Do you have your tongue pierced? Sure, it only cost you $40, and that includes the jewelry. But in the end, it might just be the most expensive hobby you have. It turns out that the gums of people with piercings are exposed to high amounts of all sorts of bacteria, and that causes the gums in the front teeth to recede, leading to something called periodontal disease. As if that’s not enough of a problem, half of people with piercings wind up with chipped teeth, mostly in the back of the mouth. Dentistry to salvage your teeth can dwarf the cost of the initial piercing, even if you have a diamond stud.
Whether you care about the appearance of your teeth or not, piercings will eventually make your gums bleed and become sore – that’s called gingivitis. And when the roots of the teeth are exposed, they become sensitive to cold and heat and eventually lead to tooth loss.
But that’s not the only problem associated with tongue piercings. It turns out that bacteria love the channel that traverses your tongue. And these germs set up little communities called biofilms on the surface of the studs. The bugs create little fortresses that make the bacteria resistant to mouthwash and even antibiotics. Studs made of stainless steel make the best homes for these colonies of bacteria and ones made of the plastic called polypropylene make the worst. Bacteria in your mouth cause increased inflammation in your body. Many doctors think that this type of inflammation can lead to all sorts of problems, including heart disease.
So, the simple act of piercing your tongue, seemingly so cool to 17-year-olds, can lead to all sorts of dental and medical problems.
Think about this: the next time you pucker up and kiss your pierced mate, as you entwine your tongues, you will be visiting the 80 or more different species of bacteria that call that piercing “home."
Dr. James Miller is a Scottsdale Arizona Family and Cosmetic Dentistry. His website is www.drjamesmiller.com
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Many physicians still resist doing oral health assessments
December 30, 2010 -- It's been 10 years since the U.S. surgeon general's report on oral health in America, which among other things advocated interdisciplinary training between medical and dental providers. But current research shows that primary medical care providers are still not comfortable performing basic oral health assessments, and many consider oral health outside their realm of practice.
"The time has arrived for each profession to recognize the benefit of coordinated treatment plans to better manage patients," Charles Cobb, DDS, PhD, professor emeritus at the University of Missouri-Kansas City School of Dentistry and co-author of a new study that used the theory of planned behavior to examine nurse practitioners' understanding of the link between periodontal disease and systemic health (Journal of Periodontology, December 2010, Vol. 81:12, pp. 1805-1813).
The researchers surveyed 200 primary care providers about practice behaviors, attitudes, opinions, and knowledge regarding the periodontal disease-systemic link and used 137 partially and fully complete questionnaires for their data analyses. Of the 137 questionnaires, 123 were completed by nurse practitioners.
Dr. Cobb and colleagues found that 22% of the respondents reported they always or routinely screen for periodontal disease. Using the theory of planned behavior -- which explains behavior as a function of intent, including such factors as attitudes, social norms, and perceived control -- they found that the likelihood of screening increased if the providers felt confident in their training (attitude), felt like it was within their scope of practice (social norm), and felt that they had control over office protocols (control).
"A change in professional and peer expectations about periodontal assessments would be an important factor in improving rates of screening," said Dr. Cobb. Limited time and concerns over reimbursement were also found to be factors. Interdisciplinary/interprofessional education
In addition to recognizing the importance of the oral and systemic health link, primary medical care providers are being asked to assess oral health to help overcome disparities in access to care. Low-income and minority children, the elderly, people with developmental disabilities, and adults with less than a high school education are at particular risk for limited access to oral health services and a shortage of dental providers, according to the U.S. Centers for Disease Control and Prevention.
To address these disparities, health personnel who encounter patients without oral healthcare need to be able to perform simple assessments (Journal of Dental Education, May 2004, Vol. 68:5, pp. 505-512). Personnel also need to be aware of oral health resources in the community that will take patients on referral. In the case of infants and young children in the U.S., 95% have a physician but very few have a dentist, the researchers noted.
Other studies have shown that pediatric residents receive little training before completing their programs. When 661 pediatric graduating residents were surveyed in 2006, 35% of respondents stated they received no oral health training during residency (Pediatrics, August 2008, Vol. 122:2, pp. e465-e471). Of those who did receive some training, 73% had less than three hours of training and only 14% had clinical observation time with a dentist.
Similarly, a survey sent to 1,618 postresidency fellows of the American Academy of Pediatrics found that while more than 90% of pediatricians said they should examine their patients' teeth for caries and educate families about preventive oral health, in practice only 54% reported examining the teeth of more than half of their 0- to 3-year-old patients (Academic Pediatrics, November-December 2009, Vol. 9:6, pp. 457-461). In addition, the survey found that less than 25% of pediatricians had received oral health training.
Primary care training for adults fared no better. In a survey issued to incoming internal medicine trainees, 82% of the 115 respondents reported they never asked patients if they had been diagnosed with periodontal disease, and 90% reported not receiving any training about periodontal disease in medical school (J Periodontol, March 2010, Vol. 81:3, pp. 359-363). Nearly 70% reported that they were not comfortable "at all" doing a simple periodontal exam, 46% felt that discussing/screening for periodontal disease was outside their role as physicians, and 23% said they never referred patients to dentists.
"Somehow, there must be a recognition of value to doing even a 'tongue blade' visual examination of the oral cavity to determine obvious signs of inflammation," says Dr. Cobb. "Currently, such a visual examination is not part of the routine in medicine and nursing."
However, the "historic separation" of medicine and dentistry have kept the systems of education and training, financing, and service delivery separate, noted Wendy Mouradian, MD, MS, professor of pediatric dentistry and pediatrics at the University of Washington Schools of Dentistry and Medicine and co-author on the 2009 Academic Pediatrics and 2004 Journal of Dental Education papers.
"While microorganisms know no such barriers, health professional education and primary care practice lags behind today's science," she told DrBicuspid.com. "What is needed are cultural changes within medicine and dentistry and practical strategies to ensure better communication between practitioners and integration, or at least coordination, of health services." Improving education
Efforts are under way to address these disparities. A 2003 Institute of Medicine (IOM) report, "Health Professions Education: A Bridge to Quality," concluded that all health professionals should be educated to:
