Author: howtolookafteryourteeth

Alcohol and smoking.

I have already written about the effects of alcohol and smoking on your dentition and your mouth in general in previous chapters but suffice it to say that they are major risk factors in both gum disease [periodontal disease] and oropharyngeal cancer. See chapters 5 and 14.

Some other things to be considered with alcohol and dental treatment are; –

• General Anaesthetic– People who use alcohol to excess are more resistant to general anaesthetic, however once liver damage sets in because it is not working properly some drugs can have a greater effect than normal.
• Painkillers such as aspirin and Ibuprofen [Nurofen] a NSAID [non-steroidal anti-inflammatory] should not be taken for mouth problems such as after an extraction as they are more likely to cause bleeding and stomach ulcers. Anyone with a damaged liver should also not use paracetamol of course but it’s probably the safest choice if desperate.
• Antibiotics– penicillins and erythromycin will not work as well and metronidazole MUST NOT BE TAKEN at all with alcohol or the patient will be severely, dangerously ill.
• Wound healing– anyone using alcohol to excess will not heal as well and extraction sockets will have a greater chance of developing severe infection.

Illegal Drugs.

You don’t need me to tell you they are not a good idea. They are an expensive, harmful habit to partake in and even more expensive habit to kick emotionally, psychologically, socially and monetarily.

Illegal drugs are classified into;-

• Class A- Most dangerous [includes cocaine in all its forms, heroin, LSD and magic mushrooms]
• Class B- Dangerous [includes ecstasy, barbiturates, cannabis].
• Class C- Least harmful [includes ketamine].

They are all illegal to possess and illegal to supply leading to heavy fines and/or a prison sentence.

FRANK is ‘a national anti-drug advisory service jointly established by the Department of Health and the Home Office of the British Government in 2003. It is intended to reduce the use of both legal and illegal drugs by education especially amongst the young’.

It is a very good easily navigable website, it lists every single drug you can think of including all the current street and club names with a host of information on each one of them. There is lots of help and advice for anyone who may need it for themselves or someone they may be worried about including a phone number for anyone needs to talk to someone.

www.talktofrank.com

Effects of drug abuse on teeth and the mouth are;-

• Rampant, rapid decay [caries] affecting all tooth surfaces caused by lack of saliva, poor oral hygiene due to self-neglect, excess sugar consumption as some drugs lead to a sugar craving.
• Tooth surface loss, caused by grinding and clenching of the teeth, erosive acidic drinks taken to rehydrate and satisfy sugar craving, regurgitating and vomiting especially in alcoholism.
• Thrush infection in the mouth [candida]- often seen in drug users due to a dry mouth from lack of saliva, a compromised immune response and poor dental hygiene.

Coupled with these problems is the associated problem that many IV drug users are also HIV+ve and so also suffer from the associated mouth infections/ diseases due to immune suppression.

Please get help if you need it.

Other forms of treatment/ medicine not part of conventional medicine are called Complementary- if used in addition to conventional medicine or Alternative- if used instead. They are known collectively as CAM.

All conventional medicines/ treatments in the UK have to be evidenced based before they are advised or recommended for use. That is there has to be enough proper scientific evidence that they work and they are not going to do the patient any harm. If the treatment is experimental then the patient has to be told and give their permission for use.

NICE- is The National Institute for Health and Care Excellence www.nice.org.uk it is ‘an executive, non-departmental public body of The Department of Health in England. NICE guidelines are recommendations based on the best available evidence for the care of people by health care and other professionals’. It has a high reputation internationally.

The Cochrane Policy Institute is a British international charitable organisation formed to organise medical research findings to facilitate evidence based choices about health interventions involving health professionals, patients and policy makers. It includes 53 research groups that are based at research institutions worldwide’. ‘Cochrane reviews are systemic reviews of primary research in human health care and health policy and are internationally recognised as the highest standard in evidence based health care. They investigate the effects of interventions for prevention, treatment and rehabilitation’. www.cochrane.org

Conventional Western Medicine is known Allopathic Medicine but other ‘systems ‘exist such as Ayurvedic and Traditional Chinese Medicine.

CAM is becoming more widely used in the west so much so that some disciplines are now considered quite mainstream for example Acupuncture and Hypnosis often being recommended by ‘conventional’ doctors/ dentists myself included.

All I would say is that the evidence for the efficacy for some CAM therapies is thin, however that doesn’t necessarily mean they don’t help to make the patient feel better, emotionally if nothing else.

Most of us have, I am sure used one or more of the following;- acupuncture, homeopathy, massage, aromatherapy, herbal medicine, music therapy, deep breathing exercises, hypnotherapy, meditation, yoga can’t think of any others but there are more, these are just the ones I have used myself.

What I would say is get the correct diagnosis first, go to someone who is properly trained, qualified and is happy to show you the evidence. Any properly trained CAM practioner will send you to a ‘mainstream’ clinician if they feel your problem requires conventional expertise. Beware of anyone who thinks their particular discipline will cure everything, it won’t, but it may help.

Herbal Medicine.

Many conventional drugs originally came from plants, some used for many hundreds of years before being produced synthetically. For example digoxin used in the treatment of heart disease came from fox gloves, aspirin from willow bark and the humble Madagascan Periwinkle has given us 2 very important anti-cancer drugs Vinblastine and Vincristine. Vincristine has helped increase the chances of surviving childhood leukaemia from 10%- 90%!

More and more research is being done into the almost magical properties and ingredients some plants have.

BUT NATURAL DOES NOT NECESSARILY MEAN SAFE some plant products are toxic and some addictive.

Bleeding– some herbal products prolong bleeding eg;- evening primrose, feverfew, garlic, ginger, ginkgo biloba, ginseng, green tea and turmeric.

Cardiovascular probs– some herbal products interact with drugs used in the treatment of cardiac disease eg;- foxglove, hawthorn, willow bark, garlic, gingko.

If you do self-medicate with natural/ herbal supplements/ remedies you should be very careful to buy from a reputable source, always read the label instructions very carefully as to dose and especially any warnings/ contraindications. Always tell your GP, Dentist or any other clinician if you take these products.

Some natural products/ treatments you might use that affect your treatment at the dentist;-

Aloe Vera– used for its anti- inflammatory, antiseptic and pain relief [analgesic] properties, vitamin content [A, B12, C, E, folic acid], minerals [calcium, copper, selenium, magnesium, potassium, sodium and zinc amongst others]. Often taken to help with conditions such as; – dermatitis, psoriasis, herpes, burns, wound healing, acne, lichen planus and mouth ulcers. Aloe Vera can have quite a few side effects and should not be taken by pregnant or nursing mothers. Aloe Vera should not be taken for 2 weeks before extractions or other surgery as it increases bleeding. As it is often used by some people ‘straight from the plant’ it would be a good idea for anyone who uses it regularly to look it up especially if they have other medical conditions.

Gingko Biloba– taken to prevent or reduce retinal problems, age- related macular degeneration, Alzheimer’s disease and to improve cognitive function. Needs to be stopped 2 weeks before surgery.

St John’s Wort– taken to help with mild to moderate depression. There is a long list of drugs not to be taken with St John’s Wort, it is imperative that you follow instructions and you tell your GP if you take it. Should be stopped at least 5 days before surgery.

Some natural products/treatments sometimes used in dentistry.

Hypnotherapy– can be very useful in helping people who are very fearful at the dentist. Some dentists are trained hypnotherapists as well and specialise in helping people with dental phobia. To find a dually qualified practioner contact The British Society of Medical and Dental Hypnosis on www.bsmdh.org

Patients can be taught and can teach themselves to self-hypnotise. I have a couple of patients who have been taught to self-hypnotise which is a very useful technique to have up your sleeve if you find dental visits stressful.

Propolis– is made by bees who collect resin from trees and plants, add wax to it and transform it into a complex biological product which protects the hive by providing its immunity. Both the Greeks and the Egyptians used it in medicine and there has been a growing interest in the last 30 odd years in its healing powers. Its composition is approx 50% resin [particularly from the poplar tree] and the rest is composed of wax, essential oils, pollen, organic and amino acids, vitamins and bioflavonoids [thought to be an active ingredient in the healing process]. The bees coat the inside of the hive and seal up any holes with propolis [bee glue] thus protecting the hive from outside while also providing a combined antibiotic, antiviral and antifungal defence for its inhabitants.  There has been quite a lot of ‘proper’ research on propolis in amongst other institutions the Universities of Manchester, Oxford, Strathclyde and East London.

There is a range of products for use in ‘medicine’ and I use the liquid very successfully to treat such things as ulcers and pericoronitis [infection around an erupting wisdom tooth]. www.herbalapothecaryuk.com

Homeopathy– I don’t myself subscribe to the ‘science’ behind homeopathy, however it is something that a lot of patients feel helps them and who am I to dispute that. If homeopathy or any other CAM helps my patient whether I subscribe to it or not, then surely that is a good thing and to be facilitated. Lots of patients like to bring their remedies with them and use them before or after their treatment and that is fine by me, I want them to be happy, at ease, feel cared for and safe.

Voltaire-‘The art of medicine consists of amusing the patient while nature cures the disease’.

We have an immune system to keep us healthy but we can’t expect it to manage by itself if we don’t keep it healthy. The right food, fresh air and exercise. Any type of CAM that increases our feeling of well-being while also reducing stress in our lives also boosts our immune system. It doesn’t matter if it’s effects can’t be proved if it makes you feel better, it doesn’t do you any harm and any practioner you go to has a qualification from a regulated body then the ‘medicine’ you choose is your choice.

Just remember you do not need ‘a pill for every ill’, our bodies are wonderful at defending us all by themselves!

Also remember vaccinations and modern medicine have rid the western world of amongst outer things;- smallpox, cholera, typhoid, diphtheria, scarlet fever, measles, mumps, German measles, rickets, polio, rabies, anthrax, whooping cough and TB all of which are deadly and which the collective consciousness has forgotten about. Anyone as old as me will remember children at school in callipers from rickets, or who were polio victims or with diabetes Type 1 who were not expected to live past their early 40s. Diseases such as these and others leprosy, syphilis, gonorrhoea, haemophilia the list is endless that blighted peoples lives can now be cured/ managed quite easily by modern medicine. So be thankful and appreciate it.

If you take any prescription drugs [this also includes creams, ointments, regular injections etc] it is very important that you update the dental team at every visit.

If you take lots of drugs and you can’t remember all the names, the spellings, how to pronounce them, the dosage or anything else keep a list or a repeat prescription in your purse or wallet. It’s very important that spellings are correct as often drugs for widely different things have very similar spellings. I’m sure I’m not the only dentist people have said things like ‘Oh you know I take the little pink ones, I don’t know what they’re for the doctor gives ‘em to me’. Could be anything, for anything as far as I’m concerned! Years ago I’ve had to send the patient home without treating them because they didn’t know what tablets they were on, my patients are better trained now.

Co morbidities.

Now a days we are all living longer due to better nutrition, sanitation, clean water supplies, vaccinations,  better diagnosis, medical advances in understanding and treatment, less infant mortality etc . Lots of us are living with what are known as co morbidities that is medical conditions that we live with and have to manage on a day to day basis. 50 years ago we wouldn’t have been living with them as we wouldn’t have been alive. So lots of patients are on drugs and combinations of drugs for these conditions. I think I read somewhere that the average 55 year old is on 5 different tablets. That may not be you but if it’s not you then it means that some people are on a lot more than 5. Lots of drugs a person may be on affect your teeth, your gums, your mouth or your treatment in some way.

It is very important that if you are on any prescription drugs for anything, if you are to visit the dentist that you take your normal dose, at the normal time and you eat your normal meals when you normally would UNLESS TOLD OTHERWISE BY YOUR DENTIST. I have lost count of the number of times someone has fainted on me or felt funny after an injection because their Mum, their Auntie or the cat has told them not to eat before a dental visit!

Side effects and secondary effects.

With drugs there is what is known as the main therapeutic effect, this is its main function but there are 2 other effects;- side effects, which are a nuisance and unwanted and secondary effects which are not the main therapeutic effect but another effect that can be useful in some way. The best example I can think of is Aspirin which is of course a painkiller [analgesic] but also has another effect in stopping the platelets in your blood from clumping together so your blood can form a clot should you cut yourself [ clotting is a complicated many component mechanism more than just this]. So if you were going to have a tooth out it would be a good idea if you clotted afterwards, it is imperative that you tell the dentist in advance.

Allergic reactions and Anaphylactic shock.

A current concern in medicine [of which dentistry is a part] is an increasing incidence of hypersensitivity [allergic type] reactions in people to drugs and other substances.

This can range from itchy skin [this is called a delayed Type 1V reaction] through to full blown anaphylaxis [immediate type 1 reaction] leading to sudden death if not treated promptly.

If you are allergic to anything at all you must tell the dentist.

If you carry an Epipen always have it to hand.

The commonest things I find people are allergic to that affect their treatment and visits to the dentist are;- Penicillin, Erythromycin, latex, oranges, volatile substances, aspirin, chlorhexidine [corsodyl].

Anaphylaxis is most likely to occur at the dentist if the substance is applied or accidentally gets into broken skin or the eyes.

Corsodyl is a mouth wash and gel used extensively in dentistry to treat gum disease. It contains Chlorhexidine. It is only to be used topically.

There have been 2 [that I know of] fatalities in the UK to chlorhexidine in the past 10 years, in both cases this was when chlorhexidine was used to clean a tooth socket after an extraction. The only thing that should be used to clean a socket is salt water [saline].

Dry mouth.

A lot of drugs patients might be on cause a dry mouth. The commonest ones are the ‘anti’s’ antihistamines, antihypertensives and antidepressants but there are lots more.

Patients who have a dry mouth due to reduced salivary flow will be more suseptable to caries [tooth decay] and gum disease as their mouth is not constantly bathed in lovely protective saliva [see chapter 11].

Sleep apnoea is a complex condition of which there are several different types. Obstructive sleep apnoea is where essentially the person stops breathing momentarily while they are asleep, this wakes them up and can occur many, many times during the night. Consequently these poor people have no sleep, are constantly tired and are unsafe to drive or operate machinery. It has many causes and it is very important that these people are seen by a medical specialist in sleep medicine. The treatment for this distressing condition may involve wearing different types of face masks, breathing apparatus or oral [mouth] appliances, further leading to the patient complaining of a dry mouth.

Gum swelling.

Some prescription drugs may cause the patient’s gums to swell. If your gums are swollen, more  debris and bacteria are likely to accumulate ‘down the back’.

Some common ones are;-

• Phenytoin- taken by people who have epilepsy and other seizure conditions.
• Calcium channel blockers- taken for hypertension [high blood pressure] and angina. eg Nifedapine.
• Ciclosporin- taken for rheumatoid arthritis and various other auto immune and inflammatory conditions.

Anaesthetics.

Some drugs a patient may be on might react with certain types of local anaesthetic [injection] and some local anaesthetics should not be used on people with certain medical conditions and pregnancy. Your dental professional is trained to know which these are and to choose a suitable local anaesthetic accordingly. All dental professionals who treat the patient [with the exception of clinical dental technicians] study pharmacology [the science of drugs] in their training and all are required to keep their knowledge up to date by undergoing mandatory continuing professional development [CPD]. New and better drugs and drug regimens are constantly evolving. If the dentist is unfamiliar, doesn’t recognise, or is prescribing something they don’t often use they may look it up to check it out first. In the UK they will use the BNF [British National Formulary] which used to be produced in book form but now is online. This is not because they are useless but because they are being safe and cautious on your behalf. ‘Always look it up’ is a mantra advised in dentistry by specialists in such subjects. Better to waste 2 minutes to refresh ones memory and be sure of your course of action.

Anticlotters.

If you have had a clot [thrombus] while flying for example, a TIA [transient ischaemic attack /mini stroke], a stroke, a heart attack, heart or blood vessel surgery and a hundred and one other reasons, you may be put on anti clotters. This can range from a baby aspirin [75mgs] to other more powerful drugs depending on the severity of your condition. If you self medicate aspirin on a regular basis you must tell the dentist.

If you are on Warfarin you will know that you have to have your blood tested on a regular basis to find your INR [international normalised ratio if you want to know] to make sure you would still clot in a reasonable time. The less often you need to have it tested the more stable your condition. You are given a read out in a ‘yellow book’ in the old fashioned method or probably nowadays a computerised print out. It is very important that you take this information with you to the dentist and that if you are to have anything complicated done that the reading is less than 72hours old.

There are lots of new anti clotters available now which don’t require constant blood tests.

Anyone on anti clotters obviously needs to be managed very carefully at the dentist. Let’s say you need several teeth out for whatever reason, they might have to be done one at a time or I might take out the easiest one first or perhaps clean the patients teeth to assess how much they bleed and if that’s OK carry on.

Whatever you take, make sure you tell the dentist what it is, what it’s for and the dosage [how much, how often and for how long you are to take it] and that whatever you are to have done you make sure you follow to the letter any instructions given to you re after care.

Bisphosphanates.

These are a class of drug that is used in the treatment of osteoporosis and in the treatment of some types of cancers to stop them invading the bone. Here is a simple little explanation;-  so you know most tissues/systems in your body make new cells all the time;- skin cells, blood cells anything else you can think of [not brain neurones, cardiac muscle cells or those in the eye lens], you also make new bone cells and to do that you need to get rid of the old ones or your skeleton would just get heavier and heavier. You have special little cells called osteoclasts which nibble away old bone cells so other cells called osteoblasts can make new ones. Bisphosphonates stop the nibbling ones so then the making ones can’t make new bone cells [it is very definitely far more complicated biologically and pharmacologically than this but this will do for now]. If your clinician is to put you on these drugs it is very important that you visit your dentist well in advance [and you should be advised to do so by your GP or medical specialist ] and that your oral hygiene is tip top to ensure as far as possible that you do not have gum disease and you will not need anything extracting whilst you are on these particular type of drugs. The stronger the drug and the bigger the dose, the more likely you are to have complications that affect healing in the mouth. It is absolutely no good turning up at the dentist on the day before you are to have your first dose, it gives the dentist no time to sort anything out that might need sorting.

There is a newer type of drug that is sometimes prescribed for the same reasons, they work in a different way [pharmacologically]. The same precautions are needed. I don’t know if there are more than one of these drugs but you will know what they are for as all the names end in –mab.

Make sure you tell the dentist what drug you are going to be taking, what it’s for, the dosage;- how much, how often and for how long you are to take it and in the case of these drugs how it is to be administered [tablets or injection]. Whatever you are to have done at the dentist make sure you follow to the letter any instructions given re after care.

Pregnancy.

All drugs unless essential should be avoided in pregnant women and some in breast feeding mothers. This also includes some over the counter medicines for example Ibuprofen [Nurofen].

It is very important you read the back of the packet before taking anything if you are pregnant or breast feeding, if in doubt seek medical advice.

Some local anaesthetics [injections], dental materials [eg amalgam], certain treatments [eg bleaching/whitening] should be avoided in pregnancy.

It is very important that you tell your dental professional if you think there might be a possibility you may be pregnant so that your treatment can be managed accordingly for example a temporary restoration to relieve pain and a more permanent solution in the future.

Alternative/ Herbal/ Complimentary etc Medicines/ Suppliments are all dealt with in the next chapter.

Conclusion.

The subjects I have talked about are by no means all of the story, they are the things that most of us in the dental profession manage on a regular day to day basis, hopefully you will understand that you need to;-

• Tell your dental professional what drugs you are on, what they are for, the correct spellings, the dose, how often you need to take them, for how long and IF THERE ARE ANY CHANGES TO THIS.
• You always carry a list around with you.
• You take your normal dose of medication at the normal time, in the manner directed by your doctor and you eat your normal meals if you are to visit the dentist. UNLESS TOLD OTHERWISE BY YOUR DENTIST.
• Always read the back of the packet first before taking or applying anything for the first time even with over the counter drugs. If you are unsure seek medical advice first. Do not exceed the stated dose.
• Always follow any instructions given by your dentist, doctor or the back of the packet as to how drugs should be taken.
• After dental treatment always follow to the letter any instructions given as to after care.

When you go to see your dentist it is very important that you tell them all about your past and your present medical history, which is any past or present medical problems.

Your dentist/ hygienist/ therapist will need to update this at every visit. They may ask you to fill the information in on a tablet/ computer, on a printed form or they may just ask you, write it down and get you to sign it. All of these are perfectly acceptable, all dental health professionals have different systems.

Anyone under 16yrs in the UK has to have this information signed by a parent or legal guardian. A friend, grandparent, childminder, older sibling cannot sign this document.

If you have a very complicated medical history or you can’t remember it all write it down or get someone else to write it down for you. If it is possible this information is better typed for better understanding. If your medical problems are very complicated it is a good idea to carry this list around in your wallet or purse in case you have an accident. In the last 5 years I have picked up 3 people in the street who have tripped over and been confused because they have banged their heads. It is so much easier for ambulance paramedics to look after you if they know all about you. Don’t think it won’t happen because it will, the youngest of these people was in his late 20s, it can happen to anyone at any age. People with certain conditions will be advised to have a medical alert wrist band, always look for this if you happen to be the rescuer.

It is also very important you tell the dental professional any drugs/ medicines you may be on. Carry a list around, a copy of a repeat prescription is sometimes the easiest way to do this. Very important that you get the spellings right, sometimes medicines for widely dissimilar conditions have very similar spellings, it is important that they are correctly noted.

The St Johns Ambulance Brigade and probably other similar organisations have a very handy little system consisting of a box with a sticker on it in which you put one of every tablet you are on [a list would be good as well]  which you then place in your fridge. There is a matching sticker which goes on your front door so if you are taken ill in the night and an ambulance is called the ambulance paramedics know to go straight to the fridge to find all the information they need to know.

Sometimes when I’m asking a patient about their medical history they will withhold information which they do not think is relevant because they think it doesn’t concern their teeth. Your teeth are part of your mouth and that is part of the rest of your body. All good health care professionals practice holistically, they look at whatever is their field of expertise in the context of the whole body.

You do not know what is relevant and what is not, you are not trained to know. Tell the dental professional everything, they will sift out anything they do not need to know.

Here are 2 seemingly innocuous examples;-

The patient may tell me they are allergic to oranges, this may on the surface of it seem to have nothing to do with your teeth but some polishing pastes and solvents are orange flavoured. I don’t want the patient to have an allergic reaction when I am doing something as simple as polishing their teeth. Similarly if the patient tells me they are allergic to avocados, I know they are probably allergic to latex as it is the same plant family and so I know to be doubly careful that no rubber even that used to rub out pencil mistakes gets anywhere near them, lots of things used in dentistry are made of latex; – gloves, bungs in local anaesthetic cartridges, ‘O’ rings on tubing- all sorts.

‘Your eyes are the mirrors of your soul’ so they say. Well your mouth is a mirror of the rest of you. Lots of serious systemic [whole body] diseases can be picked from your mouth and I’m not talking in a ‘reading your palm’ type of way, I’m talking about proper medical signs.

Signs and Symptoms- what’s the difference?

A Symptom is what you tell the clinician about your problem [in medical parlance ‘what the patient is complaining off’] and the history [the story] of that problem [complaint].

A Sign is what the clinician sees when they examine you.

There is a saying in medicine ‘Listen to the patient, they are telling you the diagnosis’. This means that as a clinician you must listen carefully to what the patient says. This relies on the patient telling you everything and answering any questions you might put to them as completely as possible- if you can’t remember write it down.

Here are a few serious conditions that can be picked up, most of which I have picked up over the years on patients from examining their mouths and surrounding areas;- anaemia, leukaemia, heart failure, diabetes, high cholesterol, oral and pharyngeal cancers, Gardeners Syndrome, HIV, Syphilis, Shingles, Pemphigoid, Pemphigus, TB, vitamin and iron deficiencies, Chicken pox, Hand Foot and Mouth, Chron’s disease, Behcet’s disease, Lichen Planus, Sjogren’s syndrome, Acromegaly, Haemophilia, Bell’s Palsy, high cholesterol, bulimia, anorexia. That’s all I can think of for the minute, but hopefully it is enough of a list for you to realise that the dentist’s function is not just teeth.

We all have a ‘duty of care for our fellow human beings’, I have a patient who’s malignant skin cancer on the back of their neck was picked up by their hairdresser’s eagle eye. Not many people’s lives are literally saved by their hair dresser but this persons was.

I’ve had peoples medical practioners be pretty snotty to me over things I have noticed on patients ‘tell her to stick to dentistry’ was one comment relayed to me by a patient. It doesn’t matter if it’s me, your hairdresser, or a concerned friend or relative. Better to flag something up that turns out to be nothing than not bother when something could have been picked up early. Don’t ignore it go and find out!

The thing is people go to the doctors when they are ill but hopefully they go to the dentist on a more regular basis as a preventative measure. This is a golden opportunity for a well-informed clinician to pick up other conditions in a timely manner. 

Below are some of the major conditions that affect your treatment at the dentist. The list is by no means exhaustive, these are the commonest things that I can think of.

Diabetes.

There are several types of diabetes, the commonest ones are Type 1 and Type 2. Type 1 is where for some reason your pancreas does not produce insulin and so you cannot metabolise the sugar in your blood so your cells are starved of fuel, this condition is usually picked up in your early teens often because you fall asleep in class or have no energy and are tired all the time [the other symptoms are excessive thirst, excess urine production, weight loss, tingling and numbness in your fingers and toes]. This is treated with insulin. Type 2 [used to be called late onset but younger and younger people are being diagnosed] is where you produce insulin but for some reason your cells are blind to it. Obesity is the main factor that generates medical intervention, this condition is treated with diet, drugs and sometimes insulin as well [it is by no means as simple as this but this will do for now].

As far as the dentist is concerned it is very important that whatever your visit is for unless you are told otherwise that you take the medication you normally take, at the time you have been told to take it and you eat as you have been advised to. Always carry emergency sugar/ sweets/ bananas with you. If you are rushing to the dentist from work and you haven’t had time to eat as normal tell the dentist, I would much rather run 10 minutes late while the patient eats a banana than have them go into a coma on me.

It is important that you visit the dentist at a time of day when you are most stable.

Diabetics are more prone to infection and are slower to heal than others. It is very important that you follow ‘post-operative instructions’ after an extraction to the letter and that your oral hygiene is tip top as diabetes is one of the factors in gum disease [periodontal disease].

Asthma.

This is a condition where the patients breathing is compromised by constriction of their airways making breathing out especially difficult. It can be brought on by lots of things; – hypersensitivity to inhaled particles, as a response to exercise or cold and as a result of anxiety. For a lot of people visiting the dentist can make them very anxious. Asthma is known as a step disease, the more drugs the patient is on the more serious the condition. If you are an asthma sufferer find a dentist you like, go and see them regularly, the more familiar the environment the less likely you are to suffer an attack whatever the procedure. Always carry your inhalers with you, I get my patients to put them on the work surface at the ready, just in case- you never know, no good having to rummage around in the bottom of your handbag in a crisis.

Allergies.

If you are a person who suffers from multiple/ severe allergies to anything [foods, household dust/ mites, drugs etc] make sure you tell the dentist. If you need to carry an epipen put it on the work surface so it is close at hand just in case. I have had a bee fly in the window just as I was treating a patient with a severe allergy to them. How vulnerable must someone feel flat on their back with a bee circling overhead, it was frightening for me and the patient. Her condition had only just been diagnosed, she had only just told me. Now I always close the windows in advance. ‘Always expect the unexpected’.

Heart conditions, strokes, TIAs [transient ischaemic attack], clots, other respiratory [breathing] conditions, cancer treatment, transplants, new hips/ knees anything else in the way of severe illnesses/ conditions.

The list is too numerous to mention, make sure you tell the dentist.

Epilepsy.

If you are a person who suffers from epilepsy, however mild, however long ago your last fit make sure you tell the dentist. ‘Fore warned is fore armed’, ‘always expected the unexpected’. Fits can sometimes be brought on by stress [at the dentist] and flickering light [a florescent tube on its way out/ the charger on a curing light].

Pregnancy.

Always tell the dentist if there is even the remotest chance you might be pregnant. Some local anaesthetics, antibiotics and pain killers should not be given to pregnant women. A pregnant woman should not have radiographs [x rays] even though the dose of radiation is very small- just as a precaution.

HIV.

If you think you may possibly be HIV positive, please tell the dentist. There is not and there never was anything to be ashamed off. Just because something is transmitted by sex rather than coughing and sneezing does not make it different to any other disease. It is just how those particular nasty little organisms travel from one person [host] to another. They want to infect as many people as possible that is their remit, you are just unlucky enough to have been chosen! Practice safe sex- don’t give them a chance. Further info on www.SH24hrs [sexual health 24 hours a day including self-testing kits].

Nothing you ever tell your dental or medical clinician will ever be repeated outside of the surgery.

The next chapter is on drugs and the dentist so I won’t go into that now. Suffice it to say tell the dental professional everything even if you don’t think it’s relevant, let them decide.

There are a few conditions that people have that are not sinister or worrying but that deviate from the normal and give cause for concern to the patient until they are reassured by a professional. It cannot be emphasized enough that if you notice something which you feel you have never noticed before go and see your dentist or of course your doctor if it is anywhere else but your mouth. The correct diagnosis is the most important thing.

Normal anatomy.

How often do we really look in our mouths? I mean really look close up, well how often do we really look at our leg? Well probably never. It is often not until we have traumatised a bit of ourselves that we really look and some bits of normal anatomy can look pretty alarming if we have never noticed them before.

As a general rule of thumb if something is in the midline [central] – it’s normal, if you have one on either side [bilateral], even if they don’t quite match- it’s normal but if something is only on one side [asymmetrical] – it’s not normal or rather you need someone who knows about these things to tell you what it is.

This rule does not follow for your skin as your skin is a whole body organ, in fact the biggest organ in your body, it’s designed to hold the bits in and protect you from infection.

Here are all the commonest things I can think of that people are sometimes worried about;-

Torus [plural- tori] mandibularis- these are bilateral [both sides] bony bumps on the inside of your lower jaw. Hook your index fingers over your teeth and down the inside of your lower jaw [mandible], feel side to side about half way along, chances are you have them. They are highly unlikely to be completely symmetrical but you have one on either side- normal.

Torus Palatinus- this is a central bony bump in the middle of your palate sometimes it’s as big as, and resembles half a walnut. This is highly unlikely to be symmetrical, but it’s in the midline- normal.

Bony exostosis- these are bony bumps over the outside of the roots of most/all of your top teeth. Sometimes they can be quite large and resemble a pie crust frill. These are normal, very occasionally you may grow a new one. If you grow more than 1 new one go and see the doctor this is sometimes a symptom of a condition called Gardener’s Syndrome where you also get polyps in your colon, part of your intestine.

Tongue papillae- All over your tongue you have papillae, and you have several different types [circumvallate, foliate, fungiform and filiform] apart from filiform these contain your taste buds, which detect different tastes- sweet, sour, salty, bitter and umami [savoury]. Some of them can look a bit alarming if you have never noticed them before. Most of us never look at our tongues until we damage them in some way usually by biting them. It can be a bit alarming to suddenly see something strange at the back. So if you notice a row of what looks like darlicks heads across the back of your tongue do not be alarmed these are your circumvallate papillae- they are on both sides- normal.

Parotid Papillae- Your parotid glands are a pair of major salivary glands that are more or less in front of your ears [they are what swell up when you get mumps]. They are known as exocrine glands, that is they make whatever it is they make, in this case saliva and then a bit of pipe work, a duct takes it to where ever it is it is needed [as opposed to endocrine glands that discharge directly into your blood system]. If you run your thumb up the inside of your cheek you will find a bump about in line with your upper first molar. This is the hood over the end of the parotid duct. You have one on either side- normal.

Common conditions.

These are conditions that are seen relatively frequently in patients, that need to be correctly diagnosed by a dentist to ensure they are nothing else and like anything that deviates from ‘normal’ should be kept an eye on by a professional at regular intervals.

Geographic tongue [erythema migrans] – this is a very common condition which affects about 2% of the population in the UK.  This is where [mainly] the top surface of the tongue [dorsum] has irregular pink/red map like areas which move, change shape sometimes within a few hours, these patches sometimes have a yellowish border. The cause is unknown, it often runs in families, not thought to be infectious, sometimes associated with psoriasis, diabetes, hay fever and certain foods. There is no cure but it is not anything to be worried about now or in the future. It may be sore with acidic foods such as tomatoes or citrus and sometimes with cheese. Very occasionally it is sore but I usually find that most people don’t know they have it until I point it out to them. If it is sore on a regular basis and avoiding certain foods doesn’t help your dentist can prescribe things that can help. It is important to get it diagnosed by a professional especially as it may be associated [goes together but not caused by] with diabetes and anaemia. I have defiantly picked up diabetes in one patient that I can think of because I was alerted by their geographic tongue.

Lichen Planus- this tends to affect people in their mid years [30- retirement] and affects about 2% of the population. There are various different types based on appearance but basically it consists of white/red patches on the skin inside your mouth which very occasionally can be painful. The cause is unknown and not thought to be inherited or infectious. Some people also get skin, nail and genital lesions. It is really, really important for this to be diagnosed and monitored by a professional as occasionally a cancer can develop within it. So if you have had it diagnosed at some stage or other it is really important that you do not let your dental visits lapse so it can be monitored. Occasionally people will have something that looks like lichen planus but it is only on one side in their mouths, this is a lichenoid reaction- a reaction to something that gives the appearance of Lichen Planus but isn’t, sometimes this happens next to a very old amalgam filling, the best thing is to replace this filling and see if it goes away. Do not be alarmed if your dentist either performs or sends you for a biopsy as sometimes he or she may wish to confirm that it is lichen planus and not something else more worrying.

The rules for everything are;-

Eat plenty of fruit and veg [5 a day].

Don’t; – smoke, drink more than 14 units, chew tobacco or betel nut, use other tobacco products- snuff or snus.

Good oral hygiene to eliminate bacteria, fungi and viruses.

Practice safe sex.

Go to the dentist at regular intervals as advised.

Go and see your dentist or GP if you notice;-

A new white, fiery red or speckled patch in your mouth.

An ulcer in your mouth or on your lip which doesn’t heal within 3 weeks.

A new lump in your mouth or on your lip that doesn’t go away within 3 weeks.

Why 3 weeks?

Because most things that are traumatic [you’ve damaged yourself in some way] or infective will go away or at least start to look a lot better in 2 weeks, add another week on for luck as some of us are slower healers than others. If you are not sure make an appointment, you can always cancel it nearer the time if it goes away.

Pain- is there for a reason, to alert us to something going on, don’t ignore it.

Prevention is better, simpler, cheaper and less painful than cure!