Other Causes of a Swollen Tongue?

Swelling is a warning in our bodies. Swelling fights off harmful bacteria and parasites, and helps with injury and healing. There are multiple chemical systems that turn swelling on and off, which are complicated and only partially understood.

Medications. Many cases of a swollen tongue are the result of a reaction to a medication used for high blood pressure, or non-steroidal anti-inflammatory drug, such as aspirin, ibuprofen [Advil, Motrin], or naproxen [Aleve, Naprosyn].

Allergens. I found allergic reactions to medications and including those that are happening in other parts of the body occur at the same time. allergic reactions to other substances such as foods or bee stings are the most common.

Herpes. These viruses also can cause infections that result in swelling of the tongue. While there is no treatment for viral infections, recovery can sometimes be enhanced with the medicine Zovirax.

Medical illness. Very slow swelling of the tongue over weeks or months can occur in a condition called amyloid, a disease in which harmful amyloid proteins are deposited into tissues and organs.

Bits and irritating substances. You may find that your tongue swells if you accidentally bite it or burn it. Dental appliances also can irritate your tongue and cause it to swell. Tobacco is yet another irritant that can cause tongue pain and swelling.

Tongue cancer. Tongue cancer is a common cancer of the head and neck — more than lump, ulcer, or white spot or patch on the outer layer of the tongue or a surrounding area. Suspicious lesions need to be biopsied and treated. A red white patch on the tongue is often painless, but has a higher chance of being associated with cancer than a white patch.

Treating a Swollen Tongue

I know a swollen tongue can lead to breathing problems, and it should be considered at as an emergency situation. If the problem is caused by a drug reaction, the person must stop the medication immediately and get help. In food allergies, obviously foods that trigger the swelling must be avoided. If it’s a persistent problem, see your doctor so he can determine the cause of your tongue swelling and find the most appropriate treatment.

The usual cause is severe muscle spasm. At first the pain can be from slight to severe. There are many treatments, some much better than others. Some may even be dangerous. Here is my advice from a guy that has been there.

1. Contact your Dr. first. He will be able to determine what requires immediate medical intervention. Immediate investigation is needed for injury or if you have serious health problems. Sometimes cancer, weakness, tingling, loss of feeling in a leg, fever or weight loss need to be treated immediately.

2. Try OTC pain relievers first. While not terribly strong they do help some in less sever cases. Tylenol is a good start but you have to be careful. Exceeding the maximum dose of 4000 mg can cause liver damage. Most doctors recommend no more than 3250 mg per day. If you decide to go with Tylenol, Advil or Alleve, I personally choose the generics because I feel they are just as good.

3. Prescription muscle relaters are frequently given. Medications such as Soma, Amrix and Skelaxin are addicting and sedating have not proven of much value. Powerful pain drugs such as Percocet, Lortab and Vicodan usually offer some relief. Most people find that the prescription drugs do little good, especially longer term.

4. Don’t have imaging tests early on. Tests such as CT scans, x-rays and MRIs are generally show little early on. These scans can show some abnormally that is unrelated but can lead to unnecessary treatment. There are issues with these tests including cost, radiation and diagnostic value.

Here is my personal bottom line. For back pain I take OTC pain medications with moderate activity has been best.

I always try to avoid rushing into aggressive treatments and give myself time to heal. It works for me. I call it tincture of time.

Sometimes no treatment is the best treatment

Allan Melnick, DDS

Some relatively new products are available and I wanted to touch on those and fill you in:

First is honey.  The main components of honey are fructose and glucose. Used in large amounts it will lead to the same problems as sugar. A little bit of honey is still considered okay.

Second is fruit juice concentrate. This is made by removing the water, color and natural flavor. It is again high in fructose. So the same recommendations apply: Use only in moderation.

Third is Agave nectar: This product is high in fructose and is less likely to spike your blood sugar. The downside is that agave nectar can cause increases in blood triglycerides.

Fourth is Evaporated Cane juice. This has been described as equal to table sugar. It often contains some molasses. Consider it the same as white sugar.

So what is a person to do? We all need a sweetener. Some of us more, some less. Do as I do: try stevia. It is extracted from a plant in Central and South America. It is 200 times sweeter than sugar. The only downside is that it is slightly bitter.

Stevia has been said to be “Generally Recognized as Safe” by the Food and Drug Administration.

Throw away your old toothbrush every 3 months. It may look fine, but there are problems lurking. The bristles soften enough to decrease the removal ability on plaque. Also, there is a ton of bacteria on the brush. We can’t see Them, but they are there. Tests have shown that thing gets really nasty at 3 months.

Allan Melnick DDS

With that said, dentists have a special interest in that 0.5%. That 0.5 percent is known as “salivary mucin” to Encino dentists like myself. This mucin has been shown to help protect the teeth from bacteria that decay and damage the enamel.

We used to think the mucus was designed only to keep saliva stringy and slippery but as a basically inactive substance. We were wrong. We have long known that when there is not enough saliva a host of severe oral problems develop including a large amount decay.

In a new study at Harvard and MIT it has been found that these salivary mucins. play an active role in keeping the mouth healthy. It is thought that boosting the body’s natural defenses, like boosting the amount of saliva, would be the most helpful way to reduce dental decay. The researchers  believe that this can be even more helpful than fluoride treatments.

In the mouth the mucus keeps the bacteria suspended and slippery thus preventing them from attaching to the teeth. The bacteria S. mutans only causes decay when it is attached or in a film directly on the teeth. That film is called a bio-film and is it is a densely packed ultra thin layer of bacteria and salivary mucin. Saliva itself does not kill the bacteria.

In this study at Harvard and MIT it was determined that the best approach to preventing decay is to weaken the sticking and damaging bacteria and preserve the normal healthy ones. That reduced the amount of decay occurring the most of several methods tried.

To you and an Encino dentist like myself, what does this all mean? First, if you have a dry mouth, get in to your dentist very often and use lubricants. Second, everyone should be using fluoride in toothpaste and other times when it is available such as when your dentists office. Dry mouth is your enemy, big time.

Tip of the Day: Try using “Stimudents.” It is a soft triangle of wood similar to a tooth pick. It cleans tough areas without causing damage. It has been around about 100 years. Worth a try. It helps many people.

Allan Melnick DDS

So, what to do? What would make a good substitute? I researched the subject, and the Center for the Public Interest has done some work on this subject. According to senior scientist Lisa Y. Lefferts, there are both good and bad options. This is the outline of their report.

The major sugar substitutes fall in three main categories. They are:
1. Artificial Sweeteners
2. Natural High Potency Sweeteners
3. Sugar Alcohols.

I will leave off the chemical names to make this easier to understand, and I have included the Centers reconditions.

Artificial Sweeteners:
1. Advantamine : Safe
2. Equal : Avoid
3. Equal , Nutrasweet : Avoid
4. Sweet and Low : Avoid
5. Splenda : Caution

Natural High Potency Sweeteners:
1. Stevia leaf extract : Safe

Sugar Alcohols:
1. Nectreese : Safe in Moderation
2. Xylotol : same
3. Sorbitol : same
4. Manitol : same

So, what do we have here? Some pretty good substitutes. Advantame is new on the market and should be available soon. Meanwhile we have Stevia. Originally from a plant leaf that grows naturally in Brazil, it is now is grown in California. It is processed in different ways so each brand tastes a bit different.

I personally use a product called “Stevia in the Raw“. It is available in most all markets. Does it taste just like sugar? No. But it is sweet and satisfies my cravings for sweets. Give it a try.

Tip of the Day: Check out my new Facebook page! We just redesigned it. There are a variety of posts on all sorts of topics. Look at “Encino dentist–Allan Melnick DDS”. NOTE *Likes are much appreciated!*

Allan Melnick, DDS

For many, many years people have been assuming that fat was the enemy because it produced cholesterol, which was blocking arteries. The problem is that’s not true. I think it shows some  important things in terms of how we sometimes misinterpret health science.

The misinformation began in the ’70s. In fact, it came from a U.S. Senate Commission that saw that people with high levels of cholesterol tended to die early of heart disease. And then there were other studies that showed if you ate a diet high in fat, it raised your cholesterol. I am already confused.

So now we try to eat low fat in this country. And nothing much changed with the low fat diet. Things got worse. Cardiovascular disease remains the biggest killer of men and women. Diabetes rates are higher than ever. Dental decay increased in adults.

The problem is that what we replaced fat with was sugar. And sugar may be more of a problem than fat for someone who’s worried about heart disease and their health.

Let me try to understand what you say, doc:  It’s not that fat is good for you, it’s that if you replace fat with sugar it’s worse for you? That’s right.  Sugar is Worse.

First the sugar goes to the liver. The liver says I don’t know what to do with all this sugar, so it gets turned into what are known as low density lipoproteins, fats. And that is the worst kind of cholesterol.

Regretfully for the body, a slice of white bread and a packet of sugar are essentially the same. The body sees them as the same. White bread for the body is sugar. It gets turned into sugar just the same way as the bread.

So what is to be concluded from all this. Sure, sugar causes lots of tooth decay. But that’s not the worst of it. Our liver turns the sugar into a very bad form cholesterol. I hear your exasperation. I feel your pain.

Can science genetically engineer a food that’s good for us? If that ever happens, I bet it will look like a vegetable.

Tip of the Day: In my Encino dental office I now have available a medication that treats cold sores. It is a long lasting paste and is remarkably effective. Ask me about it.

Allan Melnick DDS

When a drug company develops a  new drug it is  known as a brand name drug. They are under patent protection. This is to protect the investment of the big drug company or so they say. They have the sole right to manufacture and sell the  drug while the patent is in effect ands set it’s price.

When patents expire, other manufacturers can submit an application to the FDA for approval to market a generic version of the brand-name drug. Usually much cheaper than brand name it is said that because the drug has not been developed from scratch they are less expenses to produce it can be sold for less.

Although generic drugs are chemically identical to their branded counterparts or act the same on the body, this does not mean that the FDA requires the generic version to look like the brand name in color or shape. They can also be plus or minus 20% in strength. To me that is a lot of variation. As an Encino dentist I am worried about this.

Often there is confusion when the look of a drug changes. Researchers at Boston and Woman’s Hospital found many people won’t take their medication when the shape or color changes. They found that when a changed generic heart pill was given, there is a 66% greater chance that heart attack survivors stopped taking their pills. Yes, stopped taking their medication.

FYI  generic  drugs are prescribed 93% of the time. This is up from 83% of the time in 2003. Of all drugs sold in the U.S. 40% are from overseas. Regretfully  only 11% of overseas manufactures are inspected by the FDA. India is the largest producer of generic drugs closely followed by China.

Bottom line, I take generic drugs when available.. but ask where it was made. I myself prescribe generics in  my Encino dental office. The cost is the factor. A non-generic brand name equivalent can easily be 10+ times the generic  version. In my opinion something is very wrong with the system. Medication prices are not a problem in Canada. Why is this? I for one don’t want medications made in India or China. What is a fellow to do?

Tip of the Day:  Shop medication on the phone. Prices at different pharmacies vary greatly. Also ask the country of origin. Be a wise consumer.

Allan Melnick, DDS

What Is It?

It’s actually no wonder there are so many cracked teeth. Teeth are subjected to great forces daily plus large  temperature changes. So much so that almost everyone has cracks in their teeth. These cracks can be very painful and causes what dentists call “cracked tooth syndrome.” They also can be no problem at all. Here are some of the details.

Why Is It

Cracked tooth syndrome is most commonly found in lower back molars. That’s because these teeth repeatedly absorb more of the forces of chewing than the others.

Many people grind or clench their teeth. This is a Big Problem in many ways. These people are highly likely to have cracked tooth syndrome. Sometimes how a person’s teeth come together can cause too much pressure on one tooth or just one point. This concentrated pressure can cause the teeth to flex too much and break.

Teeth with large fillings are weakened and are also very likely to crack. This applies especially to teeth with old silver mercury fillings. These fillings expand and contract and stress the tooth.

How To Tell

You will probably find that the tooth hurts at times when you bite or chew. The sensitivity or pain can be intense. People call it a “shooting pain’. It may be painful only when you eat certain foods or when you bite in a specific way. It is a different feeling than you would have if you had a cavity or infection. The tooth may also  be especially sensitive to cold temperatures.

As the crack gets bigger, sometimes a piece of the tooth breaks off.  You may also develop swelling of  an infection. This can happen in the gum around the fractured tooth. You may even notice a pimple-like bump that drains on the gum near the tooth.

Many people with cracked tooth syndrome have painful symptoms on and off for months. Cracked tooth syndrome is one of the most difficult dental problems to diagnose because the pain is not consistent. That makes it very hard to be sure of the problem.

Finding It

Your dentist will examine your mouth and teeth, focusing on the tooth in question. He may use a pointed instrument called an explorer to feel for cracks in the tooth. Your dentist will also check the gums around the tooth. He  may have X-rays taken, but X-rays often do not show the crack.

Your dentist may use a special instrument to test the tooth. It looks like a toothbrush handle but without bristles. It fits over one part of the tooth at a time as you bite down. If you feel pain, the part of the tooth being pressed most likely has a crack in it.

Prevention

If you grind or clench your teeth, talk to your dentist about treatment options. Grinding does increase your risk of cracked tooth syndrome. Here in my Encino dental office I can make a night guard to prevent  grinding of your teeth. This will relieve the pain from grinding and sore muscles. For some people it can also stop tooth sensitivity. The night guard can be worn during sleep. It also can be worn at other times if clenching or grinding happens during waking hours.

Treatment

Treatment depends three thing that tell the story.  1. How large is it  2.Where the crack is located and 3. How deep the crack is. In my Encino Dental Office I take a history to answer these questions first thing.

Sometimes a crack starts with one or more high spots of a tooth. In this case situation the tooth may be fixed with a crown. Some cracks affect the nerve at the center of the tooth. In that case, the tooth will need root canal treatment and a crown.

In some cases, the tooth may need to be removed. Some cracks affect the root of the tooth into the jaw. There’s no way to fix this type of crack. If your tooth is removed, you can have it replaced with an implant or a bridge. We can discuss it in my dental office here in Encino.

When To Call Me

If you feel sharp pain when you bite or chew, contact me ASAP. The problem just gets worse. Treatment of cracked tooth syndrome is not always successful. I will talk with you about the alternatives that might happen and your treatment options.

Tip of the Day:  Keep your tooth brush where it will be dry. There should also be air circulation. Kept dry, a brush will have a lower bacteria count.

Allan Melnick, DDS

We know that poor oral health is associated with a number of diseases. That list includes heart disease, birthing issues, and certain blood disorders, among many others. It is a new ballgame out there.

The reverse is also true. Many diseases  adversely affect oral health. The most well known is diabetes. I have personally seen in my Encino dental office that diabetics always seem to have a terrible problem with their gums. Healing and infection fighting are poor. It is a battle.

Being concerned about my patients overall health I have some information to share with you about a major cause of many health problems: obesity. It’s a national epidemic.

FYI below is a list of the fat content of some fast foods for your information. Note that the USDA recommends no more than 65grams of fat per day in our diets.

1.Firehouse Thai Chili Pork Sub.               95 grams of fat.
2. Hardee’s Monster Thickburger.              95 grams of fat
3. Burger Kings Triple Whopper.               75 grams of fat
4. Wendy’s Triple Cheese Burger.             66 grams of fat.
5. McDonald’s Clubhouse Sandwich.         38 grams of fat.
6. Taco Bell’s Cantina Burrito.                    28 grams of fat
7. Subway’s Pepperoni Flatizza.                26 grams of fat

The average amount of sodium for the above is 2045 mg . Recommend daily  max is 2300mg.

Don’t forget that typically these foods are not eaten alone. Fries come to mind. If you eat these or similar fast foods on a regular basis you have a problem. Admittedly I have picked some of the worst offenders but there are many similar.

My point in writing all of this  is not only how dental health is related to heart health. That is pretty well known.  I  understand how we often choose to ignore health risks sometimes. As an Encino dentist I see it everyday. It reminds me of the same behavior I see daily with flossing or the lack there of. Remember, your dentist knows. You can’t fool me.

Tip of the Day: A toothpick is not obsolete. It effectively removes food and massages the gum at the same time. It can remove plaque. Used gently it can be very beneficial. Ask your Dental Hygienest.

Allan Melnick DDS

One of the most common drug groups prescribed in America is called Statins. In fact it’s the number 2 most commonly dispensed of all. Lipitor is a common choice for statin prescriptions but many generics are available. Its is used to help control high cholesterol levels among with other heart protective medications.

A new study was published in the Journal of the American Cardiology. It was conducted at the University of Toronto. The study included 83 persons and lasted 12 weeks. The group was at high risk of heart disease or already had it. Both high and low dosages of statins were tried.

Remarkably, at 12 weeks those on the higher dose had significantly less GUM swelling, bleeding and inflation than the lower dose group change. Those people with the most severe gum disease showed the greatest improvement. Wow, it is nice to see a good side-effect for a change.

The statins do there magic by reducing inflammation in both the coronary arteries and in gum disease’s arterial inflammation. Presumable all areas of the body will see inflammation reduced. Tests are underway to find other benefits of the reduced inflammation.

So what do we have here? It is another link between heart issues and gum diseases. All the more reason for those with major gum disease to have a heart check up. In addition a form of statins may be developed for treatment for gum disease itself. It’s quite a breakthrough.

Tip of the Day: How long should I brush? Two, three or four minutes? There is no correct answer. I say brush until the plaque is removed. The time necessary to do this varies quite a bit from one person to another. So how do I tell you ask? The best guide is bleeding. Bleeding on brushing is NEVER ok. None. Adjust your brushing time accordingly if you see any blood.

Allan Melnick, D.D.S.