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Common Dental Problems

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Oral care doesn't just keep your teeth strong; it can have a significant effect on your general wellness, too. Nearly one in 10 people have some sign of poor dental health, and in some instances that number goes up to almost 100 percent. The most common oral diseases are:

What Is It?
Dental caries is the scientific term for tooth decay or cavities. It is caused by specific types of bacteria. They produce acid that destroys the tooth's enamel and the layer under it, the dentin.

Many different types of bacteria normally live in the human mouth. They build up on the teeth in a sticky film called plaque. This plaque also contains saliva, bits of food and other natural substances. It forms most easily in certain places.

These include:

  • Cracks, pits or grooves in the back teeth
  • Between teeth
  • Around dental fillings or bridgework
  • Near the gum line

The bacteria turn sugar and carbohydrates (starches) in the foods we eat into acids. The acids dissolve minerals in the hard enamel that covers the tooth's crown (the part you can see). The enamel erodes or develops pits. They are too small to see at first but they get larger over time.

Acid also can seep through pores in the enamel. This is how decay begins in the softer dentin layer, the main body of the tooth. As the dentin and enamel break down, a cavity is created.

If the decay is not removed, bacteria will continue to grow and produce acid that eventually will get into the tooth's inner layer. This contains the soft pulp and sensitive nerve fibres.

Tooth roots exposed by receding gums also can develop decay. The root's outer layer, cementum, is not as thick as enamel. Acids from plaque bacteria can dissolve it rapidly.

Symptoms
Early caries may not have any symptoms. Later, when the decay has eaten through the enamel, the teeth may be sensitive to sweet, hot or cold foods or drinks.

Diagnosis
A dentist will look for caries at each visit. The dentist will look at the teeth and may probe them with a tool called an explorer to look for pits or areas of damage. The problem with these methods is that they often do not catch cavities when they are just forming. Occasionally, if too much force is used, an explorer can puncture the enamel. This could allow the cavity-causing bacteria to spread to healthy teeth.

Your dentist will take X-rays of your teeth on a set schedule, and also if a problem is suspected. They can show newly forming decay, particularly between teeth. They also show the more advanced decay, including whether decay has reached the pulp and whether the tooth requires a root canal.

Newer devices also can help to detect tooth decay. They are useful in some situations, and they do not spread decay. The one most commonly used in dental offices is a liquid dye or stain. Your dentist brushes the nontoxic dye over your teeth, then rinses it off with water. It rinses away cleanly from healthy areas but sticks to the decayed areas.

Expected Duration
Caries caught in the very early stages can be reversed. White spots may indicate early caries that has not yet eroded through the enamel. Early caries may be reversed if acid damage is stopped and the tooth is given a chance to repair itself naturally.

Caries that has destroyed enamel cannot be reversed. Most caries will continue to get worse and go deeper. With time, the tooth may decay down to the root. How long this takes will vary from person to person. Caries can erode to a painful level within months or years.

Prevention
One way you can prevent cavities is by reducing the amount of plaque and bacteria in your mouth. The best way to do this is by brushing and flossing daily. You also can use antibacterial mouth rinses to reduce the levels of bacteria that cause cavities. Other rinses neutralize the acid in your mouth to make the environment less friendly to the growth of these bacteria.

You can reduce the amount of tooth-damaging acid in your mouth by eating sugary or starchy foods less often during the day. Your mouth will remain acidic for several hours after you eat. Therefore, you are more likely to prevent caries if you avoid between-meal snacks.

Chewing gum that contains xylitol helps to decrease bacterial growth. Unlike sugar, xylitol is not a food source for bacteria. Other products also can reduce the acid level in your mouth. Ask your dentist about them.

Another way to reduce your risk of cavities is through the use of fluoride, which strengthens teeth. A dentist can evaluate your risk of caries and then suggest appropriate fluoride treatments. Fluoride in water strengthens teeth from within, as they develop, and also on the outside. Dentists also can paint fluoride varnish on children's primary teeth to protect them from decay.

In adults, molars can be protected with sealants. In children, both baby molars and permanent molars can be sealed. Dentists also can use sealants on molars that have early signs of tooth decay, as long as the decay has not broken through the enamel.

Treatment
Caries is a process. In its early stages, tooth decay can be stopped. It can even be reversed. Fluorides and other prevention methods also help a tooth in early stages of decay to repair itself (remineralise). White spots are the last stage of early caries.

Once caries gets worse and there is a break in the enamel, only the dentist can repair the tooth. Then the standard treatment for a cavity is to fill the tooth. If a drill is used, the dentist will numb the area. If a laser is used, a numbing shot is not usually required. The decayed material in the cavity is removed and the cavity is filled.

Many fillings are made of dental amalgam or composite resin. Amalgam is a silver-grey material made from silver, mercury, copper or other metals. Composite resin offers a better appearance because it is tooth-coloured. Newer resins are very durable.

Amalgams are used in molars and premolars because the metal is not seen in the back of the mouth. Composite and ceramic materials are used for all teeth.

If a cavity is large, the remaining tooth may not be able to support enough filling material to repair it. In this case, the dentist will remove the decay and cover the tooth with a ceramic inlay, onlay or artificial crown.

Sometimes bacteria may infect the pulp inside the tooth even if the part of the tooth you can see remains relatively intact. In this case, the tooth will need root canal treatment. A general dentist or an endodontist will remove the pulp and replace it with an inert material. In most cases, the tooth will need a crown.

When to Call a Professional
The early stages of decay are usually painless. Only regular dental examinations and X-rays (or other caries-detecting devices) can show early trouble. If your teeth become sensitive to chewing or to hot, cold or sweet foods or drinks, contact your dentist.

Prognosis
If caries is not treated, it likely will cause the tooth to decay significantly. Eventually, uncontrolled decay may destroy the tooth.

Having caries increases your risk of more caries for several reasons:

  • Caries is caused by bacteria. The more decay you have, the more bacteria exists in your mouth.
  • The same oral care and dietary habits that led to the decay of your teeth will cause more decay.
  • Bacteria tend to stick to fillings and other restorations more than to smooth teeth, so those areas will be more likely to have new caries.
  • Cracks or gaps in the fillings may allow bacteria and food to enter the tooth, leading to decay from beneath the filling.

Gingivitis means, quite literally inflammation of the gingivae or gums. Gum problems occur when there is an inflammation or infection of the support tissues of the teeth. There are two main forms of gum disease:

  1. Gingivitis is when the gums are affected superficially
  2. Periodontitis is when the deeper structures are affected.

Of the two conditions periodontitis is the more severe disease, although long standing gingivitis may in some cases lead to periodontitis.

If gingivitis is present, the gums will be red in colour rather than the usual healthy pink. They will also tend to be slightly puffy or swollen. Inflamed gums also bleed, usually when tooth brushing or biting into something hard such as an apple. In severe cases of gingivitis, gums may bleed of their own accord. The major cause of gingivitis is dental plaque. Plaque is the build-up of bacteria (germs) and saliva that collects on the tooth surfaces and other parts of the mouth. If the plaque is allowed to collect around the necks of the teeth (where the teeth meet the gums), the gums become inflamed and gingivitis can occur. Some of the plaque bacteria are harmful and can cause gum disease. Plaque can become hardened (mineralised) and form into a hard surface layer of tartar (calculus). The bacteria in the tartar continue to attack the tissues that support the tooth roots. Prevent plaque and tartar formation by brushing thoroughly twice a day.

Gingivitis can affect anyone at any age, although it is less likely to be seen in younger children. Mild cases may go unnoticed for some time and there may be no symptoms during the early stages of the disease. However, if left untreated, gingivitis can gradually progress, resulting in the destruction of the tooth attachment and the bone around the teeth. This causes the affected tooth or teeth to become loose. It is best to visit a dentist or hygienist as soon as it is suspected that gingivitis is present so that treatment can begin promptly to prevent the condition from worsening. The dentist or hygienist will carry out a thorough examination and will treat the condition.

The first step is to make sure that the teeth are brushed regularly and effectively, and making sure that the toothbrush is applied correctly to the tooth gum margin at the neck of the tooth. First move the lower jaw until the teeth are in edge-to-edge contact and brush all the outside surfaces of the teeth and gums gently and thoroughly with a circular motion.

Next, open the mouth and do the same to the inside surfaces of the top teeth and the surfaces of the lower teeth next to the tongue. Finally, brush all the biting surfaces and spit out to excess to clear away the debris. Providing that a very hard tooth brush is not being used, any bleeding that may occur is not alarming. Once you are brushing effectively, and the inflammation disappears (in about two weeks) the bleeding will stop. The dentist may also recommend a special mouthwash to help the gums return to a normal healthy condition.

The dentist or dental hygienist will also remove any other hardened deposits in your mouth (tartar or calculus) that may be helping the plaque to congregate, for example, the tartar that collects behind the bottom front teeth (incisors) and the outsides of the upper cheek teeth (molars). This tartar is plaque that has become hardened or mineralised by salts in the saliva. The process of removing these hard deposits is known as scaling and may be carried out using hand instruments or with advanced ultrasonic technology. The task is usually completed with a refreshing polish.

The cold sore virus is very common and is carried by up to 80 percent of the population. It is caused by a virus called 'herpes simplex' (HSV). Cold sores are highly infectious and capable of spreading to other parts of the body. Once you have been infected, the virus lies dormant in the nerves that supply feeling to the face and mouth. The virus can subsequently be reactivated, and it is the reactivation that presents as cold sores on the lips.

Triggers
It is important in managing this condition to identify what triggers an outbreak of cold sores. Most cold sore sufferers can identify everyday events that cause the reactivation of the virus and lead to the development of a cold sore. These triggers can vary between individuals, for example, where one person is more affected by the cold, another sufferer may be more susceptible to sunlight. Identifying the trigger is the first step to take towards managing cold sores.

Common trigger factors include:

  • Ultraviolet (UV) light from sunshine or sun bed exposure
  • Emotional stress or exhaustion
  • Common cold, flu or feverish illness
  • Feeling physically low or fatigued leading to a weakened immune system
  • Menstruation
  • Exposure to extreme temperatures or weather conditions
  • Pregnancy
  • An injury to the mouth, surgical operation or dental treatment
  • A knock on the lips or face.
The cold sore cycle

There are five different stages:

Tingle:
This stage normally lasts between a few hours and a day. The cold sore is 'invisible' at this stage but a tingling or burning sensation may be felt. If an antiviral cream (Aciclovir) is applied at this stage it may prevent the visible signs of the cold sore from appearing. Aciclovir attacks the virus and stops it from multiplying.

Blister:
This stage is characterised by a small group of painful, fluid-filled blisters. These are normally seen on the second day of the cold sore cycle. Here again, treatment with an antiviral cream will reduce the life of the cold sore.

Ulcer:
Once the small blisters have burst, a weeping ulcer is seen that may last for several days. This stage is also very painful. The clear liquid that is released from the ulcer contains a high number of viral particles and as such is highly contagious.

Scab: After about four days a thin scab will form, acting as a protective covering for the new skin that is forming beneath. The skin around the scab may dry and crack and even bleed. Moisturising the area will help to reduce this. The scab may also be itchy, but is not contagious at this stage.

Healing:
After 9-12 days the cold sore will have healed. A slightly red/pink area of skin will remain but will quickly fade. Most people who get cold sores will usually experience about two to three attacks per year, although some people may get as many as 12.

Reduce the risk of spreading the virus

  • Try not to break the blisters or pick the scabs
  • Always wash hands after touching the cold sore or applying medication
  • Avoid kissing
  • Do not touch the eyes and take extra care when applying or removing make-up
  • Do not wet contact lenses with saliva while suffering a cold sore and always wash the hands before touching your lenses
  • Sharing eating or drinking utensils, such as cutlery and cups, should be avoided, especially with children
  • Do not share personal hygiene items such as toothbrushes, face cloths or towels
  • Make sure the cold sore is healed before visiting a dentist
  • Consult a doctor if a cold sore becomes severe or extensive.

Once infected, the virus cannot be removed. There are medicines available to treat the first episode of infection and to treat recurring cold sores. These are a few key points to remember when treating cold sores:

Treat the cold sore as soon as it starts developing (the tingle stage) as this can reduce the duration of the cold sore by up to 50 percent.

It is never too late to start treating a cold sore as even during the blister stage, antiviral creams are effective. An untreated cold sore will usually last between nine and 11 days.

Treatment with an antiviral cream will also help prevent the spread of the virus.

Treating the first infection
For an adult or child over two years old with a first infection, tablets from your dentist or doctor can be taken five times a day for five days.

Treating recurring cold sores
To treat recurring cold sores, antiviral cream can be applied five times a day for five days beginning as soon as the tingling sensation begins, or as soon as the cold sore appears on the lip. The cream can be bought from a pharmacy, but the tablets must be prescribed by a dentist or a doctor.

Although not actually a disease, 40 percent of children worldwide experience injuries to their mouths as a result of unsafe conditions, accidents and violence. Your best bet for preventing injuries during sports is to wear a mouthguard, but in the event of an unexpected injury off the field, get medical care as early as possible. A tooth that has been knocked out can be replaced if you rinse it with water and see the dentist quickly enough. Your chance of re-implanting the tooth in its socket are best within 30 minutes of the accident, but it can still prove successful for up to two hours afterward depending on the case.

The term 'mouth cancer' or 'oral cancer' is used to describe cancers that are found in the mouth, on the lips and in the throat. It is estimated that there are about 3,500 new cases of mouth cancer each year in the United Kingdom. Mouth cancers make up between one and four of every 100 UK cancers. In other parts of the world, such as the Indian subcontinent, mouth cancers make up about four of every ten.

Like a cancer in any other part of the body, mouth cancer impacts on quality of life and can cause death. It occurs with a similar frequency to cervical cancer and skin cancer and has a high death rate. A person has a 50/50 chance of surviving for more than five years following treatment. This is because many people do not become aware of a possible mouth cancer until it is well advanced.

The edges of the tongue are the most common sites for mouth cancer, followed by the floor of the mouth, and the gums towards the back of the lower jaw.

The early signs to look for are:

  • An ulcer or sore that has been present for about one month
  • A white or red patch.

These early signs may be overlooked because they are painless. Later signs may include:

  • Difficulty chewing or swallowing
  • Swelling of any part of the mouth
  • Difficulty moving the tongue or jaw.

There are two major factors that increase the chances of getting mouth cancer. These are tobacco (either chewed or smoked) and alcohol use. Eight in every ten cases are linked to a person using tobacco and alcohol together. The risk of mouth cancer is increased 35 times if you smoke more than 40 cigarettes and drink more than four units of alcohol daily. Being in the sun a great deal is a major cause of lip cancer.

A diet that lacks the vitamins found in fresh fruit and vegetables is a risk for all cancers, including mouth cancer.

Self-help action

  • Stop tobacco use – whether smoked or chewed
  • Reduce alcohol use
  • Wear a suitable sun block outdoors in bright sunshine
  • Eat five helpings of fresh fruit and vegetables daily
  • Carefully examine the lips, tongue and floor of the mouth regularly – the earlier a cancer is spotted, the better chance of a successful recovery
  • Visit a dentist regularly

A thorough mouth examination by a dentist is recommended for everyone at least once a year. During this general review a cancer may be spotted. This examination should take place even if you have no teeth and wear a denture.

The dentist may ask about tobacco and alcohol use, and advise on stopping or reducing the amount. Stopping tobacco and alcohol use will not only help to prevent mouth cancer but also many other health conditions. The dentist can provide a clear explanation and answer any questions about mouth cancer, including what treatment is available and how it is arranged.

If soreness or irritation in the mouth continues for about a month then a dentist should be consulted. If the dentist thinks you have mouth cancer, he will refer you to a specialist unit. Further tests will be carried out in the specialist unit so that a clear diagnosis can be made.

Dry mouth (xerostomia) may result from one of a number of causes. The mouth is supplied with saliva by pairs of major salivary glands and hundreds of tiny minor salivary glands scattered all over the lining of the mouth. There may be damage to or disease of these salivary glands. Alternatively, the glands themselves may be normal, but the rate at which saliva is produced is low. Dry mouth may also occur with diabetes, stress or depression. It may follow radiotherapy to the head and neck. The most common reason for a dry mouth is as a side-effect of prescribed medicines.

The main disease causing a dry mouth is Sjögren's Syndrome (pronounced 'show-grunz'). This condition can either occur by itself, when it is known as primary Sjögren's Syndrome, or in secondary form alongside conditions such as rheumatoid arthritis. Because it will affect all salivary glands, both major and minor, the whole mouth will be drier. In both conditions, there is associated dryness of the eyes, and there may be other symptoms such as tiredness. Both types of Sjögren's Syndrome can be investigated with blood tests, and sometimes a small biopsy of the minor salivary glands in the lower lip.

The most commonly prescribed medicines that cause a dry mouth are tablets used for treatment of blood pressure. The next most common are those used to treat anxiety and depression, and antihistamines taken for hay fever and treatment of allergies. In younger people, inhalers used to treat asthma may also cause a dry mouth.

A dry mouth is often quite uncomfortable and may make eating difficult. One of the functions of saliva is to help prevent tooth decay and gum disease so if you have a dry mouth you will be more at risk of getting these diseases. It is especially important for sufferers:

  • To avoid having sugary snacks and sweets
  • To keep teeth really clean
  • To visit a dentist regularly
  • Use a fluoride mouthwash or an antibacterial mouthwash such as chlorhexidine (available from pharmacies).

If the sufferer wears dentures there is an increased risk of developing thrush in the mouth. To avoid this, it is important to take the dentures out at night and clean them regularly. It may occasionally be necessary for the dentist or doctor to prescribe a medication to treat or prevent oral thrush.

If there is some salivary gland function, then the flow of saliva can be increased by chewing gum or sucking a sweet – they should be sugar-free.

Regular sips of water throughout the day may help to keep the mouth comfortable and it is helpful to take sips of water while eating.

There are a number of saliva substitutes that may be bought from a pharmacy or prescribed by a dentist or doctor. Other saliva stimulants are available; these are mainly sprays, gels, tablets or pastilles to suck.

There is a medication available (pilocarpine) which can stimulate salivary glands that still have some saliva-producing ability left. A doctor or hospital specialist can prescribe this. However, it has a number of side-effects which some people may find unpleasant.

If in doubt, consult a dentist or doctor.

Dental erosion is the loss of enamel and dentine from the tooth as a result of direct acid attack. It can be caused by excessive exposure to acid substances such as fruit juices and fizzy drinks. It is an irreversible condition. Tooth erosion differs from tooth decay as tooth decay is the progressive loss of tooth enamel by plaque acid attack. Bacteria in the mouth break down sugars into acids which then attack the teeth. The most common teeth affected by dental erosion are the upper front teeth, although all teeth can be affected. Teeth that have been eroded look glassy, can appear short, and have uneven tips that are easily chipped away. Teeth that have been eroded may become sensitive. Research has shown that erosion is very common (50 percent of 4-18-year-olds have some tooth erosion).

The source of acid that causes the erosion is either from an intrinsic source from within the body (eg acid from the stomach) or from an extrinsic source from outside the body (eg acidic foods, drinks or medicines). Intrinsic causes are vomiting and acid reflux (where acid from the stomach escapes up into the mouth) which can be caused by a hiatus hernia, obesity or certain drugs. Fruit juices and soft drinks, together with foods such as rhubarb and citrus fruits, are examples of extrinsic sources of acid.

Regular check-ups at the dentist mean signs of erosion can be detected early. If dental erosion has been diagnosed the first stage is to record accurately how severe and extensive the damage is; this is best done by the dentist taking impressions of your teeth. The impression is cast in plaster and can be used to see if the amount of erosion is getting worse over a period of time.

For those affected by erosion it is important to:

  • Limit acidic foods and drinks to meal times
  • Reduce the number of times during the day that acidic foods and drinks are consumed
  • Choose soft drinks which have no added sugar and have been shown to pose a negligible risk of tooth erosion
  • Finish meals with a small piece of cheese or a drink of milk
  • Delay brushing teeth immediately after having acidic foods or drinks.

It may be possible to improve the appearance of teeth that have been eroded with the use of adhesive filling materials, veneers or crowns. However, it is important that the cause of tooth erosion is identified first before this kind of dental treatment is undertaken.

The best drinks for children's teeth are water or milk. Many people believe that natural fruit juices or squashes are the safest alternatives to water or milk, however, most contain fruit acids (often quite a lot). Even drinks marked with "no added sugar" still contain acids that can cause tooth erosion. Fizzy drinks (whether diet or regular), fruit squashes, cocoa and milk shakes may all cause harm to teeth. The sugar in them can cause tooth decay whilst the acid in both normal and diet drinks dissolves the enamel on the teeth leading to erosion. Always dilute squashes correctly – follow the manufacturer's directions for use. Natural fruit juices should be diluted with water to reduce the risk of tooth damage, although even when very diluted, the acids are still there and can-do harm to the teeth. Remember that if a child is genuinely thirsty, they will always drink water! Water can be made more exciting by giving it in a special cup, adding ice or using a straw. If children require an alternative drink to milk or water look for a no added sugar squash that has been specially designed to pose a negligible risk of tooth erosion.

If comfort feeders and bottles containing sugary drinks are given to young children, they can cause severe dental problems. Milk or water is the only drink that should be given in a baby's bottle. When using feeding bottles hold the baby until the feed is finished. Never leave a baby propped up with a bottle; they might choke and it's bad for their teeth. Never leave a bottle or feeder cup with a sweetened drink by a child's bed overnight.

REMEMBER

  • Ideally a child should drink only milk, or water between meals – use a straw for all other drinks to help direct the drink right into the mouth and away from the teeth
  • Do not give concentrated drinks – always dilute them correctly and follow the manufacturer's directions for use
  • Sugary and acidic drinks, such as fruit juices, squashes and fizzy drinks should only be taken at meal times
  • Take drinks over a short time, rather than constantly sipping at them over a long time, as this reduces the time that the drink is in contact with the teeth
  • After brushing teeth at bedtime, allow a child to drink only water afterwards.
  • Cheese is very rich in calcium salts and is a tooth friendly food that helps to protect the tooth surfaces from acid attack
  • Always try and get sugar-free liquid medicine formulas from the pharmacist.

Tooth sensitivity (also known as dentine hypersensitivity) often appears as a painful reaction to temperature changes, pressure, sweet and acidic food or drink. This reaction may be mild and tingling, or sharp and intense. People whose teeth are sensitive often feel pain when they eat or drink things which are very cold. The classic example is eating ice cream, but simply being out in the cold weather is sometimes enough to set off the problem. Sensitivity to touch may also mean that tooth brushing is uncomfortable.

Research shows that one in three people in the UK suffer from sensitive teeth at any one time. Dentine hypersensitivity can occur from 15 to 70 years of age or more, however the age group when it occurs most is between 20 and 40 years.

Triggers of tooth sensitivity and the severity will vary from person to person, although the most common are: -

  • Cold food and drinks (e.g. ice cream)
  • Over-enthusiastic or incorrect tooth brushing
  • Hot food and drinks (e.g. hot tea or coffee)
  • Sharp acidic foods (e.g. apples, oranges)

Any teeth can be affected but the most likely are those at the front corners of the mouth. It is suggested that this might be because these are the teeth which tend to be brushed more vigorously causing the wearing away of protective tooth enamel.

A healthy tooth has a chamber inside it for the tooth pulp, which consists of nerves and blood vessels. A young and healthy tooth has a large pulp chamber where the sensitive nerves are more exposed to temperature or pressure changes from the outside. However, tooth sensitivity can occur at any age. There are two general ways in which this sensitivity can develop:

  • Wearing or destruction of the hard, protective outer layer of the tooth crown called enamel. This may be related to:
  • Biting abnormalities or abnormal tooth grinding
  • Toothbrush abrasion, i.e. the wearing-away of enamel and/or recession of gums caused by over-enthusiastic or incorrect brushing
  • Dietary erosion – the destruction of enamel by acidic food and drink or by acid regurgitation from the stomach
  • Habit – nail biting or the placing of metal objects between the teeth
  • Attrition – the wearing away of enamel by tooth grinding.

Gum recession exposing the softer porous tooth structures called dentine and cementum. This may be related to: -

  • Chronic gum (periodontal) disease
  • Surgery – difficult tooth extractions
  • Incorrect tooth brushing.

Sensitivity and dental pain can also be experienced for a number of other reasons:

  • Chipped teeth
  • Fractured or cracked fillings
  • Dental decay (caries)
  • Deep fillings
  • Cracked teeth.

Avoidance of this condition is possible if the teeth are cleaned thoroughly but carefully twice a day. Chewing a disclosing tablet (obtainable from chemists) after brushing will show if any plaque is left behind. Using the correct brushing technique is essential and use of a specialist toothpaste formulated for sensitive teeth. If you need advice as to the best technique to use, ask a dentist or hygienist.

Care should be taken with diet: a high intake of acid-containing food and drink such as citrus fruits and fizzy drinks will make teeth more sensitive and can lead to destruction of the tooth enamel. A dental professional can help by:

  • Applying fluoride varnish to exposed sensitive dentine or cementum
  • Applying a sealer to exposed root surfaces to block the tiny tubes which are exposed or offer treatment that will desensitise the dental nerves (no drilling is required)
  • Correcting any bite abnormalities to help reduce the wearing of enamel
  • Placing fillings to cover exposed dentine or cementum on root surfaces.

Bad breath (halitosis) is a common reason why many people visit a dentist. Everyone suffers from bad breath to some degree at some time – for example, when waking in the morning, especially when we have eaten strong foods or drunk alcohol the night before. In the great majority of cases, the causes of bad breath originate in the mouth; in a minority of cases the problem may originate elsewhere in the body such as the stomach or nasal passages. It is important to know whether this is a cause of concern. This is where a dentist can help.

The main causes of bad breath are:

  • Gum disease (periodontitis or gingivitis)
  • Broken fillings or tooth decay trapping food between the teeth
  • Secretions from the nose coating the back of the tongue.

It can be worsened by:

  • Food (e.g. garlic, onion or curry)
  • Alcoholic drinks
  • Smoking
  • Certain drugs (e.g. some heart medications, and drugs which decrease saliva production)
  • Menstruation
  • Illnesses (e.g. diabetes, kidney disease, liver disease, nasal infections, and sinusitis)
  • Stress
  • Gum disease.

Gum disease is the most common cause of bad breath. It has two forms, gingivitis (inflammation of the gums) and periodontitis (infection of the gums). Periodontitis is the more severe condition and affects the structures that hold the tooth in its socket so can result in tooth loss. It often occurs with little or no pain and we are only aware of it when it is at a late stage. Bad breath can help us to detect this disease early.

Everyone has bacteria living in their mouth but when there is an inflammation or infection in the mouth, these bacteria digest human cells and produce by-products called volatile sulphur compounds, which smell like bad eggs. These compounds are produced in everyone's mouth during the night. People with gum disease produce more.

To avoid bad breath, regular six-monthly visits to a dental surgery are essential. The dentist will check for signs of decay, broken fillings or gum disease, and either the dentist or the hygienist will remove any hard tartar (calculus) deposits that have built up on the teeth. The better the oral hygiene, the less the tartar builds up. A dentist or hygienist will advise on the best oral hygiene techniques to use.

Tongue cleaning removes the surface coating on the tongue. It helps to reduce the number of sulphur-producing bacteria and dead cells which tend to stick to the tongue. This will also remove any fluids that have dripped from the nose back on to the tongue (post-nasal drip). A tongue can be cleaned daily either by using a specially made tongue scraper [obtained from a dentist] or by brushing it with a normal toothbrush (without using toothpaste).

Mouth rinses and tooth pastes
Mouth rinses have been shown to be very effective at reducing bad breath. They remove the sulphur compounds from the mouth, thereby preventing them developing the 'bad eggs' smell. The use of antibacterial mouthwashes, gels or toothpaste, if used with good oral hygiene techniques, will reduce the number of bacteria in the mouth. They are best used at night in order to reduce morning bad breath. There is a wide variety available and a dentist will advise on the most suitable.

Improving your breath
Avoid food or drinks which produce strong smells, such as garlic and onions, especially uncooked. Chew sugar-free chewing gum. Eat regular meals. Rinse your mouth with water or sip water during the day, especially if you have a dry mouth.

Lichen planus is a condition that affects the lining of the mouth and tongue, as well as the skin but not all areas may be affected. It is unusual to have it affecting the mouth as well as the skin. It is not an infection; it cannot be caught or passed on.

The cause of lichen planus is not well understood, but it is known that it is an inflammatory condition. It causes soreness, sensitivity and discomfort in the areas affected.

The condition has a variety of appearances. It is commonly seen as a network of fine white lines on the inside of the cheeks, often on a reddish background. Less commonly it can appear as white patches of different sizes and shapes on the tongue or roof of the mouth. Occasionally the gums can be affected, both with white patches and, sometimes, shiny red sore-looking gums.

In the mouth, lesions similar to those described above, can occasionally be seen which have a different cause. These are called lichenoid lesions, and may be triggered by particular substances. For example, some medicines can cause them, commonly blood-pressure medications and anti-diabetic tablets. Also, some dental filling materials such as amalgam fillings and occasionally white filling materials can cause a lichenoid reaction. Before replacing fillings to try to remove the lesion, it would be sensible to see a hospital specialist such as an oral medicine consultant to confirm the diagnosis.

For some patients there is no discomfort as a result of the lichen planus. Other patients may well notice that the soreness is made worse when eating spicy or hot foods, citrus fruits and using strongly flavoured toothpastes and mouthwashes.

The nature of lichen planus is that it goes through periods of increasing soreness and periods when there is little or no discomfort. The condition will eventually disappear of its own accord, but the period for which it is present varies from a couple of years to many years. The average length of time it may be present is about seven years.

No treatments are available which will cure the condition. Some medications can be bought over the counter in a pharmacy. Other treatments, which can be prescribed by a dentist or doctor, are available which can lessen the discomfort. These include chlorhexidine antiseptic mouthwashes or sprays; a paste, spray or tablet application of a mild steroid.

Other more complex treatments are available for the treatment of lichen planus, and these will be used under the direction of a specialist in oral medicine after referral as appropriate.

Denture-induced stomatitis is a condition caused by candida, a fungus infection. It is manifested as redness in the gum covered by a denture, often without soreness. Persistent cracking or soreness at the corners of the mouth (angular cheilitis) may also be a sign of oral candida infection.

Candida is often present in the mouth without causing symptoms, even in healthy people. Wearing a denture increases the accumulation of plaque (bacteria and other micro-organisms such as candida). If the denture is not kept clean and oral hygiene is poor, candida and bacteria can cause inflammation of the gums under the denture. Some general health problems can increase the susceptibility to candida infections, for instance, diabetes, nutritional deficiencies and medications such as steroids and antibiotics.

Denture-induced stomatitis is aggravated if the denture is ill-fitting. The dentist will examine the mouth and dentures and give advice on whether the denture needs adjustment or replacement.

In the treatment of denture-induced stomatitis it is important to keep the mouth, teeth and dentures clean to control the candida infection. The following measures will help:

  • Brush the teeth and dentures thoroughly, especially the surface against the gums
  • Avoid frequent intakes of food or drinks containing sugar and refined carbohydrates
  • Take the dentures out at night and soak them overnight in an anti-bacterial solution such as hypochlorite or chlorhexidine. These are available from any chemist. Milton should not be used for dentures containing metal parts.
  • If the condition does not improve with these simple measures, the dentist may arrange further tests and prescribe anti-fungal medication. Alternatively, a special gel is applied to the fitting surface of the denture after meals. The course of treatment lasts a month and should be completed even if the mouth appears better after one or two weeks.

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