(360) 629-7229

7204 267th St. NW, Suite 102
Stanwood, WA 98292

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Chronic Bad Breath? Causes and Treatment.

Rapidly Dividing Oral Bacteria

Bad breath or what is known clinically as halitosis, can be embarrassing.  For most of us it is pretty infrequent occurrence but for others they suffer from this condition chronically.  So, what causes this phenomenon and what can be done about it?

Although short term bad breath may be due to whatever you just ate, think garlic and onions, longer term bad breath is a bit harder to deal with.  If you just had something stinky to eat, the best way to deal with that is to try and get rid of the remaining food odor either rinsing with water and/or chewing sugar free gum to trigger your salivary flow to help rinse and cleanse your mouth. 

If you suffer from chronic bad breath it is more likely due to the presence of bacteria that release noxious odors that are hiding in the many nooks and crannies of your mouth.  There are a couple obvious places that bacteria like to hide in your mouth.  If you can manage to disrupt these colonies of bacteria, your bad breath should subside.

The most obvious place bacteria like to hide is your teeth.  If you have a lot of buildup on your teeth, this buildup is comprised of colonies upon colonies of bacteria.  We recommend visits (for most of you) of every six months to see our hygiene team to help in removing this buildup as it’s impossible to remove tartar with an ordinary toothbrush.  Another location on your teeth that is commonly forgotten, is between your teeth.  Correct and regular flossing and/or waterpiking can help disrupt these colonies of bacteria to help keep their numbers low.

Other areas that are often underestimated are your taste buds on your tongue.  If you have a condition known as “hairy tongue”, “fissured tongue”, etc, your anatomy may be trapping bacteria making it harder to clean your tongue.  If you are not brushing your tongue already, try that.  If you have tried this already, take a look at your local drug store or online for a “tongue scraper” – these can work wonderfully.

Bad breath can be a pretty significant sign of a larger underlying dental condition known as periodontal disease.  Periodontal disease is a chronic and non-painful condition that leads to the destruction of the bone around your teeth and can lead to eventual tooth loss if left untreated.  Similarly to bacteria hiding between your teeth, periodontal disease leads to the loss of bone around your teeth creating new areas, below your gum line, where bacteria will fester.

If you have not been in to visit us recently and would like a dental exam to address this and any other dental conditions you may have, please feel free to call us at (360) 629-7229.

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DIY Orthodontics

Lately I have been seeing a lot of advertising and interest in “do it yourself” orthodontics. Multiple start-up companies are heading to the internet to promote “clear braces” – all completed in the comfort of your own home. While this may seem compelling to some, caution should be taken when considering something as personal and important as the alignment of your teeth. Though it may be possible to correct some minor orthodontic issues with a do-it-yourself program, bypassing your general dentist or orthodontist to improve your smile can be an ill-advised treatment option.

The most comparable version of do-it-yourself orthodontic treatment is the Invisalign program, a service offered by Cascadia Dentistry and other general dentists as well as many orthodontists. A big consideration for Invisalign versus traditional braces is whether you are even a good candidate for one option or the other. There are many ways teeth can move and not all of them are easy. Similarly, health considerations and general overall dental health is important to consider when deciding between these two options. For instance, some patients should not move their teeth at all due to poor periodontal health. If you suffer from uncontrolled periodontitis, moving your teeth can lead to a significant worsening of your condition. Do-it-yourself orthodontics programs may indicate they have qualified and trained professionals to make the assessment as to whether you are a good candidate for treatment, but their ability to do so is limited without seeing you in person for an exam.

Assuming that you are a good candidate for Invisalign over traditional braces, there remain other considerations for safely performing do-it-yourself braces. Once we establish that you are a good candidate for Invisalign, we work closely with orthodontists and technicians online to establish a customized treatment plan. Treatment plans vary significantly, however, they typically involve placing tooth-colored attachments on your teeth to give each tray the anchorage they need. Similarly, we periodically need to perform a procedure throughout your treatment progression to make minor adjustments to your teeth to allow for more room for movements. Both of these treatments should only be performed by a trained professional and without them, your ultimate goal of straighter teeth and a healthier smile may not be achievable.

If you would like to discuss further, please contact us today. We are always a resource to discuss your treatment options so that you make an informed decision for your oral health.

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Non-fluoridated Toothpastes

Occasionally, patients will ask for guidance with the use of fluoride as it relates to their dental care. I understand their concerns as there can be some misinformation about its risks.  I have talked about the many benefits of fluoride use before and continue to remain a firm advocate of its responsible use based upon the extensive research conducted on this naturally-occurring compound.  Per the American Dental Association (ADA): “More than 70 years of scientific research has consistently shown that an optimal level of fluoride in community water is safe and effective in preventing tooth decay by at least 25% in both children and adults. Simply by drinking water, Americans can benefit from fluoride’s cavity protection whether they are at home, work or school. The Centers for Disease Control and Prevention named community water fluoridation one of 10 great public health achievements of the 20th century.” (See https://www.ada.org/en/public-programs/advocating-for-the-public/fluoride-and-fluoridation). 

 
Recently, I encountered new research that provides further evidence on the continued responsible use of fluoride.  New research results, published by the National Institute of Health, conclude that the use of non-fluoride containing toothpastes do not aid in the prevention of cavities.  In essence, the primary benefit of utilizing toothpaste while brushing is caries prevention. For patients that choose non-fluoride containing toothpastes, this recent research continues to support existing evidence that these patients will see higher rates of tooth decay.  I encourage those looking for more information to review the peer-reviewed findings published at https://www.ncbi.nlm.nih.gov/pubmed/29766564. 

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Opioids in Dentistry

As the current opioid epidemic continues to grow and impact communities across our nation, one of the challenges I face as a dental provider is assisting my patients in very real pain while also considering the body of evidence linking opioid overprescription with addiction.  To address this correlation, I’d like to briefly discuss the practices I have always followed in prescribing pain relievers.  First, there are many compelling studies that show that taking Ibuprofen and Acetaminophen together at certain dosages are more effective than traditional opioid medications (see https://www.nytimes.com/2018/04/25/well/common-pain-relievers-beat-opioids-for-dental-pain-relief.html).  Studies have examined the way in which these two medications, when taken together, amplify each other and become more effective at controlling pain.  For many adult patients, a dosage of 600mg of Ibuprofen (3x Advil regular strength) and 650mg of Acetaminophen (Tylenol 2x regular strength) taken together every 5-6 hours can help to manage pain until we are able to determine the dental issue they may be experiencing, or during recovery post treatment.

Opioids, although a good pain reliever, have some very nasty side effects. The most obvious effect of opioids is that they are incredibly addictive. National prescription policies have been linked with a substantial increase in opioid related deaths and higher levels of addiction nationwide.  Long-term dependence on opioids, besides its damaging effects on the addicted individual’s quality of life as it relates to mental, social and financial considerations, can cause major health concerns, including nausea and vomiting, constipation, liver damage, brain damage due to hypoxia (depressed breathing) and in many cases, death. Opioids impair mental and physical activity and should be avoided in patients needing to drive or operate heavy machinery.

We understand that dental emergencies happen and pain is, unfortunately, a significant side effect of any oral condition.  It has long been the policy of Cascadia Dentistry to only prescribe any opioid-containing medications as a last resort and only at minimal quantities.  Our first line of pain management will continue to be the combination of Ibuprofen and Acetaminophen to help our patients manage their discomfort until we can assist with addressing the source of their pain through treatment at our office.

If you have any questions about this policy or how Cascadia is focused on reducing the risk of addiction in our communities, please do not hesitate to contact us to discuss further. For more information about our nation’s opioid epidemic, please see https://www.cdc.gov/drugoverdose/prescribing/guideline.html

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Invisalign Considerations

You may have heard of Invisalign, or “clear braces” orthodontic treatment. Invisalign is available to our patients at Cascadia Dentistry to accomplish a variety of dental goals such as straightening teeth, closing spaces and correcting poor occlusion (your “bite”). For patients that do not want to pursue more traditional braces but could still benefit from orthodontics, Invisalign is an excellent treatment option. If you’ve wondered how the Invisalign process works, let me offer a quick rundown as well as some tried-and-true tips and tricks for success.

The first step with Invisalign is to determine if you are a good candidate. The majority of patients with minor to moderate crowding and spacing concerns tend to be good candidates for Invisalign. Patients that have had braces before but are finding that their teeth have moved over time also tend to be good candidates. On the flip side, for patients with uncontrolled periodontal disease or significant crowding and spacing concerns, Invisalign may not be the right treatment option. Our Invisalign consultations are free to determine whether Invisalign may be a good option for you.

Invisalign treatment consists of wearing thin, clear plastic “trays” over your upper and lower teeth that click into place by lining up to small brackets that adhere on to several of your top and bottom teeth. You can remove the trays, but the brackets stay on your teeth until treatment is complete. You wear each set of trays for one week before switching to the next set. The optimal amount of time to keep your trays in each day is roughly 22 hours – which means that unless you’re eating or drinking, you really have to commit to wearing your trays all the time. As your teeth experience significant movement during Invisalign treatment, failure to wear your trays as often as required will impact the trajectory of movement and may require additional impressions to get back on track, extending the entire process. Once your treatment is complete, patients will need to wear retainers daily for six months. After six months, patients must wear retainers nightly to ensure the achieved movement of your teeth is maintained. If wearing retainers nightly “forever” seems daunting, don’t despair, there are other alternatives to consider that may be a better fit.

The most common feedback I hear from patients is that usually there is an initial adjustment period over the first week or so of wearing trays. During the adjustment period, you may find you are still getting used to speaking comfortably with your trays in, establishing good habits for wearing your trays except while eating/drinking, and really ramping up your overall oral hygiene to ensure your teeth and your trays stay as clean as possible. You will also find you are adjusting to the feeling of tightness while wearing trays as well as a heightened awareness of your teeth gradually shifting. I find patients generally report that by the 3rd day after changing into a new set of trays, tightness and soreness does subside. I recommend that patients be prepared for casual snacking to become more challenging and that they carry a travel toothbrush. Water is fine to consume with your trays in but you should remove your trays for any other food or drink to reduce your risk for cavities.

After you get started with your Invisalign treatment, periodic appointments are required every three to four weeks to monitor your progress and make adjustments as necessary. We distribute 3-4 sets of trays that you are responsible for switching weekly between these visits. Most patients indicate that once the process is underway, they become used to wearing their trays frequently and generally don’t have many challenges seeing their treatment through successfully.

If Invisalign is something you’ve considered or you are interested in learning more about it, please give us a call to schedule a consultation. We would love to show you the ways in which this treatment may benefit you and your smile!