One of the many subdivisions of the Kurpis Center for Advanced Dentistry is the Oral Systemic Evaluation Center. In response to growing scientific evidence linking periodontal disease with other diseases and conditions in the body, we founded the Oral Systemic Evaluation Center as a way to address this very important connection between the health of the mouth and the health of the body. Our dental facility is dedicated to the diagnosis and treatment of chronic oral inflammation and dental pathology in order to improve oral health and general health. One of our main areas of focus is to eliminate oral infections and inflammation associated with periodontal disease, thereby reducing the overall inflammatory burden on the body. We believe that through proper dental treatment, potential progression and complications associated with many medical conditions may be minimized.
To learn more the oral systemic connection, please visit our other website, www.oralsystemicevaluationcenter.com, or click on the link below.
Do you suffer from a dry mouth? Do you often wake up at night with a dry mouth or throat? Are you continually licking your lips or drinking fluids in an effort to moisten your mouth? If so, you may be suffering from xerostomia.
Xerostomia, more commonly known as dry mouth, is a significant condition resulting from poorly functioning salivary glands. When there is not enough saliva in your mouth, it can be difficult to eat and speak properly. Saliva lubricates and protects your mouth and teeth, and a reduction in saliva can lead to an array of oral health problems. While xerostomia affects nearly 25 percent of adults 65 years of age and older, rates can reach as high as 50 percent in some elderly populations. Xerostomia, however, is not simply a result of the normal aging process. Certain medical conditions and prescription medications lead to salivary gland hypofunction, causing a reduction in saliva output. Xerostomia should never be ignored because lack of adequate saliva can be detrimental to your oral health and overall wellbeing.
If you believe you may be suffering from dry mouth, it is time to seek treatment at the Kurpis Center for Advanced Dentistry. We recognize the warning signs of xerostomia and know how to treat patients suffering from this condition. We offer a treatment regimen to address the problems associated with dry mouth and work to protect your mouth from the side effects of reduced saliva. Come in for an evaluation and learn what our doctors can do to help manage your dry mouth.
There are numerous oral and systemic conditions that can cause changes in both the amount of saliva produced and the composition of the saliva. Local conditions affecting mainly the oral cavity can cause salivary gland hypofunction. These include tumors, sialoliths (calculus build-up in the salivary ducts or glands), abnormalities of the salivary ducts, poorly developed salivary glands, and radiation damage following cancer treatment. In fact, xerostomia is the most common complication associated with radiation therapy to the head and neck. Following radiation treatment, dry mouth first occurs due to an inflammatory reaction. Later on fibrous tissue develops around the salivary glands and the condition becomes permanent. The degree of damage to the salivary glands depends on the amount of the gland that was exposed to the radiation and the dose of radiation received.
Systemic conditions affecting the entire body can also cause xerostomia. Examples include nerve damage, dehydration, sympathetic nervous system responses, inflammation caused by infection, hormonal imbalances (such as during pregnancy and menopause), and autoimmune diseases (such as Sjogren's syndrome). Other conditions including anxiety, depression, bulimia, diabetes, thyroid disease, hypertension, lupus, cystic fibrosis, cerebral palsy, Bell's palsy, endocrine disorders, scleroderma, and nutritional deficiencies can cause xerostomia.
Xerostomia is a common side effect of numerous prescription medications, and more than 400 medications reportedly cause dry mouth. This occurs because many medications alter the neural pathways that stimulate salivary gland secretion. Others produce vasoconstriction of the salivary glands. The most common xerostomia-inducing medications are antihypertensives, antidepressants, anticholinergics, antipsychotics, anorexiants, analgesics, decongestants, and bronchodilators. Others include antiemetics, statins, antianxiety agents, diuretics, skeletal muscle relaxants, amphetamines, and majiuana. Even over-the-counter cold medicines and antihistamines can cause dry mouth.
Reductions in salivary flow are dose dependant for many of these medications. This means that the greater the dose of the medication, the more likely a person is to experience dry mouth. Taking more than one medication at a time may also increase the risk.
The good news is that dry mouth caused by medications is not always permanent and can often be reversed if the medications are decreased or discontinued.
Saliva is an essential lubricant for the mouth. It enables us to more easily chew and swallow our food without it sticking to the tissues in our mouth. Saliva plays an essential role in our ability to taste foods, and it lubricates our mouth so we can speak properly. There are enzymes in saliva that begin the breakdown of food before it enters our digestive tract. Saliva is also rich in antibodies and antimicrobial agents which protect our teeth from decay, our gums from periodontal disease, and our mouth from infections. Adequate salivary flow is an important factor in maintaining a healthy oral cavity.
These are some of the many signs and symptoms that are suggestive of xerostomia:
Having a dry mouth or throat, especially at night
Constantly licking lips, mouth feels sticky and dry
Thick, “ropey” saliva
Lack of pooled saliva in the floor of the mouth
Difficulty chewing certain foods, especially those that are dry or spicy
Increased need to drink fluids
Feeling of soreness or burning of the mouth and/or tongue
Cracking and fissures of the tongue and mucosa
Cracking at the corners of the mouth or the lips
Blisters and mouth sores
Pebbled, lobulated tongue
Shiny and red tongue and cheeks
Distortion of taste, food not tasting like it used to
Unusual or exaggerated awareness of the oral cavity
Waking up more frequently in the middle of the night
Dentures no longer stay in place
Increase in plaque levels around teeth
Increase in decay of the teeth
Periodontal disease and tooth loss
Oral fungal infections
Salivary gland infections
Xerostomia, if left undiagnosed and untreated, can lead to many serious complications in the oral cavity. Dry mouth can cause enamel demineralization, increased plaque levels, and a significant increase in the incidence of decay. Rampant caries (cavities) are often seen on the roots of the teeth cusp tips, and under crown margins.
Patients with xerostomia have numerous other oral complications, including reddened, fissured, lobulated tongues, gingivitis, apthous ulcers (canker sores), halitosis (bad breath), mucositis (inflammation of the oral mucosa), and cracked, bleeding tissues.
Decreased salivary flow predisposes the mouth to bacterial, viral, and fungal infections. In particular patients can develop an overgrowth of Candida Albicans, causing fungal infections such as candida or angular cheilitis. These infections are especially prevalent in patients that wear dentures, and in patients suffering from dry mouth following radiation or chemotherapy treatment.
Dry mouth also makes it difficulty to chew and swallow, and decreases the sense of taste. This can lead to poor nutrition.
Many people do not realize they are suffering from xerostomia, and often do not experience symptoms of dry mouth until there is a 50% reduction in saliva output. Therefore it is important to come in for regular dental screenings. Frequent dental examinations, cleanings, and x-rays are important to remain proactive. An undiagnosed and untreated dry mouth can have a significant impact on the health of your oral cavity and your overall quality of life.
Once it has been determined that you are suffering from xerostomia, there are many things that the dentists at the Kurpis Center for Advanced Dentistry can do to help alleviate your symptoms. If your dry mouth is caused by medication, we can speak to your physician about changing the dose or brand of your medications. There are often other medications that can be substituted for those that are causing the dry mouth. If your dry mouth is caused by poorly functioning salivary glands, we can consult with your physician about prescribing a medication that can help the glands to work better and produce more saliva. Medications such as Pilocarpine (Salagen) and Cevimeline (Evoxac) can reduce the symptoms of dry mouth and increase salivary secretion in many patients. These medications, however, are not approved for the treatment of medication-induced xerostomia.
Finally, we can create a treatment regimen that can reduce the discomfort and relieve the symptoms of xerostomia. After taking a detailed medical history, performing a dental examination including an oral cancer screening and digital x-rays, and completing a periodontal examination, we will design a treatment regimen specifically tailored to your individual needs. Your program may include regular dental examinations and cleanings, repair of teeth with existing cavities, synthetic saliva to aid in speech, chewing and swallowing, fluoride treatments to help reduce the incidence of cavities, and oral rinses to soothe the dry mouth and remineralize existing cavities. In addition, we will teach you simple lifestyle tips to help improve your symptoms and prevent complications from dry mouth.
If you are suffering from dry mouth, do not ignore the warning signs any longer. Please call us at 201-447-9700 to schedule an evaluation.
If you suffer from temporomandibular joint (TMJ) pain or dysfunction, you are not alone! It is estimated that more than 35 million Americans suffer from TMJ disorders, and as many as 75% of Americans have experienced the signs and symptoms of TMJ problems at one time. Temporomandibular Joint Dysfunction (TMD), commonly referred to as "TMJ," is a complex set of conditions that cause pain and dysfunction in the jaw joint and the surrounding muscles that control jaw movement. While both men and women experience these disorders, the majority of those seeking treatment are women in their childbearing years. Women also tend to have more severe symptoms than men.
At the Kurpis Center for Advanced Dentistry, we can help alleviate the pain and dysfunction associated with TMJ disorders. You do not have to suffer any longer! Call us today to schedule a TMJ evaluation and to begin treatment.
The temporomandibular joint (TMJ) is a socket joint that connects the lower jaw (mandible) to the temporal bone of the skull. This socket joint allows the lower jaw to open, close, and move sideways when speaking, chewing, and yawning. Each individual has two temporomandibular joints, one on either side of the head located about one centimeter in front of the ears. If you place your fingers directly in front of your ears and open your mouth, you can feel your joints. TMJ complications are not limited to the joints; in fact, it is the muscles, tendons, and ligaments that enable the joint to move that are usually the source of pain and dysfunction.
Location of the temporomandibular joint
The temporomandibular joint is one of the most complicated joints in the body. It is both a hinge and a gliding joint, meaning that it opens and closes like a hinge and also slides forward, backward, and side to side. It is also the most constantly used joint in the body. When we open our mouths, the rounded ends of the lower jaw, called the condyles, glide along the joint socket of the temporal bone. Between each condyle and socket is a soft disc made of cartilage. These discs act as cushions to absorb stress and allow the condyles to move easily when the mouth opens and closes.
The Temporomandibular Joint (TMJ)
Temporomandibular joint disorders, or TMD, are complex and poorly understood conditions of the jaw joint and muscles that control jaw movement. According to the National Institute of Dental and Craniofacial Research, temporomandibular joint and muscle disorders fall into three main categories:
Myofascial pain, the most common temporomandibular disorder, involves pain or discomfort in the muscles that control jaw function
Internal derangement of the joint involves a displaced disc, dislocated jaw, or injury to the condyle
Arthritis refers to a group of degenerative and/or inflammatory joint disorders that can affect the temporomandibular joint
An individual suffering from temporomandibular joint disorders may have one or more of these conditions simultaneously. Researchers have also found that many people with TMD often have other painful and debilitating conditions of the body, prompting studies in search of a common factor underlying these disorders. Among these co-morbid conditions are chronic fatigue syndrome, chronic headaches, fibromyalgia, sleep disorders, irritable bowel syndrome, endometriosis, and others.
People who have a rheumatic disease, such as rheumatoid arthritis, may also develop a TMJ disorder as a secondary condition. Rheumatic diseases cause pain, stiffness, and inflammation in the joints, muscles, and bone. While both rheumatoid arthritis and TMJ disorders involve inflammation of the joint tissues, the exact relationship between these conditions remains unknown.
It is unclear how temporomandibular joint and muscle disorders progress. Symptoms may worsen or ease over time, sometimes even disappearing spontaneously. For some people, symptoms improve significantly or even resolve completely within weeks or months. For others, the condition causes long-term, persistent, and debilitating pain and dysfunction. The reason for this is still unknown.
The source of most TMJ disorders is idiopathic, or unknown. Researchers simply do not know the exact cause of the majority of temporomandibular joint and muscle problems. Some TMJ problems arise as a result of osteoarthritis in the joint itself or from trauma to the jaw or joint. Most TMJ disorders, however, begin for no apparent reason. Since these conditions are more common among women than men, scientists are exploring a possible link between female hormones and TMJ disorders.
Pain is the main symptom of temporomandibular joint disorders. It is often described as a dull, aching pain in the jaw joint and surrounding areas which comes and goes. Some people, however, have no pain but still have jaw dysfunction.
Symptoms of TMD can include:
Pain in the jaw joint or chewing muscles
Radiating pain in the face, jaw, neck, or shoulders
Jaw muscle stiffness
Limited movement or locking of the jaw
Ear pain or pressure
Painful clicking, popping or grating in the jaw joint when opening or closing the mouth
A change in the way the upper and lower teeth fit together, or a feeling that the bite is “off”
Popping or clicking noises in the jaw joint, unaccompanied by pain or decreased mobility, do not mean you have a TMJ problem.
Occassional discomfort in the jaw joint or chewing muscles is common and may not indicate a problem with the TMJ. However, if the pain is severe or lasts for more than a few weeks, it is time to seek treatment at the Kurpis Center for Advanced Dentistry.
At the Kurpis Center for Advanced Dentistry, we approach the treatment of TMJ disorders differently from most dental offices. We understand TMD and have a conservative treatment approach that many patients benefit from greatly. We are also aware that TMD can be confused with other painful disorders such as neuralgias, neoplasms, vascular disorders, otic problems, dental pathology, and others. We don't group all facial pain disorders into the "TMJ" category. We look into other possible causes of facial pain and have the ability to distinguish between the different pain disorders. We have the tools and knowledge necessary to make a proper differential diagnosis and to treat our patients, or refer if necessary.
Once you have been evaluated by one of our dentists and a diagnosis of TMD has been confirmed, we will begin treating your TMJ symptoms. We believe in conservative, reversible, and non-surgical treatment of TMJ disorders and facial pain. Our treatments do not involve changing your bite or invading any tissues of the face or jaw. Conservative approaches are the first line of treatment and patients usually respond well to them. Jaw exercises are taught, and anti-inflammatory medications or muscle relaxants are often recommended. Daily self-care tips are encouraged and these simple practices can greatly ease the symptoms of TMD. Stress management techniques or physical therapy may also be recommended.
A nightguard, or stabilization splint, is widely used in the treatment of TMJ disorders. This horseshoe shaped plastic appliance, usually worn at night, fits over the teeth and keeps the upper and lower teeth separated. It prevents the teeth from locking together, thereby relaxing the muscles and relieving much of the force placed on the teeth and joints.
We also understand how difficult it can be to undergo dental treatment if you suffer from TMD or any chronic pain disorder of the head and neck. We take your painful condition into consideration when performing dental procedures and pay special attention to your needs. We allow for rest periods during treatment, we offer premedication to alleviate pain, and we have different levels of sedation to ease anxiety and discomfort if needed.
Many patients report significant pain relief and improved function with these conservative treatments for TMD. Do not suffer with pain or dysfunction any longer. Call 201-447-9700 for a TMJ evaluation and to begin treating your TMJ symptoms.
Oral cancer is cancer that forms in the tissues of the oral cavity (the mouth and lips) or the oropharynx (the part of the throat that begins at the back of the mouth).
Each year in the United States, approximately 35,000 men and women are diagnosed with oral cancer and about 7,600 people die from the disease. Of those newly diagnosed individuals, only slightly more than 50% will be alive in 5 years. Why is the death rate for oral cancer so high? It is because mouth cancer is often diagnosed when it is already in a later stage of development, making it more difficult to treat. Often it is discovered after the cancer has metastasized (spread) to another location in the body, such as the lymph nodes of the neck. Once the cancer has metastasized, the prognosis is much worse than if it had been caught when it was a small localized cancer in the oral cavity or throat.
Oral cancer, if caught early, can be treated successfully. However, the difficulty in discovering these cancers at an early stage lies in the fact that people often have no pain or symptoms associated with oral cancer and do not notice small lesions forming in their mouth or throat. Therefore, it is extremely important to learn the risk factors and warning signs of mouth cancer and to see a dentist regularly for examinations and oral cancer screenings. Seeing a dentist on a regular basis for oral cancer screenings can literally save your life!
There are certain risk factors which make some individuals more likely to develop oral cancer than others. Understanding these causative factors will help contribute to the prevention of this disease. The risk factors include:
Tobacco is considered the primary cause of oral cancer in individuals over 50. Cigarettes, pipes, cigars, and smokeless tobacco (chewing tobacco) are all causes of oral cancer. Heavy smokers who have smoked for many years have the highest risk of developing mouth cancer. The risk is even greater for tobacco users who also consume a lot of alcohol, because the two act synergistically. People who both smoke and drink are at a 15 times greater risk of developing mouth cancer than those who do not.
Heavy alcohol use:
back to top Heavy drinkers are more likely to develop oral cancer than those who do not consume alcohol. The more alcohol a person drinks, the greater their risk. The risk of developing oral cancer increases even more if a person drinks alcohol and uses tobacco products.
The human papilloma virus, or HPV, is a very common sexually transmitted virus which affects nearly 40 million Americans. One strain of HPV in particular, HPV16, has been definitely implicated in oral cancer. HPV16 and HPV18 are also the causative agents of more than 90% of all cases of cervical cancer. Oral cancer caused by HPV16 most often occurs at the base of the tongue, the back of the throat, in the soft palate, or in the tonsils.
Throughout history, the majority of people diagnosed with oral cancer have been over 50 years old. Recently, however, this demographic has been changing and mouth cancers are now occurring more frequently in younger populations due to HPV. In fact, the Oral Cancer Foundation believes, based on published data, that HPV16 may be the primary cause of mouth cancer in individuals under the age of 50.
Ultraviolet radiation from sun exposure is a causative agent in cancers of the lip as well as other skin cancers. Using a lotion or lip balm with sunscreen can reduce your risk of developing cancer. The risk of developing cancer of the lip increases if a person smokes.
Some studies suggest that people who eat diets that are lacking in fruits and vegetables may have an increased risk of developing mouth cancer.
Betel nut use:
Although uncommon in the United States, chewing betel nut is fairly common in Asia. Betel nut is a type of palm seed wrapped with a betel leaf and often mixed with sweeteners, spices, and tobacco. Chewing betel nut causes oral cancer, and the risk increases if a person also drinks alcohol and uses tobacco.
Age is often considered a risk factor for oral cancer because historically, the majority of individuals diagnosed with oral cancer have been over the age of 50. This may be due to a biological process that takes place in aging cells that allows for the malignant transformation of the cells. Or, perhaps, our immune systems begin to diminish with age, making us more vulnerable to developing cancer. Recent scientific data, however, has shown that the fastest growing segment of the oral cancer population are non smokers under the age of 50. This paradigm shift is thought to be due to the increasing incidence of HPV among younger populations.
Oral cancer occurs more often in the black population than the white population. Furthermore, survival statistics are poorer with a 33% 5 year survival rate for black people and a 55% 5 year survival rate for white people. While there may or may not be a genetic component to this, lifestyle choices remain the biggest cause.
The more risk factors that an individual has, the greater the chance that oral cancer will develop. However, most people with risk factors for oral cancer never end up developing the disease.
The survival rate for oral cancer is low because, in its early and treatable stages, oral cancer can go unnoticed. It can be painless, and physical changes to the oral tissues can be so slight that an individual may not even notice they are there. Your dentist, however, can see most cases of oral cancer while they are small and in their earliest stages. Therefore, it is extremely important to see your dentist regularly for examinations and oral cancer screenings. It is also important to learn some of the warning signs and symptoms of oral cancer and to see a dentist or physician if these symptoms develop:
A white or red patch of tissue in the mouth
A sore or ulcer in the mouth or on the lip that does not heal
Bleeding in the mouth
A lump or mass in the neck or mouth
Difficulty swallowing, speaking, or chewing
A wart-like mass in the mouth
A persistent earache
Hoarseness in the throat which lasts for a long time
Numbness in the oral/facial region, including the lower lip and chin
If you have any of these signs or symptoms, you should notify your dentist or physician as soon as possible. Although these symptoms are most likely not from oral cancer, it is still very important to have them checked by a professional.
The following is a series of atypical mouth lesions. Some of these lesions were normal variations of anatomy or benign growths, while others were more serious oral pathologies.
All patients should receive an oral cancer examination every 3-6 months, depending upon family history and risk factors. An oral cancer examination should include the following ten parameters:
Full dental/medical history
Family history of cancer or abnormal tissue growth
Digital panoramic x-ray to examine the jaws and sinuses
Intra-oral digital photograph of any abnormal lesion found in and around the lips, cheeks, tongue, and throat
Limited periodontal exam to ascertain the presence of chronic oral inflammation
Examination of the teeth for any sharp or broken edges that may contribute to pre-cancerous lesions forming in response to chronic irritation
Examination of abnormal occlusal relationships that may contribute to chronic irritation of soft tissues
Detailed description of the color, shape, and size of any suspicious intra oral lesions
ADA approved velscope analysis of any suspected pre-cancerous lesion
Lifestyle analysis for any factors that commonly contribute to oral cancer
Dr. Kurpis Examing a Patient
Suspicious patches, bumps, and lesions are sometimes difficult to diagnose and may require a biopsy so that the cells of the abnormal tissues can be studied under a microscope. Although classic pre-cancerous and cancerous lesions have typical signs and symptoms, atypical lesions may also be pre-cancerous. Any patch, bump, or lesion that is abnormal in appearance should be examined by a dentist familiar with oral pathology as quickly as possible.
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