Thursday, September 29, 2011

Dental care in Behcet's General concepts

Regarding Behcet's and dental care, here are my thoughts.

Do all the preventative things possible:

1) Brush and floss always. The basic most important thing you can do.
2) Use an ultrasonic toothbrush. It will clean beyond where you touch the brush, many times better than you can with a manual toothbrush. Sonicare
3) Prevident or some other kind of prescription flouride. It will help remineralize teeth, strengthening them every day.
4) No sodium lauryl sulfate in toothpaste. Biotene, and Rembrandt make a tooth paste specifically without this. This can help cut down the number of sores in the mouth.
5) Regular cleanings. You clean the plaque every time you brush and floss, but tartar build up cannot be brushed off. It is much like a hard water deposit on your sink, it is harder to remove. It is very rough and porous so it harbors a lot of bacteria that causes inflammation and infection.
6) Use mouthwashes without alchohol, like Crest ProHealth. Scope, Listerine etc, are good at killing bacteria, but the alchohol dries your mouth which is bad for Behcet's sores, both sores already present and in helping to generate more.
7) Dry Mouth? Use saliva substitutes. Biotene, Oasis, Spry, Breath Rx and others. There are sprays, gels, mints, lozenges, rinses. Use what works in your lifestyle best. Decreased saliva causes increased cavities and gum disease. Make sure you are not wetting your mouth with things with sugars in them.
8)Eliminate colas. Coke, Pepsi, Mtn.Dew, Dr.Pepper, generic colas have phosphoric acid in them. (Look on the ingredients on the label). This etches and weakens the teeth. (I use phosphoric acid to etch the teeth to roughen the surface before doing a filling so the filling will bond to the tooth better.) They will weaken and wear down your teeth.
9) Don't postpone the crown on the tooth with the big filling in it. (I am hearing "teeth breaking off in chunks" over and over here.) A crown will protect you from that.
10) Arestin, Perio chip, etc. (Antibiotics placed in the gums next to the teeth) are a good idea where there periodontal pockets. For sure for pockets, 6mm and greater. Good for 5mm pockets if you can afford it. It puts antibiotics where needed for periodontal disease where the blood stream can't reach.
11) Disclaimer: this is my own personal theory, not yet fully studied and tested:
Painful teeth: Consider a root canal with a teeth that are not presenting with the "classic symptoms" for a tooth abscess. For example: Pain to cold that develops several minutes after a cold drink, ice cream etc. then worsens the more time passes and the pain lingers for several hours or even a day or more. / Exquisitely sensitive or painful to touch or bite. It hurts as much to push the tooth side to side as it does to tap or touch the top of the tooth. Tooth pain that increases and decreases coinciding with your "flares". This can happen even in the abscence of anything showing on an xray.
Also, getting proper treatment for the Behcet's can stop the tooth problems. I have seen it happen.
12) Eliminate all rough spots, overhangs or any other irritants on the teeth.
13) Denture wearers - Ill fitting dentures should be replaced or relined to fit better. Loose movement on a denture creates friction, inflammation and thus more Behcet's sores. It also increases bone resorption of the ridges under the denture. (It does that, Behcet's or not)
14) Be vigilant. Remember, in Behcet's, inflammation in the mouth increases inflammation everywhere else.
Periodontal (Gum) disease is a chronic, inflammatory infection. Generalized 6mm pocket periodontal disease is the equivalent of having a 2 square inch sore anywhere else. If you had a bed sore, 2 square inches in size, you wouldn't ignore it, don't ignore periodontal disease.

I hope this helps.

David Petersen DDS

2 comments:

  1. I'm glad you're writing about all this. It's good to collect these thoughts in places where other people can benefit from them. Thanks.

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  2. I have been diagnosed with behcets. I also have a tooth which the root canal of incomplete due to recurring inflammation, more my dentist days that we need to extract it. I am afraid that that after extraction the gum will turn into a huge sore and take forever to heal. Any ideas on behcets and teeth extraction?

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