Gentle dentistry by a perfectionist

What should I do if I have bad breath?

Bad breath (halitosis) can be an unpleasant and embarrassing condition. Many of us may not realize that we have bad breath, but everyone has it from time to time, especially in the morning.

There are various reasons one may have bad breath, but in healthy people, the major reason is due to microbial deposits on the tongue, especially the back of the tongue. Some studies have shown that simply brushing the tongue reduced bad breath by as much as 70 percent.

What may cause bad breath?

• Morning time – Saliva flow almost stops during sleep and its reduced cleansing action allows bacteria to grow, causing bad breath.
• Certain foods – Garlic, onions, etc. Foods containing odor-causing compounds enter the blood stream; they are transferred to the lungs, where they are exhaled.
• Poor oral hygiene habits – Food particles remaining in the mouth promote bacterial growth.
• Periodontal (gum) disease – Colonies of bacteria and food debris residing under inflamed gums.
• Dental cavities and improperly fitted dental appliances – May also contribute to bad breath.
• Dry mouth (Xerostomia) – May be caused by certain medications, salivary gland problems, or continuous mouth breathing.
• Tobacco products – Dry the mouth, causing bad breath.
• Dieting – Certain chemicals called ketones are released in the breath as the body burns fat.
• Dehydration, hunger, and missed meals – Drinking water and chewing food increases saliva flow and washes bacteria away.
• Certain medical conditions and illnesses – Diabetes, liver and kidney problems, chronic sinus infections, bronchitis, and pneumonia are several conditions that may contribute to bad breath.

Keeping a record of what you eat may help identify the cause of bad breath. Also, review your current medications, recent surgeries, or illnesses with your dentist.

What can I do to prevent bad breath?

• Practice good oral hygiene – Brush at least twice a day with an ADA approved fluoride toothpaste and toothbrush. Floss daily to remove food debris and plaque from in between the teeth and under the gumline. Brush or use a tongue scraper to clean the tongue and reach the back areas. Replace your toothbrush every 2 to 3 months. If you wear dentures or removable bridges, clean them thoroughly and place them back in your mouth in the morning.
• See your dentist regularly – Get a check-up and cleaning at least twice a year. If you have or have had periodontal disease, your dentist will recommend more frequent visits.
• Stop smoking/chewing tobacco – Ask your dentist what they recommend to help break the habit.
• Drink water frequently – Water will help keep your mouth moist and wash away bacteria.
• Use mouthwash/rinses – Some over-the-counter products only provide a temporary solution to mask unpleasant mouth odor. Ask your dentist about antiseptic rinses that not only alleviate bad breath, but also kill the germs that cause the problem.

In most cases, your dentist can treat the cause of bad breath. If it is determined that your mouth is healthy, but bad breath is persistent, your dentist may refer you to your physician to determine the cause of the odor and an appropriate treatment plan.

How often do I need to brush and floss?

Brushing and flossing help control the plaque and bacteria that cause dental disease. Plaque is a film of food debris, bacteria, and saliva that sticks to the teeth and gums. The bacteria in plaque convert certain food particles into acids that cause tooth decay. Also, if plaque is not removed, it turns into calculus (tartar). If plaque and calculus are not removed, they begin to destroy the gums and bone, causing periodontal (gum) disease.

Plaque formation and growth is continuous and can only be controlled by regular brushing, flossing, and the use of other dental aids.

Toothbrushing – Brush your teeth at least twice a day (especially before going to bed at night) with an ADA approved soft bristle brush and toothpaste.

• Brush at a 45 degree angle to the gums, gently using a small, circular motion, ensuring that you always feel the bristles on the gums.
• Brush the outer, inner, and biting surfaces of each tooth.
• Use the tip of the brush head to clean the inside front teeth.
• Brush your tongue to remove bacteria and freshen your breath.
• Electric toothbrushes are also recommended. They are easy to use and can remove plaque efficiently. Simply place the bristles of the electric brush on your gums and teeth and allow the brush to do its job, several teeth at a time.

Flossing – Daily flossing is the best way to clean between the teeth and under the gumline. Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

• Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
• Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
• Curve the floss into a “C” shape around each tooth and under the gumline. Gently move the floss up and down, cleaning the side of each tooth.
• Floss holders are recommended if you have difficulty using conventional floss.

Rinsing – It is important to rinse your mouth with water after brushing, and also after meals if you are unable to brush. If you are using an over-the-counter product for rinsing, it’s a good idea to consult with your dentist or dental hygienist on its appropriateness for you.

Do I need fluoride for healthy teeth?
What is fluoride?

Fluoride in Your Water

For decades, fluoride has been held in high regard by the dental community as an important mineral that strengthens tooth enamel, and helps to prevent decay of tooth structures. Water fluoridation is endorsed by nearly every major health and safety-related organization in the world. Communities make it a common practice to "fluoridate" their drinking supplies in order for the general population to benefit from this inexpensive and effective preventative treatment.

Basically, and in layman's terms, fluoride is great for your teeth, and is not bad for your health in the doses used in water supplies. The consistent use of bottled water or water filters and home treatment systems can affect your fluoride intake and should be kept in mind. You can make up for a lack of fluoride in your water by using a toothpaste or mouthwash containing fluoride.

If you want to know if your water system is fluoridated, you can check at the Centers for Disease Control (CDC) sub site My Water's Fluoride.

Fluoride in Toothpaste

The warning label on toothpastes are there for your safety, however, please make sure they are not scaring you off fluoride toothpaste all together, especially for your children. The ADA has pointed out that a child could not absorb enough fluoride from ingesting toothpaste to cause any serious problem and that the excellent safety record on fluoride toothpaste argues against any unnecessary regulation.

Enamel fluorosis (too much fluoride)

Children are susceptible to a condition called enamel fluorosis if he or she receives too much fluoride during the years of tooth development (ages 1 - 4). Too much fluoride can result in defects in tooth enamel. In its mild form, which is most common, fluorosis appears as tiny white streaks or specks, which are usually unnoticeable, and do not need treatment, other than for cosmetic purposes. If acute, fluorosis can cause black or brown stains and can even crack or pit your teeth.

Most severe cases of fluorosis are caused by naturally fluoridated to levels above recommended levels, or by exposure to sources like pollution.

Are amalgam / silver fillings safe?
What are my other options?

Many people wonder about traditional fillings (dental amalgams) - whether they are safe or a smart choice, and if there are other options that match your tooth color, for example. The American Dental Association, the FDA, and other USPHS organizations have researched fillings, and have found no evidence suggesting that fillings can cause harm to patients, except in rare cases of allergic reactions.

Silver fillings are made from a mixture of mercury and an alloy of silver, tin and copper. The mercury is used to bind the metals together and provides a strong, durable filling for your tooth. Some people have qualms about using mercury in their mouth, or may prefer a filling that matches their tooth color for aesthetic reasons.

If you are interested in having your fillings replaced, or would like to know more about your filling options, feel free to contact us. We would love to chat.

Alternatives to Amalgams

Composite fillings - Composite fillings are just what they sound like: a mixture of resins and fine particles designed to mimic the color of natural teeth. While not as strong as dental amalgam (the silver stuff), composite fillings provide a pleasing aesthetic alternative. Sometimes, composite resins need to be cemented, or bonded to a tooth to allow for better adhesion.

Ionomers - Like composite resins, these materials are tooth-colored. Ionomers are made from a combination of various materials, including ground glass and acrylic resins. Ionomers are typically used for fillings near the gum line or tooth root, where biting pressure is not a factor. A small amount of fluoride is released by these compounds in order to facilitate strengthened enamel in the affected area.

Porcelain (ceramic) - This material is usually a combination of porcelain, glass powder and ceramic. Candidates for porcelain fillings are typically crowns, veneers and onlays and inlays. Unlike ionomers, porcelain fillings are more durable but can become fractured if exposed to prolonged biting pressures.

Sealants

Sealants work by filling in the crevasses on the chewing surfaces of the teeth. This shuts out food particles that could get caught in the teeth, which would cause cavities. The application is fast and comfortable and can effectively protect teeth for many years (usually around 5). In fact, research has shown that sealants actually stop cavities when placed on top of a slightly decayed tooth by sealing off the supply of nutrients to the bacteria that causes a cavity.

Sealants are best suited for permanent first molars, which erupt around the age of 6, and second molars, which erupt around the age of 12. Sealants are most effective when applied as soon as the tooth has fully come in. Because of this, children derive the greatest benefit from sealants because of the newness of their teeth.

How can I tell if I have gingivitis or periodontitis (gum disease)?

Gingivitis is the medical term for early gum disease, or early periodontal disease. In general, gum disease can be caused by long-term exposure to plaque, the sticky but colorless film on teeth that forms after eating or sleeping. Gum disease originates in the gums, where infections form from harmful bacteria and other materials left behind from eating.

Early warning signs include chronic bad breath, tender, painful, or swollen gums and minor bleeding after brushing or flossing. In many cases, gingivitis can go unnoticed. The infections can eventually cause the gums to separate from the teeth, creating even greater opportunities for infection and decay. If gingivitis goes untreated, more serious problems such as abscesses, bone loss or periodontitis can occur.

Although gum disease is the major cause of tooth loss in adults, in many cases it is avoidable. Regular flossing, brushing, and fluoride rinses can help you get rid of gingivitis, and avoid problems like periodontitis.

How can I make my teeth whiter?

Teeth can become stained by many factors in life: food, drink, smoking, and natural aging can cause your teeth to loose that "pearly white" color we see on models and children.

With teeth whitening, we can provide a safe and effective solution to staining and yellowing. Making sure you use professional tools rather than home kits is important. Some home kits can cause damage to your enamel, and put your teeth at risk for cavities, sensitivity and more.