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He Snored Last Night! No! She Snored Last Night! No Snoring Please! As the father of a third grader, I try to use some of the teachings from my son’s homework and apply them to some of our everyday life’s teachings. Here is an acrostic poem to think about: A little test you or your snoring partner can take. S (Snore) Do you snore loudly, (louder than talking or loud enough to be heard through closed doors?) T (Tired) Do you often feel tired, fatigued, or sleepy during daytime? O (Observed) Has anyone observed you stop breathing during your sleep? P (Blood Pressure) Do you have or are you being treated for high blood pressure? B (BMI) BMI more than 35 kg/m? A (Age) Age over 50 yr old? N (Neck Circumference) Neck Circumference greater than 40 Cm (16 in)? G (Gender) Gender male? High risk of Obstructive Sleep Apnea: answered yes to three or more items Low risk of Obstructive Sleep Apnea: answered yes to less than three items Snoring is not to be Ignored.
I recently sent an email to my three children (ages 18, 19 and 26) with the subject line “An important topic no one wants to talk about” that had them jokingly saying they were going to mark future emails from me as Spam. The unpleasant topic was related to the correlation between HPV (human papillomavirus), oral cancer and oral sex. HPV is the broad term for a group of viruses, some of which are considered “low risk” and others which are “high risk” and cause genital cancers. HPV-16 is the strain that causes both genital and oral cancers. In the past, the “model” for oral cancer was an older man who had spent a lifetime of smoking and drinking. But now, young people without the risk factors of smoking and drinking are being diagnosed with oral cancer. It is suspected that oral sex, considered by many young adults to be “safer” than intercourse, is considered the culprit. According to the Journal of the American Medical Association, about 7 percent of men and women between the ages of 14 and 69 living in the United States carry HPV in their mouths. Advances in diagnosis have allowed researchers to test for viral DNA and have found HPV in many oral cancers. Even the location of HPV related oral cancer varies from the “traditional” oral cancers, with lesions being found primarily in the back of the throat and in the crypts, or crevices, of the tonsils. I advise all my patients to be aware of the potential signs and symptoms of oral cancer: A unexplained white or red lesion in the mouth that is present for more than two weeks. A swelling in the throat Difficulty or painful swallowing A change in your voice If you notice any of the above, call us for a complete evaluation. Oral sex is not the only cause of transmission; HPV infection increases with the number of partners you have and is transmissible by skin to skin contact. Not all infections with HPV will lead to cancer. Of the 150 related viruses, about 40 are sexually transmitted and only some of those will cause cancer. Most infections with HPV are cleared by the body without any long term consequences. If you would like additional information about HPV and cancer, visit our website at www.adamsdentalnj.com or contact our office at 973-377-6500. Additional information is available on the websites below. http://abcnews.go.com/Health/ReproductiveHealth/hpv-oral-cancers-rise-oral-sex-popular-spread/story?id=11916068#.T2Ozo8WPUTY http://www.cancer.gov/cancertopics/factsheet/Risk/HPV http://oralcancerfoundation.org/facts/index.htm
Just about everyone snores occasionally. Even a baby or a beloved pet may snore! However snoring can affect the quantity and quality of your sleep. Poor sleep can lead to daytime fatigue, irritability, poor behavior, trouble with relationships and increased health problems. Sleep also affects your mood. People who chronically lack sleep are also more likely to become depressed. Sleep disorders deprive you of a “good night’s sleep”, chronic daytime exhaustion, and long-term cardiovascular stress. Snoring is a most common problem plaguing the world. Studies show that almost 46% of the male and 30% of the female populace in the world snore on a regular basis. The question remains as to how snoring can affect your marriage. For many it most certainly can. But before diving into that topic, let us first know what is snoring. If you snore regularly and experience these symptoms, you may have a condition called sleep apnea. It is as widespread as Asthma and Diabetes; however sleep apnea often remains undiagnosed. What is sleep apnea? Under normal conditions, the muscles that control the upper airway relax during sleep. If they relax too much, the upper airway becomes narrow and some people begin to snore. If the airway becomes to narrow, this may cause difficulties in breathing. Sometimes the airway becomes completely blocked and the person temporarily stops breathing – experiencing obstructive apnea. Apnea means without breath. This can last for 10 seconds or more. It may happen frequently or even several hundred times a night. If you have this condition, every time an apnea occurs, you struggle to breathe, placing stress on your brain and heart. Research shows that snoring and sleep apnea are associated with many serious conditions. Left untreated, they are a contributing risk factor in high blood pressure, heart disease, stroke diabetes and depression. So don’t IGNORE the symptoms if you SNORE. To learn more about snoring and sleep apnea visit www.drsamromano.com
How Vitamin D Affects your Body and Dental Health This past year one of my patients, at our Madison, NJ office, had a small basel cell removed. Being fair she has always tried to protect her skin from the sun. The advice of her surgeon was to stay out of the sun. A recent routine blood test indicated that her Vitamin D level was deficient. It was interesting that all her medical doctors told her to avoid the sun but none, until the blood test, told her about supplementing her Vitamin D intake. As a dentist, we care about our patients overall health as well as their Dental Health. Vitamin D’s health benefits have been in the news a lot lately. I took the time to understand the effects of Vitamin D on dental health. I want to share some information I have learned with all of my dental patients and more. Many people understand that Calcium helps build strong bones ands teeth. However, most probably don’t know the relationship Vitamin D has with Calcium and your dental health. So, what does Vitamin D do for the body? Vitamin D helps our bodies absorb the calcium we need for optimal bone and teeth development. Without enough Vitamin D in childhood, bone deformities can develop. If we do not get enough in our adult life it can lead to reduced bone density, osteoporosis & increased risk of bone fractures. The latest research suggests that Vitamin D plays a role in helping to prevent a variety of health conditions, including multiple sclerosis. It can also reduce the risk of breast cancer in women. So you are probably wondering, what about how it benefits your mouth? The importance of Vitamin D for your teeth is very significant and almost completely overlooked in the medical field. How often have you been told to take Vitamin D for the prevention of periodontal/gum disease and the formation of cavities? Probably not very often. Since we were kids we have heard about the importance of Calcium, but, the relationship of Vitamin D is just as important. For many of our patients, brushing regularly, flossing daily and seeing our dental hygienist twice a year hasn’t always stopped all of periodontal disease. As a dentist this is very discouraging. When patients suffer from this disease they have a weakening of the bone that anchors teeth into their socket. This leads to redness, bleeding, inflammation (also known as gingivitis), which if untreated can eventually lead to loss of teeth. Vitamin D is also important because it acts as an anti-inflammatory. It is an important stimulator of our immune system. When your immune system health is at its best, you are less likely to get bacterial infections in your gums and elsewhere. So how does it all work? Calcium is stored in bones and teeth. This stored nutrient is always in a state of movement. When the body needs more Calcium in the bloodstream due to low levels, the body extracts it from its storage in bones and teeth. When there is an abundance of Calcium in the bloodstream, it is put back into bones and teeth, thus making our skeleton very strong and resilient. Vitamin D acts as the regulator of this whole process. When Vitamin D levels are too low, no Calcium is put back into bones and teeth. Then our bones become weakened and susceptible to fractures. Low levels of Vitamin D can be a contributing factor to osteoporosis and periodontal disease. To sum it up, Calcium and Vitamin D are critical for the general health and strength of bones and teeth. With the avoidance of sun exposure many people are becoming Vitamin D deficient. In the case of my patient, once skin cancer was detected, and the recommendation to stay out of the sun was made, the importance of supplementing Vitamin D was not suggested. It is very important to make sure we get enough Vitamin D in our diet and from supplements. It is recommended to take 1,000 IU of Vitamin D daily for adults and 400 IU for children. Eating foods high in Vitamin D is also helpful. Such foods include milk, yogurt, salmon, orange juice, tuna, eggs, and cheese. If you would like more information on how Vitamin D affects your mouth or your overall health please contact me firstname.lastname@example.org or visit our website at www.drsamromano.com
For years, dentists have known that oral health and overall systemic health are linked. Now, more and more research recognizes the significant link between diabetes and periodontal (gum) disease. Diabetes is a disease that affects the body’s ability to fight infection and diabetics are more prone to develop gum disease. Inflammation, and the destruction that occurs as a result of it, is a key factor in the development and progression of both diabetes and gum disease. Diabetics may have difficulty controlling their blood sugar levels, even with medication, if they have uncontrolled gum disease. Conversely, patients with gum disease, even those who are undergoing treatment for it, may find their efforts unsuccessful if they lack glycemic control. If you are diabetic, you should see your dentist regularly. You may need to have cleanings done more frequently depending on the condition of your gums. Signs of gum disease: • Red, swollen gums • Gums that pull away from the teeth • Bleeding gums with brushing and flossing • Bad breath • Teeth feel like they don’t fit together properly If you have any of the above signs, regardless of whether or not you are diabetic, you should see your dentist for an evaluation. The good news is that both physicians and dentists are aware of the relationship between these two diseases and will work with one another to co-manage a patient’s care. For more information, please visit our website at www.adamsdentalnj.com or email us at email@example.com.
Madison's first, second and third graders received Halloween toothbrushes in preparation for next week's candy. Central Avenue, Torey J. Sabatini, Kings Road and St. Vincent Martyr schools were all visited by Kelly Olsen and Andrea Ceresa of Adams Dental in Madison. They delivered children's toothbrushes with orange handles and black bristles along with instructions on how to brush their teeth. The brushes will be handed out to all first, second and third graders during their Halloween festivities. Kelly Olsen, hygienist, felt it was important to put a different spin on Halloween. She said: "I know that children will eat candy on Halloween and it's not realistic to tell a second grader to turn down a Tootsie Roll. But at least we can encourage good brushing habits afterwards."
Disrupting the biofilm – sounds like a great name for a ‘90s punk rock band, huh? Unfortunately, it’s not really that exciting or glamorous. Biofilm is actually the new description for the plaque in your mouth. Read on and see why it’s so important. A little technical, but this is a great definition of biofilm that I recently found: “Bacteria living in a biofilm can have significantly different properties from free-floating bacteria, as the dense and protected environment of the film allows them to cooperate and interact in various ways. One benefit of this environment is increased resistance to detergents and antibiotics, as the dense extracellular matrix and the outer layer of cells protect the interior of the community.”* Read the definition again and you’ll be impressed by what it says – loose, single bacteria are like the kid who is trying to be tough, but doesn’t have any muscle. So, what does he do? He joins the local gang (other bacteria) and now by sheer numbers and support creates a protective environment that gives him not just the illusion, but real, power. When it comes to your mouth, we used to think that plaque was made up of single bacteria that could be brushed and flossed away. The more we learn, the more we discover that plaque is really a collection of a variety of both dangerous and benign bacteria that create a “matrix” that they live in. The longer the bacteria are present, the stronger and more dangerous they become. That’s why dentists annoy you about brushing and flossing daily. The bacteria present on day one is not good for your teeth and gums, but if you don’t floss and the bacteria is left undisturbed, it becomes more virulent, with the ability to lead to gum disease, bone loss and tooth loss. After a few days, it becomes harder and harder to floss away the bacteria. Some of it attaches to teeth and some actually begins to invade gum tissue. That’s why the topic of “disrupting the biofilm” is so important. Okay, so you get the picture – you need to get the “gang” of bacteria out of your mouth before it does damage, primarily gum disease that leads to tooth loss. What do you do? How do you disrupt the biofilm? It’s all about who wins the fight. Bacteria are forming a complex matrix that is impermeable to antibiotics and rinses. You have to get it BEFORE it is in the matrix, the “gang”. Regular brushing (and I mean twice a day, two minutes each time) with an electric, sonic toothbrush (Sonicare**), daily flossing and a rinse like Listerine or The Natural Dentist (based here in Madison on Cook Avenue http://www.stopbleedingnaturally.com/rinses.php) are a no-brainer. Additionally, regular dental cleanings are a necessity. Regular in this instance is a personal thing between you and your dentist. Some people have light plaque, no bleeding, and great home care – they can go six months between cleanings. Other people build up plaque like crazy, bleed when you look at their gums and haven’t flossed in a year – they might need cleanings every three months. The hardest situation is the people who do everything they’re supposed to at home with brushing and flossing and still have bleeding – they are a special group that have an exaggerated immune response to plaque (a blog for a different day…), but they might also need cleanings every 3 months. Cleanings for people with lots of bleeding should include the use of ultrasonics to help disrupt the bacteria under the gumline. The key is to overwhelm the bacteria with all the tools in your arsenal. Microbiologists talk about “bacterial burden”, basically, how much bacteria is hanging out in the street corner of your mouth. You have to bring all your guns to the fight so you can beat the bacterial gang. Hope you win the war! If you have any questions about plaque, biofilm, or how it impacts your overall health, contact me at firstname.lastname@example.org. *http://www.bionewsonline.com/n/what_is_biofilm.htm ** http://www.usa.philips.com/c/electric-toothbrushes/139863/cat/en/
I remember growing up hearing people talk about exactly what they were doing the day President Kennedy was shot. It always amazed me that years later, people would so vividly remember where they had been and what they were doing. But that all changed with 9-11. I will never forget where I was or the experiences I had as a result of it. The morning of September 11th, I was seeing a patient, and as was common at the office, we had the television on in the operatory. By the time we had gotten to work that morning, we’d already heard about the “accidental” plane crash into one of the towers, so we were watching the news to track what was happening. When we saw the second plane crash and realized it wasn’t an “accident”, we cancelled the day and started reaching out to family. My husband went to pick up our children, and I went to the Red Cross. At the time, I was on the Red Cross board and we all thought there would be a need to organize blood drives and emergency medical care. Unfortunately, as we all know, there was little care that could be provided because there were so many more deaths than injuries. We fielded phone calls from people and tried to figure out what needed to be done. I remember we needed to photocopy a lot of papers on the Red Cross’ old copier (although I don’t remember what we were copying). I called up Staples in Madison, asked them if the Red Cross could borrow a better copier and without hesitation, they said yes. When I went to pick it up, they graciously told me we could keep it. As a member of the NJ Disaster Victim’s Recovery Team, a group of trained forensic dentists that participate in identifying the missing and deceased, I waited with my colleagues hoping our task would be small. However, as the magnitude of the missing became apparent, we were asked to work 12 hour shifts to help with identification. My first shift was about two weeks after the tragedy and I had to work starting at midnight. It was an eerie ride through the Lincoln Tunnel and the quiet city to the Office of Chief Medical Examiner (OCME) on First Avenue. I arrived to barricades and police and was directed to a “room” about the size of a closet that was the dental office. Eventually, we were moved to a trailer parked on the street that was to become our “office” for the next year. Our group consisted of dentists and dental hygienists who were responsible for organizing all the information that was received by the medical examiner. We had separate files for ante mortem– the dental records that families or dentists gave us about the missing – and post mortem – the information that we collected once a body or a part was brought to the OCME. We worked together in teams to record information. The goal was not on speed, but on precision. Forensic dentistry involves creating a picture of what a person’s mouth looked like when they went missing based on an investigation of their previous dental records and then matching it to a unknown. X-rays don’t always tell the whole picture and sometimes pages of illegible handwriting had to be studied to develop our ante mortem records. The post mortem chart was created in a similar way – precisiely charting all the information that we discovered upon examining a body or a tooth. Then the tedious process of comparing the files begins. Dr. Jim McGivney developed a computer program called WIN-ID that compares similarities between ante and post mortem records and he spent many months at the site helping the team with identification. The program helps to narrow down possibilities and then charts are pulled and again examined with a team approach. The importance of a correct positive ID was more important to us than speed. Most people don’t realize that more of the IDs were accomplished with dental than other methods, although they may have been confirmed by another method like DNA or fingerprint. The first shift was difficult. The logistics of identification had been rehearsed in training many times, but the emotional impact of what we were doing could never be prepared for. The condition of the bodies was never something I wanted to share with friends or family. I knew some of the missing, as most of us in Madison did, three fathers from St. Vincent’s as well as a patient. I would study their ante mortem charts at the beginning of each shift so their dental “fingerprint” was fresh in my mind as I looked at post mortem records. I found that while I was working a shift I was strong, not letting the horror affect me, only to be distraught when I was at home. I spent a year trying to rediscover priorities in my personal and professional life. It became hard to worry or even care about inconsequential things when compared to what I saw each week. The Salvation Army was set up in a tent, named “Sal’s”, to supply us with food round the clock. But they provided so much more. I will always remember the Salvation Army workers as a breath of fresh air in a stagnant evening. They profusely thanked us for all we were doing and after a few weeks, the tent was plastered with drawings and cards from children writing to show their support and thanks for our help. Whenever the shift became overwhelming, a cup of coffee and a conversation at Sal’s helped to calm us. My most memorable experience at the medical examiner’s office was an evening when a Man of Service was brought in. A Man of Service refers to a uniformed officer – police, fire or Port Authority – and while every single person received the ultimate respect, a Man of Service sometimes had more ceremony. The night was long and cold, I had been working with a team in the morgue and we received notification that a fireman had been discovered at the World Trade Center site. The story was pieced together for us – the body was found but not removed from the site until members of the victim’s fire company could get to the site (they were able to see his company number on his jacket) so that they could have the honor of removing him from the rubble. When the body arrived at the OCME, he was draped with an American flag and his company stood on either side while he was silently rolled into the building. As always, the same protocol was followed –visits at personal effects, anthropology, fingerprinting, x-ray and dental. The fire company waited patiently, knowing that identification was not a definite. Just because he had on a jacket with a company number and a name on it, the victim could have picked up someone else’s jacket in the chaos. He deserved the right to a proper identification. After only a few hours, we were able to make a positive ID, mostly because we had the name on the jacket to guide us. As the flag draped body was removed from the building, his company again flanked him, together for a final walk to a secure tent across from the OCME. There was no music, no speech, no fanfare, just a group of men committed to one another in life and death. I spent almost a year in the trailer at the medical examiner’s office working 12 hours shift about two to four times a month. I was joined by almost 300 dental professionals from across the country who committed their time and knowledge to a unified goal – identification of as many victims as possible so that their families could have closure. I remember driving home one morning from the city, depressed and tired from a fruitless night, and suddenly, I noticed the ubiquitous flags that had appeared on cars and buildings after the attack. As sad as I was, I was proud of my country and proud of myself. I felt as though we were making a difference. Before 9-11, I often had colleagues question why I “wasted my time” learning about forensics since it wasn’t something that would be profitable for me. It’s true, there was no financial gain from my involvement with World Trade, but the knowledge that I helped our country and my neighbors during a horrible time in our history will forever be remembered and is priceless to me.
For years, I’ve heard how wonderful Madison is and how people who move here compare it to Mayberry from the Andy Griffith Show. (I can still whistle the tune). Having lived and worked in town all my life, I feel uniquely qualified to weigh in on their assessment of Madison. I was onlypartly right. First of all, let me tell you a little about myself. I was born in 1959 and grew up on Bardon Street. My mother, who is 83, still lives there. I went to Central Avenue School,the Junior School, and Madison High, graduating in 1977. I went to Fairleigh Dickinson University for undergrad and UMDNJ in Newark for Dental School. I’ve lived in Madison all my life with the exception of a few years in Florham Park and a year in Chatham. Not exactly the world traveler. I started to realize that Madison was special while I was in dental school in Newark. When the doctors on staff found out I was from Madison, they would say “that’s a good town.” I never thought much about it, I was more focused on exams. After I finished school and in the early years of my career, I worked at several practices in North Jersey, both urban and suburban settings. That’s the first time I started to “get it.” You see, having never really lived or worked anywhere before, I thought every place was just like Madison. I didn’t know what I had because I didn’t know what others didn’t have. When those newbies in town become so enamored with Madison, I remember thinking, “Yea, I remember when it really was Mayberry.” As a kid, if I rode my bike in a part of town that I wasn’t supposed to be in, my mother knew about it before I got home. And there were no cell phones back in those days! (Opie’s got nothing on me.) A long time has passed since I began my career, and I have traveled extensively throughout the U.S. and even to Central America to practice dentistry. The places ranged from nice resorts to inner city hospitals and small remote villages. But for all the places I’ve been to, I realize that Dorothy in the “Wizard of Oz” had it right when she said, “there’s no place like home.” As I start my fifth decade in town, I’m happy to see the storefronts in the downtown filled with new businesses. I’m happy many of my friends and fellow business owners are still around. They have ridden out the financial storm and have kept their businesses in town. In spite of a significant slump in the housing market, homes in town still keep selling. My vision for the future of Madison is bright. I was disappointed that New Jersey Monthly didn’t include Madison in the top 100 towns in New Jersey! (What’s up with that?) I know we have a parking problem. I know about the budget. I know taxes are high. I know we have all the same problems as most other towns. I encourage those in town who have the responsibility of decision making to keep in mind the image of what Madison looked like in the past and to see what the future needs to be and make decisions that support that vision. You know, I’ve never won the lottery. I don’t have much luck in Atlantic City. I have enough losing raffle and 50/50 tickets that if I burnt them in the fireplace, I could heat the house for the month of February. But that’s OK, because I’ve been blessed to live and work in a great place: Madison. And I don’t even have to click my heels three times to get there. For more information, please visit our website at www.DrSamRomano.com Thanks for the ride, Sam Romano
Between 30 and 40% of adults have xerostomia or dry mouth. Its prevalence increases with age and is caused mostly by medications or systemic disease. Dry mouth can’t be solved by having a drink of water and there are a lot of problems that may result from having it. The main cause of dry mouth is taking a medication that interferes with the normal production of saliva. Saliva is critical to the overall health of a person’s mouth. Saliva does something fancy called “buffering” that regulates or modifies the pH in your mouth. Think back to high school chemistry. pH deals with acids and bases. The bacteria in your mouth thrive in an acid environment and the enamel on your teeth break down the more acid the conditions. With less saliva present, this leads to erosion, cavities, and sensitivity – all bad stuff. Additionally, saliva helps to lubricate your mouth when you eat so crusty Italian bread doesn’t scrape your cheek. So – what causes dry mouth? And is there a way to reduce it? Causes of dry mouth 1. Medications are the primary cause of dry mouth and considering that a Google search I did reported that Americans filled 11.5 prescriptions per capita and spent over $291 billion on prescription medications, it is safe to say that this is a big problem for the public. 2. Systemic conditions are the next thing that cause dry mouth. Systemic means it affects your whole body and in certain diseases, the mouth is also affected. Sjogren’s syndrome, Alzheimer’s disease, diabetes, rheumatoid arthritis, and high blood pressure have all been linked to dry mouth. 3. Aging and hormonal changes. 4. Damage to the salivary glands – this happens primarily due to head and neck radiation and chemotherapy from cancer treatment. I’ve included an abridged list of some medications and their uses that cause dry mouth. Anti-anxiety – Ativan, Valium, Vistaril, Xanax Anti-convulsant – Lamictal, Neurontin, Tegretol Anti-depressant – Celexa, Effexor, Paxil, Prozac, Tofranil, Wellbutrin, Zoloft Anti-histamine – Allegra, Benadryl, Claritin, Vistaril, Zyrtec High blood pressure – Accupril, Altace, Cardura, Coreg, Lopressor, Norvasc, Tenormin Anti-inflammatory – Dolobid, Motrin, Naprosyn Cholesterol reducting – Lipitor Diuretic – Diuril, Dyazide, Lasix How to treat dry mouth and prevent problems that result from dry mouth As previously mentioned, just rinsing with or drinking water is not enough to solve dry mouth. While there are medications you can take to help stimulate saliva production, simpler methods include: 1. Toothpastes or rinses specifically for dry mouth. Biotene or Oasis are great products that help lubricate the mouth. 2. Using lozenges like Salese with Xylitol. These are placed in your cheek and allowed to dissolve creating lubrication in your mouth, especially helpful when used 20-30 minutes prior to eating. 3. Using a fluoride toothpaste or rinse at home to protect and strengthen at risk enamel. 4. Have fluoride treatments when you visit the dentist. 5. Using sugar free mints and gums. 6. Drinking water or sugar-free drinks – this is a short term fix, but it helps, especially when you are eating. 7. Decrease alcohol and caffeine consumption. 8. Avoid salty, spicy, hard foods. Keeping dental appointments to monitor the effects of dry mouth is important. It is amazing how quickly deterioration of enamel can happen in an acidic, dry environment. Meticulous home care and regular dental checkups and cleanings will allow you and your dentist to keep track of your dry mouth and the effects it may be having on your dental health. If you have any additional questions about dry mouth, please contact me at email@example.com or visit the American Dental Association’s website at: http://ada.org/3014.aspx?currentTab=1.