Let’s discuss the steps you can take to maintain good oral health and hygiene.

1. Brushing Your Teeth

Brushing your teeth twice a day is one of the most crucial steps in maintaining good oral health. Brushing helps remove plaque and bacteria that cause tooth decay and gum disease.

To brush your teeth effectively, try the following tips:

• Use a soft-bristled toothbrush: Hard-bristled toothbrushes can cause damage to your gums and tooth enamel.
• Use fluoride toothpaste: Fluoride helps prevent tooth decay and strengthens tooth enamel.
• Brush for at least two minutes: Brushing for less than two minutes may not effectively remove plaque and bacteria.
• Use gentle circular motions: Scrubbing your teeth back and forth can cause damage to your gums and tooth enamel.
• Don’t forget to brush your tongue: Bacteria can also accumulate on your tongue and cause bad breath.

2. Flossing

Flossing is another essential step in maintaining good oral health. It helps remove food particles and plaque from between your teeth and along the gumline.

Here are some tips for flossing effectively:

• Use a flossing tool that is comfortable for you: Flossing tools come in different shapes and sizes. Find one that works for you.
• Gently insert the floss between your teeth: Roughly inserting the floss between your teeth can cause damage to your gums.
• Use a clean section of the floss for each tooth: Reusing floss can transfer bacteria from one tooth to another.
• Don’t snap the floss as it can damage your gums: Snapping the floss can cause bleeding and damage to your gums.

3. Mouthwash

Mouthwash can help kill bacteria in your mouth, freshen your breath, and prevent gum disease. However, it should not replace brushing and flossing.

Here are some tips for using mouthwash effectively:

• Use a mouthwash that contains fluoride: Fluoride helps prevent tooth decay and strengthens tooth enamel.
• Rinse your mouth with mouthwash for at least 30 seconds: This allows the mouthwash to reach all areas of your mouth.
• Spit out the mouthwash after rinsing: Do not swallow the mouthwash as it can be harmful if ingested.
• Don’t use mouthwash immediately after brushing your teeth: Wait at least 30 minutes after brushing to use mouthwash.

4. Healthy Diet

Eating a healthy diet is essential for maintaining good oral health. Here are some tips for a healthy diet:

• Limit sugary and acidic foods and drinks: These can erode tooth enamel and cause tooth decay.
• Eat plenty of fruits and vegetables: These provide essential vitamins and minerals for strong teeth and gums.
• Drink plenty of water: Water helps rinse away food particles and bacteria from your mouth.
• Avoid snacking between meals: Frequent snacking can increase your risk of tooth decay.

5. Regular Dental Checkups

Regular dental checkups are crucial for maintaining good oral health. A dentist can identify and treat dental problems early on, preventing them from becoming more severe.

To make the most of your regular dental checkups, consider these tips:

• Visit your dentist at least twice a year: Regular checkups can help detect dental problems early on.
• Inform your dentist about any dental problems or concerns: Your dentist can provide personalized recommendations for your oral health.
• Follow your dentist’s recommendations for treatment and oral care: Your dentist may recommend specific treatments or oral care practices based on your individual needs.

Conclusion

In conclusion, good oral health and hygiene are crucial for overall health and well-being. Daily care, healthy habits, and regular dental checkups can help prevent dental problems and promote a healthy, beautiful smile. Remember to brush, floss, use mouthwash, eat a healthy diet, and visit your dentist regularly to maintain good oral health.

In this article, we will explore the causes, prevention, and treatment of bad breath.

Causes of Bad Breath

Bad breath is typically caused by the breakdown of food particles in the mouth. Bacteria in the mouth break down these food particles, which releases a foul-smelling gas.

However, there are many other causes of bad breath, including:

1. Poor Oral Hygiene: Failing to brush and floss regularly can lead to the buildup of bacteria in the mouth, causing bad breath. Bacteria feed on the food particles and dead cells that accumulate on the tongue, gums, and teeth, producing an unpleasant odor. A tongue scraper can also help remove bacteria and debris from the tongue.
2. Dry Mouth: Saliva plays an important role in washing away bacteria and food particles in the mouth. When the mouth is dry, bacteria can thrive and cause bad breath. Dry mouth can be caused by certain medications, medical conditions, or simply by breathing through the mouth.
3. Diet: Certain foods, such as garlic and onions, are known to cause bad breath. These foods contain sulfur compounds that are released when they are digested, causing an unpleasant odor. In addition, low-carbohydrate diets can cause a condition known as ketosis, which can also lead to bad breath.
4. Smoking and Tobacco Use: Smoking and using tobacco products can cause bad breath, as well as stain the teeth and increase the risk of gum disease and oral cancer. Tobacco use also dries out the mouth, which can exacerbate bad breath.
5. Medical Conditions: Certain medical conditions can cause bad breath, including respiratory infections, acid reflux, and liver and kidney problems. Infections in the throat or sinuses can produce mucus and bacteria, which can cause bad breath. Acid reflux can also lead to bad breath by causing stomach acid to flow back up into the esophagus and mouth.

Prevention of Bad Breath

Preventing bad breath starts with good oral hygiene. Here are some tips to help prevent bad breath:

1. Brush and Floss Regularly: Brush at least twice a day and floss at least once a day to remove food particles and bacteria from the mouth. Make sure to brush your tongue and the roof of your mouth as well.
2. Use Mouthwash: Using an antibacterial mouthwash can help kill bacteria in the mouth and freshen breath. Look for a mouthwash that contains chlorhexidine, which is effective at killing bacteria.
3. Drink Water: Drinking water can help wash away bacteria and food particles in the mouth. It also helps to stimulate saliva production, which is important for preventing dry mouth.
4. Chew Sugarless Gum: Chewing sugarless gum can help increase saliva production, which can wash away bacteria and food particles. Look for gum that contains xylitol, which has been shown to inhibit the growth of bacteria in the mouth.
5. Avoid Certain Foods: Avoid foods that are known to cause bad breath, such as garlic and onions. Instead, try to eat foods that are high in fiber, such as fruits and vegetables, which can help promote good oral health.

Treatment of Bad Breath

If you have bad breath, there are several treatment options available:

1. Mouthwash: Using an antibacterial mouthwash can help kill bacteria in the mouth and freshen breath. Look for a mouthwash that contains chlorhexidine, which is effective at killing bacteria.
2. Toothpaste: Some toothpaste brands contain antibacterial agents that can help kill bacteria in the mouth. Look for toothpaste that contains triclosan or stannous fluoride.
3. Dental Cleanings: Regular dental cleanings can help remove plaque and bacteria from the teeth and gums. Your dentist may also recommend a deep cleaning or scaling and root planing if you have gum disease.
4. Treating Underlying Medical Conditions: If your bad breath is caused by an underlying medical condition, such as acid reflux or a respiratory infection, treating that condition can help alleviate the bad breath.
5. Quitting Smoking: Quitting smoking and tobacco use can help improve bad breath, as well as improve overall oral health.
6. Drinking Water: Drinking water can help keep the mouth moist and wash away bacteria and food particles. Aim to drink at least eight glasses of water per day.
7. Chewing Sugarless Gum: Chewing sugarless gum can help increase saliva production, which can wash away bacteria and food particles in the mouth. Look for gum that contains xylitol, which has been shown to inhibit the growth of bacteria in the mouth.

Conclusion

Bad breath is a common condition that can be caused by a variety of factors. Poor oral hygiene, dry mouth, certain foods and drinks, smoking and tobacco use, and underlying medical conditions can all contribute to bad breath. Fortunately, there are several preventative measures and treatment options available.

Practicing good oral hygiene, using mouthwash and toothpaste, regular dental cleanings, treating underlying medical conditions, quitting smoking, drinking water, and chewing sugarless gum are all effective ways to prevent and treat bad breath.

If your bad breath persists despite these measures, it is important to see your dentist or healthcare provider to rule out any underlying medical conditions.

The tooth inside out is composed of the pulp, the dentine composed of dentinal tubules, enamel on the crown and cementum on the root.

Tooth sensitivity also known as dentin hypersensitivity is a condition characterized by a short sharp pain due to an external stimulus such as cold or hot food. The pain cannot be explained by any other dental pathology and this makes it a diagnosis of exclusion.

What are the causes of tooth sensitivity?

Tooth sensitivity occurs when there is exposure of crown dentine or root dentine to the external environment. Therefore, any condition causing communication between dentine and the external environment can cause tooth sensitivity.

These include:

Periodontal problems

Gingival recession principally is known to lead to tooth sensitivity. This can be due to:

• Incorrect tooth brushing.
• Periodontal diseases.
• Bone dehiscence or fenestration.
• Periodontal nonsurgical and surgical procedures.

Gingival recession leads to exposure of the root cementum which is less mineralized than the enamel. This wears off easily during mechanical contact with objects like toothbrushes and during chemical contact with acid produced by the oral flora. This process eventually in the long term will lead to exposure of root dentine to the external environment and subsequent sensitivity.

Enamel loss

Lemon or orange juice contains eroding acid that slowly affects teeth

Enamel loss by processes other than caries can be due to:

• Abrasion which is defined as tooth loss caused by mechanical contact with abrasive objects like hard-bristled toothbrush.
• Erosion which is tooth loss caused by chemical substances like acid contained in drinks (citrus fruit juice, carbonated drinks, iron tonics, etc).
• Abfraction which is tooth loss due to flexural forces.
• Attrition is tooth loss due to tooth to tooth contact. It can be due to parafunctional habits like bruxism etc.

Tooth whitening

Chemicals (hydrogen peroxide and carbamide peroxide) used during bleaching have the ability to penetrate the enamel and get to the dentine and the pulp causing sensitivity.

How to diagnose tooth sensitivity?

As said previously, tooth sensitivity is a diagnosis of exclusion so it is important to rule out all the possible causes of tooth sensitivity such as:

• Caries (also called cavities or tooth decay).
• Cracked tooth syndrome.
• Pulpitis.
• Fractured tooth.
• Postoperative sensitivity.
• Enamel invagination restorations.

This means that a thorough history and clinical examination must be done. And by doing this, the dentist must be guided by the patient to the area of sensitivity.

Dental caries may trigger tooth sensitivity

Radiographic examination is also an important aspect of the diagnostic process and it is compulsory.

It is important to know that in the case of tooth sensitivity; pain does not outlast the stimulus.

Teeth at the corners of the mouth (canines and premolars) are more affected than the other teeth (incisors and molars).

How to manage and treat tooth sensitivity?

A stepwise approach is recommended.

First, the diagnosis needs to be confirmed and then the etiology determined. Based on the etiology, a treatment modality is adopted.

As part of treatment modalities, desensitizing agents can be applied at home (dentifrices like Sensodyne), in-office procedures (varnishes, burnishing of dentine and use of silver nitrate, fluoride compounds, and oxalates).

The patient can also be educated on possible causes of gingival recession like plaque control, tooth brushing techniques and dietary counseling.

Other treatment modalities include:

• Nerve desensitization using Potassium Nitrate.
• Protein precipitation using Glutaraldehyde or Silver Nitrate.
• Plugging of dentinal tubules using Sodium Fluoride.
• Dentine adhesive sealers using Fluoride varnishes, Glass Ionomer Cements; Composites.
• Lasers using Neodymium: yttrium aluminum garnet laser to melt the dentine surface in order to seal the dentinal tubules.

Xerostomia, commonly known as dry mouth or hyposalivation, is not a disease but a symptom of certain conditions. This is mainly due to impaired salivary gland function resulting in reduced or lack of saliva.

Importance of saliva

Saliva is very essential to the oral health and general wellbeing of an individual.

• The water component of saliva provides a cleansing effect reducing plaque and debris accumulation.
• Bicarbonate serves as a buffer to neutralize the acid produced by bacteria after the metabolism of fermentable carbohydrates and ingestion of acidic foods.
• Saliva aids in tasting.
• Salivary enzymes aid in digestion.
• Saliva serves as a lubricant making chewing and swallowing easier.
• Saliva has an antimicrobial effect.

What are the causes of dry mouth?

These can be temporary or permanent. In cases where the causes are temporary, elimination of the underlying cause provides relief.

Temporary causes include:

• Mouth breathing.
• Not drinking enough fluids.
• Dry hot weather.
• Psychological conditions such as anxiety and depression as well as medications used to treat these conditions.
• Salivary duct stones/calculi result in blockage of the salivary gland and impair the flow of saliva. This is usually accompanied by pain and swelling especially at the thought, sight or smell of food. If untreated, the obstruction may lead to progressive fibrosis and further to permanent xerostomia.
• Side effects of medications such as antihistamines, antihypertensives, bronchodilators, antipsychotics, antiparkinson agents, sedatives, anticholinergic, skeletal muscle relaxants, etc.

Permanent causes include:

• Salivary gland aplasia which refers to the congenital absence of one or more of the major salivary glands.
• Radiotherapy for head and neck tumors results in glandular atrophy partly due to reduced vascularity and due to the direct effect of the x-rays on the specialized epithelial cells.
• Sjogren’s syndrome is a chronic inflammatory autoimmune disorder characterized by dry mouth and dry eyes. Commonly affects women over 40 years of age.
• Other systemic conditions such as diabetes, because of frequent urination(polyuria), Parkinson’s disease, cystic fibrosis, sarcoidosis, as well as vitamin A, riboflavin and nicotinic deficiencies and anemia.
• Physical or surgical trauma to salivary gland duct may impair saliva secretion.

Signs and symptoms

• Thick and reduced saliva.
• Dry, sticky and burning sensation in the mouth.
• Halitosis (bad breath).
• Dry and sore throat.
• Dry, grooved, painful tongue.
• Altered taste (dysgeusia).
• Angular cheilitis which presents as ulcers at the corners of the mouth.

Complications

Dry mouth affects the quality of life of an individual as well as the nutritional, dental and psychological wellbeing.

Chronic xerostomia predisposes an individual to rampant dental caries as the protective effect of saliva is lost. Other complications include mouth ulcers, gingivitis, halitosis, unstable and unretentive dentures for denture wearers, oral candidiasis, dysgeusia, difficulty in chewing and swallowing, malnutrition due to poor feeding and in some cases sialadenitis.

When to see a doctor?

• Sudden or unexplained dry mouth requires medical attention to rule out any underlying medical conditions and to seek immediate care.
• Prolonged or chronic dry mouth.
• When it’s a side effect of a medication.
• Difficulty chewing, speaking and swallowing.
• When there are associated signs and symptoms such as pain, swelling, lymphadenopathy, dryness and soreness of the eyes.

Diagnosis of xerostomia

Diagnosis of xerostomia is mainly based on the presenting symptoms. Once you see your doctor, a thorough history of the condition will be taken including your medical, dental and drug history after which you will be examined to ascertain the underlying cause.

Salivary gland imaging, sialometry, punch biopsy and serological tests may be needed to confirm diagnosis.

Treatment and prevention of dry mouth

The management of xerostomia dwells on eliminating or addressing the causative factor.

Prevention with restrictions

Avoid dehydrating habits such as alcohol use, smoking, and caffeinated drinks.

Cut down on dry, spicy, astringent or excessively hot or cold foods which irritate the oral mucosa and exacerbate the symptoms.

Sugary and acidic foods which increase the risk of tooth decay must also be avoided.

Home remedies

• Frequent intake of water.
• Sugarless (xylitol) chewing gum.
• Sucking on sugarless candy.
• Aloe vera gel or juice serves as a moisturizer.
• Ginger, sweet pepper and cactus have a sialogogue effect, which means that they stimulate the production of saliva.
• Improvement of oral hygiene by frequent brushing with fluoridated toothpaste, flossing and regular dental check-ups at least twice a year.

Medical care

• Sialogogues are prescribed to stimulate saliva production and increase its flow rate.
• Saliva substitutes: your doctor will prescribe artificial saliva when natural production is limited or cannot be stimulated.
• Review of medication: medications can be changed or their dosages altered to alleviate the symptoms. No medication should be stopped without consulting your doctor.
• Surgery is intended when a duct stone or salivary gland tumor is diagnosed.

Bleeding gums is a sign or symptom of gum disease. It is characterized by blood coming out of the gingivae or gums. This can be spontaneous or due to contact with an irritant. It is often the first and the most common symptom characterizing gum disease. However, this can also point to other health problems.

What are the causes of bleeding gums?

There is no current classification concerning the causes of bleeding gums.

Bleeding gums can be due to:

Tooth brushing

Vigorous tooth brushing or use of hard-bristled toothbrush can cause gum bleeding as a result of trauma. The use of toothpick as well can also cause trauma to the gum and subsequent bleeding.

Gingivitis

Used to characterize gingival inflammation, one of the first symptoms of gingivitis is bleeding gums during brushing. Bleeding on probing is also a sign. For more information on gingivitis, please refer to our article on gingivitis.

Periodontitis

Used to characterize inflammation and destruction of the periodontium, periodontitis occurs when gingivitis is left untreated. Bleeding on probing is also one of its cardinal signs. For more information on periodontitis, please refer to our article on periodontitis.

Malnutrition

Vitamin K and C deficiencies can lead to a weakening of the gum and cause subsequent bleeding.

Vitamin C plays a key role in collagen production, a protein that is abundant in connective tissues like skin, hair, joints, bones and blood vessels. When deficient, the walls of the blood vessels are weakened and therefore can easily rupture and bleed.

Vitamin C is an essential nutrient that must be consumed regularly to prevent deficiency. The most common risk factors for vitamin C deficiency are poor diet, alcoholism, anorexia, severe mental illness, smoking, and dialysis.

Vitamin K plays a big role in stabilizing the blood as it helps it clot. In the absence of factors that will promote blood clotting, easy bleeding can occur.

Other causes

Other causes of bleeding gums include:

• Too tight dentures or ill-fitting dentures.

If too tight, dentures exert a high pressure on the gum causing inadequate blood to reach certain areas of the gum. This can cause what is called pressure sores.

If too loose, the denture will be subject to movements during function (mastication, speech, and even breathing) and this can damage the gums especially if the edges are sharp.

• Pregnancy as a result of hormonal disturbance. This imbalance can cause the gums to become more sensitive and therefore bleed easily.
• A bleeding disorder like hemophilia can also cause the gums to bleed.

Haemophilia is a rare blood disorder in which blood does not clot due to lack of protein (clotting factors). This makes the affected individual bleed more than usual when the least trauma occurs.

• Anticoagulants like aspirin, heparin, warfarin, etc. prevent blood to clot. This has a presentation similar to people affected by blood disorders.

How to treat bleeding gums?

Treatment of bleeding gums depends on the causative factor. Because of that, it is important to first seek the assistance of a dentist for proper diagnosis and treatment.

Depending on the etiologic factor, the treatment varies.

• If due to gingivitis or periodontitis, scaling and polishing or scaling and root planing will be done by the dentist.
• If due to trauma during tooth brushing, the type of toothbrush and technique of toothbrushing may be modified. In this case, a soft-bristled toothbrush and the Bass technique of toothbrushing is advised. The use of electric brushes also is advised because of their design which can cause less trauma to the gums.
• If due to malnutrition, the consumption of foods containing the deficient supplement is advised.

In case of vitamin C deficiency, the consumption of a diet containing vitamin C is advised. Examples include strawberries, potatoes, tomatoes, broccoli, citrus fruits and juices, and bell peppers.

In case of vitamin K deficiency, the consumption of a diet containing vitamin K is advised.

Examples include olive oil, soybeans, lettuce, swiss chard, etc.

• In case of a too tight or ill-fitting denture, denture fabrication is the treatment of choice.
• In case of a bleeding disorder, referral to a physician is the best treatment.
• If due to drugs, consultation with the affected individual physician to change the medications is advised.

The healthy tooth is supported by four structures which are: the alveolar bone, the periodontal ligament, the cementum, and the gingivae or gum.

The gingiva is divided into two:

• The free gingiva which is not attached to the tooth.
• The attached gingiva which is attached to the cervical portion of the tooth via an epithelial attachment which is known as the junctional epithelium.

The distance between the margin of the free gingivae and the attached gingivae when healthy is normally 3mm or less and is termed as being a pocket if that distance exceeds 3mm. A distance of more than 3mm indicates epithelial attachment loss.

Gingivitis is simply defined as an inflammation exclusively limited to the gum or gingivae without pocket formation. It has no age predilection.

It is mainly characterized by redness, swelling and bleeding on gentle probing during a dental examination. Affected individuals usually complain of ‘bleeding gums during brushing’. The ‘knife-edge’ margins and stippled appearance associated with healthy gingiva disappear and are replaced by a more rounded, shiny appearance. Halitosis (bad breath) may be present but pain is usually not a feature.

What are the causes of gingivitis?

Gingivitis can be caused by:

• Poor oral hygiene as this can lead to plaque or tartar (bacteria communities) accumulation around the cervical portion of the teeth and irritation of the gingivae leading to inflammation.

Dental Tartar Causes Gingivitis

Certain local factors may increase the likelihood of plaque accumulation. These include crowns with positive or negative ledge, overhanging amalgam or composite restorations, unpolished or inadequately polished amalgam or composite restorations, calculus, fracture teeth, etc.

• Endocrine conditions such as puberty, menstruation, pregnancy and diabetes mellitus especially when uncontrolled.
• Blood dyscrasias such as leukemia.
• Medications such as oral contraceptives, antihypertensives (Nifedipine) and antiepileptic drugs (Phenytoin).
• Malnutrition due to vitamin C deficiency or protein deficiency.
• Bacterial (Neisseria Gonorrhoea, Treponema Pallidum and Streptococcus species), viral (Herpes Simplex virus and Varicella Zoster Virus) or fungal (Candida species) infections.
• Trauma, allergies, foreign body reactions or even genetic.

What are the complications of gingivitis?

If untreated, gingivitis can lead to periodontitis and subsequent tooth mobility and finally tooth loss. This can have a big effect on aesthetics and lead to a lack of confidence.

How to prevent gingivitis?

Usually a very good oral hygiene aids in the prevention of gingivitis. Oral hygiene habits to adopt include:

• Brushing twice daily with fluoridated toothpaste and a soft-bristled toothbrush to frequently remove food debris and provide an antagonistic environment for bacterial growth.
• Cleaning of interdental spaces using dental floss or interdental brushes.
• Use of mouthwashes.
• Vigorously rinsing the mouth after eating.
• Visiting the dentist at least twice a year for scaling and polishing to remove accumulated plaque.

The main idea behind all these practices is to keep an oral cavity that will not be conducive to bacteria proliferation and subsequent plaque/tartar formation. Also, these measures ensure that the oral flora is maintained at a harmless level.

How to treat gingivitis?

Treatment usually depends on the etiologic factor.

If due to poor oral hygiene, scaling and polishing and improvement of oral hygiene by consistently practicing oral hygiene habits enumerated above is the treatment of choice.

Gingivitis caused by medication necessitates consultation of the individual’s physician to change the drug or amend the dosage.

Protein and vitamin C supplements are the treatment of choice in cases of malnutrition and vitamin deficiencies.

If caused by a bacterial, fungal or viral infection, respective treatment of the conditions with the right antibiotics, antifungals or antiviral drugs is the treatment of choice.

In case there is associated gingival hyperplasia, a gingivectomy can be done to improve aesthetics.