovery News.

Maintaining healthy teeth and gums is part of maintaining a healthy body, Low said. "That is why it is so important to find simple ways to boost periodontal health, such as regularly drinking green tea -- something already known to possess certain health-related benefits."

Toothaches- causes, home remedies, and treatment

“Tooth ache” can be generally regarded as pain around a particular tooth, teeth or jaws. Tooth pain can range from mild discomfort or sensitivity to being excruciatingly painful. Some women have even compared toothpain to being as painful as child birth. Of course, these might be exaggerated claims from some desperate women, but it does reflect the intensity of the pain arising from a toothache.

The actual pain we feel is due to the irritation of the nerves which are associated with the tooth/teeth. If you didn’t know, nerves are responsible for carrying sensations like heat, cold, touch and PAIN to the brain. In this case when the nerves inside the tooth are irritated, these carry the pain impulse to the brain.

Causes of toothpain

Most of the causes of tooth pain are limited to oral/dental causes.

The oral causes of toothpain are

• Tooth Decay or Cavity (being the most common cause of tooth pain)

The most common cause of tooth pain is Tooth Decay. Tooth decay is the degradation of the tooth due to harmful acids secreted by bacteria in the oral cavity.

• Gum Disease

The next important causing agent of tooth pain is gum disease. Poor oral hygiene leads to bacterial plaque accumulation and the toxins release from these bacteria damage the gums. The gums become swollen, red and painful (Gingivitis). If gum disease is not controlled early, you are at a risk of losing your tooth.

• Root Sensitivity

Root sensitivity (commonly termed as tooth sensitivity) is when the roots of the teeth become exposed due to recession of the gums. The roots are very sensitive and respond with pain to reasonably hot or cold foods.

• Cracked teeth

A painful accidental blow or extreme biting force can cause the tooth fracture which can become a source of intense pain whenever the fractured tooth is even touched.

• Temporomandibular joint(TMJ) Disorder

TMJ disorder is an inflammatory reaction at the sight of the lodgment of the lower jaw at the skull. Various factors such as Bruxism (Night grinding or teeth grinding), arthritis can cause TMJ disorders.

• Wisdom tooth eruption or impaction

The eruption of a wisdom tooth often causes pain due to its misalignement. It can become impacted (does not erupt) and require surgical extraction.

• Fillings:

People who have undergone fillings can get severe toothache suddenly. This might be because of the spread of the decay to the pulp and you will need to undergo root canal treatment for that. It can also occur due to accumulation of fluid with organic debris and bacteria between the filling and your teeth often termed as microleakage in dental jargon.

The non-oral causes include Ear and Sinus infections .

Prevention of toothpain

There is no magic trick to prevent tooth pain from occurring. All you need to do is maintain a good oral hygiene.

Home remedies for toothpain

There isn’t a fixed time for toothpain to occur. You can’t drive to your dentist at 3 am at night. However, you can surf the net looking for home remedies. Although, these should not be substituted for a visit to the dentist, they can provide temporary relief from the agonizing pain.

I have not tried any of them and do not suggest their use either. They are listed here for informational purposes only

1. Sensodyne Therapy: Works for tooth cavities

1. Rinse your mouth with warm water.
2. Put max strength sensodyne toothpaste on the cavity.
3. You can feel the pain relief after few minutes.

The effect will decrease when you drink water or other liquids after putting the sensodyne.

2. The Whiskey BC Mix: Works for nearly all tooth pains and is quite effective. Note that this can be nasty when you try it.

1. Add teaspoon of baking soda in a shot of Whiskey.
2. Dissolve a packet of BC pain relief powder in the above mix.
3. Swish around the affected tooth for two minutes.

Try this if you have unmanageable tooth pain and you cant get health care right away.

3. Nyquil therapy: Lots of people swear by this fast and effective trick. It works very well indeed and I have quite a few people thanking me for this one.

Take half a teaspoon of Nyquil or Kroger Nitetime (cold/flu syrups) and swish around the affected area.

Other

Try sucking at a clove or put clove oil on the affected tooth.

Place a raw piece of onion on the affected tooth.

Treatment for Tooth Pain

The treatments for toothpain vary greatly. They treat the actual cause of your tooth pain. For example

If you have tooth decay, you will have to undergo a filling procedure.

If the tooth decay has reached your pulp, you would have to undergo a root canal procedure.

If you have impacted wisdom teeth, they need to be extracted.

Your dentist will determine the best treatment option for you after examining you.

We subconsciously connect a dull smile with age

We subconsciously connect a dull smile with age — enamel wears over time, darkening our teeth. A bright smile, on the other hand, gives the impression of good health and youth. One quick anti-aging beauty tip: Cut back on teeth-staining habits such as drinking coffee and red wine and smoking cigarettes. But oral health habits are much more than skin-deep. Every day, it seems like another new study links oral health problems to other big health issues such as heart disease, premature birth, and erectile dysfunction. Of course, taking care of your chompers starts with daily brushing and flossing and regular dentist checkups — something we're not all so diligent about. About 17% of adults admit to never flossing, according to one report, and about 25% of adults ages 35 to 59 have untreated tooth decay. But even if you're a dentist's dream patient, there are other surprising habits to start — and to skip — for a prettier, healthier smile. Here, 10 simple steps to try today:

Limit carbs to mealtimes Even not-so-sweet treats — like a handful of potato chips or a whole wheat roll — can be as damaging to your teeth and gums as a double-fudge brownie, if you're not careful. That's because all carbohydrates break down into simple sugars, which are ultimately converted by bacteria in the mouth into plaque, a sticky residue that is the primary trigger of gum disease and cavities. Carb-based foods such as breads and crackers tend to have a chewy, adhesive texture, making it easier for them to get caught between teeth or under the gum line, where bacteria can then accumulate, says Christine Gerbstadt, MD, RD, a spokesperson for the American Dietetic Association. Smile Rx: Have carbs at mealtimes rather than as a snack: When you eat a larger amount of food, you produce more saliva, which helps wash food particles away.

Don't drink and brush Here's one time when you shouldn't clean your teeth: right after you drink a soda or other acidic beverage, says Mary Hayes, DDS, spokesperson for the Chicago Dental Society: Acid in the drink, combined with the abrasive action of brushing, can erode your tooth enamel. Smile Rx: To protect your pearly whites against the caustic compounds in soda, sip water or chew gum to activate acid-neutralizing saliva — then brush your teeth. It's also smart to follow the same routine if you have chronic heartburn, which keeps your mouth in an acidic state.

Increase your C intake Vitamin C is the cement that holds all of your cells together. "So just as it's vital for your skin, it's important for the health of your gum tissue," says Paula Shannon Jones, DDS, spokesperson for the Academy of General Dentistry. People who consumed less than 60 mg per day of C (8 ounces of orange juice or one orange contains more than 80 mg) were 25% more likely to have gum disease than people who took in 180 mg or more, according to a study of more than 12,000 US adults conducted at the State University of New York University at Buffalo. Smile Rx: Add a daily glass of OJ to your breakfast routine, and make sure your multi meets the RDA for vitamin C.

Have tea The antioxidants are good for your gums. Black and green teas contain polyphenols, antioxidant plant compounds that prevent plaque from adhering to your teeth and help reduce your chances of developing cavities and gum disease. "Tea also has potential for reducing bad breath because it inhibits the growth of the bacteria that cause the odor," explains Christine D. Wu, PhD, professor and director of caries research at the University of Illinois at Chicago College of Dentistry, who has conducted several studies on tea and oral health. Many teas also contain fluoride (from the leaves and the water it's steeped in), which helps protect tooth enamel from decay and promotes healthy teeth. Smile Rx: Steep a cup every afternoon. Added bonus: a bit of caffeine for a postlunch perk.

Sip with a straw Soda junkies, listen up! Most sodas, sports drinks, and juices contain acids, such as citric and phosphoric, that can erode dental enamel — even if they're diet or sugar-free versions. Sipping acidic drinks through a straw positioned toward the back of your mouth limits their contact with your teeth and helps preserve the enamel, says a study in the British Dental Journal.  Smile Rx: Stock up on straws in your desk drawer at work and kitchen at home so you always have one handy.

Boost calcium consumption The same way the mineral makes for strong bones, it's also necessary to protect your pearly whites. People who get at least 800 mg a day are less likely to develop severe gum disease, says a study by the Buffalo researchers. The reason: About 99% of the calcium in your body is in your bones and teeth. Dietary calcium — available in foods like cheese, milk, and yogurt — strengthens the alveolar bone in the jaw, which helps hold your teeth in place. Eat up! A few simple changes to your diet can help keep your teeth healthy for life. Smile Rx: The recommended amount is 1,000 mg per day for women younger than 51 and 1,200 mg for those older. A calcium supplement could do the trick, but you should aim to get as much as you can from your diet. You get about 300 mg each from an 8-ounce glass of milk, a 6-ounce yogurt, or a 1.5- to 2-ounce serving of cheese.

Protect your smile when you swim It sounds surprising, but dental researchers have found that excessively chlorinated pool water can erode and stain tooth enamel. If you're a frequent swimmer, pack a toothbrush along with your towel when you take your next dip. "More chlorine in a pool may equal more protection against bacteria, but overdoing it lowers the pool's pH level and makes it dangerously acidic," says Matt Messina, DDS, consumer advisor for the American Dental Association. Smile Rx: Brush your teeth and use a fluoride rinse immediately after spending more than an hour in the pool. "If you're swimming a lot and have any tooth discomfort whatsoever, check with your dentist," adds Messina.

Have an apple a day Yep, it helps keep the dentist away too. Crunchy foods, including apples, celery, and carrots, act like little toothbrushes when you chew them, and they actually help scrub away stubborn stains over time. The cleansing effect on your teeth may be noticeable — if ever so slightly — especially if you're a coffee drinker who wasn't eating apples every day to begin with. "The mildly acidic nature and astringent quality of apples, combined with their rough, fiber-rich flesh, makes them the ideal food for cleansing and brightening teeth," explains Jeff Golub-Evans, DDS, founding president of the New York Academy of Cosmetic Dentistry. Smile Rx: If you start eating an apple a day as a between-meal snack and don't get the chance to brush your teeth afterward, be sure to chase it with a glass of water to rinse away the sugar, acid, and any plaque it may have removed from your enamel.

Smooch your partner From the who-knew school of thought: Kissing your mate can also help safeguard your grin. Although you enjoy a kiss for other reasons, it also increases saliva in your mouth, which cleans your teeth of the bacteria that can cause cavities, according to Anne Murray, DDS, a spokesperson for the Academy of General Dentistry, Smile Rx: Consider this a healthy excuse to pucker up! But don't sweat it if you have no one to kiss. Sugar-free gum with xylitol will also do the trick.

Go for whole grains Whole grains are like dental insurance, suggests research from McMaster University, Canada. Add this to the laundry list of their benefits, which include keeping your heart healthy, preventing diabetes, and more: Whole grains keep teeth healthier longer. Among 34,000 men studied for 14 years, those who ate at least three daily whole grain servings were 23% less likely to suffer tooth-loosening gum inflammation (periodontitis) than those averaging fewer than one. Eating more whole grains helps stabilize blood sugar levels, which has been shown to reduce periodontitis in diabetics. Smile Rx: Swap white rice and regular pasta for brown and whole wheat versions. Check labels to make sure brown rice or whole grains are listed as the first ingredient.

Gum Disease linked with gestational diabetes risk

Pregnant women with gum disease may be more likely to develop gestational diabetes than those with healthy gums, researchers have found.

Gestational diabetes arises during pregnancy and usually resolves after the baby is born, but it can raise a woman's risk of developing type 2 diabetes later on. It can also contribute to problems during pregnancy and delivery, including maternal high blood pressure and a larger-than-normal baby, which may necessitate a cesarean section.

The new findings, published in the Journal of Dental Research, suggest that gum disease may be a treatable risk factor for gestational diabetes.

Among pregnant women researchers followed, the 8% who developed gestational diabetes had higher levels of gum-disease-causing bacteria and inflammation.

Gum disease can trigger an inflammatory response not only in the gums, but throughout the body. It's possible that such inflammation may exacerbate any pregnancy-related impairment in blood sugar control, contributing to gestational diabetes in some women, the researchers speculate.

Past studies have also linked gum disease to a higher risk of premature birth, with one theory being that systemic inflammation is involved.

Of the 265 women in the study, 83% were Hispanic, a group that is at higher-than-average risk of both gestational diabetes and type 2 diabetes. The women who developed gestational diabetes were also significantly more likely to be heavier before they became pregnant, have had gestational diabetes before, and higher C reactive protein levels, a marker for inflammation and cardiovascular disease.

"In addition to its potential role in preterm delivery, evidence that gum disease may also contribute to gestational diabetes suggests that women should see a dentist if they plan to get pregnant, and after becoming pregnant," Dr. Ananda P. Dasanayake, the lead researcher on the study, said in a statement.

"Treating gum disease during pregnancy has been shown to be safe and effective in improving women's oral health and minimizing potential risks," added Dasanayake, a professor at the New York University College of Dentistry.

Future studies, Dasanayake noted, should investigate the link between gum disease and gestational diabetes in other high-risk groups, such as Asian and Native American women.

Journal of Dental Research

Your Dentist Knows Your Heart

I've had a number of patients say to me, "Doctor, my dentist says I should get my heart checked out, what does a dentist know about hearts?" Then after some tests, I have to tell my patients, that, yes, their dentist was right, they have a heart problem. There is definitely a gum-heart connection and that connection is inflammation. Untreated chronic inflammation can lead to severe health complications. This is how it happens. When you consume anything, residue collects on your teeth, and this residue forms plaque. Plaque is a sticky deposit of mucus, food particles and bacteria formed at the base of your teeth within hours of eating. If you don't remove the plaque it can cause gingivitis, the collection of plaque in pockets between swollen gums and the base of your teeth. Gingivitis is also the source of bad breath. Left untreated, gingivitis can lead to periodontal disease; also know as gum disease. Your mouth has the highest concentration of bacteria in your body under normal conditions, but if you have gum disease, the bacteria count gets even higher. Inflamed gums present a good portal for bacteria to enter your bloodstream and move on to your heart. There it can damage your heart walls or values. It might also provoke blood-clotting, leading to stroke or a heart attack. The Good News is - You Can Stop Gum Disease At Your Bathroom Sink Gum disease is one of the easiest preventable diseases out there. Yet some 50 percent of the adult population has gum problems. Good dental hygiene can eliminate or slow gum disease and all it takes is making a conscious effort to brushing your teeth after every meal and flossing before you go to bed. Here are the steps recommended by the American Dental Association Brushing Your Teeth Place your toothbrush at a 45-degree angle against the gums. Move the brush back and forth gently in short (tooth-wide) strokes. Brush the outer tooth surfaces, the inner tooth surfaces, and the chewing surfaces of teeth. Use the "toe" of the brush to clean the inside surfaces of the front teeth, using a gentle up-and-down stroke. Brush your tongue to remove bacteria and freshen your breath. Flossing Your Teeth Break off about 18 inches of floss and wind most of it around one of your middle fingers. Wind the remaining floss around the same finger of the opposite hand. This finger will take up the floss as it becomes dirty. Hold the floss tightly between your thumbs and forefingers. Guide the floss between your teeth using a gentle rubbing motion. Never snap the floss into the gums. When the floss reaches the gum line, curve it into a C shape against one tooth. Gently slide it into the space between the gum and the tooth. Hold the floss tightly against the tooth. Gently rub the side of the tooth, moving the floss away from the gum with up and down motions. Repeat this method on the rest of your teeth. Don't forget the back side of your last tooth. Nutrients for a Healthy Smile Nutrition plays an important role in gum health. Crunchy fruit and vegetables can actually clean your teeth as you are eating, and the acid delays the formation of plaque. Vitamins A, C, D, E and K and the B vitamins; folic acid; biotin; choline; calcium; zinc; and magnesium have all been found important for your oral health. Two dietary supplements, coenzyme Q10 and aloe vera, are helpful to gum health. Coenzyme Q10 (CoQ10) may help with periodontal pocket depth. In early research, Dr. Edward G. Wilkinson, of the U.S. AirForce Medical Center, gave patients 50 mg of CoQ10 a day. His patients experienced reduced periodontal pocket depth. Wilkinson said, "Treatment of periodontitis with coenzyme Q10 should be considered as an adjunctive treatment with current dental practice." Later studies have reconfirmed this. Hanioka, et al., say "These results suggest that the topical application of CoQ10 improves adult periodontitis" (Molecular Aspects of Medicine. 1994. 15 Suppl) Aloe vera is known to kill bacteria. Dr. Eugene R. Zimmerman and Dr. Ruth A. Sims have (Aloe Vera of America Archives, Stabilized Aloe Vera, Vol. I) noted that aloe does have bactericidal properties. This means it may be useful in periodontal disease, which is a bacterial infection. Simply rub the liquid or gel on the gums. When you take care of your gums and teeth, you are helping yourself on many levels. Superficially, you will retain your beautiful, white-toothed, smile. Your breath will smell sweet. Moreover, your heart and   arteries will have an added protection against the onslaught of bacteria. Institute For Healthy Aging

Dental Botox gains popularity -- and adversaries

Dentists aren't just wielding needles filled with Novocain these days. Many are now injecting their patients with Botox to improve appearances and alleviate pain -- while at the same time inciting the ire of dermatologists, plastic surgeons, and some of their colleagues.

As state dental boards around the U.S. struggle with how to regulate such injections, some dentists are forging ahead -- and establishing a lucrative new sideline in the process. "We are creating a new category in dentistry," said Louis Malcmacher, D.D.S., president of the American Academy of Facial Esthetics, who teaches dentists how to use Botox.

“It takes a lot more than teeth to make a great-looking smile.”
— Louis Malcmacher, D.D.S.

Nearly 10% of dentists now use Botox, Dr. Malcmacher said, and demand to learn how to administer it is exploding. Dr. Malcmacher expects to teach about 60 two-day seminars on Botox this year, three times as many as last year. And no wonder. With the recession damaging many dentists' bottom line, it's hard to resist the prospect of earning tens of thousands of dollars each year with a relatively simple addition to the services they offer.

"It's a real no-brainer," said Catherine Maley, an aesthetic industry marketing expert who began selling Botox marketing kits for dentists six months ago. "There's a 50% markup, and it takes a couple of minutes to do." She estimates that the average dentist can earn $148,780 a year doing Botox injections, assuming that 20% of their current dental patients will want to get injections two to three times a year. The cost to remove wrinkles between the eyebrows can range from $300 to $400, and getting rid of vertical pucker lines around the mouth can cost $100 to $200 more. In addition, since Botox effects can fade after a few months, many patients return repeatedly for refresher injections.

Dentists are well-positioned to take advantage of the Botox boom because they see patients several times a year, Maley said. With Botox patients needing regular touch-ups, it's convenient for them to have the treatments added to their routine dental cleanings, she added.

Yet Maley advises dentists not to advertise the services in order to reduce the chances that other professional groups will challenge their ability to do such work. Some dentists simply hang up signs in their offices offering the injections -- and watch demand soar, she said.

A turf war?

As Botox demand continues to surge, turf wars over who should be able to administer the medication show no signs of abating. Plastic surgeons and dermatologists are adamant that dentists should not be giving injections in the face. "I'd be very reluctant to let someone stick a needle in my forehead with no training in that area," said Renato Saltz, M.D., president of the American Society for Aesthetic Plastic Surgery (ASAPS). "Everybody feels qualified to handle this. But it boils down to people's ability to handle complications."

In addition to the aesthetic effects achieved with Botox, some dentists use it to treat bruxism, temporomandibular disorders, and migraine headaches.

But many dentists are equally adamant that Botox offers numerous clinical advantages outside of cosmetics (see sidebar). And some argue that they are more qualified to give Botox injections than even dermatologists and plastic surgeons.

"Dentists give more injections than any other healthcare professional," Dr. Malcmacher said.

In addition, almost all of the dental protocols for Botox were co-developed by a dentist. Howard Katz, D.D.S., a San Diego dentist, said he designed most of the protocols while he was co-developing a drug to reverse the effects of numbing agents (OraVerse, Novalar Pharmaceuticals). Dr Katz’s protocols for Botox use are among those that are taught to dentists and physicians around the world.

He initially went to Allergan, which manufactures Botox, looking for studies that might be relevant to his work. At that time, Botox was cleared by the FDA for only a small number of therapeutic purposes, including treating such conditions as crossed eyes and uncontrollable blinking. Allergan didn't have any studies to help Dr. Katz, so he developed protocols for Botox and patented them. Dr. Katz eventually developed 19 uses for Botox in dentistry.

Qualifications questioned

Clinical applications In addition to its cosmetic uses, Botox is used to alleviate a variety of dental problems. Orthodontists may use it to retrain muscles not to work so hard, preventing teeth from shifting back after braces are removed, said Louis Malcmacher, D.D.S., president of the American Academy of Facial Esthetics. Similarly, prosthodontists may inject it to help patients relax their muscles and not spit out new dentures. Dentists have also used Botox to help patients suffering from bruxism, temporomandibular disorders, and migraine headaches. Many people turn to the medication when they can't get relief from mouthguards, said Howard Katz, D.D.S., describing people who come to his office carrying supermarket bags filled with night guards that didn't work. "It doesn't make sense that generic splints are still considered the standard of care for bruxism," he said. Even periodontists can benefit from using Botox, said Dr. Katz, pointing out that one leading cause of losing gum tissue involves muscles pulling too hard on frenums that join lips to gums. "In just about every aspect of dentistry, there's a necessity to control force without being aggressive," he said.

The majority of Botox injections performed by dentists are in Europe and the U.K., he said. But for dentists in the U.S., he said, "it's taken 10 years to catch on." Part of the problem for U.S. dentists is that they are often challenged about their qualifications, even by some of their peers.

In Maryland, an oral surgeon complained to the state dental board about a dentist doing Botox injections, said Gigi Meinecke, D.M.D., who has a private practice in Potomac, MD. That complaint led to a protracted discussion in the state about when and whether dentists should be allowed to do Botox treatments.

At first, the state dental board said dentists could not do such cosmetic treatments, Dr. Meinecke said, with a board member telling her he believed dentists should "only be drilling teeth." But later, the state attorney general said that state law neither allowed nor barred dentists from doing injections. Now, the state dental board has launched a committee to determine whether to support a change in the law.

Dr. Saltz said the ASAPS has been talking to state regulators in Utah, Oregon, California, New Jersey, and other states to educate them about the potential problems with dentists and other professionals performing Botox injections.

In 2009, 18 state dental boards had specific policies on cosmetic usage of Botox, according to the Academy of General Dentistry. All states allow dentists to inject Botox for therapeutic reasons.

But separating therapeutic from cosmetic applications of Botox amounts to making a distinction without a difference, according to Dr. Katz. When you inject it, "it doesn't stay where you put it," he said. So, for example, if patients get injections around their temples and forehead to reduce teeth clenching, they will get an added cosmetic benefit: their smile lines will disappear, too.

Cosmetic dentists, meanwhile, say they have used Botox to replace complicated procedures aimed at eliminating gummy smiles. Rather than offering patients just "horrible surgical options" that involve crown lengthening and veneers, Dr. Meinecke said she can simply inject Botox into one of the five muscles that raises the upper lip.

In fact, cosmetic dentists say they need to go beyond teeth and gum work to improve their patients' appearances. Patients who walk out of the office with beautiful veneers and thin, wrinkled lips simply won't look good, said Dr. Malcmacher, who injects Botox in almost all of his patients who get veneers.

"We've become very tooth-centric in dentistry," he said. "It takes a lot more than teeth to make a great-looking smile."