General Dentistry

Bad breath, or halitosis, is a signal that something is not right inside your mouth. It may be as simple as the need to pay more attention to your daily oral hygiene, or it may indicate tooth decay, gum disease, or another medical or dental health problem. Whichever it is, bad breath is a red flag: take another look at your mouth!

Commercial products claim they will make your breath fresher, but the only way to make sure your breath permanently fresh is to practice good oral hygiene. In fact, too many breath mints and hard candies with sugar will lead to tooth decay. If you are constantly using breath mints, breath sprays, or mouth rinses in an effort to cover up your bad breath, realize that you may have a medical or dental care problem that needs addressing.

There are a number of reasons you may experience a bad taste in your mouth, and even be able to smell your own breath. Food may be lodged between your teeth if you are not brushing at least twice daily and flossing regularly. Food particles can be very tiny and can wedge themselves between teeth and below the gum line.

Brushing after meals is important and flossing is imperative to get at the particles that the brush can't reach. Brush your tongue or use a tongue scraper, even if it feels odd at first. Bacteria collects on the tongue and can contribute to bad breath. If you wear removable dentures, take them out at night and clean them thoroughly before you wear them again.

If you neglect your daily hygiene over time, bad breath can become a symptom of more serious dental health problems. Teeth that are not cleaned properly become a place for bacteria to reside as food particles stay in your mouth and decay. Bacteria attack your teeth and gums and cause cavities and gum disease. If this is happening, gum disease will cause an unpleasant odor.

If you are brushing and flossing on a regular basis, but are still experiencing bad breath, you may have teeth that are crooked or crowded, and it may be hard for you to clean between them. If you wear dentures that do not fit properly, they may be trapping food or irritating your mouth. Your bad breath is may be caused by another medical problem: drainage from your sinuses, gastrointestinal problems, kidney or liver problems, or other medical conditions.

Here's what you can do to investigate on your own. Write down what you're eating and notice whether your breath smells bad because of certain foods. Garlic and onions actually cause odor, but the odor is coming from your lungs as you breathe, not from your mouth itself. The odor from these foods is temporary, and will be gone once the food is out of your bloodstream.

Are you dieting? Hunger can contribute to bad breath, because of the chemical changes as your body turns fat and protein into the energy it needs. Are you taking prescription or over-the-counter medications? Add these to the record of what you're eating to see whether there's a relationship between your medications and your bad breath. And don't forget to tell your dentist if there's been a change in your overall health since your last visit.

Are you suffering from dry mouth? Saliva provides constant rinsing in your mouth and washes away food particles. Your dentist may recommend more liquids, or sugarless candy to stimulate natural saliva, and perhaps some of the commercial products that are available to combat dry mouth.

If bad breath continues after you have done your best job of regular brushing and flossing, go see your dental care professional. He or she can tell you whether the odor is caused by an oral problem; if it is not, then your dentist will suggest you see your doctor for a physical check-up.

Regular dental check-ups with a dentistry professional will help keep your mouth healthy and working well. Your dentist can stop problems before they cause trouble, including problems that cause bad breath.

By Brian J. Gray, DDS, MAGD, FICO

The proverbial way of referring to older people as being "long on the tooth" suggests that it is predetermined that as we get older our teeth get "longer" or "no longer." This is not true.

Periodontal disease, plaque and loss of teeth is not an inevitable aspect of aging. Loss of attachment or bone support around a tooth is the result of a bacterial infection. What is true is that as we get older, we have more exposures to these infectious organisms, and more probability of being infected and developing periodontal disease. Half of the people over 55 have periodontal disease.

Risk factors that make older adults more susceptible to periodontal disease include:

Systemic diseases: Certain systemic diseases such as diabetes may decrease the body's ability to fight infection and can result in more severe periodontal disease. Osteoporosis also can increase the amount and rate of bone loss around teeth. Systemic illnesses will affect periodontal disease if it is a pre-existing condition. To reduce the effects of systemic diseases on the oral cavity, maintain meticulous plaque control and visit your dental care provider routinely for examinations and professional cleanings.

Medications: Heart medications can have a direct effect on the gums by creating an exaggerated response to plaque and resulting in gum overgrowth. Antidepressants may create dry mouth and reduce the saliva's ability to neutralize plaque.

Immunosuppressants and other disease-fighting medications may reduce the body's ability to combat infection, increasing the risk for periodontal disease. The dental care provider needs to be aware of any medications you may be taking and you need to maintain meticulous plaque control and visit your dental care provider routinely for examinations and professional cleanings.

Dry mouth: Lack of saliva can result from the use of certain medications or as a result of illness. If there is not enough saliva available to neutralize plaque it can result in more cavities and periodontal disease.

Also, dry mouth, or xerostomia, can make dentures more difficult to wear and may also complicate eating, speaking, or swallowing of food. Oral rinses or artificial saliva can be very helpful with these problems.

Frequent sips of water or eating candy may be helpful as long as it doesn't contain sugar. Fluoride rinses and gels are helpful in reducing or preventing the cavities that can be caused by having a dry mouth.

Dexterity problems: Physical disabilities can reduce dexterity and the ability to remove plaque on a daily basis. Poor oral hygiene can increase the risk for cavities and periodontal disease.

Electric toothbrushes and floss holders are helpful in improving plaque control. Frequent professional cleanings combined with oral anti-microbial or fluoride rinses also may be helpful in reducing the incidence of cavities and periodontal disease.

Estrogen deficiency: Older women may have some special concerns in relation to periodontal disease. Scientific studies have suggested that the estrogen deficiency that occurs after menopause may increase the risk for severe periodontal disease and tooth loss. Estrogen replacement therapy may reverse these effects.

It is important to keep teeth as we age because every tooth has an important function in chewing and speaking. They affect our appearance and self esteem.

Having dentures or loose or missing teeth can restrict our diets, resulting in poor nutrition and systemic complications. With the advances in modern dentistry and with current prevention and treatment techniques, we must count on keeping our teeth for a lifetime -- no matter how "long" that may be!

Q. What is endodontics?

A. Endodontics is the area of dentistry that specifically deals with what is called the pulp within a tooth.

Q. What is dental pulp?

A. The dental pulp is a soft tissue comprised of tiny arteries, veins, nerves and lymph vessels for the tooth.

Q. Where does the term root canal come from?

A. The tooth is comprised of three basic components. The first component is the crown/enamel, which is seen by the naked eye.

The next level of the tooth is dentin, which is under the enamel and the "housing” for the dental pulp. The final component is the dental pulp and is the core of the tooth. This bulk of the dental pulp is in the center of the tooth or the pulp chamber, and is connected to the Mandibular Canal through the root canals. The root canals are like veins for the dental pulp.

Q. What does the procedure root canal mean?

A. Root canal has become a term for a procedure involving the dental pulp. When the dental pulp has been exposed and damaged, it must be treated professionally and this process is usually referred to as getting a root canal.

Q. What does a root canal procedure entail?

A. Once the dental pulp has been infected, it must be removed from both the pulp chamber and the root canals. Once it has been removed, the pulp chamber and root canals are thoroughly cleaned and enlarged. Based on the level of infection, the dentists may choose to clean the area more than once. After the area is free of infection, the dentist will fill the root canals and pulp chamber with a filling that will prevent any bacteria from entering the area. Finally, the dentist will place a crown over the tooth to restore it to its original shape.

Q. What causes dental pulp to become damaged or infected?

A. Normally, when a deep cavity occurs, it exposes the dental pulp to the bacteria inside the mouth. When exposed to this bacteria, the dental pulp can become infected and thus cause the inside of the tooth to be infected.

Q. What can happen if infected dental pulp is not treated?

A. Overtime, the infected pulp will die. At the same time, pus from the infection will develop at the base of the tooth and cause an abscess to form. If this occurs, it is not uncommon for the abscess to cause the bone holding the tooth to deteriorate. If this deterioration becomes too severe, the tooth will fall out.

Q. What role does the computer play in the dental care industry?

A. In the future, patient records may be kept on computer disks, including visual images captured on intraoral cameras. A computerized workstation beside the patient’s chair will give the dentist the ability to view the patient’s history from disk.

Also, the dentist might use a voice-recognition system to ask the computer to assist in finding that data, or create a “before and after” image so the patient can preview the result of dental work before it is done.

An aching tooth you get from a cavity is no fun, but it's something that can be easily seen and quickly solved. Unfortunately, toothaches also stem from problems that aren't so easily recognized.

Tooth pain can be a little like that weird noise your car engine makes but always disappears the moment you drive it into the repair shop.

A tooth that aches only in the morning may be the result of overnight tooth grinding (bruxism). Bruxism is quite common, and has the potential of deteriorating tooth enamel. But it's also treatable. Occasionally a patient will experience some hot/cold sensitivity after a new filling or crown. That's normal, and should go away after a few days. If it doesn't, the problem may lie elsewhere. And we want to know about it.

There's also pain from "root surface sensitivity." This can result from years of brushing teeth too hard, "heartburn acid" which enters the mouth overnight and attacks the enamel of your teeth, receding gums, or periodontal pockets of infection. A toothache may even be the result of a microscopic crack in a molar. These pains are not easy to pinpoint, and often require that you and I work together to help determine the actual cause.

And, yes, toothaches come from decay. But whatever the reason, if you're experiencing tooth discomfort, call the dentist so we can help you solve the mystery of an achy tooth. With all the resources at our disposal, an aching tooth is something no one should have to live with.

During a dental examination, the dentist examines the soft tissues of the mouth for any abnormalities or pathology (including oral cancer), the teeth for tooth decay or defects, the gum tissues for periodontal (gum) disease, the neck for swollen lymph nodes, the amount of plaque, tartar, and debris on teeth, as well as the need to replace any missing teeth or dental prostheses. Regular examinations by a dentistry professional are crucial to maintaining your dental health and are a necessity in any dental care plan.

Dentists begin the dental examination with a complete dental and medical history, including medications the patient is currently taking. The skin of the face and neck is examined for any abnormalities, especially pigment changes. The lymph nodes in front and behind the ears, under the floor of the mouth and chin, and the midline of the neck, sides, and back of the neck are palpated to determine if any swelling or tenderness is present.

Inside of the mouth, the lips, cheeks, gums, and roof of the mouth are inspected and palpated. During this process, the tip of the tongue is placed on the roof of the mouth just behind the upper teeth for inspection of the front floor of the mouth and sides of the tongue.

The back floor of the mouth, the area behind the lower wisdom teeth, and the back sides of the tongue are inspected by grasping the tip of the tongue with a small gauze sponge and pulling the tongue forward and toward the opposite side of the mouth.

To inspect the back of the throat, soft palate, and tonsil area (sides of the throat), the tongue is depressed with a dental mirror or tongue blade and then a deep breath is taken by the patient.

To detect swelling on the floor of the mouth, the area inside the mouth is felt with the finger of one hand while a finger of the other hand feels below the chin. Salivary gland enlargement, saliva flow, or xerostomia (dry mouth) are determined by milking the major salivary glands to assess the quantity and consistency of saliva.

Today's dentist has many analytic tools available to pinpoint dental and oral diseases. The basic tools are the dental instruments, lights, and radiographs (X-rays). Depending upon the dentist and the individual's dentistry needs, additional diagnostic tests are available. Testing for essential proteins and buffering capacity can evaluate the protective ability of saliva.

To determine tooth decay risks, microbiological testing of saliva can measure the level of decay-producing organisms. Periodontal susceptibility tests, which test for the DNA of gum disease-producing organisms, can be performed to assess an individual's risk for gum disease.

If removable dentures are present, dentists check them for bite, retention, stability, and overall fit. Dental impressions or models also may be taken to study the mouth and tooth structures to initiate fabrication of prostheses. Photographs may be exposed for a variety of reasons, including before and after treatment comparisons.

The level of oral hygiene and home dental care practices are assessed and reviewed. Recommendations for home care devices and products may be made. Instruction and methods for maintaining a good oral hygiene regimen can also take place.

Once basic information about dental health status is gathered, the dentist will be better able to discuss dental care plans that are available.

By Denise J. Fedele, DMD, MS

Q. How do you clean your dentures?

A. In cleaning your dentures you should first rinse away loose food particles thoroughly. Then moisten your toothbrush and apply denture cleanser. Brush every surface, scrubbing gently to avoid damage.

Q. Why do your teeth seem darker as you age?

A. Your teeth may seem darker because plaque can build up faster and in larger amounts as you age. Changes in dentin can cause your teeth to appear a little darker as well.

Q. Why does your mouth seem dry?

A. Dry mouth is a common problem among seniors. It is caused by certain medical disorders and is often a side effect of some medications.

Q. Are seniors more susceptible to gum disease?

A. Yes. The severity of gum disease may be increased due to ill-fitting dentures or bridges, poor diets, poor oral hygiene, other medical diseases, and even some medications.

Q. Why do seniors lose their sense of taste?

A. Seniors tend to lose their sense of taste because age decreases the sense of taste and smell. Certain diseases, medications and dentures can also contribute to the decrease of your sense of taste.

Q. Should seniors be worried about cavities?

A. Yes. The majorities of seniors have tooth-root decay and are more susceptible to cavities.

Q. Why should women be more careful with their oral health?

A. For many women, dental care depends on their different stages of life that are directly related to surges in sex hormone levels. Your dentist may request to see you more frequently during hormonal surges.

Q. How do oral contraceptives affect women’s oral health?

A. Gingivitis may occur with long-term use of oral contraceptives because they contain estrogen or progesterone. Women who use oral contraceptives are two times as likely to develop dry sockets and require dental care more often.

Q. How does pregnancy affect oral health?

A. There is an increase in the amount of plaque on your teeth due to pregnancy because there is an increase in estrogen and progesterone.

Q. How does morning sickness affect oral health?

A. The acid in vomit causes tooth erosion. Women can neutralize the acid by using a baking soda and water paste and rubbing it on their teeth. Rinse the paste off after 30 seconds and then brush and floss.

Q. What is the likeliness of having tumors during pregnancy?

A. Women are at risk for developing pregnancy tumors that are benign growths that develop when swollen gums become irritated. The tumors usually shrink soon after the pregnancy is over.

Q. How does plaque build-up affect pregnant women?

A. If plaque is not removed it can cause gingivitis and women with periodontal disease may be at risk for pre-term, low-birth weight babies.

Q. What problems occur for girls experiencing puberty?

A. The surge in hormones that occurs during puberty may cause swollen gums, especially during menstruation. Herpes-type lesions and ulcers can also develop. They may also experience sensitive gums that react more to irritants.

Q. What are intraoral cameras?

A. An intraoral camera is a miniature video camera that the dentist places in the patient’s mouth so that together they can view any dental problems that the patient is having. The image from the camera is enlarged and sent to a monitor for viewing.

Q. What is the purpose of intraoral cameras?

A. The purpose behind intraoral cameras is to allow the patient to see the specific area that needs treatment so that they are more likely to understand the dentist’s recommendation and accept it.

The world of modern dentistry is embracing exciting advances in technology for increased patient comfort, care, and convenience. Here are some ways dentistry is taking oral care into the new millennium.

Air Abrasion: High-speed delivery of "blasting particles" to a decayed tooth can replace the drill in many cases. The fine stream of air and aluminum oxide provides dentists with a more precise tool for removing decay quickly, without damaging surrounding sections of the tooth. This exciting dental treatment is also a plus for patients because it normally doesn't require any local anesthesia. While air abrasion may not be suitable for large areas of decay or the removal of silver fillings, it can be used to repair tiny cracks, remove stains, and smooth the tooth surface so that bonding materials adhere to the tooth.

Intra-oral Cameras: A tiny camera inserted into the patient's mouth allows the dentist to show the patient the exact nature of the problem. The image is enlarged and sent to a monitor that the patient and doctor view together. When patients can see the specific area in need of treatment, they're more likely to understand and accept the dentist's recommendation.

Lasers: Research continues at a fast pace in laser dentistry. Lasers have been used for years in a limited capacity, but their role in oral surgery is likely to increase.

Digitized X-rays: Computerized technology will allow a small sensor inside the patient's mouth to take the X-ray and immediately display it on a computer screen, eliminating film and darkroom processing, and reducing the radiation exposure for the patient.

Computers: There is a growing recognition of the role that computers can play in dental care. In the future, patient records may be kept on computer disks, including visual images captured on intraoral cameras. A computerized workstation beside the patient's chair will give the dentist the ability to view the patient's history from disk. The dentist might also use a voice-recognition system to ask the computer to assist in finding that data, or generate a "before and after" image so the patient can preview the result of dental treatment before it is done.

By Brian J. Gray, DDS, MAGD, FICO

During a dentistry examination, the dentist examines the mouth mucosa (soft tissues) for any abnormalities or pathology (including oral cancer), the teeth for tooth decay (dental caries) or defects, the gum tissues for periodontal (gum) disease, the neck for swollen lymph nodes, the amount of plaque, tartar (dental calculus), and debris on teeth, as well as the need to replace any missing teeth or dental prostheses.

The dental examination begins with a complete dental care and medical history, including medications the patient currently is taking. The skin of the face and neck is examined for any abnormalities, especially pigment changes. The lymph nodes in front and behind the ears, under the floor of the mouth and chin, and the midline of the neck, sides, and back of the neck are palpated to determine if any swelling or tenderness is present.

Inside of the mouth, the lips, cheeks, gums, and roof of the mouth are inspected and palpated. During this process, the tip of the tongue is placed on the roof of the mouth just behind the upper teeth for inspection of the front floor of the mouth and sides of the tongue.

The back floor of the mouth, the area behind the lower wisdom teeth, and the back sides of the tongue are inspected by grasping the tip of the tongue with a small gauze sponge and pulling the tongue forward and toward the opposite side of the mouth.

To inspect the back of the throat, soft palate, and tonsil area (sides of the throat), the tongue is depressed with a dental mirror or tongue blade and then a deep breath is taken by the patient.

To detect swelling on the floor of the mouth, the area inside the mouth is felt with the finger of one hand while a finger of the other hand feels below the chin. Salivary gland enlargement, saliva flow, or xerostomia (dry mouth) are determined by milking the major salivary glands to assess the quantity and consistency of saliva.

Today's dentist has many analytic tools available to pinpoint dental and oral diseases. The basic tools are the dental instruments, lights, and radiographs (X-rays). Depending upon the dentist and the individual's dental needs, additional diagnostic tests are available. Testing for essential proteins and buffering capacity can evaluate the protective ability of saliva.

To determine mouth caries risks, microbiological testing of saliva can measure the level of caries-producing organisms. Periodontal susceptibility tests, which test for the DNA of gum disease-producing organisms, can be performed to assess an individual's risk for gum disease.

If removable dentures are present, they are checked for bite, retention, stability, and overall fit. Dental impressions or models also may be taken to study the mouth and tooth structures to initiate fabrication of prostheses. Photographs may be exposed for a variety of reasons, including before and after treatment comparisons.

The level of oral hygiene and home care practices are assessed and reviewed. Recommendations for home care devices and products may be made. Instruction and methods for maintaining a good oral hygiene regimen can also take place.

Once basic information about oral health status is gathered, the dentist will be better able to discuss dental treatment alternatives that are available.

By Denise J. Fedele, DMD, MS

Q. What is the new technology dentists are using that reduces or eliminates discomfort from shots given during a dental procedure

A. A computerized injection system called The Wand has been shown to significantly reduce patient discomfort in delivering oral anesthetics. In a study of patients who have had procedures using it, more than 80% of them reported that it was a completely painless process. Consult your dentist to see if this dental procedure is covered by your dental care payment plan.

A very thin needle is attached to a pen-sized wand and placed near the gums. A drop of anesthetic numbs the gum before the needle is inserted. There is no prick or burning sensation with this system. As the needle glides through the gum, the anesthetic continues to be released. When the needle is fully inserted, the computer slowly releases the anesthetic. This eliminates the usual cause of the discomfort of the traditional dental shot -- the pressure associated with the stream of anesthetic flowing into the gum.

Q. How can early tooth decay be detected?

A. A dentist can put a "caries detection dye" on a suspicious tooth. This colored liquid helps identify the position and the extent of decay that is not visible to the naked eye. The dental procedure price may very.

Q. Are there any new prevention treatments for reducing tooth decay?

A. New prevention treatments are being studied. Research has shown that a tooth-decay inhibiting treatment can effectively eliminate the bacteria that cause tooth decay in humans. One promising treatment still in development is a caries vaccine, CaroRX, a tasteless, colorless antibody from genetically-altered plants, which is painted on clean teeth to prevent decay-causing bacteria from sticking to teeth. Planet Biotechnology, the manufacturer of CaroRX, hopes to gain FDA approval and make this product available to dentists within the next few years.

Q. What are intraoral cameras?

A. An intraoral camera is a miniature video camera that the dentist places in the patient's mouth so that together they can view any dental problems that the patient is having. The image from the camera is enlarged and sent to a monitor for viewing.

Q. What is the purpose of intraoral cameras?

A. The purpose behind intraoral cameras is to allow the patient to see the specific area that needs treatment so that they are more likely to understand the dentist's recommendation and accept it. Ask your dentist about this dental procedure and whether it's covered under your dental patient financing program.