By Cesar Acosta, DMD, Family Dentistry
November 12, 2021
Category: Oral Health
Tags: gum disease  
TroublingDataSaysSmokingMarijuanaCouldWorsenGumDisease

It seems with each new election cycle another U.S. state legalizes marijuana use. It remains a flashpoint issue that intersects politics, law and morality, but there's another aspect that should also be considered—the health ramifications of using marijuana.

From an oral health perspective, it doesn't look good. According to one study published in the Journal of Periodontology a few years ago, there may be a troubling connection between marijuana use and periodontal (gum) disease.

Gum disease is a common bacterial infection triggered by dental plaque, a thin biofilm on tooth surfaces. As the infection advances, the gum tissues become more inflamed and lose their attachment to teeth. This often results in widening gaps or "pockets" between the teeth and gums filled with infection. The deeper a periodontal pocket, the greater the concern for a tooth's health and survivability.

According to the study, researchers with Columbia University's College of Dental Medicine reviewed data collected from nearly 2,000 adults, a quarter of which used marijuana at least once a month. They found the marijuana users had about 30 individual pocket sites on average around their teeth with a depth of at least 4 millimeters. Non-users, by contrast, only averaged about 22 sites.

The users also had higher incidences of even deeper pockets in contrast to non-users. The former group averaged nearly 25 sites greater than 6 millimeters in depth; non-users, just over 19. Across the data, marijuana users appeared to fare worse with the effects of gum disease than those who didn't use.

As concerning as these findings appear, we can't say that marijuana use singlehandedly causes gum disease. The condition has several contributing risk factors: diet, genetics, and, most important of all, how well a person manages daily plaque removal, the main driver for gum disease, through brushing and flossing.

Still, the data so far seems to indicate using marijuana can make gum disease worse. Further studies will be needed to fully test this hypothesis. In the meantime, anyone using marijuana should consider the possible consequences to their oral health.

If you would like more information on marijuana and oral health, please contact us or schedule an appointment for a consultation.

By Cesar Acosta, DMD, Family Dentistry
November 02, 2021
Category: Oral Health
Tags: tooth decay  
TheresMoreWeCanDoAboutToothDecayBesidesDrillandFill

Until recently, the standard treatment for tooth decay remained essentially the same for nearly a century: Remove any decayed structure, then prepare and fill the cavity. But that singular protocol has begun to change recently.

Although "drilling and filling" saves teeth, it doesn't fully address the causes of decay. In response, dentists have broadened their approach to the disease—the focus now is on an individual patient's particular set of risk factors for decay and how to reduce those.

At the heart of this new approach is a better understanding of oral bacteria, the true cause of decay. Bacteria produce acid, which can erode tooth enamel and create a gateway into the tooth for decay to advance. We therefore want to lower those risk factors that may lead to bacterial growth and elevated acidity.

One of our major objectives in this newer approach is to reduce plaque, a thin film of food particles used by bacteria for food and habitation. Removing plaque, principally through better oral hygiene, in turn reduces decay-causing bacteria.

Plaque isn't the only mechanism for bacterial growth and acidity. Appliances like dentures or retainers accumulate bacteria if not regularly cleaned. Reduced saliva flow, often due to certain medications or smoking, limits this fluid's ability to buffer acid and acid reflux or acidic beverages like sodas, sports or energy drinks can disrupt the mouth's normal pH and increase the risk for enamel erosion.

Our aim, then, is to develop a long-term strategy based on the patient's individual set of oral disease risk factors. To determine those, we'll need to examine their medical history (including family), current health status and lifestyle habits. From there, we can create a specific plan targeting the identified risk factors for decay.

Some of the elements of such a strategy might include:

  • Daily brushing and flossing, along with regular dental cleanings;
  • Fluoride dental products or treatments to strengthen enamel;
  • Changes in diet and excess snacking, and ceasing from any tobacco use;
  • Cleaning and maintaining appliances, as well as monitoring past dental work.

Improving the mouth environment by limiting the presence of oral bacteria and acid can reduce the occurrence of tooth decay and the extent of treatment that might be needed. It's a more nuanced approach that can improve dental health.

If you would like more information on tooth decay prevention and treatment, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Decay: How to Assess Your Risk.”

By Cesar Acosta, DMD, Family Dentistry
October 23, 2021
Category: Oral Health
AfteraDevastatingInjuryPromptActionSavedSingerCarlyPearcesSmile

Performing for an awards show is a quite a feather in an entertainer's cap. So, up-and-coming country music star Carly Pearce was obviously excited when she gained a slot on last November's Country Music Awards. But an accident a couple of weeks before the event almost derailed her opportunity when she fell and knocked out two of her front teeth.

Fortunately, Pearce took quick action and, thanks to a skilled dental and medical team, was able to put her mouth back together before the show. Those watching her perform her hit single, “I Hope You're Happy Now,” as she smiled broadly would never have known otherwise about her traumatic emergency if she hadn't spilled the beans.

Orofacial injuries can happen to anyone, not just entertainers. You or someone you love could face such an injury from a motor vehicle accident, hard sports contact or, like Pearce, a simple slip and fall. But if you also act quickly like Pearce, you may be able to minimize the injury's long-term impact on dental health and appearance.

Here are some guidelines if you suffer a dental injury:

Collect any tooth fragments. Dental injuries can result in parts of teeth—or even a whole tooth—coming out of the mouth. It may be possible, though, to use those fragments to repair the tooth. Try to retrieve and save what you can, and after rinsing off any debris with cold water, place the fragments in a container with milk.

Re-insert a knocked-out tooth. You can often save a knocked-out tooth by putting it back in its socket as soon as possible. After cleaning off any debris, hold the tooth by its crown (never the root) and place it back in the empty socket. Don't fret over getting it in perfectly—your dentist will assist its placement later. Place a piece of clean cloth or cotton over the tooth and have the injured person bite down gently but firmly to hold it in place.

See the dentist ASAP. You should immediately see a dentist if any tooth structure has been damaged, or if a tooth is loose or has been moved out of place. If you're not sure, call your dentist to see if you should come on in or if you can wait. If a dentist is not available, go immediately to an emergency room or clinic. With many dental injuries, the longer you wait, the more likely the teeth involved won't survive long-term.

A dental injury could happen in a flash, with consequences that last a lifetime. But if, like Carly Pearce, you take prompt action and obtain necessary dental care, you could save an injured tooth—and the smile that goes with it.

If you would like more information about dental injuries, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “The Field-Side Guide to Dental Injuries.”

By Cesar Acosta, DMD, Family Dentistry
October 13, 2021
Category: Oral Health
Tags: osteoporosis  
OsteoporosisCanCauseComplicationsForSomeTypesofDentalWork

October 20th is World Osteoporosis Day, putting the spotlight on this degenerative bone condition and the impact it has on millions of people. Not only does it significantly increase the risk of potentially life-threatening fractures, but it can also indirectly affect dental health.

This connection arises from the use of certain treatment drugs that ultimately could lead to complications following some forms of dental work. These particular drugs, mainly bisphosphonates like Fosamax™ and RANKL inhibitors like Prolia™, destroy bone cells called osteoclasts, whose function is to clear away worn out regular bone cells (osteoblasts). With fewer osteoclasts targeting them, more older osteoblast cells survive longer.

In the short-term, a longer life for these older cells helps bones afflicted by osteoporosis to retain volume and density, and are thus less likely to fracture. Long-term, however, the surviving osteoblasts are less elastic and more brittle than newly formed cells.

In the end, these longer living cells could eventually weaken the bone. In rare situations, this can result in parts of the bone actually dying—a condition known as osteonecrosis. The bones of the body with the highest occurrences of osteonecrosis are the femur (the upper leg bone) and, of specific concern to dental care, the jawbone.

The effect of these medications on the jawbone actually has a name—drug-induced osteonecrosis of the jaw (DIONJ). Fortunately, there's only a 1% risk of it occurring if you're taking these drugs to manage osteoporosis. It's also not a concern for routine procedures like cleanings, fillings or crown placements. But DIONJ could lead to complications with more invasive dental work like tooth extraction, implant placement or periodontal surgery.

It's important, then, that your dentist knows if you're being treated for osteoporosis and the specific drugs you're taking. Depending on the medication, they may suggest, in coordination with your physician, that you take a "drug holiday"—go off of the drug for a set period of time—before a scheduled dental procedure to ease the risk and effects of osteonecrosis.

Because infection after dental work is one possible consequence of osteonecrosis, it's important that you practice thorough oral hygiene every day. Your dentist may also prescribe an antiseptic mouth rinse to include with your hygiene, as well as antibiotics.

You may also want to talk to your doctor about alternative treatments for osteoporosis that pose a lower risk for osteonecrosis. These can range from traditional Vitamin D and calcium supplements to emerging treatments that utilize hormones.

Osteoporosis can complicate dental work, but it doesn't have to prevent you from getting the procedures you need. Working with both your dentist and your physician, you can have the procedures you need to maintain your dental health.

If you would like more information about osteoporosis and dental care, please contact us or schedule a consultation.

By Cesar Acosta, DMD, Family Dentistry
October 03, 2021
Category: Oral Health
Tags: oral health  
AHealthyDietIsanImportantPartofYourDentalDiseasePreventionPlan

If you think brushing and flossing and regular dental visits are all you need to do to avoid dental disease, you're missing a key component in your prevention plan. What you eat could also help close the door on tooth decay or gum disease—or open it even wider if you're eating nutritionally deficient foods.

Let's look first at the latter scenario. Like us, the oral bacteria most responsible for dental disease also have to eat to survive and thrive. And, often like us, they have a favorite food—provide them ample amounts of that and they'll continue to multiply and raise your risk of disease.

That favorite bacterial food is simple carbohydrates, particularly refined sugar. A diet heavy in added sugar can increase oral bacteria, which in turn elevates your chances of a gum infection. Bacteria's main by-product, acid, may also increase. That's bad news for your teeth. At high levels, acid contact softens and erodes enamel, the precursor to tooth decay.

Obviously, then, a "tooth-friendly" diet should be low on sugar and other simple carbohydrates like refined breads, pasta or pastries. Soda, energy and sports drinks high in both sugar and acid should also be avoided or restricted to mealtimes. You should also be careful with how much fruit you're eating as their natural sugars can also feed bacteria.

A well-rounded diet, however, isn't simply about avoiding foods—you'll also want to include foods that help you build and maintain healthy teeth and gums. That includes:

  • Fiber-rich plant foods: Their fiber reduces the effects of any carbohydrates and they're packed with nutrients;
  • Whole grains: Whole grains don't promote decay as refined products do, and chewing them stimulates saliva flow for neutralizing acid;
  • Fresh fruits: Eaten in moderation, fruits can provide a bevy of vitamins and minerals. But avoid dried fruits as their sugars are more concentrated;
  • Dairy: Milk-based products, particularly cheese, contain nutrients like Vitamin D, calcium and phosphorus, which strengthen teeth against dental disease.

For the most part, a diet that promotes overall well-being will also provide optimum benefits for your dental health. Along with your dental hygiene efforts, eating the right foods can help protect your teeth and gums from both tooth decay and gum disease.

If you would like more information on how better nutrition can boost your dental health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Nutrition & Oral Health.”





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Cesar Acosta DMD, Family Dentistry

(209) 250-2560
1065 Colorado Avenue Ste 3 Turlock, CA 95380