Diseases of the Oral Cavity

Tooth Decay

Tooth decay, known formally as dental caries, has been a serious health problem for all nations since time immemorial. For centuries, tooth decay was thought to be the handiwork of an elusive and, in some cultures, evil tooth worm that gnawed holes into the white, highly mineralized enamel and left all those in its wake in pain. But superstition has yielded to science and its explanation that certain oral bacteria discharge mineral-eroding acid onto the enamel, starting the gradual process of decay. Over the last several decades, dental researchers have made tremendous progress in defining and learning to thwart the decay process. This work has involved the three-pronged strategy of discovery, innovation, and prevention – and produced one of the major public health success stories of the 20th century.

Yesterday

Few people were spared the ordeal of losing teeth, often early in life. The combination of tooth decay and periodontal diseases left 17 million people age 45 and older — about three out of 10 Americans — with none of their natural teeth. In fact, the most common cause of WWII draft rejection was too few teeth because of tooth decay. Until the 1970s, the cause of tooth decay continued to be a subject of debate, with some believing dietary deficiencies were the culprit and others focusing on oral bacteria. This uncertainty made effective prevention strategies difficult, if not impossible, to create. Moreover, brushing one’s teeth each day was a fairly recent hygienic step forward in dental care, reportedly popularized by returning soldiers from World War II.

The NIH completed the first water fluoridation study that established the benefits of fluoride in fighting tooth decay. Several years would pass before fluoride, the mainstay of modern prevention strategies, would become a common ingredient in water, toothpaste, and other products.

Tooth decay was considered an irreversible disease process — once a cavity started, the only remedy was to drill out the decay and fill the tooth with a restorative material.

Today

Tooth decay is no longer the national epidemic it was a few generations ago. Millions of American children now have little or no decay, and total tooth loss or edentulism is now much less common. Without research progress in the fight against dental caries and periodontal diseases, there would be an additional 18.6 million Americans age 45 and older with none of their natural teeth. 

Prevention is now the mantra in American dentistry. In addition to improved products to fight tooth decay, more people benefit from preventive dentistry, including the use of fluorides and dental sealants to prevent decay. Compared to previous years, these techniques have made it possible for millions more people to keep their natural teeth for a lifetime. It is estimated that from 1979 through 1989 alone, the American public saved more than $39 billion in dental expenditures due to the power of prevention. Since the 1950s, the total federal investment in NIH-funded oral health research has saved the American public at least $3 for every $1 invested.

Tomorrow

New technologies will further prevent tooth decay. Research is underway to develop powerful imaging tools that can detect the earliest demineralization of tooth enamel. These tools will allow the application of special solutions to remineralize the tooth and reverse early decay.

Advances in DNA sequencing produced vast gene databases for many of the bacteria that cause tooth decay. These bacterial blueprints now allow scientists to identify specific genes essential to the decay process, and it may be possible in the future to directly target these genes and inactivate the ability of these bacteria to cause decay.

The bacteria that cause tooth decay live in complex communities called biofilms. Great strides have been made in learning how the bacteria communicate with one another within this biofilm. By jamming the communication signals among the bacteria, it may be possible one day to disrupt the biofilm and end the threat of tooth decay.

Periodontitis (Gum Disease)

There are many different varieties of periodontal disease, and many ways in which these variations manifest themselves. All require immediate treatment by a periodontist to halt the progression and save the gum tissue and bone. Here are some of the most common types of periodontal disease along with the treatments typically performed to correct them:

Gingivitis

Gingivitis is the mildest and most common form of periodontitis. It is caused by the toxins in plaque and leads to periodontal disease. People at increased risk of developing gingivitis include pregnant women, women taking birth control pills, people with uncontrolled diabetes, steroid users and people who control seizures and blood pressure using medication.

Chronic Periodontal Disease

Chronic periodontal disease is the most common form of the disease, and occurs much more frequently in people over 45. Chronic periodontal disease is characterized by inflammation below the gum line and the progressive destruction of the gingival and bone tissue. It may appear that the teeth are gradually growing in length, but in actuality the gums are gradually recessing.

Aggressive Periodontal Disease

Aggressive periodontal disease is characterized by the rapid loss of gum attachment, and the rapid loss of bone tissue. The disease itself is essentially the same as chronic periodontitis but the progression is much faster. Smokers and those with a family history of this disease are at an increased risk of developing aggressive periodontitis.

Periodontal Disease Relating to Systemic Conditions

Periodontal disease can be a symptom of a disease or condition affecting the rest of the body. Depending on the underlying condition, the disease can behave like aggressive periodontal disease, working quickly to destroy tissue. Heart disease, diabetes and respiratory disease are the most common cofactors, though there are many others. Even in cases where little plaque coats the teeth, many medical conditions intensify and accelerate the progression of periodontal disease.

Necrotizing Periodontal Disease

This form of the disease rapidly worsens and is more prevalent among people who suffer from HIV, immunosuppression, malnutrition, chronic stress or choose to smoke. Tissue death (necrosis) frequently affects the periodontal ligament, gingival tissues and alveolar bone.

Oral Cancer

About Oral Cancer

Oral cancer includes cancers of the mouth and the pharynx (the back of the throat). Oral cancer accounts for roughly two percent of all cancers diagnosed annually in the United States. Approximately 35,000 people will be diagnosed with oral cancer each year and about 7,600 will die from the disease. On average, 60 percent of those with the disease will survive more than 5 years. Oral cancer most often occurs in people over the age of 40 and affects more than twice as many men as women. 

What Puts Someone at Risk?

Tobacco and alcohol use.

Most cases of oral cancer are linked to cigarette smoking, heavy alcohol use, or the use of both tobacco and alcohol together. Using tobacco plus alcohol poses a much greater risk than using either substance alone.

HPV. Infection with the sexually transmitted human papillomavirus (specifically the HPV 16 type) has been linked to a subset of oral cancers.

Age. Risk increases with age. Oral cancer most often occurs in people over the age of 40.

Sun Exposure. Cancer of the lip can be caused by sun exposure.

Diet. A diet low in fruits and vegetables may play a role in oral cancer development.

Possible Signs & Symptoms

See a dentist or physician if any of the following symptoms lasts for more than 2 weeks. 

  • A sore, irritation, lump or thick patch in your mouth, lip, or throat
  • A white or red patch in your mouth
  • A feeling that something is caught in your throat
  • Difficulty chewing or swallowing
  • Difficulty moving your jaw or tongue
  • Numbness in your tongue or other areas of your mouth
  • Swelling of your jaw that causes dentures to fit poorly or become uncomfortable
  • Pain in one ear without hearing loss

Early Detection

It is important to find oral cancer as early as possible when it can be treated more successfully. An oral cancer examination can detect early signs of cancer. The exam is painless and takes only a few minutes. Your regular dental check-up is an excellent opportunity to have the exam. During the exam, your dentist or dental hygienist will check your face, neck, lips, and entire mouth for signs of cancer.

TMJ

It is estimated that around 10 million Americans struggle with the effects of Temporal Mandibular Joint disease. One of the most common, irritating and difficult dental issues to diagnose, Temporal Mandibular Joint disorder (TMJ) is commonly associated with head and/or neck pain. This is because the TMJ is located near the ear where the top of the mandible or lower jaw meets the upper jaw at the base of the skull. 

There are many causes of TMJ disorder, which is one of the reasons why it can be so difficult to diagnose.

Some contributors to the disease are:

  • genetic disposition
  • arthritis
  • injury to the jaw
  • stress
  • constant clenching and/or grinding of teeth

Symptoms of TMJ

Like many other joints in the body, the TMJ is subject to inflammation and other chronic joint problems. It is also vulnerable to a general breakdown of the joint as well.

What makes TMJ problems even more difficult to diagnose, and treat properly, is the fact that the symptoms vary widely in both location and severity, which is why working with a dentist, skilled in the signs and symptoms of the disease, like Dr. Joshua M. Ignatowicz, is vital. Symptoms can range from:

  • pain or tenderness of the jaw
  • a slight clicking in the jaw with no pain
  • severe head and neck pain that is not relieved by medication
  • pain in or around your ear
  • ringing in the ear
  • locking of the jaw

Diagnosing TMJ

Diagnosing TMJ usually takes place during a thorough dental exam where the following procedures can be expected:

  • obtaining a history of your symptoms
  • examining your jaw joints for tenderness
  • listening for any clicking or popping sounds
  • checking for lock jaw by having you open and close your mouth
  • testing your bite for any misalignments
  • x-rays to get a better view
  • MRI to make sure the TMJ disc is in the right place

Treatment of TMJ

Once diagnosed, proper treatments include:

  • placement of a nightguard
  • over-the-counter meds
  • hot and cold packs
  • soft foods
  • relaxation techniques
  • injections
  • surgery in severe cases

For most people, the symptoms of TMJ disorder can go away on their own, but only a dentist specializing in the disease can comfortably rule out the most severe cases and set up a program to help alleviate discomfort from the disease as well as set up a preventative program.

TMJ can be an irritating, overwhelming condition to live with. But there are so many simple remedies available that living in pain is no longer necessary. Contact Dr. Joshua M. Ignatowicz today and let us show you how we can help you be pain-free from the effects of TMJ disease.

Contact us for an appointment!