Non-surgical Periodontal Therapy

KatieM

Katie Moynihan, BS RDH

Non-surgical Periodontal Therapy

If your hands bled when you washed them, you would be concerned. However, many people think it is normal if their gums bleed when they brush or floss. False! Inflammation and bleeding are early signs that your gums are infected with bacteria. If not treated quickly and properly, those early signs of gingivitis may lead to a more serious infection called periodontal disease.

Periodontal disease affects the supporting tissues around the teeth including the gums, the periodontal ligament, and the bone. As the plaque in your mouth spreads and accumulates below the gum line, the toxins within that plaque infect and break down the “foundation” that hold your teeth in place. If not treated with periodontal therapy, the disease will only get worse and tooth loss may occur.

In the presence of periodontal disease, a “regular” prophylaxis cleaning can NOT be completed. The definition of prophylaxis is the prevention of disease. Once periodontal disease is diagnosed, your dentist and dental hygienist will recommend non-surgical periodontal therapy. Non-surgical periodontal therapy is also referred to as scaling and root planing, or a deep cleaning. Scaling and root planing involves thoroughly removing the plaque and calculus (tartar) that resides above and below the compromised gums. Smoothing the tooth roots allows a clean surface for tissue re-attachment and pocket reduction. Local anesthetic is recommended to make this procedure comfortable and painless for the patient. The goal for non-surgical periodontal therapy is to treat and eliminate the active infection, reduce periodontal pocketing around teeth, prevent further bone loss. The shallower the pockets are around your teeth, the easier they are to keep clean and healthy! When periodontal health is achieved, your oral health care provider will recommended more frequent periodontal maintenance cleanings every 3-4 months to keep tissues healthy and stabilized. In few circumstances where periodontal health cannot be achieved, a referral to a Periodontist may be recommended for further treatment.

Signs & Symptoms of Gum Disease:

  • Swollen, red, tender or bleeding gums
  • Gums that recede or move away from the tooth
  • Persistent bad breath or bad taste in mouth
  • Pain/sensitivity when chewing
  • Loose teeth
  • Visible pus surrounding the teeth and gums

You can prevent periodontal disease by practicing good oral hygiene and visiting your dentist regularly for professional cleanings. In recent years, gum disease has been linked to overall health problems. You can read more about those on Andra’s recent blog post Oral Health: A Window to your Overall Health! Remember, taking care of your oral health is an investment in your overall health.

Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

Sources:

www.perio.org

www.colgate.com

The Secrets About Halitosis

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Wendy Parker, RDH

The Secrets About Halitosis

Before we even start trading secrets, what is Halitosis?  Halitosis is the fancy word for “Bad Breath.”  We’ve all had it at one point or another.  Whether that is morning breath, when we’ve forgotten to brush, or when we’ve eaten something with a strong taste.  Whether temporary or permanent, bad breath comes to everyone.  So let’s talk about the secrets of where it comes from, why we get it, and most importantly, how to get rid of it!

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Bad breath can come from several sources.  Here’s a list of some of the most common ones:

  • Tooth decay or / and gum disease such as gingivitis
  • Dentures and bridges
  • Mouth sores
  • Dry mouth
  • Post-nasal drip and congestion of the nasal passages
  • Food stuck between the teeth
  • Coating of the tongue caused by a build up of bacteria
  • Infection of the throat and tonsils
  • Sinusitis
  • Nasal polyps
  • Bronchitis or pneumonia
  • Acid reflux and GERD
  • Chronic constipation
  • Digestive problems and stomach ulcers
  • High-protein diet that includes fish, cheeses, and meats
  • Foods that are strong smelling or spicy such as onions and garlic, exotic spices (ie. curry)
  • Supplements, such as Fish Oil Capsules
  • Low Carb Diets – causing “Ketone breath” as a result of the low carb consumption causing the body to burn fat as it’s energy source which then causes an end product of the body making ketones, which causes a fruity acetone-like odor when exhaled
  • Certain medications
  • Smoking
One of the most common reasons people have halitosis is due to a condition called “Black Hairy Tongue” or a coated tongue.  It sounds scary and unusual, but it’s something that can be cured quickly.
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The bacteria build up on tiny rounded projections called papillae which are on the surface of the tongue, also known as tastebuds. These papillae grown longer catch all the food and bacteria in the mouth.  Without brushing your tongue or removing the bacteria, it can embed in the tongue and causing a coating.  Black hairy tongue is caused by bacteria or fungi in the mouth, which make the tongue to appear black and hairy.

Certain lifestyle habits and conditions can make people more likely to develop black hairy tongue. They include:

  • poor oral hygiene
  • smoking tobacco
  • drinking a lot of coffee or tea
  • using antibiotics (which may disrupt the normal balance of bacteria in the mouth)
  • being dehydrated
  • taking medications that contain the chemical Bismuth (such as Pepto-Bismol for upset stomach)
  • not producing enough saliva
  • regularly using mouthwash that contains peroxide, witch hazel, or menthol
  • getting radiation therapy to the head and neck

Black hairy tongue is more common in men, people who use intravenous drugs, and those who are HIV-positive.

Now that we learned about Halitosis and Black Hairy Tongue, here are tips and tricks to getting rid of it:

Gently brush your teeth twice a day with a soft toothbrush, but more importantly, don’t forget your tongue!!! Start at the back of your tongue and scrape forward, being sure not to scrub the tongue and embed the bacteria even further.   You can use a tongue scraper to make sure you’re thoroughly cleaning the area. Be sure to come in for your regular check up and cleanings so that your friendly hygienist can help you too!  Soon, the coating will go away and so will the bad breath.

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If you find that you have consistent bad breath you can try our other tips:

  • If you smoke, quit.
  • Add more roughage to your diet. Soft foods won’t clean off the tongue effectively.
  • Drink plenty of water throughout the day to help keep your mouth clean.

Natural home remedies include:

  • Fenugreek should be consumed in the form of a tea made with one teaspoon of fenugreek seeds in one liter of water. Simmer till the water is infused and strain before drinking. When consumed regularly, fenugreek seeds are an excellent home remedy for halitosis.
  • Making a tea or infusion with fresh parsley or cloves is also a good way to treat bad breath. Simply boil water with freshly chopped parsley and drop in a few cloves to the mix. Cool the mixture and strain before using it as a natural mouthwash after eating. There have been numerous studies supporting claims about the efficacy of cloves and clove oil in dental care.
  • include fresh vegetables, fruits and grains into your daily diet.
  • increase your intake of Vitamin C from foods
  • include guava in your diet

An individual should consult their physician for a diagnosis if they have

  • persistent dry mouth
  • sores in the mouth
  • pain with chewing or swallowing
  • white spots on the tonsils
  • Fever
  • any other symptoms of concern

Call your doctor or dentist if the problem doesn’t get better on its own. Your doctor may prescribe antibiotics or an antifungal drug to get rid of the bacteria or yeast. Topical medications, such as tretinoin (Retin-A), are also sometimes prescribed. As a last resort, if the problem doesn’t improve, the papillae can be surgically clipped off with a laser or electrosurgery.

Hopefully this let you in on some of our secrets to a happy healthy mouth!  Happy brushing and breathing everyone!

Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

Sources: 

http://www.webmd.com/oral-health/guide/black-hairy-tongue

http://www.home-remedies-for-you.com/remedy/Halitosis.html

http://www.emedicinehealth.com/bad_breath_halitosis/page4_em.htm

Hydrogen Peroxide

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Lora Cook RDH

 Is Using Hydrogen Peroxide as a Mouth Rinse Safe?

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Many commercial mouth washes and whitening strips have hydrogen peroxide as one of the key active ingredients. However many are using straight hydrogen peroxide as a mouth wash to kill germs. Is this a safe and effect practice?

Hydrogen peroxide is compose of water and oxygen that works to kills germs and bacteria, and helps to whiten teeth.  It comes in either 1% or 3% concentrations. You can even see it in action!  When it foams in your mouth you know that it is working at killing bacteria.  It also can be used to clean your night guard, retainers, or even soak your tooth brush in.  Best of all it is inexpensive. 

 However this is not the magic cure all, there are some strong precautions that I would like to share with you.  While there are many benefits it can be harmful on gum tissue if used in too strong a solution or too long.  It is very drying to the tissues. This will also work to kill good bacteria in the mouth.  This will leave opportunity for yeast infections of the mouth to flourish, also called thrush.  Candidiasis is a fungal or yeast infection of the mouth or throat. Candida yeast that normally live in the mucosa membrane will flourish causing a over growth of candida, commonly called yeast infections. 

This can be a relatively safe practice by following a few guidelines; dilute peroxide with 50% water, and do use every day.  If you are one of the many people who suffer from dry mouth stick with a over the counter rinse formulated for dry mouth sufferers. 

Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.using-hydrogen-peroxide.com/hydrogen-peroxide-as-mouthwash.html

http://copublications.greenfacts.org/en/tooth-whiteners/l-3/6-tooth-whitening-side-effects.htm

http://www.healthline.com/health/thrush#Symptoms4

Tooth Brushes!!

Karen

Karen Kelly RDH

As a dental hygienist, one of my most frequently asked questions is, ‘There are so many toothbrushes, which one should I use or should I just switch to an electric toothbrush?’.  My response is, first, always use a SOFT name brand toothbrush (I know stores sell medium and even hard toothbrushes but don’t buy them!!) and second to make sure you are brushing correctly at least 2 times daily and brushing for at least 2 minutes.  When I say correctly, I mean to aim the toothbrush up into the gums at a 45 degree angle.

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 Properly angled brushing

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Unhealthy vs. healthy gum tissue

I see lots of people who do brush their teeth, but since they don’t actually brush along the gumline, their gums are red and puffy.  So, brush the gums like you are giving them a massage; use little back and forth or circular motions.  Don’t use long scrubbing strokes, it is abrasive!  Then floss and/or use an interdental cleaner of some kind each and every day.  No matter how good a toothbrush is and how good someone brushes, it’s impossible to get in between the teeth clean with just a brush.  Also, change your brush often!  When the bristles begin to flare out or it’s been 3 months, change it, it makes a difference to use a new brush.

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                        If your brush looks like this, throw it out!                

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 A brand new SOFT toothbrush

If you brush really well with a manual toothbrush, you probably won’t see that much of a difference if you were to switch to an electric toothbrush.  The problem is, many people don’t clean their teeth that well with a manual toothbrush so that’s where the electric toothbrush can really help.  We recommend 2 brands of the electric brushes, the Sonicare and the Oral-B Braun.  These are not the battery powered toothbrushes, these brushes plug into the wall and have a rechargeable battery.  They just have so much more brushing action than a manual toothbrush that even if you aren’t that great of a brusher, you can do an excellent job if you use one of these brushes daily.  In a recent study conducted by the National Institute of Health, they stated, “The subject group using the powered toothbrush demonstrated clinical and statistical improvement in overall plaque scores. Powered toothbrushes offer an individual the ability to brush the teeth in a way that is optimal in terms of removing plaque and improving gingival health, conferring good brushing technique on all who use them, irrespective of manual dexterity or training.”(1)  In another study, “the Sonicare DiamondClean toothbrush was found to be safe and significantly superior to a manual toothbrush in reducing gingivitis, sites of gingival bleeding and plaque over time.  DiamondClean reduced gingivitis and gingival bleeding sites up to two times more and removed up to four times more plaque than a manual toothbrush after four weeks of use.”(2)   Sonicare also states that their ‘DiamondClean toothbrush effectively removed extrinsic tooth stain within one and two weeks of use, and it was significantly superior to a manual toothbrush at both one and two week checks.'(3)  On the Oral B website, they state that their Professional Precision 5000 toothbrush has produced these results:  34% less gingival bleeding at 6 months vs. a regular manual toothbrush and 29% lower gingival bleeding scores at 3 months vs. Sonicare® FlexCare (4)

It is still important to use the powered toothbrush 2 times daily for at least 2 minutes and allow the toothbrush to clean along the gumline.  If you have an electric toothbrush but it mostly sits on your counter, that doesn’t count when we ask if you use an electric toothbrush!

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Philips Sonicare DiamondClean

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                                                     Oral-B® Professional Precision 5000

Electric toothbrushes come in many different models and prices.  Take a look at a store like Target or Walgreens, they have lots of choices so you can find one that will fit your budget and taste.  We carry our favorite electric brushes and replacement brush heads in our office as well, and we are happy to answer any questions you might have about toothbrushes.  I like to answer questions about brushes so much that I go to Target and walk up and down the dental isle just so I can give advice to shoppers!!

So, remember what I tell my younger patients:  2 times a day for 2 minutes.  It’s easy to do and easy to remember!

Karen Kelley  R.D.H.

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 Just some fun photos to make you smile!

 

1.  http://222.ncbi.nlm.nih.gov/pubmed/23674927

2.  http://sonicare.com/professional/en_AU/pdf/Gingival_DC_2011_Milleman.pdf

3.  http://staging1.microsites.ce.philips.com/DP_AU_EN_3_3_Orc2/pdf/Stain_DC_2010_Colgan.pdf

4.   http://www.dentalcare.com/en-US/oral-b-crest-professional-products/category/electric-toothbrushes/oralb-5000-professional-trial.aspx

Image Sources

http://www1.macys.com/shop/product/sonicare-hx9332-diamondclean-rechargeable-electric-toothbrush?ID=827710

http://www.webmd.com/oral-health/proper-angle-for-brushing-your-teeth

http://www.impledent.com/patient-services/teeth-dental-cleanings/

http://blog.sciencemuseum.org.uk/talkscience/2011/10/27/wonderful-things-more-than-meets-the-eye/

http://www.oralb.com/products/pro-health-gentle-clean/

http://www.oralb.com/products/professional-care-smart-series-5000/?utm_source=google&utm_medium=cpc&utm_term=%2Boralb%20%2B5000&utm_campaign=Oral-B_Search_Desktop_Brand+Awareness_Power|ProfessionalCare+SmartSeries+5000&utm_content=sGVAVXD2P|dc_21461550775_b_%2Boralb%20%2B5000

www.pinterest.com

Mouth Breathing

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Julie West BS RDH

Parents take heed; if your child breathes through his mouth instead of his nose, he can have more problems than bad breath!

     Mouth-breathing contributes to: sleep disorders, changes in posture, jaw deformity, lowered immune function, gum disease, and tooth decay.

Mouth-breathing causes the jaws to grow in an altered fashion, resulting in long faces, tooth crowding, and an altered head posture. The lower jaw remains too far behind in its growth, producing a small chin, an abnormal bite, and a distorted profile.

Sleep disorders can be caused by the lower jaw and tongue being positioned too far back, constricting the upper airway.  Enlarged tonsils and adenoids due to chronic allergies may also constrict the airway to such an extent that normal nasal breathing becomes impossible.

Nasal breathing produces a hormone that regulates normal blood circulation. It also filters, warms and moisturizes the air. The lack of oxygen in mouth breathers, who usually snore at night and struggle for air, weakens the immune system, disrupts deep sleep cycles, and interferes with growth hormone production.  Children may be fatigued and less attentive in school due to this disruption in sleep.

Saliva helps to naturally cleanse the tissues of the mouth.  Salivary flow is disrupted by mouth-breathing, leaving a dry environment that irritates tissues and leaves them susceptible to infection such as tooth decay, gingivitis, and periodontal disease, as well as contributing to bad breath.

If you notice that your child breathes through his mouth, you can get help before these problems arise.

     Typical treatment options include myofunctional therapy to help retrain your child to breathe through their nose and the use of orthodontic appliances to help move the lower jaw forward.   The earlier mouth-breathing is addressed, the better the outcomes of treatment will be.

Below is a picture of a patient before and after treatment for mouth-breathing.

http://mcgannfacialdesign.com/before-after/

http://www.asha.org/public/speech/disorders/OMD.htm

Which Mouth Rinse Should I Use?

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Julie West BS RDH

As you stroll down the dental product aisle in your local grocery store, have you ever taken the time to fully acknowledge the amount of dental products that are out there?  While we are fortunate to have options available to us, it can also make the process of selecting the product right for you more challenging.   When it comes to oral rinses, one size does not fit all.  Taking time to examine the labels of the mouth rinses on the shelf can help you make the best choice for your specific needs.

There are two categories of oral rinses: therapeutic rinses and cosmetic rinses.  Cosmetic rinses mask bad breath and leave you with a “fresh” feeling; however the results are short in duration. Therapeutic rinses will do a variety of things such as: reducing halitosis (bad breath), aiding in the reduction plaque levels and inflammation by killing oral bacteria, and providing additional anti-cavity protection.  To ensure you are getting a mouth rinse that will be therapeutic and not just cover odor, look for a seal from the ADA and words such as “antigingivitis” and “anticavity”. Now that you’ve narrowed down the contenders, let’s discuss ingredients.

Rinses that are antiseptic and kill oral bacteria have active ingredients of essential oils such a menthol and thymol.  These rinses also usually include a high percentage of alcohol.  You may notice a “sting” or burning sensation when using these types of rinses.  For those who have xerostomia (dry mouth) naturally or from medication may want to stay away from these rinses as alcohol will dry out the tissues even more. Other types of rinses act as anticavity rinses by providing more fluoride to the teeth.  The active ingredient in these rinses will often be sodium fluoride.  Many rinses today will combine these two types of rinses into an anticavity/antigingivitis rinse containing all of the above ingredients.

Some rinses may stain teeth after prolonged use. A third type of oral rinse that is not usually discussed contains the active ingredient stabilized chlorine dioxide.  Several studies have been conducted on the CloSYS stabilized chlorine dioxide product line.  This ingredient has been shown to kill oral bacteria that cause gingivitis and periodontal disease with results similar to the prescription oral rinse, chlorhexidine, dispensed at your dentist’s office, as well as reduces volatile sulfur compounds which cause halitosis.

CloSYS is available over-the-counter and allows patients to leave the rinse unflavored or add in the amount of mint flavoring they want.  The rinse does not contain alcohol that will burn or dry tissues and does not stain teeth as chlorhexidine does. Using this information, you are prepared to walk down the dental product aisle with the ability to appropriately choose the rinse that will provide you with the specific results you need.

 

American Dental Association. (2013). Mouthrinses. Retrieved from http://www.ada.org/1319.aspx

Rowpar Pharmaceuticals, Inc.. (2013). CloSYS Research. Retrieved from http://www.closys.com/pros/research.html

David Drake, MS, PhD. Alissa L. Villhauer, BS, Dows Institute for Dental Research, College of

Dentistry, University of Iowa An In Vitro Comparative Study Determining Bactericidal Activity

of Stabilized Chlorine Dioxide and Other Oral Rinses Journal Clin Dent 2011;22:1-

M. Robert Wirthlin, DDS, Brand J AHN, DDS, Belma Enriquez, BS, and M. Zamirul Hussain,

PhD. Effects of stabilized chlorine dioxide and chlorhexidine mouthrinses in in vitro cells

involved in periodontal healing. Periodontal Abstracts, The Journal of the Western Society of

Periodontology, vol. 54, no. 3, 2006.

Bad Breath? No Problem!

Do you suffer from bad breath? Does it linger with you throughout the day and you just can’t get rid of it? Don’t be embarrassed, you and the 40 million Americans are not alone.

Halitosis, also more commonly known as bad breath occurs when unpleasant odors are exhaled through the mouth. In most cases, bad breath originates from the mouth. One of the most common causes of bad breath is the build-up of plaque. When people don’t floss, or brush as much as they should, the plaque then begins to harbor bacteria resulting in bad breath, even if you just brushed your teeth! Some symptoms to be on the look out for bad breath are; smell, bad taste or taste changes in your mouth, dry mouth, and a coating on your tongue.

 Most causes of bad breath are due to inadequate oral hygiene. If good oral hygiene practices, or a dentist do no eliminate bad breath, you should consult your physician. Very few causes of bad breath may need medical attention from a physician. When to seek that type of medical attention is when you have a persistent dry mouth, sores in the mouth, pain with chewing or swallowing, white spots on the tonsils, fever,  or just started a new medication. New parents need to watch their babies or young children because bad breath may be a sign of infection or undiagnosed medical problem.

If your bad breath is a result of poor oral hygiene, here are a few tips to help your teeth stay healthy, and smelling clean!

  • brush twice a day with toothpaste containing fluoride
  • brush teeth after meals, especially meals that contain foods high in acid
  • replace your toothbrush every 2 months, this helps your overall health as well. This way you won’t keep putting the same bad bacteria in your mouth over and over again.
  • make sure you are seeing a dentist twice a year for your regular cleanings and check-ups to avoid any problems that might be brewing in your mouth
  • brush your tongue regularly, it really makes a huge difference
  • make sure you are flossing regularly so those food particles that get stuck in between your teeth don’t harbor bacteria
  • keep your mouth moist and wet by drinking lots of water! It’s not a bad idea to make it a habit to drink more water throughout the day because your overall health also benefits from it! Who doesn’t love a 2 for 1 special?

Don’t be embarrassed if you have bad breath, just remember you aren’t alone. Try the tips suggested above, and if they don’t work, come in and see a dentist. We want you to be comfortable, and our number one goal is to see you walk out the door with happy smiles!

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