In light of recent media reports concerning an Oklahoma oral surgeon who treated patients in unsafe conditions and may have exposed them to hepatitis and HIV, Dr.s’ John and Peter DiGrazia are assuring their patients that their dental team abides by strict infection control guidelines. Infection control refers to the recommended policies and procedures used to minimize the risk of spreading infections that all health care professionals (including dentists) follow to protect patients from disease. We take great pride by delivering quality dental care in a safe and clean environment. Our sterilization equipment is monitored and checked for effectiveness each and every cycle, so you can be assured that the instruments we use are sterile. In addition, your safety is something that the Nevada State Board of Dental Examiners is actively monitoring. Dr. John DiGrazia serves on this committee as an inspector who performs random audits in Northern Nevada dental offices to verify infection control recommended safety precautions are being used.

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You’re at a family gathering, seeing cousins, aunts and uncles you haven’t seen for years. Everyone is excited to see you and greets you with hugs, but…., as conversations roll along they are giving you a little space, moving a little further away as you talk. At first you don’t notice they are giving you your space. Then your closest cousin comes running to greet you and give you a hug and quickly backs away. You talk briefly, she offers you some gum and she excuses herself. Hmmm, that’s odd you think, but don’t read anything into it. Soon after your favorite niece arrives; she just turned five last week, she runs and jumps into your arms “Uncle Joe!” she exclaims. Then she too, pushes back but with her fingers pinched over nose, “Uncle Joe,” she says, “Your Breath smells bad.” Embarrassed, you put her down and she runs off to play with the other children.

It may not have happened to you like this and no one may have even told you, but they may have left you little hints. How do you tell someone they have bad breath other than leaving a tin of Altoids on their desk? Well it’s not easy, but it is important. Bad breath also known as a condition called Halitosis can be caused by a number of things, diet, smoking, dry mouth, poor oral hygiene and numerous medical disorders. The things that you eat can contribute to bad breath, items like garlic and onions, or any kind of food, are absorbed into the bloodstream as they are digested, become transferred to the lungs and odors are expelled when you breathe. Chances are if it stinks going in… well you get the idea.

Certain medical conditions can contribute to your bad breath as well, such as lactose intolerance, digestive conditions such as acid reflux or GERD. Respiratory infections such as bronchitis or pneumonia, or sinusitis (an infection in the sinuses) and often results in a post nasal drip where phlegm or mucus drains into the back of the throat.   All of these conditions, plus many more, have odor causing properties that can contribute to bad breath and require diagnosis and treatment from a medical professional.

Poor oral hygiene is a major cause (about 90%) of periodontal disease and contributor to bad breath. Without consistent proper, brushing, flossing and routine cleanings and examinations by your dentist, food remains in the mouth and gets trapped between the teeth; in the gums and becomes a breeding ground for bacteria. This bacteria, just like humans, consumes food and excretes wastes. The waste products produced by some types of oral bacteria are smelly sulfur compounds. These compounds are referred to as “volatile sulfur compounds” (VSC’s) and are the byproducts of anaerobic bacteria and they thrive in areas that are devoid of oxygen (periodontal pockets and areas with heavy plaque build-up). Most VSC’s are created when these bacteria digest proteins; this means the things we eat like meat and fish are also consumed by the bacteria in our mouths. Even without an obvious source, like having eaten something, there is always protein floating around in our mouths from dead skin cells to the compounds that make up saliva, which makes everyone at risk.  The accumulation of dental plaque provides the perfect environment for these bacteria to flourish, which is why oral hygiene is so important. Brushing and flossing on a daily basis to remove plaque and any food debris will help reduce the amount of these odor causing bacteria. Routine cleanings and exams to treat any dental issues such as decay and periodontal disease will also help. You will never eliminate these bacteria but with good oral hygiene you can keep things under control.

Only your doctor or dentist can determine the cause of halitosis and it is different for everyone. Some tips you can try at home all start with your oral home care:

•       Brush twice a day after meals (The insides of your cheeks and the roof of your mouth also build up bacteria, so don’t forget to brush those areas too).
•       Floss once a day making sure to curve the floss around your teeth to remove plaque from the sides and out from underneath the gum.
•      Make sure to brush your tongue or use a tongue scraper, if you don’t have one you can use a spoon, and gently scrape your tongue. No need to remove taste buds!
•      Use a good mouthwash, your dentist can prescribe or recommend one that is right for you.
•      Drink a lot of water, sipping on water throughout the day instead of sugary drinks, will help keep your mouth moist and helps rinse food particles away.
•      Chewing gum, sugarless of course can help stimulate saliva production which also helps rinse bacteria away
•       If you wear dentures they need to be cleaned frequently (after each meal) to remove food debris and bacteria. Use an ultra-soft bristle brush, to clean the roof of your mouth and/or lower jaw to remove bacteria on your gums. And don’t forget to let your tissues breath, leave your dentures out when you can.
•     Quit smoking. We know it’s not easy

 Bad breath isn’t fun and can be the result of something serious if not treated. Talk to your dentist or doctor and don’t be embarrassed. We are here to help! And for that friend or family member with the bad breath, don’t just blurt it out “Hey your breath stinks!” but pull them aside and tell them that your concerned and you would want someone to tell you if that was the case.  If that doesn’t work, then try the anonymous Altoids box!

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Fractured teeth are usually caused from one talking, chewing on, or playing with the jewelry, especially “barbells”.  Some of these fractures can also lead to root canals or tooth loss. Gum recession and bone loss around the teeth can also be caused by oral piercings.  Piercings in the philtrum, the area beneath the nose and above the upper lip, known as the “Medusa and/or Madonna piercing” or in the “Labret”, the area between the lower lip and chin, irritate the surrounding tissue and can cause recession from the constant rubbing against the gum and generally require a referral to a periodontist for gum surgery to correct it. Infection is the most serious of these conditions, although any piercing is prone to infection, oral piercings are more likely to become infected because of the different bacteria that is present in our mouths. The moment the tongue or lip is punctured, these bacteria may be introduced into the bloodstream. Dentists are learning that oral infections can lead to infections in other parts of the body as well. Bacteria can reach your heart and cause a variety of health problems. Handling jewelry once it has been placed in the mouth also increases your chances of getting an infection. Swelling around the site of the tongue piercing is normal during the approximately four week period necessary for healing. Every person will heal differently, which is why you shouldn’t panic if minor swelling continues briefly (four to six days) after this time. Excessive swelling (indicated by difficulty swallowing or talking) and/or extended periods of minor swelling may be signs that an infection has developed as a result of the piercing. A dentist or doctor should be consulted at the very first sign of infection.

There are many ways in which you can prevent many of these complications from occurring.  The best advice we can give of course is avoid piercings in the mouth, the risks are a bit high for an unnecessary dental or medical procedure. If you have decided to go through with the oral piercing, despite these risks, do your research. Visit the studio/piercing shop and ask questions. What are the risks?  Do they use a hospital grade sterilizer and/or use disposable instruments and needles? Does the staff wear disposable gloves? Are instruments kept in sterile packages until ready for use? Ask to see the studios health certificates. If the staff is not friendly, or willing to answer all of your questions, consider finding another studio. Next, be sure to keep it clean! A pierced tongue can take four to six weeks to heal. Pierced lips can take between one to two months to heal. During this healing period this is what you should do:

• Refer to the aftercare instructions provided by the technician. If you are not provided with aftercare here is a great link:

 http://www.safepiercing.org/piercing/oral-aftercare/

• Don’t smoke or use tobacco based products
• Avoid alcohol, spicy foods and hard or sticky foods
• Wash hands before touching site
• Make sure barbells are on tight to avoid aspirating jewelry
•  Brush your teeth and rinse with an alcohol free antiseptic mouthwash after every meal, consult your dentist for a mouthwash
• Brush or use a Q-Tip dipped in mouthwash to clean around the piercing
• After swelling goes down get a smaller barbell, this will less likely get in the way and make it more difficult to chew on.
• Once healed you should remove the jewelry to protect your teeth when you eat or sleep. Some parlors sell plugs that you can put in to keep the site from closing and allow you to leave the jewelry out for long periods of time.

In the event, regardless of your efforts to keep the piercing site clean, should you experience any of the following, contact a health professional immediately:

• Yellow or green discharge from the piercing
• Scarring or thickened tissue that builds up and darkens around the site
• Increased redness, pain and tenderness or swelling at the piercing site
•  A pimple like abscess on the piercing site
• Bleeding or tearing after the initial healing of the piercing
• A low grade fever that is persistent in the days following piercing
• Discoloration around the site( green, grey, purple or black) is a sign of serious infection
• Foul odors or tastes

Our goal is to help patients understand risks and be informed before and after a piercing. WE care about your oral health and hope to help you prevent any complications!

References:

Academy of General Dentistry (AGD):

 http://www.knowyourteeth.com/infobites/abc/article/?abc=O&iid=321&aid=1297

http://www.ada.org/sections/scienceAndResearch/pdfs/patient_04.pdf

http://wwwnc.cdc.gov/eid/article/8/8/01-0458_article.htm

http://www.safepiercing.org/piercing/oral-aftercare/

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Preventing the Spread of Tooth Decay

Taking note of the below mentioned facts would help in preventing the spread of infection responsible for causing decays.

      Tooth decay can actually be passed on by pregnant women to their newborns. Research has it that cases of tooth decay which develop in babies could actually have been inherited from their mothers. Women who have not been visiting dentists on a regular basis 4 to 6 months prior to getting pregnant are more likely at risk of transmitting dental infections. If you are planning for a baby make sure you get your routine tooth-work done on time.

      Do not share toothbrushes and oral rinse cups with your kids. Unknowingly, you might be transmitting germs that would cause tooth decay.

      Don’t drink from the same cup or glass as your child. This would aid transfer of infection causing bacteria.

Remember, contagious infections would spread with slightest hint of physical contact. Therefore, you need to adhere to stringent hygiene practices for staying away from them. Apart from this tooth decay can be effectively be controlled with the help of the following measures.

      Brush daily. Ideally, you should brush every time you eat or drink something.

      Always rinse your mouth with fluoridated cleansers or mouthwashes.

      Consider using dental sealants which can plug the grooves which are more likely to develop cavities. Frequent replacements aren’t required as well.

      Avoid foods which are highly sweetened. Sweet concoctions tend to settle at the base of your tooth encouraging tooth decay causing bacteria Visit to your dentist on a regular basis. Most often, your teeth would require fluoridated or anti-bacterial treatments. Do not ignore toothaches or other problems related to dental hygiene. Seek medical help immediately.

Averting tooth decay is all about sticking to healthy practices and understanding the precautionary measures which need to be followed. However, in certain cases, chronic tooth decay could actually prove to be manifestations of other illnesses.

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