Brian Gurinsky, DDS, MS, PC

Trying to get pregnant? Better hope you don’t have gum disease.

For you women out there that are trying to get pregnant, listen up.  A recent published study found that a specific  bacteria that is highly linked to gum disease was found at a rate of 4x higher in women who were trying to conceive (but could not) than those that were able to get pregnant.  This is another study proving that gum disease bacteria are systemically involved adversely in the body.

Gum disease and early death in women!

Listen up you post-menopausal women with gum disease!!   Research published in the Journal of the American Heart Association suggests “gum disease and tooth loss are connected to a higher risk of early death in women past the age of menopause.”  To be clear, the findings only suggest an association between oral health and premature death and it does not show gum disease or tooth loss cause early death.  That said, there is a definite link and this link is likely attributed to the fact that those with gum disease have higher levels of inflammation coursing their bodies.

For the study more than 57,000 women aged 55 and older were tracked.  The researchers found that “a history of gum disease was associated with a 12 percent higher risk of death from any cause.” In addition, researchers found that loss of natural teeth was associated with “a 17 percent increased risk of death from any cause.”

I was told I need a “night guard” but I don’t think I grind my teeth.

Most people will clench or grind their teeth while they are asleep and never know. While you are awake, you may be clenching or grinding, but because you are conscious, the forces you do that with are not destructive. While asleep, the forces are thought to be in the order of 10x as much force as when you are awake. Wearing an occlusal guard can help protect your mouth while this is occurring. Call it a night guard, grinding guard, occlusal guard, clenching guard or mouthpiece but they are all very similar. All should have a hard plastic biting surface. Some will a soft inside portion (area that actually sits on the teeth) and some will have the same hard plastic that is on the outside.

“So even if I am clenching or grinding, so what?” The obvious damage of grinding is that you will wear down the edges of the teeth which shortens the teeth and also makes a very aged appearance. Not only do your teeth suffer and have an increased risk of fracture, but you will also start developing notches around the necks of the teeth near the gumline which can lead to recession. As a periodontist, this keeps me in business, so grind away! But really, why not make a small investment and protect the teeth, gums and bone before it starts to lead to costly repairs, possible surgery, and an aged smile.

E-cigarettes

The ADA News (12/8/16) reports that the US Surgeon General said in a report released Dec. 7 that e-cigarette use among youth has been increasing in recent years at an “alarming rate”.

It seems that the smoking community is under the assumption that E-cigarettes are not that harmful. Research is starting to come out (Europe, especially) that shows that not only is it harmful, but that it may be as bad or worse than traditional cigarettes. Sadly, kids are under the impression that it is not bad for them.

E-cigarettes – Not so kind to your teeth and gums

Former and would-be smokers who opt for electronic cigarettes may not be doing their teeth a whole lot of good, according to a new study.

Research published in the journal Oncotarget, which focuses on cancer-related issues, suggests that electronic cigarette smoke may wreak the same type of havoc on teeth and gums that conventional tobacco does.

A team of scientists from the University of Rochester and Stony Brook University found that the vapors released in e-cigarettes can cause tissue inflammation and damage comparable to that produces by regular ones.  Furthermore, chemicals used to flavor some e-cigs may cause even more harm to mouth tissue, the researchers say.

Some caveats: This particular experiment was conducted on gum tissue, not live human participants. It’s possible that there are other confounding factors that may contribute to gum disease and in e-cig and regular cigarette users alike.

But it’s the latest example of scientific skepticism surrounding the health benefits of e-cigarettes. Manufacturers claim that they are an obviously superior alternative to conventional products that contain known carcinogens; but the overall public health ramifications of the products remain unclear, including whether or not they may actually be encouraging more kids to smoke.

Cannabis use and Periodontal disease linked!

People who use cannabis for up to 20 years may be more likely to have periodontal disease, according to research published in June in The Journal of the American Medical Association Psychiatry. Using self-reported data on cannabis and tobacco use, the longitudinal study compared health outcomes in persistent cannabis users versus tobacco users and found cannabis usage associated with poorer periodontal health at age 38, and within-individual decline in periodontal health from ages 26 to 38 years. Cannabis use was not, however, found to be associated with other physical problems in early midlife, according to the open access article

Gum Disease/Tooth Loss and Dementia

As the numbers of people with Alzheimer’s disease and other cognitive disabilities increase, scientists are investigating how these conditions may be related to oral health. After evaluating available research, the International and American Associations for Dental Research concluded that individuals with fewer than 20 teeth face a 26% greater risk of cognitive decline and 22% greater risk of dementia.

Tooth loss was the primary oral health indicator in all of these studies. Cognitive function was ascertained during follow-ups ranging from 4 to 32 years. In 4 of the studies, cognitive decline was the reported outcome. In 5 of them, dementia was the outcome. Previous research suggests 3 mechanisms accounting for this association.

First, research suggests tooth loss may lead to cognitive decline via reduced mastication-induced sensor stimulation to the brain. Second, suboptimal dentition and mastication could lead to poor nutrition and then reduced cognition. Third, the presence of periodontal disease may play a role in cognitive diseases.

Does “Do you take my insurance?” equal “Are you in-network?”

Do you think the above means the same thing? Most patients do. But it really does not. When you call a dental office and ask, “Do you take my insurance?” without asking any additional questions, almost 100% of the time they will say “Yes”. But are you and that office agreeing on what that means?

Let’s define some things. “Taking insurance” just means that the dental office will file a claim to your insurance on your behalf. They are free to charge what they want and what is not covered by your insurance, you pay. They are not tied to any fees dictated by the insurance company.

What does “in-network” mean? It means that your insurance company has already negotiated the fees on your behalf and that is all the dental office can charge. Usually, this means it’s more affordable for you. I say usually because there are some shenanigans that offices pull in order to charge you more than necessary but that’s for another article. But generally, you pay less.

So, was the office you went to lying when they said they took your insurance but after a few visits you realize that they were not in-network? No. But it might be a good public relations move for these offices to explain the differences on the front end. In their defense, you’re ultimately responsible for what plan you purchased. Dental offices are not obligated to walk you through your insurance plan. But we usually do it as a courtesy.  Dental plans are incredibly confusing (even for us and we deal with them daily).

Here’s another thing I hear: “I wasn’t allowed to go to my last dentist because he is out of network”. Not true! If you liked the guy and the staff, you can still go there! The insurance company police will not track you down and throw you in jail! Unless you made a radical change (like going from a PPO to and HMO), you can still see the doctor you like and use your dental benefits. Yes, you may pay a few bucks more but it may be worth it to you!

Why wouldn’t all offices be in-network? Because some insurance plans are just plain lousy. To be profitable, the dentist would have to cut corners on your actual treatment or schedule you next to ten other people and you get to wait an hour to be seen.   People think that healthcare is immune to basic economic principles. It is not. In healthcare, just like everywhere else, you get what you pay for.

We are in-network with many plans that allow us to do top quality work at reasonable fees. But we are not in all the plans for the reasons above. We occasionally drop plans and add some plans. The nice thing about dentistry in the US is that you have to freedom (still) to see any doctor you want.  You may have to pay a little more, but if you like the doctor and staff, it’s well worth it.

In conclusion, if being in-network is very important to you, then ask, “Are you in-network?” In our office, this is sorted with the first phone call.

I keep hearing about the Pinhole Technique. Am I a candidate and what is it all about?

The “Pinhole” technique is a technique for treating gum recession, described by Dr. Chao.   The marketing for this technique has been quite extraordinary, however the technique is not a new technique.   It involves making a hole in the gum tissue under the lip and then moving the gum tissue toward the tooth to cover the recession.  In fact, there have been very similar techniques which do not even require making a hole and thus would be much more conservative.  The Pinhole technique also involves stuffing collagen strips into the gum to supposedly add thickness to gum.  Unfortunately, there is almost no long term data showing this technique to be effective long term.  While there are a few indications to doing a conservative approach like this, the cases must be very mild and selected carefully.

I was thinking of getting dental work at the dental school – Is it worth the cost savings?

Is treatment at a dental school a good idea? it’s a great idea if you have extra time for your appointments! All schools have clinics where 3rd and 4th year students treat patients. You may think that you wouldn’t want a student working on you but these students have had countless hours working on mannequins and shadowing dentists before they get to see patients. And many patients forget that these students are getting graded and they all want to get an A! Also, you have a seasoned dentist looking over their shoulder, guiding them every step of the way. The obvious advantage of a dental school is that fees are usually lower than at a private practice. The only thing you give up is: convenience as the school may not be in your neighborhood, a possible waiting list to get treatment, and treatment that may take 1-2 visits in private practice may take several visits at a dental school. But the dental treatment itself is usually satisfactory. When I have patients that simply can’t afford the treatment they desire, I usually recommend the dental school. This option usually works well for retired patients that don’t mind treatment taking a little longer or going in for multiple appointments.