Bad breath can have a serious impact on a person's social and business life. Americans are well aware of this fact, and spend nearly $3 billion each year on gums, mints, and mouth rinses in order to make their breath “minty fresh.”

Bad breath or halitosis (from the Latin halitus, meaning exhalation, and the Greek osis, meaning a condition or disease-causing process) can originate from a number of causes; but oral bacteria are the most common source. About 600 types of bacteria grow in the average mouth. If bacteria act on materials that have been trapped in your mouth, many of them produce unpleasant odors.

Most often, bad breath starts on the back of the tongue, the largest place in the mouth for a build-up of bacteria. In this area bacteria can flourish on remnants of food, dead skin cells, and post-nasal drip. As they grow and multiply these bacteria produce chemical products called volatile sulfur compounds or VSCs. These compounds emit smells of decay reminiscent of rotten eggs.

In addition to bacteria on the tongue, halitosis may come from periodontal (gum) disease, tooth decay, or other dental problems. If you have halitosis, it is thus important to have a dental examination and assessment, and to treat any such problems that are found. Treating bacteria on the tongue without treating underlying periodontal disease will only temporarily cure bad breath.

The next step is to take control of tongue bacteria by brushing or scraping your tongue, with possible addition of antiseptic mouth rinses. People who have bad breath have more coating on their tongues than those who don't, and regularly cleaning the surface of the tongue has been demonstrated to reduce bad breath.

Implements have been designed specifically for the purpose of scraping or brushing the surface of the tongue. Using a toothbrush is not as effective because it is designed to clean the hard tooth surface, rather than the spongy surface of the tongue. To keep your breath fresh, you must regularly remove the coating from your tongue. This means acquiring a tongue scraper or brush and using it every day.

Contact us today to schedule an appointment to discuss your questions about tongue cleaning and bad breath. You can also learn more by reading the Dear Doctor magazine articles “Tongue Scraping” and “Bad Breath.”

If you engage in frequent air travel, you have probably experienced pain in your ears and sinuses related to pressure changes. The pain is caused by “barotraumas” (from baro meaning pressure — also the root of the word “barometer” — and trauma meaning injury) and is also called a “squeeze.” Divers also sometimes experience this discomfort or pain.

The cause of barotraumas is air pressure (or water pressure, in the case of divers) on the outside of your body that is not equal to the pressure inside your body. Normally when pressure outside your body changes, your organs such as your blood, bones, and muscles transmit the changes equally from outside to inside. Some structures in your body, such as your middle ear spaces and your sinus cavities (spaces in the facial bones of the skull), don't transmit the pressure as well because they are filled with air and have rigid walls. The maxillary (upper jaw) sinuses are pyramid-shaped spaces in the bone located below your eyes, on either side of your nose.

You have probably tried to stop such pain in your ears by yawning, chewing, or moving your jaw back and forth. These maneuvers, called “clearing,” allow air to move from the back of your throat into your ear canals so that the pressure can equalize. Similarly, your sinuses have small openings near their lower borders, so that you can clear pressure changes within them. If you have a head cold or flu and the membranes lining your sinuses are swollen and inflamed, they may close off the openings and make it difficult to clear these spaces. This can sometimes lead to intense pain.

Because the lower walls of these sinuses are adjacent to your upper back teeth, these teeth share the same nerves as the maxillary sinuses. This sharing sometimes causes pain felt in your back teeth to be perceived as pain in the sinuses, or vice versa. Pain felt a distance from its actual stimulus because of shared nerves is called “referred pain.”

Be sure to make an appointment with us if you experience pain in any of your teeth. Any defect in a filling or tooth can allow air to enter the tooth. It could be referred pain from your sinuses, or the result of pressure changes on trapped air within a filling or a tooth. Such pain, called barodontalgia (from baro meaning pressure, don't meaning tooth, and algia meaning pain) is an early sign of injury in a tooth.

Contact us today to schedule an appointment to discuss your questions about tooth and sinus pain. You can also learn more by reading the Dear Doctor magazine article “Pressure Changes Can Cause Tooth & Sinus Pain.”

Ensuring that your children have good oral health is (or should be) the goal of every parent or caregiver. But how confident are you about this topic? The following true/false quiz will help you evaluate your expertise while learning more about keeping your child's teeth healthy.

Questions

1. All children older than 6 months should receive a fluoride supplement every day.
2. Parents should start cleaning their child's teeth as soon as the first tooth appears.
3. Parents should start brushing their child's teeth with toothpaste that contains fluoride at age 3.
4. Children younger than 6 years should use enough toothpaste with fluoride to cover the toothbrush.
5. Parents should brush their child's teeth twice a day until the child can handle the toothbrush alone.
6. Young children should always use fluoride mouthrinses after brushing.

Answers

1. False. Check with your child's physician or dentist about your children's specific fluoride needs. If your drinking water does not have enough fluoride to help prevent cavities, parents of a child older than 6 months should discuss the need for a fluoride supplement with a physician or our office.
2. True. Start cleaning as soon as the first tooth appears by wiping the tooth every day with a clean, damp cloth. Once more teeth erupt, switch to a small, soft-bristled toothbrush.
3. False. Parents should start using toothpaste with fluoride to brush their children’s teeth at age 2. Only use toothpaste with fluoride earlier than age 2 if the child's doctor or our office recommends it.
4. False. Young children should use only a pea-sized amount of fluoride toothpaste. Fluoride is important for fighting cavities, but if children younger than 6 years swallow too much fluoride, their permanent teeth may develop white spots. Using no more than a pea-sized amount of toothpaste with fluoride can help prevent this from happening.
5. True. Because children usually do not have the skill to brush their teeth well until around age 4 or 5, parents should brush their young children's teeth thoroughly twice a day. You should continue doing this until the child can demonstrate a proper brushing technique.
6. False. Fluoride mouthrinses have a higher concentration of fluoride than toothpaste containing fluoride. Children younger than 6 years of age should not use fluoride mouthrinses unless your child's doctor or our office recommends it. Young children tend to swallow rather than spit it out, and swallowing too much fluoride before age 6 may cause the permanent teeth to have white spots.

Learn More

If you feel you missed too many of the above questions, read the Dear Doctor article, “Oral Hygiene Behavior.”

We tend to think of aspirin as a harmless medication. It is dispensed over the counter and is the most widely used OTC medication in the U.S. We take it without thinking we may be exposing ourselves to risks. But in certain situations aspirin can cause dangerous side effects.

What is aspirin, and how does it work?
The chemical name for aspirin is acetylsalicylic acid. It is used to reduce mild pain, inflammation and fever. When you take an aspirin, it blocks the formation of prostaglandins, substances your body creates that are associated with inflammation. Prostaglandins cause inflamed tissues to become red and swollen, but they also serve protective purposes, such as forming a barrier that protects the stomach from the acid it produces to digest your food. That's why long-term aspirin use can sometimes cause stomach bleeding and ulceration or other health problems.

Why do cardiac patients take aspirin?
Another effect of aspirin is to prevent blood platelets from clumping together. Blood platelets are structures in the blood, smaller than white or red blood cells, that aid clotting by sticking together at the site of an injury. This effect of aspirin can cause prolonged bleeding, but it may be beneficial to people who have cardiovascular (from cardio, meaning heart; and vascular, meaning vessel) disease with narrowed blood vessels.

Aspirin can keep blood flowing in the obstructed vessels and thus prevent heart attacks and strokes; but it can also increase the risk for strokes that are caused by bleeding in the brain. Most physicians attempt to lower such risks by asking their patients to keep their daily aspirin consumption to a low dose 81 mg “baby” aspirin.

How does aspirin affect your teeth and gums?
Be sure to let your medical and dental professionals know you are taking aspirin, and how much you take. Also tell us about other OTC medications you take, including herbal medications and supplements, because they may interact with aspirin to cause side effects.

If you have been told to take aspirin because of a cardiac condition or procedure, be sure to follow your recommended treatment. Do not suddenly discontinue aspirin therapy; doing so can increase your risk for heart attack and stroke. Ask us if you should stop taking aspirin before a major dental or oral surgery, but do not stop taking it on your own. We will consult with your physician about your medical condition and let you know our recommendation. In most cases you can continue your aspirin therapy without causing excessive bleeding during the dental procedure.

Contact us today to schedule an appointment. You can also learn more by reading the Dear Doctor magazine article “Aspirin: Friend or Foe?”

Periodontal (gum) disease, though it may be invisible to everyone but your dentist, can have a powerful effect on your entire body. Not only is it dangerous to your teeth and jaws, but it can increase your risk of heart attack and stroke, cause preterm births in pregnant women, and affect blood sugar control in diabetics.

Diabetics are our subject for today. Symptoms of diabetes include abnormally high levels of glucose (a form of sugar) in the blood, leading to frequent urination, excessive thirst, blurred vision, unexplained weight loss, and loss of energy. The disease can also cause severe complications in various parts of the body.

Normally, glucose, your body's main energy source, is kept under control by a hormone called insulin, which is made by an organ called the pancreas. In type 1 diabetes, a person's pancreas does not produce enough insulin to deal with all the glucose in his or her blood. In type 2 diabetes — a condition related to increased age, physical inactivity, overweight, and heredity — the pancreas may produce enough insulin, but the body is not able to use it effectively. This condition is called insulin resistance.

People with type 1 diabetes need insulin to survive. Type 2 may be treated with exercise, diet, medications, and insulin supplements.

Serious complications of diabetes range from kidney failure, blindness, and nerve damage to infections that do not heal, gangrene and amputation of limbs.

Diabetes and periodontal disease seem to have reciprocal effects on each other. Diabetics are more likely to have periodontal disease than non-diabetics; and those with periodontal disease are likely to face worsening blood sugar control over time.

Periodontal disease (from “peri”, meaning around and “odont”, meaning tooth), is caused by dental plaque — a film of bacteria that settles on your teeth and gums every day. It's what you remove with daily brushing and flossing. Any bacteria that remain cause inflammation, which can lead in the worst cases to loss of bone and eventual loss of teeth.

The close relationship of diabetes and periodontal disease probably results from changes in the function of immune cells responsible for healing. Inflammation is a part of normal wound healing — but chronic or prolonged inflammation can destroy the tissues it was meant to heal. This may be a major factor in the destructive complications of diabetes.

Many of these complications begin in the blood vessels. Like the eyes and the kidneys, gum tissues are rich in blood vessels. Gum tissues are also under constant attack from bacteria. If you are a diabetic, effective plaque control, along with regular professional dental cleaning, can have positive effects not only on periodontal disease, but also on control of your blood glucose level.

Contact us today to schedule an appointment to discuss your questions about periodontal disease and its connections with diabetes. You can also learn more by reading the Dear Doctor magazine article “Diabetes & Periodontal Disease.”