Oral Health Foundation delighted by announcement that boys will get HPV vaccine

The Oral Health Foundation is delighted by the announcement today [24 July 2018] from the Department of Health and Social Care to accept the advice of the government’s vaccination advisory committee and extend England’s HPV vaccination programme to include adolescent boys in England.

This follows the very welcome decision last week from health ministers in Wales and Scotland confirming that they would be introducing vaccinations for boys in line with the advice from the Joint Committee on Vaccination and Immunisation (JCVI) advising that it would be cost effective to do so.

The charity sees this as a huge step in reducing the number of mouth cancer cases in Britain and is calling for a quick implementation of the programme to help save lives.

Dr Nigel Carter OBE, CEO of the Oral Health Foundation, feels this decision will lead to hundreds of thousands of boys finally being protected from potentially deadly diseases caused by the Human Papillomavirus, including mouth cancer.

Dr Carter says: “This decision has been an incredibly long time coming and one which is undoubtedly a watershed moment in the ongoing battle against mouth cancer in the UK, alongside many other HPV related diseases, we now need a quick roll out of an effective programme.

“We want to see a plan put in place to implement the vaccine as early as possible and are giving our support to HPV Action in setting a deadline of September 2019 at the latest.

“Since 2008, girls have been offered an HPV vaccination through a school-based programme to protect against cervical cancer, but this has been proven to offer little protection for boys and men from life-threatening diseases caused by HPV; including mouth, penile and anal cancers as well as genital warts.

“We have had to wait five arduous years for this decision, with every year putting more boys at risk, and brings the UK in line with roughly 20 other countries who have already decided to protect boys alongside girls by introducing a gender-neutral HPV vaccine.

“HPV is one of the leading causes of mouth cancer; which every year more than 7,500 Brits are diagnosed with and claims more than 2,000 lives – more than testicular and cervical cancer combined.

“We believe that with the swift implementation of the vaccination programme we will see a significant reduction in these numbers.”

Diabetics face a higher risk of mouth cancer, with women far more at risk

New research has discovered that women who suffer from diabetes face a dramatically increased chance of developing mouth cancer.

The research, published in Diabetologia, discovered that women have a 13 per cent higher chance of developing oral cancer if they suffer from diabetes1.

Overall women faced a 27 per cent increase of developing any form of cancer if they had diabetes, while men also faced a 19 per cent increased risk according to the study.

With previous research showing close links between diabetes and the development of mouth cancer, as well as other forms of the disease, leading health charity the Oral Health Foundation, is calling on people to be aware of the close links between their oral health and their wider wellbeing.

CEO of the charity Dr Nigel Carter OBE, which campaigns tirelessly to raise awareness of mouth cancer, believes the research could help to identify individuals at risk of mouth cancer.

Dr Carter said: “This could be a very significant piece of research, and one that could help to save lives. Diabetes has previously been linked to poor oral health, but this new research shows a specific link to mouth cancer.

“This makes regular dental visits an absolute must. If your dentists know that you are diabetic, they will check your mouth accordingly. For many years we have known that diabetic patients are more likely to get gum disease and need extra dental care but this is yet another reason for regular checks.

“It is important, not just for diabetics but for everyone to be aware of what the signs and symptoms of mouth cancer are. Be alert to ulcers which do not heal within three weeks, red and white patches in the mouth and unusual lumps or swellings in the head and neck area.  If you experience any of these visit your dentist immediately.

“More people lose their lives to mouth cancer every year in Britain than from cervical and testicular cancer combined. Without early detection, the five-year survival rate for mouth cancer is only 50 per cent but if it is caught early, survival rates can dramatically improve to up to 90 per cent, as well as the quality of life for survivors being significantly increased.

“Smoking, drinking alcohol to excess, poor diet and the human papillomavirus (HPV), often transmitted via oral sex, are all lifestyle choices that will increase the risk of developing the disease. As diabetes has now been shown to be another potential risk factor, amending your lifestyle to make sure you take yourself out of harm’s way makes it more important than ever to be mouth aware.

In the UK, it is estimated that over four million live with diabetes, with many cases going undiagnosed. Type 2 diabetes, which is closely linked to lifestyle and diet, has been rapidly increasing in recent years and is now one of the world’s most common long-term health conditions

Understanding Tooth Decay

The mouth is colonized by hundreds of bacterial species, but only a small number of these are the type that is responsible for tooth decay. These bacteria adhere to the tooth surface in layers of plaque that all of us develop on our teeth.

These bacteria consume carbohydrates that we place in our mouth. As they metabolize the carbohydrates they produce acid as a byproduct, which lowers the pH in our mouth and leads to the breakdown of the enamel that normally protects our teeth, resulting in a cavity. There are several ways to combat this in our mouth:

First, we can reduce the effect of these harmful bacteria by routinely brushing the plaque off our teeth. This serves as a scaffolding for them to establish themselves and cause damage. Brushing our teeth is like demolishing their work and making them start from scratch again.

Second, we can avoid eating processed foods and refined sugars that are high in carbohydrates. Cavity-causing bacterial thrive with this type of continual food supply. These kinds of foods that are unhealthy for the rest of our bodies are also unhealthy for our mouth.

Some people have health conditions that cause a greater number of these bacteria to be present in their mouth, which increases their risk for tooth decay. We can test saliva samples to determine who may be high risk. A thorough health evaluation is important to understand why these risks are present and to take proactive steps to reduce these risks to avoid future dental problems.


One key to good oral health is fluoride, a mineral that helps prevent cavities and can repair teeth in the very early, microscopic stages of the disease. Fluoride can be obtained in two forms: topical and systemic.
Topical fluorides are applied directly to the tooth enamel. Some examples include fluoride toothpastes and mouthrinses, as well as various treatments that are provided in the dental office.
Systemic fluorides are those that are swallowed. Examples include fluoridated water and dietary fluoride supplements.  Because of its contribution to the dramatic decline in tooth decay in the United States since the 1960’s the CDC named community water fluoridation one of the 10 great public health achievements of the 20th century.
The maximum reduction in dental caries is achieved when fluoride is available both topically and systemically.  If you, or a family member, are at a moderate-to-high risk of developing cavities, discuss with your dentist how the various forms of fluoride treatment might help.

Teeth Whitening

The process of whitening teeth with the aid of a dentist is fairly simple.  On a microscopic level our enamel has a very porous surface with tubules that collect stain from the things we eat.  To reverse this process, a peroxide gel is used to bleach the teeth, breaking stains in to smaller pieces in a similar way stains are removed from fabrics.

This process results in a whiter tooth color.  Yellow teeth tend to whiten particularly well.  Teeth with shades that are more brown or grey can prove tougher to whiten.  It should also be noted that, once whitened, all teeth will darken again over time and require some touch up whitening from time to time to maintain their lighter color.

The nice thing about whitening is that it is simple to do and each person gets to decide when they have arrived at the color they’re looking for.  Consult your dentist for their opinion on the results that can be achieved.

Tooth Discoloration

Over time our teeth can go from white to not-so-bright for a number of reasons.  Coffee, tea, and red wine are some major culprits.  Their pigments attach to the white enamel of our teeth.  Tar and nicotine found in tobacco both have a naturally dark color which also discolors teeth.  While age alone does not cause darker teeth, we can wear the outer white layer of enamel.  As that layer thins, the inner core of tooth which has a more yellow color starts to show through contributing to a darker color.
Antihistamines, certain medications used to treat high blood pressure and depression medication can cause tooth darkening as a side effect.  Certain antibiotics taken while young can also discolor adult teeth later in life.  Finally, taking a blow to the mouth can traumatize teeth and cause one or more of the to take on a grey or dark brown color.
The good news is that restoring teeth to a whiter color is relatively easy and safe.  Tooth whitening will be addressed in our next article.

A New Kind of Old Fluoride

Last year the New York Times published an article about a powerful type of fluoride that has been around for many years and seems to be making a comeback.  Silver Diamine fluoride is a liquid that has been around for many decades but for some reason never found its way into mainstream dentistry in the United States.  I don’t recall it ever being mentioned while I was in dental school.  It is a clear liquid that is about 25% silver, which has very strong anti-microbial properties.  It also has about 5% fluoride, which is similar to the fluoride treatments that are provided to patients today in dental offices.

What is unique about silver diamine fluoride, and what seems to be garnering all the attention these days, is its unique ability to not only prevent decay but also to arrest decay.  Without getting too technical, this uniqueness is due to the presence of the silver, which has strong antimicrobial properties and also holds and preserves tooth structure that normally breaks down when cavities develop.

Silver diamine fluoride is not without its drawbacks.  This most noted is that when it is applied to an area of decay, the area is stained a dark black color.  For obvious reasons, this type of treatment should be avoided in the smile zone where a permanent black spot could lead to embarrassment.

But for people who can’t seem to gain control over cavities and are looking for a solution have the upper hand, talk to your dentist about this treatment option to determine whether it is right for you.

Bleeding Isn’t Normal

One of the things I do with a patient during their initial interview is listen to them describe their oral health.  From time to time I will have a person say something to the effect of, “My gums always bleed when I brush or floss.  That’s just normal for me.”

While bleeding gums might be the norm for that person, it is not considered normal.  It’s sort of like someone with fair skin saying, “I always get sunburned.  That’s normal for me.”  What they are saying is that it’s common or typical for them.  But it’s not normal, because each sunburn increases the risk of skin cancer and causes permanent cell damage to the skin.  Bleeding of the gums during regular brushing and flossing is an indication of inflammation in the mouth, and that’s almost never a good thing or a sign of normal health.

For some reason, the gums are the only area of skin on our body that some consider acceptable to bleed.  Can you imagine if, while clipping your fingernails or pushing back the cuticles, your skin around the nails began to bleed?  What would someone do if while plucking their eyebrows blood began to ooze from the brow?  We would never waive that off as being normal, yet we dismiss bleeding gums as no big deal.

There are a set of narrow circumstances where people’s skin, and gum tissue, may be expected to bleed more than normal.  An example of this could be pregnant women or people who take blood thinners as medication.  These conditions are generally known to the patient and tend to be systemic, affecting people’s entire body including the mouth.

For those people whose bodies are seemingly healthy but whose gums still bleed, talk to your dentist to determine the cause of bleeding.  If left untreated, bleeding gums is often an early warning signal of more serious problems in the mouth to come.


Doc Can I Get Some Norco?

Every day 78 Americans die from an opioid overdose1, 2.  Opioids are also known as narcotics and have the effect of relieving pain to various degrees.  Certain narcotics such as herion are illegal.  Others such as morphine, hydrocodone, and codeine are legal when prescribed by a physician to relieve pain.  They all have addictive properties that can cause people to become hooked on them and abuse the drug.

That has been at the root of a rising opioid addiction in America, what has recently reached endemic proportions.  In the 1990’s this class of drug became the most widely prescribed pain reliever by doctors.  And with that rise in prescriptions came a corresponding rise in drug abuse – people obtaining it illegally without a doctor’s order, or people with a legal prescription not following directions either in an attempt to relieve pain or just get high.

Many dentists including myself are now making a concerted effort to not prescribe opioids at all.  Studies have shown evidence there are safer pain relievers that are more effective at relieving pain.  So why wouldn’t everybody discontinue opioid use if something else is safer and better at pain relief?  Many times it’s because of the addictive properties opioids have.

This problem now has the attention of the US Surgeon General and doctors nationwide.  A program has been initiated to dramatically curb the use of these drugs, or in the case of my own practice, eliminate them altogether.  I say good riddance.




1. US Department of Health and Human Services.  Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: 2016
2. Centers for Disease Control and Prevention. Injury Prevention & Control: Opioid Overdose. https://www.cdc.gov/overdose/index.html. Accessed May 3, 2017.

What Is Enamel Erosion?

If your dentist has brought up enamel erosion, it’s worth listening. “Enamel is the hard, calcified tissue that covers the crown of the teeth,” says Ana Ferraz-Dougherty, DMD, a dentist in San Antonio, Texas, and a spokesperson for the American Dental Association. “It’s basically the shield against anything we eat and drink to protect against cavities.”

It’s also the white part of your teeth, so when it wears away, you’ll begin to see more of the underlying dentin, which is more yellow. And that’s something that whitening treatments, which work primarily on removing stains caused by foods and drinks, can’t fix.

How Enamel Is Worn Away

Dental enamel provides an incredibly hard shield for your teeth, but it has one major weakness: its pH. Made of carbonated calcium hydroxyapatite, it has an estimated pH of 5.5. Your saliva works to neutralize acids and maintain that balance, as well as to help replace phosphate and calcium ions that are lost to keep the enamel strong. But when saliva can’t keep up with the acids, enamel erosion can happen.

While enamel is incredibly strong, once it wears away, there’s no going back. Since there are no living cells in the enamel of your teeth, it can’t regenerate or heal itself. And if the protective covering wears away, it can expose the nerves in the center of your teeth, making them sensitive to hot and cold. If left untreated, eventually it can even lead to the loss of your teeth.

However, some enamel erosion is simply a natural part of aging. “We use our teeth for eating, drinking, and chewing. As a result, the enamel wears away over time,” says Dr. Ferraz-Dougherty.

Enamel Erosion and Your Diet

Oftentimes, enamel erosion is due to your diet. “If you’re eating a healthy, balanced diet, it shouldn’t be too damaging. But if you’re drinking sodas all day, every day, that’s going to cause really fast damage to your enamel,” says Ferraz-Dougherty.

Some of the biggest culprits are drinks: sodas, sports drinks, and especially sweet tea, which is more acidic than soda and packs a lot of sugar. “The acids wear down the enamel, and the sugar starts in on developing cavities,” says Ferraz-Dougherty. “It’s a double whammy.” But “sugar-free” doesn’t necessarily mean your drink is in the clear either. Seltzers are very acidic too.

Talking to your dentist about your diet habits can help you determine what types of lifestyle modifications you should make to help prevent enamel erosion.

Medical Problems That Contribute to Enamel Erosion

For some people, erosion of tooth enamel is caused by frequent vomiting or acid reflux, which repeatedly exposes the teeth to stomach acid and can cause pitting in the enamel. The risk is magnified during sleep, when you produce less saliva to protect the teeth.

“A lot of people don’t even know it’s happening,” says Ferraz-Dougherty. But a dentist can tell by looking at the specific patterns of wear in your mouth. For example, with acid reflux that happens at night, a dentist might see it on just the side of the mouth that you predominantly sleep on. Or somebody who is bulimic might have enamel loss on the inside surfaces of the upper teeth.

Grinding your teeth can also physically wear down the enamel, so it’s important to talk to your dentist to figure out the root cause of grinding — from stress to tooth position — and find a solution.