Why Bad Breath?!

Bad BreathMost people have occasional bad breath, especially after a long night sleeping with the mouth open, eating foods with powerful odour or smoking. The Department of Periodontology at the University Hospital in Muenster, Germany states that twenty percent of the German population has “chronic bad breath” (scientific name – Halitosis), in German also called “Mundgeruch”. A study published by the American Dental Association shows that Americans also are in high proportion suffering from the same problem and that 90% of all halitosis originates from the oral cavity itself.

This can be caused by an imbalance among different types of bacteria in the mouth, throat or upper airways. There can be up to 700 types of bacteria co-existing in the mouth but the smelliest ones accumulate in top of the tongue and in the periodontal pockets around the teeth. The deeper the pockets, the higher the amount of “Red Complex” bacteria, which is more powerful and can live in the absence of oxygen, also posing a systemic risk through the endotoxins they are releasing.

Few common mouth odours are:

  • Rotten eggs determined by Hydrogen sulfide
  • Rotten cabbage – Methyl mercaptan
  • Garlic – Allyl mercaptan & Allyl – methyl sulfide
  • Fish – Dimethylamine & Trimethylamine.

However, there are other mouth odours, which are not generated just by bacteria overgrowing in the mouth but due to serious system diseases such as GERD (Gastroesophageal reflux disease), diabetes, liver or kidney disease.

Perio-BacteriaIn these cases, the dentist is the first line of defence. During a regular check-up, he can diagnose the presence and the type of bad breath. The ones caused by periodontal pockets – the most common – can be successfully treated by removing the accumulation of hard calculus and sticky biofilm above and especially below the gum line. This has also a beneficial impact on the health of periodontal ligaments around the teeth and is preventing gum and bone recession. Combined with the Probiotics treatment it can be extremely effective.

In addition to teeth brushing, flossing and the use of mouth rinses, daily tongue cleaning is a must. If in spite of all these prophylactic measures, if a person is still experiencing a bad mouth odour, there might be leaking dental crowns which cause constant bacterial accumulation in the periodontal pockets or systemic pathology. The systemic problems require close collaboration between the dentist and the family doctor.

Costin Marinescu
Dr.-medic stom, D.D.S. (USA)

Snoring – just Annoying or also Dangerous?

Snoring - annoying

Everyone knows how annoying snoring can be, especially for the partner sleeping next to you. But is it just an annoyance or is it more than that? Research shows that snoring could be the first step towards sleep apnea (Obstructive Sleep Apnea – OSA) and…. this is dangerous, possibly life-threatening. Let’s go a bit into details to find out how these harsh sounds are generated.

Snoring is caused by a vibration of the soft tissues in the throat (Pharynx) consequent to the narrowing of air passages. Snoring can occur due to throat muscle weakness, fat deposits in and around the throat, malposition of the jaw (mandible), different medications, alcohol or drugs that cause muscle relaxation or obstruction in the air passageways. Besides the sound produced while sleeping, snoring also signifies a possible insufficient quantity of air reaching the lungs. For OSA patients this is even more significant since impaired breathing leads to systemic hypoxia with symptoms such as restless sleep, concentration problems during awake times, aggravated clenching and grinding. In addition, Dr. Kathleen Yaremchuk from Henry Ford Hospital in Detroit also showed in a recent study that snorers exhibit changes in the tunica intima-media of the carotid arteries and subsequent inflammation caused by the vibrations of snoring.

Is there anything that can be done against snoring to prevent more serious systemic problems and also not bother our partner with those terrible noises?

Yes, in fact, there are a couple of remedies, surprisingly, some of them quite non-invasive and provided by a dentist:

  1. One of them is a dental appliance that is worn in the mouth overnight. It positions the jaw slightly forward allowing the throat to stay open more and the air to freely pass through. It is important to mention here that “do-it-yourself” devices found in the stores can cause malposition of the jaw, which can negatively affect the joints. It is recommended that all anti-snoring appliances be fabricated specifically for each patient and adjusted by a dentist who is familiar with the OSA dental appliances. When a narrowing of the nasal passageways causes snoring, a special nose clip could also work well.
  2. Laser-assisted uvula-palato-plasty (LAUP) is a more invasive procedure where the vibrating soft tissue (uvula) in the throat is removed. This is a surgical procedure used when dental appliances do not work anymore.
  3. A sleep mask (CPAP – Continuous Positive Airway Pressure), which could be a bit cumbersome to wear but for severe OSA patients can be life-saving.

Out of these treatment options, the easiest and least intrusive method to start with would be the custom-fabricated overnight appliance. It is scientifically proven to work in a non-invasive way and is quite predictable in results. Therefore, at your next check-up appointment, tell your dentist if you are snoring. It might now be just about the noise…

Costin Marinescu
Dr.-medic stom., D.D.S. (USA)

Probiotics in Modern Dentistry

Did you know that there is Good and Bad mouth bacteria?!

The human mouth contains over 700 strains of pathogens and their balanced coexistence is the key. Influencing that balance by promoting more Good Bacteria has been proven to diminish chronic periodontal inflammation (gum disease) by colonizing the tooth surfaces (and even implant or abutment surfaces) and preventing Bad Bacteria from developing. Products such as Perio Balance from Gum USA or BioGaia Prodentis from Sweden are providing a “new weapon” in the Preventive Dentistry arsenal – Lactobacillus Reuteri Prodentis (LRP).

Pink Probiotics

The first article published in 2009 on LRP showed very encouraging results in preventing the development of gingival inflammation and the latest studies support the revolutionary findings.

What does that mean for the patients suffering with chronic periodontal inflammation?
in Germany those are about 70.9%, in the 35-44 years age group and 87.4% in the 65-74 years age group, with one-fourth and respectively one-half presenting severe forms.

In our experience, periodontal therapy together with probiotic treatment has an astounding success through rapid healing and delayed biofilm build-up on the teeth. Even dental implants are benefiting of probiotics by diminishing the peri-mucositis risk (soft tissue inflammation around the implant).

What are the benefits of using Probiotics?!
  • Lower risk of irreversible gingival recession and bone loss.
  • Longer intervals between periodontal maintenance appointments.
  • Better chance of maintaining a beautiful smile for a lifetime – the proportions Pink / White / Shadow are preserved.

However, probiotics don’t cure periodontal disease. They considerably enhance the treatment efficiency only if diagnosis and therapy are accurately performed. If you are one of those 70-80% having recurrent mouth issues, Probiotics might be your best ally in naturally and non-intrusively helping your body fight Bad Bacteria.

Costin Marinescu
Dr.-medic stom., D.D.S. (USA)

The battery in the mouth

Did you know we can generate electric currents with our metal crowns and fillings?!

 

The Battery in the Mouth

Have you ever felt a “shock” or a “metallic taste” caused by a piece of aluminum foil or a metal spoon that touched a silver-mercury filling or a gold inlay in your mouth? That is an electric current (Oral Galvanism); it happens when different metals are exchanging ions through a liquid, just like a battery. The same current can also exist through the teeth, the nerve inside or through the body. This can’t be good right?! Well, research shows that it can lead to cellular changes similar to cancer…

The galvanic current is a term that has been used in dentistry since 1933. Researchers expressed their concern about Oral galvanism, which occurs when two or more different metals (silver/copper amalgam fillings, metallic or metal-ceramic crowns, gold inlays-onlays) coexist in the mouth. Saliva acts as a conductive medium and the different electric potentials of metals generate an exchange of ions. This is exactly how also a battery works – try touching the terminals of a 9V battery with your tongue …

Latest studies show that the electric exchange of ions between different metals in the mouth could pose a serious health risk.

In 2012, the team of researchers led by Prof. Dr. Wilhelm Niedermeier from Köln Dental School determined the “oral galvanism induces subcellular changes similar to the oral squamous cell carcinoma cells in vivo”.1.

There are two types of dental galvanism:

  • Between restorative materials or metal instruments placed in the mouth: an amalgam (silver & copper & mercury) filling placed in opposition or next to a tooth with another metallic restoration, in the presence of saliva, constitutes an electric cell. Since the two dissimilar metals are close to each other, the flow of electrical current is established through saliva and a metallic taste can be felt.
  • Between metal dental restorations and other metals touching the body or the mouth: if different metals come in indirect contact, the electric circuit can close through the pulp (tooth nerve) and the person experiences discomfort and tooth sensitivity.

In the past, metals have been used in dentistry due to lack of good ceramic or composite alternatives. Nowadays, we have quite a large selection of durable, tooth-colored ceramics, porcelain nano-filled composites and sophisticated bonding systems. All-ceramic restorations and composite materials are also posing electric insulating properties and are much more biocompatible than any metal restorations.

Nowadays, There Is No Reason Anymore to Use Metals in Dentistry!

In regards to “silver fillings”, Norway, Denmark and Sweden have banned the use of dental amalgam (silver & mercury based fillings) in dentistry due to their mercury toxicity and negative impact to the environment.

Costin Marinescu
Dr.-medic stom., D.D.S. (USA)

 


  1. Induction of apoptosis and up-regulation of cellular proliferation in oral leukoplakia cell lines inside electric field.
    Ahmed Korraah, BDS, MS, Margarete Odenthal, PD Dr., Marion Kopp, Dipl-Biol, Nadarajah Vigneswaran, DMD, DDS, Peter G. Sacks, PhD, Hans Peter Dienes, Prof. Dr. Med., Hartmut Stützer, Dr Med Dipl–Math, Wilhelm Niedermeier, Prof. Dr. Med. Dent.
    Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 113, Issue 5, May 2012, Pages 644–654

“Damage Control”

– Damage control is also known as Managed Preventive Care

Teeth wear down but they do not heal. However, if their age matches the overall body’s chronological age, it is not an issue since they are built to last longer than the average lifespans. As long as premature wear due to grinding or chemical erosion does not occur, they could easily last over 100 years. Our body does age but it does it slower and slower thanks to the latest medical advances. Stress, bad nutrition and inappropriate prophylaxis cause the occlusion (the bite – how teeth come in contact with one another) to become unbalanced, leading to a premature aging of the teeth, faster than our body.

Do crowns, implants, fillings help preserving our teeth?! 

Yes, they do. However, in spite of the amazing possibilities that modern dentistry offers such as the variety of ceramics, dental implants and composite materials, none of them are better than the original tooth structure or its periodontal support system. 

Therefore, oral prophylaxis and in particular, Managed Preventive Care is much more valuable than any crown or implant. Statistical research clearly shows that no crown, filling and even implant can last a lifetime.  Teeth however, can. Preserving and managing what nature built still turns out the most predictable results; all we have to do it to prevent premature ageing.

538px-Age_Specific_SEER_Incidence_Rates_2003-2007.svg

Source: Aging-associated diseases, Wikipedia

So, how can we keep our teeth from needing crowns, fillings or simply not losing them? 

Establish the risk factors – genetic, epigenetic, nutritional, wear prevention – and determine how long can we wait until the point where the damage can become unmanageable. Statistically, that can be determined by integrating all patient’s data into a coherent Preventive protocol. Only at the time when individualized preventive dentistry is not capable anymore to stop rapid degradation, we resort to restorative dentistry such as all ceramic restorations, composite materials together with regenerative & bio-stimulating procedures. Postponing invasive treatments should be done scientifically, with the help of high-resolution differential diagnostics and not by overlooking the symptoms hoping for a healing effect. Remember, teeth don’t heal and periodontal ligaments cannot regenerate. Evidence-Based Dentistry is proven to succeed in preserving the teeth and their associated structures and more importantly, prevent the need of inorganic prostheses such as crowns, bridges or implants.

Costin Marinescu
Dr.-medic stom., D.D.S. (USA)

Tooth Wear

Tooth structure is more valuable than gold. Dentists actually did use gold in the past to restore teeth. Today, some of the most advanced computerized technologies are used to fabricate micron-precision restorations. Currently, dentistry benefits from 3D cameras and laser-guided milling machines to create biocompatible ceramics that reinforce the tooth structure and protect the nerve inside from mechanical injuries and temperature variations. Dental caries is notorious in destroying tooth structure but could it be another one that is even more dangerous?

Tooth Wear – Slow and irreversible loss of tooth structure.

Tooth wear is probably today the most undiagnosed disease of the mouth and “has been recognized as a major problem in dentistry”. (“Tooth wear and investigations in dentistry” Lee A., He LH, Lyons K., Swain MV. in Journal of Oral Rehabilitation, 2012) We assume teeth are strong (after all, enamel is hardest organic substance in the body) and last a lifetime but when muscles bring teeth in contact – enamel on enamel – way too often and too hard (Bruxing or Clenching), valuable tooth structure gets lost. Muscles “listen” to posture, joints, body chemistry, nutrition, stress… so it becomes important to understand what is causing them to be hyperactive. In many situation, verifying and equilibrating the bite can remove the trigger that causes grinding. In other instances, the trigger lies with other functional issues such as snoring, OSA – Obstructive Sleep Apnea, inadequate bite guards…

Why is tooth wear one of the most under-diagnosed diseases of the body?! – because it does not hurt and it happens very slowly. We might think that since it does not hurt and the body can adapt by over-erupting the teeth, everything is okay. Actually, when one or more teeth get worn so much that dentin (secondary layer of the tooth) is exposed that means the biting surface is getting closer to the nerve chamber. When we try to repair the teeth and cover the worn parts, there is no space left to build the tooth back up. To repair worn teeth, we need to “make space” for the covering restoration either by preparing more tooth structure – getting us even closer to the nerve – or use braces to push the teeth back in the bone – where they used to be before they got slowly worn. Either option is invasive! There is a third option: so called Raising the VDO (Vertical Dimension of Occlusion) – capping all the teeth in the mouth – but that is even more invasive than the first two options.

How much wear is too much?! – when we wore a tooth through enamel and dentin.

Dentin is Not capable of withstanding chewing forces nor can resist for long the mouth acids and enzymes. Changes in tooth size or position can also lead to joints, muscles and periodontal problems, which are even more difficult to treat than teeth. Tooth Wear is considered pathological when we lose more than 20-38 µm of vertical tooth structure per year / 1.6 – 3.04 mm in 80 years. (“Current concepts on the management of tooth wear: part 1. Assessment, treatment planning and strategies for the prevention and the passive management of tooth wear” Mehta S. B., Banerji S., Millar B. J., Suarez-Feito J.-M. in British Dental Journal, 2012)

What does it take to diagnose it and treat it early? – first of all, Knowledge … enhanced by newer diagnostic technologies.

“We see only what we know”, therefore we treat only what we see. Old-fashion dentistry focused on tooth decay and soft tissue inflammation often overlooks the developing tooth wear. Diagnosing tooth wear not matching one’s chronological age makes the difference between preserving the original tooth structure for a lifetime or developing the need for extensive restorative dentistry. No matter how sophisticated the current dental materials are, they are inorganic and cannot get remineralized like the human enamel can. (Maintaining the integrity of the enamel surface: the role of dental biofilm, saliva and preventive agents in enamel demineralization and remineralization” Garcia-Godoy F., Hicks MJ. in Journal of American Dental Association, 2008)

Distinguishing between different forms of wear – Attrition, Abrasion, Erosion and Abfraction or a combination of any of them – might also hold the key to identifying contributory systemic  factors. At your next visit to the dentist, ask if you can benefit from a functional bite analysis (preferably with a computerized technology) and a digital photographic evaluation of your teeth wear level. It is better to reach the AHA moment sooner rather than later.

Costin Marinescu
Dr.-medic stom., D.D.S. (USA)