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DENTISTRY

DENTAL IMPLANTS

 

Available in the United States since the 1980s, dental implants are metal posts, usually titanium, that are surgically placed in your jawbone beneath your gum tissue.

The posts provide stable anchors or “roots” for artificial replacement teeth, which look like natural teeth and are attached to the implants.

 

Dental implants can replace one tooth, several or all teeth. Dental implants are successful because of osteointegration -- a natural process in which your jawbone grows around and anchors to the metal implant. This provides a solid foundation for the artificial teeth, allowing you to once again chew and speak comfortably. “Dental implants feel and function very much like natural teeth,” says Dr. Sheridan. “Most people love them.”

 

ARE DENTAL IMPLANTS RIGHT FOR YOU?

 

Anyone who is missing teeth-- be it one or all of them-- can benefit from dental implants. Implants can be the solution if you are unable to wear dentures because sections of your jaw are missing due to an accident, disease or birth defect. Your jawbone can often be reconstructed by using implants in conjunction with bone grafts.

You’re a good candidate for dental implants if you:

* Have enough dense jawbone to secure the implants

* Are in good physical health

* Have reached full growth

* Are not a smoker

* Don’t have a disease or condition-- such as uncontrolled diabetes-- that interferes with proper healing after implant surgery.

Your dentist and oral surgeon will conduct thorough oral examinations and medical consultations to determine if the procedure is appropriate for you. During the examination they may take X-rays and build models of your jaw.

If you have a heart murmur or orthopedic implants, your doctor may advise you to use antibiotics before dental procedures. In the case of a heart murmur, this is to avoid bacterial endocarditis -- an infection of your heart’s inner lining (endocardium) that typically involves one of your heart valves. In the case of orthopedic implants, it’s to avoid infection of the implanted joint. Tell your surgeon about any existing health conditions you may have prior to the procedure.

“It’s important that you understand and be comfortable with the implant process,” says Dr. Sheridan.

Dental implants are more expensive than conventional dentures and may not be covered by your insurance. Weigh the benefits of implants against dentures before you decide which option is right for you.

 

TYPES OF IMPLANTS

Two types of dental implants are available:

* Endosteal. An implant similar in shape to the root of a natural tooth is placed directly into your jawbone and becomes solidly anchored through the process of osteointegration. Mayo Clinic dentists recommend this type of implant.

* Subperiosteal. An implant that fits over remaining bone is used when your jawbone is weak or otherwise inadequate.

Mayo Clinic dentists discourage this type of implant because you’re at increased risk of nerve damage, lip numbness and infection.

 

DENTAL SURGERY

 

The surgical procedure to place implants is usually performed in an outpatient setting under local anesthesia. The procedure involves several steps over a number of months:

* Placing the implants in the bone. Gum tissue is lifted to expose the bone, and precisely measured holes are placed where each implant will be inserted. The implants are inserted into the holes, and stitches (sutures) close the gum tissue around the bon and implants. The sutures will either dissolve or will need to be removed by your doctor.

After the procedure your gums may be swollen for a few days. Your gums and the skin around your mouth and jaw may be bruised or discolored. Using an ice pack during the first 24 hours after surgery may help reduce swelling. Medication and antibiot- ics can be prescribed to help you feel better and prevent infection. Minor bleeding is normal on the day of surgery, but excessive bleeding should be reported to your doctor immediately. You should be able to resume normal activity within 1 or 2 days after surgery.

“Surprisingly, there is little discomfort after implant surgery,” says Dr. Sheridan. “If pain does occur, it’s usually related to implant failure or infection.”

You will be given special instructions on how to clean your mouth during the healing process.

A soft diet is generally recommended to avoid undue pain and stress on the new implants. If you normally wear dentures, a soft lining may be placed in them so that they can be worn comfortably over the implants until the implants become secure and you can receive your new replacement teeth. If you don’t wear dentures, temporary teeth -- a removable, partial denture -- can be made so the implants won’t show.

Osteointegration takes place as healing progresses. The implants are usually anchored firmly by bone within 3 to 6 months of placement.

* Attaching metal posts. After healing is complete, your gums are reopened and small metal posts are attached to the now secure implants. These posts are threaded, like a bolt, and will support new artificial teeth. This stage of the implant procedure involves less discomfort and a healing time of only 1 to 2 days.

* Making new teeth. When your gum tissue has recovered, impressions are made of your mouth that will be used to make models of your jaw and any remaining teeth. New artificial teeth-- called restorations or prostheses-- are then made based on these models.

Artificial teeth can be either removable, fixed or a combination of both. A removable prosthesis is similar to a conventional denture, but it has the advantage of being fastened to the implant by clips or magnets. The artificial gum and teeth are mounted on a metal frame that attaches to the implants.

Artificial teeth are screwed onto the implants and held firmly in place. They’re designed to be removed only by a dentist.

 

MAINTAINING DENTAL IMPLANTS

Self-care is an important part of maintaining dental implants. To care for your implants:

* Practice exceptional oral hygiene. Implants, artificial teeth and gum tissue must be kept clean. Specially designed brushes and floss holders can help.

* Avoid damaging habits. Smoking, excessive alcohol consumption and chewing hard foods such as ice and hard candy may damage your implants-- as well as your remaining natural teeth.

* Maintain professional care. Periodic checkups are necessary to ensure the health and proper functioning of your jawbone. Although the overall success rate of dental implants is about 90 percent, a small percentage fail due to poor maintenance. “People need to be aware that implants can fail,” says Dr. Sheridan. “They can become infected or break.”

Dental implantation is an extensive process that requires serious commitment. But for appropriate candidates, dental implants may provide healthier eating, improved speech and a more comfortable lifestyle.

 

Additional Resources

Find a periodontist: The American Academy of Periodontology

© 1998-2002 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.

 

 

 

WHAT IS PERIODONTITIS?

 

Periodontitis is an advanced stage of gum (periodontal) disease that can threaten the loss of your teeth. Some form of gum disease affects about 75 percent of adults after age 35.

The cause of gum disease is bacteria, which can turn into tartar buildup, irritate your gums and lead to bleeding. The early stage of gum disease is called gingivitis. Left unchecked, gingivitis can lead to the more serious periodontitis. Untreated, periodontitis will progress until your teeth loosen and fall out. Thorough, daily brushing, regular flossing and frequent professional cleaning reduce your chances of developing serious gum disease.

Signs and symptoms of periodontitis may include:

* Swollen or recessed gums

* Unpleasant taste in your mouth

* Bad breath

 

 

SIGNS AND SYMPTOMS

* Pain in one of your teeth when eating hot, cold or sweet foods

* Dull sound when one of your teeth is tapped

* Loose teeth

* Change in your bite

* Drainage or pus around one or more teeth.

 

CAUSES

 

Gum disease is caused by plaque, a sticky, colorless film of bacteria that coats your teeth. If allowed to harden, the film turns into tartar (calculus). If plaque and tartar build up along the gingiva-- the part of your gum around the base of your teeth-- they can irritate your gums and create pockets of bacteria between your gums and teeth. This can make your gums red, swollen, tender and prone to bleeding-- a condition called gingivitis. If plaque and tartar extend farther, beneath your gumline you may develop periodontitis. Your gums gradually withdraw from around your teeth. Pockets of infection (pus) can form in this dark, airless region and destroy the tissue and bone supporting your teeth. Untreated, periodontitis will lead to your teeth loosening and falling out.

RISK FACTORS

 

Everyone’s susceptible to gum disease, and the most common contributing factor is a long-term lack of attention to proper oral hygiene. But these factors can increase your risk:

* Genes. Bacteria that lead to gum disease are more harmful to some people’s gums than to others. Those who are susceptible have a hereditary predisposition to gum disease.

* Medications. Many prescription and over-the-counter drugs contain ingredients that decrease saliva, leaving you with a dry mouth. Without the cleansing effect of saliva, plaque and tartar can build up more easily. Alcohol also can decrease saliva.

* Smoking. Smoking slows your gums’ ability to heal themselves and replace tissue destroyed by bacteria.

* Diabetes. People with uncontrolled or poorly controlled diabetes are more susceptible to gum disease. Diabetes may result in a thickening of your blood vessels, making them less able to carry nutrients to your gum tissue and remove wastes. This can leave your gums less healthy and more prone to infection.

* Pregnancy. Hormone changes during pregnancy may make your gums more susceptible to the damaging effects of plaque.

* Decreased immunity. Illness or drugs such as cortisone can weaken your immune system. This makes you prone to infection, which can lead to gum disease.

 

WHEN TO SEEK MEDICAL ADVICE

 

If your gums are painful, swollen, bleed easily and are dusky red rather than pink in color, see your dentist. The sooner you see your dentist, the better your chances of getting your gums into a more healthy condition, preventing the progression of periodonti- tis and potentially avoiding the loss of some teeth.

 

SCREENING AND DIAGNOSIS

 

The key to the health of your gums is the depth of the groove between your gums and your teeth, called the gingival sulcus. Your dentist uses a metal tool (periodontal probe) to measure the depth of this groove, inserting the probe beneath your gum until he or she feels a slight resistance.

To screen for gum disease, your dentist measures the sulcus depth at multiple sites inside your mouth. A depth of 2 or 3 millim- eters (mm) -- about one-eighth of an inch -- indicates a healthy gum. If your dentist probes beyond 3 mm, this means a pocket has formed between your tooth and gum. The deeper the pocket, the more serious your gum disease.

Dental X-rays also help your dentist gauge the health of your gums by revealing bone loss.

 

COMPLICATIONS

Having periodontal disease may put you at greater risk of:

* Heart disease and stroke. Researchers have found a link between oral bacteria and clogged arteries and blood clots, which can lead to heart attack and stroke. Some researchers have found people with periodontal disease are more likely to have a heart attack or stroke than those with healthy mouths. The more severe the periodontal disease, the greater the risk.

* Uncontrolled blood sugar if you’re diabetic. As with other infections, having diabetes puts you at greater risk of developing periodontal disease. In turn, oral infection makes blood glucose levels harder to control.

* Pneumonia. If you have serious gum disease and lung problems, inhaling bacteria from your mouth into your lungs may result in pneumonia.

* Osteoporosis of the mouth. Researchers suspect a link between the loss of bone mineral density that occurs with osteoporosis and an increased susceptibility to oral bacteria. If osteoporosis causes the bones of your mouth to lose density, that may open the way for bacteria to further increase gum detachment and the risk of tooth loss. So sometimes, gum disease or tooth loss may be an indication of osteoporosis.

 

TREATMENT

 

If you have pockets between your gums and your teeth that are 5 millimeters or less in depth, your dentist may recommend one of the following nonsurgical treatments:

* Scaling and root planing. Scaling removes tartar and bacteria from your tooth surfaces and beneath your gums. Sometimes, scaling is done with an ultrasonic device. Root planing smoothes the root surfaces, discouraging further accumulation of tartar. With good daily oral hygiene, scaling and root planing may be all the treatment you’ll need.

* Antibiotic therapy. Dentists can pinpoint the specific strains of bacteria that cause periodontal disease and prescribe antibiotics to deal with them.

If you have advanced periodontitis -- the depth of the pockets between your gums and teeth is more than 5 millimeters -- you may need surgery.

The options:

* Flap surgery. If you have a deep infection pocket, your dentist can “fold up” a section of your gum surgically, exposing the roots for more effective scaling and planing. Antibiotics may help fight the infection.

* Bone grafting. If the bone surrounding your tooth root is destroyed, your dentist can secure sterilized bone segments from a bone bank to fill the space and keep your tooth in place.

* Guided tissue regeneration. This technique allows bone destroyed by bacteria to regrow. Your dentist places a special piece o biocompatible fabric between existing bone and your tooth. This material prevents unwanted tissue from entering the healing area, thereby encouraging the bone to grow back.

 

 

PREVENTION

 

The best means of preventing gum disease is good dental hygiene, including regular brushing and flossing of your teeth and periodic professional cleaning to prevent buildup of plaque and tartar.

Follow these tips to keep your gums healthy:

* Pick the right brush. Select a brush with soft, end-rounded or polished bristles, small enough to clean your back teeth as well as your front teeth, and that has been approved by your dentist or the American Dental Association.

* Buy fluoride toothpaste. Fluoride toothpaste helps remove plaque while protecting against cavities.

* Brush at least twice daily. Do your brushing just before bedtime and again each morning. During sleep, saliva flow lessens and gives bacteria a chance to multiply.

* Brush properly. To clean outer surfaces of your teeth and gums, use short, back-and-forth, then up-and-down strokes. Use vertical strokes to clean inner surfaces. Include both teeth and gums.

* Angle your brush. To clean the junction between your teeth and gums, hold your brush at a 45-degree angle to your teeth. This allows the bristles to clean the groove between your gums and your teeth.

* Floss daily. Hold the floss taut and bent around each tooth in a “C” shape, scraping up and down each side of each tooth. Each stroke should go slightly below your gumline until you feel resistance. Flossing removes plaque between your teeth and helps massage your gums. Unwaxed floss works as well as waxed.

 

In addition to daily oral hygiene, visit your dentist at least annually for a routine cleaning and dental checkup. If you’re at increased risk of gum disease, daily removal of plaque is particularly essential. You may also need more frequent professional cleanings. Ask your dentist for recommendations.

 

Additional Resources

National Institute of Dental and Craniofacial Research National Oral Health Information Clearinghouse American Dental Association

American Academy of Periodontology

© 1998-2002 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.

 

 

WHAT IS ORAL THRUSH?

 

Most healthy people have small amounts of the fungus Candida albicans in their mouth, in their digestive tract and on their skin. Ordinarily, the fungus causes no problems because its growth is kept in check by normal bacteria (flora) in the body. But when this delicate balance is disturbed — usually by an illness, medications or stress — Candida can grow out of control, leading to several types of infections, including diaper rash in infants and vaginal yeast infections in women. Candida can also cause a mouth infection known as oral thrush.

Thrush causes creamy white lesions, usually on your tongue or inner cheeks. The lesions can be painful and may bleed slightly when you scrape them or brush your teeth. Sometimes the infection may spread to the roof of your mouth, gums, tonsils or back of your throat.

Although oral thrush can affect anyone, it occurs most often in babies and toddlers, older adults, and people whose immune systems have been compromised by illness or medications. It’s usually a minor problem for healthy children and adults and can be effectively treated with natural remedies or antifungal medications. But for those with weakened immune systems, symptoms may be more severe, widespread and difficult to control.

 

SIGNS AND SYMPTOMS

 

Oral thrush usually develops suddenly, but it may become chronic, persisting over a long period of time. In most cases, it produces creamy white lesions that may resemble cottage cheese. The lesions are often painful and may bleed slightly when rubbed or scraped. They commonly appear on your tongue and inner cheeks, but can also affect the roof of your mouth, gums and tonsils.

In severe cases, the lesions may spread downward into your esophagus — the long, muscular tube stretching from the back of your mouth to your stomach. When this happens, the condition is known as Candida esophagitis. Signs and symptoms may include:

* Pain or difficulty swallowing

* A feeling that food gets stuck in the throat or midchest area

* Possible fever if the infection spreads beyond the esophagus

 

Symptoms in infants and breast-feeding mothers

Healthy newborns with oral thrush usually develop symptoms during the first few weeks of life. In addition to the distinctive white mouth lesions, infants with the infection may have trouble feeding or be fussy and irritable. They can also pass the infection to their mothers during breast-feeding. Women whose breasts are infected with Candida may experience the following signs and symptoms:

* Unusually red or sensitive nipples

* Taut, shiny skin on the areola

* Unusual pain during nursing or painful nipples between feedings

* Stabbing pains deep within the breast

 

CAUSES

 

Microorganisms such as viruses, bacteria and fungi are everywhere. Your respiratory and digestive tracts, mouth, and skin are home to more than 200 species of bacteria and several kinds of fungi.

In general the relationship between you and this array of microbes is mutually beneficial. You provide nutrition, protection and transportation for them, while they stimulate your immune system, synthesize essential vitamins, and help protect against harmful viruses and bacteria.

But your relationship to microorganisms in the world at large is more complex. Some microbes are highly beneficial, but others — such as those that cause malaria and meningitis — can be deadly. For that reason, your immune system works to repel harmful invading organisms while maintaining a balance between “good” and “bad” microbes that normally inhabit your body.

But sometimes these protective mechanisms fail. Oral thrush and other Candida infections occur when your immune system is weakened by disease or certain drugs, or when medications disturb the natural balance of microorganisms in your body. The diseases, medications and lifestyle factors listed below can increase your risk of oral thrush.

 

Diseases

These illnesses may make you more susceptible to oral thrush infection:

* Chronic mucocutaneous candidiasis. This group of rare disorders usually affects children younger than age 3. Chronic mucocutaneous candidiasis causes an ongoing and widespread Candida infection that usually involves the mouth and fingernails as well as the skin on the scalp, trunk, hands and feet. Scaly, crusted lumps known as granulomas also may develop in the mouth or on the nails and skin. These disorders sometimes occur with other conditions such as diabetes mellitus. Adults occasionally develop the disorder as well — usually as a result of a tumor on the thymus gland (thyoma).

* HIV/AIDS. The human immunodeficiency virus (HIV) — the virus that causes AIDS — damages or destroys the cells of your immune system, making you more susceptible to opportunistic infections your body would normally resist. One of these opportunistic infections is oral thrush. Thrush is rare in the early stage of AIDS, usually appearing only when counts of helper T cells — one of the key cells in your immune system — fall below 350. Although oral thrush is the least serious of the fungal infections that can affect people with HIV, it may be an indication that HIV is worsening. Candida esophagitis, which occurs when thrush spreads to the esophagus, generally develops when T cell counts are 200 or less and is considered an AIDS-defining illness (an opportunistic illness that indicates a person with HIV is developing AIDS).

* Cancer. If you’re dealing with cancer, your immune system is likely to be weakened both from the disease and from treatments such as chemotherapy and radiation. A weakened immune system increases the chances that you may develop Candida infections such as thrush.

* Diabetes mellitus. If you don’t know you have diabetes or the disease isn’t well controlled, your saliva may contain large amounts of sugar. This can encourage the growth of Candida.

* Vaginal yeast infections. It’s estimated that three out of every four women will have a vaginal yeast infection (Candida vulvovaginitis) at least once before menopause. Vaginal yeast infections are caused by Candida albicans — the same fungus that causes oral thrush. Although a yeast infection isn’t dangerous, a pregnant woman can pass the fungus to her baby during delivery. As a result, her newborn may develop oral thrush within the first several weeks after birth. Up to 5 percent of healthy newborns with oral thrush are infected through mother-to-child transmission.

* Dry mouth (xerostomia). This occurs when the salivary glands in your mouth don’t produce enough moisture. Dry mouth disrupts the balance of normal microorganisms in your mouth, increasing your risk of oral thrush. Although not itself a disease, dry mouth can be a symptom of certain illnesses, including Sjogren’s syndrome — an autoimmune disease that causes an extremely dry mouth and eyes. Bone marrow transplants, stress or anxiety, depression, and certain nutritional deficiencies also can cause a dry mouth. So can chemotherapy, radiation to the head and neck area and hundreds of medications — especially antidepressants, pain and high blood pressure medications, tranquilizers, diuretics, and antihistamines.

 

Medications

Certain medications can make you or your child more susceptible to oral thrush by weakening the immune system or reducing the number of organisms that keep Candida albicans in check. These medications include:

* Oral or inhaled corticosteroids (prednisone, prednisolone, methylprednisolone). Doctors use these powerful drugs to reduce inflammation in skin diseases and illnesses such as asthma and systemic lupus erythematosus. But steroids can severely suppress your immune system, making you susceptible to a wide range of infections.

* Antibiotics. These drugs are used to combat both minor and life-threatening bacterial infections, ranging from acne and urinary tract infections to pneumonia. Unfortunately, antibiotics often destroy beneficial bacteria along with harmful ones. This is especially true of broad-spectrum drugs — such as amoxicillin (Amoxil, Polymox) and tetracycline (Achromycin V, Apo-Tetra) — which attack a wide range of bacteria. When the number of bacteria that normally keep Candida in check decline, the fungus can grow uncontrollably, leading to thrush and other Candida infections.

* Birth control pills. Hormonal changes that result from the use of birth control pills can upset the natural balance of microorganisms in your body.

The same is true of normal shifts in hormone levels that occur during pregnancy.

 

Lifestyle factors

* Smoking. Chronic hyperplastic candidiasis is a type of thrush that occurs in people who smoke. It causes creamy white patches on the insides of the cheeks and tongue, along with persistent nodules or lumps. Red patches also may sometimes appear, which may be a sign that cancerous changes are occurring in the cells.

* Wearing dentures. People who wear dentures — especially if they don’t fit properly — sometimes develop a type of thrush

marked by redness and swelling.

 

RISKFACTORS

 

Anyone can develop oral thrush, but the infection is especially common in infants and toddlers whose immune systems aren’t yet fully developed. In addition, babies can pass the infection to their mothers during breast-feeding.

Oral thrush is also more likely to occur in older adults, people with compromised immune systems and those who use medications — such as steroids, antibiotics and birth control pills — that weaken the immune system or upset the natural balance of microorganisms in the mouth. People who smoke or wear dentures also are at increased risk.

 

SCREENING AND DIAGNOSIS

 

If you or your baby develops painful white lesions inside the mouth, see your doctor or dentist. He or she will likely diagnose oral thrush simply by looking at the lesions but may also examine a small sample under a microscope to confirm the diagnosis.

If thrush develops in older children or adolescents who have no other risk factors, seek medical care. An underlying condition such as diabetes may be the cause. In that case, your doctor will perform a thorough physical exam as well as recommend certain blood tests to help find the source of the problem.

Thrush that extends into the esophagus can be serious. To help diagnose this condition, your doctor may ask you to have one or more of the following tests:

 

* Throat culture. In this procedure, the back of your throat is swabbed with sterile cotton and the tissue sample is cultured in a special medium. This helps determine if a bacterium or fungus is causing your symptoms.

* Esophagogastroduodenoscopy (EGD). In this procedure, your doctor examines the lining of your esophagus, stomach and the upper part of your small intestine (duodenum) using a lighted, flexible tube with a camera on the tip (endoscope). The test takes between 30 and 60 minutes. You’ll be given a sedative to make you more comfortable and a local anesthetic so you don’t cough or gag when the endoscope is inserted. There is a slight risk of perforation of your esophagus, stomach or duodenum and of an adverse reaction to medication you may be given.

* Barium swallow. In this test, you’ll need to drink one or two barium “milkshakes” — glasses of thick, chalky liquid that may be flavored so they go down more easily. X-rays are then taken as the barium flows through your esophagus into your stomach.

 

COMPLICATIONS

 

Oral thrush is seldom a problem for healthy children and adults, although the infection may come back after it has been treated. For people with compromised immune systems, however, thrush can be more serious.

Children with HIV may have especially severe symptoms in their mouth or esophagus, which can make eating painful and difficult. As a result, they don’t receive adequate nutrition, just when they need it most. In addition, thrush is more likely to spread to other parts of the body in people with cancer, HIV or other conditions that weaken the immune system. In that case, the areas most likely to be affected include the digestive tract, lungs, liver and skin.

 

TREATMENT

 

The goal of any treatment is to stop the rapid spread of the fungus, but the best approach for you may depend on your age and the cause of the infection.

 

Treating oral thrush in children

Toddlers with mild oral thrush who are otherwise healthy may need no treatment at all. If the infection develops after a course of antibiotics, your doctor may suggest adding unsweetened yogurt to your child’s diet to help restore the natural balance of bacteria. For infants or other children with persistent thrush, an antifungal medication — usually in an oral suspension — may be necessary. Other prescription medications may be needed for stubborn or more severe thrush.

 

Treating oral thrush in infants and nursing mothers

If you’re breast-feeding an infant who has oral thrush, you and your baby will do best if you are both treated. Otherwise, you are likely to pass the infection back and forth. Your doctor may prescribe a mild antifungal medication for your baby and an antifungal cream for your breasts. If your baby uses a pacifier or feeds from a bottle, wash and rinse nipples and pacifiers and then air-dry every day until the thrush clears up.

 

Treating oral thrush in healthy adults

If you’re a healthy adult with oral thrush, you may be able to control the infection by eating unsweetened yogurt or taking acidophilus capsules. Acidophilus is available in natural food stores and many drug stores. Some brands need to be refrigerated to maintain their potency.

Yogurt and acidophilus don’t destroy the fungus, but they can help restore the normal bacterial flora in your body. If this isn’t effective, your doctor may prescribe an antifungal medication.

 

Treating oral thrush in adults with weakened immune systems

Most often, your doctor will recommend an antifungal medication such as nystatin (Mycostatin, Nilstat), clotrimazole (Mycelex), itraconazole (Sporanox) or fluconazole (Diflucan). This may come in one of several forms, including a liquid that you swish in your mouth and then swallow, lozenges or tablets.

 

The normal course of treatment is usually 10 to 14 days. Unfortunately, Candida albicans can become resistant to antifungal medications, especially in people in the later stages of HIV infection. A drug known as Amphotericin B (Amphocin) may be used when other medications aren’t effective.

Some antifungal medications may cause liver damage. For this reason, your doctor will likely perform blood tests to monitor your liver function, especially if you require prolonged treatment or have a history of liver disease.

 

PREVENTION

The following measures may help reduce your risk of developing Candida infections:

* Try using yogurt or acidophilus capsules when taking antibiotics.

* Treat any vaginal yeast infections that develop during pregnancy as soon as possible.

* If you smoke, ask your doctor about the best ways to quit.

* See your dentist regularly — at least every 6 to 12 months — especially if you have diabetes or wear dentures. Brush and floss your teeth as often as your dentist recommends.

* Try limiting the amount of sugar and yeast-containing foods you eat, including bread, beer and wine. These may encourage the growth of Candida.

 These suggestions may help during an outbreak of thrush:

 

 

SELFCARE

 

*Practice good oral hygiene to aid healing. Many dentists recommend brushing at least twice a day and flossing at least once. If you have problems with strength or dexterity in your hands, an electric toothbrush can make brushing easier. Avoid mouthwash or sprays — They can destroy the normal flora in your mouth.

* Try warm saltwater rinses to soothe pain. Dissolve 1/2 teaspoon of salt in 1 cup of warm water. Or rinse with a mild baking soda solution — 1 teaspoon of soda in 1 cup of warm water. Swish the rinses, but don’t swallow.

* Use nursing pads. If you’re breast-feeding and develop a fungal infection, this will help prevent the fungus from spreading to your clothes.

Look for pads that don’t have a plastic barrier, which can encourage the growth of Candida. For more information on breast-feeding, you can contact the La Leche League at 847-519-7730. Or check their Web site.

 

 

 

COMPLIMENTARY AND ALTERNATIVE MEDICINE

Some adults have found that taking these substances can help prevent or treat oral thrush:

 

* Garlic capsules. Garlic may have antifungal and antibacterial properties. One study found that ajoene, a compound obtained from garlic, was as effective in treating the fungus that causes athlete’s foot as standard antifungal medications. You can find garlic capsules in natural food stores and many drugstores. Look for deodorized capsules. Including raw garlic in your diet also may be beneficial.

* Yeast-Gard tablets. Usually found in natural food stores, this product may help prevent yeast infections and soothe irritated tis- sue. Check with your doctor to make sure Yeast-Gard doesn’t interfere with any other medications you may be taking.

* Caprylic acid capsules. This fatty acid, derived from coconut oil, has been shown to have antifungal properties. You can find the capsules in most natural food stores and online. They shouldn’t be used by people who have ulcerative colitis.

 

Additional Resources

La Leche League International

National Institutes of Health: Oral Thrush

National Institutes of Health: Esophagitis Candida

December 06, 2001

© 1998-2002 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.

 

WHAT IS ORAL CANCER?

 

Recently, you’ve noticed a pale lump inside your mouth that doesn’t seem to be healing. It’s not like anything you’ve seen before. What you may have encountered is an early sign of oral cancer.

About 30,000 new cases of oral cancer — cancer of the lips, mouth, tongue, gums and salivary glands — and oropharyngeal cancer (cancer of the upper part of the throat just behind the mouth) occur annually in the United States. Each year, about 7,800 Americans die of these cancers. Periodic self-examination of your mouth is the best way to detect the early signs. And, when detected early and treated adequately, oral cancer is almost always curable. Unfortunately, more than half of all oral and upper throat cancers are far advanced by the time a doctor is made aware of the situation.

SIGNS AND SYMPTOMS

 

An early indication of oral cancer is one or more changes in the way the soft tissues of your mouth usually look or feel. Signs and symptoms may include:

* A sore in your mouth that doesn’t heal or increases in size

* Persistent pain in your mouth

* Lumps or white, red or dark patches inside your mouth

* Thickening of your cheek

* Difficulty chewing or swallowing or moving your tongue

* Difficulty moving your jaw, or swelling or pain in your jaw

* Soreness in your throat or feeling that something is caught in your throat

* Pain around your teeth, or loosening of your teeth

* Numbness of your tongue or elsewhere in your mouth

* Changes in your voice

* A lump in your neck

About 80 percent of oral cancers arise on the tongue or on the floor of the mouth. They also may occur inside your cheeks, on your gums or on the roof of your mouth.

 

CAUSES

 

Oral cancer appears to occur as a result of situations that damage the cells in your mouth. Both smoking and excessive alcohol consumption damage mouth tissues. The combination of both smoking and excessive drinking creates a much higher risk of oral cancer. Excessive exposure to ultraviolet light, chewing your lips and the inside of your mouth and wearing loose-fitting dentures also can damage and irritate cells inside your mouth. Damage to cells may cause them to malfunction and to reproduce rapidly as cancer cells.

 

RISK FACTORS

A variety of factors that you can control increase your risk of oral cancer. They include:

 

* Use of tobacco. Tobacco can damage cells in the lining of the oral cavity and upper throat. Smokers are six times more likely than nonsmokers to develop oral or upper throat cancers. About 90 percent of people who develop these cancers use some form of tobacco. People who use smokeless tobacco are at high risk of cancers of the cheek and inner surface of the lips. Tobacco use is more prevalent among men, and oral cancer is twice as common in men as in women.

* Excessive alcohol consumption. Alcohol also can damage cells inside your mouth and upper throat. About 75 percent to 80 percent of people with oral and upper throat cancers are frequent drinkers of alcohol. The combination of alcohol and tobacco use adds to the risk.

* Chronic irritation from jagged tooth surfaces or poorly fitting dentures. Irritation caused by the dentures doesn’t appear to be a factor in oral cancer. However, poorly fitting dentures can trap particles of tobacco and alcohol, which may irritate the lining of your mouth.

* Prolonged exposure to ultraviolet light. Too much ultraviolet light can damage the cells on your lips and increase your risk of lip cancer.

* Leukoplakia (white patches on the inside of the cheek or tongue). Most of the time leukoplakia is not dangerous. But leukoplakia can be serious, as some of the patches may show early signs of cancer, and a large percentage of cancers of the mouth occur in areas in which leukoplakia is adjacent. Leukoplakia may result from a variety of causes, including smoking or chewing tobacco products, ill-fitting dentures, a rough spot on an adjacent tooth or cheek-biting.

 

WHEN TO SEEK MEDICAL ADVICE

See your doctor if you:

* Notice sores inside your mouth that don’t heal

* Have lumps or white, red or dark patches in your mouth

* Feel persistent pain or have a loss of feeling inside your mouth

* Have repeated bleeding in your mouth

* Notice any persistent change in the way the soft tissues of your mouth usually look and feel

 

Any of the above factors may indicate oral cancer. The earlier you seek medical advice, the better your chances of successful treatment.

 

SCREENING AND DIAGNOSIS

 

Diagnosis initially involves you and your doctor discussing the history of your signs and symptoms and your doctor performing an examination of your mouth. To determine whether cells within your mouth are cancerous, your doctor will need to take a small tissue sample (biopsy) to be examined in the laboratory.

Almost all oral cancers are of the squamous cell type. Squamous cells are firm and flat, and they form the lining of the oral cavity and upper throat as well as the surface of the skin. Squamous cell cancer begins with abnormal cells located only on the surface. As it progresses, the malignant cells invade deeper layers of the oral cavity and upper throat and may spread to the lymph nodes as well as to other parts of the body.

For your doctor to determine how far the oral cancer may have spread, you’ll need to undergo imaging procedures, which may include:

 

* X-ray. Your doctor may want to see dental X-rays as well as X-rays of your head and chest.

* Computed tomography (CT) or magnetic resonance imaging (MRI) scan. A CT scan allows your doctor to see your organs in two-dimensional slices. Split-second computer processing creates these images as a series of very thin X-ray beams are passed through your body. An MRI scanner uses no X-rays. Instead, a computer creates tissue slice images from data generated by a powerful magnetic field and radio waves. These images can be viewed from any direction or plane.

* Ultrasound. This imaging technique uses no radiation. Instead, it combines high-frequency sound waves and computer processing. Ultrasound is especially good for providing information about the shape, texture and makeup of tumors and cysts. While you relax on a bed or examining table, a wandlike device (transducer) is placed along your head. It emits inaudible sound waves that are reflected back to the transducer (like sonar). Those reflected sound waves are then translated into a moving image by a computer.

 

More than half of oral cancers aren’t detected until they are far advanced. When detected early and treated adequately, squamous cell cancer is almost always curable. More than 80 percent of all people with oral or upper throat cancers survive at least one year after diagnosis.

 

 

COMPLICATIONS

 

You may not have any major side effects from surgery to remove a small tumor from your mouth. However, extensive surgery may require major adjustments in the way you chew, swallow, breathe and speak. You may need a prosthetic device in your mouth to replace removed portions of your teeth, gums and jaw. In more advanced cases, you may need to use tubes for feeding and breathing and an artificial voice aid for speaking.

TREATMENT

 

Surgery at an early stage provides the best chance for cure and fewer side effects. If a tumor can’t be completely removed, your doctor may recommend radiation. Sometimes, doctors recommend chemotherapy prior to surgery or in combination with radiation treatment.

Surgery

The type of surgery you may need depends on the size and location of the tumor. Tumors that haven’t grown into nearby tissues can be surgically removed with relatively few side effects. However, if the tumor has invaded nearby tissues, the surgery is more extensive. Sometimes surgeons need to remove bone tissue from the jaw or roof of the mouth. To treat a cancer of your tongue or the upper part of your throat, your surgeon may need to remove tissues that you use to swallow and in some cases your voice box (larynx). If the cancer has spread beyond your mouth, your surgeon also may need to remove lymph nodes in your neck.

 

Radiation therapy

Your doctor may advise treatment with radiation therapy if your tumor is small. Radiation therapy uses X-rays to kill cancer cells. This approach also may be used along with surgery to destroy small amounts of cancer cells that couldn’t be removed during

surgery.

 

Chemotherapy

Chemotherapy uses drugs to destroy cancer cells. You take these drugs either through your veins (intravenously) or orally. The type of drugs and the length of treatment depend on the size and location of the tumor. Chemotherapy may be used before surgery in order to shrink a tumor. Or, in the case of a large and invasive tumor, chemotherapy may be used in combination with radiation therapy and in place of surgery.

 

Following removal of an extensive tumor, reconstructive surgery or speech pathology may enhance your recovery and rehabilitation.

 

Reconstructive surgery

The goal of reconstructive surgery is to improve your appearance and to help you adjust to difficulties you may have chewing, swallowing, speaking or breathing. Sometimes you’ll need grafts of skin or other tissue from other parts of your body to rebuild areas in your mouth, throat or jaw. You also may need to have a dental prosthesis implanted to replace a part of your jaw removed during surgery. If you’ve had extensive surgery in your neck, you may also undergo surgery to create a hole in your neck (tracheostomy) to help you breathe more easily. If muscles you need for swallowing have been removed, you’ll need surgery to create a hole in your abdomen (gastrostomy) in order to receive food directly into your stomach through a feeding tube.

 

Rehabilitation

Adjusting to life after your surgery may mean working with a speech therapist and dietitian. A speech therapist can help you over- come problems with speech and eating. If you’ve lost the ability to speak, you can learn to speak by forcing air up through your esophagus (esophageal speech). Artificial devices also are available to help you speak or speak more loudly. A dietitian can help you choose foods that are suitable for you if you’ve lost some of your ability to chew and swallow. In addition, you may benefit from sessions with a physical therapist and occupational therapist to help you make adjustments in your personal and work lives.

 

PREVENTION

 

Tobacco and alcohol are by far the most important risk factors for oral cancer. You can greatly reduce your risk of oral cancer by not smoking and by limiting the amount of alcohol you drink or avoiding alcohol altogether.

Other steps you can take to help prevent oral cancer or to prevent its progression include:

 

* Use well-fitting dentures. If you wear dentures, be sure they fit properly and are well cleaned and rinsed. Oral irritation increases your risk of oral cancer.

* Don’t chew on the inside of your mouth. Doing so also irritates your oral tissues.

* Limit your exposure to the sun. Ultraviolet light damages the skin on your lips and increases your risk of cancer. When you’re out in the sun, use lip balm and a wide-brimmed hat to protect your face, including your lips.

* Check your mouth and tongue periodically. Standing in front of a mirror, use your forefinger and thumb to pull facial tissue aside to get a good view of the tissue on the inside of your lips, your cheeks and elsewhere inside your mouth. Look for bumps and for changes in color. Use your thumbs and fingers to check for lumps and tender spots. If you notice changes, talk to your dentist or doctor. Oral cancer is curable. But success depends on detecting it early.

 

COPING SKILLS

 

A diagnosis of cancer can be extremely challenging. It’s important to remember that no matter what your concerns or prognosis, you’re not alone. Here are some strategies and resources that may make dealing with cancer easier:

 

* Know what to expect. Find out everything you can about your cancer — the type, stage, your treatment options and their side effects. The more you know, the more active you can be in your own care. In addition to talking with your doctor, look for information in your local library and on the Internet. The National Cancer Institute will answer questions from the public. You can reach them at 800-422-6237. Or contact the American Cancer Society at 800-227-2345.

* Be proactive. Although you may feel tired and discouraged, don’t let others — including your family or your doctor — make important decisions for you. It’s vital that you take an active role in your treatment.

* Maintain a strong support system. Having a support system can help you cope with any issues, pain and anxieties that might occur. Although friends and family can be your best allies, they sometimes may have trouble dealing with your illness. If so, the concern and understanding of a formal support group or others coping with cancer can be especially helpful. Although support groups aren’t for everyone, they can be a good source for practical information. You may also find you develop deep and lasting bonds with people who are going through the same things you are.

* Set reasonable goals. Having goals helps you feel in control and can give you a sense of purpose. But don’t choose goals you can’t possibly reach. You may not be able work a 40-hour week, for example, but you may be able work at least half time. In fact, many people find that continuing to work can be helpful.

* Take time for yourself. Eating well, relaxing and getting enough rest can help combat the stress and fatigue of cancer. Also, plan ahead for the down times when you may need to rest more or limit what you do.

* Stay active. Being diagnosed with cancer doesn’t mean you have to stop doing the things you enjoy or normally do. For the most part, if you feel well enough to do something, go ahead and do it. It’s important to stay involved as much as you can.

* Look for a connection to something beyond yourself. Having a strong faith or a sense of something greater than yourself seems to be a key factor in successfully coping with cancer.

 

Additional Resources American Cancer Society National Cancer Institute National Institutes of Health

March 02, 2001

© 1998-2002 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.

 

 

 

 

 

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