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Family Dentistry: Dental Hygiene and Your Dental Care Team

The new dentistry brings together a unique complement of skills, knowledge, and capabilities with one primary focus: ensuring your dental health. Working as a team, your dentist and the dental team he or she has assembled wants to recruit you to join them in making sure this focus is maintained. The dental team has two major parts that you may hear referenced during your visits: the "back" and the "front." These terms refer to two very specific functions of your dental team. The front office handles all the administration, scheduling, and financial details, and the back office provides the treatment.

Your front office team makes sure you know about scheduling opportunities, handles finances, and keeps the administrative details under control to provide you efficient services and support. The back office team is thus free to do what they do best: provide the best care and service for you. You'll find the dentist, dental hygienist, and dental assistant ready to assist you during your appointments.

The key component for success of any team is each member's commitment to do their part. As a consumer and team member, your commitment involves three things:

1. Maintaining your commitment to your dental health through regular dental hygiene appointments and the daily practice of flossing and brushing.
2. Asking questions and getting the essential information you need about your teeth and gums or to understand any treatment plans.
3. Staying open to options and opportunities that the new dentistry offers you by thinking about the information and feedback that your dentist provides you about the status of your dental health.

You can maximize the benefits of the skills and expertise of your dental team by deciding for yourself what kind of relationship you want with your dentist and the dental team and how they can help you achieve a positive outcome for your dental future.

Bad breath, or halitosis, is a signal that something is not right inside your mouth. It may be as simple as the need to pay more attention to your daily dental hygiene, or it may indicate tooth decay, gum disease, or another medical problem. Whichever it is, bad breath is a red flag: take another look at your mouth!

Bad breath is a social problem; if you have bad breath, you may notice that people actually back away as you talk to them. Mouth odors are embarrassing, and they tell other people that you aren't taking care of yourself. Sometimes people are not aware that their breath smells bad; be alert to how other people react when they're close to you, and be grateful if a friend or family member lets you know about the problem.

Commercial products claim they will make your breath fresher, but the only way to make sure your breath permanently fresh is to practice good oral hygiene. In fact, too many breath mints and hard candies with sugar will lead to tooth decay. If you are constantly using breath mints, breath sprays, or mouth rinses in an effort to cover up your bad breath, realize that you may have a dental or medical problem that needs addressing.

There are a number of reasons you may experience a bad taste in your mouth, and even be able to smell your own breath. Food may be lodged between your teeth if you are not brushing at least twice daily and flossing regularly. Food particles can be very tiny and can wedge themselves between teeth and below the gum line; brushing after meals is important and flossing is imperative to get at the particles that the brush can't reach. Brush your tongue or use a tongue scraper. As odd as it will feel at first, bacteria collects on the tongue and can contribute to bad breath. If you wear removable dentures, take them out at night and clean them thoroughly before you wear them again.

If you neglect your daily dental hygiene over time, bad breath can become a symptom of more serious dental problems. Teeth that are not cleaned properly become a place for bacteria to reside as food particles stay in your mouth and decay. Bacteria attack your teeth and gums and cause cavities and gum disease. If this is happening, gum disease will cause an unpleasant odor.

Perhaps you believe that you are brushing and flossing on a regular basis, but are still experiencing bad breath. If you have teeth that are crooked or crowded, it may be hard for you to clean between them. If you wear dentures that are not fit properly, they may be trapping food or irritating your mouth. Or perhaps your bad breath is caused by another medical problem: drainage from your sinuses, gastrointestinal problems, kidney or liver problems, or other medical conditions.

Here's what you can do to "investigate" on your own. Write down what you're eating and notice whether your breath smells bad because of certain foods. Garlic and onions actually cause odor, but the odor is coming from your lungs as you breathe, not from your mouth itself. The odor from these foods is temporary, and will be gone once the food is out of your bloodstream.

Are you dieting? Hunger can contribute to bad breath, because of the chemical changes as your body turns fat and protein into the energy it needs. Taking prescription or over-the-counter medications? Add these to the record of what you're eating to see whether there's a relationship between your medications and your bad breath. And don't forget to tell your dentist if there's been a change in your overall health since your last visit.

Suffering from dry mouth? Saliva provides constant rinsing in our mouths and washes away food particles. Your dentist may recommend more liquids, sugarless candy to stimulate natural saliva, and perhaps some of the commercial products that are available to combat dry mouth.

If bad breath continues after you have done your best job of regular brushing and flossing, start with your dentist. He or she can tell you whether the odor is caused by an oral problem; if it is not, then your dentist will suggest you see your doctor for a physical check-up.

Regular dental check-ups will help keep your mouth healthy and working well. Your dentist can spot problems before they cause trouble, including problems that cause bad breath.

By Brian DesRoches, PhD

What Occurs During A Dental Examination

During a dental examination, the dentist examines the soft tissues of the mouth for any abnormalities or pathology (including oral cancer), the teeth for tooth decay or defects, the gum tissues for periodontal (gum) disease, the neck for swollen lymph nodes, the amount of plaque, tartar, and debris on teeth, as well as the need to replace any missing teeth or dental prostheses. Regular examinations by a dentistry professional are crucial to maintaining your dental health and are a necessity in any dental care plan.

Dentists begin the dental examination with a complete dental and medical history, including medications the patient is currently taking. The skin of the face and neck is examined for any abnormalities, especially pigment changes. The lymph nodes in front and behind the ears, under the floor of the mouth and chin, and the midline of the neck, sides, and back of the neck are palpated to determine if any swelling or tenderness is present.

Inside of the mouth, the lips, cheeks, gums, and roof of the mouth are inspected and palpated. During this process, the tip of the tongue is placed on the roof of the mouth just behind the upper teeth for inspection of the front floor of the mouth and sides of the tongue.

The back floor of the mouth, the area behind the lower wisdom teeth, and the back sides of the tongue are inspected by grasping the tip of the tongue with a small gauze sponge and pulling the tongue forward and toward the opposite side of the mouth.

To inspect the back of the throat, soft palate, and tonsil area (sides of the throat), the tongue is depressed with a dental mirror or tongue blade and then a deep breath is taken by the patient.

To detect swelling on the floor of the mouth, the area inside the mouth is felt with the finger of one hand while a finger of the other hand feels below the chin. Salivary gland enlargement, saliva flow, or xerostomia (dry mouth) are determined by milking the major salivary glands to assess the quantity and consistency of saliva.

Today's dentist has many analytic tools available to pinpoint dental and oral diseases. The basic tools are the dental instruments, lights, and radiographs (X-rays). Depending upon the dentist and the individual's dentistry needs, additional diagnostic tests are available. Testing for essential proteins and buffering capacity can evaluate the protective ability of saliva.

To determine tooth decay risks, microbiological testing of saliva can measure the level of decay-producing organisms. Periodontal susceptibility tests, which test for the DNA of gum disease-producing organisms, can be performed to assess an individual's risk for gum disease.

If removable dentures are present, dentists check them for bite, retention, stability, and overall fit. Dental impressions or models also may be taken to study the mouth and tooth structures to initiate fabrication of prostheses. Photographs may be exposed for a variety of reasons, including before and after treatment comparisons.

The level of oral hygiene and home dental care practices are assessed and reviewed. Recommendations for home care devices and products may be made. Instruction and methods for maintaining a good oral hygiene regimen can also take place.

Once basic information about dental health status is gathered, the dentist will be better able to discuss dental care plans that are available.

By Denise J. Fedele, DMD, MS

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