Tips for Caring for Your Teeth and Mouth: For the Patient ......water is public water with enough...

REPRINT COLLECTIONJUNE 2020VOL 151 NO. 6R

Publication of this reprint collection was supported by the ADA Foundation.

Tips for Caring for Your Teeth and Mouth:For the Patient Pages

REPRINT COLLECTION

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Table of Contents

June 2020 n Volume 151 n Number 6R

Introduction

R1 Empowering Patients Through Oral Health EducationCraig S. Armstrong

For the Patient Pages

R2 Your Child’s Teeth

R3 Protection From Tooth Decay: Dental Sealants

R4 Fighting Cavities With Fluoride

R5 Helping Your Child Fight Tooth Decay

R6 What Is Dental Erosion?

R7 Dental X-Rays

R8 Choices for Fixing Cavities

R9 Smart Shopping With the ADA Seal of Acceptance

R10 Vaccines for Your Child: Human Papillomavirus

R11 Keeping an Eye on Your Gums

R12 Just What the Doctor Ordered: Relieving Dental Pain

R13 Oral and Throat Cancer: What You Should Know

R14 Dealing With Tooth Pain

R15 Why Does My Jaw Hurt?

R16 Using Antibiotics Wisely

R17 Dental Care During Pregnancy

R18 Can Diabetes Affect My Oral Health?

R19 The Word on Vaping: Don’t Start

R20 Your Teeth and Jaws Under Pressure

R21 Oral Care During Cancer Treatment

R22 Oral Health Care Tips for Caregivers

Publication of this reprint collection was supported by the ADA Foundation. The support of this reprint collection does not imply that theeditors of The Journal of the American Dental Association (JADA) nor the American Dental Association endorse the advertised products orservices.

All content has been peer reviewed by the designated editors of JADA. The opinions or views expressed in this reprint collection are those ofthe authors, and do not necessarily reflect the opinions or views of The Journal, the ADA Foundation, or the American Dental Association.

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, com-pounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses anddrug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier or the American Dental Association for anyinjury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods,products, instructions, or ideas contained in the material herein.

JADA 151(6R) n http://jada.ada.org n June 2020 A1

EDITORIAL POLICYAll statements of opinion and of supposed fact are published under the authority of the authors,including editorials and letters. They are not to be accepted as the views of the American DentalAssociation or its subsidiaries unless such statements have been expressly adopted by the Association.Articles are accepted with the understanding that they have not been published previously and thatthey are submitted solely to The Journal. Information on any products mentioned may be availablefrom the authors.Neither theAmericanDentalAssociation nor any of its subsidiaries has any financialinterest in any productsmentioned in editorial content, andThe Journal requires all authors to discloseany financial or other interests they may have in products or services described in their articles.

PERMISSIONS POLICY� 2020 TheAmericanDentalAssociation holds the copyright for articles published inThe Journal.Unlike other portions of JADA, the print and online versions of this page may be reproduced as ahandout for patients without reprint permission from ADA Publishing. Any other use, copying, ordistributionof thismaterial, whether in printed of electronic form, including the copying and postingof this material on a website, is prohibited without prior written consent of ADA Publishing. Forinformation on how to seek permission visit www.elsevier.com/permissions. “For the Patient” pro-vides general information on dental treatments. It is designed to prompt discussion between dentistand patient about treatment options and does not substitute for the dentist’s professional assessmentbased on the individual patient’s needs and desires. You can find more information for patients atADAcatalog.org or at MouthHealthy.org. For information on the Permissions Policy for otherJADA articles, please refer to the information in the June 2020 issue of JADA.

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NoticeNo responsibility is assumed by the publisher or the American Dental Association for any injuryand/or damage to persons or property as a matter of products liability, negligence or otherwise, orfrom any use or operation of any methods, products, instructions or ideas contained in thematerial herein. Because of rapid advances in the medical sciences, in particular, independentverification of diagnoses and drug dosages should be made. Although all advertising material isexpected to conform to ethical (medical) standards, inclusion in this publication does notconstitute a guarantee or endorsement of the quality or value of such product or of the claimsmade of it by its manufacturer.

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Staff & Policies

June 2020 n Volume 151 n Number 6R

A2 JADA 151(6R) n http://jada.ada.org n June 2020

Introduction

Empowering patients through oral healtheducation

Craig S. Armstrong, DDS, MAGD

The American Dental Association (ADA) Foundation has been a tireless advocate for thepromotion of oral health and patient education, and over the last several years has developedprograms and materials that are easily accessible by the public. At the same time, the ADA

has developed numerous brochures and other resources that can be used as educational tools duringa dental visit.

The coordination of the delivery of dental care by the dentist and the dental team is a criticalcomponent of maintaining a healthy mouth. The establishment of a regimen of regular dental visitsand a successful oral home care program are crucial to the overall goal of optimum oral health. TheADA has developed the following Healthy Smile Tips with this goal in mind:

n brush your teeth twice a day with a fluoride toothpaste;n clean between your teeth daily;n eat a healthy diet that limits sugary beverages and snacks;n see your dentist regularly for the prevention and treatment of oral disease.Following the Healthy Smile Tips requires the use of various dental products that are available in

the oral health care aisle. The ADA Seal of Acceptance provides the consumer with a tested, safe,and effective product that meets the highest industry standards.

We have compiled some of the For the Patient pages from The Journal of the American DentalAssociation on topics that we think are the most beneficial to the public. There are various topicscontained within these pages, such as why baby teeth are important and ways to protect them, andinformation on conditions that affect the mouth and different available treatments.

For the Patient pages have been written specifically with the purpose of helping the public enjoya lifetime of optimum oral health. We hope you enjoy reading them and find the information withinuseful. Improving your oral health and making regular dental visits can lead to healthier life. Oralhealth is an important part of overall health. n

https://doi.org/10.1016/j.adaj.2020.03.015Copyright ª 2020 American Dental Association. All rights reserved.

Dr. Armstrong is the chair, Board of Directors, American Dental AssociationFoundation.

Address correspondence to Anita M. Mark, senior scientific contentspecialist, ADA Science & Research Institute, 211 E. Chicago Ave, Chicago,IL 60611, e-mail [email protected].

JADA 151(6R) n http://jada.ada.org n June 2020 R1

http://crossmark.crossref.org/dialog/?doi=10.1016/j.adaj.2020.03.015&domain=pdf

http://jada.ada.org

R2

For the Patient

Your child’s teeth

T eeth help your child chew and speak. Baby teeth alsohold a spot for permanent teeth to come in.

TEETHINGTeething babies may be fussy, drool, and want to chew.1 If youwant to let your child chew on a teething ring, go for one thatis hard and solid.1,2

Steer clear of teething products that have benzocaine in them.The US Food and Drug Administration warns that benzocainecan make your baby very sick and may even cause death.3

CAVITIESTo reduce your child’s risk of cavities, help him or hern brush twice a day with a fluoride-containing toothpaste;n use fluoride;n limit sugary snacks and drinks.

ToothbrushingYou can start brushing your child’s teeth twice a day when thefirst tooth comes in. For children younger than 3 years, use nomore than a smear of toothpaste about the size of a grain ofrice. Children older than 3 years can use a drop of toothpasteabout the size of a pea.

You’ll need to brush younger children’s teeth for them.Older children may be able to handle toothbrushing them-selves, but watch to make sure they use the right amount oftoothpaste and spit out as much as possible.4

FluorideFluoride keeps the outside layer of teeth strong. Using fluori-dated toothpaste is 1 way to take advantage of fluoride. Havingyour child drink fluoridated water is good, too. Fluoridatedwater is public water with enough fluoride to help keep teethhealthy. Your dentist may be able to help you find out if yourwater is fluoridated. If it is not, he or she may recommendfluoride tablets or drops to help your child get the most benefitfrom fluoride.

Limiting sugary snacks and drinksTeeth are covered with a thin, sticky film of bacteria, whichproduces acid when exposed to sugar. It is this acid that causescavities.

Drinks are the largest source of sugar in the American diet.5

Juices, for example, can contain sugar. The American Acad-emy of Pediatrics suggests avoiding juice for the first year.6

The pediatrics group also says children should not sip onjuice throughout the day or go to bed with juice. These be-haviors increase the risk of tooth decay.7

VISIT THE DENTISTTake your baby to see the dentist sometime after the first toothcomes in but before his or her first birthday.The dentist may

n perform an oral examination;n assess your child’s risk of tooth decay;n check to see that the teeth are developing on schedule;n identify whether any habits like thumb sucking or pacifieruse are affecting your child’s oral development.8

CONCLUSIONTake care of your child’s teeth from the time the first toothcomes in to help get him or her started on the path to goodoral health. n

https://doi.org/10.1016/j.adaj.2018.11.009

Prepared by Anita M. Mark, senior scientific content specialist, ADAScience Institute, American Dental Association, Chicago, IL.

Disclosure. Ms. Mark did not report any disclosures.

Copyright ª 2019 American Dental Association. Unlike other portions ofJADA, the print and online versions of this page may be reproduced as ahandout for patients without reprint permission from the ADAPublishing Division. Any other use, copying, or distribution of thismaterial, whether in printed or electronic form, including the copyingand posting of this material on a website, is prohibited without priorwritten consent of the ADA Publishing Division.

“For the Patient” provides general information on dental treatments. It isdesigned to prompt discussion between dentist and patient abouttreatment options and does not substitute for the dentist’s professionalassessment based on the individual patient’s needs and desires.

You can find more information for patients at ADAcatalog.org or atMouthHealthy.org.

1. American Dental Association. MouthHealthy: Teething. Available at: https://www.mouthhealthy.org/en/az-topics/t/teething. Accessed October 26, 2018.2. American Academy of Pediatric Dentistry. Teething: 4-7 months. Available at:https://www.healthychildren.org/English/ages-stages/baby/teething-tooth-care/Pages/Teething-4-to-7-Months.aspx. Accessed October 26, 2018.3. US Food and Drug Administration. Risk of serious and potentially fatal blood dis-order prompts FDA action on oral over-the-counter benzocaine products used forteething and mouth pain and prescription local anesthetics. Available at: https://www.fda.gov/Drugs/DrugSafety/ucm608265.htm. Accessed November 2, 2018.4. American Dental Association Council on Scientific Affairs. Fluoride toothpaste usefor young children. JADA. 2014;145(2):190-191.5. US Department of Health and Human Services and US Department of Agriculture.Dietary Guidelines 2015-2020: a closer look at current intakes and recommended shifts.Available at: https://health.gov/dietaryguidelines/2015/guidelines/chapter-2/a-closer-look-at-current-intakes-and-recommended-shifts/. Accessed October 31, 2018.6. Heyman MB, Abrams SA, Section on Gastroenterology, Hepatology, and Nutrition,Committee on Nutrition. Fruit juice in infants, children, and adolescents: current rec-ommendations. Pediatrics. 2017;139(6).7. American Dental Association. MouthHealthy: Training cups and your toddler’s teeth.Available at: https://www.mouthhealthy.org/en/babies-and-kids/training-cups. AccessedOctober 26, 2018.8. American Academy of Pediatric Dentistry. Perinatal and infant oral health care.AAPD Reference Manual. 2016;40(6):216-220.

JADA 150(2) n http://jada.ada.org n February 2019

This article is reprinted from the February 2019 issue of The Journal of the American Dental Association (2019;150[2]:160).

R3

For the Patient

Protection from tooth decayDental sealants

Do you know what tooth decay is? When most peopletalk about tooth decay, they think of a cavity (a holein your tooth). That is sort of right, but tooth decay

actually starts before you get to that point.Everyone has a coating of bacteria, called plaque, that forms on

their teeth. When you eat or drink, those bacteria can turn foodsand many sugary beverages into acid. This acid breaks down thehard coating of your teeth called enamel. This is tooth decay. Ifnot caught early, it can develop into a painful cavity.

Why not stop tooth decay in the early stages, or better yet,prevent it in the first place? Dental sealants may help.1

WHAT ARE DENTAL SEALANTS?Dental sealants are a protective coating that your dentist canplace over the chewing surfaces of your back teeth. These areasare at high risk of developing tooth decay. They are notsmoothdthey have deep pits and grooves. Your toothbrushcannot get into these areas to keep them clean, so food andplaque can be trapped and easily cause tooth decay.

Your dentist can apply sealants to the chewing surfaces ofthese teeth to form a barrier over the rough surface. Sealantsgo on as a gel-like liquid and then harden into a thin butstrong protective coating. Often, your dentist will shine a lighton the sealants to help them harden.

Dental sealants usually last for years, but they can becomeworn.2 Your dentist can check them during your dental visitsto see if they need to be repaired or replaced.

WHO CAN BENEFIT FROM SEALANTS?We know that children benefit from sealants. Children whohave sealants are much less likely to develop tooth decay thanchildren who do not have sealants.3 But what about adults? Areview of the research related to sealants could not find anystudies of the effect of sealants on tooth decay in adults.However, a panel of dental experts suggest that sealants mayhelp reduce the risk of tooth decay in this group, too.3

Sealants may save you money in the long run by helping toprevent tooth decay,4 but there may be costs associated withapplying them. Talk to your dentist and check with your in-surance carrier to see if sealants are covered under your plan.

DO I STILL NEED TO BRUSH MY TEETH?Sealants do not take the place of toothbrushing. They helpprotect the chewing surfaces of your back teeth, but you still

need to brush and clean between your teeth to reduce the riskof tooth decay.

To take care of your teeth, you shouldn brush twice a day with a toothpaste that contains fluoride;n clean between your teeth once per day with floss or anotherinterdental cleaner;

n eat a healthy diet that limits sugary drinks and snacks;n see your dentist regularly.

CONCLUSIONDaily oral care is key to keeping your mouth healthy, butsealants may be able to offer you extra protection against toothdecay. Talk to your dentist about whether sealants are a goodoption for you. n




Copyright ª 2018 American Dental Association. Unlike other portions ofJADA, the print and online versions of this page may be reproduced as ahandout for patients without reprint permission from the ADAPublishing Division. Any other use, copying, or distribution of thismaterial, whether in printed or electronic form, including the copyingand posting of this material on a Web site, is prohibited without priorwritten consent of the ADA Publishing Division.



1. Wright JT, Crall JJ, Fontana M, et al. Evidence-based clinical practice guidelinefor the use of pit-and-fissure sealants: a report of the American Dental Associationand the American Academy of Pediatric Dentistry. JADA. 2016;147(8):672-682.e12.2. Kuhnisch J, Mansmann U, Heinrich-Weltzien R, Hickel R. Longevity of ma-terials for pit and fissure sealing: results from a meta-analysis. Dent Mater. 2012;28(3):298-303.3. Wright JT, Tampi MP, Graham L, et al. Sealants for preventing and arrestingpit-and-fissure occlusal caries in primary and permanent molars: a systematic re-view of randomized controlled trialsda report of the American Dental Associ-ation and the American Academy of Pediatric Dentistry. JADA. 2016;147(8):631-645.e18.4. Lee I, Monahan S, Serban N, Griffin PM, Tomar SL. Estimating the cost savings ofpreventive dental services delivered to Medicaid-enrolled children in six southeasternstates [published online ahead of print November 30, 2017]. Health Serv Res. https://doi.org/10.1111/1475-6773.12811.

JADA 149(9) n http://jada.ada.org n September 2018

This article is reprinted from the September 2018 issue of The Journal of the American Dental Association (2018;149[9]:827).

R4

For the Patient

Fighting cavities with fluoride

T eeth are coated with a thin layer of bacteria calledplaque. These bacteria feed off the sugars you eat ordrink, and some make acids that cause cavities. Fluoride

helps fight these “acid attacks.”

WHO CAN BENEFIT FROM FLUORIDE?

Infants and children whose teeth are still developingWhen children eat food or drink beverages that containfluoride, it is carried to teeth developing beneath the gums.

Children and adults whose teeth have eruptedFluoride that comes in contact with tooth surfaces helpsstrengthen enamel and fight cavities.

HELPING KIDS GET THE RIGHT AMOUNTChildren who are waiting for permanent teeth to eruptneed the right amount of fluoride. Too little can increase therisk of cavities, but too much can cause fluorosisdlight spotsor lines that develop on teeth still growing beneath thegums.

Here are some things you can do to help children get theright amount of fluoride:n Watch how much toothpaste they use. Children youngerthan 3 years should use no more than a smear of toothpaste,about the size of a grain of rice. Anyone older should use apea-sized amount;

n Do not allow children younger than 6 years to use fluori-dated mouthrinses, unless your dentist recommends one;

n Spit out toothpaste and rinses. These products protecttooth surfaces. They have more fluoride than needed inthe diet for cavity protection, and swallowing themregularly may increase the risk of fluorosis;

n Use fluoride supplements as directed by your dentist.

SOURCES OF FLUORIDEThe best sources of fluoride are fluoridated water, fluoridetoothpastes and mouthrinses, and fluoride treatments fromyour dentist.

Fluoridated waterMany communities add fluoride to the water supply to helpprevent cavities. The ideal fluoride level for cavity preventionis 0.7 milligrams of fluoride per liter of water (0.7 mg/L).About 75% of people in the US receive fluoridated commu-nity water.1 If you have a private well, you can have your watertested for fluoride.2 Talk to your dentist or physician about the

level of fluoride in your water. If it is low, he or she mightsuggest a fluoride supplement.Bottled water may or may not contain fluoride. If it is not

listed on the label, check with the manufacturer to find outhow much fluoride the bottled water has.

Fluoride toothpastesEveryone should brush twice a day with a fluoride toothpaste.Remember to keep an eye on how much toothpaste is beingused (see above).

Fluoride mouthrinsesSome mouthrinses contain fluoride. Ask your dentist whetheryou or your child would benefit from adding a fluoridemouthrinse to the daily oral care routine.

Fluoride treatments from your dentistYour dentist may apply a fluoride gel or varnish to helpprotect against cavities. If the risk of cavities is high, yourdentist may prescribe a mouthrinse or toothpaste with morefluoride than the ones you can buy over the counter.

CONCLUSIONSFluoride helps prevent cavities. Talk to your dentist about thefluoride needs of you or your child. n





“For the Patient” provides general information on dental treatments. Itis designed to prompt discussion between dentist and patient abouttreatment options and does not substitute for the dentist’sprofessional assessment based on the individual patient’s needs anddesires.


1. Centers for Disease Control and Prevention. Community water fluoridation: fluori-dation growth data table. Available at: https://www.cdc.gov/fluoridation/statistics/fsgrowth.htm. Accessed May 22, 2019.2. U. S Environmental Protection Agency, Office of Water. Manual of individualand non-public water supply systems. Available at: https://nepis.epa.gov/Exe/ZyPDF.cgi/2000U9HN.PDF?Dockey¼2000U9HN.PDF. Accessed April 26, 2019.

JADA 150(8) n http://jada.ada.org n August 2019

This article is reprinted from the August 2019 issue of The Journal of the American Dental Association (2019;150[8]:728).

R5

For the Patient

Helping your child fight tooth decay

Tooth decay is the first step to a cavity. Just like adults,even healthy babies can have bacteria in their mouths.Sugar from food or drinks can cause some types of this

oral bacteria to produce acid, which can break the tooth down.This is tooth decay. Anytime a child younger than 6 years hastooth decay and needs a filling or has lost a tooth because of acavity, he or she has early childhood caries (ECC).1

ECC can be painful, and it can make your child sickdsickenough to go to the emergency room or even have to stay atthe hospital.

WHAT CAUSES EARLY CHILDHOOD CARIES?

BacteriaThe risk of developing ECC starts with the introduction ofdecay-causing bacteria into a baby’s mouth. This can happenanytime a baby comes in contact with someone else’s saliva,for example, through kissing on the lips or sharing a spoon.

Sugary drinks and snacksWhat your child eats or drinks can set off tooth decay. Drinks likejuice, formula, soft drinks, and even milk can trigger the bacteriain the mouth to produce acid. Crackers, cereal, and other starchyor sweet food can increase the risk of tooth decay, too.

WHAT CAN YOU DO?There are some steps you can take to lower your child’s risk oftooth decay:n use fluoridated water, which helps harden the outside ofteeth and protects them from decay, in your child’s bottle orsippy cup;

n limit sugary snacks and drinks like crackers and juices;n do not give a bottle or sippy cup to your child when he orshe is going to bed or taking a nap;

n take your baby to the dentist by his or her first birthday sothe dentist can check your baby’s oral health and give youtips on caring for your baby’s mouth;

n start brushing as soon as that first tooth comes in (Box).

CONCLUSIONBaby teeth are important. Protect them from tooth decay witha healthy diet, good brushing habits, and a relationship with adentist that starts in the first year. n





“For the Patient” provides general information on dental treatments. Itis designed to prompt discussion between dentist and patient abouttreatment options and does not substitute for the dentist’sprofessional assessment based on the individual patient’s needs anddesires.


1. American Academy of Pediatric Dentistry Council on Clinical Affairs. Policy onEarly Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies.Available at: https://www.aapd.org/research/oral-health-policies–recommendations/early-childhood-caries-classifications-consequences-and-preventive-strategies/. Accessed November6, 2019.

Box. How to brush

n Brush your child’s teeth gently twice a day with achild-sized toothbrush that has soft bristles.

n Use the right amount of toothpaste for the child’sagedyounger children use less than older children(Figure).

Figure 1. For children younger than 3 years, use only a small amount oftoothpaste (about the size of a grain of rice). For children older than 3years, use no more than a pea-sized amount.



R6

For the Patient

What is dental erosion?

Your teeth are covered by enamel, which is hard but canbe damaged. If your teeth are exposed to acidic food orliquids over time, enamel can be lost. This process is

called dental erosion.1

WHERE DOES THE ACID THAT CAUSES DENTALEROSION COME FROM?Common sources of acids associated with dental erosion2,3

include acidic food and drinks, acid reflux, and vomiting.Acidic food and drinks. Dental erosion is associated acidic

food and drinks. For example, eating acidic fruits more thantwice a day, drinking soda every day, or drinking sports drinksonce a week may contribute to dental erosion.4

Acid reflux. During acid reflux, acid is forced out of thestomach and back into the mouth. People who have untreatedacid reflux for a long time may be at risk for dental erosion.2

Vomiting. Repeated vomiting over a period can put you atrisk for dental erosion.2

WHAT SHOULD YOU WATCH FOR?Early signs of dental erosion are shallow pits on your teeth, aflattening of your back teeth, or both.5 As more enamel is lost,the dentin is exposed, which can cause changes in how yourteeth look and can cause tooth pain.6,7

Tooth appearance. You may notice that your front teethappear to shorten or start to look yellow.

Tooth pain. Dentin is sensitive, so you may experiencesharp tooth pain when, for example, your teeth are touched orthe temperature in the mouth changes to hot or cold.

WHAT CAN YOU DO?Unfortunately, once enamel is lost, it cannot be replaced. Butyou can take the following steps to prevent or stop dentalerosion: drink water or milk while eating; avoid eating ordrinking acidic food or beverages; if you drink acidic bever-ages, use a straw placed behind your front teeth, and don’tswish the liquid around or hold it in your mouth; rinse yourmouth with water or milk after vomiting, eating acidic food, ordrinking acidic beverages; and if possible, wait at least 1 hourbefore brushing your teeth after vomiting, eating acidic food, ordrinking acidic beverages.3,8-10

Here are other tips to think about.n Chewing sugar-free gum can increase saliva flow, whichhelps remove acid.

n Use a soft-bristle brush and fluoride toothpaste when youbrush your teeth.

n Look for products that have the American DentalAssociation Seal of Acceptance to help prevent or reduceenamel erosion from dietary acids. The Seal means anindependent group of scientific experts has agreed that theproducts are safe and effective when used as directed.

CONCLUSIONDental erosion is caused by repeatedly exposing your teeth to acidover time. Talk to your dentist if you think you are at risk ofdeveloping dental erosion. You can work with him or her to mapout a plan to keep your enamel healthy and your smile lookinggreat. n







1. Kanzow P, Wegehaupt FJ, Attin T, Wiegand A. Etiology and pathogenesis of dentalerosion. Quintessence Int. 2016;47(4):275-278.2. Scheutzel P. Etiology of dental erosion: intrinsic factors. Eur J Oral Sci. 1996,

104(2, pt 2):178-190.3. Zero DT. Etiology of dental erosion: extrinsic factors. Eur J Oral Sci. 1996,

104(2, pt 2):162-177.4. Jarvinen VK, Rytomaa II, Heinonen OP. Risk factors in dental erosion. J Dent Res.

1991;70(6):942-947.5. Tooth Erosion: The harmful effects of acid. Chicago, IL: American Dental Association;

2017.6. Schlueter N, Jaeggi T, Lussi A. Is dental erosion really a problem? Adv Dent Res.

2012;24(2):68-71.7. Meurman JH, ten Cate JM. Pathogenesis and modifying factors of dental erosion.

Eur J Oral Sci. 1996, 104(2, pt 2):199-206.8. Schlossman M, Montana M. Preventing damage to oral hard and soft tissues. In:

Spolarich AE, Panagakos FS, eds. Prevention Across the Lifespan: A Review of Evidence-Based Interventions for Common Oral Conditions. Charlotte, NC: Professional AudienceCommunications; 2017:97-120.9. Carvalho TS, Colon P, Ganss C, et al. Consensus report of the European Federation

of Conservative Dentistry: erosive tooth wearddiagnosis and management. Clin OralInvestig. 2015;19(7):1557-1561.10. Amaechi BT, Higham SM. Dental erosion: possible approaches to prevention andcontrol. J Dent. 2005;33(3):243-252.

JADA 149(6) n http://jada.ada.org n June 2018

This article is reprinted from the June 2018 issue of The Journal of the American Dental Association (2018;149[6]:564).

R7

For the Patient

Dental x-rays

X -rays can detect problems that would be missed by justlooking in your mouth, such asn an infection in your tooth or tooth root;

n cavities between teeth or under fillings;n trouble with teeth and jaw development in children andteens who are getting their permanent teeth;

n bone loss from severe gum disease.Sometimes x-rays are needed as part of your dental treat-

ment. When deciding whether to recommend x-rays, yourdentist will consider factors such asn your current oral health, including any oral health problemsyou are having;

n your age;n your risk for tooth decay or gum disease.Your dentist might recommend x-rays if you are a new pa-

tient. X-rays help your dentist evaluate your oral health andgive him or her something to compare against when looking atchanges that may occur later.

COMMON TYPES OF DENTAL X-RAYSThere are several types of dental x-rays. Each one helps thedentist see different areas of your mouth.

Common x-rays used in the dental office include bite-wing,periapical, and panoramic x-rays. Bite-wing x-rays help the dentistcheck for tooth decay between the back teeth or under dentalfillings. These are taken with a small film or digital sensor that youbite with your back teeth. Periapical x-rays help the dentistobserve conditions below the gumline, showing the roots of theteeth. They can be taken of front or back teeth. Panoramic x-raysuse a machine that rotates around the head. It produces a longfilm that shows the entire jaw and all of the teeth in 1 image.

Cone-beam computed technology is used to make a specialtype of x-ray that is used less often. This technology takes aseries of images to create a 3-dimensional image. Because itrelies on multiple images, the radiation exposure is higher thanthat of commonly used x-rays. It is used when more detailedinformation is needed.

ARE DENTAL X-RAYS SAFE?Because dental x-rays expose us to radiation, patients sometimeswonder if they are safe.We are exposed to radiation fromanumberof sources, even the sunshine, air, and soil around us.1

To help limit the amount of radiation exposure to yourthyroid gland when taking x-rays, your dentist may cover yourthroat with a special collar.2

Pregnant women may wonder if dental x-rays can affecttheir unborn children. Dental x-rays are considered safe atany stage during the pregnancy.3 In fact, The AmericanCongress of Obstetricians and Gynecologists notes thatdelaying dental treatment, including x-rays, could leadto more serious problems like an infection.3 Tell yourdentist if you are or might be pregnant. A protectiveblanket may be used to cover your abdomen when x-raysare taken.3

CONCLUSIONDental x-rays are a safe way to let your dentist observe con-ditions beyond the surfaces of your gums, teeth, cheeks, ortongue. They can help him or her spot tooth decay, keep aneye on advanced gum disease, watch how a child’s teeth aredeveloping, and more. n




Copyright ª 2019 American Dental Association. Unlike other portions ofJADA, the print and online versions of this page may be reproduced as ahandout for patients without reprint permission from the ADAPublishing Division. Any other use, copying, or distribution of thismaterial, whether in printed of electronic form, including the copyingand posting of this material on a website, is prohibited without priorwritten consent of the ADA Publishing Division.



1. United States Nuclear Regulatory Commission. Background radiation. Available at:https://www.nrc.gov/reading-rm/basic-ref/glossary/background-radiation.html. Accessed April12, 2019.2. American Dental Association Council on Scientific Affairs, U.S. Department ofHealth and Human Services, Public Health Service, Food And Drug Administration.Dental radiographic examinations: recommendations for patient selection andlimiting radiation exposure. 2012. Available at: http://www.ada.org/en/w/media/ADA/Publications/ADA%20News/Files/Dental_Radiographic_Examinations_2012. AccessedFebruary 18, 2019.3. American College of Obstetricians and Gynecologists Committee on Health Care forUnderserved Women. Committee opinion: oral health care during pregnancy andthrough the lifespan. American College of Obstetricians and Gynecologists, 569, August2013 (Reaffirmed 2017). Available at: https://www.acog.org/-/media/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/co569.pdf. Accessed April10, 2019.

JADA 150(7) n http://jada.ada.org n July 2019

This article is reprinted from the July 2019 issue of The Journal of the American Dental Association (2019;150[7]:636).

R8

For the Patient

Choices for fixing cavities

M any adults grew up with “silver” fillings when theyhad a cavity. Although these fillings are still anoption, there are now other choices, such as tooth-

colored fillings and materials that release fluoride to helpprotect your teeth from developing new cavities. Each of thesechoices has its pros and cons, but most importantly, you andyour dentist have choices available when repairing a cavity.

AMALGAMYou may have seen silver, or amalgam, fillings. These fillingsare a mixture of mercury, silver, tin, copper, and very smallamounts of other metals. Usually amalgam fillings are used onthe chewing surfaces of the back teeth because these fillingsare very strong and can typically hold up without formingcracks when you chew. They also last longer than fillings madeof other materials.1

Some people wonder about amalgam fillings because theycontain mercury. Many government agencies, professionalgroups, and national health associations agree that dentalamalgam fillings are safe.2

RESIN COMPOSITESResin composites are a tooth-colored material. They can beused to repair a cavity in any tooth but are often used in frontteeth because the color can be matched to the tooth beingrepaired. Although they seem to be able to handle chewingforces as well as amalgam without cracking, they do not usuallylast as long as silver fillings.1 Small cavities can sometimesdevelop around the edges of a resin composite filing, whichthen may need to be replaced.3

Also, resin composites need to be placed on a clean, drysurface, free from blood or saliva. For this reason, they mightnot be best for people who have trouble sitting still, like smallchildren. However, resin composites have become more pop-ular with older children and adults,4 probably because theyusually look like real teeth.

GLASS IONOMERSGlass ionomers are another kind of tooth-colored filling ma-terial. These release small amounts of fluoride, a cavity fighter.Fluoride helps harden the outside of the tooth and, togetherwith brushing and flossing, helps protect it from developingcavities.5 Unlike resin composites, blood and saliva are not asmuch of a problem when placing a glass ionomer filling.5 Glassionomers can be used on areas of teeth that you do not bitedown on and the chewing surfaces of primary teeth. But

because adults chew with much greater force than childrenand need their fillings to last much longer, glass ionomers maynot be the right choice for chewing surfaces in adults.5

SILVER DIAMINE FLUORIDESome cavities may be managed with silver diamide fluoride(SDF), which can be painted directly onto the cavity. SDFstops the cavity from getting worse, but it does not repair theworking surface of the tooth like the previously mentionedfillings. The tooth will be weak until it is repaired. However,SDF is easy to apply and inexpensive. Often, it is used to treatcavities in baby teeth or in situations in need of a quick fix.SDF is not tooth colored. The treated area of the tooth willturn black.

CONCLUSIONYou and your dentist can talk about the options that can bestmeet your needs. The best choice may depend on your indi-vidual situation, such as which tooth has the cavity and howlong the treatment needs to last. n


Prepared by Anita M. Mark, senior scientific content specialist, ADAScience & Research Institute, Chicago, IL.


Copyright ª 2020 American Dental Association. Unlike other portions ofJADA, the print and online versions of this page may be reproduced as ahandout for patients without reprint permission from ADA Publishing.Any other use, copying, or distribution of this material, whether inprinted of electronic form, including the copying and posting of thismaterial on a Web site, is prohibited without prior written consent ofADA Publishing.



1. Moraschini V, Fai CK, Alto RM, Dos Santos GO. Amalgam and resin compositelongevity of posterior restorations: a systematic review and meta-analysis. J Dent. 2015;43(9):1043-1050.2. American Dental Association. Oral health topics: amalgam. Available at: https://www.ada.org/en/member-center/oral-health-topics/amalgam. Accessed February 19,2020.3. Nedeljkovic I, De Munck J, Vanloy A, et al. Secondary caries: prevalence, charac-teristics, and approach. Clin Oral Invest. 2020;24(2):683-691.4. Eltahlah D, Lynch CD, Chadwick BL, Blum IR, Wilson NHF. An update on thereasons for placement and replacement of direct restorations. J Dent. 2018;72:1-7.5. Dhar V, Hsu KL, Coll JA, et al. Evidence-based update of pediatric dental restorativeprocedures: dental materials. J Clin Pediatr Dent. 2015;39(4):303-310.

JADA 151(5) n http://jada.ada.org n May 2020

This article is reprinted from the May 2020 issue of The Journal of the American Dental Association (2020;151[5]:380).

R9

For the Patient

Smart shopping with the ADA Sealof Acceptance

Looking for a dental product to help keep your mouthhealthy and your smile bright? The store shelves arestocked with options. How do you know which to try?

HOW DO I KNOW WHICH PRODUCTS REALLY WORK?The American Dental Association (ADA) can help. Look forthe ADA Seal of Acceptance (Seal) (Figure). The Seal saysthat a dental product is safe and effective. Also, visitMouthHealthy.org or follow the ADA on social media. TheADA provides information on the science behind dentalhealth claims. Through these outlets, the ADA also identifiesideas and trends that are not supported by science. And listento your dental professionals. They are familiar with your needsand can point you in the right direction.

HOW DO I KNOW WHAT A PRODUCT IS SUPPOSED TODO?Products with the Seal make it easy to identify what benefitshave been scientifically proven according to Seal program re-quirements. Companies clearly state, in a bulleted list alongsidethe Seal, which benefits are supported by science. For example,if a toothpaste says that it helps with cavity prevention, dentalsensitivity, enamel erosion, or whitening, the company hasprovided research showing that it does just that.

And toothpastes are not the only products that carry theSeal. More than 200 over-the-counter products have the Seal,including toothbrushes (both powered and manual), mouth-rinses, products that clean between your teeth, and productsthat help relieve oral pain or dry mouth. The Seal programeven has categories for water filters, sports mouthguards, andsugar-free chewing gum.

HOW DO PRODUCTS EARN THE SEAL?Companies cannot use the Seal without permission from theAmerican Dental Association (ADA), and the ADA will notgive that permission without sufficient proof that the productdoes what the manufacturer says it will do, safely and effectively.

What qualifies as proof? Science. Companies must provideresults from laboratory tests and clinical studies supportingeach oral health claim made for a product. These studies haveto be performed by laboratories and researchers who are notassociated with the company.

The ADA even has a voluntary program to make surelaboratories that conduct independent research in support ofproducts with the ADA Seal of Acceptance can providereliable results.

In addition to reviewing study results and research sites, theADA conducts its own research on products such as tooth-brushes, toothpastes, and mouthrinses.

LOOK FOR THE SEALThe number of dental products in stores and online that makeall kinds of promises seems almost limitless. Look for the ADASeal of Acceptance to be sure that the claims made by thedental product you choose are backed by science. n




Copyright ª 2020 American Dental Association. Unlike other portions ofJADA, the print and online version of this page may be reproduced as ahandout for patients without reprint permission from the ADAPublishing Division. Any other use, copying, or distribution of thismaterial, whether in printed or electronic form, including the copyingand posting of this material on a website, is prohibited without priorwritten consent of the ADA Publishing Division.

“For the Patient” provides general information on dental treatments. It isdesigned to prompt discussion between dentist and patient abouttreatment options and does not substitute for the dentist’s professionalassessment based on the individual patient’s needs and desires. You canfind more information for patients at ADAcatalog.org or atMouthHealthy.org.

Figure. The ADA Seal of Acceptance.

JADA 151(1) n http://jada.ada.org n January 2020

This article is reprinted from the January 2020 issue of The Journal of the American Dental Association (2020;151[1]:72).

R10

For the Patient

Vaccines for your childHuman papillomavirus

O ropharyngeal cancer develops near the back of themouth and throat, including the back and base ofthe tongue, the soft part of the roof of the mouth, and

the tonsils.1 Approximately three-fourths of these cancers wererelated to the human papillomavirus (HPV).2

Many people are exposed to HPV in their lifetime.3 Most ofthe time, the virus clears up, and people never develop anysigns or symptoms of infection. However, in some people, thevirus does not go away, and it can cause several types ofcancer, including oropharyngeal cancer.

A main concern is that HPV-related oropharyngeal canceris on the rise. In 1999, 7.2 of 100,000 people had HPV-related oropharyngeal cancers; in 2015, 10.2 of 100,000did. 4 Men are 6 times more likely than women to be infectedwith the strain of HPV associated with oropharyngealcancer.5

Luckily, there is a vaccine that can protect against infectionwith the strains of the HPV virus known to cause somecancers.

The Centers for Disease Control and Prevention (CDC)has recommended use of this vaccine for girls since 2006 andboys since 2011. The vaccine has been found to reduceinfection with HPV and prevent a variety of HPV-relatedcancers.6,7

The CDC recommends that children receive 2 doses of theHPV vaccine from the ages of 11 through 12 years (although itcan be given in 2 doses from the ages of 9-14 years). Children,teens, and adults (15-26 years) who missed getting the vaccinealso can be vaccinated, although they will require 3 doses(Table).8,9

CONCLUSIONThe CDC considers vaccination against HPV as important asvaccination against measles or mumps. Armed with protectionof the HPV vaccine, your child stands a better chance offighting off an infection that may cause cancer in the future.Talk to your child’s physician about getting the HPVvaccination. n




Copyright ª 2018 American Dental Association. Unlike other portions ofJADA, the print and online version of this page may be reproduced as a

handout for patients without reprint permission from the ADAPublishing Division. Any other use, copying, or distribution of thismaterial, whether in printed or electronic form, including the copyingand posting of this material on a website, is prohibited without priorwritten consent of the ADA Publishing Division.



1. Chi AC, Day TA, Neville BW. Oral cavity and oropharyngeal squamous cell car-cinoma: an update. CA Cancer J Clin. 2015;65(5):401-421.2. Osazuwa-Peters N, Simpson MC, Massa ST, Adjei Boakye E, Antisdel JL,Varvares MA. 40-year incidence trends for oropharyngeal squamous cell carcinoma in theUnited States. Oral Oncol. 2017;74:90-97.3. Pytynia KB, Dahlstrom KR, Sturgis EM. Epidemiology of HPV-associated oropha-ryngeal cancer. Oral Oncol. 2014;50(5):380-386.4. Van Dyne EA, Henley SJ, Saraiya M, Thomas CC, Markowitz LE, Benard VB.Trends in human papillomavirus-associated cancers: United States, 1999-2015. MMWRMorb Mortal Wkly Rep. 2018;67(33):918-924.5. Sonawane K, Suk R, Chiao EY, et al. Oral human papillomavirus infection:differences in prevalence between sexes and concordance with genital humanpapillomavirus infection, NHANES 2011 to 2014. Ann Intern Med. 2017;167(10):714-724.6. Chaturvedi AK, Graubard BI, Broutian T, et al. Effect of prophylactic humanpapillomavirus (HPV) vaccination on oral HPV infections among young adults in theUnited States. J Clin Oncol. 2018;36(3):262-267.7. Centers for Disease Control and Prevention. Human papillomavirus (HPV): ques-tions and answers. Available at: https://www.cdc.gov/hpv/parents/questions-answers.html. Accessed August 27, 2018.8. Meites E, Kempe A, Markowitz LE. Use of a 2-dose schedule for human papilloma-virus vaccination: updated recommendations of the Advisory Committee on Immuni-zation Practices. MMWR Morb Mortal Wkly Rep. 2016;65(49):1405-1408.9. Centers for Disease Control and Prevention. Recommended immunization schedulefor children and adolescents aged 18 years or younger, United States. Available at: https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf;2018. Accessed August 28, 2018.

Table. Recommended human papillomavirus vaccination schedule.*

POPULATION DOSES, NO. TIME BETWEEN DOSES

Children 9-14 Yearsof Age

2 Second dose: 6-12 months after the first

People 15-26 Yearsof Age†

3 Second dose: 1-2 months after the firstThird dose: 6 months after the second

People With LoweredImmunity 9-26Years of Age†

3 Second dose: 1-2 months after the firstThird dose: 6 months after the second

* Sources: Meites and colleagues8 and Centers for Disease Control andPrevention.9 † As of October 2018, the Centers for Disease Control andPrevention recommend this vaccine for adults up to age 26 years. The U.S.Food and Drug Administration has approved use of the vaccine in people upto age 45 years.

JADA 149(12) n http://jada.ada.org n December 2018

This article is reprinted from the December 2018 issue of The Journal of the American Dental Association (2018;149[12]:1086).

R11

For the Patient

Keeping an eye on your gums

Gum disease can sneak up on you if you don’t knowwhat to look for.It starts out in a mild form called gingivitis, which

rarely causes pain, so you’ll probably see the signs before youfeel anything unusual (box). You might noticen red, swollen gums orn bleeding after you brush or clean between your teeth.A professional cleaning is key to tackling gingivitis. After

that, you’ll need to do your part:n Brush your teeth for 2 minutes twice a day.n Clean between your teeth with floss or another inter-dental cleaner once a day.You also should talk to your dentist about products with

the ADA Seal of Acceptance that prevent and reduce thegerms that cause gum disease.

GUM DISEASE GETS SERIOUSGingivitis can progress into periodontitis, which is more serious.Periodontitis affects your gums and breaks down the bone andother tissues that hold your teeth in place. Periodontitis cancause tooth loss. The following are some signs of periodontitis:n receding gums that may make your teeth look longer;n teeth that are loose or shifting in your mouth;n a change in the way your teeth fit together;n bad breath or a bad taste that won’t go away.You’ll need your dentist’s help to get rid of periodontitis. As

with gingivitis, you’ll also need to take care of your teeth and gumsat home:n Brush twice a day for 2 minutes each time.n Clean between your teeth daily.Talk to your dentist about products with the ADA Seal of

Acceptance that prevent and reduce the bacteria that causegum disease.

WHAT PUTS ME AT RISK?Anyone can get gum disease, but some things increase yourrisk:n poor oral hygiene:Caring for your teeth and gums every day helpsprotect against gum disease. This means brushing your teethevery day for 2 minutes and cleaning between your teeth daily.

n tobacco use: Steer clear of tobacco. It is bad news for youroral health.1

n illnesses that lower your ability to fight infection: Some condi-tions like diabetes,2 osteoporosis,3 or cancer and cancertreatment4 can increase the risk of gum disease. Let yourdentist know about your overall health as it will help him orher be aware of any special needs you may have.

n medications: Some medications may affect your gums, likethose used for high blood pressure or heart conditions.5 Letyour dentist know what medications you are taking. It canhelp him or her provide better care.

n pregnancy: During pregnancy, a woman can become moresensitive to the bacteria that cause gum disease.6

CONCLUSIONYou know your mouth better than anyone elsedkeep an eyeout for the signs of gum disease, and let your dentist know ifyou notice anything unusual. n




Copyrightª 2018 American Dental Association. Unlike other portions of JADA,the print and online versions of this page may be reproduced as a handout forpatients without reprint permission from theADA Publishing Division. Any otheruse, copying, or distribution of this material, whether in printed or electronicform, including the copying and posting of this material on a website, isprohibited without prior written consent of the ADA Publishing Division.



1. Kunzel C, Lalla E, Lamster IB. Management of the patient who smokes and thediabetic patient in the dental office. J Periodontol. 2006;77(3):331-340.2. National Institute of Diabetes andDigestive and KidneyDiseases. Diabetes, GumDisease,&Other Dental Problems. Available at: https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/gum-disease-dental-problems. Accessed January 23, 2018.3. Martelli ML, Brandi ML, Martelli M, et al. Periodontal disease and women’s health.Curr Med Res Opin. 2017;33(6):1005-1015.4. Peterson DE, Minah GE, Reynolds MA, et al. Effect of granulocytopenia on oralmicrobial relationships in patients with acute leukemia. Oral Surg Oral Med Oral Pathol.1990;70(6):720-723.5. American Dental Association. ADA/PDR Guide to Dental Therapeutics. 5th ed.Montvale, NJ: Physicians Desk Reference, Inc.; 2009.6. Daalderop LA, Wieland BV, Tomsin K, et al. Periodontal disease and pregnancyoutcomes: overview of systematic reviews [pubished online ahead of print September 25,2017]. JDR Clin Trans Res. https://doi.org/10.1177/2380084417731097.

Box: Watching out for gum disease

Between dental visits you can watch for signs of gum disease.You might ask yourself these questions:

n Do my gums seem red and puffy?

n Do my gums bleed when I brush or clean between myteeth?

n Do I have any permanent teeth that feel loose?

n Do my teeth look like they are getting longer? Do I see moreof the roots?

n Is there a tooth that has moved or is suddenly crooked?

n Do my teeth fit together differently when I bite down?

If you answered “yes” to any of the questions above, talk toyour dentist about gum disease.

JADA 149(7) n http://jada.ada.org n July 2018

This article is reprinted from the July 2018 issue of The Journal of the American Dental Association (2018;149[7]:662).

R12

For the Patient

Just what the doctor orderedRelieving dental pain

Your dentist has a number of options for relieving short-term dental pain. These options can be either prescrip-tion or over-the-counter (OTC) medications that you

can buy in the store without a prescription. Inmost cases, anOTCmedication or combination ofOTCmedications will do the trick.1

OVER-THE-COUNTER MEDICATIONSOTC pain-relief medications include acetaminophen andnonsteroidal anti-inflammatory drugs (NSAIDs).

Acetaminophen. Acetaminophen products, like Tylenol(Johnson & Johnson), might be a good choice if you are takingcertain other medications, like those used to prevent bloodclots. Acetaminophen affects blood clotting less thanNSAIDs1 and may help avoid bleeding problems. Some con-ditions, like asthma or kidney disease, also might make acet-aminophen the best choice for you. That is because NSAIDscan set off trouble associated with either of these conditions.2

As with any medication, you should not take more acet-aminophen than your dentist recommends. This is veryimportant because too much acetaminophen can cause per-manent liver damage.1 Sometimes acetaminophen is in othermedications you may take, so it is important to check thingslike cold medicines to help keep you from taking too much.

NSAIDs. NSAIDs help keep swelling down in addition toreducing pain. There are a number of NSAIDs: ibuprofen(such as Advil [Pfizer] or Motrin [Johnson & Johnson]),naproxen sodium (such as Aleve [Bayer]), and aspirin. Usedalone or with acetaminophen, these drugs are as good if notbetter at relieving pain than many prescription medications.3

PRESCRIPTION MEDICATIONSDepending on your paindthe severity, or how long it lastsdyourdentist may suggest a prescription medication. These medicationscan include some of the OTC drugs given at higher doses; forexample, 200-milligram tablets of ibuprofen are sold OTC, but400-mg tablets require a prescription.

Other prescription medicines may be a combination of anOTC and an opioid medication. Some examples are Vicodin(AbbVie), which is a mixture of acetaminophen and hydro-codone; Percocet (Endo), which is a mixture of acetaminophenand oxycodone; and Tylenol #3 (Johnson & Johnson), which is amixture of acetaminophen and codeine.

Opioid medications can have side effects. Most commonly,opioids can cause nausea, vomiting, and constipation. Ofgreater concern, they can make you feel “high,” which can leadto addiction. Also, if too many are taken or they are taken withalcohol, opioids can be dangerous because you may breathe tooslowly and not deeply enough,1 which can be fatal. For thesereasons and because OTC medications can be as good or better,opioids are not the first choice in pain relief.

Opioids can be helpful in some situations,1 but they need tobe taken and handled (Box) as directed.

HOW CAN YOU HELP?Tell your dentist about your level of pain and how long you havehad it. Give a complete medical history including all the medi-cations you are taking. Also, tell your dentist if you or a familymember has had a problem with drug or alcohol abuse. n







1. Moore PA, Hersh EV. Principles of pain management in dentistry. In: O’Neil M, ed.The ADA Practical Guide to Substance Use Disorders and Safe Prescribing. Hoboken, NJ:John Wiley & Sons; 2015:31-45.2. Aminoshariae A, Kulild JC, Donaldson M. Short-term use of nonsteroidal anti-inflammatory drugs and adverse effects: an updated systematic review. JADA. 2016;147(2):98-110.3. Moore PA, Ziegler KM, Lipman RD, et al. Benefits and harms associated withanalgesic medications used in the management of acute dental pain: an overview ofsystematic reviews. JADA. 2018;149(4):256-265.e3.4. US Food and Drug Administration. Where and how to dispose of unused medicines.Available at: https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm101653.htm.Accessed May 14, 2018.5. Centers for Disease Control and Prevention. Prevent opioid misuse. Available at:https://www.cdc.gov/drugoverdose/patients/prevent-misuse.html. Accessed May 14, 2018.

Box: Storing and disposing of opioids

Opioids must be stored and disposed of carefully.4,5 For example:n store opioids in a secure place, where othersdchildren,family, friends, or visitorsdcannot get hold of them;n keep track of how many pills you should have in your bottle;n dispose of leftover pills properly:

� follow directions on the label or product information sheetabout flushing the medication down the toilet (not allmedications should be flushed);� mix the unused pills with something in your garbage, likeused coffee grounds or kitty litter;� talk to your dentist or pharmacist about options, liketake-back programs in your community.

JADA 149(8) n http://jada.ada.org n August 2018

This article is reprinted from the August 2018 issue of The Journal of the American Dental Association (2018;149[8]:744).

R13

For the Patient

Oral and throat cancerWhat you should know

C ancer can develop in or around the mouth or in thethroat. Cancer that develops on the lips, in the front ofthe mouth or tongue, under the tongue, or on the in-

sides of the cheeks is called oral cancer.1 Cancer in the back ofthe mouth, including the throat, the back part of the tongue,the soft part of the roof of the mouth, and the tonsils, is calledoropharyngeal cancer.2

Chances of survival from head and neck cancers are good ifthey are treated before they spread to other parts of the body.3

Two keys to helping you avoid the disease or spot it early areknowing what puts you at risk and recognizing the signs andsymptoms of these cancers.

WHAT PUTS YOU AT RISK?Some people are at higher risk of developing oral andoropharyngeal cancers than others. For example, men developthese cancers more often than women.3 They also are morecommon after age 65 years.4

Some behaviors can increase the risk, such as tobacco useand heavy alcohol use (more than 4 drinks per day).1,2,5

People who do bothddrink heavily and use tobaccodsignificantly increase the risk of developing these cancers.

There are other risks specific to certain types of cancer.Spending a lot of time in the sun increases the risk of devel-oping lip cancer, for example. And the human papillomavirus(HPV) has been associated with oropharyngeal cancer. Chil-dren as young as preteens can get HPV, but the cancer maynot develop until years later, as late as the mid-50s.6 BecauseHPV-associated cancers are preventable, the Centers for Dis-ease Control and Prevention recommends that children asyoung as 9 years old get vaccinated against HPV.7 Talk to yourdentist or physician about whether the vaccine is right for youor your child.

WHAT TO WATCH FORYou know your body better than anyone else does. If younotice any of these signs, talk to your dentist or physician1,2:n a sore on the lips or in the mouth that does not heal;n red or white patches in the mouth that don’t go away;n pain, tenderness, or numbness on the lips or in the mouth;n a lump, thickening, or swelling in or around the mouth orthroat;

n a rough or crusty or eroded area on the lips;n difficulty chewing, swallowing, speaking, or moving the jawor tongue;

n a change in the way your teeth fit together when you closeyour mouth or the way your dentures fit;

n a cough or sore throat that won’t go away;

n earaches;n hoarseness or other changes in your voice;n trouble opening your mouth fully.

CONCLUSIONOral and oropharyngeal cancer is easiest to beat if it istreated early. Watch for any signs that could signal a prob-lem. Avoid behaviors that can increase the risk of devel-oping these cancers. If you are between 9 and 26 years old(or if recommended for you when older), ask your dentist orphysician about getting vaccinated against HPV. And seeyour dentist regularly, so he or she can help look for any-thing unusual. n




Copyright ª 2019 American Dental Association. Unlike other portionsof JADA, the print and online versions of this page may bereproduced as a handout for patients without reprint permissionfrom the ADA Publishing Division. Any other use, copying, ordistribution of this material, whether in printed or electronic form,including the copying and posting of this material on a website, isprohibited without prior written consent of the ADA PublishingDivision.

“For the Patient” provides general information on dental treatments.It is designed to prompt discussion between dentist and patientabout treatment options and does not substitute for the dentist’sprofessional assessment based on the individual patient’s needs anddesires.


1. National Cancer Institute. Lip and oral cavity cancer treatment (adult) (PDQ®)epatient version. US Department of Health and Human Services. Available at: http://www.cancer.gov/publications/patient-education/wyntk-oral.pdf. Accessed January 15,2019.2. National Cancer Institute. Oropharyngeal cancer treatment (adult) (PDQ®)epatient version. Available at: https://www.cancer.gov/types/head-and-neck/patient/adult/oropharyngeal-treatment-pdq. Accessed January 15, 2019.3. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7-34.4. National Cancer Institute Surveillance Epidemiology and End Results Program(SEER). SEER Cancer Statistics Review (CSR), 1975-2012, section 20, oral cavity andpharynx. Available at: http://seer.cancer.gov/csr/1975_2012/results_merged/sect_20_oral_cavity_pharynx.pdf. Accessed January 15, 2019.5. Chi AC, Day TA, Neville BW. Oral cavity and oropharyngeal squamous cellcarcinoma: an update. CA Cancer J Clin. 2015;65(5):401-421.6. Benson E, Li R, Eisele D, Fakhry C. The clinical impact of HPV tumorstatus upon head and neck squamous cell carcinomas. Oral Oncol. 2014;50(6):565-574.7. Centers for Disease Control and Prevention. Recommended immunization schedulefor children and adolescents aged 18 years or younger, United States, 2018. Available at:https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf. Accessed August 28, 2018.

JADA 150(4) n http://jada.ada.org n April 2019

This article is reprinted from the April 2019 issue of The Journal of the American Dental Association (2019;150[4]:324).

R14

For the Patient

Dealing with tooth pain

Do you have tooth pain? Whether it’s a short-lived,sharp, shooting pain or a prolonged, mild ache, youshould see your dentist. (NOTE: There are other

sources of oral pain that are not discussed here, like oral sores,jaw pain, and headaches that your dentist also may be able tohelp with.)

TYPES OF PAIN

Sharp painYou may feel a shooting pain when you eat or drink some-thing hot or cold or sweet or sour. Pressure, likefrom toothbrushing or biting, also might spark this kind ofpain.

Some things that may cause this short-lived pain reactioninclude1

n a cavity;n a cracked tooth;n an exposed tooth root.Any of these can leave the inner portion of your tooth,

called the pulp, unprotected. The pulp is your tooth’s nerveand blood supply. In a healthy, undamaged tooth, the pulp isprotected by 3 outer layers: enamel, cementum, and dentin.Enamel is the part of the tooth that you see, and it connects tothe dentin. Cementum also connects to the dentin, but itcovers the tooth root (Figure).

Things that damage the enamel, like a cavity, chip, orcrack, may cause tooth pain.

Anything that exposes the cementum also might set you upfor pain. Cementum is softer than enamel. When it is leftunprotected by the gums, it can be worn away easily.Damage to the enamel or cementum may leave the dentin

exposed. The dentin directly connects to the pulp throughtiny tubes or canals. Researchers do not know why, but exposureof the dentin may leave the pulp sensitive to things like changesin temperature, certain foods and beverages, or pressure.

Dull, throbbing painSometimes dental pain involves an area in or around themouth and jaw with a steady ache that goes on for days. Thistype of pain may indicate an infection.

TREATMENTTreatment depends on the cause of the pain you are hav-ing. Sharp pain might be caused by enamel damage likecavities, chips, or cracks, which might call for repair. Youmay need a new dental filling or crown. When thecementum is damageddexposing the dentindtopical var-nish, which goes on as a liquid and then hardens to protectthe exposed tooth roots, might be applied.Treatment for throbbing pains also depends on what is

causing the problem. If an infection is involved, your dentistwill work to identify the source. Once that has been narroweddown, he or she can look at options like removing the infectedtissue (for example, with a root canal).

CONCLUSIONTooth pain can be experienced in different ways. Taking careof the problem requires finding the reason for the pain. n







1. Napenas JJ. Intraoral pain disorders. Dent Clin North Am. 2013;57(3):429-447.

Figure 1. Tooth structure.

JADA 150(9) n http://jada.ada.org n September 2019

This article is reprinted from the September 2019 issue of The Journal of the American Dental Association (2019;150[9]:812).

R15

For the Patient

Why does my jaw hurt?

D o you have pain in or around your jaw joint? Doesyour jaw get stuck? Do you have painful clickingor popping? Are frequent headaches, like migraines, a

problem? If so, you may want to ask your dentist abouttemporomandibular (TEM-puh-roh-man-DIB-yoo-ler) disor-ders (TMDs).

Your temporomandibular joint allows you to open or closeyour mouth and slide your jaw from side to side or back andforth. It is a complicated system of muscles, connective tissues,and the bony joint itself. Because it is so complex, your jawjoint can develop a number of problems.1

Some possible causes of TMDs include1

n diseases that affect the muscles or joints, like arthritis;n injury to the jaw joint or connective tissues;n habitual movements of the teeth and jaws, like grinding orclenching.Other things, like sinus infections, can cause pain in your

jaw area.1 Your dentist may want to rule some of these outbefore identifying TMDs as the source of your pain.

DIAGNOSISSigns and symptoms of TMDs can include1

n pain in or around the ear;n pain when chewing;n tender jaw muscles;n painful clicking or popping when opening or closing thejaw;

n difficulty opening or closing the mouth;n pain when opening your mouth wide;n headaches, facial, or neck pain.One large, multiyear study also found that people in whom

TMDs develop are more likely to report chronic somaticsymptomsdlike runny nose, fatigue, or dizziness.2 Anxiety anddepression have also been associated with TMDs.1

If TMDs are suspected, your dentist may check yourjoints and muscles for tenderness. He or she may listenfor noises like clicking or popping, ask you about pain, orexamine how your jaw moves.

Symptoms may come and go or may bother you all the time.Or may go away without any treatment.

TREATMENTIt is difficult to identify the cause of TMDs. Treatmentusually focuses on relieving the symptoms associated with it.There are several things you can try that might help1:n eat softer foods;n limit wide jaw movements;

n avoid chewing gum or biting down on anything hard;n apply moist, warm compresses.If your pain is still a problem, your dentist might suggest

n exercises to strengthen your jaw muscles;n medications like muscle relaxants, pain medicine, anti-anxiety drugs, or anti-inflammatory medications;

n a nightguard or bite plate to decrease clenching or grindingof teeth during sleep.Your dentist also may refer you to a specialist who has

experience working with patients who have dental-relatedpain. Be well informed before making permanent adjust-ments, like changing the way your teeth fit together. Askabout the credentialing and educational background ofthose providing the care, as well as the success rates for theparticular procedure you are considering. Explore all treat-ment options and potential outcomes before making anypermanent changes to your bite.

CONCLUSIONBecause the jaw joint is so complex, it can be difficult toidentify what causes pain in and around the joint. Mosttreatment focuses on relieving the painful symptoms. Yourdentist may be able to teach you ways to reduce the discomfortthat comes with TMDs or, if necessary, refer you to a specialistwho can offer other treatment options. n



Special thanks to Dr. Deepak Kademani for his review of this article.





1. Gauer RL, Semidey MJ. Diagnosis and treatment of temporomandibular disorders.Am Fam Physician. 2015;91(6):378-386.2. Slade GD, Ohrbach R, Greenspan JD. Painful temporomandibular disorder: a decadeof discovery from OPPERA studies. J Dent Res. 2016;95(10):1084-1092.

JADA 150(12) n http://jada.ada.org n December 2019

This article is reprinted from the December 2019 issue of The Journal of the American Dental Association (2019;150[12]:1066).

R16

For the Patient

Using antibiotics wisely

Antibiotics fight bacterial infections. They can curemany diseases that, in the past, would have made youvery sickdmaybe even killed youdlike tuberculosis.

Because antibiotics are so effective, some people want to usethem for everything from the common cold to a toothache. But,antibiotics don’t kill viruses, so they won’t help with the commoncold, and not every toothache calls for an antibiotic (box).

HELPING ANTIBIOTICS WORK

Not all dental infections require antibioticsA toothache, for example, might be treated at the site of theinfection in the dental office rather than having you take pillsat home that won’t help fight the infection.

Use only when neededTalk to your dentist or physician about your symptoms. Afever, for example, can mean that an infection has spreadbeyond the original site and may respond to antibiotics. Aninfection that has not spread might be able to be treated at theoriginal site without disturbing the surrounding area.

Don’t share medicationsDo not share your medicine with others. Antibioticsmight not help them feel better, and side effects couldoccur (like a rash or diarrhea), which could make themfeel worse. You should only take antibiotics on therecommendation of a health professional. He or she istrained to recognize the signs of an infection that can betreated with this type of medicine.

RISKS OF ANTIBIOTIC USE

Side effectsAntibiotics can have side effects, includingn diarrheadfrom short bouts lasting less than a day tomore severe cases caused by Clostridioides difficile (orC. diff), which may require care in a hospital andcould be deadly, especially for older adults;

n yeast infections;n nausea or vomiting.Some people are allergic to certain antibiotics. They may

develop a rash or have a more severe, even life-threateningreaction.

Antibiotic resistanceWhen bacteria are antibiotic resistant, they are no longer killedby the antibiotics. This can occur naturally, as bacteria multiplyon their own or as a result of being exposed to antibiotics. Thiscan happen when you use antibiotics improperly (for example,

taking antibiotics when not needed). When bacteria are resis-tant to antibiotics they can grow quickly, causing illnesses thatare difficultdsometimes impossibledto treat.Antibiotic-resistant bacteria can spread from one person to

another, affecting the whole community.

CONCLUSIONSAntibiotics are helpful medications, and we must use themwisely to ensure that they will continue to work against bac-terial infections. n




Copyright ª 2019 American Dental Association. Unlike other portions ofJADA, the print and online versions of this page may be reproduced as ahandout for patients without reprint permission from the ADA PublishingDivision. Any other use, copying, or distribution of this material, whether inprinted or electronic form, including the copying and posting of thismaterial on a website, is prohibited without prior written consent of theADA Publishing Division.



Box. What can be done when your toothhurts

Many things can cause pain when you bite down or eator drink something hot or cold. Your tooth may evenhurt when you do nothing at all! Causes of tooth painincluden injuries;n swelling of the tissues in or around your tooth;n bacterial infections in or around the tooth.

Injuries or swelling that cause pain without othersymptoms may feel better if you take pain relievers (likeaspirin or ibuprofen) or use hot or cold packs. In somecases, your dentist might recommend a root canal orother dental treatment.Antibiotics, though, should only be taken when pre-scribed by a health professional. Fever, swollen glands,and extreme tiredness are signs that antibiotics mightbe the right choice.

JADA 150(11) n http://jada.ada.org n November 2019

This article is reprinted from the November 2019 issue of The Journal of the American Dental Association (2019;150[11]:986).

R17

For the Patient

Dental care during pregnancy

A re you worried about seeing the dentist while you’repregnant? Relax. The American Dental Associationand the American College of Obstetricians and

Gynecologists agree that oral health care during pregnancy issafe and delaying treatment can be bad for you.1

Pregnancy can trigger oral health problems, including gumproblems and dental erosion.

GUM PROBLEMSHormonal changes increase the risk of gum problems duringpregnancy.

Inflammation of the gums is known as gingivitis. Signs ofgingivitis can include swelling and bleeding. Some extra effortin caring for your teeth may help. Take the time ton brush twice a day for 2 minutes with a toothpaste that hasfluoride;

n clean between your teeth once per day with dental floss oranother interdental cleaner.Left untreated, gingivitis can lead to periodontitis. With

periodontitis, the infection goes beneath the gum line and candamage the tissues that hold your teeth in place. Withoutdental treatment, teeth can become loose and may even fallout or need to be pulled.

Also, some women may develop lumps on their gums duringpregnancy. They don’t usually hurt, but they can make itdifficult to keep your teeth clean. Typically, they go away afterthe baby is born, but if they interfere with taking care of yourteeth, your dentist may suggest removing these lumps.2

DENTAL EROSIONDental erosion is the loss of the hard, outer layer of your teeth.It can happen when your teeth are repeatedly exposed to acid.If you are vomiting frequently, you may be at risk of devel-oping dental erosion.

To help prevent dental erosion, rinse your mouth aftervomiting with a teaspoon of baking soda dissolved in 1 cup ofwater. But don’t brush right away! The rinse will help stop theacid from attacking your teeth, and time will allow the enamelon your teeth to harden.2 You can brush after about an hour.3

OTHER THOUGHTSYou might also be wondering about radiographs (x-rays),medication use, or when it would be safest to see the dentist.

Dental radiographs are considered to be safe duringpregnancy.1 The American College of Obstetricians andGynecologists recommends that a protective apron coveryour throat and abdomen during radiographs.1

Your dentist may need to use or prescribe medications aspart of your care. For example, you may develop a cavity thatwould need to be treated. Your dentist has safe optionsavailable for local anesthetic, antibiotics, and pain relief thathe or she can turn to during pregnancy.4

Although treatment is safe throughout pregnancy, youmay be more comfortable during the second trimester.Nausea and vomiting could be a problem during the firsttrimester,2 and during the third trimester, you may be un-comfortable when the chair is reclined because of theweight of the baby.5 Tell your dentist if you are uncom-fortable or lightheaded during treatment, and he or she canhelp you change positions.

CONCLUSIONProfessional groups for dentists and obstetricians agree thatoral health care is safe and important during pregnancy. Seeyour dentist regularlydeven when pregnantdto help keepyour mouth healthy. n







1. American College of Obstetricians and Gynecologists. Committee on Health Carefor Underserved Women. Oral health care during pregnancy and through the lifespan,2013 (reaffirmed 2017). Available at: https://www.acog.org/-/media/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/co569.pdf?dmc¼1&ts¼20161014T1326459399. Accessed September 26, 2018.2. Steinberg BJ, Hilton IV, Iida H, Samelson R. Oral health and dental care duringpregnancy. Dent Clin North Am. 2013;57(2):195-210.3. Attin T, Knofel S, Buchalla W, Tutuncu R. In situ evaluation of different remin-eralization periods to decrease brushing abrasion of demineralized enamel. Caries Res.2001;35(3):216-222.4. Donaldson M, Goodchild JH. Pregnancy, breast-feeding and drugs used in dentistry.JADA. 2012;143(8):858-871.5. Shessel BA, Portnof JE, Kaltman SI, Nitsch R. Dental treatment of the pregnantpatient: literature review and guidelines for the practicing clinician. Todays FDA. 2013;25(6):26-29, 31-33.

JADA 149(11) n http://jada.ada.org n November 2018

This article is reprinted from the November 2018 issue of The Journal of the American Dental Association (2018;149[11]:1001).

R18

For the Patient

Can diabetes affect my oral health?

I f you have diabetes, it is recommended that you see yourdentist regularly.1 People with diabetes are at a higher riskof experiencing oral health problems such as gum disease,

dry mouth, cavities, and thrush.The risk of these things may be greater in people with dia-

betes because of changes in blood glucose levels, medicationsused to manage diabetes, and the body’s response to infection.

GUM DISEASEGum disease (gingivitis) is an infection below the gum linealong your teeth. Anyone can develop gum disease, but itoccurs more often and may be worse in people with diabetes.1

It also seems that gum disease may affect diabetes. Some re-searchers suggest that gum disease may make it harder forpeople with diabetes to control their blood glucose levels.2

Gum disease develops when a thin layer of bacteria, calledplaque, collects along the gum line. If you do not remove it bybrushing twice a day and cleaning between your teeth once aday, you can develop gum disease. If plaque is not removed, itcan harden into tartar, which can trap plaque even farther belowthe gum line. The only way to remove tartar, and the plaquebeneath it, is by a professional cleaning at the dental office.

When you have gum disease, your gums pull away from yourteeth. They become swollen and tender and may bleed. Inserious cases, your teeth can become loose and may even fallout or need to be pulled.

People with diabetes are at increased risk of developing gumdisease, in part, because of theway their bodies react to infections.When an infection develops in people with diabetes, the swellingthat occurs is greater than in people who do not have diabetes.This swelling can damage the gums and jaw bone beneath.3

DRY MOUTH AND CAVITIESWhen you have diabetes, you may take a number of medications.Any of these medications may cause dry mouth. In addition tobeing uncomfortable, dry mouth can cause bad breath, soretongue or throat, and trouble chewing, speaking, or swallowing.4

If you wear dentures, you might notice a difference in theway the dentures fit when your mouth is dry. Poorly fittingdentures can cause mouth sores, which may heal more slowlybecause of your diabetes.

If you have diabetes, you also may be more likely to get newcavities or to develop cavities under fillings you already have.2

Brushing your teeth twice a day with a toothpaste that hasfluoride and cleaning between your teeth once a day may helplower the risk of getting cavities. Fluoride is important. Itstrengthens teeth and helps prevent cavities.

THRUSHThrush is a type of yeast infection, and people with diabetesare at greater risk of getting thrush. It appears as white and redpatches on your tongue and the insides of your cheeks. It can

cause a painful, burning feeling. Your dentist may give you anantifungal medicine to treat thrush.The fungus that causes thrush also can attach to dentures,

making the infection worse. If you wear dentures and developthrush, it is important to clean your dentures as directed byyour dentist.

CONCLUSIONDiabetes can affect your mouth in other ways as well, and it canmake it difficult for you to heal after certain dental treatmentsor if oral sores develop. For these reasons, it is important to keepyour mouth healthy (box) and to visit your dentist regularly. n







1. American Diabetes Association. 3. Comprehensive medical evaluation and assess-ment of comorbidities: standards of medical care in diabetes-2018. Diabetes Care. 2018;41(suppl 1):S28-S37.2. Ship JA. Diabetes and oral health: an overview. JADA. 2003;134(special number):4S-10S.3. Mesia R, Gholami F, Huang H, et al. Systemic inflammatory responses in patients withtype 2 diabetes with chronic periodontitis. BMJ Open Diabetes Res Care. 2016;4(1):e000260.4. Plemons JM, Al-Hashimi I, Marek CL. American Dental Association Council onScientific Affairs. Managing xerostomia and salivary gland hypofunction: executivesummary of a report from the American Dental Association Council on Scientific Affairs.JADA. 2014;145(8):867-873.

Box: What can you do to protect youroral health?

n Keep your blood glucose at a healthy level. Blood glucoselevels that go up and down can increase your risk of experi-encing oral health problems.

n Brush your teeth twice a day with a toothpaste that hasfluoride.

n Clean between your teeth daily with floss or anotherinterdental cleaner.

n See your dentist regularly. Tell him or her about your dia-betes and all medicines you take.

JADA 149(4) n http://jada.ada.org n April 2018

This article is reprinted from the April 2018 issue of The Journal of the American Dental Association (2018;149[4]:328).

R19

For the Patient

The word on vaping: don’t start

V aping, or use of electronic-cigarettes (e-cigarettes), isstill pretty new, and the long-term health effects arerelatively unknown. However, 2019 and 2020 reports of

serious health problems developing after vaping, some requiringhospital stays for seizures and serious (even deadly) lung damage,have been headline news.1,2

WHAT IS VAPING?Vaping looks a lot like smoking a regular cigarette, but instead ofburning tobacco, users are heating up a liquid, creating a finevapor that is inhaled. E-cigarettes (also known as vape pens) areused for vaping. They come in a variety of sizes and shapes. Someare small and may be difficult to spot. They may look like a realcigarette, pipe, or even like a USB drive. Others are larger, likethe size of a cigarette package.

WHAT IS IN THE VAPOR?It’s hard to say exactly what is in the vapor being inhaled.Studies have found that these vapors may contain chemicalsthat are known to cause cancer or serious lung diseases, likeasthma or chronic obstructive pulmonary disease.3,4 Somesweet flavors may also increase your risk of developingcavities.5

Just like smoke from tobacco cigarettes, the vapor ine-cigarettes typically contains nicotine.6 Even products thatsay they are “nicotine-free” or “nonnicotine” may containthis addictive agent.7

CAN VAPING HELP ME QUIT SMOKING?Research on whether vaping is a good step toward stoppingsmoking is mixed. Some studies suggest it may help; others seem toshow that it can lead some people not only to vape but to smoketobacco as well.8 The Centers for Disease Control and Preventionsays if you have picked up vaping to quit smoking tobacco andwant to stop, do not go back to tobacco.9 Professional health caregroups like the American Dental Association10 and the AmericanMedical Association11 have called for a ban on vaping productsand urge smokers who want to quit to use methods approved bythe US Food and Drug Administration. Talk to your dentist orphysician about suggestions that may be right for you.

SUMMARYThe long-term effects of vaping are unclear, but research andreports of health effects suggest that vaping may not be helpful

and may be harmful. Don’t pick up the habit. If you havestarted vaping, talk to your dentist or physician about ways toquit. n


Prepared by Anita M. Mark, senior scientific content specialist, ADAScience & Research Institute, Chicago, IL.





1. US Food and Drug Administration. Tobacco product problem reports. Available at:https://www.fda.gov/tobacco-products/tobacco-science-research/tobacco-product-problem-reports#ends. Accessed January 14, 2020.2. Gaub KL, Hallyburton S, Samanic C, et al. Patient characteristics and product use

behaviors among persons with e-cigarette, or vaping, product use-associated lung injury:Indiana, June-October 2019. MMWR Morb Mortal Wkly Rep. 2019;68(49):1139-1141.3. Centers for Disease Control and Prevention. E-cigarettes shaped like USB flash

drives: information for parents, educators, and health care providers. Available at: https://www.cdc.gov/tobacco/infographics/youth/pdfs/e-cigarettes-usb-flash-508.pdf. AccessedJanuary 14, 2020.4. Kaisar MA, Prasad S, Liles T, Cucullo L. A decade of e-cigarettes: limited research

& unresolved safety concerns. Toxicology. 2016;365:67-75.5. Kim SA, Smith S, Beauchamp C, et al. Cariogenic potential of sweet flavors in

electronic-cigarette liquids. PLoS One. 2018;13(9):e0203717.6. Romberg AR, Miller Lo EJ, Cuccia AF, et al. Patterns of nicotine concentrations in

electronic cigarettes sold in the United States, 2013-2018. Drug Alcohol Depend. 2019;203:1-7.7. Peace MR, Baird TR, Smith N, Wolf CE, Poklis JL, Poklis A. Concentration of

nicotine and glycols in 27 electronic cigarette formulations. J Anal Toxicol. 2016;40(6):403-407.8. Dunbar MS, Davis JP, Rodriguez A, Tucker JS, Seelam R, D’Amico EJ. Disen-

tangling within- and between-person effects of shared risk factors on e-cigarette andcigarette use trajectories from late adolescence to young adulthood. Nicotine Tob Res.2019;21(10):1414-1422.9. Perrine CG, Pickens CM, Boehmer TK, et al; Lung Injury Response Epidemiology/

Surveillance Group. Characteristics of a multistate outbreak of lung injury associated withe-cigarette use, or vaping: United States, 2019. MMWR Morb Mortal Wkly Rep. 2019;68(39):860-864.10. American Dental Association. Official policies and statements on tobacco use andvaping. Available at: https://www.ada.org/en/advocacy/current-policies/tobacco-use.Accessed January 14, 2020.11. Berg S; AMA. Stop sales of e-cigarettes that lack FDA approval. Available at:https://www.ama-assn.org/delivering-care/public-health/ama-stop-sales-e-cigarettes-lack-fda-approval. Accessed January 14, 2020.

JADA 151(3) n http://jada.ada.org n March 2020

This article is reprinted from the March 2020 issue of The Journal of the American Dental Association (2020;151[3]:222).

R20

For the Patient

Your teeth and jaws under pressure

Do you clench your teeth when you are feeling stressed?Do you wake up with a headache? Do your jawmuscles hurt? Talk to your dentist. You may have a

habit called bruxism.1

WHAT IS BRUXISM?Bruxism is a habit during which you grind your teeth orclench or thrust your jaw forward over and over again.2

This habit can affect your oral health. It can cause teeth tobreak or crack, and increase the chance of gum problems.3,4

Adults are not the only ones affected. Studies have foundthat this can be a problem in children as young as preschoolaged.3,5

WHAT CAUSES IT?Researchers do not know for sure what causes people to dothis. Some think stress could be a factor.4 In preschoolers,studies find an association between grinding their teeth orclenching their jaws and signs of stress such as anxiety or socialwithdrawal.3

Children also can develop this habit when they are losingtheir baby teeth and their permanent teeth are coming in.1

Nail biting also may lead to grinding of teeth or jawclenching. Some children outgrow this, but often adultswho grind their teeth or clench their jaws did so aschildren.6

Like many habits, you may be unaware that you do this. Youmay even do it in your sleep. Tobacco and alcohol use mayincrease your chances of doing this when you are sleeping.Large amounts of caffeinedfor example, 8 or more cups ofcoffee a daydalso can increase this risk.2 Some medications orillegal drugs may cause users to grind their teeth or clench orthrust their jaws as well.

WHAT CAN YOU DO?You should talk to your dentist if you notice any of thefollowing3:n jaw pain;n headaches when you wake up;n teeth sensitivity to hot or cold drinks or food;n chipped teeth or fillings.

A number of things can contribute to the problem ofbruxism, and there has not been a lot of research on how bestto treat it. Your dentist may suggest some options,1,7 such asn decreasing or quitting tobacco use;

n limiting how much caffeine you eat or drink;n seeking counseling to help you identify when you aredoing it while you are awake and to develop ways torelax;

n looking at the medications you take and talking to yourphysician about other options.Your dentist also may talk to you about using an oral

appliance, which is a plastic tray that fits over either your topor bottom teeth.1,7 Use of an appliance may help reducegrinding,7-9 clenching, and thrusting and may protect yourteeth and gums.1,7 n





“For the Patient” provides general information on dental treatments. Itis designed to prompt discussion between dentist and patientabout treatment options and does not substitute for the dentist’sprofessional assessment based on the individual patient’s needs anddesires.


1. Goldstein RE, Auclair Clark W. The clinical management of awake bruxism. JADA.2017;148(6):387-391.2. Bertazzo-Silveira E, Kruger CM, Porto De Toledo I, et al. Association between sleepbruxism and alcohol, caffeine, tobacco, and drug abuse: a systematic review. JADA. 2016;147(11):859-866.e4.3. Machado E, Dal-Fabbro C, Cunali PA, Kaizer OB. Prevalence of sleep bruxism inchildren: a systematic review. Dental Press J Orthod. 2014;19(6):54-61.4. Wieckiewicz M, Paradowska-Stolarz A, Wieckiewicz W. Psychosocial aspects ofbruxism: the most paramount factor influencing teeth grinding. Biomed Res Int. 2014;2014:469187.5. Castroflorio T, Bargellini A, Rossini G, et al. Risk factors related to sleepbruxism in children: a systematic literature review. Arch Oral Biol. 2015;60(11):1618-1624.6. Carlsson GE, Egermark I, Magnusson T. Predictors of bruxism, other oral para-functions, and tooth wear over a 20-year follow-up period. J Orofac Pain. 2003;17(1):50-57.7. Lobbezoo F, van der Zaag J, van Selms MK, Hamburger HL, Naeije M. Principles forthe management of bruxism. J Oral Rehabil. 2008;35(7):509-523.8. Glaros AG, Owais Z, Lausten L. Reduction in parafunctional activity: a po-tential mechanism for the effectiveness of splint therapy. J Oral Rehabil. 2007;34(2):97-104.9. Guaita M, Hogl B. Current treatments of bruxism. Curr Treat Options Neurol. 2016;18(2):10.



R21

For the Patient

Oral care during cancer treatment

C ancer treatments, such as chemotherapy drugs and radia-tion, can cause trouble in your mouth.

Oral side effects from cancer treatments can include1

n cavities;n changes in taste;n dry mouth;n jaw stiffness;n oral sores.Some side effects from cancer treatments can cause prob-

lems with eating, talking, or swallowing; others can make itharder to fight infections. You may be able to reduce the risk orseriousness of oral side effects by working together with yourdentist and the doctor treating your cancer.

WHAT CAN YOU DO?There are some things you can do to help reduce the risk orseriousness of these problems.

See your dentistThe National Cancer Institute recommends that you see thedentist 4 weeks before you begin chemotherapy or radiationtreatment.2 Your dentist can look for things like cavities, gumdisease, and mouth soresdanything that can get worse orcause problems during your cancer treatment. Your dentist cantake care of problems in your mouth and may help you avoiddelay in the treatment of your cancer.

Reduce the risk of cavitiesCancer treatment may increase your risk of cavities. Good oralhygienedtaking care of your teethdcan help lower this risk. Totake care of your teeth, do the following:n brush your teeth twice a day with toothpaste that hasfluoride in it;

n clean between your teeth once a day with floss or anothercleaner designed for that purpose;

n avoid sugary foods and drinks.

Limit the effects of dry mouthRadiation treatments for head and neck cancer can damagethe salivary glands, which can cause you to have a dry mouth.Many medications, including those that are used for chemo-therapy, also can cause dry mouth.

Here are some tips for making yourself more comfortable ifyour mouth is dry:n sip water or sugarless drinks that do not contain caffeine;n suck on (do not chew) ice chips;n apply lanolin-based lip balm often;n use sugar-free chewing gum or sugar-free candy to stimulatesaliva production;

n if you use a mouthrinse, choose one that is alcohol free;n use a humidifier at night.Here are some other things that might be helpful:

n avoid salty or spicy foods;n limit alcoholic beverages;n stop any use of tobacco.

Lessen jaw stiffnessRadiation treatment for head and neck cancer can cause stiff-ness of the jaw muscles. This can be painful and may make itharder to chew and swallow. Your dentist or the doctor treatingyour cancer can teach you stretching exercises that may help.3

Seek treatment for oral soresOral sores are painful and can result in infections that mayinterfere with your cancer treatment. Talk to your dentist or thedoctor treating your cancer if you notice a sore developing3 soyou can get treatment for it started as soon as possible. They alsomay suggest an ointment or rinse to reduce pain from the sore.

CONCLUSIONCancer treatment can have side effects that affect your mouth.Working together with your dentist and the doctor treatingyour cancer may help you reduce the risk and seriousness ofthese side effects. Your dentist can help. See your dentistbefore you begin treatment for cancer and let him or her knowabout any problems with your mouth during treatment. n







1. National Cancer Institute. Managing oral complications during and after chemotherapy orradiation therapy. Available at: https://www.cancer.gov/about-cancer/treatment/side-effects/mouth-throat/oral-complications-pdq#section/_9. Accessed October 19, 2018.2. National Cancer Institute. Preventing and treating oral complications beforechemotherapy and radiation therapy begins. Available at: https://www.cancer.gov/about-cancer/treatment/side-effects/mouth-throat/oral-complications-pdq#section/_7.Accessed October 19, 2018.3. Levi LE, Lalla RV. Dental treatment planning for the patient with oral cancer. DentClin North Am. 2018;62(1):121-130.

JADA 150(1) n http://jada.ada.org n January 2019

This article is reprinted from the January 2019 issue of The Journal of the American Dental Association (2019;150[1]:82).

R22

For the Patient

Oral health care tips for caregivers

O ral health care is important for everyone, but somepeople may not be able to provide this care forthemselves. Brushing gently with a soft-bristled

toothbrush and fluoride toothpaste twice daily and cleaningbetween teeth daily is the general rule, but some people maybe challenged by this routine. Here are some tips for helpingothers who have trouble with oral self-care.

DAILY MOUTH CARESome people may need only to be talked to or shown how tobrush and clean between their teeth. Others might need you totake care of their oral hygiene completely.

You may need to adapt the standard routine on thebasis of the individual needs of the person you are help-ing. For example, some people may find it difficult to holdor use a traditional toothbrush. They might do better witha powered toothbrush. For someone who has troublerinsing or has swallowing problems, try using a toothbrushmoistened only with water.1 And although cleaning be-tween teeth may be challenging, there are a number of“interdental cleaners” that may make this task easier suchas prethreaded flossers, tiny brushes that reach betweenthe teeth, water flossers, and wooden plaque removers, aswell as dental floss.

Here are some tips for providing hands-on care1,2:n The National Institute for Dental and CraniofacialResearch suggests trying a “tell-show-do” approach: Tell theperson how you’ll help him or her brush and what it mightfeel like. Show how you’re going to do each step before youdo it. Do the steps in the same way that you’ve explainedthem.

n Before you begin, prepare the work area. You don’t neces-sarily have to use the bathroom for this activity. Set upwherever you and the person you’re caring for will becomfortable. Have all the things you’ll need within easyreach: toothpaste, a toothbrush, an interdental cleaner, aglass of water, and a bowl to spit into.

n Have the person sit up (or raise the head of the bed), anddrape a towel over his or her chest.

n Wash your hands and put on disposable gloves.n When you are ready, place a pea-sized amount of toothpasteon the moistened brush and brush each tooth surface, usingshort (toothwide) strokes.

n Help the person you are working with rinse with plainwater, if possible. If there’s a risk of choking, such as aswallowing problem, you can swab the mouth gently withmoistened gauze or a soft cloth.

n Clean between all teeth that touch, using an interdentalproduct as directed.

n The dentist may recommend an oral rinse. If so, have theperson you care for swish and spit the rinse out, as directedby the dentist.People who wear dentures need daily oral care, too. Den-

tures should be cleaned twice a day and stored in a cup ofwater when they are not being worn. Any removable full orpartial dentures should be taken out before sleeping. Talk toyour dentist or dental hygienist about the best way to care fordentures and how best to clean the mouth of the person you’recaring for.

PROFESSIONAL DENTAL CARERegular visits with a dentist are key to oral health. The dentistcan look for signs of tooth decay, gum disease, or oral cancer.Dental visits also are important for denture wearers. In addi-tion to making sure the denture is fitting properly, the dentistcan check for oral diseases like thrush.People with diseases associated with dementia, like Par-

kinson or Alzheimer’s, might consider seeing their dentist soonafter diagnosis.3 Sitting still for dental treatments mightbecome more difficult as the disease progresses.

CONCLUSIONProviding dental care for another may present challenges, butwith time and help from a dentist, you should be able to developa routine that works for you and the person you care for. n







1. National Institute of Dental and Craniofacial Research. Practical oral care for peoplewith disabilities: dental care every dayda caregiver’s guide. Available at: https://www.nidcr.nih.gov/sites/default/files/2017-09/dental-care-every-day-caregiver.pdf. AccessedMarch 6, 2019.2. American Dental Association. The caregiver’s guide to dental health. Available at:https://www.mouthhealthy.org/en/adults-over-60/caregivers-guide. Accessed March 6,2019.3. Alzheimer’s Association. Dental care. Available at: https://alz.org/help-support/caregiving/daily-care/dental-care. Accessed March 6, 2019.

JADA 150(5) n http://jada.ada.org n May 2019

This article is reprinted from the May 2019 issue of The Journal of the American Dental Association (2019;150[5]:480).

Tips for Caring for Your Teeth and Mouth: For the Patient ......water is public water with enough...

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