Uncommon Dental Issues After 40

As we grow old, our bodies go through a multifaceted transformation that leaves us looking weak and worn out—one of the areas primarily affected by these changes in the mouth. Many dental complications come with age, including cavities, gum diseases, loose teeth, tooth decay, and many more.

However, some dental issues are not common in people who are 40 years and above. Continue reading to learn more about the uncommon dental problems after 40.

Crowded or Misaligned teeth

The problem of crowded or misaligned teeth happens when there isn’t enough room in your jaw for teeth to erupt. It can also occur when there is too much space in your jaw, resulting in spaced and gapped teeth (diastema). This problem is only common in teenagers and young adults who are likely to develop more teeth like wisdom teeth. So, it’s uncommon to find a 40-year-old patient with this problem.

To prevent this problem, you should remove the problematic wisdom teeth immediately. If it’s not because of an impacted wisdom tooth, you can wear dental braces to rectify the misalignment.

Impacted Wisdom Teeth

When a person reaches puberty, they develop two molars in their upper and lower jaws. These molars are commonly referred to as wisdom teeth. Sometimes these last molars, which erupt at the back of the mouth, have to push themselves out through the tiny room available in your jaw.

This means that they will either get stuck inside the gum or grow at the wrong angle. This is what dentists refer to as impacted wisdom teeth. The problem of impacted wisdom teeth is only common in people aged between 15 and 25. Therefore, it’s very rare to have an impacted wisdom tooth after 40 years unless you have had the problem since your adolescence.

Oral Cavities

Oral cavities are a result of permanently damaged areas of teeth that caused tiny holes. These damages can be a result of bacterial infection, excess sugar, and poor oral health. If left untreated, cavities can cause toothache, infections, and tooth loss. however, cavities are only common in kids and young adults.

Studies have shown that 20 percent of children will have an oral cavity in their childhood. Therefore, it’s very rare to find a 40-year-old patient with an oral cavity. You can prevent cavities by avoiding sugary food and drinks and maintaining proper oral hygiene. It’s also good to go for regular dental checkups so that the problem can be detected and dealt with before it advances.

We’re Reopening for Elective and Emergency Cases on May 13th

The last 6 weeks have been trying times for us as we were all dealing with the unprecedented issues surrounding the global pandemic.  The pandemic has affected all aspects of our lives and resulted in the closure of essentially all elective surgery except but emergency care. Through Governor Waltz’s leadership we are beginning to reopen our elective surgical and dental services as of May 13th. Although we are grateful and excited about returning to work, it is not the time to let down our guard and as a community we need to work together to ensure we continue to minimize the spread of the virus while resuming our daily activities.

We have carefully followed the progress of the pandemic and implemented recommendations for minimizing its spread. Based on guidelines from the Centers for Disease Control (CDC), Minnesota Department of Health Services (MDH), Centers for Medicare and Medicaid Services (CMS) and the Governor’s office we have formulated a plan that maximizes the safety of our patients and their families as well as our healthcare team. We would like to share with you the many changes that we have implemented. As time passes and recommendations change, our protocols will also change and evolve to encompass the best available evidence for our patients.

What will not change is our continued commitment to the safety of our staff and patients.

PATIENTS:

  • In an effort to minimize in-office time, when at all possible, prior to arriving at the office, patient registration paperwork should be completed online through our website.
  • A viral exposure intake form will be completed by any person, patient or escort that comes into the office.
  • All individuals entering the office to wear their own face mask.
  • Every person entering the office will have their temperature checked.

RECEPTION AREA:

  • Hand sanitizer will be provided in the office.
  • Our staff will be routinely cleaning chairs, tables and the general waiting area and bathroom.
  • There will be no magazines or books in the waiting area, so please bring any desired reading material.
  • No food or beverages will be permitted in the waiting room.
  • The number of chairs in the waiting room have been reduced. Each chair will be set a minimum of 6 feet apart.

APPOINTMENTS:

  • Whether it be a surgical consultation or a surgical procedure, we request that only necessary individuals be present.
  • We request that adult patients enter the waiting room alone and have others wait in the car or outside.
  • Only one escort for minor patients will be permitted. All others wait in the car or outside.
  • To minimize the amount of individuals in our waiting and surgical area, we will be staggering surgical and consultative appointments.
  • After every appointment, all areas and our equipment and areas will be thoroughly cleaned per our protocol.

STAFF/DOCTOR:

  • Any staff member feeling ill will stay at home.
  • Our entire staff will daily complete viral exposure intake forms and have their temperatures taken.
  • All staff will follow CMS and CDC universal source guidelines.
  • Masks will be worn in non-treatment and treatment areas.
  • Staff will adhere to regular hand washing and sanitizing.
  • All of our staff will arrive at our office in their personal clothing, change into work PPE, and upon completion of their work day, change back into personal clothing. All scrubs (PPE) will be thoroughly cleaned and sanitized.
  • Any staff member that comes in contact with a person texting positive or any person that is being tested will self-quarantine. They will not return to work without a note from their physician.

GENERAL GUIDELINES:

We thank you for your patience as these protocols are an adjustment for all of us. In order to ease the transition, the following will also be available.

  • If necessary, another individual can phone into a consultation via speaker phone to listen and ask questions.
  • If additional explanation of insurance, financial obligations, or options is needed, a follow up phone call can be made.
  • Virtual Consultations, with encrypted software, are available to minimize exposure. Please call for more information.

Our doctors and staff at Minnesota Oral and Facial Surgery Center appreciate your efforts and cooperation to limit the spread of the virus. We look forward to continuing to be of service to you and our community.

Sincerely,

Deepak Kademani DMD MD FACS and Rod VanSurskum DDS

Minnesota Oral and Facial Surgery

Partners for your Healthcare Journey-Providing Excellence in Surgical Care

Head and Neck Cancer Awareness Month

Cancer-Awareness-Month-Dr-Kademani

Approximately 650,000 people worldwide are diagnosed with head and neck cancer each year, and more than 330,000 deaths are attributed to these diagnoses on an annual basis.1 More than 90% of these tumors arise from the mucosa of the oral cavity, oropharynx, and larynx, and the majority are histologically verified squamous cell carcinomas.2 Overall, in 2020 the 5-year survival rate of oral and oropharyngeal cancer is estimated to be approximately 65%. In the United States, these cancers account for about 50,000 new cancer diagnoses each year and almost 1 death every hour of every day. Risk factors for oral and oropharyngeal cancer include the use of smokeless and inhalational tobacco, use of alcohol, the synergistic interaction of tobacco and alcohol, human papillomavirus (HPV) and use of betel quid (paan).

Improved Survival Rates

Improved survival rates are noted when these cancers are diagnosed at early stages- approximately 84% for localized disease, 66% for regional disease, and 39% for distant disease. A delay in diagnosis has been shown to increase the risk of experiencing progression to advanced stages of disease and increased mortality. Thus, early detection of potentially malignant and overtly malignant mucosal disease will enhance the possibility for complete recovery and increase the quality of life for patients with oral and oropharyngeal cancers.

Oral health care professionals are the best suited among all health care professionals to perform effective screening for oral and oropharyngeal cancer, which should consist of an assessment of risk factors and a detailed oral and oropharyngeal examination. The reference standard for screening remains a clinical examination and tissue biopsy. Although, numerous adjunctive tests are available, all have shown a level of sensitivity and specificity that makes them ill-suited to be used for routine screening. As early diagnosis can decrease both morbidity and mortality of oral and oropharyngeal cancer, the oral health care community is in an ideal position to perform screening, and we need to understand our critical role in affecting the epidemiology of these devastating cancers, which unfortunately has not improved significantly in the past decades.

The management of oral potentially malignant disorders (OPMD) is an important step in the prevention and early detection of oral cancer. In 2018, the American Dental Association produced guidelines for the management of OPMD, which for high-risk lesions should involve monitoring for changes, followed by serial biopsies with histologic confirmation for high-risk lesions. It is important to recognize that all patients, and particularly those at high risk of developing OPMD, should be educated about the risk of experiencing malignant transformation and should be monitored in a structured follow-up program.

Recently, HPV has garnered a great interest as a virally induced variant of head and neck cancer. HPV is the most commonly sexually transmitted disease in the United States, and it has been identified in 70% of oropharyngeal cancers and 10% of oral cancers. In 1999, cervical cancer (13,125 new diagnosed cases) was the most common HPV-associated cancer with 3,750 more cases of cervical cancer diagnosed than oropharyngeal cancer. In 2015, oropharyngeal cancer (18,917 new diagnosed cases) was the most common HPV-associated cancer, including 15,479 cases in men and 3,438 cases in women, which represent a 2.7% increase in incidence in only 16 years. Several factors might account for the increase in oropharyngeal cancers, including changes in sexual behaviors, which include risk factors of early sexual debut and lifetime number of oral sex partners. The lack of routine tonsillectomies in the current Millennial generation might also explain the increased incidence of oropharyngeal cancer during this time.

Vaccination Strategies

Vaccination strategies for HPV have existed since 2006 when the US Food and Drug Administration licensed the quadrivalent Gardasil (Merck) vaccine to protect against HPV types 6, 11, 16 and 18. Thereafter, the US Food and Drug Administration licensed the bivalent Cervarix (GlaxoSmithKline) vaccine to protect against HPV types 16 and 18 in 2009 and the 9-valent Gardasil vaccine to protect against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58 in 2018. Although the Centers for Disease Control and Prevention established a target of 80% US HPV vaccination rate as part of its Healthy People 2020 initiative, the national HPV vaccination rate has fallen behind other vaccination rates. In 2018, 51.1% of adolescents aged 13 through 17 years were current with their HPV vaccine series, and 68.1% had received 1 or more doses.

Increased survival rates of oral and oropharyngeal cancer have been realized over the past 20 years, likely owing to earlier detection by providers, aggressive surgical and adjuvant chemoradiotherapy protocols, precautionary statements on smokeless tobacco and cigarette packages, and other public health measures. Just as routine cervical examinations and Papanicolaou tests (PAP smears) have led to a decrease in cervical cancer, oral health care and medical health care professionals alike must develop a sense of urgency regarding routine examination of the mucosa of the oral cavity and oropharynx to provide earlier detection of potentially malignant lesions and obvious cancers. With improved vaccination strategies and adherence outcomes with Gardasil 9, it is possible that oropharyngeal cancer rates will begin to decrease. Over time, hopefully, HPV vaccination will decrease the incidence of cervical cancer further. Therefore, all health care providers, including all oral health care professionals, must engage in conversation with young patients regarding the highly beneficial and safe nature of the HPV vaccination. HPV vaccination is recommended for boys and girls aged 11 or 12 years before HPV exposure occurs. The vaccine can be started as early as age 9 years and should be completed before the child’s 13th birthday. The vaccine is given in 2 injections with 6 through 12 months between injections. Three injections of the HPV vaccine are required for children who start the vaccine at age 15 years or older, and it can be administered up to age 26 years. The benefit of vaccinating after the age of 26 years is unclear.

Copyright 2020 American Dental Association. All rights reserved.

Eric R. Carlson, DMD, MD, EdM, FACS; Deepak Kademani, DMD, MD, FACS

Story of Oral Cancer Caused by HPV

Shortly after getting married, Steve learned he had an oral cancer caused by HPV. Steve and his wife want parents to protect their children from HPV-related cancers by getting them vaccinated.