Saturday, September 10, 2016

Smell Your Breath

 / by Dr Margaret Aranda /



 Yup. Smell your breath. Is it bad? That could be due to boiled eggs, garlic, onions or peridontitis. What is peridontitis?


Well, anytime you see a word with the ending or suffix "-itis," that means there's "inflammation" that could be deadly. The original medical derivation is from the Hebrew or Greek, who coined this medical condition, peridontitis.



Medical Conditions with a Word ending in "-itis:"







Image 1. Glossitis is swelling of the tongue. What is the most common cause of tongue swelling? It is dentures. Does it hurt? The patient's Chief Complaint is tongue soreness. A common medical condition associated with this 'beefy' tongue is Vitamin 12 deficiency. Medical students will enjoy the clinical aspects here, Image Courtesy:  #StanfordMedicine25.



So Let's Talk about Peridontal Disease

Peridontitis is inflammation of the gum area around the teeth, the peridontis. A quick look at the American Academy of Peridontology article entitled, "How to Keep a Healthy Smile for Life" states this:


"What you may not realize is that oral health is not just important for maintaining a nice-looking smile and being able to eat corn on the cob."



Image 2. Quality of Life is a Part of Good Oral Health. A smile is important for giving a great First Impression. It also makes us feel happy inside. People with bad teeth don't usually smile brightly because they are embarrassed by their teeth. Fully 25% of people over age 65 have lost their teeth and put dentures in bubbly stuff every night when they sleep. While this generation looses all their teeth less so than previously, the medical profession is still weighing in to wrap their arms around all the bad diseases that lead to death and can be caused by "bad teeth."




Risks and Complications of Peridontitis in Older Adults:


  • Gingivitis - swelling of the gums that can lead to peridontitis and loss of gum attachment, peridontal disease 
  • Peridontitis - inflammation of the gum, leading to receeding gums and exposed teeth bases; this leads to tooth and jaw bone loss
  • Heart disease - The Number One killer in the world
  • Atherosclerosis - hardening of the arteries
  • Decreased QoL - unable to actually smile
  • Forgetfulness - may inhibit a good preventive dental schedule
  • Stroke, or Cerebral Vascular Accident (CVA)
  • Diabetes - usually associated with chronic metabolic syndrome and heart disease
  • Dry mouth - decreased saliva as a lubricant disrupts the protective barrier to gums:teeth
  • Arthritis - may have adverse effects onQoL, hindering: "Activities of Daily Living, Mobility, and Instrumental Activities" (i.e., brushing the teeth) as described in the historic 1983 article by Sidney Katz, MD (1924 - May 4, 2012) in the Journal of the American Geriatrics Society
  • Cigarette smoking - toxic chemicals affect more than tooth color: QoL without a smile
  • Financial Considerations - reduced income from any source may put dental care to the side
  • Medications - may cause decreased saliva, due to unpredictable anticholinergic side effects
  • Treatment for decreased saliva - mouth swishes, sugarless gum and even artificial saliva
  • Postmenopausal women - increased risk of tooth decay and gum disease due to estrogen deficiency
  • Postmenopausal women and osteoporosis - osteoporosis eats away at the bones and probably the teeth, too. Further research may show that taking Hormone Replacement Therapy (HRT) decreases gum and tooth disease


Dental Replacements
  • Need - do we really need all the extreme dental work that is being given in America? I think it's time to increase our knowledge, given the voracity of dental hygiene 'un-knowledge.' I mean seriously, who talks about this topic? Doctors? I don't think doctors talk about nutrition or dental care nearly as much as they need to, given the debilitating chronic illnesses we suffer.
  • Questioning the System -  For culture change purposes, I'm going to be radical here. Why? Because age management principles teach doctors to guide patients in nutrition, exercise and diet so they are predisposed to less risk of getting heart disease, diabetes, and a stroke. All at once. Every day, someone is going to the Emergency Room to discover, "WoW. I had a heart attack. And I'm diabetic and I didn't even know it." That's not acceptable in American medicine. We're just better at Preventive Medicine and obviously we are still falling short. To change this scenario now, you have to question not only every morsel you put in your mouth: you need to question how meticulous you are with your dental hygiene and gum care.
  • Notes on Peridontitis - it's more common in patients with heart disease, diabetes and obesity. What the 'circle dynamics' show is that this is a vicious circle. You can stop it by paying attention to nutrition and meticulous dental care.

"I just don't want you to have a heart attack with bacteria in your teeth that goes up to your brain and throughout your entire body." -Dr Margaret Aranda

  • Dentures -  they are less common in the aging population than in previous decades. The denture-wearing group requires high self-maintenance and not all the aging can do ADLs
  • Dental Implants - don't need to use healthy, neighboring gums support a new implant. An implant is an artificial root to the tooth; it holds an artificial tooth or bridge in a way that leaves them synchronized with the gums and jaw bones. It feels more like a real tooth
  • Facial Structure - loss of teeth leaves the jaw muscles and skin many changes in structure that add to aging and adversely affect nutrition, especially in our elders


In the coming weeks, I'll be taking a closer look at common dental practices, with a specific slant: the effects on patients with an Invisible Illness. Because there's just so much more to know. In the meantime, please increase vigilance to keep your mouth free from being a bacteria-Festival.

I mean, care for your mouth even moreso now. 
Try to clean up shop if you could and just see how you can build on improvements.
 - talk to your doctor and dentist about meticulous dental care. 



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Dr Margaret Aranda is a Stanford alumni of anesthesiology and critical care. She and her beautiful daughter were in a tragic 2006 car accident that left Dr Aranda with dysautonomia, vertebral artery dissection, and traumatic brain injury. 🎀Her daughter is just fine. Dr Margaret Aranda is a Public Figure in Patient Advocacy for Invisible Illnesses, Teens and Ethics.


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