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Bad breath (scienfic word: Halitosis) can be caused by factors linked to the mouth and teeth (intra-oral) or due to health issues arising from the lungs, digestive system or hormonal disturbances (extra-oral).
The most common causes of bad breath are intra-oral. The build up of bacteria in the mouth, associated with poor oral hygiene, is one of the main causes. Bacteria grow on plaque (food debris) which builds up around teeth, under the gum margins and tongue surface, hence the need for thorough brushing, flossing and regular professional cleans. More severe cases of bad breath can be attributed to established gum disease as a result of poor oral hygiene and neglect over an extended period of time. The types of bacteria in the oral cavity evolve over time if the plaque level keeps growing and this can lead to more virulent bacteria that cause gum disease and bad breath.
Large cavities in a tooth and infected teeth are also breeding grounds to bacteria that contribute to bad breath. The wearing of appliances such as braces and dentures can also make oral hygiene more difficult, increasing the level of plaque bacteria in the mouth that contribute to bad breath.
If you are concerned about possibly having bad breath, the Melbourne Smile Clinic is able to assist you with the right advice. Call us or book an appointment online.
Reference: Halitosis: Prevalence, risk factors, sources, measurements and treatment- a review of the litterature. Wu J., Cannon R., Ji P. et al. Australian Dental Journal (volume 65, issue 1, pages 4-11), March 2020
Mouth ulcers can be caused by
Recurrent aphtous stomatitis: This is the most common cause of mouth ulcers that have a tendency to recur for no apparent reason. These are more common in younger people (10-29 yoa). They can lead to small, large or a cluster of ulcers which are quite painful. The most common underlying cause for recurrent aphtous ulcers are genetic factors, stress and nutritional deficiencies (mainly of iron, folic acid and vitamin B12). Rinsing with salt water can help heal the smaller and less painful ulcers. Otherwise, topical steroid ointment can be helpful and must be prescribed by a health professional.
Trauma: cheek biting or chewing, rubbing against a sharp tooth/ ill-fitting dentures and piercings, foods that are too hot or hard-textured are all possible causes of ulceration. Usually these ulcers are once-off and disappear once the cause is removed.
Chemical: Ulcers can be caused by a chemical irritant, such as keeping a tablet of aspirin against a tooth in the hope that it will alleviate a toothache (please note that aspirin must be swallowed for any pain-relief result). Another example is the improper use or application of teeth bleaching gel. These contain high levels of peroxide that when in contact with the mucosa for too long, will lead to ulcerative burns.
Medication-related: Chemotherapy medications used in cancer cause oral ulceration while radiotherapy cause ulcers only when used in the head and neck region. Medications used to prevent transplant rejection also have this effect. It is usually recommended that patients ensure that their dental health is good prior to starting such medical treatments. This is because dental treatment is made more difficult and uncomfortable due to the presence of ulcers in the mouth and there are higher risks of infection.
Infections: Viral infections can cause of recurrent mouth ulcers. For example, first-time infection by the Herpes virus can cause red, sore gums and blisters that rupture to form ulcers. In Hand, food and mouth disease, a different virus is responsible (coxsackier virus). The patient develops malaise and fever and ulcers can appear anywhere in the mouth.
Mucocutaneous and autoimmunce diseases:
Mucocutaneous diseases are disorders directly affecting the soft tissues of the mouth. The oral soft tissues are hypersensitive and hyper-reactive. An example is Lichen Planus, a rare condition affecting only 1-2% of the population, where manifestations are sloughing and bleeding gums, ulcerations, altered taste and sensitivity to spicy foods.
Autoimmune diseases include inflammatory bowel diseases such as celiac disease, Crohn's disease and Ulcerative colitis. These can have oral manifestations including mouth ulcers which usually resolve when the underlying disease is treated. Other autoimmune diseases such a Behcet's disease and SLE (systemic lupus erythematous) affect multiple systems in the body, including the oral cavity, leading to ulcerations.
Reference: Recurrent oral ulceration. Aetiology, classification, management and diagnostic algorith. Elizabeth A. Bilodeau, Lalla R.V. Periodontology 2000 (Volume 80, issue 1, pg 49-60) June 2019
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All materials used in the dental setting have been approved by the Australian TGA (therapeutic goods administration)
Resin composites are commonly used routinely as a tooth-coloured filling material. There is concern from members of the public that they contain bisphenol A (BPA) which is thought to have oestrogenic effects on cells. The evidence comes from studies showing that BPA binds to oestrogen receptors in vitro. However, the oestrogenic effect of BPA is 1000-fold less potent than the native oestrogen hormone.
All current resin composites consist of methacrylate monomers (such as Bis-GMA) and DO NOT contain BPA. However, BPA is a synthetic chemical starting point from which all methacrylates are derived – in dentistry as well as many other plastics.
No evidence exists that dental composites have estrogenic effects in vitro or invivo.
Dental ceramics are very chemically inert materials and remain stable over very long periods of time. They therefore have excellent biocompatibility.
They furthermore exhibit excellent flexure strength, fracture toughness, wear resistance and colour stability. The ceramics can also be formed into precise shape to replace missing parts of a tooth.
They are an excellent material where a substantial part of a tooth is missing or for crowns.
However, in order to be held onto the tooth, the ceramic restoration has to be bonded to the tooth surface with a cement. The cement in some cases has to be a resin cement in order to provide the best adhesion. Resin cements have chemical similarities to resin composites which have been described above.
Reference: Phillips’ Science of Dental Materials, Kenneth J. Anusavice 2007.
Gum Health & Oral Hygiene
Why do my gums bleed?
We often have patients reporting that their gums bleed during brushing or eating or even spontaneously, and this is often a cause of anxiety.
The most common cause of bleeding gums is gum disease. Gum disease means that the gum tissues are inflamed. This inflammation is most often caused by a deposit of plaque and calculus (soft and hard debris) , which act as an irritant, around the gum lines. Inflamed gums usually look red, swollen and bleed easily. The more severe the inflammation, the more severe the bleeding.
In the early stages of gum inflammation, this is known as gingivitis. Gingivitis is reversible. When the irritant is removed, the gums are able to recover and stop bleeding.
However, continuous inflammation over a long period of time can lead to irreversible changes where the gums recede. This more advanced state of disease is known as periodontitis. Periodontitis can lead to teeth becoming loose and eventually falling out. Periodontitis requires immediate professional treatment to stop its progression.
Inflamed gums that bleed easily can make other dental treatment more challenging. It is important that prior to more complex dental treatment such as cosmetic dentistry, orthodontics, implant placement, and even filllings, that the gums are as healthy as possible.
The best way to prevent gum disease is with good oral hygiene both by adequate tooth brushing and flossing as well as professional cleans on a regular basis.
While bleeding of the gums from gum disease is not life-threatening, it is indicative of chronic inflammation of the gums and we recommend that you seek advice from your dentist as soon as possible.