Big Red Tooth – Dr Candice Schwartz

Where teeth and health meet

What is a Periodontist ?

Many patients come for a routine dental visit and are then referred off to see a “periodontist“. Here I will answer what a periodontist does and you can then decide if you need one.

I am going to being with a few definitions to get us on the same page:

PERIODONTIUM: This refers to all the supporting structures that surround the teeth. The specific tissues that make up the periodontium are the alveolar bone, periodontal ligament, cementum and the gingiva (or gums).

PERIODONTICS: This is the study of the periodontium and the branch of dental specialty that treats diseases of the periodontium.

Therefore, a periodontist is a specialist dental practitioner who treats and manages diseases and conditions of the periodontium. Most often a patient requires the expertise of a periodontist when they suffer from periodontal disease. Anyone can develop periodontal disease. It is usually a slow process (but sometimes can be very acute & develop rapidly) of destruction that develops over time when the oral hygiene of the mouth is poor. Initially patients suffer with bleeding gums. People assume that this is normal and do not seek treatment. Bleeding gums then become a part of their daily life. The bleeding is caused from a chronic inflammation of the gums due to the presence of bacteria in dental plaque. This is known as gingivitis. The dental plaque present on the tooth surfaces will turn to calculus, a hard accretion that cannot be removed with a toothbrush. The gingivitis, if untreated, will turn into periodontal disease which causes the destruction of the alveolar bone that houses teeth. The result is loosening of the teeth and if untreated, eventual loss of the teeth. The primary role of a periodontist is to treat periodontal disease, by removing the calculus that has accumulated and reverse the chronic inflammatory process. The objective is to halt the destructive process of bone loss through a number of minor surgical and non surgical procedures.

In addition the treating periodontal disease, a periodontist may place dental implants, surgically extract problem teeth, place bone grafts and place gingival grafts.

In general, it is advisable to see your dentist for an assessment first before booking directly with a periodontist. An astute dentist will be able to assess the severity of any possible gum problems and refer you to a suitable periodontist if you need one.

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How do you know if you have bad breath?

One of the most difficult things to tell is if your own breath really smells. Our own nose becomes desensitized to the odour of our own breath because the human brain does not register any sensations that are sensed for long periods of time: this includes the smell of your own breath. Halitosis (bad breath) is a common problem my patients complain about and they find it very embarrassing. Some bad breath symptoms are sour taste in the mouth, metallic taste, post nasal drainage, halitosis, film on tongue, tongue film, dry mouth, yellow film. Usually there is a simple solution, but this depends on the cause. Some dental causes of bad breath are extensive dental decay, gum disease, dental abcess, oral cancer, xerostomia (dry mouth). Medical conditions may also lead to bad breath: post nasal drip, tonsillar infections, lung diseases, liver diseases and diabetes.

As mentioned, numerous factors may contribute to halitosis. The first I would like to write about (and one I see daily) is gingivitis and periodontal disease (gum disease). When bacteria becomes trapped in the small pockets and spaces between the gum and the tooth, they make a home for themselves in the warm, dark, wet oral environment. As the amount of bacteria increases, they produce byproducts which contain a foul odor. It is this bacteria that causes the distinct fetid smell from gum disease patients. Regular scale and polish treatments at the dentist combined with daily oral hygiene home practice will eradicate and prevent this.

Dry mouth is a common symptom with people suffering from halitosis, and it is also one of the causes of halitosis. Dry mouth  (also known as xerostomia) causes a number of changes to occur in the mouth. First of all the bacteria become more concentrated in the saliva, and they tend to evaporate more readily into the air. When this occurs, bad breath will be stronger and more noticeable at greater distances. Additionally, the pH or acid/base balance of the mouth becomes altered, and this provides an environment that is more conducive to the growth of anaerobic bacteria (bacteria that grow without the presence of oxygen). Because there is less saliva the flushing or cleansing effect of saliva is reduced. If you find yourself suffering with dry mouth, try chewing sugar free (or xylitol based) chewing gum. This will increase the amount of saliva you produce and will flush out the excess bacteria.

Smokers not only have the stench of cigarette smoke emanating from their mouths, but the breath is heavy and thick. The obvious cure would be to stop smoking, however if you are not ready to go down this path, brushing your teeth three times a day (with a soft toothbrush), flossing every evening, chewing a xylitol chewing gum and using an alcohol-free mouth rinse will reduce the bad breath symptoms.

If you’re not sure whether or not you have bad breath, and you have nobody to ask try these at home:

1. The Cotton Test: Wipe the top surface of your tongue with a piece of cotton gauze and smell it. This is probably the most honest way. Also, if you notice a yellowish stain on the cotton, it’s likely that you have an elevated sulfide production level. Sulfides are one of the byproducts produced by the offending bacteria that lead to halitosis.

2. The Lick Test: Lick the back of your hand. Let that dry for about 10 seconds and then smell. If you notice an odor, you may have a breath disorder because the sulfur salts from your tongue have been transferred to your hand.

3. The Dental Floss Test: Run a piece of dental floss between your back teeth (this is the mostly likely place where you may get food caught) and then smell the floss. This may be an indication of the level of odors others detect.

If you don’t have the constitution to perform any of these home tests then visit your dentist!