Periodontics
Full Mouth Smell Therepy

What is Mouth smell

Mouth smell, which is also called halitosis, is an embarrassing health condition that affects approximately 30% of people around the world. It is associated with a foul oral odor. According to the Academy of General Dentistry, in over 90% of mouth smell cases, the odor originates in the mouth, throat, and tonsils.

The mouth smell odor is usually caused by a group of anaerobic, sulfur-producing bacteria that breed beneath the surface of the tongue and often in the throat and tonsil area. These bacteria occur naturally in your oral environment and are supposed to be there because they assist your digestion by breaking down proteins into amino acids. Proteins are commonly found in food, mucus or phlegm, blood and in diseased oral tissue.

As the mouth smell bacteria feast on proteins in your mouth, sulfur compounds are released from the back of your tongue and throat. The bacteria excrete waste as hydrogen sulfide, methyl mercaptan and other odorous and bad tasting compounds known as volatile sulfur compounds. As long as this process of anaerobic bacteria feeding on proteins and excreting volatile sulfur compounds continues unchecked, your breath will become worse and worse.

Mouth smell Treatment

In most cases mouth smell can be successfully treated. mouth smell treatment depends on its cause.

Please keep in mind that you cannot eliminate the bacteria that cause mouth smell from the tongue. Consequently, scraping or brushing the tongue is a temporary solution at best, and is typically frustrating for those who believe tongue scraping or tongue brushing is a permanent solution to mouth smell. The bacteria that cause mouth smell are actually part of your normal oral flora and need to be present in order to break down proteins as a key step in proper digestion.

A much simpler and clinically-proven method to treat mouth smell is to interrupt the bacterias chemical production of odors by the introduction of oxygenating compounds to your oral environment. Oxygen is lethal to the bacteria that cause mouth smell because they are anaerobes and cannot survive or function in the presence of oxygen.

In general, a dentist will recommend mouthwashes and toothpastes that contain oxidizing agents such as chlorine dioxide or sodium chlorite to neutralize volatile sulfur compounds and help control odor causing bacteria found in the mouth.

If you are experiencing dryness in the mouth, your dentist will recommend a saliva substitute to moisten the mouth throughout the day.

Some effective, natural ingredients to look for in oral care products are zinc gluconate, aloe vera, green tea, tea tree oil, xylitol, CoQ10, glycyrrhizic acid and oral probiotics like K12 and M18.

Scaling- Polishing

Dental cleanings involve removing plaque (soft, sticky, bacteria infested film) and tartar (calculus) deposits that have built up on the teeth over time. Your teeth are continually bathed in saliva which contains calcium and other substances which help strengthen and protect the teeth. While this is a good thing, it also means that we tend to get a build-up of calcium deposits on the teeth. This chalky substance will eventually build up over time, like limescale in a pipe or kettle. Usually it is tooth coloured and can easily be mistaken as part of the teeth, but it also can vary from brown to black in colour.

If the scale, or calculus (tartar, as dentists like to call it) is allowed to accumulate on the teeth it will unfortunately provide the right conditions for bacteria to thrive next to the gums. The purpose of the cleaning and polishing is basically to leave the surfaces of the teeth clean and smooth so that bacteria are unable to stick to them and you have a better chance of keeping the teeth clean during your regular home care.

Also it leaves your teeth feeling lovely and smooth and clean, which is nice when you run your tongue around them. Actually, come to think of it, there is nothing worse than someone you fancy running their tongue around your teeth and finding a piece of spinach or something! Still, if they are hungry

The professional cleaning of teeth is sometimes referred to as prophylaxis (or prophy for short). Its a Greek word which means “to prevent beforehand” - in this case, it helps prevent gum disease.

Pocket Removal Treatments

Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed, forming “pockets” around the teeth.

Over time, these pockets become deeper, providing a larger space for bacteria to live. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss. Eventually, if too much bone is lost, the teeth will need to be extracted.


Mild Periodontitis

Advanced Periodontitis

Your periodontist has measured the depth of your pocket(s). A periodontal pocket reduction procedure has been recommended because you have pockets that are too deep to clean with daily at-home oral hygiene and a professional care routine.

During this procedure, your periodontist folds back the gum tissue and removes the disease-causing bacteria before securing the tissue into place. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone.

Reducing pocket depth and eliminating existing bacteria are important to prevent damage caused by the progression of periodontal disease and to help you maintain a healthy smile. Eliminating bacteria alone may not be sufficient to prevent disease recurrence. Deeper pockets are more difficult for you and your dental care professional to clean, so its important for you to reduce them. Reduced pockets and a combination of daily oral hygiene and professional maintenance care increase your chances of keeping your natural teeth - and decrease the chance of serious health problems associated with periodontal disease.

Gingival Depigmentation

Smile expresses a feeling of joy, success, sensuality, affection, and courtesy, and reveals self-confidence and kindness. The harmony of the smile is determined not only by the shape, the position, and the color of the teeth, but also by the gingival tissues. Although melanin pigmentation of the gingiva is completely benign and does not present a medical problem, complaints of “black gums” are common, particularly in patients having a very high smile line. Thus, perio-esthetic treatment modalities strive to achieve a harmonious inter- relationship of the pink with white, which is imperative of all treatment procedures. For depigmentation of gingival, different treatment modalities have been reported, such as bur abrasion, scraping, partial thickness flap, cryotherapy, electrosurgery, and laser. In the present case series, scraping, electrosurgery, and diode laser have been tried for depigmentation, which are simple, effective, and yield good results, along with good patient satisfaction.

Bone Grafting

It is not unusual for the patient to present for a consultation at the oral surgeons office and be informed at some point in the discussion that he or she may require a “bone graft” in order to maximize the outcome of dental implant surgery. While this sounds pretty scary at first, the truth is that bone grafting in the oral cavity today is a routine, predictable and painless procedure.

Treatment

While the need for bone grafting has been significantly reduced, it has not been eliminated entirely. However, in most cases it is now relegated to small minimally invasive interventions that can be managed quite easily in an ambulatory (office) setting. Furthermore, while bone grafting of earlier years involved harvesting and using large quantities of the patients own bone (autogenous grafts), today we can often use processed bone that has been harvested from animals (i.e., cows). These grafts are termed xenografts and are generally comprised only of the mineral content of natural bone, have been sterilized and have had all organic material removed. Using bovine bone (cow bone) as a graft material has become commonplace in most oral surgical offices today and has been a tried and proven technique for many years. A simplified explanation for the success of this form of grafting is that a bovine bone graft is placed to act as a “biological placeholder.” Initially, it mechanically prevents the collapse of the surrounding tissues, whether that is bone or soft tissue. Then, through a process called “guided tissue regeneration,” the human body is fooled biochemically to recognize the graft as natural bone and over time resorbs and replaces it with the patients own native bone.

Gingivoplasty or Gingivectomy

This dental code is somewhat unique in that it covers more than one specific procedure. While both a gingivectomy and gingivoplasty involve the surgical excision of gum tissue, a gingivectomy is done to remove diseased gum tissue surrounding a gum “pocket,” and a gingivoplasty is performed to reshape gum tissue – sometimes after a gingivectomy, but most often independent of a gingivectomy.

Both procedures can also be performed solely for Esthetic reasons, but when done so, are not covered under this code. When these two procedures are covered, it is because of a clinical cause, namely, periodontal disease.

Periodontal disease -literally, disease “around the tooth” - affects the gums and the bone to which a tooth is attached. It is an advanced bacterial infection that causes gum recession and tooth loss, and is preceded by gingivitis. Symptoms can include bleeding from the gums, bone loss that displays itself on an X-ray, excessive tooth mobility, gum recession, or the existence of any “exudate,” (pus or clear fluid) along or under the gumline.

As periodontal disease progresses, the visible markers of the disease (plaque and calculus) migrate down along the side of the tooth into the natural “pocket” between the ridge of the gumline and the tooth’s enamel. In doing so, it inflames the gum tissue and widens the naturally slim gap between the tooth and gum. As this gap becomes wider, even more bacteria are allowed access to the sensitive tissue fibers along the root’s outer surface, and much damage can be done.

In order to arrest the progression of the disease, a gingivectomy is often prescribed. Likewise, a gingivoplasty which can re-shape the gumline, can be used to combat disease in oddly shaped or overgrown gums.

The procedures for this dental procedure code are fairly straightforward despite their “surgical” nature. In both procedures, your dentist would first thoroughly clean your teeth to ensure the area is free of plaque and calculus from the area (likely, periodontal scaling and root planing), and then administer a local anesthetic to numb the area. Then, with a gingivoplasty, your dentist would shape and remove any portion of gum tissue that was contributing to disease. Gingivoplasty incisions only take a few minutes, and are done with an eye towards aesthetics.

With a gingivectomy, after the area is numb, your dentist would use a probe to determine the depth of the pocket so as to understand where to make the incision. The idea is to remove enough gum tissue to eliminate the pocket, and no more. Therefore, once this depth is determined, the gum tissue is cut at a 45 degree angle to the tooth, with the downward slope of the angle aiming toward the tooth’s root. Since this can be difficult to envision, consider the example below.

The cut the dentist makes in this procedure is the same sort of cut you would make if you were wanting to remove a portion of the wood from a pencil to get to a stubby graphite tip. So, if your tooth were the stubby tip that you didn’t want to cut off, the cut you would make would slope downward toward the eraser in the pencil example, and in the gingivectomy example, downward toward the root. Dentists refer to this cut as apical. Your dentist will only remove as much tissue as is necessary - remember, tooth pockets are measured in millimeters, not inches.

While most gingivectomies are usually performed with a scalpel, they can also be performed using electrosurgery units, diamond burrs, and lasers. Once the procedure is complete, a surgical dressing would be placed on the gum tissue that has been cut, and you would be given instructions as to how you should care for your mouth in the days following the procedure.

Gums Esthetic Surgery

If you're not happy with the appearance of your smile, your periodontist can suggest a number of options to correct the aesthetics of your teeth and gums. Esthetic surgery has become more popular than ever before, and now periodontal Esthetic surgery has also jumped on this upward trend.

Are you unhappy with your smile? Many procedures now exist that can give you the smile you've always dreamed about. For patients with teeth that look too short or have the "gummy smile," crown lengthening might be your solution. Excess gum tissue is removed, exposing more of the tooth. The gum line is then evenly sculpted to develop your new, broad smile.

Another problem patients want to repair is gum recession, which causes the tooth root to be exposed. Periodontal disease is one cause for receding gums, which make your teeth look long. Left untreated, your exposed roots are prone to bacteria and at risk for developing cavities. Root coverage procedures, including soft tissue grafts, are performed to cover the exposed tooth roots to protect them from decay and further recession.

Other popular Esthetic procedures include dental implants to restore missing teeth and ridge augmentation to repair indentations in the jawbone and gums.