2019/2020 Community Report

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.

ualberta.ca/school-of-dentistry

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what’s inside.....

ARE YOU USING THE

Brushing or flossing? Which should be d

32

DOES CHARCOAL ACTUALLY WHITEN TEETH?

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IS LEMON WATER GOOD FOR YOUR TEETH? Acidic drinks can erode teeth enamel, find out how to prevent this from happening

32

HOW YOUR DENTIST CAN HELP TREAT A COLD SORE Treatments are available that may prevent future flare-ups

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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

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PERIODONTAL DISEASE VS GINGIVITIS One of these can be reversed

CORRECT TOOTHBRUSH?

done first according to dental experts

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16

CANNABIS AND YOUR TEETH

18

TO PULL OR NOT TO PULL

DOES CHARC ACTUALLY WH TEETH?

COAL HITEN

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 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 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

CORRECT

TOOTHBRUSH?

“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 professor at the School of

it doesn’t really matter – as long as you floss.

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.

Dental picks are similar to interdental brushes.

UNCONTROLLED diabetes

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?

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

enamel loss.

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

acidic drink.

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

medications.”

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

contact.

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,

says.

cold sores can be prevented.

W

DEN

m abo

SEX

WHY

your

NTIST

may ask out your

LIFE

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

oral cancer.

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

oropharyngeal cancer.

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

ups.”

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.

vaccinated.

“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

she says.

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

gum disease.

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

your dentist”

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.

explained Campbell.

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.”

CANNABIS

TEETH

AND YOUR

Now that pot is legal, dentists

checking to see the level of

and dental hygienists are warning

impairment they have and

users that its use can have

whether or not they are able to

The oral health implications need

detrimental effects on your oral

give consent for treatment.”

to be taken into consideration as well. There are many negative effects that come with smoking cannabis says Sheppard. A more intense form of dry mouth develops as a cannabis user than a tobacco user. Cannabis

health.

The effects of smoking and Just like smoking tobacco,

vaping cannabis can begin as

smoking cannabis impacts your

quickly as within 30 minutes

teeth, gums, and mouth. Further,

and last up to 12 hours explains

if you’re coming in for a dental

Sheppard. Someone who is

visit, it may delay your cleaning

impaired by the drug will present

and treatment.

a higher heart rate and anxiety and may have difficulty following

“Smoking cannabis has the same

and remembering instructions.

effects as tobacco on your oral health. Also, if you have been

“We’re looking for signs and

using cannabis before an

symptoms of impairment,” says

appointment, we may have to

Sheppard. “If we need to use local

delay your treatment,” says

anesthetic during treatment, we

dental hygiene clinical professor

need to know when was the last

Alexandra Sheppard. “We ask all

time the patient used cannabis

our patients when they last

was. There may be interactions

consumed it because we are

with medications. It can affect

your treatment.”

stomatitis can develop where the roof of your mouth becomes red.

“Users may have more caries because they are eating more than usual,” she says, adding that most often the gums will also be inflamed. “Cannabis use increases food cravings, which increases the amount of time your teeth are exposed to sugar.

Making cannabis users higher risk to cavities, gum disease, and oral infections.”