When Dr. Suman Reddivari gazes into the mouths of patients at Manchester Family Dentistry, he scans portraits of their eating, drinking and smoking habits, oral hygiene routines and overall health. He sees threats that can morph into serious, wallet-popping problems if not addressed.
Diets high in processed foods and sugar, Reddivari said, coupled with insufficient tooth and gum care and infrequent or non-existent dental checkups, are contributing to a rise in cavities — a universal ailment that must be treated before decay and infection progress to something worse.
Acidic beverages, such as soft drinks, energy drinks and seltzers flavored with fruit juice, higher rates of marijuana use, and an aging population taking multiple medications — sometimes a dizzying list — are leading to more complaints of dry mouth, he said.
That condition sounds harmless enough, but insufficient saliva causes a host of tooth and gum ailments and reduces someone’s ability to fight infection elsewhere in the body.
Dentists can be the first to spot emerging medical complaints. For instance, bruxism or teeth grinding can be a sign of sleep apnea, which interrupts breathing during sleep. A large tongue that covers a small throat opening is a risk. Sleep apnea, which Reddivari said he’s seeing more frequently, increases the risk of heart attacks and dementia.
“My job is not just treating teeth,” said the Manchester dentist. “It’s connecting the dots. All I can do is give (patients) a way to fix things or maintain things. As a dentist, the best thing I can do is educate people about their options. Dental treatment is expensive,” he said, “but the cheapest day is today” — before any condition becomes much more embedded and complex.
“People have to put importance on dental health,” he said. “That’s the biggest hurdle.”
Dr. Jeffrey Vachon of Vachon Dental in Manchester, president-elect of the New Hampshire Dental Society, said Americans overall seem to be more aware and attentive to oral health than decades ago, but he wishes they would take care of their mouths as much as they tend to their bodies.
COVID led to lapsed dental checkups and skipped or delayed procedures, he said, resulting in higher costs for correcting problems that simmered.
During periods of high inflation, economic uncertainty and belt tightening, dental care can drop to the bottom of the to-do list.
“I would love for a paradigm shift to prioritizing oral health as much as they do their overall, systemic health,” said Vachon. “That’s going to be the best for our population, regardless of what toothbrush they use.”
Teeth and gums usually, but not always, warn us with pain and recurrent bleeding when they’re ailing. But sometimes disease is brewing below the gums or inside the teeth in places we can’t see or feel.
Here’s a quick guide to common issues that warrant our attention.
Dry mouth
People are not always aware they have dry mouth until there’s a 70% reduction in saliva, said Reddivari.
At root is reduced saliva production. Saliva lubricates your mouth, protects your teeth, neutralizes acid, and helps fight decay and hold dentures in place. It makes it easier to speak and eat, according to the American Dental Association.
Smoking, vaping, alcohol and caffeine can worsen dry mouth. So can chemotherapy and radiation treatments for cancer. But a main and increasing cause is polypharmacy — or taking multiple medications for multiple conditions.
“Sometimes individual meds cause dry mouth,” said Vachon. “Sometimes it’s the interactions of medications.” About 400 medications can cause dry mouth, including some for anxiety, depression, high blood pressure, allergies and sinus congestion, according to the Journal of the American Dental Association.
People with diabetes or Alzheimer’s disease, those who’ve had a stroke, and people who smoke or chew tobacco may experience dry mouth. Regularly drinking alcohol or caffeinated beverages can aggravate it.
People who smoke marijuana may also drink soda, energy drinks and consume lots of snacks — “a deadly combo,” said Reddivari.
It’s important to tell your dentist about all the prescription and over-the-counter medications you’re taking.
Decay will start quicker and can become rampant, especially in older patients who take an assortment of medications, said Laura Cailler, a dental hygienist at Nashua Dental Associates. Despite good hygiene, new cavities can form under existing dental work because of a lack of saliva. Without adequate saliva, the mouth becomes more acidic, which hastens the break down of teeth and gums.
Products, such as Xylamelt tablets, stick to gum tissue for up to 8 hours and can help stimulate saliva production.
“Try to stay as hydrated as you can,” said Cailler.
The American Dental Association tells patients with dry mouth: Drink water throughout the day or suck on crushed ice. Chew or suck on sugar-free gum or candy. Limit or steer clear of hard-to-chew, spicy, or dry foods, including crackers and chips. Use lip balm, and try running a humidifier at night.
Sleep apneaAn estimated 30 million Americans, including children, are estimated to suffer from obstructive sleep apnea, which interrupts normal breathing and can have major health repercussions if not addressed.
For decades the standard treatment has been CPAP, an air-pumping machine connected by tubes to a face mask, which forces air into the windpipe while people sleep.
Compliance studies have shown that only 30% to 40% of people with CPAP continue to use them, said Dr. Stephen Cohen, a dentist at Nashua Dental Associates who is trained in sleep dentistry.
Dental appliances that pull back the jaw, allowing the tongue to relax without covering the throat, can be less cumbersome and better tolerated than CPAP, especially for patients with mild to moderate sleep apnea.
Dentists can’t officially diagnose sleep apnea, but they can spot signs in the mouth and consult with physicians who can order sleep studies and prescribe treatment options.
The 75 types of dental appliances currently on the market with FDA approval range in price from roughly $750 to $5,000, said Cohen.
The custom-made devices are adjustable. A patient’s teeth and jaws are monitored for position and bite — which doesn’t occur when you order a standard device online, he said.
“Pediatric sleep apnea is a real thing,” said Cohen. Parents need to observe and report their children’s symptoms, including snoring, teeth grinding, jaw pain, increased ear infections and strep throat, he said.
Impacted wisdom teethAccording to the Mayo Clinic and Cleveland Clinic, wisdom teeth — our third molars — typically emerge between ages 17 and 26, and not everyone develops them. About 53% of the general population has at least one wisdom tooth.
A partially impacted wisdom tooth shows some of its crown. A fully impacted wisdom tooth never breaks through the gums. Wisdom teeth can grow sideways into a neighboring tooth, straight up or down, or horizontally within the jawbone.
Complications include infections, decay, wisdom teeth that are hard to reach or clean, adjacent teeth that need straightening, and cysts that threaten the jawbone.
Symptoms of ailing wisdom teeth include red, swollen, tender or bleeding gums, pain and swelling around the jaw, bad breath or a bad taste in your mouth, or difficulty opening your mouth.
Dental x-rays at regular intervals can spot impacted wisdom teeth before any symptoms start. There’s no need to remove them if they’re not causing problems.
A perfect white smile or else
Photoshopped smiles on social media and Hollywood actors and singers with beautiful teeth have led to a higher demand for white smiles, especially among people in their 20s and 30s.
“If you’re seeing someone on TV with perfect teeth, it’s usually because they’re not real,” said Cailler at Nashua Dental. “You’re seeing such a polished version.”
In general, genetics determines the color of your teeth, and some medications, food and beverages can darken them.
Whitening toothpastes that feel gritty can be too abrasive to use daily and “they don’t whiten all that much,” said Cailler. If whitening is important to you, try using a white strip or true whitening product every day for two weeks. Tooth sensitivity can develop, but typically goes away within a few days of stopping the product.
Cailler recommends a single day, 90-minute whitening treatment in a dentist’s office instead. Your teeth willl “stay pretty white for quite a while, but it does depend on how much coffee, tea or red wine you drink. If you’re a heavy coffee, tea or red wine drinker, you’re going to see them discolor quicker,” she said.
Veneers are an alternative, but they can cost $2,000 per tooth, require shaving some of the tooth’s enamel, aren’t necessarily permanent, and require regular preventative hygiene at home.
The root of the problemRoughly 15 million root canals are performed yearly across the U.S., according to the Cleveland Clinic.
“People are wanting to save their teeth more and root canals are a way to do that,” said Vachon at the Dental Society.
Root canal procedures remove inflamed or infected pulp on the inside of a tooth, which is then cleaned, disinfected, filled and sealed. The goal is to eliminate bacteria from the tooth’s root canal, prevent reinfection and salvage the natural tooth.
According to the American Association of Endodontists, root canals are often needed for cracked teeth, deep cavities and decay and infection simmering under previous fillings. The treatment is similar to getting a filling, and saving the tooth helps preserve normal chewing, bite force and tooth sensation.
Generally, restoring the tooth is less expensive than extracting and replacing it with an implant or bridge.
Putting off a necessary root canal raises the risk of losing the tooth and infection spreading to your jawbone or other teeth.
Implants are on the rise, Vachon said, as fewer patients seek full or partial removeable dentures to replace teeth that fall out or need to be pulled, and as the technology improves.
Implants can cost up to $6,000 per tooth and typically involve an extraction, bone graft, the implant and a crown to restore normal appearance and proper bite.
The procedure can head off jaw bone infection and bone less. It boils down to personal preferences and finances.
Implants last 10 to 15 years with proper care, said Vachon. “You still need to brush and floss” and pay close attention to the gum around the implant, he said.
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