UAlberta SMILES 2019/2020
Message from the School of Dentistry
Your oral health is more important than you might realize The School of Dentistry is responsible for educating students who want to become oral health practitioners otherwise known as dentists and dental hygienists. It is also our responsibility to create awareness on the importance of oral health. Many people only see the dentist or dental hygienist when there is pain in the mouth which is often a sign that you waited too long. The human mouth is full of bacteria that can harm your mouth by forming a sticky layer called plaque on your teeth, causing damage to your teeth and gums. If left untreated oral health conditions can lead to other problems with your overall health. Inside this report, there are easy-to-read stories such as getting a simple head and neck examination during your regular dental check-up can be vital in detecting oral cancer early. We hope that these stories provide oral health guidance and insight.
ARE YOU USING THE
Brushing or flossing? Which should be d
DOES CHARCOAL ACTUALLY WHITEN TEETH?
IS LEMON WATER GOOD FOR YOUR TEETH? Acidic drinks can erode teeth enamel, find out how to prevent this from happening
HOW YOUR DENTIST CAN HELP TREAT A COLD SORE Treatments are available that may prevent future flare-ups
UNCONTROLLED DIABETES ADVERSELY AFFECTS GUM HEALTH
WHY YOUR DENTIST MAY ASK ABOUT YOUR SEX LIFE HPV in men is rising and getting vaccinated is vital
PERIODONTAL DISEASE VS GINGIVITIS One of these can be reversed
done first according to dental experts
TO PULL OR NOT TO PULL
EXPANSION OF SERVICES AT BOYLE MCCAULEY
DOES CHARC ACTUALLY WH TEETH? 6
Charcoal-based toothpaste can be more harmful to your teeth than beneficial warn dental hygienists. “It’s just another marketing fad,” says dental hygiene clinical associate professor Sally Lockwood. “There is no convincing scientific evidence to support the claims made by charcoal-based toothpaste. On the other hand charcoal is an abrasive material that can lead to the loss of luster and enamel of teeth.” Charcoal-based toothpaste claim to whiten teeth, help with bad breath, and absorb other bacteria in the mouth. “Charcoal-based toothpaste has become a fashionable marketing gimmick,” says Lockwood, adding the first documented use of charcoal on teeth was in the time of ancient Greece. “Again, none of these claims have been proven. I would not recommend this product to any of my patients.” Aside from damaging the tooth surface, Lockwood says charcoal toothpaste can damage gum tissue, root surfaces, tooth restorations, and leave particles behind in periodontal pockets. “One of the biggest concerns that come from using charcoal toothpaste is that they no longer have sufficient amounts of fluoride in them. Evidence suggests that charcoal in the toothpaste can absorb the fluoride, making it unavailable to the tooth and reducing the paste’s cavity fighting ability,” she says. “The claim is that charcoal toothpaste is antibacterial, antifungal and it will remove tooth stains. “But in reality, the charcoal absorbs the fluoride even before you use it and charcoal only helps remove surface stains not the intrinsic ones. This means you’re using a toothpaste without available fluoride and putting your teeth at risk.” Lockwood says to ensure you are not jeopardizing your oral health, seeking professional care from a dentist and dental hygienist for teeth whitening is recommended.
Standing in the toothbrush aisle surrounded by hundreds of choices, how do you know you’re choosing the right toothbrush? Do you go manual or electric? The choices can be daunting, but one general rule to keep in mind when searching for the correct toothbrush is to always choose one that has soft or extra-soft bristles says Nadia Kobagi, a dental hygiene clinical assistant professor at the School of Dentistry. “You can create irreversible gum damage if your brush bristles are too hard,” she says. “If you’re heavy-handed when you brush your teeth, you wear away the gum tissue which may lead to root exposure and sensitivity.” Kobagi says finding a toothbrush that fits your mouth is important as well. Ideally, your toothbrush should be large enough to be able to brush two teeth at a time.
ARE YOU USING THE
“People with smaller mouths need to look for a compact brush. Large toothbrushes can miss food and plaque buildup in tight spots,” she says. “Either manual or electric toothbrushes can be used. Both are effective if used correctly.” Battery-powered toothbrushes are not as researched as the electric ones says Kobagi. And people with dexterity problems should consider purchasing toothbrushes with modified handles that make them easier to grasp. It is recommended that everyone brush their teeth twice a day for two minutes using a fluoride containing toothpaste.
Brushing or flossing - which should be done first? When it comes to flossing your teeth, should you floss
“All we want to know is that you’re flossing,” says Nadia
before or after you brush your teeth? Dental hygienists say
Kobagi, a dental hygiene clinical assistant professor at the
it doesn’t really matter – as long as you floss.
School of Dentistry. “Personally, I floss first but we just want to see that you are flossing.”
When it comes to flossing, there are many different types of floss’ to choose from. Here are a few to consider:
Traditional dental floss comes in either waxed or unwaxed form, both which are equally effective. Disposable floss picks are an easy to use alternative to traditional dental floss. They have a plastic handle with the floss across the top. You simply insert the floss between your teeth and when done throw it out. Non-disposable floss picks have a longer handle and floss head. You can purchase replacement floss heads for these. The non-disposable floss picks are ideal for people who have trouble flossing their back teeth.
The interdental brushes are easier to use for flossing over traditional thread floss. They have a thin bristled flossing head and do not need to be thrown out after each use. Water flossers or water picks use a stream of water to clean between your teeth. Water picks are ideal for people who don’t want to use traditional dental floss or have tight spaces between their teeth. 9
adversely affects gum health Many of us know diabetes is a leading cause
of heart disease and stroke. But what we fail to realize is that diabetes – especially if left uncontrolled – can adversely impact our oral health and increase your chances of getting periodontitis (or gum disease). Patients with undiagnosed and/or uncontrolled diabetes are more likely to develop a more severe form of periodontitis because of delayed wound healing and impaired immune response. Further, having untreated gum disease is also associated with significantly higher blood glucose levels in the body. “Patients with poorly controlled glucose levels suffer from periodontitis more often than those with controlled levels. Therefore, practicing good oral hygiene and maintaining healthy blood sugar level is key,” says Monica Gibson, periodontist and assistant professor at the School of Dentistry. “Patients who have uncontrolled diabetes respond less favorably to dental treatment. Elevated glucose levels lead to high levels of bad bacteria and decreases the healthy bacteria in the mouth. These bad bacteria make your mouth more susceptible to having periodontal tissues breakdown faster because your immunity is compromised.” Patients who have uncontrolled diabetes can show signs of delayed wound healing, mouth dryness, mouth ulcers, increased bone loss and increased severity of periodontitis. “Controlling diabetes within a normal range set by your physician goes a long way in keeping your gum health in check,” says Gibson. “Having any periodontitis issues treated also helps get your glucose tolerance under control. Get your sugar
checked annually and follow the recommended protocol.”
h Tips for maintaining good oral health • Brush your teeth twice a day • Use traditional floss or a water flosser • Brush the inside of your cheeks, gums, roof of your mouth and tongue • Visit your dentist regularly • Visit your physician and ensure your blood sugar is within normal range
Is Lemon Water GOOD for your Teeth? 12
Lemons are all the rage in the health and
suggests drinking the beverage quickly
diet world these days. The health benefits
and all in one sitting. This will help prevent
of drinking water infused with lemon is being
broadcasted everywhere. They are a rich source of vitamin C, a detoxifying agent,
“Sports drinks are by far the worst beverage
and drinking lemon water in the morning
for your teeth. People sip on sports drinks
maintains pH balance in the body.
for much longer, demineralizing teeth much more,” she says. “These three drinks also
But like everything else in life, you can have
have significant amounts of sugar and the
too much of a good thing and moderation is
sugar will be metabolized by the bacteria in
definitely key – well in the case of lemons.
your mouth and as a by-product the bacteria produces acid too. This is in addition to the
Lemons are extremely acidic and what many
acidity of the drink already.”
may fail to realize is that they will erode tooth enamel over time.
Chow suggests drinking with a straw and rinsing your mouth after you consume an
“Anything that is acidic will demineralize
your teeth,” says Ava Chow, an associate professor in dental hygiene at the School of
“A straw will help bypass the teeth and will
Dentistry. Sports drinks, orange juice and
not expose them to acid. Rinsing your mouth
soft drinks all fall into this category as well.
with water afterwards will help restore the
“All of these drinks decrease the pH in your
pH in your mouth,” she added.
mouth and make your saliva more acidic. When the saliva is acidic, it will break down
And as far as lemon water goes, if you are
the enamel on your teeth.”
going to drink an acidic beverage, lemon water doesn’t have the extra added sugar
The sour flavor is what attracts most people
that soft drinks have – making it a somewhat
to these acidic drinks says Chow. She
a better alternative.
How your dentist can help treat a cold sore
Cold sores can be painful and
“I had one patient who suffered
irritating. But if caught early
from cold sores frequently and
enough – just when that tingling
we couldn’t figure out what the
feeling starts - your dentist can
trigger was. We put her on an
help you treat your cold sore and
antiviral medication, which she
prevent it from resurfacing.
took every day for six months, and she hasn’t had any outbreaks
“Dentists can help identify
since,” says Ganatra.
cold sores and prescribe a treatment to prevent them,”
There are other types of sores
says oral pathologist and dentist
that occur inside the mouth
Seema Ganatra. “Cold sores
as well. An aphthous ulcer or
are cause by a virus and can
canker sore is a recurrent sore
be treated with antiviral
or ulcer inside the mouth. Unlike
cold sores, these sores don’t occur around your lips and aren’t
A cold sore is most often appears
contagious. They occur inside
as a red blister around your
the mouth mainly on the lips and
mouth or lips, or sometimes even
tongue and are quite painful.
inside the mouth. It is associated with a herpes virus strain that is
These types of ulcers can be
spread through saliva and by skin
related to an immune system
imbalance, thin skin in the mouth or an allergy. Stress, vitamin
“Most people are infected with
deficiency, anemia and genetics
this virus at a young age and it
can be contributing factors she
remains dormant in the nerves.
explains. Aphthous ulcers/canker
There are triggers that cause it to
sores can also be associated with
reappear in the form of blisters,”
malabsorption conditions such as
says Ganatra, adding that these
celiac disease or inflammatory
triggers can include sun
bowel disease such as Crohn’s
exposure, stress and illness.
disease added Ganatra.
Cold sores can last up to six days. “There is no cure but they
“In most cases, treatment is
can be managed if caught early.”
symptomatic, and in others, the ulcers become less frequent
Dentists and physicians should
over time. The main stay of
be your first line of defense.
treatment is topical steroid
Ganatra says that by regularly
creams or mouthwashes,” she
using an antiviral medication,
cold sores can be prevented.
may ask out your
Don’t be surprised if your dentist asks you
- 45 - 55 years of age - when compared
questions about your sex life during your
to those with tobacco and alcohol-reated
next dental visit. Oropharyngeal cancer,
oral cancers explains Ganatra. People are
caused by the human papillomavirus (HPV),
having sex at a younger age and many are
is on the rise and a head and neck exam-
engaging in oral sex. Changing sexual
ination during your regular dental check-up
preferences arose in the 1980’s when oral
can be vital in detecting the cancer.
sex was thought to be safer with the emergence of HIV disease.
Oropharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues
Patients with oropharyngeal cancer are
of the throat (oropharynx). Although most
treated by ear nose and throat specialists.
cases of HPV infections resolve on their
The good news is that these patients have
own, HPV can cause six different types of
a better outcome with surgery, radiation
cancer. Oropharyngeal cancer is one of
treatment and chemotherapy in comparison
the types of cancer that is increasing at
to patients with tobacco and alcohol-related
alarming rates says oral pathology
specialist Seema Ganatra. For Ganatra the biggest concern is that Oropharyngeal cancer, also known as throat
the awareness and education around HPV
or tonsil cancer, is associated with oral sex.
oropharyngeal cancer is not where it needs to be. People are aware of HPV and cervical
“This type of cancer is transmitted through
cancer but not of its association with
oral sex. One issue is that we as dental
professionals cannot easily detect this cancer because it occurs in the back of
“This is where we as dentists come in.
the mouth and throat, and this area is
The head and neck is our area,” she says.
difficult to examine. It goes undetected
“We need to educate our patients and have
until it spreads ot the neck and is caught
tough conversations around this topic. We
in later stages as a lump or mass of the
need to be diligent in completing head and
neck,” she says, adding other symptoms
neck examinations during dental check-
include difficulty swallowing, a lump in the
throat or experience ear pain. “But head and neck cancer examinations are citical
HPV related cancers can be prevented.
during dental check-ups.”
Vaccinations are available and whereas before they were primarily targeted to
With sexual preferences changing,
women, but now both younger and older
oropharyngeal cancer is occurring more
men are being encouraged to get
in younger people explained Ganatra.
“They think oral sex is safer. But if you
“As dentists, we have the opportunity to
have had six or more unprotected oral sex
promote HPV vaccinations and good oral
partners, you are at risk of type of cancer,”
health practices,” says Ganatra. “There are
a lot of myths and stigma’s associated with this type of cancer but our role is to screen
This cancer affects a younger age group
and educate all of our patients.”
PERIODONTAL DISEASE VS
GINGIVITIS Did you know one of these can be reversed? Having bleeding or inflamed gums while
disease leading to bone loss and possibly
brushing is a tell-tale sign that you have
tooth loss,” says Debevc. “We try to treat
the disease as early as we can but sometimes, because the process is
The good news is that gingivitis, the mildest
painless, it’s not noticed until it’s
form of gum disease, is largely preventable
progressed. Fortunately in most cases
with good oral hygiene. Luckily, gingivitis is
the disease can be treated and managed.
easily reversible with professional care and
However, bone loss can be permanent.
improved oral hygiene. Debevc says that not all people have the But, if left unchecked, gingivitis can
same susceptibility to periodontal disease.
progress to a more severe form of gum
Factors in gingivitis and periodontitis
disease known as periodontal disease.
include genetics, systemic conditions, diabetes, and smoking. That’s why dental
“When bacteria in your mouth grows in
treatment is not one size fits all. Some
the form of biofilm it will sit in a pocket
of us can get by with preventative
around the tooth. If that plaque is allowed
appointments on a yearly basis. Others
to sit there and is not removed with your
will need more frequent care.
brushing and flossing it can start absorbing the calcium from the saliva and turns into
“It’s important to go to the dentist
tartar,” says periodontist Teresa Debevc
regularly to be checked for both cavities
at the School of Dentistry. “The plaque
and gum disease” she stresses.”If our
triggers an immune response and your
hands bled when we washed them, we
gums become inflamed.”
would probably have that checked out at the doctor. Similarly, if you gums bleed when
“That inflammation in the gums,if left
you brush you should seek a consult with
untreated, can develop into periodontal
TO PULL OR NOT TO PULL
That is the question Health, comfort, and function are a
Campbell says patients shouldn’t get
Prosthetics can also affect your
few reasons saving the natural tooth
a tooth pulled because they think it’s
smile and confidence he added. Root
is ideal. While pulling a tooth or
easier and more cost-effective. He
canal therapy is virtually painless
getting implants are alternatives, the
encourages patients to consider all
compared to a tooth extraction
function of the teeth can be limiting.
their options first.
Therefore, endodontists recommend
“Missing teeth can affect your ability
“Patients are very motivated to keep
a root canal as the best way to save
to chew and it can cause your teeth
their natural teeth. A root canal will
the natural tooth.
to shift,” he says. “Again, no denture
treat the infection in the tooth and
or implant will feel or function as
preserve the rest of it,” he says.
“Nothing is going to do the same
well as your natural tooth. Our first
“Endodontic treatment has a high
job as your natural teeth,” says Les
priority is to always save the tooth.
success rate and the longer you wait
Campbell, an endodontist at the
Visiting an endodontist is the
for treatment, the chance of saving
School of Dentistry. “Preserving
highest level of care you can get
your tooth lessens.”
what you are born with is important
for root canal therapy. We are
for your quality of life. We sometimes
specialists in saving teeth, it’s what
have patients that will refuse
we do every day.”
treatment. But when they get an abscess, they come back.”
Expansion of services at Boyle McCauley Inner city low-income residents,
Major, chair of the University of
The modern eight-chair clinic
newcomer immigrants and Indig-
Alberta’s School of Dentistry.
will be able to accept 1,000
enous peoples have a new dental
more visits per year, with
clinic thanks to community part-
Located in its new site in
reduced wait times for follow-up
nership and support.
the Métis Capital Housing
appointments and increased
Corporation Renaissance Tower,
capacity to accommodate more
The newly expanded Boyle
the $1.5 million expansion
McCauley Health Centre
was made possible by a
Dental Clinic (BMHC) provides
partnership between the
“We are very excited that our
convenient access to dental care
School of Dentistry, The Métis
partnership with Alberta Health
for vulnerable populations and
Nation of Alberta, BMHC and
Services and the University of
will continue to be a valuable
Alberta Health Services (AHS).
Alberta’s School of Dentistry
hands-on learning environment
has resulted in the expansion of
for dentistry and dental hygiene
Oral health-care services have
our dental clinic, making it
been provided by the BMCH since
possible for more members of
1993. It had since outgrown the
our community to access
“We are able to provide dental
space. Each year, more than
comprehensive, affordable dental
care to an underserved
2,000 patients visited the clinic,
care,” said Cecilia Blasetti,
population that often goes
which had only four operatory
executive director of the BMHC.
without adequate care,” said Paul
BMHC Dental Clinic Patient Statistics 2016-2017 • 2197 active patients • 367 new patients • 2158 total visits • 1742 regular visits • 414 emergency visits
Kaye Edmonton Clinic 8th Floor, 11400 University Avenue Edmonton, Alberta T6G 1Z1
Edmonton Clinic Health Academy 5th Floor, 87 Avenue NW Edmonton, Alberta T6G 1C9
Katz Group Centre for Pharmacy and Health Research 87 Avenue - 114 Street, 7-020H Edmonton, Alberta T6G 2E1
School of Dentistry's annual publication.