Biofilm – what is it?

What Is Biofilm?

biofilm teethYou may not be familiar with the term biofilm, but it is something that you come into contact with every day. The plaque that forms on your teeth and causes tooth decay and periodontal disease is a type of biofilm. Clogged drains also are caused by biofilm, and you may have encountered biofilm-coated rocks when walking into a river or stream.

Biofilms form when bacteria adhere to surfaces in some form of watery environment and begin to excrete a slimy, gluelike substance that can stick to all kinds of materials–metals, plastics, soil particles, medical implant materials, biological tissues. Biofilms can be formed by a single bacterial species, but biofilms more often consist of many species of bacteria, as well as fungi, algae, protozoa, debris, and corrosion products. Essentially, a biofilm may form on any surface exposed to bacteria and some amount of water.1

Dental plaque is a yellowish biofilm that builds up on the teeth.

Dental plaque is a yellowish biofilm that builds up on the teeth. Biofilms contain communities of disease-causing bacteria and their uncontrolled accumulation has been associated with cavities and gum disease (both gingivitis and periodontitis).1,3

In the past, scientists studied bacteria by looking through a microscope at cells suspended in a water droplet. Today, scientists believe that the disease-causing bacteria do not exist as isolated cells, such as in the water droplet, but rather they adhere to various wetted surfaces in organized colonies that form diverse communities–biofilms.

Where Biofilms Form

Biofilms happily colonize many household surfaces in the bath and kitchen, including toilets, sinks, countertops, and cutting boards. Poor disinfection practices and ineffective cleaning products may increase the incidence of illnesses associated with pathogenic organisms encountered during normal household activity.

How Biofilms Form

  • Free-swimming bacterial cells land on a surface, arrange themselves in clusters, and attach.
  • The cells begin producing a gooey matrix.
  • The cells signal one another to multiply and form a microcolony.
  • The microcolony promotes the coexistence of diverse bacterial species and metabolic states.
  • Some cells return to their freeliving form and escape, perhaps to form new biofilms.

Antibiotic Control of Biofilm

Although gum disease can be controlled by proper oral hygiene (toothbrushing, flossing, rinsing), gingivitis (the mildest form) is still experienced by most of the US population at some point in life; a smaller proportion (30% to 40%) experience periodontitis (the severe form). Treatment of oral infections requires removal of the biofilm and calculus (tartar) from the teeth and gums by surgical or nonsurgical procedures, followed by antibiotic therapy. Unfortunately, these infections are not completely responsive to antibiotics. For this reason, oral infections are chronic diseases that require ongoing treatment and daily care by proper oral hygiene measures. Prevention is the best strategy.2

Oral infections are chronic diseases that require ongoing treatment and daily care.

Chemical Control of Biofilm

When good oral hygiene practices fail to prevent the development of biofilms, toothpastes and mouthwashes with chemotherapeutic agents can be used. These agents can kill microorganisms in the biofilm. Chlorhexidine, triclosan, and essential oils and minerals–agents proven to kill the harmful bacteria–can reduce the degree of plaque and gingivitis, while not allowing disease-causing microorganisms to colonize.3

Biofilm and Your Health

Biofilms are highly resistant to antibiotics. Consequently, very high and/or long-term doses are often required to eradicate biofilm-related infections. Biofilms are responsible for diseases, such as4:

  • Otitis media the most common acute ear infection in US children
  • Bacterial endocarditis infection of the inner surface of the heart and its valves
  • Cystic fibrosis a chronic disorder resulting in increased susceptibility to serious lung infections
  • Legionnaire’s disease an acute respiratory infection resulting from the aspiration of clumps of Legionnella biofilms detached from air and water heating/cooling and distribution systems
  • Hospital-acquired infections infections acquired from the surfaces of catheters, medical implants, wound dressing, or other medical devices

Is Biofilm on Your Oral Appliances?

In addition to biofilm being present in the mouth, it also forms on dental prostheses and appliances, such as removable dentures and partials, mouthguards, and nightguards. Dental prostheses can become colonized with large numbers of microorganisms within 2 hours. Biofilm on your oral appliances and prostheses can increase your risk for cavities and gum disease, especially on the teeth used to maintain your dental prosthesis in your mouth.5

4 Tips to Control Biofilm

  • Brush your teeth and all mouth prostheses or appliances to mechanically disrupt the biofilm. Choose a toothpaste containing antibacterial ingredients, such as triclosan.
  • Rinse your mouth with a mouthwash containing antibacterial ingredients, such as chlorhexidine, cetylpiridinium chloride, or mixture of essential oils in alcohol.
  • Soak your prosthesis with a commercially available cleaner.
  • If your denture liner is cracked, porous, or peeling, ask your dentist to repair it. To eliminate unwanted diseasecausing organisms, ask your dentist to replace your prosthesis every 7 years.

Understanding Gum Disease

What is Gum Disease?

Gum disease is an inflammation of the gums that can progress to affect the bone that surrounds and supports your teeth. It is caused by the bacteria in plaque, a sticky, colorless film that constantly forms on your teeth. If not removed through daily brushing and flossing, plaque can build up and the bacteria infect not only your gums and teeth, but eventually the gum tissue and bone that support the teeth. This can cause them to become loose, fall out or have to be removed by a dentist.

There are three stages of gum disease:

  • Gingivitis: this is the earliest stage of gum disease, an inflammation of the gums caused by plaque buildup at the gumline. If daily brushing and flossing do not remove the plaque, it produces toxins (poisons) that can irritate the gum tissue, causing gingivitis. You may notice some bleeding during brushing and flossing. At this early stage in gum disease, damage can be improved, since the bone and connective tissue that hold the teeth in place are not yet affected.
  • Periodontitis: at this stage, the supporting bone and fibers that hold your teeth in place are irreversibly damaged. Your gums may begin to form a pocket below the gumline, which traps food and plaque. Proper dental treatment and improved home care can usually help prevent further damage.
  • Advanced Periodontitis: in this final stage of gum disease, the fibers and bone supporting your teeth are destroyed, which can cause your teeth to shift or loosen. This can affect your bite and, if aggressive treatment can’t save them, teeth may need to be removed.

How do I Know if I Have Gum Disease?

Gum disease can occur at any age, but it is most common among adults. If detected in its early stages, gum disease can be improved so see your dentist if you notice any of the following symptoms:

  • Gums that are red, puffy or swollen, or tender
  • Gums that bleed during brushing or flossing
  • Teeth that look longer because your gums have receded
  • Gums that have separated, or pulled away, from your teeth, creating a pocket
  • Changes in the way your teeth fit together when you bite
  • Pus coming from between your teeth and gums
  • Constant bad breath or a bad taste in your mouth

How is Gum Disease Treated?

  • The early stages of gum disease can often improve with proper brushing and flossing. Good oral health will help keep plaque from building up.
  • A professional cleaning by your dentist or hygienist is the only way to remove plaque that has built up and hardened into tartar. Your dentist or hygienist will clean or “scale” your teeth to remove the tartar above and below the gumline. If your condition is more severe, a root planing procedure may be performed. Root planing helps to smooth irregularities on the roots of the teeth making it more difficult for plaque to deposit there.

By scheduling regular checkups, early stage gum disease can be treated before it leads to a much more serious condition. If your condition is more advanced, treatment in the dental office will be required

Healthy Gums – healthy gums are firm and don’t bleed. They fit snugly around the teeth.
Gingivitis – gums are mildly inflamed, may appear red or swollen and may bleed during brushing.
Periodontitis – gums begin to separate and recede from the teeth. This allows plaque to move toward the roots, supporting fibers and bone.
Advanced Periodontitis – supporting fibers and bone are destroyed. Teeth become loose and may need to be removed.

If you are concerned about gum disease, call  Dr. Jeffrey Fester in Roswell, GA 770.587.4202 for a free consultation!

, ,

Fillings – Crowns – Root Canals

Lost Filling Or Crown

Fillings, which are materials used to fill cavities in the teeth, and crowns, which slip over and cover the tops of damaged teeth, sometimes loosen and fall out. This is rarely an emergency, but it can be painful because the exposed tooth tissue is often sensitive to pressure, air or hot and cold temperatures. In some cases, a filling or crown may come loose because decay has developed underneath it. The decay can cause the tooth to change shape and as a result, the crown of filling no longer fits the tooth properly.

What You Can Do

You may be eating, or biting on something hard when you discover that a filling or a crown has become lose or fallen out. You may feel the lost filling or crown in your mouth.

If it’s a crown, put it in a safe place and make an appointment to see your dentist as soon as you can. You don’t want to wait too long because the tooth will be weak and could be damaged more if it is not protected by the crown. Also, when a crown is missing for a long time, your teeth may move. If this happens your crown may no longer fit.

If the tooth is sensitive and you can’t get to your dentist right away, here’s what you can do:

  • If you can reach the sensitive area, apply a little clove oil with a cotton swab. It works well to dull tooth pain. You can buy clove oil in pharmacies and also in the spice aisle of many supermarkets.
  • If you have the crown, you may be able to slip it back over the tooth. Before you do that, it’s important to clean the inside of the crown as best you can. To hold it in place temporarily, coat the inner surface of the crown with tooth “cement,” which you can buy in the dental section of your pharmacy. There are several temporary cements available. Some need to be mixed; others come ready to use. You also can use denture adhesive or even petroleum jelly if nothing else is available. These aren’t permanent solutions, but they will help to hold the crown in place until you can see your dentist. You should not use any household glues to hold the crown in place. These products are not safe to put in your mouth and can damage the tooth and crown.
  • If you’ve lost the filling or crown, you can use over-the-counter dental cement to cover the tooth surface. This will help to protect and seal the area until you’re able to see your dentist, and can make you more comfortable.

What Your Dentist Will Do

If the tooth is structurally sound and the crown still fits properly, your dentist will clean the area and then replace the crown.

If the tooth has been affected by decay, your dentist will need to prepare the tooth again by removing the decay and then making a new filling or crown to replace the old one.

If you are concerned about a loose filling or crown, call  Dr. Jeffrey Fester in Roswell, GA 770.587.4202 for a free consultation!

,

Tooth Sensitivity

Tooth Sensitivity – Overview

Tooth sensitivity is due to the exposure of dentin, the part of the tooth which covers the nerve, either through loss of the enamel layer or recession of the gums. Temperature changes and certain foods (acidic or sweet) can cause the tooth or teeth to be painful. The pain usually subsides after a short period of time.

The dentin contains a large numbers of pores or tubes that run from the outside of the tooth to the nerve in the center. When the dentin is exposed, these tubes can be stimulated by changes in temperature or certain foods. Here is an image of what the dentin tubes look like under the microscope:

The dentin contains a large numbers of pores or tubes that run from the outside of the tooth to the nerve in the center. When the dentin is exposed, these tubes can be stimulated by changes in temperature or certain foods. Here is an image of what the dentin tubes look like under the microscope:

Tooth dentin

The best way to find out why a tooth is sensitive is to have dental professional examine you. They can look for the signs of dentin exposure, and run tests to determine what the true cause of the sensitivity is. Sometimes, the sensitivity is due to a cavity or gum disease – these can be treated to address the sensitivity. Other times, the cause of the sensitivity is because the enamel has been lost through abrasion or erosion, or the gums have receded, causing the roots to be exposed.

What Can Be Done?

If the sensitivity is due to a cavity, a restoration can be placed. If gum disease is the cause, the dental professional can perform a thorough cleaning of the area.

However, if the cause is from dentin being exposed, then there are a number of professional and at home treatments that can be used to reduce the sensitivity.

  • In Office Procedures:
    • Fluoride varnish can be applied to exposed areas, strengthening the enamel and dentin
    • Fluoride foam or gel can be placed into a mouth tray; you then sit with this in your mouth for 3-5 minutes, providing the teeth with a high concentration of fluoride to strengthen the areas
    • Bonding agent, the material used to stick tooth colored restorations to teeth, can be used to seal the dentin surface and provide a barrier to the stimuli that cause sensitivity
  • At Home:
    • Use a very soft bristle tooth brush, with low abrasive tooth paste
    • Brush correctly and do not over brush
    • Use a tooth paste specially formulated to soothe the nerve endings in the tooth
    • Use a high concentration fluoride toothpaste (given to you by the dental professional) to strengthen the tooth surface

There are a number of treatments available, and Dr. Jeffrey Fester can help you find those that will work best, depending on your situation. Always seek a dental professional’s help – do not try to diagnose this problem yourself. It may be the sign of something more serious, and only a dental professional can tell you what it really is.

If you are experiencing tooth sensitivity, call  Dr. Jeffrey Fester in Roswell, GA 770.587.4202 for a free consultation!

How To Floss – Flossing Tips

What is the Right Way to Floss?

Proper flossing removes plaque and food particles in places where a toothbrush cannot easily reach — under the gumline and between your teeth. Because plaque build-up can lead to tooth decay and gum disease, daily flossing is highly recommended.

To receive maximum benefits from flossing, use the following proper technique:

  • Starting with about 18 inches of floss, wind most of the floss around each middle finger, leaving an inch or two of floss to work with
  • Holding the floss tautly between your thumbs and index fingers, slide it gently up-and-down between your teeth
  • Gently curve the floss around the base of each tooth, making sure you go beneath the gumline. Never snap or force the floss, as this may cut or bruise delicate gum tissue
  • Use clean sections of floss as you move from tooth to tooth
  • To remove the floss, use the same back-and-forth motion to bring the floss up and away from the teeth

What Type of Floss Should I Use?

There are two types of floss from which to choose:

  • Nylon (or multifilament) floss
  • PTFE (monofilament) floss

Nylon floss is available waxed and unwaxed, and in a variety of flavors. Because this type of floss is composed of many strands of nylon, it may sometimes tear or shred, especially between teeth with tight contact points. While more expensive, single filament (PTFE) floss slides easily between teeth, even those with tight spaces between teeth, and is virtually shred-resistant. When used properly, both types of floss are excellent aremoving plaque and debris.

If you would like to learn more about dental care, call  Dr. Jeffrey Fester in Roswell, GA 770.587.4202 for a free consultation!

, ,

Tooth Discoloration

What Is It?

Your teeth can become discolored by stains on the surface or by changes in the tooth material. Dentists divide discoloration into three main categories:

  • Extrinsic discoloration — This occurs when the outer layer of the tooth (the enamel) is stained by coffee, wine, cola or other drinks or foods. Smoking also causes extrinsic stains.
  • Intrinsic discoloration — This is when the inner structure of the tooth (the dentin) darkens or gets a yellow tint. Causes include excessive exposure to fluoride during early childhood, the maternal use of tetracycline antibiotics during the second half of pregnancy and the use of tetracycline antibiotics in children 8 years old or younger.
  • Age-related discoloration — This is a combination of extrinsic and intrinsic factors. In addition to stains caused by foods or smoking, the dentin naturally yellows over time. The enamel that covers the teeth gets thinner with age, which allows the dentin to show through. Chips or other injuries to a tooth can also cause discoloration, especially when the pulp has been damaged.

In rare cases, children with a condition called dentinogenesis imperfecta are born with gray, amber or purple discolorations.

Symptoms

Symptoms include stains on the enamel or a yellow tint in the dentin.

Diagnosis

No special tests are needed. A dentist can diagnose tooth discoloration by looking at the teeth.

Expected Duration

Some tooth discoloration can be removed with professional cleaning, but many stains are permanent unless the teeth are treated (whitened) with a bleaching gel.

Prevention

Brushing your teeth after every meal will help to prevent some stains. Dentists recommend that you rinse your mouth with water after having wine, coffee or other drinks or foods that can stain your teeth. Regular cleanings by a dental hygienist also will help to prevent surface stains.

Intrinsic stains that are caused by damage to a nerve or blood vessel in the inner part (the pulp) of a tooth sometimes can be prevented by having root canal treatment, which removes organic material before it has a chance to decay and darken. However, teeth that undergo root canal treatment may darken anyway. To prevent intrinsic stains in children, avoid water that contains a high fluoride concentration. You can check the concentration of fluoride in your drinking water supply by calling the public health department. Then consult your dentist.

Treatment

Discoloration often can be removed by applying a bleaching agent to the enamel of the teeth. With a technique called “power bleaching,” the dentist applies a light-activated bleaching gel that causes the teeth to get significantly whiter in about 30 to 45 minutes. Several follow-up treatments may be needed.

It’s also possible to remove discoloration with an at-home bleaching gel and a mouth guard given to you by your dentist. The bleaching gels designed for use at home aren’t as strong as those applied by your dentist, so the process takes longer — usually two to four weeks. Whitening toothpastes may remove minor stains, but they aren’t very effective in most cases.

If you’ve had a root canal and the tooth has darkened, your dentist may apply a bleaching material to the inside of the tooth.

When a tooth has been chipped or badly damaged or when stains don’t respond to bleaching, your dentist may recommend covering the discolored areas. This can be done with a composite bonding material that’s color-matched to the surrounding tooth. Another option is to get veneers, which are thin shells of ceramic that cover the outer surfaces of the teeth.

When To Call a Professional

Tooth discoloration is mainly a cosmetic problem. Call a dentist if you’re unhappy with the appearance of your teeth. Any change in a child’s normal tooth color should be evaluated by a dentist.

Prognosis

The prognosis is very good for extrinsic stains. Intrinsic stains may be more difficult or take longer to remove.

If you are concerned about tooth discoloration, call  Dr. Jeffrey Fester in Roswell, GA 770.587.4202 for a free consultation!

,

Stress and TMJ

Your Temporomandibular Joints (TMJ) on both sides of your lower jaw. These joints connect your lower jaw to your skull and allow you to move your lower jaw back and forth, up and down, and side to side. While very useful and necessary for chewing and speaking, the TMJ is a sensitive joint. Tense facial muscles or a misaligned bite can cause chronic pain in the TMJ area, which along with various other symptoms is known as Temporomandibular Joint Disorder (TMD).

TMJ SymptomsTMJ

Some of the symptoms that can be caused by your TMJ include:

  • Aching pain around your TMJ and your ears
  • Tension or migraine headaches
  • Back, neck, and shoulder pain
  • Popping or clicking of your jaw
  • Clenching or grinding teeth
  • Ringing in your ears
  • Difficulty opening and closing your mouth
  • Facial discomfort or tender muscles

Any of these TMJ symptoms can be made aggravated by talking, chewing, yawning, or even opening your mouth too wide. Many patients discover that they cannot open their mouths very wide due to pain. Patients who suffer from migraine like headaches may be unable to function because the pain is so great.

Stress is often a symptom that affects the TMJ and causes pain and discomfort in the face, neck, and upper back. There is a direct correlation between stress and TMJ symptoms.

People who have a great deal of stress due to a hectic family life or rigorous work schedule may unknowingly clench their jaws. Clenching of the jaws can fatigue facial muscles and lead to pain around the TMJ and jawbones. People with other symptoms affecting their TMJ may feel stressed that they are in pain all the time and begin to clench their jaws leading to more pain in their TMJ. Stress can be the beginning of an endless cycle involving the TMJ.

Treating Your Stress and TMJ

A knowledgeable dentist can help eliminate the pain and treat the cause of your TMJ symptoms. The treatments that are right for you depend on your specific needs. You may need one treatment or a combination of treatments to correct your TMJ.

There are many TMJ treatment options available. Most patients find relief with non-surgical treatments while a few patients require TMJ surgery. The treatments used for stress that affects the TMJ include:

  • Stress management therapy
  • Facial muscle relaxation exercises
  • Oral therapy appliances to relieve tension on the jaw muscles
  • Cold and hot compresses
  • A TENS unit
  • Correction of the alignment of your upper and lower jaws

For more information – contact Dr. Fester in Roswell. (770) 587-4202