Halitosis, or bad breath, can have a number of causes. One of the biggest and most common of these is oral thrush as a result of a fungal infection. Candida Albicans can cause a large white, yellow, or brownish patch on the tongue. This typically forms when saliva flow is low, there is increased mouth breathing, insufficient oral hygiene, smoking, or in cases of reduced immunity.
Saliva is not only important to flush away bacteria from the teeth and gums, but also fungal pathogens from the tongue. Low saliva flow is called Xerostomia. When this occurs pathogens are allowed to accumulate and settle in on the tongue resulting in oral thrush.
Xerostomia can be caused by dehydration, most medications, caffeine and alcohol consumption, smoking, advancing age, and Sjogren’s syndrome (an auto-immune condition of the salivary glands that commonly presents with other auto-immune conditions.)
To improve xerostomia drink plenty of water, switch medications (where possible), reduce caffeine and alcohol intake, and quit smoking. There are also certain aides you can purchase that can stimulate saliva flow delivered in mouthwashes, toothpastes, and gels.
Mouth breathing may be due to sinus congestion, so if there are issues here it is advisable to investigate these with your GP or an Ear Nose and Throat Surgeon. Nasal sprays can be useful for periods of heavier congestion.
In addition to improving your saliva, brushing your tongue every time you brush your teeth will help clear this fungal accumulation. Using your toothbrush is fine, however, since a soft or ultrasoft toothbrush is the preferred brush for your teeth, it is best to use a tongue scraper. You can also use fungal lozenges and gels that your dentist can prescribe for you, though these tend to have a somewhat limited effect.
Whenever you notice any abnormal patches on your tongue or elsewhere in your mouth, ensure you see your dentist to investigate. Though oral thrush is the most common cause, this could be due to other conditions which will need further treatment.
When halitosis is particularly mentionable by your peers, it could be due to gum disease, either severe gingivitis or periodontitis. Both will present with red, bleeding gums, particularly when brushing and flossing. Without intervention, gum disease is likely to worsen over time and can lead to wobbly teeth and early tooth loss.
To prevent gum disease ensure you are brushing for two minutes, twice a day, brushing your gums gently but thoroughly. Floss at least once a day. Don’t be scared if you see any bleeding. Bleeding means there is bacteria and it’s the bacteria inflaming your gums. Remove the bacteria and the gums should improve.
Ensure any issues with the gums are assessed by a dentist. Once severe periodontitis sets in the damage is often irreversible. Bad breath from gum disease generally responds very quickly to treatment.
Reflux can occur with a weak oesophageal sphincter (GORD), related to your diet and quantity of food eaten, stomach ulcers, or from other issues from the stomach or gastrointestinal tract. When halitosis is caused by reflux you’ll likely experience multiple periods of an acidic taste occurring in your mouth. You may also present with a higher amount of tooth wear. Drinking plenty of water and eating smaller portions may help. Also avoid acidic and carbonated beverages. If simple changes to your diet doesn’t improve your reflux it is best to investigate with your GP.
Small white/yellow calcifications may develop within your tonsils which are generally shed from time to time. Tonsil stones are more likely to occur with dehydration and regular alcohol and caffeine intake. Most of the time these will be shed and swallowed without you realising, though someone smelling your breath at the time may detect something a bit stale. Unless you suffer any symptoms tonsil stones aren’t usually too much of a concern. Simply drink plenty of water and few, if any, tonsil stones will develop. If you notice a fair number of these shedding, or have sore, enlarged tonsils without signs of an infection, have your tonsils examined by your dentist or GP.
Tooth Decay and Abscesses
When bad breath is a result of tooth decay or abscesses within the mouth, you’ll likely be aware of the issues. For tooth decay to be severe enough to cause halitosis you’ll be able to feel the size of the holes easily with your tongue. Abscesses will usually be quite painful. There may be pus leaking giving a foul taste and cellulitis, swelling around the cheeks and jaws. See your dentist immediately if you show any of these conditions. Cellulitis is of particular concern, as swellings arising from infected teeth could also block airways in severe cases.
Lesions Within the Mouth
Sores, cuts and ulcers could also lead to bad breath. In cases of extracted teeth, food can occasionally get caught here and will cause a smell. Keep any lesions clean with salt water rinses and ensure you do not pick at the area. Picking at sores will remove the healing factors in place and delay healing. If any sore persist after two weeks without improvement or worsening smells see you dentist immediately as this could indicate an infection or some other chronic condition.
Lesions that do not resolve in time or come and go, that are painful or bleed, should always be assessed by your dentist. Some of these could be auto-immune related or, in rare cases, carry carcinogenic properties. Early identification and management is vital in these cases.
Toothaches are a major source of dental pain. Tooth pain can originate from a number of sources. From exposed dentine to leaky fillings, traumatic pressure, hypersensitivity from grinding or abrasive brushing, or referred pain from gums or nearby sinuses. Generally the most severe toothaches arise within the pulps, or “nerves”, of the teeth. This is commonly called pulpal pain or “nerve pain”.
How does pulpal pain, or “nerve pain”, occur in a tooth?
A toothache that can be described as an 8 to an 11 out of 10 would usually be caused by pulpal pain. It will likely be hot and cold sensitive, worsened with pressure, and give a severe ache. The primary source of this tooth pain is pulpal infection.
The first stage of tooth infection is when bacteria breaks down the outer layer of the tooth. To achieve this, bacteria needs to be well established on the tooth surface and given access to carbohydrates to metabolise. Bacteria quickly forms into a soft white layer called plaque. The longer it is left undisturbed, the greater the decay potential. If one little spot of plaque is left for more than 24 hours and given access to carbohydrates, particularly sugars, then tooth decay can occur. Once decay reaches inside the tooth it is unlikely to stop without intervention.
Early tooth decay, or tooth infection, can be treated with fillings. The decay is removed by a dentist and the lost tooth structure is restored using composite resin, a white tooth coloured material, in most cases. If left untreated this decay will usually extend until it reaches the interior of the tooth – the pulp. The pulp is a nutrient rich area that feeds the tooth blood and nerves, it is what makes the tooth alive. Imagine bone marrow but for teeth. Unfortunately, it is so nutrient rich that as soon as bacteria reaches here it spreads and multiplies almost instantly. The infected tooth becomes an infected pulp and severe tooth pain, or pulpal pain, results.
Why is pulpal pain so bad?
The nutrient-rich, lush area of the pulp becomes the perfect breeding ground for bacteria. It spreads quickly, releasing nasty toxins into the bloodstream. The body detects the bacteria has invaded areas it shouldn’t be and mounts a defence to try to destroy the bacteria. When there is an immune response, inflammation occurs. However the pulp is encased by hard tooth walls and doesn’t allow for swelling. So pressure builds up within the pulp, full of tiny nerves which essentially become crushed. That’s when we experience severe toothaches.
Does pulpal pain go away on its own?
Treating a toothache can seem scary, expensive, and possibly even more painful, so you may be tempted just to let things play out. This is not a good idea.
The type of bacteria that invades the pulp is bacteria our body is usually good at destroying, however that tight area inside the tooth is very hard to reach. Larger white blood cells can’t access the pulp very well and the immune system isn’t capable of clearing out the bacteria on its own. This means the infection cannot be cleared without professional intervention.
If you’re lucky, an equilibrium could be achieved where bacteria is cleaned from the body as it leaks from the tooth and the pain may lessen. These states are usually only temporary however and a large bacterial load is likely to resurface in the future. You’ll also always have a source of bacteria entering your bloodstream potentially causing other health effects. If the bacterial load becomes more severe then you could also develop cellulitis, swelling within the nearby tissues. The swollen areas become very tender and may even extend further back to your airways, restricting airflow.
Treatments for pulpal pain
If you’re in a lot of pain, there’s a fair amount of swelling, or you’re just too scared to see the dentist right away, a course of antibiotics can help to clear the infection from the nearby tissues. This is only a very temporary solution however. Antibiotics, like the immune system, is not able to properly access the pulps of teeth and cannot remove the bacteria inside. It will reduce the amount of bacteria just around the tooth and reduce inflammation, so it will help with the pain. But soon after the antibiotics are finished the bacteria will spread again and the pain is likely to return.
The best way to permanently remove the bacteria is to remove the source, which is the tooth pulp. This can be achieved either through a root canal treatment or tooth extraction.
Root canal treatment
In most cases your dentist will recommend root canal treatment when they determine you have an infected pulp. This process involves removing all the decay and cleaning inside the tooth. The pulp is completely removed, and the area is shaped and then filled to prevent any bacteria from returning. It usually consists of three sessions which needs to be performed with high care. Any left-over bacteria could lead to long term failure. It has a success rate of 90% over a ten year period. Once completed the tooth will be essentially “dead”, but the bacteria will be removed and the tooth can be kept. Healing will be able to occur and the tooth will not be a source of bacteria to the body anymore.
If the cost of root canal treatment is too high, or the tooth is too compromised to have a successful outcome, the tooth can be extracted instead. With the tooth removed the source of the bacteria will be too and the bacteria that entered the nearby tissues can usually be cleared by the immune system quickly. The obvious down-side to this option is that a space is left where the tooth was. Sometimes this can be tolerated if it is a back tooth, though there will be less area to chew with. A front tooth can be unsightly and tooth replacement options will usually be recommended. Dentures, implants or bridges can provide options to replace missing teeth.
For more information on root canal treatments, dental extractions, or tooth replacement options, click on the link below.
At times when brushing or flossing you may notice some bleeding, it could be a little bit, or it could be a lot. The gums can get swollen, tender and red, a condition called gingivitis.
The cause all comes back to bacteria.
Bacteria releases chemicals that are detected by your body where your immune system tries to fight it off. But the more that builds up, the harder it is for your body to clear it away. Your first line of defense is your saliva, then immune complexes are released from the blood stream in an attempt to reach the bacteria on your teeth. However, once bacteria builds up a thick layer called plaque, it is protected from our body’s defenses. The immune system keeps trying to penetrate into that thicker plaque and as more chemicals are released from bacteria, so too are more chemicals released by the immune system. The result is inflammation: red and bleeding gums.
The solution? Remove the bacteria, aka: plaque.
Plaque is a thick layer of bacteria that has its own defenses from being removed so things like mouthwashes and antibiotics are not that effective at targeting deep into it. That means physical removal is the most effective method. This involves brushing two minutes twice a day and flossing at least once a day. Don’t be scared of the bleeding, go gently but thoroughly. Once you’re consistently removing that plaque the bleeding will subside shortly after.
Still bleeding even with thorough brushing and flossing?
Other factors such as calculus (a hard substance that builds up on teeth over time), or poor margins on restorations can lead to areas not properly cleaned. A visit to the dentist to perform a thorough and at times, deep clean, may be warranted. They can also check to see if any of your fillings are defective which may need to be replaced. Other health conditions can also lead to bleeding gums, such as pregnancy (pregnancy gingivitis), uncontrolled Diabetes, certain medications, or other oral pathology. Looking after your health and removal of the bacteria should still resolve your gums. If your gum disease is more severe it may have progressed to periodontitis, which occurs when gingivitis has been untreated for a long time. Periodontitis requires further intervention with a dental professional.
It is recommended to have regular check ups and cleans every 6-12 months. Most health funds will cover two a year so it’s good to be vigilant and take full advantage of this.
Don’t be afraid of bleeding gums, it just means you need to brush and floss more thoroughly (but gently). And don’t forget your dental maintenance appointments!
Clear aligners versus bonded braces
Both clear aligners and bonded braces have their pros and cons and what suits you best will need to be assessed by an oral health professional. With clear aligners the major advantage is that they are nearly invisible, cleaning is far easier, movements are usually more gradual and may be less painful, you get to view your digital setup before and during treatment, and your records are saved digitally and can be accessed many years after you complete your treatment, even by other oral health professionals. Bonded braces, on the other hand, are usually cheaper, require less compliance (cannot be removed), and can achieve more difficult movements and correct larger bite discrepancies. Both should be able to achieve similar outcomes depending on the original orthodontic challenges.
Am I a good candidate for clear aligners?
To be suitable for orthodontic treatment patients need to have a well managed dental health, with any decay, faulty restorations, or gum disease addressed prior to starting treatment as these can be exacerbated if not corrected beforehand. Clear aligners are taken in and out of the mouth but need to be worn for a minimum of 22 hours a day – this means compliance is essential. If a patient does not follow this then they will not likely achieve the projected movements.
Mild to moderate crowding and bite problems can usually achieve good results. More complicated cases can be addressed with clear aligners though they may pose more challenges – teeth may lag and other gum problems could arise. Better quality aligner providers are still able to correct moderate to complicated cases, though not all, so your case will need to be closely assessed. Clear aligners are generally very good at straightening the front but not as successful when attempting large movements with back teeth, so your goals here will help determine whether to go ahead.
What’s the difference with aligner brands?
Lately, a lot.
There is a big range of what you can pay for clear aligners and this is a circumstance where you really get what you pay for. Leading aligner partners, like SmileStyler involve many more sets of eyes reviewing these cases that are dentally trained. Going through a dentist or orthodontist means you’ll be able to discuss your concerns, your oral health professional will scrutinise your smile closely and likely identify many issues you weren’t even aware of. They’ll also be watching for signs where straightening is causing unintended changes. Better providers will allow more revisions during treatment and enable your health professional more control in the setups. The more oral health professional involvement, the better your outcome will be.
More recently there are systems where you take impressions at home or in a studio that gets sent to a lab. You’ll view the simulation and will be told that a oral health professional signs off on it, but you’ll never meet them or be able to talk with them. These providers are not regulated by AHPRA (Australian Health Practitioner Regulation Agency) and therefore are exempt from a lot of health protection laws. This means if there are adverse outcomes as a result of your treatment they are not usually held accountable. In addition, the orthodontist or dentist they employ to sign off on these treatments are often not Australian or not trained to our standards, and usually only look at these plans very briefly, without any further monitoring. This essentially leaves your treatment in untrained hands. The treatment delivered is limited in what can be achieved as they are not able to employ techniques dentists and orthodontics do to allow additional spacing and predictability, and gum disease and recession is much more likely to occur here. Some of these changes may be irreversible.
How do I get started at Smile Design Dental?
To start your aligner journey with us we require a comprehensive examination and x-rays, which we recommend to have with your clean. Once your are deemed dentally fit and appear to be a good candidate for aligners, we will start with a new case setup. Photos and impressions will be taken and we will discuss what your treatment goals are. One to two weeks later you will receive a digital simulation of how your teeth will look at each aligner stage right until the end. You’ll be able to view different perspectives and compare to your original starting point. If you have any concerns we can alter the setup as you wish.
Our preferred aligner partner is SmileStyler, an all Australian aligner provider that gives us the advantage of talking with your simulation technicians directly. The waiting time is far reduced to some overseas providers and you have the confidence everything is managed to Australian standards. SmileStyler are different in that scans are made at each 6 aligner interval to check how closely your teeth are tracking. If things are a bit off we simply adjust for it in the next set of 6 aligners to keep you as on track as possible. This gives us a lot more room to alter things as needed and a much higher quality result. At the end if you’re not 100% satisfied, we simply take more impressions and issue a few more aligners to make sure we get you teeth to where you want them to be. With SmileStyler, you can expect a much better result than with other aligner providers.
These aligners are normally worn for 2 weeks at a time, 22 hours of the day, however using the V5Pro this can be sped up to 1 week for each aligner. The V5Pro is a device that you bite down on gently for five minutes a day that vibrates and stimulates the supporting bone. This allows the movements to be taken up faster. The number of aligners you wear will be determined by how much movement is required, so this will vary from person to person and you will have a better understanding after your initial digital setup. Mild cases are generally around 12 aligners, moderate to advanced cases will be closer to 30+.
Once completed you will need to wear retainers at night time to prevent relapse. These are very similar to the clear aligners, just a little sturdier. All the forces that made your teeth crooked in the first place are all still there, that means that without support those teeth will want to return to their original positions. That’s why a retainer is required to be worn, just at night, to fight those forces and keep those teeth in their beautiful straight position.
Then you can enjoy your smile like never before.
Temporomandibular disorder, or TMD, describes a range of issues arising from in and around the temporomandibular joint (TMJ). These involve: night-time grinding or clenching; tooth wear and cracks in teeth; clicking or pain when opening and closing the lower jaw; pain resulting from long periods of mouth opening; or limited capacity for mouth opening. The causes of these symptoms usually have many factors involved.
So where do we start? Firstly, your general dentist will assess your symptoms and possible causes of TMD, then will tailor your treatment accordingly.
Causes of TMD
Congestive sleep apnoea: occurs as a result of your tongue rolling back in your mouth at night, blocking your airways. Grinding and clenching may occur as an attempt to wake yourself up at night. Specialised splints or C-PAP machines can be useful in treating this condition.
Crooked teeth have been occasionally associated with TMD, though usually when there are more significant bite problems. Teeth straightening, at times with jaw repositioning surgery, may help to reset your bite into a more harmonious position.
Anxiety, stress, and personality quirks may just lead some people to grind without any other clearly defined cause.
What are the treatment options?
If sleep apnoea and bite discrepancies don’t seem to play a large role we usually start with a splint. This is a clear plastic mouthguard you wear on your top teeth at night. These are specially fitted for your teeth so they don’t fall out easily and provide an even bite with a free range of movement. These will not stop your grinding or clenching, but it will help to reduce it and ease forces. The plastic material acts as a buffer between your teeth and protects them from wear and cracks. The splint can look bulky at first, but after a couple of weeks most people adapt fairly well. For our splints, we use a hard firm material on the outside and a gel layer on the inside fitting surface. These are generally reported as far more comfortable than the standard plain hard splint design.
Muscle Relaxant Injectables
Muscle relaxant injectables provide an alternative to those who find a splint still too bulky. These can be injected into the overworked, enlarged chewing muscles. The masseters, bands of thick muscle at the back of your jaws, are usually injected first and reviewed 4-6 weeks later. The muscles will lose some strength so that they will naturally release when clenched, easing tightness. The temporalis, a band over the temple and stretching laterally across the skull, may also require injecting. The injectables typically last 4-6 months and can be seen to slim the jawline giving a nice aesthetic side effect.
Physiotherapy can also be used as an adjunct to the prior treatment methods. This will f on improving range of motion and decreasing tension. If your TMD is a little more complicated you may require a more specialised splint, anti-inflammatory or anti-anxiety medications. If there are physiological changes to the joints then surgery may be required. Arthritis or other changes can occur when TMD has been present for a long time without adequate intervention. These can be difficult to treat and may only provide a small improvement, therefore early management of TMD is critical.
The Child Dental Benefits Schedule (CDBS) is eligible for families that receive Family Tax Benefit Part A. Children between the ages of 2 and 17 will be able to claim up to $1000 worth of Medicare funded treatment over a two-year period.
The Child Dental Benefits Schedule means Medicare will cover up to $1,000 over 2 calendar years for general dental services. The services Medicare will cover include check-ups, x-rays, cleaning, fissure sealing, fillings, root canal treatment and extractions. The services Medicare will not cover are orthodontic treatment, cosmetic dental work, and any dental services in a hospital.
You can confirm your child’s eligibility and balance amount by accessing your Medicare online account at my.gov.au or calling the Medicare general enquiries line on 132 011. Not all dental clinics have accepted to partner with the CBDS or may charge a gap fee, so check ahead before booking. At Smile Design Dental we will not charge you any gap fees for our services – because we want to support this initiative in encouraging good dental health for children.
If your child is not eligible for CDBS then don’t worry, the great thing about Smile Design Dental is we make looking after your children’s oral hygiene more affordable. We offer gap-free or $59 for kids under 6, $99 for kids under 12 and, $149 for adults and kids 12+ for check up and cleans.
Teeth whitening can be achieved by removing extrinsic stains (on the outer surfaces) or intrinsic stains (inside the tooth structure).
These are caused by things like tea/coffee, spices, red wine, smoking/tobacco products, or anything you consume with a deeper pigment. They tend to be more brown in pigment and can usually be removed easily when you attend your regular dental clean.
These are deeper stains that give your teeth a more yellow/grey appearance. To effectively remove these pigments hydrogen peroxide is required to penetrate deeper into the structure of the teeth. The hydrogen peroxide targets organic molecules within the dentine which are the ones susceptible to discolouration. It breaks these down and the darker pigments within them. This process can cause a little bit of sensitivity as it makes the teeth a little more porous, but this soon settles down. This leaves the clearer, light-scattering molecules, giving the teeth a much whiter and lustrous appearance. The amount of lift you get will depend on the degree of discolouration of the organic molecules to begin with, and their quantity. Therefore, in order to achieve greater lifts you should expect some sensitivity, which is temporary.
There are two methods we use in dentistry to achieve the deeper teeth whitening. One is with take home bleach, and the other is with in-office bleach. You can expect similar results with each though the latter can be done in one sitting.
What about whitening toothpastes?
Teeth whitening using whitening toothpastes are usually a bad option. These products generally work by abrading and removing the outer layer of your teeth that have discoloured. This reveals the the whiter, fresh enamel underneath. However the enamel is now much thinner. Enamel is the strongest part of your teeth and unfortunately, once it is worn away does not reform. When more is removed the yellow dentine will start to show through. Your teeth will then look darker and the whiter enamel is lost forever. These products generally contain a small amount of bleach though the quantity is so minimal that its effect is deemed negligible.
What about the shopping booth stalls?
These places generally use the strongest bleach available without a dental provider number which is usually the strength of home bleach. They use an ultra-violet light to help activate the bleach and make it work faster. In stronger concentrations hydrogen peroxide can be quite traumatic to soft tissues. Chemical burns on the gums and lips can result if not carefully administered. It is for this reason that only dentists are allowed to deliver stronger concentrations. The shopping booth bleach will give some small lift here but because the bleach is so weak, only a very minimal change can be hoped for. Multiple applications of weaker bleach, or a single application of much stronger bleach, provides the best results. We can see this with our home and in-office bleaching procedures.
Can bleach damage my teeth and gums?
Short answer, yes, but that is when poorly administered. Bleach works by breaking down organic molecules, which is precisely what your gums are made of. Lower concentrations are safe to contact the gums though care should be used to minimise this using special trays. Higher concentrations can cause chemical burns which can vary in severity. Minor burns can feel like an ulcer and can be soothed with vitamin E gel, more severe burns can cause bleeding and the gums to peel away.
In-office teeth whitening
During in-office teeth whitening we use higher concentrations of hydrogen peroxide to achieve a greater lift. Here a special barrier is placed over the gums to keep them protected and safe. A barrier may also be placed on more porous sensitive areas of exposed dentine. The occasional application of bleach is perfectly safe to use on teeth, however stronger concentrations should be used less frequently to allow the teeth to refill and recover. Stronger applications done in quick succession could irritate the pulp, or “nerves” or teeth. Too much irritation could cause it to die off due to the trauma. That’s why we recommend 3-6 month breaks between whitening sessions if you desire to go another round. All this is completely safe when administered by a dentist trained in whitening, so follow their advice to attain a brighter and safer smile.