Community Report 2018/19

UAlberta SMILES

2018/2019

ital to the health of our communities

Each year, the School of Dentistry graduates on average 40 dentists and 42 dental hygienists, and just as we are responsible for educating students to become dentists and dental hygienists it is our responsibility to educate the general public on oral health issues. Oral health encompasses more than just teeth and gums; your mouth is the window to your body. As a result, it is important to understand oral health and its connection to your overall health.

Your dentist and dental hygienist are part of a health care team and often come together with other practitioners to examine, diagnose and treat individuals with dental and medical conditions. For example, one of the articles titled: Dental concerns lead to rare diagnosis, captures the story of a teenager whose journey led her to a diagnosis that might as well saved her life.

This publication serves as an education piece on a variety of different dental and medical topics that hopefully offer you important insight from an expert and patient perspective.

School of Dentistry University of Alberta

Produced by School of Dentistry Design Tarwinder Rai Writers Tarwinder Rai Lesley Young Copy Editor Yuri Wuesnch

Edmonton Clinic Health Academy 5th Floor, 87 Avenue NW Edmonton, Alberta T6G 1C9 Kaye Edmonton Clinic 8th Floor, 11400 University Avenue Edmonton, Alberta T6G 1Z1 Katz Group for Pharmacy and Health Research 87 Avenue - 114 Street, 7-020H Edmonton, Alberta T6G 2E1 ualberta.ca/school-of-dentistry

TABLE OF CONTENTS

Message from the School of Dentistry

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MOUTHGUARDS PREVENT INJURY. USE THEM. WHAT YOU NEED TO KNOW ABOUT WHITENING YOUR TEETH DENTAL CONCERNS LEAD TO RARE DIAGNOSIS HEALING THROUGH ART HOW SLEEP APNEA CAN AFFECT YOUR TEETH ROUTINE CHECK-UP CAN FIND TONGUE-TIE ORAL CANCER SHOULD BE PART OF YOUR REGULAR DENTAL CHECK-UP HOW TO AVOID PASSING DOWN CAVITIES TO YOUR KIDS DECIDING WHEN SURGERY IS YOUR BEST OPTION ORAL HEALTH OF PERSONS WITH DISABILITIES SHOULD BE PRIORITIZED SILVER DIAMINE FLUORIDE: NOT A ONE-STOP SHOP FOR TREATING DENTAL CARIES THE TRUTH BEHIND ORAL CANCER

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Mouthguards prevent injury.

USE THEM. When playing hockey, taking an elbow or puck to the mouth may be part of the game, but the damage can be prevented – just wear a sports mouthguard.

The majority of orofacial trauma occurring from sports related-injuries can be prevented by wearing a fitted mouthguard, says Alexandra Sheppard, associate clinical professor in dental hygiene at the School of Dentistry.

“Wearing a sports mouthguard prevents injury to the teeth. Not wearing a guard may result in trauma to the lips from the teeth during an impact,” Sheppard says. “Gum and tooth trauma are preventable injuries.

Some people don’t want to wear a mouthguard, but if you get one molded to your mouth it’s not uncomfortable.”

To create a custom mold, a dentist or dental hygienist takes an impression of your teeth. These mouthguards provide the best fit, protection and comfort as opposed to store-bought mouthguards that are made to fit a wide variety of people and do not ensure the same level of protection as a custom made one.

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“Another disadvantage of store-bought mouthguards is that they can change an individual’s bite which can cause dental problems,” she says. “A custom-fit mouthguard isn’t going to fall out easily. They are easy to make and can be ready in a day or two.”

Hockey and wrestling are the most common sports requiring mouthguards, but Sheppard says it is recommended that people playing basketball and soccer consider wearing them also.

Keep in mind that a sports mouthguard is not the same as a bruxism appliance which is used at night to stop teeth grinding. People should not use a bruxism night guard as a sports mouthguard and vice versa, says Sheppard. Mouthguards should be replaced on an annual basis.

And even though mouthguards perform an important function, protecting your teeth can have its entertaining side too.

“The fun part nowadays is they come in different colours and with a variety of logos.”

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What you need to know about whitening your teeth Kelsea McCaffrey has been whitening her teeth since she was 14 and she’s learned a few lessons along the way.

Until last year, she used whitening strips. While they have worked for her, McCaffrey has since decided to switch to gel whitening trays.

Whitening strips have peroxide that bleaches the teeth whereas toothpastes have an abrasive in them.

“Just don’t fall asleep with the trays in your mouth,” she says. “Your teeth will become oversensitive. I couldn’t eat or drink for days.”

In her tooth-whitening journey, McCaffrey has tried and tested a majority of the over-the-counter products available. While trying to achieve that Hollywood smile may be a never-ending pursuit, with wedding and graduation season seeing a spike in strip and tray sales, experts say there are a few things to consider before purchasing whitening products.

“The whitening strips are an effective take-home method that patients can use,” says associate clinical professor in dental hygiene Alexandra Sheppard.

“But you need to be careful with the application. Contour the strips well into your teeth and make sure you don’t get them onto your gums. If you do, your gums can become irritated or bleed.”

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“THE WHITENING STRIPS ARE AN EFFECTIVE TAKEHOME METHOD THAT PATIENTS CAN USE. BUT YOU NEED TO BE CAREFUL WITH THE APPLICATION.” - Alexandra Sheppard Dental Hygiene Clinical Professor

And, whatever you do, avoid bleach or hydrogen peroxide to whiten your teeth, warns Sheppard.

“There are a lot of at-home recipes on the Internet promising to whiten your teeth. Many whitening agents are free radicals which potentially can be harmful to the gingival tissues. It’s recommended that a person consult with their dental hygienist regarding best practices around what whitening products to use,” she says.

For instant results, the light-activated teeth whitening systems offered in dental offices provide noticeable results more quickly, explains Sheppard.

A gel is painted on to the teeth and a specialized light is shone on them to speed up the whitening process.

She also cautions that people should not pursue whitening if they have gum recession, sensitivity issues or cavities. “The sensitivity will only become worse,” she explains.

“Also, intrinsic stains on teeth caused from medications cannot be whitened either. Only stains on the outer surface of your teeth can be restored.”

And remember: teeth whitening products do not work on crowns or restored teeth. So, if you are having any restorative work done, have your teeth whitened first.

Teeth whitening is also not recommended for women who are pregnant or breastfeeding, or children under the age 16.

Anyone considering whitening their teeth should get a dental examination first, says Sheppard.

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Dental concerns lead to rare diagnosis Hannah Seaton had been in-and-out of the hospital for months.

The 15-year-old had unbearable headaches and pain, but what was triggering them? At first, it was a mystery to her doctors.

She spent a week at the Stollery Children’s Hospital undergoing a number of tests and the cause still couldn’t be diagnosed.

“I know my daughter and this wasn’t normal for her,” says Hannah’s mother Dianna. “I felt helpless. But we tried to keep life for her as normal as possible.”

It took more than year before the Seaton family finally started to get answers thanks to a referral to pain specialist and dentist Ivonne Hernández.

Hannah was diagnosed with Granulomatosis with Polyangitis.

Otherwise known as Wegener’s disease, it is a rare immune disease that can be lethal.

“Hannah was referred to me on the basis of a pain problem and when I saw her my gut told me there was more to it,” says Hernández.

During the examination, Hernández noticed Hannah’s dark purple and reddish gums at irregular margins. “When I poked at her gums, they didn’t bleed so I knew it wasn’t gingivitis. But I knew something was wrong.”

With the assistance of Tim McGaw, a professor in the oral medicine division at the School of Dentistry, Hernández was able to identify the condition. Granulomatosis with Polyangitis is a rare long-term systemic disease in which the blood vessels become inflamed. It is a form of inflammation that affects small- and medium-sized blood vessels in many organs, but mostly the respiratory tract and the kidneys.

So what Hannah’s doctors first believed might be asthma and sinus pressure was rather symptoms of Wegener’s disease.

“It’s a very rare disease and if left untreated a patient may die within six to 12 months,” says Hernández, who notes that five to 10 people per million are affected.

What triggers or causes Granulomatosis with Polyangitis remains unknown. But Hernández stresses working with a team of healthcare professionals and dentists is vital to treating it in time.

“We are in a unique and key role in treating patients. Because we see them regularly, we are able to see changes in their oral cavity and more effectively report and treat any issues,” she says.

For Hannah finally having a diagnosis and course of treatment – along with an entire team of health care specialists to monitor her rare condition – gives her assurance.

“A year ago I couldn’t function. I was happy they finally knew what it was and that it could be treated,” says Hannah. The disease does go into remission after two years of treatment, but cannot be cured. She will require regular monitoring through blood tests.

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“Hannah was referred to me on the basis of a pain problem and when I saw her my gut told me there was more to it.�

- Ivonne HernĂĄndez Pain Specialist and Dentist

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HEALING THROUGH ART Kimberly Flowers's journey began in July 2014 when she was diagnosed with tongue cancer. Three months later, she underwent a 12-hour surgery that resulted in part of her tongue being removed.

She then underwent reconstructive surgery for her tongue, a trisectomy, a bilaterial neck dissection and 30 radiation treatments.

“I had to learn to speak, swallow and eat all over again,” says Flowers, who lost her voice for three months due to the radiation. “The anatomy of my neck had completely changed. I went from being tube fed through my nose to purees to semi-solid food. Even today, I still can’t eat certain things.”

As part of her recovery – and as soon as she was feeling well enough – Flowers started attending support groups. She then began mentoring other cancer patients and undertaking research. Eventually, she found support in an unusual place: a research project at the School of Dentistry that blends experiences and art together. see me, hear me, heal me: Transforming understandings of patients’ experiences with head and neck cancer is a project that brings together a cross disciplinary team of scholars, artists, health care providers and patients. Working collaboratively, and using innovative arts-based inquiry, the team explores the experiences of head and neck cancer patients over the course of their illness, treatment and recovery through contemporary art.

Led by principal investigator and assistant professor at the School of Dentistry, Minn Yoon, patients and their stories really form the heart of the project.

“I remember in one of the first sessions, I was shocked to see all these medical practitioners in the same room and wanting to hear about our experiences,” says Flowers. “This project is really

dear to my heart. It helped me process and identify emotions that I was unable to address through counselling. I remember leaving the session feeling so overwhelmed from the support and compassion I felt as a patient.”

The project connected artists with patients and together they explored fears, anxiety, depression, hope and all the complex emotions that come from head and neck cancer treatment and the recovery journey.

The resulting works of art have been featured in a number of exhibitions. FLUX: Responding to Head and Neck Cancer ran at dc3 Art Projects and the McMullen Galleryat Stollery Children’s Hospital last year. This year, it is being shown at the Chicago International Museum of Surgical Sciences.

“As a researcher, but more so as a human being, the project has moved me and has really achieved more than I had ever imagined,” says Yoon. “Our patient partners as well as the truly interdisciplinary team deserve the credit. The project has shown me the importance of fostering the humanistic qualities of academia, health and art. It also demonstrates the power of relationships and how authentic connections with community can enrich us individually and as a collective.”

Words, says Flowers, simply were not enough to capture the complexities of experiencing head and neck cancer.

“Sharing my story helped me process things psychologically and emotionally. The sense of community was there and it created a safe space for me to open up,” says Flowers. “It’s been a huge part of my healing process.”

For more information and to support the project, visit www.seemehearmehealme.com.

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How sleep apnea can affect your teeth Does your child snore? Or do they wake up feeling groggy and tired? If so, they may have sleep apnea.

Snoring or sleep disordered breathing (SDB) could be a sign of other underlying medical conditions that may require treatment like high blood pressure, delayed or reduced growth, behavioural changes and altered face and jaw growth that can lead to orthodontic problems.

“The biggest challenge for parents is finding a health practitioner to diagnose the issue properly,” says Michael Major, orthodontist and director of the Inter-disciplinary Airway Research Clinic (I-ARC) at the University of Alberta. “Most people assume children will outgrow it, but sleep apnea can cause longer-term damage.”

The I-ARC is a clinically based multi-disciplinary research and treatment team dedicated to correcting sleep disordered breathing in children.

Collaboration between experts in pediatric otolaryngology, pediatric respirology, sleep medicine, maxillofacial radiology, orthodontics and biomechanical engineering work together to help children receive better sleep and, in turn, health.

“Sleep apnea is a disease that requires multiple health practitioners,” says Major. “Our treatment

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plan involves working with all of our specialists.”

Major says common symptoms of sleepdisordered breathing include snoring, gasping for breath while sleeping, daytime sleepiness, bed-wetting, behavioural issues and being unable to breathe through the nose.

If you suspect your child may have sleepdisordered breathing, Major says to discuss your concerns immediately with your primary care physician, pediatrician or dentist. Follow these steps to help decrease your child’s risk for sleep-disordered breathing: • If you smoke, stop smoking! Even if you “only smoke outside,” the smoke attached to you worsens your child’s SDB. • If you have indoor pets, you must unfortunately find them new, loving homes.

Even mild allergies can worsen your child’s SDB. • If your child is overweight, try to help them lose weight through fun physical activities and a healthy diet. Excess body mass can worsen your child’s SDB. • If your child has asthma, follow your doctor’s directions precisely. Poorly managed asthma can worsen your child’s SDB.

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ROUTINE CHECK-UP CAN FIND TONGUE-TIE Tongue-tie is often identified in newborns during their initial checkup or in routine followup checkups. While it’s sometimes not as easy to spot, if left untreated tongue-tie can lead to oral cavity issues.

Tongue-tie or ankyloglossia is a condition in which there is a thin tissue (frenum) under the tongue that is attached to the bottom of the mouth and limits the tongue’s movement.

“If a newborn has tongue-tie, they will have trouble latching during breastfeeding. But sometimes, the tongue-tie is not that severe and goes unnoticed, until later on,” says periodontist and assistant professor Monica Gibson. “This is when you notice that children develop lisps or other speech impediments.”

Clicking sounds or sucking in of the cheeks while nursing could also be symptoms of tongue-tie in newborns. However, Gibson says to keep in mind that just because a newborn has trouble latching doesn’t always mean it is because they are tongue-tied.

“We ask parents to see their family doctor, pediatrician, dentist or periodontist to rule out tongue-tie as soon as possible,” says Gibson.

“The treatment is simple, fast and easily done. It’s an easy issue to correct and can have significant implications if left untreated.”

Some of these issues include speech delay, gaps between the teeth and problems latching during breast feeding.

Frenum In adults, instead of tongue-tie, a high frenum attachment can occur. This is when the muscle is attached closely to the teeth in either the upper or lower jaw.

“Early detection and treatment of abnormal frenum attachments by visiting your dentist or periodontist is always advised to avoid any gum loss or tooth root exposure,” says Gibson.

If left untreated, a tongue-tie can lead to the following issues: • Reduced oral hygiene; increased risk of caries and bad breath.

Saliva is unable to sweep away food • Poor weight gain due to impacted feeding or eating • Speech alteration • Difficulty in pronunciation • Difficulty in chewing food • Inability to swallow normally, which may also create future orthodontic problems like open bite and crowded teeth If left untreated, abnormal or high frenum attachment can lead to the following issues: • Gum recession due to excessive pull of the muscle/frenum • Lack of attached gums (gingiva) in this area due to recession • Root exposure of the teeth • Higher risk of root caries • Diastema or gap between teeth • Difficulty brushing in those areas leading to plaque accumulation 15

Oral cancer screening s regular dental check-up

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should be part of your p A brief check for oral cancer should be part of your regular dental check-up—and it’s a good idea to ask for the screening if you aren’t already getting it.

Dentists and dental hygienists in particular should be conducting oral cancer screenings on all patients, according to University of Alberta dentistry experts.

“Oral cancer screening should be taking place on patients as part of regular dental visits,” said Seema Ganatra, an oral pathologist at the U of A. “Unfortunately, it’s not clear how often this is being done by dentists or dental hygienists.”

Ganatra said a soft-tissue examination of the head and neck area—an effective way to spot cancer growths, either visually in the mouth or physically under the skin in the neck and throat area—can be conducted by dentists and dental hygienists within as little as two minutes. If a lesion or lump is found, and persists after two weeks, the dentist should refer the patient to an oral pathologist or oral surgeon for evaluation and treatment.

“But my impression is that it’s not being conducted consistently among oral health providers,” she said.

Since there are no data tracking how often patients are being screened for oral cancer, Ganatra and two more U of A dentistry faculty say they would like it to be more widely and consistently used among the profession.

“Our scope of practice includes conducting a head and neck exam along the muscle groups and lymph nodes under the chin and around the neck, and an intra-oral assessment of the tongue, particularly the lateral borders, and a visual assessment of the oropharynx,” said Alexandra Sheppard, assistant director of dental hygiene clinical education at the U of A. A screening also entails questions about alcohol and tobacco use, as well as asking patients about sexual practices, partners or vaccinations.

“We teach dental hygiene students how to conduct screenings for oral cancer,” said Sheppard, adding that hygienists are in a better position than general physicians to check for oral cancers because they may see patients more often and they are looking down into people’s mouths with

bright lighting.

“That’s why it’s a good idea to ask for a screening at your next dental visit if it’s not offered,” she added.

Sexually transmitted oral cancer on the rise The U of A dentistry faculty members are raising this issue at a time when one particular kind of oral cancer, HPV or human papilloma virus-related cancer, is on the rise among men between 40 and 55 years old.

“Dentists and dental hygienists have a larger role to play in health care than just managing the health of teeth. Oral health care is a major component of Canadians’ overall health,” pointed out Minn Yoon, an assistant professor in the School of Dentistry.

Almost 4,400 Canadians will be diagnosed with HPV-linked cancers this year and about 1,200 die from it annually, according to the Canadian Cancer Society and Public Health Agency of Canada’s annual report on cancer statistics released in the fall of 2017.

Mouth and throat cancers now represent about a third of cancers that are caused by HPV in Canada.

“The risk of oral infection rises with the number of sexual partners, and oral sexual partners, one has had,” explained Minn Yoon.

“Men are four times as likely to get HPVrelated oral cancer,” she added, pointing out that men also take longer to clear HPV infections from their body.

Almost 80 per cent of the entire population has had HPV infection at one point in their lives. For the most part, the body clears it out safely on its own, she said, adding that a small percentage of HPV cases develop into oropharyngeal cancer. “We don’t know why it takes longer for men, but one theory is that women have some natural immunity men don’t.”

“The good news is that the outcomes of those who get an HPV-related oral cancer are much better than those who have oral cancer related to tobacco and alcohol,” pointed out Ganatra.

Because HPV-related cancers tend to manifest as tumours in the neck and throat area due to local spread, it’s all the more important for the dental community to be conducting regular screenings to catch it as early as possible, she added.

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HOW TO AVOID PASSING DOWN CAVITIES TO YOUR KIDS Along with genetic traits, parents can also pass on cavities to their babies.

“Tooth decay is a transmissible disease,” said Darsi Perusini, a pediatric dentist at the School of Dentistry.

“Parents don’t realize that cavities are related to bacteria and not always caused by eating too much sugar. If you’ve had a cavity, then the cavity-causing bacteria are present in your mouth, and will stay there for life.”

That’s why the clinical instructor says regular visits to the dentist before and during pregnancy are important.

“Getting a dental exam and your teeth cleaned during pregnancy is safe,” said Perusini. “What happens in the mom’s mouth will likely happen in the child’s mouth. At some point you are going to share spit with your baby, and bacteria travels through spit. It can be transferred to your child by a kiss or sharing a straw.”

If you are pregnant or planning on getting pregnant, Perusini said, getting a dental exam will help identify any problems that could arise.

Visiting the dentist during your second trimester is most ideal, he said. The fetus is still developing during the first trimester, and the third trimester can be uncomfortable for expecting mothers.

Amanda Ross didn’t have to be told twice about the importance of visiting her dentist.

“I had a few cavities when I was younger, so I am aware I can pass this down to her,” said the mother of a four month old.

A patient of Perusini’s, Ross credits her regular visits for her own healthy mouth as well as her daughter’s.

“Sometimes I wonder if I’ve kissed her too close. I want to keep her mouth as healthy as I can,” said Ross, adding she tries to be as careful as she can snuggling and kissing Charlotte.

Ross said she wipes Charlotte’s mouth every day with a warm cloth to clean it out and prepare her for the habit of brushing her teeth once they come.

Perusini recommends that children be seen by a dentist within six months of the eruption of their first tooth or by the time they’re a year old.

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HOW

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Deciding when surgery is your best option Robbie Patterson had a malocclusion ­— extremely poorly aligned teeth caused by misaligned jaw bones. Only his back molars touched slightly and, as a result, he was unable to chew food properly.

The 19-year-old’s face was rounded and his chin touched his neck. With the excess pressure on just a few of the teeth he uses, his jaw joints were at risk of eventually developing further problems.

Patterson’s decision to undergo major surgery to reposition his upper and lower jaw was not easily made but necessary. During surgery, the upper and lower jaw bones are cut and moved to a new position to better align the bite. The bones are then held in position with titanium mini screws and bone plates. The jaw is then closed during recovery using elastics so there is no movement or opening of the mouth. This enables the bones to properly heal.

“It was a difficult road to travel,” says Patterson, who notes that his years-long relationship with his surgeon and orthodontist prior to the surgery left him feeling confident in his decision. “They were very personable and open to any and all of the concerns I had. I was armed with the correct knowledge to allow me to choose whether or not to go through with this procedure. The regular meetings we had helped boost my trust in them as professionals and as people I could trust to accomplish such a surgery.”

But deciding to undergo dental surgery is not to be taken lightly, say dental experts. It’s an elective surgery and process that requires a team approach to be successful.

Your general dentist, orthodontist, oral and maxillofacial surgery specialist, nurses, general doctors and an entire hospital care system all play a vital role. Not to mention your family and support network needed during recovery.

“Kids have to be prepared mentally and we need to let them make the decision,” says oral maxillofacial surgeon and dentistry professor Tom Stevenson. “If you are not sure,

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always ask for second opinions.”

In Patterson’s case, surgery was the only way to correct his problem. His dental issues are genetic and came from an inherited growth pattern. For Patterson, the decision to undergo surgery took more than a few years. His father, who is a dentist, ultimately left the decision in his hands.

“The recovery was very difficult and this was the biggest and most serious surgery I ever had. Having my jaw wired shut and with a splint between my teeth, which blocked my tongue, made it impossible for me to talk,” says Patterson.

“My recovery was largely successful because of my mother who helped me every second of the day with my medications, cleaning my teeth, getting the nutrients I needed through experimental smoothies and liquefied meals.”

Since the surgery, Patterson says he’s noticed significant changes in the functionality of his jaw and teeth.

“I have the confidence to smile and my jaw isn’t so narrow. So, although these momentarily inconvenient and uncomfortable procedures did bring me pain and soreness as well as other emotional battles I needed to overcome, it was a worthwhile journey,” he says. “The surgery was worth every penny and every ounce of agony.”

Stevenson says this type of elective surgery is common and oral surgeons will typically wait until the patient has stopped growing so there is less chance of relapse.

“It’s not necessarily something that needs to be done right away. While there are some instances where we suggest operating at a younger age, we try to treat patients later in their teens. With males, we will wait even longer,” says Stevenson. “Always learn the advantages and disadvantages of every surgery you are considering. If you are unsure of something, be sure to ask plenty of questions.”

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Oral health care of persons with disabilities should be prioritized If you have disability, accessing regular dental care can be challenging. However, it is a misconception that persons with a disability need to be seen at specialized clinics.

While the University of Alberta Hospital Dental Clinic and the Glenrose Rehabilitation Hospital Dental Clinic are specifically designed to accommodate persons with disabilities, other regular care can be obtained at local dental clinics.

“The oral care needs of people with disabilities are similar to anyone else,” says clinical dental professor and director of the postgraduate residency program William Preshing. “They can even be treated while sitting in a wheelchair.”

Preshing says the dentistry program at the School of Dentistry stresses and teaches students how to best handle individuals with special needs. Patients with special needs can include dexterity problems, physical disabilities or health issues.

“A big part of our mission here at the U of A is to look after people with medical or behavioural challenges that would prevent them from getting care elsewhere in the community,” says Preshing. “What we’re trying to see and show our students is that a lot of patients can be seen in their clinics. While it can be challenging, it can also be fun. There are often interesting and surprising problems to solve.”

Caregivers can make simple adaptations to brushing routines and oral care for persons with disabilities. These include: • Use an elastic band to attach the brush to the person’s hand • A toothbrush handle can be enlarged with a sponge, rubber ball or bicycle hand grip • The toothbrush handle can be lengthened using a piece of wood or ruler • Use an electric toothbrush

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SILVER DIAMINE FLUORIDE

Not a one-stop shop for tre

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eating dental caries A dental technique dating back more than a century is resurfacing as a possible method to treat dental caries in children and youth.

Silver diamine fluoride (SDF), a nonsurgical alternative to dental restoration and fillings, dropped off the dental radar in the 1950s and is now being reevaluated for use in cases where children are too small for fillings.

Use of SDF helps manage dental caries in children and adolescents, including those with special health care needs.

SDF is a liquid fluoride that is painted onto a cavity to prevent further infection. But there’s a drawback: it paints the teeth black.

“Although it works in killing the bacteria causing decay, it’s not actually fixing the cavity,” says dentistry professor Steve Patterson. “The hole is still there.”

Still, the technique is gaining popularity in treating children, says Patterson.

Especially in kids where a cavity can’t

be treated or filled right away or as a temporary solution to a tooth that may still eventually fall out.

“Yes, it helps decay from progressing.

But SDF has its limits on when and where it can be used,” he says. “It’s helpful for someone who can’t pay for a filling or a young child who would have a tough time going through the process of getting a filling. SDF is an option in places where access to care is limited and for public health clinics. The technique has hype, but it doesn’t work all the time or in all - Steve Patterson places.”

Dentistry Professor Patterson says the biggest limitation of SDF is that it turns teeth black.

“It just doesn’t look great,” he acknowledges. “A major setback with this form of treatment is that it’s not a fluoride application like others that prevent disease from happening. While SDF keeps it from progressing, essentially the concern is still there.”

“Although it works in killing the bacteria causing decay, it’s not actually fixing the cavity.”

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The truth behind oral cancer Upon receiving her diagnosis of oral cancer in 2017, Barb Pelton asked her dentist whether she was going to die. While the dentist let her know it was possible, Pelton became resolved to beat the disease.

Pelton’s diagnosis came almost five years after the first sign of it appeared in her mouth. Her first biopsy in 2012 showed she had oral lichen planus and she was told the condition would need to be closely monitored.

After a routine dental checkup in 2017, Pelton’s dentist was concerned about an abnormal area on the right side of roof of her mouth.

After being referred to oral pathologist and dentist Seema Ganatra at the School of Dentistry, Pelton made the journey from her home in B.C. to come see her. The second biopsy told another story: oral cancer. While the news was clearly unfortunate, Pelton says she was glad to have made the trip.

“Just always, always, always get a second opinion if you have any doubt,” says Pelton, adding she appreciated Ganatra’s honesty. “I don’t want this to happen to anyone else. If I can prevent this from happening to another person that would be wonderful. If it’s something that is not going away, get it checked out. If you are told it is nothing but it’s still not going away then get a second opinion.”

Echoeing Pelton’s advice, Ganatra says any lesions in your mouth that do not heal within four weeks should be checked by a dental professional.

“If there is pain that doesn’t go away or a fast growth, please visit a dentist or health care professional immediately,” says Ganatra. “It might represent cancer or an infection. Either way, both require treatment.”

Pelton was told she had verrucous carcinoma.

While she had smoked for 43 years, Pelton had quit six years prior to her diagnosis.

Oral cancer can occur on the sides, floor and palate (roof) of the mouth, under the tongue, cheek linings, gums or lips. It most often occurs as a growth or sore that does not go away. Early findings can include persistent red or white patches, a non-healing ulcer, swelling or enlargement, unusual surface changes, sudden tooth mobility without an apparent cause or unusual oral bleeding.

Pelton had a resection completed. The surgery involved removing almost a quarter of her right palate including gums, multiple teeth and bone.

She now has a plate in her mouth which enables her to speak clearly and eat normally.

“It’s an adjustment getting used to it but I’m alive and that’s number one. Life is good and I feel good,” she says. “I get to live.”

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