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General Dentistry Frequently Asked Questions

Q. Why do you need to have regular dental care check-ups?

A. Regular check-ups are needed to monitor your overall dentistry health. In addition to checking for cavities, your dentist examines the health of your entire mouth and surrounding soft tissues, checking for pre-cancerous or cancerous lesions, oral sores, and gum disease.

Your oral health is connected with your general health. General dentistry check-ups can alert the dentist to other medical conditions that have symptoms in the mouth such as diabetes, nutritional deficiencies, and hormonal irregularities. Regular dental visits are vital to prevent tooth decay, gum disease, and other conditions affecting your mouth.

Q. What can you do to feel more relaxed during a dental appointment?

A. With the combination of modern anesthetics and new technology and techniques, many procedures only have minimal discomfort or are now entirely painless. Dental care providers want their patients to have maximum comfort and approach their treatments with a relaxed attitude.

There are a number of ways to increase relaxation:

• Tell the dental staff your concerns. Studies have shown that talking about your fears of possible discomfort actually reduces pain.
• Use visualization to picture yourself relaxed, or repeat messages that have a calming effect.
• Play your favorite music on a Walkman you bring with you (some dental offices are equipped with walkmans, too.)
• Arrange a signal with the dental staff, such as raising your hand, if you need a break or feel discomfort.

Some dental offices are now offering patients new options for stress-relief: hypnosis, self-hypnosis instructions, relaxation tapes, soft lighting, warm gel-filled eye masks, scented candles, and massaging pillows. These are helpful in reducing stress and anxiety in dental patients. Be sure to avoid the use of stimulants such as caffeine prior to your visit.

Q. Aromatherapy has a relaxing effect for many people. Is this effective for patients undergoing dental treatment?

A. Research studies conducted at Case Western Reserve University have noted that the use of aromatherapy has a significant positive effect on anxious dental patients. Two-thirds of the patients receiving aromatherapy were more calm and relaxed than those patients without exposure to the scented fragrance oils.

Dentists are concerned about your comfort. Ask your dental provider if aromatherapy is available in the office, or if you can bring your own for your dental visit. Essential fragrance oils are available in health food stores, spas, and some grocery and drug store outlets.

Q. Are dental patients who are considered at risk for bacterial infections advised to take antibiotic medication prior to their appointments?

A. Certain medical conditions, such as heart valve problems or a recent total joint replacement, are considered at risk for infection at the site of the cardiac abnormality or joint replacement. This infection results from bacteria from the mouth entering the bloodstream and working its way to these vulnerable areas.

Consequently, dental care procedures likely to result in bleeding from the gums or mucous membranes will require patients to take antibiotics prior to that procedure. Such procedures could include, but are not limited to, extractions, implant surgery, incision and drainage for oral infection, and professional teeth cleaning.

Guidelines have been established by the American Heart Association and the American Dental Association to provide dentists and physicians with information regarding appropriate regimens for antibiotic therapy. It also outlines those situations when antibiotic therapy is or is not indicated.

There also are other medical conditions warranting antibiotic therapy prior to dental procedures. Be sure to update your dentist regarding your medical history. Your dentist and/or physician will advise you of any special needs.

Q. Where can you receive dental services if you do not have the money to cover the related expense?

A. If you do not have eitherdental insurance or the money to pay for general dentistry visit, you should inquire about financial aid from various sources within your community.

You may need to make several calls, but the local dental society, the local public health department, or social service agencies may be able to direct you to sources of assistance. Also, check local hospitals, dental schools, and outreach clinics that may be able to provide dental services at a reduced fee.

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Your Mouth During Oral Cancer Treatment

Each year, many people are treated for oral cancer. Chemotherapy treatments for cancer and radiation treatment for head and neck cancer often cause oral complications. About half of chemotherapy patients experience oral complications, particularly those being treated for leukemia and those who receive bone marrow transplants.

These oral cancer complications significantly decrease quality of life and can lead to serious systemic problems, complications, septicemia, eating difficulty, nutritional deficiencies, and dehydration. The following are descriptions of oral problems that can occur with cancer treatment:

Infections of the oral cavity can be caused by the usual organisms found in the mouth or by opportunistic organisms not usually found in the mouth. These infections can lead to serious systemic infections. The risk is higher for individuals who have reduced numbers of circulating white blood cells (leukopenia).

Candidiasis is the overgrowth of candida albicans, a fungal organism that normally is found in the mouth.

Musositis is painful and causes problems with eating and speaking. Soft tissues are red, ulcerated, and inflamed. The oral cavity is susceptible to mucositis because of its high cell turnover.

Hemorrhage or bleeding of the oral cavity can occur when clotting factors are affected and during bone marrow suppression.

Xerostomia or dry mouth is associated with decreased, sticky, or thickened saliva. Dry soft tissues are more susceptible to pain, infection, and irritation. Dry mouth is associated with a high number of dental caries.

Altered taste or loss of taste is common and is related to the reduced saliva volume, as well as its altered consistency.

Developmental abnormalities such as altered craniofacial growth and dental/tooth deformities occur with cancer treatment during developmental periods.

Trismus, fibrosis, and scarring of the chewing muscles and temporomandibular joint (TMJ, the joint that moves the lower jaw) that were in the radiation field may make opening the mouth difficult and limited.

Osteoradionecrosis (soft tissue and bone necrosis) can be spontaneous or secondary to trauma, extractions, or dental prostheses. The radiated tissues have reduced blood vessels, decreased cells, and decreased oxygen that predisposes the tissues for years after the radiation therapy to this compromised state that makes oral surgical procedures risky. Therefore, prior to and post oral surgery, patients who have had head and neck radiation may require hyperbaric oxygen treatments and antibiotic therapy to prevent osteoradionecrosis.

Radiation dental caries is a term used for rapid tooth demineralization and severe cavities that occur with head and neck radiation, particularly when the parotid, submandibular, submental, or submaxillary salivary glands are in the radiation field.

Pain accompanies oral infection, mucositis, xerostomia, trismus, dental caries, osteoradionecrosis, candidiasis and dental caries.

To reduce risk for oral cancer complications, a dentist should perform a pretreatment oral examination, as well as necessary dental treatment before initiating chemotherapy or head and neck radiation. It is important that the dentist consult with the physician or oncologist before dental treatment because people who are about to undergo treatments for cancer may be immunosuppressed or thrombocytopenic (blood clotting disorder).

The goals of the dental examination and dental treatment are to eliminate existing or potential oral infection and potential for trauma. Infection, potential infection, and trauma can be associated with soft tissue lesions, decayed or broken teeth, dental implants with poor prognosis, periodontal disease, and poorly fitting full or partial dentures. The oral examination consists of hard and soft tissue examinations, periodontal assessment, and necessary radiographs. Since long-term effects of head and neck cancer radiation treatments will be harmful to the bone in the radiated area (field), patients who undergo head and neck radiation treatment should have teeth and implants with potential for future problems considered for extraction before the cancer treatment begins.

The patient's ability and interest in maintaining oral health, as well as the ability to comply with an oral cancer prevention routine, should be factors that are considered as the dentist develops and discusses dental treatment recommendations with the patient.

By Denise J. Fedele, DMD, MS