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 should I 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.

Are amalgam (silver) fillings safe?

Over the years there has been some concern as to the safety of amalgam (silver) fillings.  An amalgam is a blend of copper, silver, tin and zinc, bound by elemental mercury.  Dentists have used this blended metal to fill teeth for more than 100 years.  The controversy is due to claims that the exposure to the vapor and minute particles from the mercury can cause a variety of health problems.

According to the American Dental Association (ADA), up to 76% of dentists use silver containing mercury to fill teeth.  The ADA also states that silver fillings are safe and that studies have failed to find any link between silver containing mercury and any medical disorder.

The general consensus is that amalgam (silver) fillings are safe.  Along with the ADA’s position, the Center for Disease Control (CDC), the World Health Organization, the FDA, and others support the use of silver fillings as safe, durable, and cost effective.  The U.S. Public Health Service says that the only reason not to use silver fillings is when a patient has an allergy to any component of this type of filling.  The ADA has had fewer than 100 reported incidents of an allergy to components of silver fillings, and this is out of countless millions of silver fillings over the decades.

Although studies indicate that there are no measurable health risks to patients who have silver fillings, we do know that mercury is a toxic material when we are exposed at high, unsafe levels.  For instance, we have been warned to limit the consumption of certain types of fish that carry high levels of mercury in them.  However, with respect to amalgam fillings, the ADA maintains that when the mercury combines with the other components of the filling, it becomes an inactive substance that is safe.
There are numerous options to silver fillings, including composite (tooth-colored), porcelain, and gold fillings.  We encourage you to discuss these options with your dentist so you can determine which is the best option for you.

How often should I have a dental exam and cleaning?

You should have your teeth checked and cleaned at least twice a year, though your dentist or dental hygienist may recommend more frequent visits.

Regular dental exams and cleaning visits are essential in preventing dental problems and maintaining the health of your teeth and gums.  At these visits, your teeth are cleaned and checked for cavities.  Additionally, there are many other things that are checked and monitored to help detect, prevent, and maintain your dental health.

These include:

Medical history review: Knowing the status of any current medical conditions, new medications, and illnesses, gives us insight to your overall health and also your dental health.

Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss.  X-rays also help determine tooth and root positions.

Oral cancer screening: Check the face, neck, lips, tongue, throat, tissues, and gums for any signs of oral cancer.

Gum disease evaluation: Check the gums and bone around the teeth for any signs of periodontal disease.

Examination of tooth decay: All tooth surfaces will be checked for decay with special dental instruments.

Examination of existing restorations: Check current fillings, crowns, etc.
Removal of calculus (tartar): Calculus is hardened plaque that has been left on the tooth for sometime and is now firmly attached to the tooth surface.  Calculus forms above and below the gum line, and can only be removed with special dental instruments.

Removal of plaque: Plaque is a sticky, almost invisible film that forms on the teeth.  It is a growing colony of living bacteria, food debris, and saliva.  The bacteria produce toxins (poisons) that inflame the gums.  This inflammation is the start of periodontal disease!

Teeth polishing: Removes stain and plaque that is not otherwise removed during toothbrushing and scaling.

Oral hygiene recommendations: Review and recommend oral hygiene aids as needed (electric dental toothbrushes, special cleaning aids, fluorides, rinses, etc.).
Review dietary habits: Your eating habits play a very important role in your dental health.

As you can see, a good dental exam and cleaning involves quite a lot more than just checking for cavities and polishing your teeth.  We are committed to providing you with the best possible care, and to do so will require regular check-ups and cleanings.

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

Four out of five people have periodontal disease and don’t know it!  Most people are not aware of it because the disease is usually painless in the early stages.  Unlike tooth decay, which often causes discomfort, it is possible to have periodontal disease without noticeable symptoms.  Having regular dental check-ups and periodontal examinations are very important and will help detect if periodontal problems exist.

Periodontal disease begins when plaque, a sticky, colorless, film of bacteria, food debris, and saliva, is left on the teeth and gums.  The bacteria produce toxins (acids) that inflame the gums and slowly destroy the bone.  Brushing and flossing regularly and properly will ensure that plaque is not left behind to do its damage.
Other than poor oral hygiene, there are several other factors that may increase the risk of developing periodontal disease:

Smoking or chewing tobacco – Tobacco users are more likely than nonusers to form plaque and tartar on their teeth.

Certain tooth or appliance conditions – Bridges that no longer fit properly, crowded teeth, or defective fillings that may trap plaque and bacteria.

Many medications – Steroids, cancer therapy drugs, blood pressure meds, oral contraceptives.  Some medications have side affects that reduce saliva, making the mouth dry and plaque easier to adhere to the teeth and gums.

Pregnancy, oral contraceptives, and puberty – Can cause changes in hormone levels, causing gum tissue to become more sensitive to bacteria toxins.

Systemic diseases – Diabetes, blood cell disorders, HIV / AIDS, etc.

Genetics may play role – Some patients may be predisposed to a more aggressive type of periodontitis.  Patients with a family history of tooth loss should pay particular attention to their gums.

Signs and Symptoms of Periodontal Disease

  • Red and puffy gums – Gums should never be red or swollen.
  • Bleeding gums – Gums should never bleed, even when you brush vigorously or use dental floss.
  • Persistent bad breath – Caused by bacteria in the mouth.
  • New spacing between teeth – Caused by bone loss.
  • Loose teeth – Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone).
  • Pus around the teeth and gums – Sign that there is an infection present.Receding gums – Loss of gum around a tooth.
  • Tenderness or Discomfort – Plaque, calculus, and bacteria irritate the gums and teeth.

Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease.

Why is it important to use dental floss?

Brushing our teeth removes food particles, plaque, and bacteria from all tooth surfaces, except in between the teeth.  Unfortunately, our toothbrush can’t reach these areas that are highly susceptible to decay and periodontal (gum) disease.
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.

Plaque is a sticky, almost invisible film that forms on the teeth.  It is a growing colony of living bacteria, food debris, and saliva.  The bacteria produce toxins (acids) that cause cavities and irritate and inflame the gums.  Also, when plaque is not removed above and below the gumline, it hardens and turns into calculus (tartar).  This will further irritate and inflame the gums and also slowly destroy the bone.  This is the beginning of periodontal disease.

How to floss properly:
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.
Daily flossing will help you keep a healthy, beautiful smile for life!

What are some ways I can help reduce my risk from getting Cavities?

If you have had more than 1 cavity in the last 12 months, you are at risk for getting new cavities.  This has many causes related to: frequency of snacking, drinking beverages that are acidic and or contain a fermentable carbohydrate, medications which produce dry mouth, smoking, stress and reduction in saliva.

Your saliva is key to defending against the bacteria which cause decay.  Not only does it help with eating and swallowing, it provides buffering capabilities to reduce the acids in your mouth, as well as enzymes which help to digest starch.

Sometimes, the saliva can’t buffer well, which allows more acids to predominate in the oral cavity which promotes the growth of cavity causing bacteria.  Add a few sugary or starchy snacks, and you now have a recipe for disaster.  What to do?

Our doctors at Moses Lake Dental Group have provided a plan which will help to regulate the acid levels in the mouth, and provide extra protection to the enamel and root surfaces.

Toothpaste.  Either use the Arm and Hammer Complete care with enamel strengthening or dip you favorite fluoride containing toothpaste in baking soda.  Baking soda is great for maintaining neutral saliva and helps the teeth to uptake the fluoride, and calcium, which are necessary building blocks of tooth enamel.

Toothbrush.  Sonicare makes an excellent toothbrush which through it ultrasonic action allows the fluoride and calcium ions to penetrate deeper into the hard surfaces of your teeth.  Brush 2 times a day, preferably after breakfast.  Try not to brush within 30 minutes of consuming an acidic beverage.

Anticavity rinse after brushing.  Rinse with an anticavity rinse with fluoride after brushing.  Several brands are available: ACT, Prevident are 2.  Don’t buy rinses that contain alcohol.  Daily use of alcohol rinses can increase your risk for getting oral cancer.

Xylitol – this is a sweetener that has been around since the 50’s, but has received much attention lately.  Originally found in the bark of a tree, it helps to regulate your mouth’s acid levels and turns off the cavity causing bacteria-they can’t produce the acid which causes tooth decay.  In order to provide maximum benefit, you will need to consume between 3 to 5 grams of xylitol daily.  This can be accomplished with mouth rinses, gum, candy and it is also provided as a sugar form which can be added to food or beverages.  It tastes delicious, very close to the taste of real sugar.  Ice cubes brand gum contains 1 gr. Of xylitol per piece.  5 grams=1 teaspoon.  Spry company makes candies, rinses and toothpastes.  Dr. John’s makes xylitol lollipops as well as an herbal lollipop which will also further help to reduce dental decay.  A study done at UCLA showed a 20% reduction in decay rates among the population tested, using the herbal lollipops.  They taste great and kids won’t notice the added herbal component.  Stores that sell xylitol: Target and CVS sell Ice Cubes gum; Smart and Final sell a mint called “Smints” which has xyliton.  Sprouts, whole foods, both sell xylitol gum, xylitol sugar.  Spry and Dr. johns candies can be purchased online.

Diet – Most of the healthy food choices in our diets are loaded with acid and or sugar.  From Chinese food sauces to ice tea, energy drinks etc.  They all cause cavities.  There is a table published on line titled:  “Drinks that Eat teeth” To sum it up, all drinks that contain citric acid as a preservative will cause a rise in acid levels.  The best drinks are water-we should be drinking a lot more of it, iced tea- fresh brewed and unsweetened, carbonated water.  Coffee can also be very acidic, depending on where the coffee originates.  Most Indonesian and Sumatra coffees are fairly low in acid.  Green tea is beneficial both for its low acid level, but it also has a natural source of fluoride, and has strong anti-oxidant properties.    Foods that contain arginine are also tooth friendly: nuts, dark veggies are some examples.  Aged cheese when combined with a fruit snack can reduce the acid levels from the fruit, and it also has a natural source of free calcium and enzymes which help to reduce the sugars.  Avoid a lot of starchy snacks, especially at night where the starch can sit on the teeth during sleep.  If you must have a late night snack, eat popcorn.  If you eat a meal, rich in acidic foods such as; tomatoes, citrus, vinegar, white wine, rinse afterwards with a solution of 1 teaspoon of baking soda to a cup of water.  Wait 30 minutes before brushing, as all that acid has softened the hard enamel and you will brush away the softened layer.

Professional hygiene visits:  the standard cleaning interval is 6 months for healthy teeth and gums.  If you are at risk, consider an additional cleaning along with a fluoride treatment.  We use the latest in fluoride technology, which is a varnish that has staying power to allow more fluoride to reabsorb into the enamel.  The cavity process pulls both fluoride and calcium out of the enamel and replenishment if necessary to rebuild and strengthen enamel.

Dry mouth – there are many ways to help manage dry mouth. Please feel free to contact our office or ask our staff at your next visit and we can custom design a program that will help to manage your teeth and help with the dry mouth condition.

What are the highly recommended chewing gums with Xylitol?

PÜR (Sprouts/Henry’s) Ice Cube (CVS, Target) Trident Xtra Care (Almost everywhere) SPRY (Sprouts, Trader Joe’s, Whole Foods) ZAPP (Online Only, Xylitol is an all-natural sweetener found in many fruits and vegetables. It looks and tastes like sugar. It is good for your teeth, stabilizes insulin and hormone levels, promotes good health and has none of the negative side effects of white sugar or artificial sweeteners.

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