Articles From Dr. Rauk's Personal Library

All of the content below was written by Dr. Rauk and have been featured in our local newspaper!

Canker Sores (Aphthous Ulcers)

Canker sores are small oral ulcers in the lining of the mouth that are frequently painful and sensitive. Canker sores are very common.  At any one time about 20% of the population has canker sores. 

What Are Symptoms of Canker Sores (Aphthous Ulcers)?
Canker sores are usually found on the inside lining of the lips and cheeks or at the base of the gums.  The ulcers begin as small oval or round reddish swellings that burst in a day.   Generally, the sores heal within two weeks. 

The frequency of canker sores varies considerably.  Some people have only one or two episodes a year, while others may have a continuous series of canker sores. 

What Are the Causes of Canker Sores?

The cause of canker sores is not well understood.  More than one cause is likely, even for one individual.  Canker sores do not usually appear to be caused by viruses or bacteria. The sores may be an allergic reaction to certain foods.  There is also research suggesting that canker sores may be caused by a faulty immune response that uses the body’s defense against disease to attack normal cells of the mouth. Emotional stress and local trauma to the mouth from braces or hard toothbrushes or hot foods can lead to canker sores. Some studies have shown a connection with toothpaste containing sodium lauryl sulfate for some individuals. Female hormones also apparently play a role in causing canker sores.  Many women experience aphthous ulcers only during certain phases of their menstrual cycle.  Additionally, most women see improvement or remission of their canker sores during pregnancy.

Are Canker Sores the Same as Fever Blisters?

No, canker sores are generally inside the mouth and are not contagious.  Fever blisters mostly occur on the lips and outside of the mouth and are very contagious.  Fever blisters, or cold sores, are infections caused by the herpes simplex virus (HSV).

What is the Treatment for Canker Sores?

Canker sores typically resolve without specific treatments.  However, measures can be taken to alleviate the pain and discomfort and to hasten their course.  Therapies include topical medications placed directly on the sores, mouthwashes, and oral medications. 

Topical medications includes numbing ointments, such as benzocaine (Oragel), which is available over-the-counter. The ointment should be applied several times daily directly to the sore to reduce irritation from eating or brushing.  Non-numbering medications include Glyoxide and Rincinol.   

Anti-inflammatory (steroid) gels may also be applied to reduce the inflammation.  This prescription medication is usually fluocinonide (lidex) or triamcinoline. 

There are also several mouthwash solutions one can use. One type of mouthwash is Benadryl Allergy liquid to provide temporary pain relief.  This is available over-the-counter.  Your doctor or dentist could also prescribe a mouthwash containing an anti-inflammatory steroid or tetracycline antibiotic to reduce the unpleasant symptoms of canker sores. 

Laser Treatment of Canker Sores.

In our office I have found a diode laser is effective in stopping the pain of canker sores.  During the treatment procedure, patients only feel a slight warmth as the laser beam focuses on the canker sore.  Within a day the soreness is greatly relieved.  This painless treatment can be especially helpful for people with multiple recurrent aphthous ulcers.  10% of the population suffers from this chronic recurring form of multiple canker sores.

What Research is Being Done for Canker Sores?

Researchers are trying to identify the malfunctions in patients’ immune systems that make them susceptible to repeated occurrences of  canker sores .  Blood analysis of people with and without canker sores have shown differences in their immune functions.  How these differences affect the development of canker sores is not yet known. 

Testing is being done on a new medication called amlexanue.  That is an anti-inflammatory and an anti-allergic drug.  It has shown promise in treatment of symptoms and healing of canker sores.

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Dental X-Rays and Digital Technology

Dental radiographs, or x-rays, are an important part of a thorough dental examination.  A full set of x-rays, including a panoramic x-ray that circles the head, are usually needed for patients who are new to a dental practice.  Two to four follow-up x-rays called “bitewings” are then taken every 12-18 months, depending on each individual patient’s needs.

The most common questions patients have concerning dental x-rays deal with (1) Why are they needed? (2) What is the amount of radiation exposure? (3) Are x-rays safe during pregnancy? and (4) What are the benefits of the newer digital x-ray technology?

Dental x-rays are important for many reasons. They can expose hidden dental decay; reveal a dental abscess, cyst or tumor; show impacted teeth; and also help determine the condition of fillings, crowns, bridges and past root canal treatment.  Dental x-rays will reveal bone loss from periodontal (gum) disease, locate tarter buildup, find foreign bodies within the gum or bone and see if there is enough bone for the placement of dental implants.  These are only some of the reasons dentists rely on dental x-rays. 

Some people are concerned about their exposure to dental x-rays. This is very understandable in light of the relatively higher radiation needed for some medical x-rays. Dentists try to minimize the amount of radiation any patient receives at the dental office. That is why we used high speed film in the past, and now digital x-rays sensors use even less radiation.  To give an idea of how much less x-ray dosage is needed for dental x-rays than for medical x-rays, dental x-rays requires 56,000 times less radiation than an upper GI medical series of x-rays, 800 times less radiation than a chest x-ray, and 40 times less than the typical background radiation we each receive every day from the sun and other sources.  Dental x-rays are safe and effective even during pregnancy, although we choose to only take x-rays for emergency dental needs during pregnancy. 

One new dental technology involving dental x-rays is digital x-ray sensors. They offer the advantage of further reduction in radiation needed over using film, no need for using and disposing of processing chemicals, and production of an instantaneous image.  These instantaneous digitized images can be magnified and adjusted for contrast which helps in diagnosing dental pathology.  The computer screen image is very helpful in allowing patients to see and then discuss the problems and the recommended restoration procedures with their dentist.  Because it helps the patients to clearly understand their dental health issues, the patient and dentist can work together to determine the best treatment options.

As discussed here, dental x-rays are an important tool in the diagnosis and treatment of dental problems. They do not; however replace the need for a visual examination of the head, neck, TMJ, and oral cavity.  It is only with a combination of both the x-ray and visual examination that dentists can best treat their patients.

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Denture Stability

Denture stability is a common problem for millions of Americans.  They often are unable to eat what they want due to dentures that shift, tilt and wander.  Many denture wearers resort to using denture adhesives.  These adhesives can have a taste and feel that is unpleasant.  There can also be trouble with speaking clearly and smiling confidently.

Fortunately there have been advances recently that make it possible for patients to visit their dentist in the morning and eat with their secure denture that same day.  In about two hours a partial or full denture can be improved so it is held firmly in place. This is accomplished with mini-implants to which the patient’s denture is attached. 

Dental implant therapy has been one of the most significant advances in dentistry in the past 25 years.  Tens of thousands of grateful patients bear witness to the benefits derived from the opportunity to obtain a replacement for lost teeth that restores their smiles and confidence.  Several different types of implants and restorations are available.  The choice depends upon the amount of bone available, the patient’s general health and restoration preference.  

The computer and medical worlds are both working hard to develop smaller and smaller components. In similar fashion, a small version of the dental implant has been successfully utilized in selected cases.  These mini implants (1.8mm diameter) enable your dentist to broaden the spectrum of patients that can be treated.  These implants were developed in order to provide greater denture stability for those patients who cannot withstand the rigors of conventional implant surgery, do not have enough bone to allow for full-sized implants to be placed, or are in on-going therapy from one prosthetic system to another. 

What Are Mini Implants?

Mini implants consist of a miniature titanium implant that acts like the root of your tooth and retaining fixture that is incorporated into the base of your denture.  The head of the implant is shaped like a ball, and the retaining fixture acts like a socket that contains a rubber O-ring.  The O-ring snaps over the ball when the denture is seated and holds the denture at a predetermined level of force.  When seated, the denture gently rests on the gum tissue. The implant fixtures allow for micro-mobility while withstanding natural lifting forces. 

How Are Mini Implants Placed? 

Placement of the implants is accomplished quickly and easily in a process performed in the dentist’s office, with local anesthesia or light sedation to help make you more comfortable.  Using a precise controlled, minimally invasive surgical technique, Mini Implants are placed in the jawbone.  The heads of the implants protrude from the gum tissue and provide a strong, solid foundation for securing your dentures. It is a one-step procedure that involves minimally invasive surgery but can provide significant improvement for denture patient’s quality of life.

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Diabetes and Periodontal Disease

Higher Risk

If you have diabetes, you know the disease can harm your eyes, nerves, kidneys, heart and other important systems in the body.  Did you know it can also cause problems in your mouth?  People with diabetes have a higher than normal risk of periodontal diseases.

Periodontal diseases are infections of the gum and bone that hold the teeth in place.  In advanced stages, they lead to painful chewing problems and even tooth loss.  Like any infection, gum disease can make it hard to keep your blood sugar under control. 

What is the Link Between Diabetes and Periodontal Disease? 

Diabetic Control.  Like other complications of diabetes, gum disease is linked to diabetic control.  People with poor blood sugar control get gum disease more often and more severely, and they lose more teeth than do persons with good control.  In fact, people whose diabetes is well controlled have no more periodontal disease than persons without diabetes.  Children with IDDM (insulin-dependent diabetes mellitus) are also at risk for gum problems.  Good diabetic control is the best protection against periodontal disease.

Studies show that controlling blood sugar levels lowers the risk of some complications of diabetes, such as eye and heart disease and nerve damage.  Scientists believe many complications, including gum disease, can be prevented with good diabetic control. 

Blood Vessel Changes.  Thickening of blood vessels is a complication of diabetes that may increase risk for gum disease.  Blood vessels deliver oxygen and nourishment to body tissues, including the mouth, and carry away the tissues’ waste products.  Diabetes causes blood vessels to thicken, which slows the flow of nutrients and the removal of harmful wastes.  This can weaken the resistance of gum and bone tissue to infection. 

Bacteria.  Many kinds of bacteria thrive on sugars, including glucose – the sugar linked to diabetes.  When diabetes is poorly controlled, high glucose levels in mouth fluids may help germs grow and set the stage for gum disease. 

Smoking.  The harmful effects of smoking, particularly heart disease and cancer, are well known.  Studies show that smoking also increases the chances of developing gum disease.  In fact, smokers are five times more likely than nonsmokers to have gum disease.  For smokers with diabetes, the risk is even greater.  If you are a smoker with diabetes, age 45 or older, you are 20 times more likely than a person without these risk factors to get severe gum disease. 

How Does Periodontal Disease Develop? 

Gingivitis. Inadequate brushing and flossing may allow dental plaque – a sticky film of germs – to build up on teeth.  Some of these germs cause gum disease.  The gums can become red and swollen and may bleed during tooth brushing or flossing.  This is called gingivitis, the first stage of periodontal disease. 

Gingivitis can usually be reversed with daily brushing and flossing and regular cleanings by the dentist.  If it is not stopped, gingivitis could lead to a more serious type of gum disease called periodontitis.

Periodontitis.  Periodontitis is an infection of the tissues that hold the teeth in place.   In periodontitis, plaque builds and hardens under the gums.  The gums pull away from the teeth, forming “pockets” of infection.  The infection leads to loss of the bone that holds the tooth in its socket and might lead to tooth loss. 

There are often no warning signs of early periodontitis.  Pain, abscess, and loosening of the teeth do not occur until the disease is advanced.  Since periodontitis affects more than just the gums, it cannot be controlled with regular brushing and flossing.

How is Periodontal Disease Treated?

Plaque Removal.  Treatment of periodontitis depends on how much damage the disease has caused.  In the early stages, the dentist or hygienist will use deep cleaning for removal of hardened plaque and infected tissue under the gum and to smooth the damaged root surfaces of teeth.  This allows the gum to re-attach to the teeth.  A special mouthrinse or an antibiotic might also be prescribed to help control the infection. 

Deep cleaning is successful only if the patient regularly brushes and flosses to keep the plaque from building up again and keeps the future recommended periodontal maintenance cleaning appointments. 

Periodontal Surgery.  Gum surgery is needed when periodontitis is very advanced and tissues that hold a tooth in place are destroyed.  The dentist or periodontist will clean out the infected area under the gum, then reshape or replace the damaged tooth-supporting tissues.  These treatments increase the chances of saving the tooth. 

In Summary, if you have Diabetes: 

•It is important for you to know how well your diabetes is controlled and to tell your dentist this information at each visit. 

•See your doctor before scheduling treatment for periodontal disease.  Ask your doctor to talk to the dentist or periodontist about your overall medical condition before treatment begins.

•You may need to change your meal schedule and the timing and dosage of your insulin if oral surgery is planned. 

•Postpone non-emergency dental procedures if your blood sugar is not in good control. However, acute infections, such as abscesses, should be treated right away. 

For the person with controlled diabetes, periodontal or oral surgery can usually be done in the dentist’s office.  Because of diabetes, healing may take more time, but with good medical and dental care, problems after surgery are no more likely than for someone without diabetes. 

Once the periodontal infection is successfully treated, it is then often easier to control blood sugar levels.  Having healthy gums in combination with eating properly is instrumental in this control of blood sugar levels.  And the best way to eat a nutritious diet is by keeping your teeth and their supporting gums and bone healthy.

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Eat for Good Oral Health

In recent years studies have helped to clarify our understanding of the causes of tooth decay.  Originally sugar was the only food that was blamed.  Now we know there are many other factors at play.  Taking good care of our teeth involves not only maintaining good oral hygiene, but also eating the right foods in the right combinations. 

Know Your Mouth

To understand the causes of tooth decay, one needs to keep in mind that we have the following in our mouths: 

  • teeth that are vulnerable to attack by acids;
  • saliva that circulates in the mouth and is capable of rinsing acid from the teeth;
  • Micro-organisms that ferment carbohydrates to form acids. 

Throughout the day we must try to limit the amount of time our teeth are exposed to the acid produced by the bacteria in our mouths.

Good Dental Care

Thorough oral hygiene is still the most important factor in keeping teeth and gums clean and healthy.  Therefore, before we go into what we should and should not eat, examine whether these guidelines are part of your routine.

  • Brush your teeth for 2 minutes twice a day with fluoride toothpaste.
  • Clean between your teeth with dental floss at least once a day.  Floss more frequently if food collects between your teeth. 
  • Consider using fluoride mouthwashes and gum containing xylitol to help remineralize the teeth after eating acidic foods and drinks. 
  • Do not eat after cleaning your teeth at bedtime.  Salivary flow decreases as we sleep. 

The Right Foods

Foods that help muscles and bones also help teeth and gums. Dairy contributes vitamin D.  Milk and cheese can also raise the pH values in the mouth, and so reduce tooth exposure to acid.  Breads and cereals are rich in vitamin B while fruits and vegetables contain vitamin C, both of which contribute to healthy gum tissue.  Foods high in fiber also help to increase the flow of saliva.  Saliva helps to buffer the acidic pH in the mouth that leads to dental caries. 

When it comes to “food” for the micro-organisms that produce acid, sugar is not the only culprit.  Scientists now know that all fermentable carbohydrates like bread, rice, pretzels, crackers, dried fruits and fruit juices should be taken into consideration.  Bacteria ferments carbohydrates to form acids which cause tooth decay. 

Carbohydrates should form part of any healthy diet, so the aim should not be to eliminate these foods.  Instead, carbohydrates should be combines with neutral protein foods whenever possible.  Protein foods include, fish, chicken, meats and eggs. 

Another good idea is to finish a carbohydrate-rich meal or snack with a small piece of cheese or sugar-free gum containing xylitol, if brushing is not feasible. 

Frequency of Eating

Time is of the essence when it comes to oral health.  The more time bacteria has to metabolize fermentable carbohydrates, produce acids and cause a drop in salivary pH, the greater the negative effect on your teeth. 

To reduce the time teeth are exposed to these factors, it is important to:

  • avoid continuous snacking and sipping of drinks;
  • allow time between meals for saliva to neutralize acids in the mouth; and
  • decrease intake of acidic foods and drinks.

One Final Thought

Would you put 13 teaspoons of sugar in your tea or coffee?  That is how much sugar is in a can of soda

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Enhancing Dental Treatment with Lasers

Laser dentistry incorporates state-of-the-art technology in various aspects of dental health practice, diagnosis, and treatment. The potential for laser dentistry to improve dental treatment comes from the precision with which lasers can diagnose or treat an area of focus.  The application of lasers in dentistry opens the door for dentists to perform a wide variety of dental procedures with advancedtechnology.

Caries Diagnosis with Lasers

The application of lasers in dentistry that will be discussed in this article is diagnosis of caries.  One of the most important dental treatments we do for our patients is identification and treatment of cavities.  Since even the smallest area of decay can threaten the integrity of a tooth, finding and filling cavities is the key to preventing further tooth deterioration.  Historically, that is why dental explorers have been part of a typical exam.  However, it has been found that this method of cavity detection is only 50-75% successful.  Cavities often hide along tissue lines, or inside biting occlusal surfaces.  Furthermore, these mechanical exploratory methods are limited to finding those cavities that are equal to or larger than the explorer tip.  This is where laser/diagnostic instruments are beneficial. 

Laser Reflection Technology

Laser diagnostic technology uses a laser diode to inspect your teeth, comparing reflection wavelength against a known healthy baseline wavelength to uncover decay.  This is done by first measuring a benchmark reading with the laser on a healthy enamel tooth surface.  Then we examine suspect areas in the mouth with the laser.  As the laser pulses into grooves, fissures and cracks, it reflects fluorescent light of a specific wavelength.  This light is measured by receptors, converted to an acoustic signal, and evaluated electronically on a digital scale from 1 to 100. Anytime the laser encounters a surface that is decayed, it stimulates emission of fluorescent light of a different wavelength. A reading of 10-20 indicates some enamel softening, pointing to a potential problem area that merits close monitoring. A reading of 21-100 indicates a definite area of decay requiring treatment. 

Early Detection, Precise Correction

Using laser technology allows us to catch more areas of decay sooner and with more precision.  It is completely comfortable.  Not only can it help prevent tooth decay getting deeper, but diagnosing decay early means fillings are smaller and shallower, preserving more of the tooth.  This allows us to use minimally invasive filling procedures.  Finally we are able to monitor these suspicious areas with minimal x-rays. 

Our next column will discuss advances in x-ray technology.  Digital radiography makes it possible to take x-rays with less radiation than with traditional dental film.

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Fosamax and Osteonecrosis – Is There A Link?

Since 2003 there have been several reports in medical journals regarding a link between various bisphosphonates like Fosamax, Actonel and Boniva, and a condition called osteonecrosis of the jaw.  This has led some to ask if these medications for the treatment of osteonecrosis are safe.

The consensus is that these medications (Fosamax, Actonel, and Boniva) are safe for the majority of people who take them.  But there is a small risk of this rare jaw disorder in certain people.  The exact cause of osteonecrosis developing in some people is not clear at this time.

Osteonecrosis of the jaw bone is a condition marked by pain, swelling, infection and exposed bone.  Osteonecrosis of the jaw is diagnosed by both seeing bare bone and using dental radiographs (x-rays).  The majority of cases of osteonecrosis of the jaw involved patients with cancer who are receiving chemotherapy and have been given intravenous bisphosphonates to treat cancer that has spread (metastasized) to the bone. 

However, a number of cases of osteonecrosis of the jaw have been reported in people taking oral bisphosphonates such as Fosamax, for osteoporosis.  These have been primarily associated with active dental disease or recent oral surgery procedures such as tooth extractions. 

With this correlation involving active dental disease, oral health should be a focus for anyone with osteoporosis who is considering bisphosphonate treatment. These preventive steps should be followed: 

  • If you are being treated with bisphosphonates or will begin bisphosphonate treatment, inform your dentist about the bisphosphonate treatment.
  • Good oral hygiene along with regular dental care to prevent infections or periodontal (gum) disease is the best way to lower risk.
  • Removable dentures should be examined for their potential to induce soft-tissue injury, especially tissue overlying bone, and adjusted if required.
  • Routine dental cleanings should be performed carefully, with emphasis on avoiding soft-tissue injuries.
  • Endodontic (root canal) therapy is preferable to extractions when possible.
  • It may be necessary to carry out removal of the tooth crown with subsequent root canal therapy on retained roots to avoid the need for tooth extraction and the potential development of osteonecrosis.
  • Elective jaw surgery, including dental implants, would be avoided during intravenous bisphosphonate therapy.
  • Start a course of antibiotics prior to essential dental surgery.

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There's More to Healthy Teeth Than Just What's on the Surface

Most people are surprised when their dentist tells them that they have been diagnosed with gum disease.  The reason is most forms of gum disease are painless until the condition becomes advanced.  If gum disease is treated early in the disease progresssion, a better final result and prognosis is possible.

Gum disease is caused by plaque, a bacterial film that continuously forms around the teeth and gums.  Minerals from saliva can then change the soft plaque to a hardened form called calculus.  Gum disease results as the gums become inflamed from these irritants, plaque and calculus.  Gum disease is responsible for red, swollen, and bleeding gums, bad breath, loose teeth, and eventual tooth loss.

The treatment for gum disease can involve cleaning the calculus and plaque out from under the gum line, antibiotics and sometimes gum surgery.  Early gum disease is treated with a procedure called scaling and root planing.  The dentist or dental hygienist uses thin curettes and gently removes the plaque and tartar (calculus) under the gum-line.  This procedure may require local anesthesia to numb the area prior to treatment.  Moderate to advanced gum disease is also first treated with this scaling and root planing.  After the gums heal, an evaluation is made if gum surgery would be beneficial.  With conservative treatment involving local antibiotic treatment placed around the teeth, surgery can often be avoided.  We are using such a treatment called Atridox.  It reverses some of the damage caused by chronic gum disease. 

After gum disease treatment the teeth can be sensitive on the tooth root surface.  Dentists can treat this sensitivity with fluoride in the office and patients can also use desensitizing toothpaste or home fluoride gel.  It is important for patients who have had gum disease to get on a regular dental maintenance schedule.  By seeing the dentist or dental hygienist every 3, 4 or 6 months depending on the patients need, the gum health can be improved and maintained.

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You Can Prevent More Than Cavities

As more and more health studies show correlations between dental health and our bodies’ general systemic health, more magazines are reporting these findings.  Recent articles in Readers Digest, AARP, and Consumer Reports are getting the word out:  to be as healthy as we can be, it is important to have healthy teeth and gums (periodontal health). 

“Watch your mouth,” the saying goes, and science is turning up ever more reasons to heed that advice literally. Preventing gum disease (periodontitis), the leadings cause of adult tooth loss, is gaining new urgency as research shows that gum disease can contribute to illnesses such as diabetes, heart disease, stroke, and pneumonia.

The culprit, scientists believe, is a spillover of bacteria and inflammatory agents from the mouth into the bloodstream, which bustles them off to the rest of the body.  Related problems include these:

Diabetes.  Gum disease and diabetes behave with yin-yang synergy.  Because diabetes can affect circulation, it can restrict blood flow to the gums.  That along with suppressed immunity in patients with diabetes can create the perfect setup for periodontitis. Recent research has suggested that treating periodontal disease can improve blood-sugar control.  Some major insurance companies already offer patients with diabetes extended coverage for  periodontal treatments. 

Heart disease.  Having gum disease can increase your risk of heart disease, a study found.  Other data shows that adults with the highest levels of some oral bacteria have thicker carotid arteries, a predictor of heart attack and stroke; and people who suffer from angina and heart attacks have higher levels of certain oral bacteria. Plus, oral bacteria provoke inflammation, which may increase levels of white blood cells and C-reactive protein.  That protein, found in the blood, has been linked to heart disease.  A March 2007 New England Journal of Medicine study of 120 patients found that aggressive treatment of periodontal disease was linked to improved circulation.  In a recent  trial, periodontal therapy reduced patients; C-reactive protein levels. 

Pneumonia.  Poor oral hygiene has been shown to contribute to fatal pneumonias in hospital patients and nursing-home residents.  In those settings, lax oral hygiene can foster a buildup of bacteria capable of causing respiratory infection.  A patient placed on a  respirator, for instance, is susceptible to breathing those bacteria, causing pneumonia.  Institutions can avoid such infections, by practicing stringent oral hygiene, including swabbing patients’ mouths with plaque-inhibiting rinses containing chlorhexidine (Peridex, PerioGard). 

In summary, taking care of your mouth and teeth can help stave off periodontal disease and possibly other serious illnesses. 

ABCs of Oral Care

  • Eat a diet high in calcium and vitamins C and D.  Avoid sugary foods:  When oral bacteria ferment sugar, they create tooth-eroding acids. 
  • Brush your teeth twice a day and floss daily to remove plaque and bacteria.
  • See your dentist twice yearly for checkups (including an oral cancer exam).  If you smoke or have periodontal disease or diabetes, you may need cleaning and checkups every three to four months. 

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