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FAQs on Bad Breath

What causes bad breath?

Bad breath can be caused by such things as certain foods, poor oral hygiene, gum disease, a dry mouth (Xerostomia), tobacco products or a medical disorder. When bacteria accumulate because of poor oral hygiene or gum disease, or when saliva is lacking, bad breath can result. Saliva is necessary to wash away food particles and bacteria. Certain medications and disorders can lead to a dry mouth. Sometimes a sinus infection, postnasal drip or other respiratory tract infections can cause bad breath. If bad breath is persistent, contact your dentist to determine whether the cause is of dental origin.

I have very bad breath even after I brush my teeth! What can I do?

There are several different sources of oral malodor. These include mouth and tongue sources, nasal and sinus sources, lower respiratory tract and lung sources, gastrointestinal diseases and disorders, systemic diseases, and ingestion of certain foods, fluids, and medications. The first challenge is to determine if a patient has chronic or acute bad breath. Chronic halitosis occurs all the time.

If the source of halitosis is orally–related, tooth decay and/or periodontal disease is probably involved. Other oral problems, such as dry mouth, fungal infection, and oral cancer, can also contribute to oral malodor.

You are advised to gently brush their teeth, tongue and palate. Several companies market tongue scrapers.

Your best defense against bad breath is to practice excellent oral hygiene. This includes regular brushing, flossing, and tongue–scraping.

Chew sugar–free gum, especially if your mouth feels dry. Clean your mouth after eating or drinking milk products, fish and meat. Ask your dentist to recommend a mouthwash which has been shown to be clinically effective in fighting bad breath.

Is Asian diet related to oral health?

The Asian diet is not as rich in protein, fat, or calories compared with the typical American menu. In many ways, the Asian diet is healthier than fatty American cuisine. However, problems that can occur in a deficiency include:

1. Protein deficiency may lead to problems with gingivitis (gum disease).
2. Riboflavin deficiency may cause painful lesions at the corners of the mouth.
3. Vitamin C (ascorbic acid) deficiency can cause the gum tissue, which covers erupting teeth, to appear purple, swollen, and spongy. When teeth are present, vitamin C deficiency can adversely affect the health of the gum tissue, causing it to be red and irritated. This condition is called scurvy and it is extremely rare in developed countries.

Tooth decay is rampant in many Asian countries. This is attributed to lack of basic oral hygiene and not to an insufficient diet per se. Rice and sugarcane are staple crops in China, Philippines and India respectively.

Do different liquids effect teeth differently?

Different liquids affect teeth differently. One major factor to consider is the pH of the liquid. Liquids like saliva and milk do not dissolve teeth. In fact, it is widely recommended that you place a knocked–out tooth in saliva or, alternatively, milk until you can get to the dentist to have them try to replant the tooth.

Teeth do dissolve in cola or soda pop. This is due to a number of factors. Soda usually contains acetic and/or ascorbic acid (vitamin C). This makes cola acidic. Acid dissolves teeth. If the tooth is soaking in cola, the roots usually dissolve first because they lack enamel which covers the crown of the tooth to protect it from decay. As you know, even enamel will decay over time to cause a cavity.

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FAQs on Dentures

What is a denture?

A denture is a removable replacement for missing teeth and adjacent tissues. It is made of acrylic resin, sometimes in combination with various metals. Complete dentures replace all the teeth, while a partial denture fills in the spaces created by missing teeth and prevents other teeth from changing position. Complete dentures are either “Conventional” or “Immediate”. A conventional denture is placed in the mouth. About a month after all the teeth are removed to allow proper healing, whereas an immediate denture is placed as soon as the teeth are removed. The drawback behind an immediate denture is that it may require more adjustments after the healing has taken place.

What is the best way to get used to my new dentures?

As with any new appliance, dentures may feel quite odd. They may cause increased saliva flow or they may alter speech. One should start by cutting food into small pieces, avoid hot foods, and avoid hard foods until the tissue, where the denture rests, becomes used to the new teeth. As time goes by, one will become accustomed to them.

Do I brush them like real teeth?

No, dentures should be cleaned, if possible, after each meal. The best way is to remove them and rinse them. If one is able to, brushing the dentures is advised, as well as rinsing the mouth to clean it of any debris. If some natural teeth do remain, brushing them is suggested. Always soak dentures at night after brushing them. Over the counter cleaning agents are available. Keeping the dentures soaked prevents them from warping. It is also much healthier to keep the teeth out overnight to avoid excessive pressure on the soft tissue and bone. Always remember to brush your tongue and lightly brush the gums with a soft toothbrush. Special denture brushes should be used on the dentures.

When is it time for a new denture?

As the years pass, the tissue and bone may shrink slightly. The dentures will then loosen. Also, as one loses or gains weight, one may notice that the denture may loosen. Dentures, if the dentist advises, can be relined to help tighten them. However, if their bases are too far gone, a new one may need to be fabricated.

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FAQs on Bleaching

What is the material used in the whitening process?

The most popular and extensively researched material is a 10% carbamide peroxide, which is a mild form of 3% hydrogen peroxide.

Is it harmful to my teeth?

No, not if the proper material is used after a proper diagnosis by a health professional who will devise a treatment plan. The effect on the teeth seems to be no different from commonly–ingested foods or regular dental procedures.

What is the whitening process doing to my teeth?

The carbamide peroxide soaks into the tooth’s dentin and enamel. It removes stains that have also soaked into the tooth, as well as changes the color of the inside of the tooth by an oxidation process.

How white will my teeth get?

This depends on the nature of the staining and length of treatment. You may see up to 13 shades of color change. Some people lighten 7 shades in 7 days.

Are there any reasons I should not whiten my teeth?

Yes. Restorations (fillings such as tooth–colored composites and crowns) do not change color. If you have many fillings on our teeth that show when you smile, they may become more noticeable (look darker) after the teeth get lighter. Your dentist will examine you and advise you as to whether the improvement from whitening is worth the cost and risk of replacement of those restorations.

Are there any side effects or precautions?

Yes, some people may have episodes of tooth sensitivity during treatment. These are generally mild, and will stop when treatment is completed. However, your dental office will work with you to determine the best wearing time to minimize sensitivity. There are also medications available that can be used to reduce sensitivity which can be applied using the same carrier. People who have a history of sensitive teeth can use a desensitizing toothpaste containing potassium nitrate and fluoride during treatment. Occasionally, gingival (gum) irritation can occur from wearing the tray and is relieved by removing tissue contact from the tray.

Don’t whitening toothpastes do the same thing as the professional dental whitening technique?

No. Toothpaste is primarily intended for stains on the outside of the tooth. The dramatic change in tooth color inside the tooth has not been duplicated by whitening toothpastes. Some of the toothpastes that contain peroxide may be used to help maintain white teeth after they have been whitened by the dental whitening technique. Your dentist will work with you to find the best fluoride–containing toothpaste and proper toothbrush habits to maintain your whiter teeth.

How can I lighten the color of my teeth?

There are a variety of methods that can be used to lighten teeth. Probably the most cost–effective, safest technique available is professional, dentist–dispensed whitening. Your dentist will devise a special carrier (also called a night–guard or tray) to fit your mouth. Then, you insert the whitening agent into the custom carrier, and wear it over your teeth all night, or for several hours.

How long does it take for my teeth to become white?

That depends on the type of discoloration of your teeth. It may take only 3 to 5 days to lighten your teeth, or it may take several weeks or months. The average treatment time for moderately stained teeth is 2 to 6 weeks. Teeth stained by nicotine or by drugs such as tetracycline may require 2 to 6 months, depending on the nature of the staining.

How long does the whitening last?

Although some stain removal may be permanent, the average duration of the color change is from 1 to 3 years before any darkening is noticed. After that time, there is some color lapse, but not back to the original stained color. Recovering the whitened color generally takes only a few days of re–treatment. Some teeth have remained color stable for more than 7 years.

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FAQs on Dental Implants

I am considering dental implants. I have heard that available implants have a variety of different types of surfaces. What are your recommendation concerning coated implants. I am particularly concerned with the negative effects associated with hydroxyapatite coatings? Are my concerns warranted?

Your concerns are valid, because HA (Hyroxy Apatite) will dissolve in an acidic environment. HA is indicated, however, in porous bone in situations where the implant will be completely surrounded by bone (no acid attack). Here HA has an advantage over other surfaces because HA appears to have a higher initial success rate in porous bone. Another surface that is used is TPS (Titanium Plasma Spray). It has some advantages of a roughened surface and does not degrade significantly.

I am a 42 years old and have worn upper dentures for 20 years. Is it possible to do implants on the entire upper mouth? If so how much time is involved and would I ever be in a situation where I would be without teeth during the procedure?

Depending on the remaining bone left, it could be possible. A panoramic radiograph is needed to see the amount of bone left. Also since you are young the benefits are even greater. Depending on the surgeon you may have to be without teeth from one day to as long as a week. The healing of the implants in the bone takes from 4–6 months.

What is the life span of a dental implant?

The first “Osseo–integrated” implant placed in the mouth by Dr. Branemark is still in function today (32 years later). The generally accepted figure for bone loss around such “Fixture” is .1mm bone loss per year. Conceivably, a 12mm implant could then be in function for forty years. This conservative estimate does not consider further advances in the science of dentistry and orthopedics.

I was reading some articles on tooth implants and was wondering what the age limits were to having this kind of treatment done?

Anyone in good health is a possible candidate for dental implants. There are a few absolute contraindications to the surgery. However, they include uncontrolled diabetes and substance abuse.

Could you give a cost range for a front tooth dental implant? Also, how does an implant compare to other options (bridge, etc.)?

The cost of a dental implant with the restoration is comparable to that of a traditional three unit bridge. Because only one tooth is involved as opposed to cutting down additional teeth the implant can be thought of as being a more conservative approach.

The particular fee varies according to the type of implant system being used and generally costs anywhere between Rs. 15000 to Rs. 25000 per tooth that is being implanted.

My fourteen year old daughter has been missing a front tooth since she was nine. Is it too early to begin treatment?

Implant placement should usually only be attempted after all bone growth has ceased. The services of an orthopedist may be needed to take an X–ray of the wrist to determine whether growth has ceased. If this is the case, treatment can commence.

What can dental implants accomplish?

For answer refer the table as provided below.

Replacement of a single tooth	Replacement of multiple t eeth	Replacement of the entire dental arch

What are dental implants?

Dental implants are precisely manufactured substitute tooth roots usually made from titanium or its alloy. There are several different designs such as screws cylinders or baskets.

Prosthetic crowns fastened with machined screws are placed on top of the implant to replicate the missing teeth.

How are the crowns fastened to the implants?

Prosthetic Treatment – A post is fastened to the implant and replacement teeth are made. Because implants are fused to the bone or ankylosed, precision of fit is paramount. It may take several months in some cases to finish treatment. The crowns attached to the implants may either be screw or cement retained.

What is the surgery like?

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FAQs on Pediatric Tooth Decay

What causes baby bottle tooth decay?

Baby bottle tooth decay is caused by the frequent and long–term exposure of a child’s teeth to liquids containing sugars. Among these liquids are milk, formula, fruit juice, sodas, and other sweetened drinks.

The sugars in these liquids pool around the infant’s teeth and gums, feeding the bacteria that cause plaque. Every time your child consumes a sugary liquid, acid attacks his/her teeth. After numerous attacks, tooth decay can occur, resulting in baby bottle tooth decay.

Parents and care givers should be especially concerned with giving an infant a sugary drink at nap or night time. During sleep, the flow of saliva decreases, allowing the sugary liquids to pool around the child’s teeth for an extended period of time.

How to prevent baby bottle tooth decay?

Parents sometimes do not realize that baby’s teeth are susceptible to decay as soon as they appear in the infant’s mouth. By the time the decay is noticed, it may be too late to save the child’s teeth. You can prevent this from happening to your child’s teeth by knowing how to protect them.

After each feeding, wipe the child’s teeth and gums with a damp washcloth or small soft toothbrush to remove plaque. Begin brushing your child’s teeth as soon as the first tooth erupts.

Flossing should begin when all primary teeth have erupted, usually by age 2 or 2 1/2. Never allow your child to fall asleep with a bottle containing a sweetened liquid. If your child refuses to fall asleep without a bottle, simply fill it with water and nothing else.

If your local water supply does not contain enough decay–fighting fluoride, check with your dentist to see if your child should receive fluoride supplements. Start dental visits between six and twelve months of age.

How serious is baby bottle tooth decay?

Baby bottle tooth decay can cause painful toothaches which can hinder eating. Severely decayed teeth can become infected and need to be extracted. If your child’s teeth are infected or lost too early due to baby bottle tooth decay, your child may have some of these problems:

• Poor eating habits
• Speech problems
• Crooked teeth
• Damaged adult (permanent) teeth
• Yellow or brown adult (permanent) teeth

Keep your child happy and smiling by preventing baby bottle tooth decay.

Sealants: Sealing out decay

What causes tooth decay?
Your teeth are covered with a sticky film called plaque. Bacteria in plaque break down the sugars and carbohydrates in the food we eat, creating acids that can de–mineralize the enamel of the teeth. Repeated attacks may cause the enamel to break down resulting in cavities.

Brushing helps remove the sticky plaque and decreases the acid in contact with the enamel. But the toothbrush can not reach everywhere. The pits and fissures (grooves) on the chewing surface of the back teeth are narrower than toothbrush bristles preventing thorough cleaning of these areas that are prone to decay. The normal flow of saliva that helps clean food particles from other areas of the mouth, cannot wash out the pits and fissures.

Most cavities occur in these pits and fissures (about 60%) and the molars tend to have deeper pits and fissures than the premolars.

What is a sealant?
A sealant is a plastic resin coating that fills the pits and fissures, preventing plaque and food from getting into these hard to brush spots.

How long do sealants last?
Sealants hold up well under the forces of chewing and will last for several years before a reapplication may be necessary. As the visible portion of the sealant wears the pits and fissures still retain the resin and will continue to prevent decay.

How is a sealant applied?
No needles or drilling is required to place a sealant. The tooth is cleaned to remove any adherent plaque and then the pits and fissures are etched to roughen them so that the sealant adheres to the tooth better. The tooth is rinsed and dried, then the sealant resin is painted on and cured with a light.

Who can benefit from sealants?
The likelihood of developing pit and fissure decay begins as the teeth begin to erupt. Sealants are recommended for the permanent molars in children. The first molars erupt between age 5 and 7, followed by the second molars between ages 11 and 13.

Adults can also benefit from sealants in teeth that have not had a filling placed but have deep pits and fissures. Patients with dry mouth (Xerostomia) or on non–fluoridated water are more prone to decay and sealants can decrease the incidence of decay.

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FAQs on Preventive Dentistry

What is preventive dentistry?

Preventive dentistry for children includes:

• Brushing
• Dental development
• Flossing
• Fluorides
• Oral habits
• Orthodontics
• Parent involvement
• Proper diet
• Sealants
• Sports safety

Why is preventive dentistry important?

Preventive dentistry means a healthy smile for your child. Children with healthy mouths chew more easily and gain more nutrients from the foods they eat. They learn to speak more quickly and clearly. They have a better chance of general health, because disease in the mouth can endanger the rest of the body. A healthy mouth is more attractive, giving children confidence in their appearance. Finally, preventive dentistry means less extensive, and less expensive, treatment for your child.

When should preventive dentistry start?

Preventive dentistry begins with the first tooth. Visit your pediatric dentist when the first tooth comes in. You will learn how to protect your infant’s dental health. The earlier the dental visit, the better the chance of preventing dental disease and helping your child belong to the cavity–free generation.

What role do parents play in prevention?

After evaluating your child’s dental health, your pediatric dentist will design a personalized program of home care for your child. This program will include brushing and flossing instructions, diet counseling, and if necessary, fluoride recommendations. By following these directions, you can help give your child a lifetime of healthy habits.

How do pediatric dentists help prevent dental problems?

Tooth cleaning and polishing and fluoride treatments are all part of your child’s prevention program. But there’s much more. For example, your pediatric dentist can apply sealants to protect your child from tooth decay, help you select a mouth guard to prevent sports injuries to the face and teeth, and provide early diagnosis and care of orthodontic problems. Your pediatric dentist is uniquely trained to develop a combination of office and home preventive care to insure your child a happy smile.
Composite resins

What is a composite resin (white filling)?

A composite resin is a tooth–colored plastic mixture filled with glass (silicon dioxide). Introduced in the 1960s, dental composites were confined to the front teeth because they were not strong enough to withstand the pressure and wear generated by the back teeth. Since then, composites have been significantly improved and can be successfully placed in the back teeth as well. Composites are not only used for restoring decay, but are also used for cosmetic improvements of the smile by changing the color of the teeth or reshaping disfigured teeth.

How is a composite placed?

Following preparation, the dentist places the composite in layers, using a light specialized to harden each layer. When the process is finished, the dentist will shape the composite to fit the tooth. The dentist then polishes the composite to prevent staining and early wear.

How long does it take to place a composite?
It takes the dentist about 10–20 minutes longer to place a composite than a silver filling. Placement time depends on the size and location of the cavity. The larger the size, the longer it will take.

What is the cost?
Prices vary, but composites average about one–and–a–half to two times the price of a silver filling, i.e. approximately Rs. 350 to Rs. 800.

What are the advantages of composites?
Esthetics are the main advantage, since dentists can blend shades to create a color nearly identical to that of the actual tooth. Composites bond to the tooth to support the remaining tooth structure, which helps to prevent breakage and insulate the tooth from excessive temperature changes.

What are the disadvantages?
After receiving a composite, a patient may experience post–operative sensitivity. Also, the shade of the composite can change slightly if the patient drinks tea, coffee or other staining foods. The dentist can put a clear plastic coating over the composite to prevent the color from changing if a patient is particularly concerned about tooth color. Composites tend to wear out sooner than silver fillings in larger cavities, although they hold up as well in small cavities.

How long will a composite last?
Studies have shown that composites last 7–10 years, which is comparable to silver fillings except in very large restorations, where silver fillings last longer than composites.

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FAQs on Wisdom Teeth

When should wisdom teeth be removed?

Removal of wisdom teeth is the most common procedure performed by oral and maxillofacial surgeons. There is currently no totally accurate way to predict which wisdom teeth will cause problems and which won’t. As a result of this, dentists are subjective on whether wisdom teeth, that are not causing discomfort, should be removed or not.

Since dentists are divided in their decision–making process, it may be of some benefit for you to understand some of the risks and benefits in deciding if you should keep them or lose them. First we will discuss some of the possible risks and benefits of leaving them alone.

When is it necessary to remove wisdom teeth?

Wisdom teeth are a valuable asset to the mouth when they are healthy and properly positioned. Often, however, problems develop that require their removal. When the jaw isn’t large enough to accommodate wisdom teeth, they can become impacted (unable to come in or misaligned). Wisdom teeth may grow sideways, emerge only part away from the gum or remain trapped beneath the gum and bone.
Extraction of wisdom teeth is generally recommended when:

• Wisdom teeth only partially erupt. This leaves an opening for bacteria to enter around the tooth and cause an infection. Pain, swelling, jaw stiffness and general illness can result.
• There is a chance that poorly aligned wisdom teeth will damage adjacent teeth.
• A cyst (fluid–filled sac) forms, destroying surrounding structures such as bone or tooth roots.

Patients should ask the dentist about the health and positioning of their wisdom teeth. The dentist may make a recommendation for removal or send the patient to an oral surgeon for further evaluation.

What do you risk by not having your wisdom teeth removed?

One of the most common reasons is that impacted (angled forward) wisdom teeth push the other teeth forward and cause crowding. It is difficult to believe that one lowly wisdom tooth can push two molars, two premolars, and a canine tooth and create anterior tooth crowding. Some dentists still claim this can happen, but prevention of crowding is not a justifiable reason to remove the wisdom teeth. An impacted wisdom tooth can cause damage to the tooth in front of it. This is true, but only in less than two per cent of the population.

Periodontal disease around the wisdom tooth

This is possible, but in young adults less than one per cent showed signs of gum or bone problems. Lack of good oral hygiene increased the chance of periodontitis similar to any other tooth. Pericornitis, an infection that can lead to abscess formation, is most commonly seen in wisdom teeth partially covered with gum. It is a common reason for wisdom tooth removal. The development of cysts and tumors is often mentioned. This is very rare. Often cysts are confused with other normal X–ray features and their is much disagreement in dentistry about how frequently they actually occur. Tumors are found in less than one percent of unerupted wisdom teeth.

What are the benefits of not removing your wisdom teeth?

Benefits of not removing Wisdom teeth

Keeping the wisdom teeth allows the patient full potential for growth and development of the teeth and jaws. Complete eruption into a functional position allows a complete of teeth for function. A wisdom tooth can also, under the proper conditions, be transplanted to the position of a premature tooth loss elsewhere in the jaw. You are not exposing yourself to surgical risk. The risks and benefits of removal should also be examined.

What do you risk by having your wisdom teeth removed?

Minor complications found with wisdom tooth removal include nerve damage, alveolitis (dry socket), infection, trismus (difficulty in opening the mouth), hemorrhage, fractures, periodontal injury, and damage to the adjacent tooth. Alveolitis, or dry socket, is the most common complication, and is more common in patients older than 25 years and in women. It is also seen more often in patients who had to have their tooth removed than patients who elected to have them removed. Alveolitis will occur in one to five per cent of patients regardless of the dentist’s skill or surgical method chosen. Nerve damage is rare, but can involve paresthesia (lingering numbness) of the lip or tongue.

Major complications include dysesthesia (a sensation of being pricked by needles or something crawling on the skin) and infections. Most nerve injuries heal after a certain period, but permanent injuries do occur. Any damage lasting beyond six months is likely to be permanent. Infections are usually minor but occasionally can lead to cellulitis, endocarditis, and brain, liver or heart abscesses.

What are the benefits of having the wisdom teeth removed?

The younger the patient at the time of extraction, the fewer the complications. If a tooth has been targeted as problematic, it should be dealt with as soon as possible. The degree of difficulty and post–operative complications increase with age.

You don’t have to endure the procedure later in life after the roots have completely formed and the jaw has completely calcified. These factors along with a lessened healing response make wisdom tooth removal a more involved procedure.
Wisdom teeth

Typical Procedure

Typical Procedure

An incision is made and overlying bone is removed, exposing crown of the impacted tooth. Tooth is extracted whole or surgically sectioned. The site is sutured closed.
To ease any discomfort and promote healing:

• Use ice packs on the cheek for swelling, alternating on and off every thirty minutes.
• Apply biting pressure with clean gauze to stop bleeding.
• Eat soft foods and drink extra liquids.
• Avoid hard or crunchy foods in the tender area.
• Brush carefully the day after surgery.
• Take prescribed medications and follow all instructions as directed

Detail Procedure

The cost of the whole procedure is between Rs. 800 to Rs. 2500 Slight bleeding after an extraction is normal. A clot will usually form within one hour.

If bleeding continues, place a thick gauze pad over the extraction site. Apply pressure to the area to control the flow of blood.

If bleeding still persists, you may try soaking a tea bag in water, placing it inside a thin gauze pad, and apply pressure for one hour.

The tea leaves contain minerals which may aid in the clotting procedure. If bleeding has not stopped after several hours, it is important that you contact your Dentist.

Call your dentist or physician immediately in case of excessive bleeding or swelling, persistent, severe pain or fever.