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Bad Breath and Its Relationship to Oral Systemic Diseases

Bad Breath??

“About 75 percent of bad breath or “halitosis” is caused by the mouth itself.  Other causes include gastric problems, sinus infections or severe gum disease,” says Mark Wolff, DDS, Ph.D., director of operative dentistry at the State University of New York at Stony Brook. One of the key successes in treating bad breath is determining the cause. Once your dental professional determines what the cause is then treatment for it can then begin (1).

Bad breath can be caused by the following:

  • External factors – foods such as onions and garlic, beverages like coffee and alcohol, and smoking
  • Poor oral hygiene – where plaque and food debris is left on the teeth
  • Dentures – plaque and food debris can form on dentures, which need to be cleaned daily
  • Tonsils – cryptic areas (crevices) in the tonsils can allow food debris to become lodged in the tonsil area
  • Respiratory tract infections – throat, sinus and lung infections
  • Dry mouth (Xerostomia) – can be caused by salivary gland problems, medication, mouth breathing, radiation therapy and chemotherapy

Who Should You See If You Have Bad Breath?

If you believe your diet is causing bad breath, then consult with a dietician or nutritionist who can work with you to modify your diet. If you have poor oral hygiene and are suffering from gingivitis (inflammation of the gum tissue in your mouth) or have periodontal disease (bone loss around the teeth sometimes referred to as “pyorrhea”), consult your dentist and periodontist and work with your dental hygienist to improve gingivitis and thorough oral hygiene instruction at home. The tonsils and respiratory infections will need to be followed by your physician or a specialist such as an ear, nose and throat physician or pulmonologist. A large majority of people in the United States are suffering from dry mouth due to medications they may be taking, salivary gland dysfunction and those who may be going through radiation and chemotherapy treatment for cancer therapy. Please consult your oral maxillofacial surgeon, your physician or oncologist for their professional recommendations for prescription or over-the-counter products that can alleviate dry mouth symptoms. Those patients who are diabetics, have liver or kidney conditions, and gastrointestinal disorders should see their physician, urologist or gastroenterologist for their insights on how bad breath can be reduced regarding these systemic diseases. Contact your dentist office for a recommendation of which dental or medical professional you should see for your bad breath condition.

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

Fluorosis

What Is It?

Your permanent teeth form under your gums in the jawbone during early childhood. Except for your wisdom teeth, the crowns (the part you see in the mouth) of all of the permanent teeth fully form by the time you are about 8 years old. If you consume too much fluoride as a young child, the extra fluoride can disrupt the formation of the enamel (outer part) of your permanent teeth and lead to fluorosis, which varies from minor discoloration to surface irregularities of the teeth. The extra fluoride does not affect other parts of the tooth. Once your teeth have erupted into your mouth, they are not susceptible to fluorosis.

Fluorosis is a cosmetic condition, not a disease. Often, it is so mild that only a dental professional can detect it. Most cases of fluorosis result from young children taking fluoride supplements or swallowing fluoride toothpaste when the water they drink is already fluoridated.

Symptoms

Teeth affected by mild fluorosis may show no visible changes or changes visible only to a dental professional. Mild to moderate fluorosis is characterized by white lines, streaks or spots. In more severe fluorosis, the teeth can become pitted and have brown, gray or black spots, and the enamel can be misshapen.

Diagnosis

Your dentist and dental hygienist will ask if your child received fluoride supplements, used fluoride toothpaste or drank fluoridated water in previous years. They also will ask about past and present medical conditions or disabilities that may affect your child’s teeth. Your dentist will examine your child’s teeth and gums and take X-rays to make sure there are no other defects in the teeth.

Other conditions may look like fluorosis. Developmental defects and craniofacial problems can cause disruptions in the enamel or dentin of the teeth. In addition, infants or young children who have high fevers or experience trauma (such as a fall that injures a tooth) may have discolored teeth. Young children can get cavities in their primary teeth, so any tooth discoloration should be checked at the dental office.

Expected Duration

The spots and stains left by fluorosis are permanent and may darken over time.

Prevention

If you have a child under 6, put only a small smear or pea-sized amount of toothpaste on his or her toothbrush and encourage him or her to spit rather than swallow after brushing. Avoid toothpastes with flavors that may encourage swallowing. Keep all fluoride-containing products (toothpastes, mouthwashes, etc.) out of the reach of young children.

The addition of fluoride to drinking water is one of the great preventive disease programs of the 20th century. Children should take fluoride supplements only if the water they drink does not contain enough fluoride. If your child is taking fluoride supplements now, check the amount of fluoride in your water. If you are on a public water supply, call your supplier to ask about the fluoridation level. You can also have your dentist check a sample of your water. Then discuss with your dentist whether your child needs fluoride supplements.

Some foods and beverages contain fluoride. For example, many fruit juices and soft drinks contain fluoride at levels similar to fluoridated water. Some bottled waters now have added fluoride. Young children should drink limited amounts of these beverages.

Treatment

Many cases of fluorosis are minor enough not to need treatment or the fluorosis may occur only on the back teeth, where it can’t be seen. More serious cases and cases involving the front teeth can be treated by removing the surface-stained areas through tooth whitening or other procedures. Severe cases of fluorosis can be covered with restorations, such as bonding, crowns or veneers.

When To Call a Professional

If you notice white streaks or spots on your child’s teeth or notice that one or more teeth are discolored, contact your dental office.

Prognosis

Teeth affected by fluorosis are not diseased. Cosmetic concerns can be addressed with whitening to remove surface stains and veneers or other restorative procedures to cover the discoloration.

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

Regular Tooth Scaling May Protect the Heart

By Amy Norton

NEW YORK (Reuters Health) Apr 19 – Older adults who get thorough dental cleanings may be somewhat less likely to suffer acute myocardial infarction (MI) or stroke than their peers who are less careful about oral hygiene, a new study hints.

The study, of nearly 22,000 Taiwanese adults age 50 and older, found that those who’d had a professional tooth scaling in the past year were less likely to have a cardiovascular event over the next seven years.

The findings, reported online April 5 in the American Journal of Medicine, do not prove that proper dental cleaning will cut a person’s risk of cardiovascular disease. But the study is in line with past research that has linked periodontal disease to an increased risk of heart disease, said lead researcher Dr. Zu-Yin Chen, a cardiology fellow at Taipei Veterans General Hospital in Taiwan.

Since periodontal disease is caused by bacterial infection, researchers suspect that it may contribute to MI or stroke by causing a chronic state of inflammation in blood vessels. And studies have shown that treating periodontal disease can cut the levels of inflammatory markers in blood. Still, no one knows for sure whether regular dental visits can prevent a future cardiovascular event.

For the study, Dr. Chen’s team looked at insurance records for 21,876 adults age 50 and older. Taiwan’s national healthcare program pays for tooth scaling, whether a person has severe periodontal disease or not. About half of the people in the study had had a tooth scaling in the past year, while the rest had not.

Over the next seven years, those who had tooth scaling had a lower incidence of acute MI (1.6% vs 2.2%; p<.001), stroke (8.9% vs 10%; p=.03) and total cardiovascular events (10% vs 11.6%; p<.001) compared with those that did not have tooth scaling.

After multivariate analysis, tooth scaling was independently associated with less risk of developing future acute MI (HR 0.69), stroke (HR 0.85) and total cardiovascular events (HR 0.84).

An increasing frequency of tooth scaling correlated with a higher risk reduction of acute myocardial infarction, stroke, and total cardiovascular events (p for trend <.001).

But the study also had a number of limitations. An important one, Dr. Chen said, was that they had no information on key risk factors for cardiovascular disease such as smoking, weight, diet and family history. It’s also impossible for the study to determine whether people who get regular dental cleanings might also have a healthier lifestyle in other ways.

For now, the researchers recommend good oral hygiene taking for the sake of your oral health — with the possibility of benefiting your heart health as well.

“Bad dental hygiene is detrimental to our health, so it’s very important to take care of your teeth,” said Dr. Chen, who presented some of his team’s results last November at the American Heart Association meeting.

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

SOURCE: http://bit.ly/IlKu8h

Smile Saver Quiz

Smile Saver

How much do you really know about gum disease?
Take our quiz and see.

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

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New Treatments For Cold Sores

642x361_Cold_SoresNew Treatments For Cold Sores

If you suffer from cold sores, you are not alone. Nearly 70% of Americans ages 12 and older test positive for herpes simplex virus type 1 (HSV-1), the virus that causes cold sores. At least 20% of patients with HSV experience recurring cold sores.

HSV-1 is transmitted by direct contact with infected skin or saliva. A primary infection usually occurs during childhood and causes a fever, sore gums, sore throat and swollen or tender glands in the neck. After that, the virus remains dormant in nerve roots near the infected skin. In some people, the virus rarely, if ever, reactivates. But in others, recurrences called secondary herpes episodes occur frequently, producing cold sores. While medical experts have not determined the exact cause for reactivation, a variety of stimuli, such as stress, dental treatment, illness, trauma to the lips or sun exposure can precipitate an outbreak.

“While there is no cure for cold sores, there are medications that can be useful in their treatment and prevention,” says Joel Laudenbach, D.M.D., assistant professor and director of geriatric dentistry at the Columbia University School of Dental and Oral Surgery.

Three oral antiviral medications sometimes prescribed are acyclovir (Zovirax), famciclovir (Famvir) and valacyclovir (Valtrex). Although none of these medications will eliminate the dormant HSV-1 infection that causes cold sores, they can help the sores heal faster and relieve the associated pain and discomfort. They also can also help to suppress a cold-sore outbreak.

These drugs also are effective in helping to prevent an outbreak of cold sores during a time of increased susceptibility, such as a beach or ski vacation that would involve extensive sun exposure. In addition, recent studies have shown that using valacyclovir before certain dental procedures can help decrease recurrent outbreaks. Other treatments include topical antiviral creams and ointments, such as penciclovir (Denavir) cream. Some research demonstrates that penciclovir appears to reduce the average size and duration of a cold sore.

Penciclovir reportedly is best used as soon as possible after symptoms (pain, tingling, itching, burning or blisters) begin to appear. Although the recommended dose varies with the individual, the average adult dose calls for applying the cream to the affected areas every two hours, while awake, for four days.

A topical acyclovir ointment also can be used for symptoms of HSV infections of the skin, mucous membranes, and genitals.

Cold sores and canker sores are not the same, Dr. Laudenbach says. Canker sores occur only inside the mouth, are not caused by a virus, and are not contagious. Cold sores usually occur outside the mouth on the lips, are caused by a virus (herpes simplex virus [HSV-1]), and are contagious, he says. Because canker sores are not caused by a virus, antiviral medications will not be effective in treating them.

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

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Important Reasons for Mouth Guards

Important Reasons for Mouth Guards

A mouth guard is a soft plastic or laminate device used in sports to prevent oral injuries to the teeth, mouth, cheeks, tongue and jaw. The American Dental Association projects that one third of all dental injuries are sports related.1 The use of a mouth guard can prevent more than 200,000 oral injuries to the mouth each year.

The types of dental injuries that can occur without the use of a mouth guard are chipped or broken teeth, fractured crowns or bridgework, lip and cheek injuries, root damage to the teeth, fractured jaws, and concussions. Any athlete may be at risk for oral injury and any injury can be prevented with the use of a mouth guard.

Mouth guards are mandatory in collision sports such as football, hockey and boxing where the risk of injury is likely. Children and adults involved in incidental contact sports like basketball, baseball, softball, wrestling, soccer and volleyball may consider wearing a mouth guard to prevent injuries to the mouth.

A study of high school athletes found that seventy-five percent of injuries occurred when mouth guards were not worn and forty percent occurred during baseball and basketball. Nine percent of all athletes suffered some type of oral injury while another three percent reported a loss of consciousness. Fifty-six percent of all concussions were suffered when mouth guards were not worn. Trauma related to sports is more prevalent than previously reported.2

Child or adult, a mouth guard is essential for all athletes. For more information about the right mouth guard for you, please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

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Abscess

What Is It?

An abscess is a limited area of pus formed as a result of a bacterial infection. The body’s immune system reacts to the infection, and sends white blood cells to the area to try to get rid of the bacteria. Pus is a mixture of live and dead white blood cells, enzymes and parts of destroyed cells and tissues. When there is no way for pus to drain, it forms an abscess.

Abscesses can form in almost every part of the body. In the mouth, abscesses form in gum tissue or in the roots of teeth and in the surrounding areas of the tooth. They can be caused by trauma (food or debris embedded deep in the gum), by bacteria that enters through a cavity and gets into the dental pulp, or from a deep periodontal pocket. People with a lowered resistance to infection are at increased risk of developing an abscess. At first, the abscess may cause a toothache, which can be severe. The tooth’s nerve can become infected and the infection can burrow through to the gum, forming a visible boil that can rupture in the mouth. Once the abscess ruptures, the pain often decreases significantly, but dental treatment is still necessary. If the abscess does not drain, the infection can spread to other areas of the head and neck and can become life threatening.

Symptoms

The main symptom is persistent, throbbing pain. At first, the tooth will be sensitive to heat and pressure while chewing. Later, you may develop a fever. Swollen lymph nodes under the jaw or in the neck can be tender and you may feel pain in the sinus area. If the abscess ruptures, a sudden rush of foul-smelling and foul-tasting fluid will spill into the mouth.

Diagnosis

Usually, your dentist can diagnose a tooth abscess by examining your mouth. He or she may push on the swollen area of the gum and do a pulp test on the affected tooth to see if it is still alive. A pulp test can involve:

  • Gentle tapping (percussion) on the tooth
  • Temperature testing
  • Using an electric tester on the tooth

Your dentist also may take an X-ray to look for bone erosion around the tip of the tooth’s root.

Expected Duration

Once the abscess is drained, most symptoms go away immediately or within a few days, but the abscess will not be cured unless the cause is eliminated.

Prevention

Good oral hygiene can help prevent abscesses by keeping teeth and gums free of food and debris. Regular dental checkups are also important. If you have a weakened immune system because of medication or another condition, let your dentist know before every appointment. You may receive antibiotics before the appointment to reduce the risk of infection.

Treatment

Saving an abscessed tooth begins with draining the infection, which usually relieves pain and removes much of the infection. Root canal treatment may be necessary and should be started as soon as possible to remove diseased tissue.

If the abscess involves gum tissue, your dentist may suggest that you rinse with warm salt water (1/8 of a teaspoon of salt in 8 ounces of water) a few times a day for several days. You may be prescribed antibiotics to help make sure the infection has been eliminated. Have dental X-rays performed six months later to confirm if healthy bone and tissue are filling the area of the abscess. If the bone does not fill in after the treatment, you may need to visit a periodontist who can surgically reshape the gum so that it is easier to keep clean, or an endodontist who can surgically remove a persistent abscess.

When To Call A Professional

If you have a toothache or notice evidence of an abscess on your gum, visit your dentist. Even if the abscess drains and the pain decreases, a visit to the dentist for complete treatment is crucial.

Prognosis

The outlook is excellent if detected promptly and treated appropriately.

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

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Treatment Options for Tooth Sensitivity

Tooth Sensitivity – Overview

Tooth sensitivity is due to the exposure of dentin, the part of the tooth which covers the nerve, either through loss of the enamel layer or recession of the gums. Temperature changes and certain foods (acidic or sweet) can cause the tooth or teeth to be painful. The pain usually subsides after a short period of time.

The dentin contains a large numbers of pores or tubes that run from the outside of the tooth to the nerve in the center. When the dentin is exposed, these tubes can be stimulated by changes in temperature or certain foods. Here is an image of what the dentin tubes look like under the microscope:

The dentin contains a large numbers of pores or tubes that run from the outside of the tooth to the nerve in the center. When the dentin is exposed, these tubes can be stimulated by changes in temperature or certain foods. Here is an image of what the dentin tubes look like under the microscope:

Tooth dentin

The best way to find out why a tooth is sensitive is to have dental professional examine you. They can look for the signs of dentin exposure, and run tests to determine what the true cause of the sensitivity is. Sometimes, the sensitivity is due to a cavity or gum disease – these can be treated to address the sensitivity. Other times, the cause of the sensitivity is because the enamel has been lost through abrasion or erosion, or the gums have receded, causing the roots to be exposed.

What Can Be Done?

If the sensitivity is due to a cavity, a restoration can be placed. If gum disease is the cause, the dental professional can perform a thorough cleaning of the area.

However, if the cause is from dentin being exposed, then there are a number of professional and at home treatments that can be used to reduce the sensitivity.

  • In Office Procedures:
    • Fluoride varnish can be applied to exposed areas, strengthening the enamel and dentin
    • Fluoride foam or gel can be placed into a mouth tray; you then sit with this in your mouth for 3-5 minutes, providing the teeth with a high concentration of fluoride to strengthen the areas
    • Bonding agent, the material used to stick tooth colored restorations to teeth, can be used to seal the dentin surface and provide a barrier to the stimuli that cause sensitivity
  • At Home:
    • Use a very soft bristle tooth brush, with low abrasive tooth paste
    • Brush correctly and do not over brush
    • Use a tooth paste specially formulated to soothe the nerve endings in the tooth
    • Use a high concentration fluoride toothpaste (given to you by the dental professional) to strengthen the tooth surface

There are a number of treatments available, and your dental professional can help you find those that will work best, depending on your situation. Always seek a dental professional’s help – do not try to diagnose this problem yourself. It may be the sign of something more serious, and only a dental professional can tell you what it really is.

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

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Too Much Drilling? Not All Early Tooth Decay Needs A Filling

To find tooth decay early, some dentists are using newer technologies, in addition to visual exams and X-rays. The devices claim to be able to detect the beginnings of decay, when the tooth begins to soften, before it turns into a cavity.

As with almost any new technology, the devices are expensive. Are they worth it? More importantly, if one of these devices shows that you have early decay, do you need a filling right away?

Not necessarily.

Dental decay is “a slowly progressing disease,” says David A. Albert, D.D.S., M.P.H., associate professor of clinical dentistry at the Columbia University School of Dental and Oral Surgery. “From start to finish in the general population, it can take five years to go from a new caries lesion (early decay) to full-blown involvement of the pulp (the center of the tooth, where the nerves and blood vessels are). Back in the 1920s, the way we practiced was based on [decay] progression taking a matter of months.”

So early decay doesn’t always mean you need a filling. In fact, the decay often can be reversed. A tooth starts to decay because acid in your mouth causes minerals to leach out of the enamel, and the enamel breaks down. Fluoride therapy, dietary changes and better oral hygiene habits can reverse this process by causing minerals to build up in the tooth again, making the enamel stronger.

In some cases, a filling is a no-brainer. If you’re in pain or have an obvious cavity (a break in the surface of your tooth), you need a filling. But, says Dr. Albert, “If there’s no cavity and no pain, the tooth can fix itself.

“If I saw 100 patients [who had early decay] and decided to wait six months before treating them, it would be the right decision for 95 of them. I think we do more harm by overtreating, because there will always be complications of treatment,” he says.

Once a tooth has a filling in it, there is always a chance the filling will crack, break or fall out. A space left between the filling and the tooth is a hot spot for further decay. Eventually, the tooth may need endodontic (root canal) treatment or may even need to be extracted.

Dr. Albert suggests that using the new technologies should actually lead to fewer fillings for most people, because early decay can be reversed with fluoride treatments or new oral hygiene habits. The reality may be different.

“Dentists who use these machines may actually do more [fillings],” he says. “For the general population, that’s wrong, although for some high-risk individuals, it’s good to find [decay] early and treat it early. But if you’re in a low-risk category, the treatment of choice is to do nothing.”

So why don’t most dentists watch and wait? They may be worried that the person won’t return in six months for another checkup. Or they may be worried that they will be perceived as indecisive or inexperienced.

Also, the detection devices aren’t always right. “Some things look like cavities, but they’re not,” Dr. Albert says. “A dark discoloration does not mean a cavity.”

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

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Soft Tissue Injuries

The soft tissues in the mouth are delicate and sensitive, and when they are injured, it can be very painful. Soft tissues, which include the tongue, cheeks, gums and lips, can be injured when you accidentally bite down on them, if you fall, are in an accident, or if you put food in your mouth that is too hot. Chewing on hard objects also can damage soft tissues.

What You Can Do

Soft tissue injuries usually do not bleed a lot, but when they do, the injury can seem worse than it really is. When the blood mixes with saliva, it may look like you are bleeding a lot. In most cases, the bleeding should stop within a few minutes. In the meantime, here’s what you should do:

  • Rinse your mouth thoroughly with a mild saltwater solution (1/2 teaspoon of salt in 8 ounces of water).
  • If the bleeding continues, press a damp piece of gauze against the injured area for 10 to 15 minutes. If you don’t have gauze, you can use a sanitary napkin, tampon or a clean piece of material that will soak up blood and saliva.
  • To relieve pain, slow the bleeding, and reduce swelling, hold ice to the area for five or 10 minutes.
  • If the bleeding doesn’t stop within a few minutes, the injury may be serious and you will need to see a doctor, preferably an oral and maxillofacial surgeon, right away. Maintain pressure on the area until you can be treated.

What Your Dentist Will Do

Dentists are trained to diagnose and repair damage to the soft tissues, but doctors and oral surgeons in hospital emergency rooms usually handle serious injuries to these areas.

The doctor or oral surgeon will wash the area thoroughly and determine whether the teeth are loose or damaged. If the teeth are not damaged and the injury is limited to the gum or other soft tissues, you may need stitches to close the wound and control the bleeding. In most cases, stitches will not be necessary, and the doctor will only need to wash the area thoroughly and remove any dirt or debris.

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