Effects of taking medications

Effects of taking medications for different diseases that cause xerostomia
By Dr. H. Kopel
We all need saliva to moisten and cleanse our mouths and digest food. Saliva also prevents infection by controlling bacteria and fungi in the mouth. If saliva flow is reduced or non existent then a condition called xerostomia results. Xerostomia or dry mouth may be caused by medications.

Dry mouth is a common side effect of many prescription and nonprescription drugs, including drugs used to treat depression, anxiety, pain, allergies, colds (antihistamines and decongestants), obesity, acne, epilepsy, hypertension (diuretics), diarrhea, nausea, psychotic disorders, urinary incontinence, asthma. Xerostomia can also result from certain muscle relaxants and sedatives.

When prescription medications are suspected of causing dry mouth symptoms the patient should return to their medical doctor for substitute medications or adjustment of dosage to current medication.

Here is a list of the top 15 prescribed drugs that are associated with xerostomia:
1. Hydrocodone and Acetaminaphen, narcotic
2. Lisinopril (Prinivil /Zestril), antihypertensive
3. Simvastin (Zocor), antiperlipidemic
4. Amlodipine (Norvasc), antihypertensive
5. Alprazolam (Xanax), anti-anxiety
6. Hydrochlorothiazide, diuretic
7. Omeprazole (Prilosec), anti-ulcer agent
8. Lipitor, antihyperlipidemic
9. Furosemide (Lasix), diuretic
10. Metoprolol (Lopressor), antihypertensive
11. Sertaline (Zoloft), antidepressant
12. Metoprolol (Toprol), antihypertensive
13. Zolpidem (Ambien), seadtive/hypnotic
14. Oxycodone and Acetaminophen, narcotic
15. Citalopram (Celexa), antidepressant

Blood Thinners

By Dr. O. Karnakova

One of the most common types of drugs that can cause abnormal bleeding are blood thinners.
These classification of drugs are used for treating patients who have a type of heart or blood vessel disease, poor blood flow to the brain, atrial fibrillation, heart valve surgery, or other congenital heart defects. Blood thinners decrease the risk of a stroke or heart attack by reducing the formation of blood.

There are two main types of blood thinners. Anticoagulants, such as warfarin (Coumadin) or heparin, work by increasing the length of time your body takes to form a blood clot. Antiplatelet drugs such as Aspirin or Plavix prevent platelets in your blood from clumping together to form a harmful clot.

Patients who are taking blood thinners need to fully understand the effects of these drugs. The medication interferes with the body's normal clotting mechanism to stop bleeding. This comes as a particular concern for dentists who need to perform procedures that cause bleeding. Some of the common dental procedures associated with bleeding include: tooth extractions, implants, scaling and root planing, periodontal gum surgery, and biopsies.

It is important for patient's to correctly fill out their medical history along with a list of all medications. Please inform your dentist if you are taking any blood thinners so any precautions can be made between you, the dentist, and physician. Depending on the type of procedure, INR level, or clotting risks, your physician may inform you to do the following: continue taking the medication; change the dosage or type of medication; discontinue the medication prior to treatment. Do not under any circumstances alter or discontinue your medication without consulting your physician and dentist.

Nutrition and Oral Health

Nutrition and Oral Health
by Dr. H. Kopel

Along with regular dental check ups and good oral hygiene, nutrition plays a very important role in the health of your teeth and gums. Below is a list of common vitamins and mineral found in a well balanced diet and the role they play in oral health. If a well balanced diet is not possible then consideration should be given to a daily vitamin supplement.

In addition to proper intake of nutrients and good oral hygiene the following can provide additional protection against tooth decay:

  1. Flouride: consult with your dental professional on proper administration
  2. Xylitol: naturally organic substitute for sugar or as a supplement
  3. Remin Pro: topical application contains both flouride and xylitol plus hydroxyapatite (calcium and phosphate) to strengthen the enamel

Calcium—Your teeth and jaw are mostly made out of calcium so consuming calcium on a regular basis helps keep your teeth enamel and jaw strong and healthy. Consuming too little of calcium can put you at risk of gum disease and tooth decay.
Sources of Calcium: Milk, yogurt, cheese, beans and kale

Iron—Consuming too little of iron can cause tongue inflammation or mouth sores. The main role of iron is to transport oxygen throughout your body so a lack of iron can also contribute to infections and bacteria build up in the mouth due to lack of oxygen flow in your body.
Sources of Iron: Liver and red meat

Vitamin A—Vitamin A helps maintain a healthy saliva flow that washes away bacteria and other harmful substances from your mouth. It also helps to keep the tissues in your mouth healthy.
Sources of Vitamin A: Beef liver, sweet potatoes, melon and spinach

Vitamin B3—Vitamin B3 helps your body convert food into energy and helps your nervous system function. Consuming too little of Vitamin B3 can affect your oral health by causing bad breath and mouth sores.
Sources of Vitamin B3: Chicken and fish

Zinc—Zinc helps to prevent the growth of bacteria and the build-up of plaque along your gum line.
Sources of Zinc: Wheat, cereal, wild rice, cheese, and beef

Vitamin B12 & B2—Consuming Vitamin B12 and B2 can reduce your risk of developing canker sores, which is a painful open sore that develops in your mouth.
Sources of Vitamin B12: Pasta, bagels, spinach and almonds
Sources of Vitamin B2: Red meat, chicken, liver, pork, fish, milk, yogurt, and cheese

Vitamin C—Vitamin C plays an important role in maintaining health teeth and preventing gingivitis. A lack of Vitamin C can cause your gums to bleed and loose teeth.
Sources of Vitamin C: Sweet potatoes, raw red peppers and oranges

Vitamin D—Vitamin D helps your body to absorb calcium and should be taken alongside foods that are high in calcium. A lack of Vitamin D can lead to burning mouth syndrome, which includes a bitter, metallic taste and dryness in your mouth.
Sources of Vitamin D: Milk with egg yolk or fish to increase Vitamin D intake

Magnesium—Magnesium helps to build strong enamel for your teeth and helps prevent the formation of cavities.
Sources of Magnesium: Spinach, kale, dark chocolate

Healthy Mouth

Your Top 9 Questions About Going to the Dentist

Whether you are 80 or 8, your oral health is important. Did you know that 100 million Americans fail to see a dentist each year, even though regular dental examinations and good oral hygiene can prevent most dental disease? Here are some frequently asked questions about going to the dentist.

Why do regular dental visits matter?

Regular dental visits are important because they can help spot dental health problems early on when treatment is likely to be simpler and more affordable. They also help prevent many problems from developing in the first place. Visiting your dentist regularly is also important because some diseases or medical conditions have symptoms that can appear in the mouth.

What are some signs I should see a dentist?

  • Your teeth are sensitive to hot or cold
  • Your gums are puffy and/or they bleed when you brush or floss
  • You have fillings, crowns, dental implants, dentures, etc.
  • You don’t like the way your smile or teeth look
  • You have persistent bad breath or bad taste in your mouth
  • You are pregnant
  • You have pain or swelling in your mouth, face or neck
  • You have difficulty chewing or swallowing
  • You have a family history of gum disease or tooth decay
  • You have a medical condition such as diabetes, cardiovascular disease, eating disorders or are HIV positive
  • Your mouth is often dry
  • You smoke or use other tobacco products
  • You are undergoing medical treatment such as radiation, chemotherapy or hormone replacement therapy
  • Your jaw sometimes pops or is painful when opening and closing, chewing or when you first wake up; you have an uneven bite
  • You have a spot or sore that doesn’t look or feel right in your mouth and it isn’t going away

I’m not having any symptoms. Do I still need to see a dentist?

Yes. Even if you don’t have any symptoms, you can still have dental health problems that only a dentist can diagnose. Regular dental visits will also help prevent problems from developing. Continuity of care is an important part of any health plan and dental health is no exception. Keeping your mouth healthy is an essential piece of your overall health. It’s also important to keep your dentist informed of any changes in your overall health since many medical conditions can affect your dental health too.

How often do I have to go to the dentist?

There is no one-size-fits-all dental treatment. Some people need to visit the dentist once or twice a year; others may need more visits. You are a unique individual, with a unique smile and unique needs when it comes to keeping your smile healthy.

What’s the difference between a DDS and DMD?

If you’re looking to find a dentist you may notice that while most are listed with a “DDS”, some may be listed as “DMD”. They both mean the same thing—your dentist graduated from an accredited dental school. The DDS (Doctor of Dental Surgery) and DMD (Doctor of Dental Medicine) are the same degrees. Dentists who have a DMD or DDS have the same education. The level of education and clinical training required to earn a dental degree, and the high academic standards of dental schools are on par with those of medical schools. Upon completion of their training, dentists must pass both a rigorous national written exam and a state or regional clinical licensing exam in order to practice. In order to keep their licenses, they must meet continuing education requirements for the remainder of their careers so that they may stay up to date on the latest scientific and clinical developments.
How can I maintain a healthy smile with my dentist’s help?

Here are some tips to help you take care of your smile:

  • Healthy habits. Brushing twice a day for two minutes and flossing daily are essential for everyone, no matter how unique your mouth is. It’s the best way to fight tooth decay and gum disease.
  • Build a relationship. Continuity of care is an important part of any health plan and dental health is no exception. When your dentist sees you regularly, he or she is in a good position to catch oral problems early. For instance, catching gum disease when it’s still reversible, or cavities when they are small and are more easily treated.
  • Maintain. Keeping your mouth healthy is an essential piece of your overall health. It’s important to keep your dentist informed of any changes in your overall health as well.
  • Talk about it! Only your dentist can determine what the best treatment plan is for you. Have questions about your oral health or certain dental procedures? Start a conversation. Ask your dentist to explai

Oral Cancer Treatment

by Dr. O. Karnakova

Here at Dr. Zak’s, an oral cancer screening is part of our comprehensive examination with every patient.  A visual screening is performed of the oral cavity in areas such as the tongue, floor of the mouth, buccal mucosa, throat, and including areas outside the mouth. A palpation of the head and neck is also conducted  to check for any irregularities in the lymph nodes or skin. The risk of cancer has a positive correlation between ethnicity, gender, and age. Patients who are alcoholics or tobacco users are at especially high risk for oral cancer.

If any suspicious lesions are detected, the patient will be referred to a specialist. The oral surgeon will conduct a biopsy to determine  if the tissues are malignant.  If the results return positive for cancer, the patient will have to undergo treatment as soon as possible. Depending on the type of cancer, stage, and location, different treatment options are available such as chemotherapy, radiation therapy, surgery, cetuximab, or a combination between them. Typically, cancer that has not spread or invaded the deeper layers of tissue can be treated with minimally invasive surgery. If the cancer is left untreated or undiagnosed, it may metastasize to the surrounding lymph nodes in the head and neck or other parts of the body. As the cancer becomes larger or spreads, the type of treatment becomes much more aggressive,  and the survival rate dramatically decreases.

The beginning stages of oral cancer is often asymptomatic and can be mistaken with other types of common problems such as ulcers, soreness of the jaw, or weight loss. It is important to visit your dentist regularly for oral cancer screenings regardless of age, ethnicity, or gender. Early detection increases the survival rate while minimizing the invasiveness of treatment. Having cancer diagnosed as early as possible will help ensure the treatment is as effective as possible.

TELEDENTISTRY

ADA News: House passes guidelines on teledentistry

December 07, 2015

Washington — It’s similar to visiting a bricks and mortar dental office, only the dentist may be on a computer screen instead of in person.

Or the treating dentist could have securely emailed their patient care instructions to a specialist or dental hygienist at a community dental care event. Dentists could also virtually supervise the oral health care of nursing home patients, residents in rural areas or others who don’t have access to a dentist in their area.
Teledentistry can take many forms and the ADA now has specific guidelines and expectations for dentists interested in delivering their services virtually.

The ADA House of Delegates passed Resolution 45H-2015, Comprehensive ADA Policy Statement on Teledentistry, in November at ADA 2015 – America’s Dental Meeting. The House first issued policy on teledentistry in 2012, but it focused more on the technical aspect of the service, said Dr. Terry O’Toole, vice chair of the ADA Council on Dental Practice, which took the lead on developing the resolution.

“Teledentistry in and of itself is not a service. It’s really a method by which services are delivered,” Dr. O’Toole said. “This latest policy addresses what patients can expect when receiving services via teledentistry, as well as patients’ rights, workforce, licensure and payment issues.”

Teledentistry can take a number of forms, according to the resolution, including:

  • Live video: Two-way interaction between a patient and dentist using audiovisual technology.
  • Store and forward: Recorded health information — such as radiographs, photos, video, digital impressions or photomicrographs — is transmitted through a secure electronic communications system to a practitioner. The practitioner then uses the information to evaluate the patient’s condition or render a service outside of a real-time or live interaction.
  • Remote patient monitoring: Personal health and medical information is collected from an individual in one location then transmitted electronically to a provider in a different location for use in care. This could be used in a nursing home setting or in an educational program.
  • Mobile health: Health care and public health practice and education supported by mobile communication devices such as cell phones, tablet computers or personal digital assistants. This could include apps that monitor patient brushing or other home care.

Having ADA policy is certainly critical for the profession to accept and implement teledentistry because the Association can now support dentists to do it, said Dr. Paul Glassman, a consultant to the ADA Council on Access, Prevention and Interprofessional Relations.

Dr. Glassman looks at teledentistry as an expansion of the traditional dental practice, where patients can have a virtual dental home instead of a physical one. It provides easier access to dental care to patients in nursing homes or those who live in rural areas without a dentist.

Dentists can also develop a plan for patients to receive cleanings, fluoride varnishes, sealants and other treatment at a community site from allied dental personnel, under the dentist’s virtual supervision.

“The policy states that if any allied dental personnel are participating in teledentistry, their supervision should conform to the dental practice act in the state where the patient is receiving services and where the dentist is licensed,” Dr. O’Toole said. “Dentists and allied dental personnel must also be licensed or credentialed in accordance with the laws of the state in which the patient receives care, according to the resolution.

The resolution states that dental benefit plans and other third-party payers — public and private programs — should cover services provided through teledentistry at the same level as if the services were delivered in a traditional in-person encounter.

Dr. Glassman, director of the Pacific Center for Special Care at the Arthur A. Dugoni School of Dentistry at the University of the Pacific, was instrumental in persuading the California state legislature to pass legislation requiring the state’s Medicaid agency to cover teledentistry services.

“I think it’s already sweeping the country. I predict that within a couple of years, every state will have legislation supporting teledentistry,” Dr. Glassman said. “Dentists are realizing it’s a way to expand their practice and not be bound by the four walls of their office.”