Bad breath (halitosis) can be an unpleasant and embarrassing condition.  Many of us may not realize that we have bad breath, but everyone has it from time to time, especially in the morning.

There are various reasons one may have bad breath, but in healthy people, the major reason is due to microbial deposits on the tongue, especially the back of the tongue.  Some studies have shown that simply brushing the tongue reduced bad breath by as much as 70 percent.

What else might cause bad breath?

• Morning time – Saliva flow almost stops during sleep and its reduced cleansing action allows bacteria to grow, causing bad breath.
• Certain foods – Garlic, onions, etc.  Foods containing odor-causing compounds enter the blood stream; they are transferred to the lungs, where they are exhaled.
• Poor oral hygiene habits – Food particles remaining in the mouth promote bacterial growth.
• Periodontal (gum) disease – Colonies of bacteria and food debris residing under inflamed gums.
• Dental cavities and improperly fitted dental appliances – May also contribute to bad breath.
• Dry mouth (Xerostomia) – May be caused by certain medications, salivary gland problems, or continuous mouth breathing.
• Tobacco products – Dry the mouth, causing bad breath.
• Dieting – Certain chemicals called ketones are released in the breath as the body burns fat.
• Dehydration, hunger, and missed meals – Drinking water and chewing food increases saliva flow and washes bacteria away.
• Certain medical conditions and illnesses – Diabetes, liver and kidney problems, chronic sinus infections, bronchitis, and pneumonia are several conditions that may contribute to bad breath.

Keeping a record of what you eat may help identify the cause of bad breath.  Also, review with your dentist your current medications, recent surgeries, or illnesses.

What can I do to prevent bad breath?

• Practice good oral hygiene – Brush at least twice a day with an ADA approved fluoride toothpaste and toothbrush.  Floss daily to remove food debris and plaque from in between the teeth and under the gumline.  Brush or use a tongue scraper to clean the tongue and reach the back areas.  Replace your toothbrush every 2 to 3 months.  If you wear dentures or removable bridges, clean them thoroughly and place them back in your mouth in the morning.
• See your dentist regularly – Get a check-up once a year and cleaning at least twice a year.  If you have or have had periodontal disease, your dentist will recommend more frequent visits.
• Stop smoking/chewing tobacco – Ask your dentist what they recommend to help break the habit.
• Drink water frequently – Water will help keep your mouth moist and wash away bacteria.
• Use mouthwash/rinses – Most over-the-counter products provide only a temporary solution to mask unpleasant mouth odor.  Ask your dentist about antiseptic rinses that not only alleviate bad breath, but also kill the germs that cause the problem.

In most cases, your dentist can treat the cause of bad breath.  If it is determined that your mouth is healthy, but bad breath is persistent, your dentist may refer you to your physician to determine the cause of the odor and an appropriate treatment plan.

Brushing and flossing help control the plaque (containing bacteria) that cause dental disease.

Plaque is a film of food debris, bacteria, and saliva that sticks to the teeth and gums.  The bacteria in plaque convert certain food particles into acids that cause tooth decay.  Also, if plaque is not removed, it turns into calculus (tartar).  The plaque can be removed by the patient.  Once calculus starts to form there will be hiding places for the plaque that the brush and floss cannot remove. The calculus can be removed only by a dentist or hygienist.  Creating smooth surfaces that leave no hiding places that are impossible to brush and floss is the main reason for seeing the hygienist on a regular schedule.

Toothbrushing – Most people form plaque at a rate that makes it necessary to brush twice a day.  Use an ADA approved brush, as these all have soft bristles with polished ends.  Better yet, use an electric (Sonicare or Braun); they have the same bristle requirements and require less effort to remove all of the plaque. 

Brush at a 45 degree angle to the gums, gently using a small, circular motion, ensuring that you always feel the bristles on the gums.

• Brush the outer, inner, and biting surfaces of each tooth.
• Use the tip of the brush head to clean the inside front teeth.
• Brush your tongue to remove bacteria and freshen your breath (you might want to have a separate mechanical brush if using an electric brush for teeth).

Flossing – Daily flossing is the best way to clean between the teeth and under the gumline.  Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

• Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
• Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
• Curve the floss into a “C” shape around each tooth and under the gumline.  Gently move the floss up and down, cleaning the side of each tooth.

Floss holders are recommended if you have difficulty using conventional floss.  Before giving up on regular floss, try different brands of floss.  J&J brands work well.  "Glide" floss (has coating like teflon) is easiest but not quite as effective.  The most important goal is to find a floss that works.  Flossing is not a daily decision.  The practical answer to the question, "Do I have time to floss today?" will often be, "NO".  Flossing has to become a habit.  Think about this question: Why do all dentists and hygienists insist that everyone needs to be flossing?  You would think that we should be happy that all that extra dental work that is accumulating with every day of neglect.   

Rinsing – It is important to rinse your mouth with water after brushing, and also after meals (especially after consuming sugar) if you are unable to brush.  It helps to dilute the amount of sugars that "feed" the plaque.  Theoretically, if you had perfect brushing and flossing it would not matter about the sugar (don't count on this!).

Over the years there has been some concern as to the safety of amalgam (silver/mercury) fillings.  An amalgam is a blend of copper, silver, tin and zinc, bound by elemental mercury.  Dentists have used this blended metal to fill teeth for more than 100 years.  The controversy is due to claims that the exposure to the vapor and minute particles from the mercury can cause a variety of health problems.

The general consensus is that amalgam (silver) fillings are safe as far as the mercury issue is concerned.  All government agencies and professional organizations seem to be in agreement about that conclusion.  If anyone should be concerned about the dental mercury issue it should be the dental personnel.  I have not placed any mercury fillings in my office for about ten years, but my staff and I are replacing them daily.  If there were a substantial risk, I would consider another profession or go into teaching.  How do I know that there is no risk?  I have my own blood and/or urine tested about every two years for mercury content and have never had even a trace of mercury detected. 

That having been said, how come I do not use mercury fillings in my office?  The answers are many.  The main answer is that there are so many nicer looking materials to use that actually bond to the teeth, adding strength to the teeth instead of just "filling space", which is what the mercury type filling does.  The tooth-colored composites definitely take more skill to place.  The tooth has to be kept very dry (thus the use of a rubber dam), and the increments of composite kept very small when being placed to compensate for the material's contraction during the light curing.  Once placed, composites and high tech porcelains have the same expansion and contraction as does the natural tooth.  The old mercury fillings expand more than the tooth, resulting in fractured teeth that usually require crowns to restrore.  Most of the crowns that I place daily are necessary because of broken teeth that had large amalgam/mercury fillings.  For me, these are enough reasons not to use amalgam/mercury fillings and to use higher tech tooth-colored composites and porcelains. 

You should have your teeth checked and cleaned at least twice a year, though your dentist or dental hygienist may recommend more frequent visits.

Regular dental exams and cleaning visits are essential in preventing dental problems and maintaining the health of your teeth and gums.  At these visits, your teeth are cleaned and checked for cavities.  Additionally, there are many other things that are checked and monitored to help detect, prevent, and maintain your dental health.  These include:

• Medical history review: Knowing the status of any current medical conditions, new medications, and illnesses, gives us insight to your over all health and also your dental health.
• Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss.X-rays also help determine tooth and root positions.
• Oral cancer screening: Check the face, neck, lips, tongue, throat, tissues, and gums for any sings of oral cancer.
• Gum disease evaluation: Check the gums and bone around the teeth for any signs of periodontal disease.
• Examination of tooth decay: All tooth surfaces will be checked for decay with special dental instruments.
• Examination of existing restorations: Check current fillings, crowns, etc.
• Removal of calculus (tartar): Calculus is hardened plaque that has been left on the tooth for sometime and is now firmly attached to the tooth surface.  Calculus forms above and below the gum line, and can only be removed with special dental instruments.
• Removal of plaque: Plaque is a sticky, almost invisible film that forms on the teeth.  It is a growing colony of living bacteria, food debris, and saliva.  The bacteria produce toxins (poisons) that inflame the gums.  This inflammation is the start of periodontal disease!
• Teeth polishing: Removes stain and plaque that is not otherwise removed during toothbrushing and scaling.
• Oral hygiene recommendations: Review and recommend oral hygiene aids as needed (electric dental toothbrushes, special cleaning aids, fluorides, rinses, etc.).
• Review dietary habits: Your eating habits play a very important role in your dental health.

As you can see, a good dental exam and cleaning involves quite a lot more than just checking for cavities and polishing your teeth.  We are committed to providing you with the best possible care, and to do so will require regular check-ups and cleanings.

Four out of five people have some degree of periodontal disease and don’t know it!  Most people are not aware of it because the disease is usually painless even in the advanced stages of the disease process.   Having regular dental check-ups are very important and will help detect if periodontal problems exist.

Periodontal disease begins when plaque, a sticky, colorless, film of bacteria, food debris, and saliva, is left on the teeth and gums.  The bacteria produce toxins (acids) that inflame the gums and slowly destroy the bone.  Effective brushing, effective flossing, and keeping a regular schedule with our dental hygienist give you an average of 95% chance of controlling the health of your gum tissue.  Why 95%?  If neither of your parents lost any teeth into their later years, then raise that to 99.5%.  If your genetics are such that your parents lost several teeth, then lower that to 90%.  The latter group needs to increase its attention to the advice of our hard-working, caring hygienist of almost twenty years, Joyce Johnson, RDH. 

Other than oral hygiene and genetics, there are several other factors that may increase the risk of developing periodontal disease:

• Smoking or chewing tobacco – Tobacco users are more likely than nonusers to form plaque and tartar on their teeth.

• Certain tooth or appliance conditions – Bridges that no longer fit properly, crowded teeth, or defective fillings that may trap plaque and bacteria.

• Many medications – Steroids, cancer therapy drugs, blood pressure meds, oral contraceptives.  Some medications have side affects that reduce saliva, making the mouth dry and plaque easier to adhere to the teeth and gums.

• Pregnancy, oral contraceptives, and puberty – Can cause changes in hormone levels, causing gum tissue to become more sensitive to bacteria toxins.

• Systemic diseases – Diabetes, blood cell disorders, HIV / AIDS, etc.

• Genetics plays a role – Patients with a family history of tooth loss should pay particular attention to their gums.

Signs and Symptoms of Periodontal Disease

• Red and puffy gums – Gums should never be red or swollen for more than just a day or two.
• Bleeding gums – Gums should never bleed, even when you brush vigorously or use dental floss (again for more that a day or two maximum).
• Persistent bad breath – Could be caused by bacteria in the gum infection.
• New spacing between teeth – Caused by bone loss.
• Loose teeth – Caused by bone loss.  This is a very bad sign.
• Pus around the teeth and gums – Sign that there is an infection present.
• Receding gums – Loss of gum around a tooth.  Don't panic over this one, though, as there are other causes for receding gums.

The solution is strictly a behavior one.  Since you can't control  1) genetics, then 2) do good brushing, 3) do good flossing, and 4) minimize sugar exposures.  Your regular visits with the hygienist enough times per year then become the preventive key for neutralizing any shortcomings in factors 1 - 4.  "Enough times" becomes an "educated guess" as to the minimum professional care that it will take to keep all of our patients' healthy.  For those who choose less professional help, however, dental implants have GREATLY reduced the tragedy of tooth loss.

Brushing our teeth removes food particles, plaque, and bacteria from all tooth surfaces, except in between the teeth.  Unfortunately, our toothbrush can’t reach these areas that are highly susceptible to decay and periodontal (gum) disease.

Daily flossing is the best way to clean between the teeth and under the gumline.  Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, bone.  It can eliminate one source of "bad breath"

Plaque is a sticky, almost invisible film that forms on the teeth.  It is a growing colony of living bacteria, food debris, and saliva.  The bacteria produce toxins (acids) that cause cavities and irritate and inflame the gums.  Also, when plaque is not removed above and below the gumline, it hardens and turns into calculus (tartar).  This will further irritate and inflame the gums and also slowly destroy the bone.  This is the beginning of periodontal disease.

How to floss properly:

• Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
• Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
• Curve the floss into a “C” shape around each tooth and under the gumline.  Gently move the floss up and down, cleaning the side of each tooth.

Floss holders are recommended if you have difficulty using conventional floss.  Before resorting to floss holders, however, try several different brands and types of floss.  Some are easier to hold onto than others. 

Daily flossing will help you keep a healthy, beautiful smile for life!

When we say "All good things begin with a smile" we are not just repeating a phrase from some marketing campaign.  A significant part of how people react to you is dependent upon your body language.  Your appearance is part of that body language.  One dental extreme would be meeting a person for the first time who is talking with you and has gross decay in every visable tooth.  What conclusions would you draw about that person?  How far up the spectrum from that person is the place that you would like to be?  The answer to that is, of course, a very personal judgment call.  It is also an extremely complex judgment call involving cultural norms, conclusions about self-worth, differences in value systems that have to do with focus on physical appearance and health, and/or personal mode of operation that always favors maintaining the "known" present condition.  However, if a person is interested in improving how people react to his of her personal appearance, the time has never been better.  The process has become much more conservative because of stronger materials that look exactly like real enamel, and the training available is extensive in a select few teaching institutes (Dr. Turner and his staff have attended all the LVI "hands-on" live-patient clinical courses).

Patients are becoming more and more focused on improving their overall health.  This includes dental prevention and having a healthier and better looking smile.  An additional benefit is having a healthier, more comfortable bite.

There are many cosmetic dental procedures available to improve your teeth and enhance your smile.  Depending on your particular needs, cosmetic dental treatments can change your smile dramatically, from restoring a single tooth to having a full mouth make-over.  Changing smiles is the favorite part of what we do.  Nobody gets excited or emotional about a perfectly done gold crown on an upper second molar.  But the whole staff comes in the treatment room to be part of the emotion when the day comes to place the final veneers to create someone's new smile. 

Cosmetic Procedures:

Teeth Whitening:  Most of the yellow, brown, or orange colors are stains that come from coffee, tea, caramel colors in soft drinks, and even colors in catsup.  These colors filter through the microfractures in the enamel and end up in the interface between the enamel and the dentin (about 1 1/2 mm deep).  That is why no amount of surface polishing will remove that specific stain.  The good news is that the same microfractures allow our whitening gels to penetrate into that same interface to remove those acquired stains. 

Bonded Composite Resorations: Now widely used instead of amalgam (silver) fillings to repair teeth with cavities and also to replace old defective fillings. Tooth-colored fillings are also used to repair chipped, broken, or discolored teeth.  This type of filling is also very useful to fill in gaps and to protect sensitive, exposed root surfaces caused by gum recession.

Porcelain Veneers: Veneers are thin custom-made, tooth-colored shells that are bonded onto the fronts of teeth to create beautiful smiles.  They can help restore or camouflage damaged, discolored, poorly shaped, or misaligned teeth.  Unlike crowns, veneers require minimal tooth structure to be removed from the surfaces of the teeth.

Porcelain Crowns (caps): A crown is a tooth-colored, custom-made covering that surrounds the tooth, restoring it to its original shape and size.  Crowns protect and strengthen teeth that cannot be restored with fillings or other types of restorations.  They are ideal for teeth that have large, fractured or broken fillings and also for those that are badly decayed.

Dental Implants: Dental implants are titanium cylinders that simulate the same shape(s) as the roots of the natural tooth it replaces.  It is surgically placed into the bone to replace one or more missing teeth.  Porcelain crowns, bridges, and dentures can be made to fit and attach to implants, much the same as a natural tooth would be used for these same restorations.  In some areas of the mouth, implants have a 99% success rate, making these the obvious choice for success and good value.

Orthodontics: Less visible and more effective brackets and wires are making straightening teeth with orthodontics much more appealing to adult patients.  Also, in some cases, teeth may be straightened with custom-made, clear, removable aligners that require no braces.  That system is called Invisilign and is done by several local orthodontists.  There are instances where the cosmetic and bite solution has to include orthodontics.  However, there are many times where veneers can create the beautiful smile in as little as three weeks.  The veneers have also the advantage of being able to enhance or correct the natural tooth colors.  Using veneers has the important advantage of not needing to move the teeth from their natural positions.  That means that there is no tendency for them to "go back where they came from" because they stay in their same original root positions. 

Thanks to the advances in modern dentistry, cosmetic treatments can make a difference in making your smile shine!

Porcelain veneers are very thin shells of tooth-shaped porcelain that are individually crafted to cover the fronts of teeth.  They are very durable and will not stain, making them a very popular solution for those seeking to restore or enhance the beauty of their smile.

Veneers may be used to restore or correct the following dental conditions:

• Severely discolored or stained teeth
• Unwanted or uneven spaces
• Worn or chipped teeth
• Slight tooth crowding
• Misshapen teeth
• Teeth that are too small or large

Getting veneers usually requires two visits.  Veneers are created from an impression (mold) of your teeth that is then sent to a professional dental laboratory where each veneer is custom-made (for shape and color) for your individual smile.

With little or no anesthesia, teeth are prepared by lightly buffing and shaping the front surface of the teeth to allow for the small thickness of veneers.  The veneers are carefully fitted and bonded onto the tooth surface with special bonding cements and occasionally a specialized light may be used to harden and set the bond.

Veneers are an excellent dental treatment that can dramatically improve your teeth and give you a natural, beautiful smile.

Since teeth whitening has now become the number one aesthetic concern of many patients, there are many products and methods available to achieve a brighter smile.

Professional teeth whitening (or bleaching) is a simple, non-invasive dental treatment used to change the color of natural tooth enamel, and is an ideal way to enhance the beauty of your smile.  Over-the-counter products are also available, but they are much less effective than professional treatments and may not be approved by the American Dental Association (ADA).

As we age, the outer layer of tooth enamel wears away, eventually revealing a darker or yellow shade.  The color of our teeth also comes from the inside of the tooth, which may become darker over time.  Smoking, drinking coffee, tea, and wine may also contribute to tooth discoloration, making our teeth yellow and dull.  Sometimes, teeth can become discolored from taking certain medications as a child, such as tetracycline.  Excessive fluoridation (fluorosis) during tooth development can also cause teeth to become discolored.

It’s important to have your teeth evaluated by your dentist to determine if you’re a good candidate for bleaching.  Occasionally, tetracycline and fluorosis stains are difficult to bleach and your dentist may offer other options, such as veneers or crowns to cover up such stains.  Since teeth whitening only works on natural tooth enamel, it is also important to evaluate replacement of any old fillings, crowns, etc. before bleaching begins.  Once the bleaching is done, your dentist can match the new restorations to the shade of the newly whitened teeth.

Since teeth whitening is not permanent, a touch-up may be needed every several years to keep your smile looking bright.

The most widely used professional teeth whitening systems:

Home teeth whitening systems: At-home products usually come in a gel form that is placed in a custom-fitted mouthguard (tray), created from a mold of your teeth.  The trays are worn either twice a day for approximately 30 minutes, or overnight while you sleep.  It usually takes several weeks to achieve the desired results depending on the degree of staining and the desired level of whitening.

In office teeth whitening: This treatment is done in the dental office and you will see results immediately.  It may require more than one visit, with each visit lasting 30 to 60 minutes.  While your gums are protected, a bleaching solution is applied to the teeth.  A special light may be used to enhance the action of the agent while the teeth are whitened.

Some patients may experience tooth sensitivity after having their teeth whitened.  This sensation is temporary and subsides shortly after you complete the bleaching process, usually within a few days to one weak.

Almost all of the veneers that we placed fifteen years ago still look great and are functioning the same as natural teeth (some better than natural teeth).  Expect fifteen years to twenty years.  The extra five years comes from the fact that the porcelains and bonding agents being used today are much stronger and look even more natural than those we were using fifteen years ago.

The discovery of titanium as the material-of-choice for replacing the natural root of a tooth with an artificial cylinder that is in the same position and functions much the same as the natural tooth it is replacing is undoubtedly the most significant devolpment of all that has happened in dentistry since the development of local anesthesia.

I recently finished my first case of restoring both the full upper arch and the full lower arch where there had been no teeth for over fifty years.  Now, try to imagine going from wearing removable dentures to having all your own teeth back.  That was one of the most satisfying cases of my whole dental career.

That having been said, most implant cases are something short of that extreme, but here are some of the reasons why I think that having implants is one of the nicest things that can happen to any patient with any number of missing teeth.

Again, I always like to consider the extremes.  Are these implants so good that everyone should rush in and have all their natural teeth replaced with implants?  The answer is, of course, probably not!  It is certainly not the answer for someone who has teeth healthy enough to last the rest of his or her lifetime.  However, the likelihood of an implant in the lower jaw is 99%, and I can think of hundreds of molars in my practice that have had root canals, posts, and crowns that have something less than that happy implant prognosis.  The practical application of any statistics would be to turn the situation back around to ask me, "What would Dr. Turner do if it were his own tooth needing that root canal, post, and crown?"  Absolutely, I would have my tooth removed and an implant placed.  Why would I opt for treatment that has a 95% chance of success when I can have one that has a 99% success rate?  The "standard of care" among dental professionals isn't so quick to respond to the obvious, but mark my words, scientific observation will eventually prevail.