Braces and Orthodontics
Mouth Sores and Spots
Mouth sores can be painful, annoying and unsightly.
Some appear inside the mouth – on the gums, tongue, lips, cheeks or palate (roof of the mouth). Others, like cold sores, can appear outside the mouth, such as on and around the lips, under the nose and on the chin.
Mouth sores can be caused by oral cancer or bacterial, viral or fungal infections. Some other causes include:
• Irritations, such as dentures that no longer fit properly and rub against tissues.
• Loose orthodontic wires or the sharp edge of a broken tooth or filling.
• Extreme sensitivity to ingredients found in some toothpastes or mouth rinses.
• Medication, cancer treatment side effects or reaction to therapy.
• Certain specific skin, oral or systemic diseases.
Although there are many types of mouth sores, the most common are canker sores, cold sores, leukoplakia (a thick white or gray patch) and candidiasis or thrush (a fungal infection).
Some people may experience occasional discolored, painless spots in their mouth. Most are harmless and will disappear or remain unchanged. However, some sores or spots can be serious and need the attention of your dentist or physician. For example, oral cancer may not be painful at first, but it can be deadly. That’s why regular dental checkups are important. Have your dentist examine any mouth sore or spot that fails to heal within two weeks.
Canker sores appear inside the mouth. They usually are small ulcers (minor aphthous ulcers) with a white, yellow or gray center and a flat red border. Rarely, canker sores can be very large (major aphthous ulcers) with a raised border. There may be one or several ulcers and they recur at varying periods of time.
A canker sore usually begins as a red spot or bump. It may produce a tingling or burning sensation before other symptoms appear. Canker sores are painful. Fortunately, most canker sores heal spontaneously in 7 to 10 days.
The exact cause of canker sores is not known. Genetics play a role. White cells (lymphocytes) in our immune system may affect the lining of the mouth causing these irritating, but harmless, sores. Fatigue, emotional stress, and certain foods can increase the possibility of a canker sore for some people. Even biting the inside of the cheek or tongue or chewing a sharp piece of food may trigger a canker sore.
Canker sores are not contagious or precancerous. There is no permanent cure for canker sores; therefore, treatment is for discomfort or pain. Over-the-counter topical medications (such as numbing agents or protective ointments) and antimicrobial (germ-fighting) mouth rinses may offer temporary relief. Avoid hot, spicy or acidic foods and beverages that can irritate the sore. Treatment for an attack involves corticosteroids, Prednisone-like medications that control troublesome lymphocytes. The medication may be in a topical form (applied to the skin), or systemic (taken as a tablet or capsule).
Cold sores are groups of painful, fluid-filled blisters (often called fever blisters). These unsightly sores usually erupt on the lips, and sometimes on skin around the lips. Clusters of small blisters may also occur on the gum tissue near the teeth and/or on the bony roof of the mouth.
Cold sores – caused by herpes virus Type 1 or Type 2 – are contagious. The initial infection (primary herpes), which often occurs before adulthood, may be confused with a cold or the flu. The infection can cause painful lesions to erupt throughout the mouth, and some patients can be quite ill for a week. Most people who get infected with herpes do not get sick, however. Once a person is infected with herpes, the virus stays in the body, where it may remain inactive. Unfortunately, in some people, the virus becomes activated periodically, causing the cold sore to appear on the lips or other sites. A variety of irritants (wind, sun, fever, stress) can cause a flare.
Cold sores usually heal in about a week. Once the blister breaks, an unsightly scab forms. Over-the-counter topical anesthetics and protectants, anti-inflammatory agents or topical antiviral agents may provide temporary relief for the discomfort but do little to speed healing. As with the common cold, there is no cure for these viral infections. Topical or systemic antiviral drugs can be prescribed by your dentist, but they are ineffective after 3 to 4 days of blister formation and usually are not recommended in otherwise healthy patients.
Leukoplakia (loo-koh-PLAY-kee-ah) is a white or gray patch that develops anywhere on the inside of the mouth. It is caused by excess cell growth of the lining of the mouth. It is often a response to chronic irritation, such as smoking or smokeless tobacco (snuff, chewing tobacco), certain foods, cheek biting, irregular dental restorations or broken teeth. In some instances, a cause cannot be determined. Leukoplakia patches develop slowly over a period of time. The patch may eventually become rough. It typically is not sensitive or painful.
Leukoplakia generally is harmless, but there is a risk that it can become cancerous. To be certain that a spot or sore is not a threat, your dentist may do a biopsy to determine if any potentially dangerous cells are present. If the leukoplakia is sensitive, cancer must be ruled out by biopsy.
Erythroplakia (e-ryth-ro-PLAY-ki-a) is a red patch that may be found in any part of the mouth but is most common in the floor of the mouth or on the gum tissue behind the back teeth. The cause is unknown but is most likely associated with smoking or other tobacco use and alcoholic beverages. Chronic irritation and poor nutrition may also be contributing factors. Although erythroplakia is less common than leukoplakia, most of these lesions are found to be precancerous or cancerous when biopsied. Red lesions that do not heal in a week or two should be evaluated by your dentist. This applies even if you do not smoke or drink alcohol.
Lichen planus (li-ken PLAY-nus) is a disorder that involves a chronic, itchy, inflammatory rash or lesion on the skin or in the mouth. The lesions may consist of white spots or “lacelike” white changes. Lesions on the sides of the tongue, insides of the cheek and on the gums, may be tender or painful. Its cause is genetic and related to a chronic immune system reaction.
Lichen planus generally occurs during or after middle age. Lichen planus is not contagious and does not pose a high risk for becoming cancer. There is no cure, so treatment is for discomfort or pain. Rinses, ointments, or pills can be prescribed by your dentist, if needed. The diagnosis can be confirmed by biopsy and clinical characteristics.
Candidiasis (can-di-DI-a-sis), also known as oral thrush or moniliasis, is a fungal infection. It produces creamy white and red patches that form on surfaces of the mouth. It can be painful and may cause bad breath and difficulty tasting and/or swallowing.
It occurs when the yeast Candida albicans reproduce in abnormally large numbers. For example, Candida may flourish after antibiotic treatment, when normal bacteria in the mouth have decreased, when the immune system is suppressed or when the mouth is dry (xerostomia). Dry mouth is a common side effect of many prescription or over-the-counter medications.
Candidiasis most often occurs in the very young, the elderly, and those debilitated by disease, such as diabetes and AIDS. It also frequently occurs among people who wear dentures.
Treatment consists of controlling conditions that cause the outbreak. Cleaning dentures to remove Candida is important in preventing denture-induced problems.
Saliva substitutes or prescription medications are also available to treat dry mouth. Antifungal medications may be used when the underlying cause cannot be treated or eliminated. Good oral hygiene is essential.
Oral or mouth cancer may appear on the lips, tongue, cheek lining, gums, palate (roof of the mouth) or floor of the mouth. Cigarettes and other tobacco products, including smokeless tobacco, are associated with 70 percent of oral cancer cases. Drinking alcoholic beverages can also increase your chances of having oral cancer.
Oral cancer may appear as a white or red lesion, lump or ulcer. It is usually small and painless at first, but can grow and spread quickly. Many oral cancers are discovered during routine dental examinations. Control of leukoplakia and erythroplakia may prevent some oral cancers from developing. Some oral cancers can resemble benign (non-dangerous) changes, so may delay early diagnosis.Early diagnosis and treatment increase the chance of a good quality of life.
What you can do:
• Schedule regular dental checkups. See your dentist for mouth sores that persist longer than two weeks, even if they are not painful. A biopsy (tissue sample taken for testing) can usually determine the cause or rule out cancer. Your dentist can recognize and often diagnose the type of mouth sore or spot based on its appearance and location.
• Keep a diary of what you eat and drink.
• Keep a list of oral hygiene products (toothpaste, mouth rinse, etc.) you have been using.
• Avoid all tobacco products.
• If you drink alcoholic beverages, do so in moderation.
• See your dentist if you notice any change in your mouth, including pain or discomfort, or the presence of sores in the mouth, even if they are not painful. For oral cancer, early diagnosis and treatment can increase your chance of cure.
Questions or concerns? Talk to your dentist.
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Orthodontic Treatment for a Healthy, Beautiful Smile
Crooked teeth and bite problems are often solved with orthodontic treatment. Sometimes, even when teeth look straight, the upper and lower teeth may not fit together well causing a bite problem. Braces are the most common way to correct crooked teeth and bite problems. This brochure will talk about braces and other types of orthodontic treatment.
The good news is that orthodontic treatment can lead to a healthy, beautiful smile, regardless of a patient’s age. Orthodontic treatment takes time and patience, but the end result is worth it.
Problems with crooked teeth
There are different causes of a bad bite, also called a malocclusion (mal-oh-CLUE-shun). Sometimes a bad bite happens naturally. Thumb-sucking, losing teeth too early, or accidents also can cause a bad bite.
If a bad bite is not treated, it may cause problems:
• Crooked and crowded teeth are harder to keep clean. This may lead to tooth decay, gum disease, and tooth loss.
• When teeth are in the wrong place, they may keep the jaws from developing properly. An uneven bite may make biting, chewing and speaking harder, cause excessive wear on tooth enamel, and lead to jaw problems.
Types of orthodontic treatment
There are different types of orthodontic treatment that can be used to correct a bad bite. All use constant but gentle pressure to move teeth and align jaws.
Braces consist of small brackets that are glued to your teeth. They have slots in which a wire is inserted, and the wire is held to brackets using tiny rubber bands (“ligatures”), or through a built-in mechanism that secures the wire (“self-ligating”). The wire, which is what actually moves teeth, is regularly adjusted to slowly shift your teeth and guide jaw growth in patients who are still growing. The brackets may be metal or tooth colored. Sometimes brackets are placed on the backs of your teeth, making them invisible. Braces are available for patients of all ages.
Aligners (ah-LINE-ers) are made of clear plastic or acrylic and are worn over your teeth, placing gentle pressure on them to straighten them. Each set of custom-made aligners is worn for a few weeks. Then you get a new set to advance your treatment. This way, your teeth are slowly moved into the correct positions. Aligners are available for teens and adults.
Aligners are removable and need to be taken out before you eat, brush, and floss. Be sure to follow your instructions on how long to wear them each day.
When jaws don’t line up, teeth cannot be aligned properly. Some patients may have an upper or lower jaw that sticks out and causes their bite to be uneven. In some cases, patients may need braces or aligners in combination with surgery to achieve a healthy bite.
Most people wear braces or aligners for one or two years, depending on the problem. Then they wear retainers that hold teeth in their new positions.
You can expect a little discomfort during treatment. But today’s materials use a constant, gentle pressure that makes treatment more comfortable for the patient.
Orthodontic treatment for children
When a child is about 7, he or she should have their teeth checked to see how they work together. If the child’s teeth or bite need treatment, it may be advantageous to get an early start. Treatment that begins while a child is growing may deliver results that cannot be achieved once the patient is done growing. Most treatment begins when patients are between 9 and 14.
The type of treatment recommended will be based on the patient’s orthodontic problem, treatment needs, and desired results. Patients will receive instructions on keeping their teeth, gums and “appliance” (the formal name for braces and other devices that move teeth and align jaws) clean throughout treatment.
Orthodontic treatment for adults
No matter your age, it’s never too late to improve your dental health and beautify your smile. Many adults seek treatment to correct long-time problems or to correct changes that happened over time. Sometimes an adult’s treatment takes a little longer than a child’s treatment.
Do’s and don’ts of braces
• Keep your teeth clean when wearing braces. Brushing and flossing remove plaque, a sticky film of bacteria that forms on teeth. If plaque is not removed regularly it could lead to tooth decay or gum disease.
• Go to all of your orthodontic appointments. If you delay any adjustments, your treatment may take longer.
• Visit your dentist for cleanings and exams. It is harder to keep teeth clean if you have braces. So having regular cleanings at your dentist’s office is important. Your dentist will also check for tooth decay, gum disease, and loss of minerals in the enamel (called demineralization).
• Eat foods that could get stuck in your braces or bend the wires. These foods include nuts, corn on the cob, popcorn, hard candy, ice, and sticky foods like chewing gum, caramel, or other chewy candy. Ask your orthodontist and dentist which foods to avoid.
• Eat too many sugary foods. This can lead to tooth decay around the brackets that could permanently stain or damage your teeth.
• Play sports and active games without wearing a mouthguard. A mouthguard can protect your mouth and jaw from getting hurt. Your orthodontist or dentist can suggest a proper mouthguard to wear with your braces.
Before-and-after photos courtesy of Dr. Grant Bowbeer.