Posts for: February, 2014
Halitosis (bad breath) is a major personal and social concern — so much so that Americans spend nearly $3 billion annually on rinses, mints and gum to freshen breath. While helpful in alleviating occasional bad breath caused by oral dryness (brought on by stress, eating certain foods, prescription medications, smoking or consuming alcohol), those with chronic halitosis require a much different treatment approach.
That's because there are a number of possible causes for chronic halitosis, among them: xerostomia (chronic dry mouth), caused by mouth breathing; periodontal (gum) disease; or candidiasis, a yeast infection caused by some antibiotics. It may also arise as a secondary symptom of systemic diseases like liver disease, diabetes or cancer.
The most common cause, though, is bacteria. Many types of oral bacteria can produce terrible odors, most notably volatile sulphur compounds (VSCs) with their “rotten egg” smell. Because of its relative dryness and difficulty in cleaning, the back of the tongue is a wonderful environment for bacteria to multiply and thrive.
If you suffer from chronic halitosis, our primary objective then is to try to uncover its specific cause, which will determine what course of treatment we would recommend. First, what is your experience with halitosis — have others noticed it or just you? Next, we would consider your medical history — have you had any health issues with your ears, nose or throat, or experienced any gastrointestinal disorders or lung problems? What kind of medications do you take, and are your kidneys and liver functioning properly? We would also perform a thorough dental exam for any signs of tooth decay, gum disease or a dry, coated tongue as well as look at your diet and lifestyle choices, like smoking or alcohol use.
Having a better idea of what may be causing your bad breath, we can then tailor a treatment plan that might involve, among other things, treatment for tooth decay, a periodontal cleaning (scaling), instruction on better oral hygiene and tongue cleaning with a scraper or brush, or the removal of third molars where debris may be accumulating in the gum flaps.
Finding the cause of bad breath can take time, but is well worth the effort. The end result is a treatment plan that works.
If you would like more information on understanding and treating chronic halitosis, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Bad Breath: More than just embarrassing.”
If you’re missing a tooth, you’re not alone; in fact 35 million Americans are missing all of their teeth in at least one jaw! Whether it’s one tooth or many, it’s important to replace what’s missing. Depending on the number of teeth lost, the potential drawbacks to doing nothing may become hard to ignore: impediments to eating, interference with speech, and unaesthetic appearance, for example.
Traditional bridges and dentures are the most affordable options for replacing teeth. Tooth implants — tiny titanium, screw-like substitutes for a tooth’s natural root to which natural-looking dental crowns are attached — are pricier but offer an important extra benefit. In addition to addressing the common problems previously mentioned, by acting like the original tooth root, an implant can maintain or stimulate “remodeling,” of the jawbone below. Without a tooth root to provide stimulation, mature bone cells will continue to be removed, or resorbed, but no new bone cells will regenerate to replace them, leading to a progressive loss of bone width, height and density. The more teeth are lost, and with less bone structure to support it, the whole shape of the face can change.
Unfortunately, when greater numbers of teeth must be replaced, implants can become financially unrealistic for some people. But in appropriate cases there is a third option: a bridge or denture/implant hybrid. In the case of a bridge intended to fill a gap when multiple teeth are missing, an implant can be used on either side of the gap to support the bridge, leaving the natural teeth undisturbed. Strategically placed implants can be used to support a removable denture, too.
If you would like more information about dental implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dental Implants: Your Best Option For Replacing Teeth.”
Gold is more than a financial commodity or a symbol of wealth — it’s one of the best materials for restoring damaged tooth crowns, the visible portion above the gum line. It’s extremely durable and can last for several decades if properly maintained. It also causes minimal wear to adjacent teeth.
But as new, more life-like materials have come into prominence, gold restorations have diminished in popularity. Dental porcelain in particular, a type of fired ceramic glass that mimics the look and color of teeth, has increased in popularity for use in highly visible areas.
But unlike gold, all porcelain crowns lack strength, tend to be more brittle and can abrade other teeth during biting and chewing. If they break, they can shatter beyond repair. All porcelain crowns are improving dramatically as newer space age materials become available. Historically, though, they are thought of as more unpredictable when used for back teeth; the greater biting forces make them more susceptible to failure than with front teeth.
A Porcelain-Fused-To-Metal (PFM) crown is a hybrid of these two materials that seeks to impart the strengths of both — the aesthetic appeal of porcelain and the durability of gold or platinum. But a PFM crown also has drawbacks: the porcelain surface may still abrade opposing teeth; they can lose their aesthetic appeal if the metal collar becomes visible if gum tissues recede; and they can fail if the porcelain fractures or separates from the metal.
To address some of porcelain’s weaknesses, some PFM variations reduce the amount of porcelain by placing it only on the visible side of a cast gold crown. In addition, other porcelain materials are now coming into use that may be more durable yet just as life-like.
Choosing which material to use for a crown depends on many factors: cost, the location of the crown, and, of course, the patient’s desires for the resulting smile appearance. It all begins with a comprehensive exam: from there, we can advise you on your options and help you make a choice — gold, porcelain or something in between — that’s durable and pleasing to the eye.
If you would like more information on your options regarding dental crowns, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Gold or Porcelain Crowns?”
Periodontal or gum disease is a serious condition that could lead to tooth and bone loss. Unfortunately, you may not even realize you have it — the disease in its early stages can be difficult to detect. If you know what to look for, however, a few signs can tell you something isn’t quite right.
Bleeding gums after brushing, for example, are a likely indication that your gum tissues are inflammed due to an infection caused by bacterial plaque. Coupled with chronic inflammation from the body’s response to the infection, the unhealthy tissues bleed easily.
As the disease progresses, you may also notice changes in your gums’ appearance: redness at the gum line, as well as some slight swelling. Receding gums expose more of the tooth below the enamel crown. As roots become exposed to the oral environment, you’ll begin to notice painful sensitivity to hot or cold. In time, the disease may cause bone loss producing other signs like loose teeth or teeth shifting from their original position.
In some cases, gum disease can cause a painfully acute abscess. This occurs when the bacterial infection becomes isolated in a pocket of space between the teeth and gums. As the body attempts to fight the infection, its defenses are overwhelmed and the abscess becomes painful, swollen and filled with pus.
If you encounter any of these signs, it’s important to take action quickly to minimize the damage and stop the disease’s progress. Our first priority is to remove as much bacterial plaque and calculus as possible and may consider antibacterial and antibiotic treatments. This may take more than one session, but it’s necessary in stopping the disease.
Long-term success, though, will depend on improved oral hygiene (brushing and flossing), regular office cleanings to remove difficult to reach plaque and calculus, and checkups to monitor the condition of your gums. You can also lower the risk of reoccurrence with improvements in diet and life-style (such as quitting smoking). Instituting better hygiene and lifestyle habits, as well as keeping alert to any signs of recurring disease will go a long way in preserving your teeth and overall oral health.
If you would like more information about periodontal disease and its effect on your health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Warning Signs of Periodontal (Gum) Disease.”