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Do baseball players need mouthguards?

Dear Dr. Reitz:
My son plays Little League baseball. Last summer one of his teammates was hit in the face with the ball. Fortunately there was no damage to his teeth, but he did require a few stitches to his lip.
None of the players on his team wears a mouthguard. Is there a mouthguard designed specifically for baseball? - Michelle, Shillington.

Dear Michelle:
Baseball is one of the most popular youth sports in the United States, and a relatively safe sport compared with many other athletic activities. According to the U.S. Consumer Product Safety Commission, nearly half of the injuries (44 percent) that occur playing baseball involve the head, with 25 percent to the face, of which 5 percent are to the mouth. Some studies claim 16 percent of baseball injuries to the mouth and teeth are attributed to being hit by a batted ball.

A blow to the face can result in broken, displaced or traumatized teeth. A few years ago I treated a young batboy who had the misfortune to be in the wrong place as a batter was warming up and took a bat to the teeth. His father was smart to call me from the ballfield so I could meet him at the office within an hour of the accident and stabilize his mouth.

Mouthguards in baseball have not received the universal support they have in other contact sports. Currently the only sports that require a mouthguard are ice hockey, lacrosse, field hockey and football. In addition to protecting the teeth from direct trauma, they reduce the risk of concussion to the brain by cushioning impact injuries from a blow to the chin.

My first choice of mouthguard is one made by a dentist. A custom-made guard from an impression is less bulky and more comfortable. If cost is a concern, you can purchase a "boil and bite" type of guard from a sporting goods store or the Internet.

A creative variation on the mouthguard is a product called Bite Tech, which is made by the sports-clothing manufacturer Under Armour. Bite Tech is a mouthguard that claims to protect the mouth and improve athletic ability by opening the airway space.

I am not convinced that the scientific evidence supports the increase in athletic ability from wearing a mouthguard, but the claim may help your son justify wearing a mouthguard to the rest of the team while satisfying your parental concern for his safety.

Defeat gingivitis with proper care

Dear Dr. Reitz:
I brush my teeth in the morning and at night before bedtime. I floss my teeth prior to the nightly brushing to loosen and remove any food between my teeth. My dentist said I have areas of gingivitis. Is there any reason my efforts at keeping my teeth healthy are not succeeding? - Ann, Wyomissing

Dear Ann:
Brushing and flossing are the two most important things you can do to maintain a healthy mouth. But doing it effectively is the key to eliminating gingivitis.

Some studies estimate that 75 percent of adults have areas of gingivitis in their mouths, and I suspect many of same adults brush and floss their teeth regularly. Sticky bacteria - not food particles - growing on the tooth and under the cuff of gum tissue at the base of the tooth is what causes gingivitis.

All toothpastes contain abrasive particles that help remove the sticky bacteria. However, toothpaste is only effective if you get it to the bacteria under the gums, which is where the toothbrush and floss come in.

Many patients ask which they should do first, brush or floss. The correct answer is brush. Begin by taking a dry toothbrush and adding a small amount of toothpaste. In addition to brushing the teeth, work the toothpaste down into the gums around the neck of the teeth. After you have cleaned all four quarters of your mouth, put the brush down and pick up the floss.

Spit out any excess saliva, put a little toothpaste onto your finger and rub it around the quadrant you plan on flossing. That is correct: Toothpaste working with floss is more effective than floss alone, and since it's not possible to put the paste on the floss, you need to put a little around the teeth.

Before flossing the next quarter of your mouth, you may need to add a little more toothpaste by repeating the process of using your finger. If you look in the mirror you will see the toothpaste all around the teeth; just assume some is working with the floss to remove that sticky bacteria.

Initially you may notice some bleeding as your work the floss under the gums. Gingivitis causes ulcerations in the tissue that easily bleed when touched. After two weeks of effective cleaning, the bleeding should stop.

Following these guidelines once a day (my recommendation is prior to bed) should be effective in ridding your mouth of gingivitis. This entire process takes at least five minutes; any less and you are only fooling yourself that your home care is effective.

It's tough to whiten a 'dead' tooth

Dear Dr. Reitz:
When I was a teenager, my front tooth needed a root canal because of an injury. The tooth has always looked darker than the surrounding teeth. Tooth whitening by my dentist made my teeth whiter, but the tooth with the root canal is still dark. Is there a whitening product that can be applied to just the dark tooth to make it the same color as the rest? - Michael, Sinking Spring

Dear Michael:
The pulp chamber in the center of a tooth contains a nerve, which is often injured when a tooth is traumatized. If the injury is severe, the nerve can die and require root canal treatment to remove the dead material. For some reason, which is not fully understood, these teeth often turn dark in color.

The most accepted theory to explain the change in color of the tooth suggests that when the tooth dies, iron is released from the blood cells in the pulp chamber. The dark tooth presents a great challenge to dentists because the stain does not respond as readily to the whitening products on the market.

The current tooth-whitening techniques are based on using hydrogen peroxide coming in contact with teeth for an extended period of time to change the inherent color of the teeth. Although the exact mechanism of action is unclear, it appears the peroxide soaks into the tooth and oxidizes and dissolves the stains.

Since your stain is mainly internal, most of the topically applied products, similar to what you have already tried, don't penetrate deep enough to make a difference. To get the whitening solution where it's needed requires drilling into the back of the tooth and placing the solution inside the tooth. That may sound painful, but remember the tooth had a root canal and the nerve has been replaced with filling material. In essence, the whitening solution (usually 34 percent hydrogen peroxide gel) is placed into the root canal space.

The technique is termed "walking bleach" because after the whitening solution is placed into the center of the tooth, a temporary filling is placed and the patient leaves the office. So the patient is walking around with the solution inside the tooth doing the job of whitening. After three to five days, the patient returns to the office to check the results. It is usually necessary to repeat the process a few times before obtaining the desired result.

Because the tooth had a root canal, tooth sensitivity is never a problem. Unfortunately, a dead tooth is difficult to whiten, even with repeated attempts at applying "walking bleach." In that case, your next option is to have the tooth crowned.

Most medications safe for pregnancy

Dear Dr. Reitz:
I am three months pregnant with our first child. My dentist said I have gingivitis and wants to use Novocain to numb my gums prior to doing a deep cleaning. Is it safe for my unborn baby if I have dental work done while pregnant? - Beth, Shillington

Dear Beth:
Congratulations on the beginning of your journey into parenthood. That trip has some bumps in the road, including an increased risk of gum disease and tooth decay during pregnancy. Your increased levels of the hormones progesterone and estrogen cause the capillaries in your gums to dilate, causing increased bleeding. In addition, if you have morning sickness or acid reflux, the stomach acid in the mouth causes tooth erosion and decay.

If you require dental procedures, you can be comfortable in the knowledge that most of the medications used in dentistry do not jeopardize the health of your unborn baby. The benefit to your oral health by treating your gingivitis greatly outweighs any risk to your baby.

Lidocaine with epinephrine is the most commonly used local anesthetic to numb the mouth; it is also fortunately the safest for you and your unborn baby. Unfortunately, the anesthetic that is usually applied to your gums prior to injecting the needle (benzocaine) must be used sparingly because it has been known to interact with the iron in your blood that carries oxygen, thereby reducing the blood's ability to oxygenate your body.

The antibiotics penicillin and cephalosporin are commonly used to treat dental infections, and are both considered safe for use during pregnancy. Antibiotics to avoid are erythromycin (because it can cause liver toxicity in a pregnant mother) and tetracycline (because it is known to cause tooth discoloration).

As you get into the second and third trimesters, you may find it uncomfortable to sit in the dental chair for long procedures. Lying on your back allows the pregnant uterus to compresses the large vein that returns blood to your heart, which can lower your blood pressure, causing you to faint. So I suggest you ask the dentist to only schedule short appointments or allow you to get up and walk around frequently.

Your baby's health is very important, but neglecting your dental care can result in long-term dental problems for you and your child. A newborn's mouth is free of any bacteria, and most likely the first bacteria it will receive will be from your mouth. A healthy mouth has harmless bacteria that don't cause tooth decay and gum disease.

Patients can help monitor dentists

Dear Dr. Reitz:
Last month an oral surgeon from Tulsa, Okla., was accused of following improper sterilization procedures and using rusty surgical instruments, resulting in a patient being infected with hepatitis C and HIV. I have always assumed that health care in the U.S. was the best in the world, and although going to the dentist is never pleasant, I don't expect it to be life-threatening.
What measures are taken in Pennsylvania to protect dental patients, and how can I be certain my dentist is following proper procedures to safeguard my health? - Michelle, Shillington

Dear Michelle:
In 1998 I had the privilege of being appointed to the Pennsylvania State Dental Board by Gov. Tom Ridge. While also working in private practice, I spent 12 years on the board, the last two years serving as chairman. Compared with most states, Pennsylvania has some of the most rigid requirements to ensure patient safety, some of which I helped to enact. Concerning putting patients to sleep under anesthesia, Pennsylvania established some of the first guidelines in the nation, requiring office inspections to verify compliance.

Rules and regulations can be written, but in everyday practice it requires a dedicated dentist to make sure the rules are being followed. Every dentist is taught to sterilize instruments in a heat/pressure autoclave. Yet for some unknown reason, the oral surgeon in Oklahoma decided to soak dental instruments in Clorox bleach. Every dentist also knows the needles used to inject medications are not designed to be reused, yet that is an additional allegation in the Tulsa dental case.

There is no way to guarantee your dentist is following all the regulations in place to protect your safety. With more than 1,600 licensed dentists in Pennsylvania, the state does not have the money to send inspectors into every office to verify the rules are being followed. For that reason, it's incumbent on you to be observant when visiting any health care facility. The dentist or dental staff member should put on new gloves before working in your mouth. The instruments should be unwrapped in your presence. Plus, don't be afraid to ask about their sterilization procedures.

People want dental care at reasonable rates, but at the same time deserve to be safe when visiting the dentist. Unfortunately, the Tulsa dentist may have felt the cost constraints working within the reimbursement rates dictated by Medicaid and insurance companies and therefore cut corners to save money. Usually, the Pennsylvania State Dental Board learns of a problem with a dental office when a patient files a complaint.