Bad Breath (halitosis)

 

Your first visit to Dr. Chapman's office promises to be a pleasant experience.  Many times patients are relieved to find out that their periodontal health is better than they thought it was!  Don't wait until it hurts.  The sooner you begin to get your mouth healthier, the better!  Gum disease frequently has no symtoms unless it is quite severe.

Making sound decisions about your dental care and oral health is an easy thing to do with the right preparation beforehand:

  • Make a list of questions to ask our office, so you don't forget anything on the day of your appointment. This includes any concerns you have, or oral problems you've been experiencing.

  • If you have dental insurance, remember to bring your insurance card with you.  Also, if your dentist has given you X-rays or a referral form, please bring them with you as well.

 

Periodontics is a dental specialty that involves the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.

Who is a periodontist?

A periodontist is a dentist who specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants. A periodontist typically has had two to three years of additional training in diagnosing and treating gum disease and its associated problems. Periodontists are experts in the most successful techniques for diagnosing and treating periodontal disease. Additionally, periodontists can perform cosmetic periodontal procedures to improve your smile. Often, dentists refer their patients to a periodontist when their periodontal disease is advanced.

During your first visit, Dr. Chapman will review your medical and dental history, as well as any medications you may be taking. This will be followed by:

  • A complete oral and periodontal exam of your gums to check for gum bleeding and swelling, and gum recession; your jawbone, to help detect the breakdown of bone surrounding your teeth; and your teeth, to determine their proper alignment and if any are sensitive, loose and how they fit together when you bite.
  • An assessment of the depth of the spaces, known as periodontal pockets, between your teeth.
  • X-rays, to show the bone levels between your teeth to check for possible bone loss.
  • Once the exam is completed, Dr. Chapman will in most cases immediately discuss with you his diagnosis and recommendations for treatment. He will answer your questions and you will have a thorough understanding of what your situation is and what needs to be done for optimal health. 


Treatment choices include:

  • Root Planing and Scaling, which is one of the most effective ways to treat gum disease when it is caught in its early stage, before it has progressed to significant bone loss. This is a thorough cleaning and removal of the disease -causing deposits on your teeth called tartar and is done by a dental hygienist. 
  • Pocket Reduction Treatment  (PRT) is without a doubt the most successful and time tested treatment for moderate and advanced cases of periodontal disease available today!  PRT is so effective because it involves the complete removal of tartar and the recontouring of the bone that supports the teeth to bring it back to the healthy shape that it is supposed to have.   Pocket Reduction Treatment is very beneficial when pockets are 5mm or greater.  With PRT the diseased pockets are very predictably reduced by 50%!  This allows your toothbrush to keep the now healthy pockets clean and leads to long term periodontal health!
  • Bone Grafting/Bone Regeneration is a very valuable procedure done at the same time as Pocket Reduction Treatment where Dr. Chapman places a special material into indentations in the bone caused by periodontal disease that commonly occur next to teeth.  Bone grafting helps to re-build some of the bone that supports the teeth.
  • Soft Tissue Grafts including: Connective Tissue Grafts which help to cover up the exposed root surfaces of teeth and can be a cosmetic problem as well as cause sensitivity;  Free Gingival Grafts, which move healthy gum tissue from one part of the mouth to another, and Pedical Grafts, which shift gums to cover areas where healthy tissue is needed.
  • Implants  are the most natural, most functional, best looking replacements for lost teeth that dentistry has today!  Think of an implant as a man-made tooth root that your dentist places a crown (cap) on.  Alternatives include a bridge where your dentist drills down on the teeth next to a space and the bridge is glued onto those teeth replacing the lost tooth in between.  This can lead to tooth decay (cavities) on those teeth, and can also put too much pressure on those teeth in some cases leading to additional tooth loss.  Another option is a partial denture, an appliance that you take out at night and put back in in the morning.  Many patients find that partials are cumbersome and difficult to chew with, not to mention unsightly.
  • Ridge Preservation  is done to help decrease the natural loss of bone that will occur after a tooth has been extracted.  This is commonly done in an area where an implant is to be placed.
  • Ridge Augmentation may be recommended if the bone where an implant is to be placed is too narrow and needs to be widened.
  • Crown lengthening is the lowering of the gum around a tooth, most often done so that your dentist can gain access to a cavity or fracture below where the gumline was. 
  • Cosmetic surgery is done to help reveal a beautiful smile where patients have too much gum tissue covering their teeth giving the appearance of very small teeth.  This is a  simple procedure that can have a dramatic effect on a persons smile!
  • Frenectomy is another easy procedure where excess gum tissue is removed from between the upper two front teeth that may be causing a spece to exist.  This is usually requested by an orthodontist who is trying to straighten teeth and close gaps between them. 
  • Fiberotomy is the easiest of all procedures again done at the request of an orthodontist to assist in the long term maintenance of straighter teeth. 

  

An estimated sixty-five percent of Americans have bad breath. Over forty-million Americans have "chronic halitosis," which is persistent bad breath. Ninety percent of all halitosis is of oral, not systemic, origin.

Americans spend more than $1 billion a year on over the counter halitosis products, many of which are ineffective because they only mask the problem.

What causes bad breath?

Bad breath is caused by a variety of factors. In most cases, it is caused by food remaining in the mouth - on the teeth, tongue, gums, and other structures, collecting bacteria. Dead and dying bacterial cells release a sulfur compound that gives your breath an unpleasant odor. Certain foods, such as garlic and onions, contribute to breath odor. Once the food is absorbed into the bloodstream, it is transferred to the lungs, where it is exhaled. Brushing, flossing and mouthwash only mask the odor. Dieters sometimes develop unpleasant breath from fasting.

Periodontal (gum) disease often causes persistent bad breath or a bad taste in the mouth, and persistent bad breath may mean a sign that you have gum disease.

Gum disease is caused by plaque - the sticky, often colorless, film of bacteria that constantly forms on teeth. Dry mouth or xerostomia may also cause bad breath due to decreased salivary flow. Saliva cleans your mouth and removes particles that may cause odor. Tobacco products cause bad breath, stain teeth, reduce your ability to taste foods and irritate your gum tissues. Bad breath may also be a sign that you have a serious health problem, such as a respiratory tract infection, chronic sinusitis, postnasal drip, chronic bronchitis, diabetes, gastrointestinal disturbance, liver or kidney ailment.

Here are characteristic bad breath odors associated with some of these illnesses:

  • Diabetes - acetone, fruity

  • Liver failure - sweetish, musty

  • Acute rheumatic fever - acid, sweet

  • Lung abscess - foul, putrefactive

  • Blood dyscrasias - resembling decomposed blood

  • Liver cirrhosis - resembling decayed blood

  • Uremia - ammonia or urine

  • Hand-Schuller-Christian disease - fetid breath and unpleasant taste

  • Scurvy - foul breath from stomach inflammation

  • Wegner`s granulomatosis - Necrotic, putrefactive

  • Kidney failure - ammonia or urine

  • Diphtheria, dysentery, measles, pneumonia, scarlet fever, tuberculosis - extremely foul, fetid odor

  • Syphilis - fetid

Bad breath may also be caused by medications you are taking, including central nervous system agents, anti-Parkinson drugs, antihistamines/decongestants, anti-psychotics, anti-cholinergics, narcotics, anti-hypertensives, and anti-depressants.

Caring for bad breath

Daily brushing and flossing, and regular professional cleanings, will normally take care of unpleasant breath. And don't forget your often overlooked tongue as a culprit for bad breath. Bacterial plaque and food debris also can accumulate on the back of the tongue. The tongue's surface is extremely rough and bacteria can accumulate easily in the cracks and crevices.

Controlling periodontal disease and maintaining good oral health helps to reduce bad breath.  If you have constant bad breath, make a list of the foods you eat and any medications you take. Some medications may contribute to bad breath.

Improperly cleaned dentures can also harbor odor-causing bacteria and food particles. If you wear removable dentures, take them out at night and clean them thoroughly before replacing them.

If your dentist determines that your mouth is healthy and that the odor is not oral in nature, you may be referred to your family physician or to a specialist to determine the cause of the odor and possible treatment. If the odor is due to gum disease, your dentist can either treat the disease or refer you to a periodontist, a specialist in treating gum tissues. Gum disease can cause gum tissues to pull away from the teeth and form pockets. When these pockets are deep, only a professional periodontal cleaning can remove the bacteria and plaque that accumulate.

Mouthwashes are generally ineffective on bad breath. If your bad breath persists even after good oral hygiene, there are special products your dentist may prescribe, including Zytex, which is a combination of zinc chloride, thymol and eucalyptus oil that neutralizes the sulfur compounds and kills the bacteria that causes them. In addition, a special antimicrobial mouth rinse may be prescribed. An example is chlorhexidine, but be careful not to use it for more than a few months as it can stain your teeth. Some antiseptic mouth rinses have been accepted by the American Dental Association for their breath freshening properties and therapeutic benefits in reducing plaque and gingivitis. Instead of simply masking breath odor, these products have been demonstrated to kill the germs that cause bad breath. Ask your dentist about trying some of these products.