This is the first post on various disease processes and their effects on oral health. Not to be redundant, but oral health and general health are inextricably linked. Regular preventive and therapeutic dental hygiene is vitally important for those undergoing cancer treatment, hospitalized as they recovery from injury or surgery, or are otherwise unable to visit their dental hygienist or dentist.

Mesothelioma

Mesothelioma is a form of cancer. It is most often caused by asbestos exposure. When being treated for the disease, patients may undergo radiation therapy or chemotherapy. This article will discuss the process the human body must endure during the radiation process. The impact on a patient's oral health will also be discussed.

Causes

Malignant mesothelioma cancer is most often caused by asbestos exposure. Asbestos is a naturally-occurring mineral. Breathing asbestos fibers causes the mineral to lodge in the lung tissue. This is especially likely to happen if a person is exposed to the mineral frequently over a lengthy period. Once the fibers are in the lungs, they can get into the mesothelium, a membrane inside a patient's chest. The disease can also originate in the area around the patient's heart. The cancerous cells may spread to other areas of the body.

Radiation Treatment

The purpose of radiation therapy is to kill cancerous cells and also to shrink tumors. The radiation can be administered either inside the patient's body or outside. During the internal radiation process, the healthcare professional will take a radioactive substance and insert it into the patient's body. In most cases, the substance is inserted using a catheter, needle or wire. During the external radiation process, the healthcare worker will use a machine to send the treatment into the body.

Radiation can be effective in treating cancerous cells. However, the downside is that radiation can also damage a patient's healthy cells. Some of the most common side effects caused by radiation therapy are fatigue and hair loss. Some patients report problems with sexual intercourse and also infertility. Skin rashes and blurry vision are common, too. Other side effects are headaches, urinary tract problems, swollen body parts, nausea, vomiting and difficulty swallowing.

Oral Health and Radiation

About 1/3 of cancer patients report oral health concerns due to their cancer treatment plan. Receiving radiation treatments to the head or the neck can make a person even more susceptible to dental problems. Radiation treatment can cause the patient's mouth to become dry, which increases the risk of getting cavities. Swelling may occur in the gums, which makes it hard for those with dentures to wear their false teeth. Sores may also appear in the mouth, which creates difficulty swallowing and chewing.

Dental experts recommend that a patient take certain precautionary measures before, during and after radiation treatment. For instance, the patient should brush the teeth 2-3 times per day using a soft-bristled brush. Using non-abrasive fluoride toothpaste is most often recommended. The patient should consult with a physician or dental professional before deciding to floss, as flossing could irritate gums, especially if they are already swollen or if other dental problems exist. GUM Soft-Picks,
the Quip electric toothbrush, and Peroxyl Oral Rinse are but a few of the products that can gently help patients with sensitive teeth and gums maintain good oral health.

Avoiding spicy foods can reduce gum irritation, and avoiding sugary products can help prevent dental plaque and tooth decay.

It is also recommended that the patient rinse the mouth several times per day using water and baking soda. To do this, mix one teaspoon of baking soda together with a quart of water. This solution is supposed to reduce gum soreness. It is also important that the patient not use tobacco products. Tobacco can irritate gums and additional oral sores.

As stated previously, radiation therapy can be used to fight malignant cells. While this invasive therapy can shrink tumors and combat them, it can produce some unwanted side effects. Follow your doctor's guidelines to help minimize your chances of experiencing heavy side effects. Make sure that you have regular visits with your dentist or dental hygienist to treat your oral health problems, too.

With dental need at an all time high in California and access to dental care decreasing, local programs are using the Tobacco Tax funds to find ways to increase access to preventive dental and dental hygiene care in their communities. Dental hygienists (RDH) and dental hygienists in alternative practice (RDHAP) are in high demand. Qualified dental hygiene practitioners are encouraged to call Susan and see how we can be of service.

The following was composed by Susan McLearan, RDH, RDHAP, MS, for placement in the Journal of the California Dental Hygienists' Association. She allowed me to post is also in my blog, hoping to reach dental hygienists.

CDHA sent e-mails to the 52 counties/jurisdictions that are eligible for Proposition 56 (Tobacco Tax) funding for a Local Oral Health Program funded through the Office of Oral Health. Twenty two responses were received describing the projects in various stages of development and giving some ideas as to what their needs might be. The respondent reported that the most have hygienists on their advisory boards and several are already using hygienists in their programs.

Rural areas are most in need of help. There is a particular need for hygienist Medi-Cal Dental providers to work part time. Some would want hygienists to contract with the county, others would have hygienists contract directly with schools.

The following jurisdictions have been identified as wanting hygienists to consider their programs.
Alpine                                               Mariposa                                         Orange
Berkeley                                           Placer                                              San Diego
Calaveras                                        San Bernardino                                Solano
Humboldt                                         San Luis Obispo                              Trinity
Lassen                                            Santa Barbara                                  Tulare

Although the type of services, length of the need, and meas of payment will vary, it might be worthwhile to make inquiries in the area near you. For example, Placer County reports that they pay RDHs and RDHAPs quite well on an hourly basis. They are not required to do "the paperwork". They project director feels that what they offer might be good for someone who works in an office 4 days a week but want to make some extra money now and then. They will have quite a few days this Fall for screenings and fluoride varnish applications for preschools and kindergartners.

If you wish to learn more about potential opportunities and need a contact person, please e-mail Susan McLearan at smclearan@gmail.com

I have become a reluctant blogger. :-/ There is such need for the services of advanced dental hygiene clinicians, it is hard to 'pick a lane' or topic to write about services we can perform. However, today I found this article "Why Little Teeth Matter, written in Dimensions of Dental Hygiene, a journal for dental hygiene professionals, I thought was relevant and understandable, even if you are not a dental hygienist.

To make a long story short, if you have little ones, ask your dentist if he or she will be your baby's Dental Home. A Dental Home is just what it sounds like, a place where you can take your small child for dental care, if needed. When would that be?

• Toddlers fall.
• They can bang up their tiny teeth.
• Teeth come in, sometimes slowly.
• Teeth fall out.
• Sometimes they don't and need a dentist's help.

Basically, when your toddler needs a dentist or you, as a parent, have a question, a dental home is a place you can call, who knows your child and whom you child knows.

Sometimes your dentist does not want to be your baby's dental home. That is understandable. Some dental offices are not 'child friendly'. They may refer you to a pediatric dentist. Ask your pediatrician if he or she can be a dental home until your child can be seen by the dentist. Some pediatricians and their staff members are trained to  provide visual oral health screenings, provide oral hygiene instruction, and place fluoride varnish to prevent tooth decay. 

In the early stages of life, children need dental disease prevention. I started this post with the title "Caries prevention starts by protecting the first tooth". As soon as your baby's first tooth comes in, you should begin caring for it, keeping it clean, strengthening it with fluoride, and learning how to keep it and all next 19 primary (baby) teeth that come in healthy and cavity free. Yes. it can be done. Cavities are not inevitable. Our goal, as oral health providers, is to help your child never get a cavity.  

Call an RDHAP. He or she may be able to come to your home to provide this education and preventive care. An RDHAP is a dental hygienist licensed to work outside the traditional dental practice, caring for the oral health of patients unable to get dental hygiene care in the traditional office setting. Look on our "I Need an RDHAP" map for an RDHAP near you.

Aging comes with many challenges. Among them is maintaining good oral health. It seems that when we are young there is an emphasis on daily brushing with fluoridated toothpaste and consuming less sugar to reduce the risk of tooth decay. However, as we age, both of these decay preventive strategies seem to be put on the back burner. Why is this?

Below is an overview of the common reasons tooth decay or caries increases as we age. They include:

• Skimping on professional dental and dental hygiene care
• Dry mouth
• Dietary changes
• Decreased ability to manage optimal oral self care
• Root caries/Abfraction

Skimping on professional dental and dental hygiene care
Upon retirement, if you were lucky enough to have dental insurance prior to retiring, this benefit often gets dropped from retirement insurance coverage. Private dental insurance is available, but is notoriously pricey. As a dental hygienist in private practice, I have seem many patients who previously made regular preventive visits to the dentist, then start stretching them out and put off needed restorative care after retirement. Further, when our budgets get tight, professional dental care tends to get sidelined. It should not. Oral health is linked to general health. Maintaining a regular routine of preventive dental and dental hygiene care is as important as regular visits to the MD.

Dry mouth
Many medications have the side effect of reduced saliva or the feeling of a dry mouth, called xerostomia. Medications that commonly cause dry mouth include antihistamines, antidepressants, muscle relaxants, diuretics, and decongestants, to name a few. Other processes that can contribute to the reduced saliva flow include Sjogren's Disease, salivary gland dysfunction, cancer treatment, normal aging, and even snoring and mouth breathing. Why is this important to know?

Saliva plays an important role in maintaining our oral health. Saliva contains many minerals that assist in digestion. It keeps the mouth moist to assist chewing and swallowing. Saliva has antibacterial qualities, helping to keep our oral tissues healthy. Minerals in the saliva are key to maintaining a neutral pH in the mouth. If the pH becomes too acidic, minerals are pulled from the tooth in order to neutralize the pH. If the saliva is too acidic for an extended period of time, mineral loss (called demineraliziation) will outpace minerals being redeposited (remineralization), leading to tooth decay. There are, however, many ways to reduce the effects of a dry mouth. Dry mouth can be difficult to treat and there is often no cure. An oral health professional can help patients learn to manage dry mouth and maintain a more neutral saliva pH.

Dietary changes
We all know what we should eat and drink to reduce the risk of tooth decay - fresh fruits and vegetables, complex carbohydrates, unsweetened beverages and limit the processed sugar. Why don't we do that as we age? Several reasons come to mind. However, those elderly who seem to have the most cariogenic (cavity causing) diets are those who are bed or home bound, living in assisted living situations and not in control of their own diets, as well as those on limited incomes.

Those of us who have the choice and ability to choose healthy foods can still make poor choices. It is those who lack that ability who need the help of oral health care professionals to guide them to clean their teeth better and make better choices when possible.

Decreased ability to manage optimal oral self care
As we age, we need to change the way we brush and clean our teeth. The brushing technique we learned as children needs to be adapted to adult teeth and gums. Good oral self care is challenging for the healthy individual (how many of us love to floss?), and it takes time (two minutes brushing your teeth sounds like a long time). Becoming forgetful, possibly unable to stand and concentrate on our oral hygiene for 2-3 minutes, or having arthritic issues that make managing a toothbrush and dental floss difficult can create a situation where oral health begins to suffer. 

Root caries/Abfraction
Tooth decay along the gumline is the most challenging to treat and prevent. Abfraction is the breaking down of the tooth at the gumline for reasons unknown. We do know that the root surface is much softer than the enamel, so the patient who grew up with generally healthy teeth can become very prone to tooth decay on the root surfaces. The best advise from oral health care professionals is to have the roots checked regularly. The RDHAP can provide preventive care and place small temporary restorations that may slow down or stop the progress of decay until the patient can see his or her dentist..

So now what?
Tooth decay can happen very fast if the issues I have described converge. A visit to the dentist or dental hygienist is important to help identify any dental or oral hygiene issues a patient is having. These professionals can help guide the patient and/or caregiver to create new routines and strategies to help protect the oral health of the patients. 

If you or your loved one is elderly and challenged to get to a traditional dental office, we have a solution. The RDHAP is a private practicing dental hygienist who can come to your home and help you maintain your oral health. Go to the Map to find an RDHAP in your area.


Turner MD, Ship JA. Dry mouth and its effects on the oral health of elderly people. JADA. 2007. Accessed at https://jada.ada.org/article/S0002-8177(14)62738-0/fulltext