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Apicoectomy

What Is It?

Your teeth are held in place by roots that extend into your jawbone. Front teeth usually have one root. Other teeth, such as your premolars and molars, have two or more roots. The tip of each root is called the apex. Nerves and blood vessels enter the tooth through the apex, travel through a canal inside the root, and into the pulp chamber, which is inside the crown (the part of the tooth visible in the mouth).

An apicoectomy may be needed when an infection develops or persists after root canal treatment,or retreatment. During root canal treatment, the canals are cleaned, and inflamed or infected tissue is removed. Root canals are very complex, with many small branches off the main canal. Sometimes, even after root canal treatment, infected debris can remain in these branches and possibly prevent healing or cause re-infection later. In an apicoectomy, the root tip, or apex, is removed along with the infected tissue. A filling is then placed to seal the end of the root.

An apicoectomy is sometimes called endodontic microsurgery because the procedure is done under an operating microscope.

What It’s Used For

If a root canal becomes infected again after a root canal has been done, it’s often because of a problem near the apex of the root. Your dentist can do an apicoectomy to fix the problem so the tooth doesn’t need to be extracted. An apicoectomy is done only after a tooth has had at least one root canal procedure.

In many cases, a second root canal treatment is considered before an apicoectomy. With advances in technology, dentists often can detect additional canals that were not adequately treated and can clear up the infection by doing a second root canal procedure, thus avoiding the need for an apicoectomy.

An apicoectomy is not the same as a root resection. In a root resection, an entire root is removed, rather than just the tip.

Preparation

Before the procedure, you will have a consultation with your dentist. Your general dentist can do the apicoectomy, but, with the advances in endodontic microsurgery, it is best to be referred to an endodontist.

Your dentist may take X-raysand you may be given an antimicrobial mouth rinse, anti-inflammatory medication and/or antibiotics before the surgery.

If you have high blood pressure or know that you have problems with the epinephrine in local anesthetics, let your dentist know at the consultation. The local anesthetic used for an apicoectomy has about twice as much epinephrine (similar to adrenaline) as the anesthetics used when you get a filling. The extra epinephrine constricts your blood vessels to reduce bleeding near the surgical site so the endodontist can see the root. You may feel your heart rate speed up after you receive the local anesthetic, but this will subside after a few minutes.

How It’s Done

The endodontist will cut and lift the gum away from the tooth so the root is easily accessible. The infected tissue will be removed along with the last few millimeters of the root tip. He or she will use a dye that highlights cracks and fractures in the tooth. If the tooth is cracked or fractured, it may have to be extracted, and the apicoectomy will not continue.

To complete the apicoectomy, 3 to 4 millimeters of the tooth’s canal are cleaned and sealed. The cleaning usually is done under a microscope using ultrasonic instruments. Use of a surgical microscope increases the chances for success because the light and magnification allow the endodontist to see the area better. Your endodontist then will take an X-ray of the area before suturing the tissue back in place.

Most apicoectomies take between 30 to 90 minutes, depending on the location of the tooth and the complexity of the root structure. Procedures on front teeth are generally the shortest. Those on lower molars generally take the longest.

Follow-Up

You will receive instructions from your endodontist about which medications to take and what you can eat or drink. You should ice the area for 10 to 12 hours after the surgery, and rest during that time.

The area may bruise and swell. It may be more swollen the second day after the procedure than the first day. Any pain usually can be controlled with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofem (Advil, Motrin and others) or prescription medication.

To allow for healing, you should avoid brushing the area, rinsing vigorously, smoking or eating crunchy or hard foods. Do not lift your lip to examine the area, because this can disrupt blood-clot formation and loosen the sutures.

You may have some numbness in the area for days or weeks from the trauma of the surgery. This does not mean that nerves have been damaged. Tell your dentist about any numbness you experience.

Your stitches will be removed 2 to 7 days after the procedure, and all soreness and swelling are usually gone by 14 days after the procedure.

Even though an apicoectomy is considered surgery, many people say that recovering from an apicoectomy is easier than recovering from the original root-canal treatment.

Risks

The endodontist will review the risks of the procedure at the consultation appointment. The main risk is that the surgery may not work and the tooth may need to be extracted.

Depending on where the tooth is located, there may be other risks. If the tooth is in the back of your upper jaw, the infection can involve your sinuses, and your dentist may suggest antibiotics and decongestants. The roots of the back teeth in the lower jaw are close to some major nerves, so surgery on one of these teeth carries a slight risk of nerve damage. However, your endodontist will use your X-rays to see how close the roots are to the nerves, and the chances of anything happening are extremely small.

An apicoectomy is usually a permanent solution, and should last for the life of the tooth.

When To Call a Professional

If you’re having any pain or swelling from a tooth that has had root-canal treatment, contact your dentist, who will take X-rays and do an exam. If your dentist feels you need an apicoectomy, you will need to set up an appointment for a consultation.

Please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

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Cracked Tooth Syndrome

What Is It?

Unlike teeth with obvious fractures, teeth with cracked tooth syndrome usually have fractures that are too small to be seen on X-rays. Sometimes the fracture is below the gum line, making it even more difficult to identify.

Cracked tooth syndrome more often occurs in molars, usually lower molars, which absorb most of the forces of chewing.

People who grind or clench their teeth may be more susceptible to cracked tooth syndrome because of the constant forces put on their teeth. Sometimes a person’s normal bite causes certain molar cusps (the highest points of the tooth) to exert so much pressure on the opposing tooth that it cracks.

Teeth with large fillings or teeth that have undergone root canal treatment are weaker than other teeth and may be more likely to crack. People with one cracked tooth are more likely to have others, either at the same time or in the future.

Symptoms

You may experience pain in the tooth when you bite or chew. However, it probably will not happen all the time. The tooth may be painful only when you eat certain foods or when you bite in a specific way. You will not feel a constant ache, as you would if you had a cavity or abscess, but the tooth may be more sensitive to cold temperatures. If the crack worsens, the tooth may become loose.

Many people with cracked tooth syndrome have symptoms for months, but it’s often difficult to diagnose because the symptoms are not consistent.

Diagnosis

Diagnosis of cracked tooth syndrome is often difficult. Your dentist will do a thorough examination of your mouth and teeth, focusing on the tooth in question. He or she may use a sharp instrument called an explorer to feel for cracks in the tooth and will inspect the gums around the tooth for irregularities. Your dentist also may take X-rays, although X-rays often do not show the crack.

Your dentist may use a special instrument to test the tooth for fractures. One instrument looks like a toothbrush without bristles that fits over one part of the tooth at a time as you bite down. If you feel pain, the cusp being tested most likely has a crack affecting it.

Your dentist may shine a fiber-optic light on the tooth or stain it with a special dye to search for a crack. If the tooth already has a filling or crown, your dentist may remove it so he or she can better inspect the tooth.

Expected Duration

How long symptoms last depends somewhat on how quickly a cracked tooth can be diagnosed. Even then, treatment may not always completely relieve the symptoms.

Prevention

If you grind or clench your teeth, talk to your dentist about treatment. Grinding can increase your risk of cracked tooth syndrome.

Treatment

Treatments for cracked tooth syndrome do not always completely relieve the symptoms.

Treatment depends on the location, direction and extent of the crack. Cracks vary from superficial ones in the outer layers of the tooth to deep splits in the root affecting the pulp (the center of the tooth, which contains the tooth’s nerves).

If the crack affects one or more cusps of a tooth, the tooth may be restored with a crown. If a crack affects the pulp, you probably will need root canal treatment. About 20% of teeth with cracked tooth syndrome require root canals. After a root canal, the tooth will no longer be sensitive to temperature, but it still will respond to pressure. This means that if you felt pain when you bit down before the root canal, you probably will not feel it as intensely as before, but you may feel it from time to time.

In some severe cases, the tooth may need to be extracted. Some cracks extend into the root of the tooth under the bone and there’s no way to fix the tooth. If your dentist decides the tooth needs to be extracted, you can have it replaced with an implant or a bridge.

When To Call a Professional

If you experience pain upon biting or chewing, contact your dental office.

Prognosis

Treatment of cracked tooth syndrome is not always successful. Your dentist should inform you about the prognosis. In some people, a restoration with a crown will relieve all symptoms. In others, root canal treatment solves the problem. Some people continue to have occasional symptoms after treatment, and may need to have the tooth extracted.

For more information, please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

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Cheilosis/Cheilitis

What Is It?

Cheilosis (also called cheilitis) is a painful inflammation and cracking of the corners of the mouth. It sometimes occurs on only one side of the mouth, but usually involves both sides. This disorder occurs most frequently in people with ill-fitting dentures that fail to adequately separate the upper and lower jaws. People with habits that irritate the corners of the mouth, like licking or rubbing those areas, also are more likely to develop cheilosis. Moisture gathers in skin folds at the corner of the mouth and provides a fertile environment for the formation of yeast (Candida) infections.

People with health disorders such as anemia, diabetes and immune deficiencies are particularly vulnerable.

Symptoms

Cracking, painful inflammation and sometimes weeping at the corners of the mouth.

Diagnosis

Your dentist or physician first will look to see if your dentures are fitting properly. He or she also will ask about your oral habits, such as licking the corners of your mouth. Blood tests may be done to test for anemias or immune deficiencies, and a smear or culture from the area may be tested to detect bacterial or yeast infections.

Expected Duration

Once the underlying cause is corrected, healing usually is quick.

Prevention

If you wear dentures, visit your dentist to be sure they fit properly and adequately support the face. Avoid licking or rubbing the corners of your mouth.

Treatment

Treatment focuses on eliminating causes such as oral habits or poorly fitting dentures. Infections may be treated with steroids or antifungal or antibacterial medications applied directly to the affected area. Severe infections, particularly in people with underlying medical problems, may require antifungal drugs that are taken orally.

When To Call A Professional

If you experience constant or repeat inflammation in the corners of your mouth, you should contact your dentist or doctor.

Prognosis

Good, once the cause has been eliminated.

For more information, please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

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Canker Sores

What Is It?

This disease causes painful, round ulcers to develop on the linings of the cheeks and lips, the tongue or the base of the gums. The tendency to develop these ulcers is inherited. Ulcers also can be associated with other diseases, particularly connective tissue diseases such as lupus or Behçet’s syndrome, which cause symptoms on the eyes and genitals as well as the mouth. There can be one or many ulcers at the same time, and they are recurrent, which means they keep returning. Multiple ulcers are scattered across the lining of the mouth, not clustered. Most people get one to three of these lesions at each episode, but a small number of people get more than a dozen ulcers at a time.

The cause of canker sores is not known, but most theories involve an immune abnormality. Certain blood diseases, vitamin and mineral deficiencies, allergies, trauma and Crohn’s disease cause similar ulcers. Canker sores are often confused with cold sores, which are caused by a herpes virus.

Approximately 17% of the population has recurrent aphthous stomatitis, which is classified into three categories:

  • Minor ulcers are less than 1 centimeter (slightly less then ½inch) in diameter and do not leave scars. The sores usually heal within two weeks.
  • Major ulcers (also called Sutton’s disease) are almost ½ inch or more in diameter, take longer than minor ulcers to heal and may leave scars.
  • Herpetiform ulcers are clusters of dozens of smaller ulcers. This form is rare.

People tend to have two to six ulcers per episode and have several episodes each year. For most people, canker sores are merely an annoyance, but some people experience large, painful, frequent sores that can reach 2 to 4 centimeters in diameter. The ulcers can interfere with speech and eating and can last for weeks to months, causing significant pain and disability. When they do heal, they may leave scars that can make it more difficult to move the tongue and can destroy oral tissue.

Symptoms

You may feel a burning or tingling sensation in an area of inflammation before an ulcer appears. An ulcer takes two to three days to form completely. The sores are round, shallow and symmetric, which means they are the same on all sides. The are painful. They usually are found on the inner part of the lips and cheeks and the tongue.

Diagnosis

Canker sores are the most common recurring oral ulcers and are diagnosed mostly by process of elimination. If the ulcers become more frequent or severe, are accompanied by other symptoms (such as rashes, joint pain, fevers or diarrhea) or are larger than about ½inch in diameter, you should visit your dentist or physician. He or she will try to rule out blood diseases, connective tissue diseases, drug reactions and skin disorders. A biopsy and blood tests may be required to rule out other conditions or diseases.

Expected Duration

The painful stage lasts 3 to 10 days, and most canker sores disappear within 2 weeks.

Prevention

There is no way to prevent canker sores.

Treatment

Treatment focuses on relieving symptoms. Rinsing with a warm-water solution and eating bland foods can minimize discomfort. Anesthetic medications or over-the-counter agents that are placed directly on the sores to coat them also may help.

People with more severe disease may need steroid medications placed on the lesions. These medications significantly shorten the healing time of the ulcers and prevent them from becoming larger. Other possible treatments include placing a medication called chlortetracycline (Aureomycin) on the sores or injecting steroids into the sores. In very severe, disabling cases, your dentist may prescribe oral medication.

When To Call a Professional

Canker sores usually are painful but are not a significant risk to your health. However, if you have severe, recurring canker sores, or if they are becoming worse, consult your dentist or physician. He or she may do tests to look for blood problems such as anemias or deficiencies of iron, folate or vitamin B12. Some research has shown that canker sores improve when these deficiencies are treated. Persistent or large ulcers can also occur as a part of other, more significant, disorders, including inflammatory bowel disease, connective tissue diseases, drug allergies, arthritic disorders, inflammatory skin disorders and cancer.

Prognosis

Most canker sores clear up without treatment and do not leave scars, although they usually return.

For more information, please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

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Bruxism – Teeth Grinding

What Is It?

bruxismBruxism is clenching or grinding your teeth, often without being aware that your are doing it. In the United States, bruxism affects an estimated 30 to 40 million children and adults.

Some people grind their teeth only during sleep; this condition is called “nocturnal bruxism” or “sleep-related bruxism.” Others grind their teeth during the daytime as well, most often during situations that make them feel tense or anxious. People with severe bruxism can fracture dental fillings or cause other types of tooth damage. Severe bruxism has also been blamed for some cases of temporomandibular joint dysfunction (TMD), mysterious morning headaches and unexplained facial pain.

Bruxism can have a variety of psychological and physical causes. In many cases, it has been linked to stress, but it can also simply be the body’s reaction to the teeth being aligned wrong or a poor bite (the way the teeth come together). Bruxism can sometimes occur as a complication of severe brain injury, or a symptom of certain rare neuromuscular diseases involving the face. Bruxism also can be an uncommon side effect of some psychiatric medications, including antidepressant medications, including fluoxetine (Prozac), sertraline (Zoloft) and paroxetine (Paxil).

Symptoms

Symptoms of bruxism include:

  • Rhythmic contractions of the jaw muscles
  • A grinding sound at night, which may disturb the sleep of someone who shares a bedroom with a “bruxer”
  • A dull morning headache
  • Jaw muscles that are tight or painful, especially in the morning
  • Chronic facial pain
  • Damaged teeth, fractured dental fillings and injured gums

Diagnosis

Your dentist will ask about your current life stresses, your general dental health and your daily medications. He or she also will want to know whether you routinely drink beverages containing alcohol or caffeine, because both of these chemicals seem to increase the tendency to grind your teeth.

If you share your bedroom, the dentist also may want to ask that person about your sleep habits, especially about any unusual grinding sounds heard during the night.

Your dentist will examine you, paying special attention to your mouth and jaw. During this exam, your dentist will check for tenderness in your jaw muscles, as well as for any obvious dental abnormalities, such as broken teeth, missing teeth or poor tooth alignment. If your dentist suspects that you have bruxism that is related to dental problems, he or she may conduct a more detailed assessment. In addition to checking your “bite,” the dentist will examine your teeth and gums for damage caused by bruxism. The dentist will also take a series of mouth X-rays.

If your child grinds or clenches his or her teeth, discuss the problem with your family dentist. Although many children eventually outgrow bruxism, even short-term tooth grinding can cause damage to your child’s permanent teeth.

Expected Duration

Of all children who brux between the ages of 3 and 10, more than half will stop spontaneously by age 13.

In teenagers and adults, how long bruxism lasts depends on its cause. For example, bruxism can last for many years if it is related to a stressful life situation that doesn’t go away. However, if bruxism is being caused by a dental problem, it should stop when the teeth are repaired and realigned — often within a few dental visits.

Prevention

If your bruxism is related to stress, you may be able to prevent the problem by seeking professional counseling or by using strategies to help you learn to relax. Also, try cutting down on stimulants such as tobacco and caffeine.

In both children and adults, tooth damage related to bruxism can be prevented by wearing a night bite plate or a bite splint (a dental appliance worn at night to stop teeth grinding).

Treatment

The treatment of bruxism varies depending on its cause:

  • Stress — If you have bruxism that is stress-related, your dentist or physician may recommend professional counseling, psychotherapy, biofeedback exercises or other strategies to help you relax. Your dentist or physician also may prescribe muscle relaxant medications to temporarily ease the spasm in your clenched and overworked jaw. If conventional therapy does not help, your dentist may refer you to an oral surgeon who may inject botulinum toxin directly into your jaw muscles (to temporarily interfere with muscle contractions).
  • Dental problems — If your bruxism is related to tooth problems, your dentist will probably treat it with occlusal therapy (to correct tooth alignment). In severe cases, your dentist may need to use onlays orcrowns to entirely reshape the biting surfaces of your teeth.
  • Brain injury or neuromuscular illness — Your bruxism may be especially hard to treat if you have these medical problems. Your oral surgeon may give you injections of botulinum toxin if more conservative treatments fail.
  • Medication — If you develop bruxism as a side effect of antidepressant medications, your doctor either can switch you to a different drug or give you another medication to counteract your bruxism.

When To Call A Professional

Call your physician or dentist if you have symptoms of bruxism, or if you are told that you grind your teeth while you sleep.

Also, make a dental appointment immediately if you fracture a tooth, lose a filling, or notice that your teeth are becoming abnormally loose in their sockets.

Prognosis

Even without special treatment, more than half of young children with bruxism stop grinding their teeth by age 13. Until your child stops bruxing on his or her own, your dentist can fit your child with a night bite plate to prevent excessive tooth wear. This device is effective in almost all children who use it as directed.

In teenagers and adults, the outlook is excellent if bruxism is treated properly. Even if all other therapies fail, injections of botulinum toxin can temporarily stop bruxism in most patients.

For more information, please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

Can Medication Have an Effect on My Oral Health?

Can Medication Have an Effect on My Oral Health?
oral health medication

Yes, medications can have oral side effects — dry mouth being the most common. Be sure to tell your dentist about any medications that you’re taking, even medicines that you purchase without a prescription.

These are the types of medications that will often produce dry mouth:

  • Antihistamines
  • Decongestants
  • Pain Killers
  • Diuretics
  • High Blood Pressure Medications
  • Antidepressants

Other medications may cause abnormal bleeding when brushing or flossing, inflamed or ulcerated tissues, mouth burning, numbness or tingling, movement disorders and taste alteration. If you experience any of these symptoms,  please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

A Closer Look at Cavities


Follow the development of a cavity and learn how minor changes to your daily routine can help protect your smile.

For more information, please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

How to Care for Children’s Teeth

How to Care for Children’s Teeth

This short video teaches you the correct way to brush children’s teeth giving them a healthy start toward a lifetime of good oral health.

For more information, please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

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Watch what you eat after teeth-whitening

People should avoid or limit consumption of foods and other products that stain teeth, such as tobacco, soy sauce, soft drinks, red and white wine and blueberries.Eating certain foods and avoiding others can help keep your teeth white after you’ve used an at-home whitening kit or had cosmetic bleaching, an expert says.

People should avoid or limit consumption of foods and other products that stain teeth, such as tobacco, soy sauce, soft drinks, red and white wine and blueberries.

“For many individuals who have had good results with either dentist-directed or over-the-counter whitening techniques, a significant concern is how to keep the teeth white after bleaching,” Dr. Raymond Garrison, professor and chairman of the Wake Forest Baptist Department of Dentistry, said in a Wake Forest Baptist Medical Center news release.

“We now know that there are foods that actually help to keep your teeth white rather than stain them. In fact, it may help patients avoid the time and expense of whitening retreatment.”

Firm fruits and vegetables such as apples, green beans, cauliflower, carrots and celery help scrub teeth while you chew. They also help promote the flow of saliva, which neutralizes acids and protects teeth, Garrison said.

Dairy products, especially those high in calcium, and cheeses also help keep teeth white. The lactic acid in these products helps prevent decay. Harder cheeses also help remove food particles left on the teeth.

People should avoid or limit consumption of foods and other products that stain teeth, such as tobacco, soy sauce, soft drinks, red and white wine and blueberries.

While bleaching is an effective method for whitening teeth, it can cause short-term effects such as sensitivity. Too many whitening treatments can lead to permanent damage, such as erosion of tooth enamel.

Before you undergo bleaching or use teeth whitening kits, consult a dentist, Garrison advised.

For more information, please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

Bad Breath (Halitosis)

What Is It?

bad breath halitosisBad breath, also known as halitosis, is breath that has an unpleasant odor. This odor can strike periodically or be persistent, depending on the cause. In many people, the millions of bacteria that live in the mouth (particularly on the back of the tongue) are the primary causes of bad breath. The mouth’s warm, moist conditions make an ideal environment for these bacteria to grow. Most bad breath is caused by something in the mouth.

Some types of bad breath, such as “morning mouth,” are considered to be fairly normal, and they usually are not health concerns. The “morning mouth” type of bad breath occurs because the saliva that regularly washes away decaying food and odors during the daytime diminishes at night while you sleep. Your mouth becomes dry, and dead cells adhere to your tongue and to the inside of your cheeks. Bacteria use these cells for food and expel compounds that have a foul odor.

In addition, bad breath can be caused by the following:

  • Poor dental hygiene — Infrequent or improper brushing and flossing can leave food particles to decay inside the mouth.
  • Infections in the mouth — Periodontal (gum) disease
  • Respiratory tract infections — Throat infections, sinus infections, lung infections
  • External agents — Garlic, onions, coffee, cigarette smoking, chewing tobacco
  • Dry mouth (xerostomia) — This can be caused by salivary gland problems, medications or by “mouth breathing.”
  • Systemic illnesses — Diabetes, liver disease, kidney disease, lung disease, sinus disease, reflux disease and others
  • Psychiatric illness — Some people may perceive that they have bad breath, but it is not noticed by oral-health-care professionals or others. This is referred to as “pseudohalitosis.”

Symptoms

A person may not always know that he or she has bad breath. This phenomenon is because odor-detecting cells in the nose eventually become accustomed to the constant flow of bad smells from the mouth. Others may notice and react by recoiling as you speak.

Other associated symptoms depend on the underlying cause of bad breath:

  • Poor dental hygiene — Teeth are coated with film or plaque, food debris trapped between teeth, pale or swollen gums
  • Infections in the mouth — Gums may be red, swollen and bleed easily, especially after brushing or flossing; pus may drain from between teeth; a pocket of pus (abscess) at the base of a tooth; loose teeth or a change in “fit” of a denture; painful, open sores on the tongue or gums
  • Respiratory tract infections — Sore throat, swollen lymph nodes (“swollen glands”) in the neck, fever, stuffy nose, a greenish or yellowish nasal discharge, a mucus-producing cough
  • External agents — Cigarette stains on fingers and teeth, a uniform yellow “coffee stain” on teeth
  • Dry mouth — Difficulty swallowing dry foods, difficulty speaking for a prolonged period because of mouth dryness, a burning sensation in the mouth, an unusually high number of dental caries, dry eyes (in Sjögren’s syndrome)
  • Systemic (bodywide) illnesses — Symptoms of diabetes, lung disease, kidney failure or liver disease

Diagnosis

A dentist or physician may notice the patient’s bad breath while the patient is discussing his or her medical history and symptoms. In some cases, depending on the smell of the patient’s breath, the dentist or physician may suspect a likely cause for the problem. For example, “fruity” breath may be a sign of uncontrolled diabetes. A urine-like smell, especially in a person who is at high risk of kidney disease, can sometimes indicate kidney failure.

Your dentist will review your medical history for medical conditions that can cause bad breath and for medications that can cause dry mouth. Your dentist also will ask you about your diet, personal habits (smoking, chewing tobacco) and any symptoms, including when the bad breath was noticed and by whom.

Your dentist will examine your teeth, gums, oral tissues and salivary glands. He or she also will feel your head and neck and will evaluate your breath when you exhale from your nose and from your mouth. Once the physical examination is finished, your dentist may refer you to your family physician if systemic problems are the most likely cause. In severe cases of gum disease, your dentist may recommend that you be seen by a periodontist (dentist who specializes in gum problems).

You will need diagnostic tests if the doctor suspects a lung infection, diabetes, kidney disease, liver disease or Sjögren’s syndrome. Depending on the suspected illness, these tests may include blood tests, urine tests, X-rays of the chest or sinuses, or other specialized testing.

Expected Duration

How long bad breath lasts depends on its cause. For example, when the problem results from poor dental hygiene, proper dental care will begin to freshen the mouth immediately, with even more impressive results after a few days of regular brushing and flossing. Periodontal disease and tooth abscess also respond quickly to proper dental treatment. Bad breath resulting from chronic sinusitis may be a recurring problem, especially if it is caused by a structural abnormality of the sinuses.

Bad breath the results from a systemic illness may be a long-term problem that can often be controlled with proper medical care.

Prevention

Bad breath caused by dental problems can be prevented easily. Daily maintenance calls for brushing your teeth, tongue and gums after meals, flossing, and rinsing with mouthwashes approved by the American Dental Association (ADA). Regular visits to the dentist (at least twice a year) should be made for dental examinations and for professional teeth and gum cleaning.

Bad breath also can be combated by drinking plenty of water every day to encourage saliva production. An occasional swish of the mouth with water can loosen food particles. Other products that keep breath fresh and prevent plaque from forming include sugar-free gum, sugarless lozenges, raw carrots and celery.

Treatment

The treatment of bad breath depends on its cause.

When To Call A Professional

Call your dentist promptly if you have bad breath with painful, swollen gums that bleed easily or loose teeth. Also, call your doctor if you have bad breath along with a fever, sore throat, a postnasal drip, a discolored nasal discharge or a mucus-producing cough. Even if you have none of these associated symptoms, call your dentist or physician if your bad breath continues despite a good diet and proper dental hygiene.

If you have diabetes, gastroesophageal reflux disease (GERD) or chronic liver or kidney disease, ask your doctor how bad breath can be a sign that your underlying medical condition needs immediate medical attention.

Prognosis

Once bad breath has been diagnosed, the outlook for fresh breath is usually excellent as long as you stick to your dentist’s or physician’s treatment plan.

For more information, please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.