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.

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

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

Space Maintainers in Children

by Dr. J. Slaven
When a young child loses a baby tooth prematurely due to decay, infection or accident it creates a situation that requires immediate attention. One of the purposes of the lost baby tooth was to keep space available for the permanent tooth developing in the jaw underneath the baby tooth to have enough room to properly erupt into the child’s developing jaw. When teeth are lost the teeth on either side of the now empty space will quickly begin to drift into the space and effectively block the permanent tooth from properly erupting. If this is allowed to progress without intervention the permanent tooth can become impacted which will then require a surgery to uncover it to allow orthodontic movement of the tooth into proper position.

The simple solution to this is to fabricate and place a space maintainer. A space maintainer is either a passive space holding appliance or an active space opening appliance that is cemented to the tooth or teeth next to the space to assure that the permanent tooth can erupt into its’ proper position. The space maintainer consists of one or more bands that encircle the tooth next to the space with a stiff wire loop that touches the tooth on the other side of the space and keeps it open. If front teeth are lost early the space maintainer can have artificial teeth attached to the wire to create a cosmetic result allowing the child to have their self esteem intact and avoid being teased by other children.

Once the space maintainer has been placed it is important that the child be checked regularly, so that the appliance can be removed at the appropriate time. The space maintainer itself could prevent the final eruption of the permanent tooth, so monitoring is essential.

What foods enhance people’s oral health

by Sepi Fatahi DMD

Generally, good nutrition is beneficial for oral health as well as total health. Fill your diet with fresh produce, nuts, seeds, legumes, lean meats and whole grains. These contribute to a more alkaline state in the body, which defends against bacteria and inflammation.

Avoid food with artificial preservatives, artificial sweeteners, food coloring, high fructose corn syrup, refined sugar, refined flour and partially hydrogenated oils. These contribute to a more acidic state in the body, which increases bacteria and creates inflammation.

This list of 10 superfoods for great oral health will benefit your mouth:

Kiwi. Most fruits contain Vitamin C, which is vital for the health of your gum tissue, but kiwis contain the highest amount. Without Vitamin C, the collagen in your gums breaks down, the gums become tender and more susceptible to the bacteria causing periodontal disease.

Cheese. High in phosphate and calcium, cheese helps balance the pH in the mouth, killing bacteria and preserving tooth enamel. This prevents cavities and gum disease.

Celery. As a crunchy vegetable made mainly of water, chewing celery produces saliva, neutralizing the bacteria Streptococcus mutans that causes cavities. It’s also a naturally abrasive food that massages gums and cleans between teeth.

Green Tea. Enjoyed for centuries in Asia, green tea contains catechins that kill the bacteria leading to plaque while preventing gum disease and cavities. It also inhibits the growth of bacteria leading to bad breath.

Sesame Seeds. High in calcium, sesame seeds preserve the bone around the teeth & gums. They also help slough off plaque while helping build tooth enamel.

Onions. Onions have powerful antibacterial sulfur compounds, making them terrific for oral health. They are strongest when eaten fresh and uncooked.

Shiitake Mushrooms. These mushrooms contain lentinan, a naturally occurring sugar that prevents mouth bacteria from forming plaque.

Raisins. Sweet and tasty, raisins contain phytochemicals like oleanolic acid that inhibit two species of oral bacteria to prevent cavities and gum disease.

Sweet Potatoes. Along with carrots, pumpkin and broccoli, sweet potatoes have high amounts of Vitamin A, which is essential for tooth enamel formation and promotes healing of gum tissue.

Water. Water is as effective as mouthwash at swishing away stuck particles and residue from teeth. It also keeps your gums hydrated while stimulating saliva – the best defense against bacteria.

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.