Monday, June 24, 2013

A guide to common dental problems

How to prevent or treat the (sometimes painful) troubles that can lurk in your mouth.

Problem: Tooth Decay
Also known as dental caries or cavities, tooth decay occurs when plaque, a sticky film of bacteria that forms when you eat sugars or starches, is allowed to linger on teeth for too long.

Who’s at risk: Anyone can get a cavity, but children and older people are the most prone. The incidence among children has been declining, thanks to community water fluoridation and the increased use of fluoride toothpastes, but “more than half of all children have caries by the second grade,” according to the U.S. Department of Health and Human Services report Healthy People 2010. Older adults are prone to cavities at the root because protective gum tissue often pulls away.

What to do: Don't give plaque a chance: Brush with a fluoride toothpaste and floss every day. Children can also benefit from sealants (plastic coatings applied to the chewing surfaces of their back teeth) as soon as their adult molars come in. Older people should be particularly vigilant: Those who have a tendency toward dry mouth should receive regular fluoride treatments from a dentist and use a fluoride-containing mouth rinse.

Problem: Gum Disease
A bacterial infection caused by plaque that attacks the gums, bone, and ligaments that keep your teeth in place. The early stage is known as gingivitis, the advanced stage as periodontitis.

Who’s at risk: Everyone. The National Institute of Dental and Craniofacial Research (NIDCR) estimates that half of all adults have some signs of gingivitis. Most at risk are people with poor oral hygiene; those with a systemic disease, such as diabetes, that lowers resistance to infection; and smokers. Women also have a tendency to develop gingivitis during pregnancy. Other risk factors are stress, which weakens the immune system, and genes. Some people can have gingivitis all their lives and never progress to periodontitis. It depends on a person's susceptibility to the disease.

What to do: See a dentist regularly, and tell him if your gums feel tender or bleed. Gingivitis can be reversed with regular brushing and flossing. To combat periodontitis, a dentist or periodontist may perform a deep cleaning around the teeth and below the gum lines and prescribe medication to combat the infection. If the disease has progressed to affect your gums and bone, your dentist might suggest surgery, such as a gum graft.
Problem: Tooth Infection
The pulp inside the tooth (which contains nerves) is damaged or becomes infected because of decay or injury. The root canal, which connects the top pulp chamber to the tip of the root, may become infected, too.

Who’s at risk: Anyone with a deep cavity or a cracked tooth, which can let in bacteria. An injured tooth can have a problem even if it's not visibly cracked or chipped.

What to do: If you feel pain in or around a tooth, see your dentist. He may refer you to an endodontist, who specializes in root-canal procedures. In one to three visits, the dentist will perform a root canal. He will remove the pulp, clean the pulp chamber and root canal, then fill the tooth.

Problem: Enamel Erosion
Exposure to acid, primarily from soda or citrus drinks, can wear down the surface of the teeth, making them rounded and discolored. Overbrushing can have a similar effect on enamel near the gum lines.

Who’s at risk: Anyone who sips lemonade, soda (even diet soda), or sports drinks all day. This is also an occupational hazard of wine professionals. A lot of times the only risk factor we can come up with is diet soda. Aggressive brushers may also be wearing away the enamel along with the plaque.

What to do:
If necessary, teeth can be restored with bonding materials. But to prevent further damage, you have to change your habits. If soft drinks are the culprit, for example, switch to water. Second best is to drink sodas (or sports drinks) with a full meal or sip them through a straw, then follow with a tooth brushing, sugarless gum, or a good swish of water in the mouth. If the problem is overbrushing, a soft-bristled brush or an electric toothbrush is a start. A dentist or a hygienist can demonstrate proper, gentle brushing technique.

Problem: Dry Mouth
Also known as xerostomia, dry mouth results from a decrease in the flow of saliva in the mouth. It is extremely uncomfortable and increases the chance of tooth decay, since saliva helps wash away harmful bacteria.

Who’s at risk: Those who take any of 400-plus medications, including diuretics and antidepressants. “Dry mouth becomes more prominent as women get older, in their 50s and 60s,” says Sally Cram, an American Dental Association consumer adviser and a periodontist in Washington, D.C. Hormonal and metabolic changes that come with age can also change your salivary flow. Another cause is Sjogren's syndrome, a rare disorder most common among women in their late 40s that causes a person's immune system to attack her salivary and tear glands.

What to do: Keep sugarless gum on hand; avoid caffeine, tobacco, and alcohol; and drink plenty of water. Artificial rinses or moisturizing mouth gels can help the salivary glands function. If you suspect that you have dry mouth, see your dentist or doctor. “Anyone needing additional fluids to speak or to swallow dry foods for three months or longer should be evaluated for Sjogren's,” says Jane Atkinson, D.D.S., deputy clinical director of the National Institute of Dental and Craniofacial Research (NIDCR). While there's no cure, she says, “as with lupus or
rheumatoid arthritis, you can manage it.”

Problem: Temporomandibular Joint Disorder (TMJ)
TMJ is a group of conditions that affect the temporomandibular joint, just below the ears and above the jaw. Sufferers may clench or grind their teeth subconsciously, often at night.

Who’s at risk:
About twice as many women as men are believed to have TMJ, most commonly during their childbearing years. People who are under a great deal of stress are also more prone to it, or a severe injury to the jaw may cause the condition. It's usually not chronic, though it can become so. TMJ can lead to worn-down and sensitive teeth, as well as other painful symptoms, such as a sore jaw, headaches, neck aches, and earaches.

What to do:
See your dentist if you feel pain when you chew, find that your jaw has limited movement, or have radiating pain in your face, neck, or shoulders. Treatment may be as simple as relaxation exercises, cold compresses,
ibuprofen, and avoiding foods that require serious chewing. To train yourself to stop clenching and grinding your teeth, the Mayo Clinic recommends “resting your tongue upward with your teeth apart and your lips closed.” To stop nighttime grinding, your dentist can fit you with a mouth guard.

Problem: Oral Cancers
An oral cancer may start with a small, pale, red, painless lump on some area of the mouth. A dentist can easily screen for the disease by examining and feeling around a patient's mouth, head, and neck.

Who’s at risk: Of the estimated 30,000 cases of oral cancer diagnosed each year in this country, about three-quarters are associated with tobacco use or tobacco in combination with heavy alcohol use. Most cases occur after age 40. Many people aren't screened, and detection usually occurs when the cancer is at an advanced stage. That's why the five-year survival rate is one of the lowest for all cancers.

What to do: Stop smoking, and make sure your dentist screens you every time you visit. Even people missing many or all of their teeth should see a dentist regularly to make sure their dentures fit, as chronic irritation can be a risk factor.

Thursday, June 20, 2013

Time To Take Up Bike Riding

If losing weight doesn't convince you, the sheer fun of the wind in your hair surely will

No matter your fitness level, clothing size, age, or litany of aches and pains, you can enjoy the fun, adventure, and health benefits that two wheels can bring. Whether you haven't ridden a bike in years or want to start incorporating it more regularly into your cross-training routine, here's what you need to know to get started.

If you can walk, you can ride.

"Cycling puts very little impact on your joints, so it's kind to your body," says bike fit specialist Andrew Pruitt, EdD, director of Boulder Center for Sports Medicine in Colorado. "Even if you have pain walking, you can still ride a bike, because it isn't weight bearing." In fact, most people find that they are able to cycle comfortably when they're well into their 70s and 80s.

Philadelphia attorney Rick McMenamin, 66, began cycling when a knee injury sidelined him from running. "I still wanted to exercise, and cycling was something I could do without putting stress on my knees," he says. "I started riding with my wife on mountain bikes." Six months later, Joe Wentzell, owner of Breakaway Bikes and a cycling coach, convinced him to buy a road bike and start training more seriously. "I was amazed at how much progress I made in 1 year. I've trained regularly with Breakaway team members and have even done a few time trials in my age-group," McMenamin says.

Cycling is an especially great way to up your activity when you're out of shape, because you can go farther right off the bat than you would walking or running. "If you can walk half a mile, you can ride a bike 5 miles," Dr. Pruitt says. "This boosts your confidence and makes you more likely to stick with the activity." Thanks to technology updates, bikes can take up the slack for any strength or stamina you might lack. "Bikes today have lots of gears for the steepest grades," says Lorri Lee Lown, head coach at Savvy Bike, Redwood City, CA. "You can even ask a bike shop to add special, very small climbing gears that will allow you to spin your way up any hill."

You can pedal off pounds.

Your legs and butt—the largest muscles in your body—are the power drivers for any bicycle, which makes cycling a great lower-body toner, as well as a major calorie burner. In fact, even moderate cycling—riding 12 to 14 mph—burns more than 500 calories in only 60 minutes, and many people (even novices) can easily bike for an hour or two. This makes cycling a great way to slim down, whether you have a little or a lot to lose.

Elizabeth Seifert, 47, a Web designer/IT specialist in Woodstock, GA, took up cycling just before turning 42, because she wanted to shed her last 10 pounds of baby weight and was bored with the gym. "Never once has riding felt like exercise," she says. Not only did she lose the weight, but she found a new love: "There's an indescribable sense of freedom you get while riding a bike. You feel like a kid again—I'm hooked."

Dinah Hannah, 49, a clinical laboratory scientist from Salt Lake City, started cycling when she was at her heaviest, carrying 240 pounds on her 5-foot-6 frame. "I knew I needed to lose weight. I tried running, but I developed arthritis in my feet and knees," says Hannah. "Then I heard about a commuter challenge where you had to get to work without driving for 1 week." Even though she didn't own a bike and lived 15 miles from her job, Hannah decided to go for it. She bought a mountain bike and—after scoping out a route with the lightest traffic—gave it a try. "I made it to work in just under 2 hours, and since there's no weight bearing in cycling, it didn't bother my joints," she says. "I thought, Wow, I can really do this!" Soon Hannah was addicted: "I loved riding so much that I started training for centuries—100-mile rides—and charity rides like the MS 150, which covers 150 miles in 2 days." Within 2 years, she lost 100 pounds, going from a size 20 to a size 6. "Last year, I did Race Across America on a four-woman team. We won first place for our age-group," she says.

You can do it safely.

Like skiing and other outdoor sports, cycling is as risky as you make it. You wouldn't hop off the lift and barrel down a triple diamond run out of the gate, and you shouldn't try riding down supersteep roads or in heavy traffic if you're new and unsure of your skills. "Start small and work up to more challenging routes as you become comfortable," says Lown.

Just as you did when your parents took off those training wheels decades ago, begin by practicing the basics (starting, stopping, shifting gears, and turning) where there's plenty of space and little traffic, like a parking lot or a park. Make sure you're comfortable and able to control your speed—especially on downhills—before taking your bike out for a true spin. When you feel comfortable, you can vary your routes. Talk with your local bike shop or club to find out the best spots to ride, or discover popular routes with the free app MapMyRide. Download it to your mobile phone and it will automatically find routes that other cyclists in your area have ridden. "Women my age say, 'I don't know how you do it. I'd be a nervous wreck,' " says Dede Muhler, 68, a tree pruning specialist from Oakland, CA, who rides an average of 5 to 7 hours a week. "But it's no more dangerous than 100 things you do every day—and there's nothing else like it."

You'll make new friends.

"Cycling is a great way to stay active as you get older, because it's not as isolated as running or other activities," says McMenamin. Looking to make some cycling friends? Consider joining a local club. "Cycling clubs are a wealth of information on how to ride and improve your skills. Plus, you'll be surrounded by other cyclists and make lots of friends to ride with," says Lown.

You see the world differently.

The real beauty of bicycling is all the amazing places it can take you. There's simply nothing in the world like rolling through fields of wildflowers, pedaling along the edge of the ocean, or soaking in the scenery of a mountaintop vista. "Cycling opens up worlds of territory to explore, providing a more intimate understanding of nature and the terrain," says Muhler.

Ruth Andrews, 60, a retired nurse from Simi Valley, CA, agrees: "I love that you're outside and can take in the sights and sounds—it's beautiful." Bicycling also opens the door to a variety of fun vacation possibilities. "I've biked along the Riviera in France and through the mountains of Girona, Spain," says McMenamin. "Challenging yourself on the climbs while taking in the beauty of these areas is quite an experience.”


 Choose your bike wisely.

You wouldn't dream of waltzing into a car dealer and plunking down your cash on the first car that caught your fancy. You research, test-drive, and find a dealer who treats you well. Do the same with your bike purchase. First rule: Go to a bike shop rather than a big-box store, says Lown. "Bike-shop employees are more knowledgeable about bike selection and proper fit," she says.

And while there's a dizzying array of bikes to choose from, you can whittle down your choices by considering where you'll ride, says Lown. If that's primarily pavement, go for a road bike or touring bike with comfortable, more upright geometry—as opposed to aerodynamic (very hunched forward) race geometry—which you can buy with flat handlebars (instead of curvy racer handlebars) and wider tires for comfort and stability. If you think you'll just ride to take care of errands, consider a cruiser or town bike, which sits you more upright and may have carrying capacity. Heading for trails and rough paths? A fat-tired off-road bike is in order.

Keep in mind, if the last bike you bought had a banana seat, you will likely have a case of sticker shock. Today's high-end bikes are crafted from feather-light, durable materials like carbon fiber and come equipped with finely tuned components (brakes, gears, and shifters) that provide a dreamy ride but boost prices upward of $1,000. Don't panic—you'll still get a great bike at the lower price points.

A proper fit fights soreness.

The number one thing that keeps many people from cycling is discomfort, especially in the nether regions, says Dr. Pruitt. This is where the right fit comes in. Your bike shop will adjust your position to distribute your weight properly on the saddle (the technical term for the seat) and handlebars and make sure your back isn't too stretched out and your knees track properly.

The shop's experts will also make sure that your saddle fits your sitz bones (the two lowest points on your pelvis that take your weight when you sit), which should support your weight on the rear of the seat. Whether you need a wide saddle or a skinny one has nothing to do with the size of your derriere but, rather, with the width of your sitz bones, says Dr. Pruitt, who helped develop what Specialized Bikes has playfully named the ass-o-meter, a gel-filled cushion that measures your sitz bones. (You sit on it and stand back up, and the imprints of your sitz bones are there for all to see.) If the saddle on your bike isn't immediately comfortable after a proper bike fit, continue to try others till you find one that is.