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Diseases and Conditions Affecting the Oral Cavity

Tooth Decay

Tooth decay, also known as dental caries, is one of the most prevalent diseases affecting both children and adults and is second only to the common cold in frequency. According to the World Health Organization 60-90% of children worldwide, and nearly 100% of adults have dental cavities. Although tooth decay is a worldwide epidemic, it is also a condition that is largely preventable with effective oral hygiene practices, a healthy diet as well as routine checkups and professional dental cleanings.

What causes cavities?

Tooth decay is the result of
a process that causes progressive damage
to tooth structure. The culprit behind all of this is dental plaque, a sticky film that accumulates on teeth and harbors harmful bacteria that thrive on sugar. As these bacteria metabolize
sugar, they produce acids, which over time can 
de-mineralize or eat away at healthy tooth structure. A cavity begins as a simple pinpoint defect on the outermost
enamel layer of the tooth but if left untreated will 
continue to compromise healthy tooth structure, eventually
 working its way through the inner layer of dentin to the nerve and vital tissues inside the tooth. Depending 
on the extent of the damage to the tooth, a cavity can cause anything from periodic, mild tooth sensitivity to extreme and continuous discomfort. Seeing a dentist for the treatment of tooth decay is essential to prevent damage to the nerve of the tooth, a dental infection, tooth loss, or more serious consequences to one’s overall health.

Factors that can increase one’s risk of developing tooth decay include the following:

  • Poor oral hygiene
  • A diet high in sugar
  • Dry mouth
  • Bruxism
  • Enamel defects and deeply grooved teeth
  • Receding gums

For patients at a higher risk of developing tooth decay, special toothpastes and fluoride rinses and other supplemental measures may provide an added level of protection.

 

Periodontal (Gum) Disease

The two most common forms of dental disease, caries (tooth decay) and periodontal disease (gum disease) are caused by the presence of bacterial communities in dental plaque, which is a sticky film that is constantly accumulating in the mouth.  While in the case of tooth decay the acidic products of the plaque bacteria progressively erode tooth structure, in gum disease an inflammatory response is provoked in the periodontal tissues that surround and support the teeth. If left untreated, periodontal disease can lead to gingival pocket formation, gum recession and diminishing alveolar bone with the eventual loosening and loss of teeth.

According to the Centers for Disease Control and Prevention (CDC), one out of every two adults aged 30 and over in the United States is affected by periodontal disease. Furthermore, that number increases to over 70% for individuals 65 and older. Since gum disease is the main cause of tooth loss in adults and there is an increasing association with systemic diseases such as heart disease, stroke, diabetes, respiratory problems and adverse pregnancy outcomes, periodontal disease represents a serious public health concern.

Although inadequate oral hygiene practices, infrequent dental checkups and few if any professional teeth cleanings are the main reasons for the development of gum disease, there are other factors that can contribute to the risk. An individual may be predisposed to periodontal disease because of genetic factors, smoking and tobacco use, harmful oral habits, misaligned teeth, poor nutrition, and stress as well as the fluctuating hormones in pregnancy. Diseases such as diabetes, rheumatoid arthritis and HIV infection can also increase the risk and severity of periodontal disease. Additionally, certain medications for the therapeutic treatment of systemic disease can lay the groundwork for periodontal problems by producing side effects such as dry mouth (xerostomia) or causing the gums to enlarge.

What are the signs and symptoms of gum disease?

Since much of the course of periodontal disease is not painful, there may be little awareness by an affected individual that a condition, which is harmful to oral health as well as one that is linked to larger systemic problems, is present.

Some of the signs and symptoms of gum disease to be aware of include the following:

  • Inflamed and red gums
  • Bleeding when brushing or flossing
  • Receding gums and exposed root surfaces of the teeth
  • Sensitivity to hot or cold temperatures
  • Bad breath or a bad taste in the mouth
  • Teeth that feel loose
  • The development of new spaces between the teeth or a change in the bite
  • Change in the fit of existing partial dentures
  • Discharge around the teeth and gums
  • Sharp or dull pain when biting down or chewing food

While gum disease is a progressive condition, if treated early in its onset it can be reversed to restore oral health. At more advanced stages, the disease can be managed to halt its progression and prevent the most severe consequences.

The earliest stage of gum disease is known as gingivitis, which is caused by the buildup of dental plaque at the gumline. Gingivitis is extremely common and is typically associated with bleeding when brushing or flossing. With gingivitis there is no evidence of bone loss or significant periodontal pockets between the teeth and gums. Gingivitis can be successfully treated and reversed with a series of professional dental cleanings and an improved regimen of oral hygiene at home.

If gingivitis is allowed to progress, it can advance to the next stage, which is known as periodontitis. When periodontitis is present, the tissue damage extends beyond the gums to include the loss of the collagen attachment of the tooth to the surrounding bone, the development of deep periodontal pockets and the loss of supporting alveolar bone. In this stage the connective tissue and bone that hold the teeth in place begin to break down. Without proper treatment, periodontitis will progress from a mild to moderate loss of supporting tissue to the complete destruction of the alveolar bone around the teeth. As periodontal treatment advances, more extensive procedures are required to halt its progression. The dentist may recommend a series of deeper cleanings involving root planing and scaling, surgical procedures to reduce pocket depth, bone or tissue grafts, laser dentistry procedures, or antimicrobial medications.

By far, the best approach to care is the prevention of periodontal disease. By maintaining an effective regimen of brushing and flossing at home, following a healthy lifestyle and seeing the dentist for routine checkups and professional dental cleanings, gum disease and its consequences are largely preventable.

 

Dry Mouth

Dry mouth, also known by its medical name, “xerostomia” is a condition characterized by either a lack of saliva or a decrease in its flow. Since saliva plays an important role in aiding digestion and maintaining good dental health, the consequences of xerostomia can be significant.

Three pairs of major salivary glands along with hundreds of minor salivary glands inside your mouth produce approximately 2-4 pints of saliva every 24 hours. Composed of 99% water and 1% electrolytes, enzymes and proteins; saliva washes over the teeth and surrounding soft tissues to cleanse and protect them from germs, tooth decay, and gum disease. Saliva also plays a key role in keeping the mouth lubricated and comfortable, so that food can be moved through the mouth easily for purposes of chewing, tasting and and swallowing.

A lack of saliva makes simple oral functions more difficult and causes germs to increase in your mouth. More germs lead to bad breath, dental decay, gum disease, and provide the groundwork for a host of oral infections.

Common reasons for the condition include the following:

  • Age- Dry mouth is frequently seen in the elderly
  • Medication
  • Disease
  • Cancer treatment
  • Injury or Surgery
  • Tobacco use
  • Dehydration

What is the treatment for dry mouth?

Treatment of dry mouth depends on the underlying cause of the problem. If it develops as a side effect of a particular drug, the physician may be able to prescribe an alternative medication. In some cases dry mouth may respond to drugs that promote an increased salivary flow. If not, artificial saliva can be used to keep the mouth moist and lubricated. As added protection, the dentist may recommend a prescription strength fluoride gel to help prevent tooth decay from developing. Patients can help alleviate some of the effects of dry mouth, by drinking water more often and avoiding drinks with caffeine or alcohol. They can also help to stimulate the flow of saliva by chewing sugarless gum or sucking on a sugarless candy. With dry mouth, it is essential to see the dentist on a regular basis for care.

 

Bad Breath/ Halitosis

Bad breath, which is also known as halitosis, is a common and embarrassing condition. According to recent estimates, 75 million people in the United States are affected by bad breath and 10 billion dollars are spent annually on oral hygiene products to address the problem.

While it is perfectly normal to experience an acute bout of bad breath after eating certain pungent foods such as spices, onions or garlic, being plagued by constant bad breath is a different story. Chronic halitosis can be attributed to a variety of different underlying causes including inadequate oral hygiene, dental disease, oral infections, smoking and tobacco habits, dry mouth, medications, diets, certain metabolic disorders or other systemic problems that affect an individual’s overall health.

Treating Bad Breath Related to Oral Hygiene and Oral Health Issues

Since many instances of chronic bad breath can be attributed to oral health issues, seeing the dentist is a good first step in care. In the absence of an effective regimen of oral hygiene, the odor-causing bacteria responsible for bad breath and dental disease can proliferate throughout the mouth and on the tongue as well as on dentures that have not been properly cleaned and maintained. With routine dental checkups, thorough dental cleanings and improvements in brushing, flossing and denture or appliance care at home, these types of bad breath issues can be effectively resolved.

Other sources of bad breath related to oral health issues can include chronic dry mouth (xerostomia), gum disease, tooth decay, mouth sores, oral wounds or post-operative surgical sites. When the cause of bad breath is related to dental disease, an ulceration, or injury, the dentist will provide the appropriate treatment to address the condition or to promote tissue healing. In cases of bad breath due to chronic dry mouth, the dentist may recommend methods of self-care or medications to increase salivary flow, artificial saliva and other therapeutic measures. It is important to keep in mind that dry mouth may be a side effect of essential medications to address a systemic condition.

 

Mouth Ulcers

One of the most commonly occurring lesions in the oral cavity is a mouth ulcer. While mouth sores can be annoying, uncomfortable and unsightly, they are often harmless, and will resolve within a few days without requiring any medical treatment. However, when these lesions do not get better after a couple of weeks, frequently recur, or if new symptoms begin to appear, it is important to get a more comprehensive evaluation by a dentist or other qualified healthcare provider.

While often the result of an actual injury like biting the cheek or the irritation of a sharp orthodontic wire, a mouth ulcer can also be caused by certain drugs, chemical sensitivity, diseases, or as a side effect of medical treatment like chemotherapy. A mouth ulcer such as a canker sore, which is also known as an aphthous ulcer, may even be triggered by stress and anxiety or hormonal changes.

According to statistics, up to 1 in 5 people get recurrent mouth ulcers.
 There are several underlying health conditions that can lead to the development of mouth ulcers including the following:

  • Nutritional problems like vitamin B12, zinc, folic acid or iron deficiency
  • Gastrointestinal tract diseases such as Crohn’s disease & coeliac disease
  •  An impaired immune system due to diseases such as HIV or Lupus
  • 
Reactive arthritis
  •  Certain viral infections such as cold sore virus, chickenpox, as well as hand, foot, and mouth disease in young children

It is important to be aware that occasionally, a long-lasting mouth sore may be a sign of oral cancer. A biopsy or tissue sample may be recommended when suspicious lesions in the oral cavity are present. Early detection and treatment are the best ways to ensure the most favorable outcome of care.

How are mouth sores and ulcerations managed?

Since a mouth ulcer involves the loss or erosion of a section of the delicate tissue lining the oral cavity, it can make the simple acts of eating, drinking or even talking quite uncomfortable. Treating the underlying cause (if there is one) and managing the symptoms is the best way to reduce the risk of complications until healing can take place. 
To ease the discomfort of mouth ulcers and promote healing, it is helpful to reduce or eliminate any sources of continuing irritation and avoid hot and spicy foods, drink plenty of fluids, use rinses or medication as recommended by a dentist or physician as well as brush and floss the teeth as gently as possible to keep the mouth clean.

 

TMJ Disorders

The Prevalence of Temporomandibular Joint Problems

According to the National Institute of Dental and Craniofacial Research (NIDCR), temporomandibular joint disorders (TMJ), also referred to as temporomandibular disorders (TMD), are the most common source of chronic facial pain and jaw dysfunction. It is estimated that more than 10 million people in the United States are affected by temporomandibular joint problems.

What is the Temporomandibular Joint?

There are two temporomandibular joints that connect the left and right sides of the lower jaw to the temporal bone. Both joints and their associated muscles, ligaments and tendons work together to allow for all manner of oral function as the jaw moves up and down, front to back and from side to side. Containing a shock-absorbing, soft disc that sits between the rounded condyles of both sides of the lower jaw and the corresponding concavities in the skull’s temporal bone, the TMJ makes chewing, speaking, yawning and all jaw movements possible.

Since the TMJ is a joint with both up and down hinge-like movements, as well as side to side and front to back sliding motions to perform, it is often considered one of the most complicated joints in the body and one of the most difficult to treat when problems arise.

Types and Symptoms of TMJ Disorders

TMJ disorders can fall into one or more of the following three categories:

  • Myofascial pain- Refers to pain in the area of the jaw joint due to various causes of increased muscle tension and spasm
  • Internal derangement-Involves displacement of the disc, jaw dislocation or trauma to the condyles of the jaw
  • Degenerative joint disease -Arthritis

The risk for developing a TMJ problem is greater in the presence of long-term teeth grinding or bruxism, a jaw injury or various types of arthritis such as rheumatoid arthritis and osteoarthritis. Furthermore, the manifestations of a TMJ disorder can vary from person to person with a wide range of symptoms possible, including earaches, ringing in the ears (tinnitus), headaches, back and neck pain, vertigo, muscle spasms and joint tenderness as well as jaw pain, popping or grating sounds with jaw movement, jaw locking and limited jaw movement. For some people a TMJ disorder can be resolved within a relatively short period of time, while for others it will continue to persist despite extensive therapy.

Diagnosis and Treatment

When evaluating for the presence of a TMJ disorder, the dentist will perform a thorough clinical assessment of joint symptoms and function. Special radiographic imaging and other diagnostic tests will be ordered as needed. The treatment of a TMJ disorder may include oral appliances such as night guards or stabilization splints to alleviate strain on the joints. Other types of therapy may include steroid injections, occlusal adjustments as well as orthodontic or prosthodontic treatment to improve occlusion. In cases of persistent and serious TMJ problems, surgery may be recommended.

Methods of self-care can be helpful in alleviating some of the symptoms of a TMJ disorder. Patients are typically advised to eat soft foods, avoid extreme jaw movement such as wide yawning and gum chewing, to practice stress reduction and relaxation techniques and applying ice packs or moist heat as directed. If recommended, a patient should follow the dentist or therapist’s instruction for gentle stretching exercises. The short-term use of over-the-counter, non-steroidal, anti-inflammatory drugs and pain medications may provide relief.  If not the dentist or physician may prescribe stronger pain or anti-inflammatory drugs, muscle relaxants or anti-depressants.

 

Malocclusion

A healthy occlusion refers to teeth and jaws that are well aligned and in functional harmony. When a malocclusion, more commonly referred to as a “bad bite” is present, either the teeth, the jaws or both are not in the correct positions or proper relationships.

There are many dental issues, which can affect the positions of the teeth and jaws that require orthodontic treatment to resolve. A malocclusion may be due to crowding, spacing, problems with jaw development, or the failure of certain teeth to erupt into their proper positions. Harmful oral habits such as finger sucking or tongue thrusting can also cause bite problems as well as the drifting of teeth into the unrestored spaces left by dental extractions or tooth loss. Sometimes, teeth develop in the jawbone facing in directions that prevent them from erupting at all. These teeth are referred to as impacted.

Both genetic and environmental factors contribute to the development of a malocclusion. Injuries that cause a misalignment of the jaws and diseases such as oral tumors can also play a role in changing the occlusion.

In children, most problems involving the alignment of the teeth and the growth of the jaws can be detected by the time they are in the first or second grade. That is why the American Association of Orthodontists recommends that all children have a check up with an orthodontic specialist no later than age 7. For children, most orthodontic treatment begins between the ages of 9 and 14. However, earlier and interceptive care is sometimes required at a younger age. Likewise, in cases of significant problems involving jaw relationships, orthodontic care may involve treatment throughout growth and development.

It is important to note that a malocclusion can be treated at any age. Today greater numbers of adults are actively seeking treatment for either crooked teeth or jaw problems that have bothered them since childhood, as well as to address teeth that have shifted over time due to extractions, habits, or abnormal bite patterns.

While malocclusions can be observed with a clinical exam, a more comprehensive assessment is required to make a complete diagnosis and to develop the most appropriate plan of care.

Types of Malocclusions

Malocclusions typically fall into three major types based on the kinds of discrepancies in alignment and bite that are present. They can be either due to issues of dental alignment or skeletal jaw disharmonies, or even a combination of both problems.

  • Class I: This is the most common type of malocclusion and is characterized by a normal bite with problems of tooth alignment
  • Class 2: This malocclusion is characterized by an “overbite” where the top teeth are positioned ahead of the bottom teeth and demonstrate a more extensive overlap
  • Class 3: This malocclusion is characterized by an “underbite” or mandibular prognathism, causing the lower jaw and anterior teeth to be in front of the upper teeth.

While most malocclusions will respond to the appropriate orthodontic treatment, some require a combination of orthodontic treatment and orthognathic surgery to improve the skeletal jaw relationships.

 

Oral Cancer

Oral cancer accounts for 2.9% of all diagnosed cases of cancer in the United States. According to the American Cancer Society it is estimated that 51,000 people across the country will develop oral cancer this year and that 10,000 fatalities are expected from the disease.

Oral cancer can occur anywhere in the orofacial complex but is most often found on the tongue, the tonsils and oropharynx, the gums, floor of the mouth, lips, cheek lining or the hard palate. While the disease can affect anyone, men are twice as likely to develop oral cancer as women. Those particularly at risk for oral cancer are men over the age of 50 who are heavy smokers and frequently drink alcohol. Additional risk factors may include UV exposure from the sun or sunlamps, GERD (gastro-intestinal reflux disease, prior head and neck radiation treatment, exposure to certain chemicals and poor diet.  While the death rate from oral cancer has been decreasing in the past several decades thanks to early detection and advanced methods of treatment improving the outcomes of care, there has been a recent rise in the incidence of oropharyngeal cancer due to increased transmission of the sexually transmitted human papillomavirus (HPV).

What are some of the signs and symptoms of oral cancer?

As part of a comprehensive exam, the dentist will perform a screening for oral cancer. To start, the dentist will review the patient’s medical and dental histories and ask if there have been any changes to his or her oral health or overall health. The dentist will then carefully check in and around the oral cavity as well as the head and neck area for any of the following signs or symptoms that may indicate the presence of a problem:

  • Mouth ulcers or sores that do not heal
  •  Lumps
  •  Red or white patches
  •  Persistent swelling of unknown origin
  •  Pain when swallowing, a painful tongue or a continuing ear or neck ache
  • A constant feeling that something is stuck in the throat
  • Tenderness or numbness in the mouth or lips
  • Loose teeth
  •  Jaw pain or stiffness

If a suspicious lesion, tissue abnormality or unusual symptoms are present, the dentist will refer the patient for a more comprehensive assessment. Early detection of oral cancer offers the most favorable outcomes of care.