Halitosis (bad breath) is a major personal and social concern — so much so that Americans spend nearly $3 billion annually on rinses, mints and gum to freshen breath. While helpful in alleviating occasional bad breath caused by oral dryness (brought on by stress, eating certain foods, prescription medications, smoking or consuming alcohol), those with chronic halitosis require a much different treatment approach.

That's because there are a number of possible causes for chronic halitosis, among them: xerostomia (chronic dry mouth), caused by mouth breathing; periodontal (gum) disease; or candidiasis, a yeast infection caused by some antibiotics. It may also arise as a secondary symptom of systemic diseases like liver disease, diabetes or cancer.

The most common cause, though, is bacteria. Many types of oral bacteria can produce terrible odors, most notably volatile sulphur compounds (VSCs) with their “rotten egg” smell. Because of its relative dryness and difficulty in cleaning, the back of the tongue is a wonderful environment for bacteria to multiply and thrive.

If you suffer from chronic halitosis, our primary objective then is to try to uncover its specific cause, which will determine what course of treatment we would recommend. First, what is your experience with halitosis — have others noticed it or just you? Next, we would consider your medical history — have you had any health issues with your ears, nose or throat, or experienced any gastrointestinal disorders or lung problems? What kind of medications do you take, and are your kidneys and liver functioning properly? We would also perform a thorough dental exam for any signs of tooth decay, gum disease or a dry, coated tongue as well as look at your diet and lifestyle choices, like smoking or alcohol use.

Having a better idea of what may be causing your bad breath, we can then tailor a treatment plan that might involve, among other things, treatment for tooth decay, a periodontal cleaning (scaling), instruction on better oral hygiene and tongue cleaning with a scraper or brush, or the removal of third molars where debris may be accumulating in the gum flaps.

Finding the cause of bad breath can take time, but is well worth the effort. The end result is a treatment plan that works.

If you would like more information on understanding and treating chronic halitosis, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Bad Breath: More than just embarrassing.”

1. What is a mouthguard? A mouthguard or mouth protector is a protective appliance that covers the teeth and gums to prevent or reduce injury to the teeth, gums, jaws, and lips during sports or other activities prone to injuries.
2. Who should use a mouthguard? Children, adolescents or even adults who participate in contact or injury prone sports should use a mouthguard.
3. What do you mean by contact sports? Mouthguards are used most commonly in sports such as boxing, football, hockey and lacrosse. The American Dental Association recommends protection for 27 different sports, including basketball, soccer, water polo, rugby and more. The governing bodies of football, boxing, ice hockey, men's lacrosse and women's field hockey require mouth protection. It's a good idea to use a mouthguard during any activity that could result in a blow to the face or mouth.
4. What does the mouthguard protect against? A mouthguard protects against breaking or dislodging teeth or injuring jaws, gums, lips, or tongue, all injuries that can happen when you engage in contact or injury prone sports.
5. What are my choices for mouthguards? The best choice is a custom-made mouthguard fitted and made by a dentist. Stock mouthguards that are one size fits all can be bought off-the-shelf in stores, but there is no guarantee of fit or protection. A third type is a “boil and bite” guard, in which the guard material is heated and then shaped by biting down on the softened material. This offers some attempt at fitting that is better than off-the-shelf, but not as good as a mouthguard that is designed specifically for you.
6. Why is it better to get a mouthguard from our office than to buy one at a store? Studies have shown that store-bought stock or boil-and-bite mouthguards do not offer the same protection as a custom-made mouthguard. In our office we will make a mold of your mouth and design your mouthguard to fit your individual characteristics. It will be comfortable and easy to clean and will not restrict your speech or breathing. It will be made of resilient and tear-resistant materials, properly adapted for maximum protection, comfort and injury protection.

Wearing a properly fitted and properly used mouthguard prevents injuries to teeth, jaws, gums, lips, or tongue when you or your child participates in contact sports. Make an appointment with us to discuss your custom fitted mouthguard. To learn more read the Dear Doctor magazine article “Mouthguards.”

You've probably heard of the relatively new method of straightening teeth with thin, plastic orthodontic appliances (“ortho” – to straighten; “odont” – teeth) known as clear aligners. Here are some reasons you might want to consider them for your orthodontic treatment:

1. Appearance. Looks aren't everything, as the saying goes. But it may be that metal-covered teeth will not give you a look you want to sport for perhaps a year or more. Adults in particular find that metal braces don't always fit in with their self-image. Because clear aligners are virtually invisible, your teeth will look as they always do and it will not be obvious that you are undergoing orthodontic treatment.
2. Control. When you have traditional braces, you cannot take them out of your mouth yourself. They must be professionally removed when your treatment is completed. With clear aligners, however, you can take them out to eat and also for important social occasions. Of course, that means you are also responsible for wearing them as often as needed — a minimum of 22 hours a day. It's a good bargain if you can live up to it, and most find that they can.
3. Hygiene. One of the challenges of traditional braces is to learn to clean around them so that your teeth and gums stay healthy throughout treatment. It's not always so easy to do. With clear aligners, you can maintain your usual oral hygiene routine — and also clean the aligners themselves.
4. Comfort. Sometimes the rigid brackets and wires of traditional braces can press into sensitive tissues of the mouth. It's something that you will eventually get used to, but it can be uncomfortable temporarily. The material of clear aligners is flexible, so this type of irritation is not an issue.
5. Versatility. In recent years, the clear alignment system has been improved to handle more serious malocclusions (“mal” – bad; “occlusion” – bite). Enhancements have also been made to accommodate additional growth of molar teeth in the case of teenagers.

While there are some cases in which traditional braces are still the best option, clear aligners have more applications than ever before. They also have some clear advantages that are worth considering.

If you would like more information about clear aligners, please contact us or schedule an appointment for a consultation. You can also learn more about clear aligners in general by reading the Dear Doctor magazine article “Clear Aligners For Teenagers.”

If you have to ask why anybody would voluntarily endure the pain of receiving a tongue piercing — then maybe you're just too old to understand. But seriously: no matter where you stand on the aesthetics of the issue, you shouldn't ignore the real health risks that go along with the installation of oral piercings.

According to the Journal of the American Dental Association, the most common sites for intraoral piercing are the tongue and the lip. In the case of the so-called “tongue bolt,” several significant short-term and long-term risks have been identified; most also apply to other types of oral piercings as well.

The tongue is primarily composed of muscle tissue, along with a rich supply of associated blood vessels and nerves. This explains why accidentally biting your tongue can be so painful — and bloody. Installing a tongue bolt involves piercing a small hole through the tongue, and attaching the ornament through the hole.

In rare instances — such as the case of a teenager who experienced severe pain and the sensation of electrical shocks — nerve irritation and damage may occur soon after a tongue bolt is installed. (Fortunately, her symptoms cleared up shortly after the bolt was removed.) More often, the symptoms are less severe, but the health issues are chronic.

Tongue bolts are known to cause problems with the teeth, including increased sensitivity and pain. Teeth are also prone to chipping due to contact with the ornament. These are among the reasons why you are likely to need more frequent dental checkups if you have an oral piercing.

Additionally, periodontal (gum) problems can develop in individuals with oral piercings. These frequently appear as gum recession, inflammation and infection. Eventually, bone loss may occur as well.

The good news: removing an oral piercing is generally easy, and the area is quick to heal. If it doesn't seal up by itself, the hole left behind can be closed with only minor surgery. And removing the piercing immediately reduces your health risk — thus instantly improving your overall oral health.

Thinking of getting — or removing — an oral piercing? Talk to us. No matter what you decide to do, you owe it to your health to become informed about the issues surrounding these body ornaments.

If you would like more information about oral piercings, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “How Oral Piercings Affect Your Oral Health,” and “Body Piercings and Teeth.”