Many patients feels discomfort and even a little fear when the anesthesia remains for hours after extraction or root canal. Normally the numbness will remain for 2-4 hours in lower teeth and 1-2 hours in upper teeth. Some times the tingling may remains a little longer if the case needs more than one injection.

general speaking if the numbness remained for more than 6-8 hours you should call your your dentist although in the vast majority of cases it will heal shortly. If the tingling remained more than 12 hours you should see your dentist immediately specially if the extraction is on the lower jaw.

Some times during lower wisdom surgical extraction the nerve may get pressed a little which may cause temporary nerve injury or even complete nerve cutting in rare cases which can be the cause of prolonged tingling.  But generally this type of complication is not common in any extraction except the lower wisdom surgical extraction and still very rare even with wisdom extraction.

In these cases you should see your dentist immediately to treat the case before the temporary damage becomes permanent.

The marketing specialist in our clinic has made an interview with me about teeth whitening to be presented for our clinic patients,

here it is

how teeth whitening works??

Bleaching or whitening is generally an oxidation process. When this peroxide teeth whitener gel activated a free oxygen is released and penetrates the tooth enamel to react with the large molecules of dental stains. This reaction produce a smaller lighter molecules which cause the teeth to become whiter than before.

This will make me ask ,what is the causes of dental stains??

Usually teeth are white when they erupt but prolonged contact with staining food and drinks (coffee, tea, smoking and wine) without regular brushing will give the opportunity of the stains to accumulate deep inside the teeth and become harder to remove.  Also some drugs , plaque accumulation, general medical conditions, large amalgam fillings and dental caries can produce very deep staining.

Ok now we know that teeth whitening is an oxidation process. This will lead to a very common question about the harm or effect of teeth whiteners  on human enamel? or in other word is dental bleaching is considered safe from a scientific view?

A very good question that i have to answer daily in my clinic. We have to say that the effect of teeth whitening on enamel was one of the most discussed issues between researchers in this field and we won’t be able to mention every opinion said about this here but i will try to summarize the results after carefully reading most of the researches published about the safety of teeth whitening.

• Teeth whitening has little effect on teeth enamel surface roughness and chemical composition. The effect is not extreme or even un noticed clinically and has a very little clinical actual significance. To ease it we will say that the effect is usually equivalent to keeping carbonated beverage in you mouth for minutes.
• Even this little effect is auto repaired by the natural calcium ions presented in saliva in a matter of days.
• If you still afraid of this issue you can ask your dentist to prescribe you any re-mineralizing gel  that contains fluoride or amorphous calcium phosphate (acp) and be sure that your teeth will be even better than before.

Great, But i think that we missed a very important question. Is teeth whitening really works? Will i see actual results?

Yes for sure in most of the cases it works well, all you need is to choose a good product and used it as instructed. We have to say that Some cases are resistant  and won’t respond to teeth whitening but it still a very low ratio.

so you are saying that some cases won’t respond to bleaching, Is this means that the results will vary from a case to another?

yes but in most cases you will have an acceptable to wow results. But this leads to a very important point for both dentist and patient , Keep the expectations realistic and low as possible as the high expectations in teeth whitening will lead to disappointment. We should remember that the human teeth shouldn’t be chalky white this is un natural and will look artificial, Only we want the adult teeth to be as white as a child teeth and this will be great, natural and good looking.

Are home teeth whitening as good as over the counter or home teeth bleaching alternatives??

This is one of the most popular questions regarding teeth whitening. I will compare between the two techniques here briefly but in both cases i recommend that you consult you dentist before starting any type of teeth whitening even the home bleaching so he can choose the best solution for your case and inform you if there is any contraindication of the treatment.

I remembered now i wrote a great article about this comparison between home and dentist teeth whitening you can read it from here.

At home vs dentist teeth whitening

but i will summarize it here as much as i can:

1-Comfort: dentist whitening is more comfortable as it takes much shorter time and the gum is isolated so the gum burning is minimal. With at home teeth whitening the patient have to wear the tray over night for 4-7 nights which can be very annoying

2-Cost: sure at home teeth whitening is much more cheaper.

3-Color change: my personal opinion is that dentist whitening is more effective that at home whitening although some researchers state that a similar results can be achieved with the home bleaching but after a repeated use.

ok  lets say that i want to save some money and use home or what you call  over the counter teeth whitening product, There is many forms and types of these products can we review them quickly?

home teeth whitening tray based systems: This is the original ,oldest and the most trusted  home teeth bleaching system introduced in the markets. Personally it is the first solution i recommend for my patients as i feel that this type investigated widely and we can say that the results are expected some how. The disadvantage of this system that the patient have to wear the tray for hours over night which may be uncomfortable to some patients also it coast a little bit more than the other systems.

Teeth whitening stripes: This is the second recommendation and this option is gaining popularity and trust these days specially after some researches that state that it is as effective as the tray based  systems. here is link of one of these researches

http://www.the-o-zone.cc/HTMLOzoneF/abstracts/ab197.pdf

Teeth whitening pen or brush on systems: some researches also recommend this solution although clinical results of this systems appear to be inferior to tray systems and strips. But we have to say that teeth whitening pen systems offer the most comfortable, easy to use and cheap solution.

OK this will lead to another question,  The markets are full with hundreds of teeth whitening products and many brand names which brand name you recommend??

First thing be aware of the scams. i have to say that most of the products available are ineffective or even harmful to your teeth so you have to search for the products that has FDA and  ADA approval and quality seal.

Also stick to the famous companies that has a good reputation in dental products as these company has a reputation to conserve and expose their new products to extensive testing so you can be sure that the product is safe and effective.

Last thing avoid collecting customer reviews for teeth whitening products from the internet as the marketing teams of the scams are very active and filling the web with thousands of pages of fake reviews.

And again ask your dentist about the best type.

Doctor you are giving me a very diplomatic answer, If you recommend a product to your patient what will it be?

ok i prefer to describe for my patients the home products of the world leader companies in the field of professional teeth whitening that we use in our clinics. For example Discus Dental, Ultradent and Ivoclar Vivadent are a pioneers in the field of professional teeth whitening and has a very good home teeth whitening products so i recommend the home systems of these companies.

Another option will be the products of dental care products pioneers like Oral-B, Crest, Colgate, Rembrandt and the similar companies.

So after teeth whitening what should i make to conserve the results for a longer period?

just the routine oral hygiene procedures and regular brushing, avoiding staining food like tobacco and coffee, regular tartar removal and polishing at your dentist clinic also if you will eat or drink something that will stain your teeth you have to brush just after eating not to give the stains the chance to penetrate deep in your teeth.

sometimes it will be good to have a touchup visit every 6-8 months to keep the results.

Usually how much the effect of teeth whitening remain ??

we can say from 1-4 years. But the patient has to follow the normal oral hygiene procedures like regular brushing and calculus removal and polishing every 6 months. We have to say also that even after the teeth shade rebound it usually gets back to a lighter color than before.

thanks a lot doc and have a great day.

I really surprised by the number of patients asking this question especially that we make tooth caps to strength and support teeth. Before we start our discussion about this question we have to know first what is teeth caps and the indications of using it.

Teeth caps and dental bridges are artificial porcelain or metal  covers that covers the tooth crown. As we said it is usually made of metals or special ceramics with a thickness ranging from 0.75 mm- 2 mm. It is usually indicated in case of very extensive caries that destructing most of the tooth crown(so using fillings only won’t be enough ) or after root canal as the tooth becomes really fragile. On the other hand teeth bridges are false teeth that used to replace extracted tooth.

Before manufacturing a tooth cap or dental bridge the dentist have to grind the tooth or simply remove a thin layer from the  natural crown to allow a space for the artificial tooth cap, The tooth reduction should be exactly to the same thickness of the cap (1-2 mm as we said before) or the tooth will become very bulky and may interfere with the normal occlusion. This tooth reduction is the cause that some patients think that their natural tooth is weakened. But this is completely wrong as we will discuss later.

In case of badly destructed teeth with a very large filling the tooth is already weakened and there is a very high incidence of filling fracture or falling,  so covering the fragile tooth with a metallic cover will prevent crown fracture for sure.

In case of  root canal treated tooth the tooth usually  have a very large filling,  and also the tooth becomes very fragile after root canal treatment due to dehydration and loos of nutrition. So covering the tooth with a strong tooth cap will be a very good choice.

Also we have to say that most of the materials we use to fabricate tooth caps are usually stronger that the natural tooth material . This is not meaning that we like to grind the natural enamel for no reason but if the case is indicated and the crown in fabricated properly there will be no harm but there will be an added protection to the weakened tooth.

In case of dental bridge the decision making is a little more harder as the teeth we grind is healthy and may be completely sound,  We just want to grind it because we want to replace the neighboring extracted tooth. So the idea of grinding healthy teeth is annoying to many patients.  And as a dentist i have to say that if you can afford dental implants you should use it instead of bridges as the neighboring teeth is not affected. But the problem that many patients won’t afford the high coast of the implants . So if you left the empty space untreated you will start to avoid the side of extraction in chewing which will result tartar accumulation and gum problems that may lead to more extraction in the non-functional side. So it will be much better to restore the lost tooth with bridge rather than leaving it untreated.

My final advice :if you can afford dental implants it will be the perfect choice but if you can’t so go ahead and have a dental bridge it will be great.

Teeth whitening popularity is rising rapidly these days as every one wants a pearl white teeth.  The concept of teeth whitening is based on the oxidization effect of free oxygen on stain particles. The teeth whitener or the teeth whitening agent releases free oxygen that penetrates the tooth to reach the deep layers where internal stains present.

When the free oxygen attacks the large molecules of dental stains it breaks it to a smaller particles that is lighter in color.

There is many forms of teeth whitening  available but generally we can categories it to.

• Dentist applied (which called dentist or professional teeth whitening)
• Dentist prescribed (which called at home teeth whitening).

The home teeth whitening method start by your visit to you dentist to examine your teeth and to be sure that there is no contraindications for teeth whitening treatment  like caries or gum recession , So please don’t start applying any of the products available in the market without dentist prescription as this may be dangerous and many of these products lakes the proper testing and evaluation, So your dentist is the best one who can choose you what to use and how to use it AND sometimes you are contraindicated to use teeth bleaching at all.

Dentist or professional teeth whitening products are based usually on hydrogen peroxide as an active ingredient . Some times carbamide peroxide is used but it release half of the oxygen released by the same concentration hydrogen peroxide so many dentists prefer the hydrogen peroxide based whiteners.

The procedures of teeth whitener application is depending to the system but generally we can summarize it as follow:

1-Careful examination

2- Calculus removal and teeth polishing: This is a very important step and i think it is the cause of the failure that happens with over the counter teeth whiteners. When teeth scaling is neglected the free oxygen released by the whitening gel react with tartar, plaque and superficial stains and after this reaction there will be no oxygen left to react with the deep dark stains that cause the dark color of the teeth  which will lead to failure of the treatment.

3- Soft tissue isolation : This is the reason that makes professional teeth whitening more safe and less annoying than home teeth bleaching as the dentist will isolate the gum, cheek and lips not to come in contact with the teeth whitener gel which cause the material to be more concentrated on the teeth, This can  also diminish the burning effect of oxygen on gum and lips. There is many ways to isolate the soft tissue either by using rubber dam to cover gum and lip or painting isolating resins to gum and lips before applying of the material.

4-Application of teeth whitening gel:  Teeth whitening gel may be used directly as a painting to the labial surface of the teeth or may be loaded to a custom tray that the patient wear. Also some systems like ZOOM needs light source to be activated and others may be activated chemically with no need to light. generally light systems are a little bit expensive and supposed to be more effective although some authors stated that the efficacy  is almost the same but i see that light activated systems are a little bit more effective.

The application time vary from 10 min to 45 min in some systems and also the number of application vary according to the case and the system used.

5-Rinsing the gel and removal of the insulator system.

6- Applying of desensitization gel: Dentists prefer to apply desensitizers after finishing of the whitening process as this will relive the sensitivity that happens some times and also repair the tooth surface enamel and remineralize  the lost calcium from the tooth.

After all dentist applied teeth whitening is considered the best solution to have a whiter teeth if you can afford it. It is safe,  fast and have the best results the only disadvantage is the cost as it usually coast from 500- 1000 $ which is much higher than you usually pay for home teeth whitening systems available in market so forget all the faulty information on the internet and choose it, If you can’t afford it then let your dentist describe any good at home system,  It will work too.

hello,

This is my first post about dental implants (or teeth implants like patients like to call) so you can consider it as introduction till i prepare a deeper articles.

We can consider these days as the era of dental implants in dentistry. And i have to say that it really deserve it’s reputation as dental implants really offered a solution to replace extracted teeth that was beyond our imagination. As a result of the proved  success of this technology many researchers are trying to get the best from it and today it is almost used in almost all the aspects of dental treatment. Some times  it is used to support orthodontic appliances , Fix loose dentures, Replaces single  extracted tooth or even support a dental bridge .

Teeth implants in the most simple form is an porcelain  artificial or false teeth that is supported and fixed in place by a titanium post that is screwed to the jaw bones.  The word screwing may be not scientific as bone is a living tissue not just a piece of metal so it have to be integrated with the new artificial post not to refuse it which will lead to case failure. So a different materials tried to favor the bone healing and integration around the implant and titanium is proved to be the best. Also a specific surface treatment is done in order to maximize the bi compatibility, retention and mechanical load distribution over the surface.

So who can get benefit from teeth implants simply any patient who lost one or more of his teeth. Single extracted tooth, multiple neighboring extracted teeth or even completely edentulus patient as we mentioned before teeth implants can be used to fix complete dentures .

Like any medical treatment teeth implants are contraindicated in some cases. I will mention some of the relative contraindications of using dental implants here AND take care that i say relative as there is many difference in scientific research results concerning this issue and also the list of contraindication become shorter  every day as the research continue.

first thing  some times the bone diameters like height or width is not enough to host the appropriate size post usually this happens as a result of delaying for years after extraction. Also sometimes a vital structures like nasal cavity, nasal sinus ao important nerves lying in the place that suppose to carry the implant. For sure the problems we mentioned here can be corrected efficiently with surgical repair, bone grafting or sinus lifting surgery but the coast will jump here a lot.

Also any general condition that affects bone healing will diminish the success of the cases or even prevent the surgeon from even thinking in using teeth implants like osteoporosis, uncontrolled diabetes heavy smoking history of radio or chemo therapy and even very bad oral hygiene without a strong motor to change.

last thing is the coast factor as many patients can’t afford it’s high coast and try to choose more affordable  solutions .

bye bye, come later to read more

dr ahmed galal

practicing dentist

Gum boil is a very common complain that we see in our clinics every day. The case usually is a result of neglected dental abscess.

Gum boil symptoms:

The case is usually presented as small opining in the gum that drain pus or sometimes blood if you apply pressure to it. The area around the boil  is usually a little swallowed and red. The pus drainage may stop for a while and the opining may even close, but usually if the case is not treated the pus will be accumulated again in the tissue and the opining will appear again to drain the formed pus. The neighboring tooth usually is sensitive to pressure and produce pain with chewing but sometimes the pain is not obvious in chronic cases. The neighboring tooth usually have a very large cavity or severe periodontal problems. The patient usually complain of bad breath and salty bad taste as a result of the drained pus.

Some times the case  may take an acute course and here the symptoms will be generalized in the form of face swelling, fever and lymph node tenderness.

Gum boils causes and types:

Gum boil or abscess causes includes extensive caries with necrotic nerve of tooth or severe, deep periodontal pocket we will discuss both in details.

Dental pockets start with gingival inflammation due to plaque and tartar accumulation if the gingival inflammation still untreated the bacteria will start to invade the periodontal ligament that is responsible of cementing the root  surface to the gum tissue and bone. As a result of bacterial invasion into the periodontal ligament the attachment is lost between tooth and gum forming what is called dental pocket.  Later this pocket is filled with bacteria and food debris which may cause pus formation and the pus oozing  start.

The most common cause of gum boil is teeth abscess. Teeth abscess usually formed as a result of caries that reached the pulp so the caries bacteria ferment the pulp tissue and continue to invade the periodontal ligament and jaw bones over the diseased root. As a result to body reaction to bacterial invasion pus formed and the resultant pus pressure leads tissue destruction and this continue till a canal is formed to drain the pus out witch lead in the end to form gum boil that drain the pus out.

Treatment:

Once you discover it you should see your dentist quickly as in many cases if the boil treated quickly we may avoid tooth extraction.  The dentist will examine you carefully to discover the cause and usually an x-ray film is taken.  Once the cause is discovered the second step will be draining the pus by starting root canal treatment to let the pus get out from an opining inside the tooth crown, Sometimes making a small incision in the gum to drain the pus or even extract the tooth if your decided that the tooth is hopeless.

Then if the dentist decided that the tooth is hopeful he may perform root canal treatment or gingival surgery to treat the gum pocket.

Prognosis:

Unfortunately usually many of  the teeth that cause  gum boils should be extracted to completely relief the case. But we have to say that many teeth with gum boils may be conserved and even restore it’s normal functions after successful root canal or gingival surgery. So your dentist is the only one to decide what to do with it and your role is only to see your dentist as fast as possible as this may help to conserve the tooth and avoid extraction.

What to do at home:

As we mentioned before once you have gum boil you should see your dentist as fast as possible. Till you find a date in you dentist clinic you should try to drain the formed pus by applying light pressure on the gum around the opining and use warm saline as mouth wash to increase the blood supply to the area to help the drainage and relief the symptoms.

Dr. A. Galal

practicing dentist

Regular Teeth brushing is the most effective way to prevent caries and gum disease In adults and children. You should start brushing your kid’s teeth once the first tooth erupt around 6 months. and you should continue to supervise your child during brushing till 7 years age to avoid too much ingestion of toothpaste that contains fluoride. Remember good oral hygiene is the master key to a happy and  healthy kid.

So here are some advices that will help:

1-when to start??

some authors say that no brushing is needed in the first year you just has to wipe your baby’s teeth with a wet gauze after feeding  but many oral hygiene and pediatric dentistry text books says that  You should start brushing your kid’s teeth once the first tooth erupt around 6 months and i agree to this opinion as we saw many cases where caries start just after this first year . Also  you should continue to supervise your child during teeth washing  till 7 years age to avoid too much ingestion of toothpaste that contains fluoride.

2-child should brush twice daily with fluoride containing toothpaste (the selection of the fluoride concentration in the tooth paste will be discussed later) . Also routine kids oral hygiene should include flossing that we will discuss later on a separate post.

3-how to choose your child’s toothbrush??

first the brush should be soft brush not hard (you will find that written on the package) also the brush size must fit your child’s age as using large brush will cause discomfort to your baby and also will prevent you from brushing properly also using very small toothbrush will make the process takes much longer.

last thing you should find a toothbrush that you kid likes, usually kid’s tooth brushes have painting and decoration on it’s handle so let your kid choose what he likes as this will make it fun when he use it.

4-How to choose your child’s toothpaste??

we have two main important factors here fluoride concentration and taste.

fluoride concentration is very important  as topical use of fluoride is proved to help in the prevention of teeth decay also too many fluoride ingestion can cause fluorosis that may make the teeth pitted and discolored. so it is very important to choose the toothpaste with the appropriate fluoride concentration. For children under 6 years the tooth paste should contains 600-1000 ppm fluoride concentration according to the caries risk (children with multiple cavities and fillings or children from families that suffer from caries problems should use 1000ppm toothpaste ). children above 6 years should use toothpaste with fluoride concentration 1000-1500 ppm according to the caries risk.

You should also choose toothpaste that has a good taste and smell and let your child choose the flavor he likes as this will make it much easier to let him used to tooth brushing.

5-Choose the position that make you and your child feel comfortable during the  process i prefer to stand beside or a little behind my Childs.

6-how much toothpaste you need??

put a very small amount (smear or pea size blob < 0.3 ml ) of the toothpaste on the brush bristles. Remember using too much toothpaste can be harmful and may cause teeth discoloration and roughness as the child may swallow much fluoride containing toothpaste.

7-Duration and how to brush:

the process should take from 2.5- 3 min to assure complete plaque removal 2 thirds of the  time to the posterior teeth and one third to the interiors . a short forward and backward or circular movement should be used to clean the chewing surface of molars. To clean the tongue side and lip side of the teeth the toothbrush should be 45 degrees to gum line and use short gentle circular movement and you should concentrate not to hurt the gums or push it down.  Remember each millimeter of every tooth should be cleaned so don’t neglect un accessible hard to reach surfaces. you may also brush your kids tongue very gently.

8-After finishing the process you kid should rinse his mouth gently (not to take all the fluoride away ) and you should rinse the brush completely.

last thing you should give your kid the chance to help as this will make him happy and get  used to tooth brushing.

thanks for reading,

Dr A. Galal

Most patients with new dentures expect too much. They expect from the dentist to offer a denture that as comfortable and functional as their lost natural teeth and this is simply impossible in most cases.

Coping with new dentures :

1-You have to know that wearing new denture is difficult in the beginning and you will need time to get used to wearing it so relax we are not in a hurry and you can accommodate to it  gradually. You should also know that many patients spend a horrible time in the beginning and they think that they will never be able to wear it then gradually use their dentures perfectly.

2-If you have no problems in wearing your new denture you should wear it as much as possible, but if you have problems like gagging you can start first with one jaw only until you used to it  then wear the two jaws  and increase the wearing time day after day.

3-You shouldn’t wear your denture at night keep it in a water glass or denture storing solutions.

4-How to eat with your new denture:

• At the beginning you should cut food into small pieces.
• Also you should chew your food on both sides in the same time this will help you to stabilize the denture in the beginning.
• Try to avoid hard food that needs an effort to chew till you get used to your denture.
• also sticky food food should be avoided till you become an expert.

5-Looseness of new dentures:

at first dentures can be loose a little until the patient adapt it. Also dentures usually need 10-30 minutes to become fixed when first inserted. Normally looseness will be disappeared gradually if the denture is manufactured properly

6-Cleaning new dentures: food debris sometimes accumulated under the denture or even if no food debris is accumulated the denture should be cleaned at least twice daily to be sure that there is no plaque or bacteria is adhering to the denture.

there is so many denture cleaners available and we will discuss this subject later in a separate post but at least dental brush and tooth paste should be used till you buy denture cleaner.

7-Discomfort, pain or ulcers:

it is quite normal that patient will feel discomfort in the few days after wearing new dentures . If the symptoms don’t relieve in a few days you should see your dentist.if you have ulcers or wounds stop wearing your denture and see your dentist directly.

Hello ,

We decided to make another step forward, We will answer your questions about dental care completely for free, within 24 h and prof. dentists will answer you.

How to send you question??

All you have to do is to add your question  as a comment down  this page and we well send you the answer by mail within 24 hours.

Questions we apologize not to ask :

Questions about dental care fees,  dental insurance or dentist recommendation will need someone in your country to answer you  as answerers will vary from place to another, So we apologize not to answer such questions as we want the visitors questions section to be helpful for visitors from all countries not specific location.

NOTE:

ALL THE ANSWERS WILL BE PUBLISHED FOR PUBLIC IN THE VISITORS QUESTIONS SECTION .

Every body dreams of fantastic smile but this smile can turn to horrible one if accompanied with bad breath. it is not necessary that bad breath is a sign of oral or general disease condition, it also can present in healthy people. it is like any other body odor  caused by bacteria. These bad odors is the result of bacterial fermentation of food debris and beverages which produce volatile sulfur compounds which is the main cause of bad odor.

But also bad breath can be the first significant sign of some general diseases like diabetes for example so such complain should be taken seriously and carefully investigated.

Causes of halitosis or bad breath:

oral and dental causes:

A- Medical illness or diseases:

1-bad oral hygiene: persons with bad oral hygiene tend to have bad breath due to decompositions of food debris by oral bacteria.

2-Gum disease: persons with gingival or periodontal diseases like pockets or gingival inflammation tend to produce bad breath.

3-pus formation due to dental or gum abscess also are a main cause of halitosis.

4-teeth cavities hold food debris for long time which helps bacteria to ferment food and produce sulfur compounds that cause the bad smell.

5-false teeth if not well fitted can also cause bad odors also removable dentures can cause bad odors if not kept clean.

6-Tongue is usually covered by thousands of small papillae that help in taste recognition and protect the tongue from friction with food, sometimes these papillae become longer than usual so the tongue surface become rough and hold easily bacteria, food debris and the resultant sulfur compounds for long periods.

7-blood oozing from inflamed gums can also fermented and cause unpleasant odor.

B- Morning breath:

upon waking up in the morning  due to less saliva production and lack of normal cleansing mechanisms of the mouth  like swallowing or ventilation.

C-smoker’s breath:

heavy smokers develop unpleasant mouth odor .

D-mouth breathing due to nasal or sinus problems can cause mouth dryness that lead to bad breath.

E-some types of food, drinks or medications can be excreted in saliva or excreted from the lung causing a bad odor like onion and garlic.

Non oral causes:

1-Infection of nose,nasal sinuses or throat can cause bad breath due to bacterial growth.

2-infection in the lungs,bronchi or lung abscess especially with production of pus is also a major cause.

3-kidney diseases: especially in renal failure the mouth becomes dry and the breath may have a urine like smell as the excretion of urea is from salivary glands .

4-advanced liver diseases can cause also a sulfur odor.

5-uncontrolled diabetes can cause acetone like odor.

6-stomach and digestion problems is also very common in producing bad breath.

7-psychological factors may be a cause of less oral care so bad breath.

Treatment:

• routine dental service which covers oral hygiene, caries treatment and tartar removal.
• fix the causes of food impaction like bad dentures, bridges.
• using tooth brush and interdental floss is mandatory.
• tongue brushing can really surprise you.
• periodic dentist visits.
• proper cleaning of the removable dentures with tooth brush or denture cleaners.
• chewing sugarless gum which stimulate the salivary flow and a cleaning action.
• treatment of any general medical conditions that mentioned before.

at the end we wish you wonderful smile with pleasant odor’.

Dr R. Nagaty

my lovely wife

Denture adhesives refer to a category of commercial products that used to increase the retention and stability of  different types of complete dentures. Denture adhesives are usually introduced in the form of powder, glow or adhesive  tapes.

Denture stability  is the first requirement needed to gain the patient satisfaction, No one wants to wear a denture that is not fixed in place or even fall during speaking or eating, It can be really embarrassing and can lead to denture phobia.

Dentures don’t need adhesives  if the patient has enough ridge height and healthy salivation . But sometimes the patient spend much time eating on he toothless ridge which may cause ridge bone  loss. Also there are many other causes  that can prevent  denture stability, In these cases may be you will need the assistance of denture adhesives.

Denture adhesives types and forms :

Denture adhesive  is a bio-compatible glow that used to keep the denture in place during function. There are many types and forms available today like powder, paste and tape.

So what is the best type for you??

Lets say that we can not favor one of the previous forms for every case,  it depends on the case. Some people like the paste form as it gives a good retention while the others hate it because the excess paste is spilled in the mouth and need to be cleaned. Many patients like the powder form as the excess powder is not a  problem because it is very easy to be cleaned, But we have to mention that some patients find it “Not retentive enough”.

So you should try some of the available brands until you discover the one that can give you the best results,  sure consulting your dentist will shorten the road.

Do i need denture adhesives:

First we have to concentrate on a very important point “Adhesives are not the solution for ill fitted rocking denture “.  It is very important for you to know that adhesives should only be used with properly manufactured, good fitting  and non rocking dentures. If you have a new denture and it is not fitting, rocking or cause sores and ulcers then you should  see your dentist quickly to fix it. If you neglected the problem and tried to use adhesives the jaw bone will shrink  which will be very hard for the dentist to repair and sometimes you will need to make a new denture that can be worse than the first one.

What if you have an old denture that was retentive and stable then after 2-5 years  it becomes loose, falling or rock during speaking or eating. Unfortunately denture adhesives are not the solution here this old denture needs what we call “relining”. Relining is needed when the dimension of the jaw bone under the denture shrinks  as a response to the mastication force falling on it.  In this case you have to see your dentist to take a new impression  to add a thin layer compensating the lost bone.

So it is indicated to use adhesives only when you have a properly manufactured denture, that accurately fits your gum but has a bad retention due to insufficient height of ridge bone or insufficient salivation.

Some times the denture is  fixed in place but you just need more confidence that it will not fall during speaking or eating. This fear is common among new denture wearers so it is OK to use it but you have to concentrate more in training your self to stabilize the denture in place as the muscles coordination has a great role in denture fixation.

How to use denture adhesives:

1-First clean your denture with tooth brush or denture brush.

2- If you will use powder adhesive keep the fitting surface a little wet then shake the powder container lightly to spread the powder to the fitting surface then wear your denture. Don’t eat for the next 15-30 min.

In case of paste adhesive apply a separate pea sized pieces  from the tube to the fitting surface and keep the adhesive away from the denture base periphery not  to expel the excess in your mouth. Then put the denture in place. Using too much adhesive won’t be useful and will be hard to clean .

With the tape adhesive you will just adheres the tape to the denture base and put it in your mouth after customizing it and cutting the excess.

Generally use the least amount of the adhesive first then gradually increase the amount every day till you reach the best sufficient amount needed to stabilize your denture.

Some adhesives may cause some kind of allergy that is usually presented as gum burning or redness,  in that case stop using it and call your dentist to prescribe you a different brand .

There are many denture adhesive brands  in the market. Cushion grip, Equate Firm grip, Super poli grip, Fixodent, Sea bond and Ends lip. The selection is yours you can use any of them according to your preference. The prices range from 3$ to 25&.

The human body is one unit so you have to help your dentist to record carefully a full medical history for you. Liver problems are of the medical conditions that needs special care in dental clinic. liver diseases has many types but the most common are liver fibrosis as a result of viral infection or parasitic infection (belharizeases in some countries).

Dentist usually give extra care to liver patients because Liver is responsible of producing most of the factors that are essential for blood clotting. So viral hepatitis or any other distructive liver diseases can impair the normal coagulation mechanism and the patient of the uncontrolled liver disease tend to bleed more after surgery or tooth extraction. There is also an crossinfection risk if viral hepatitis(The most common liver problem) is present.

bleeding tendency: The diagnosis should be confirmed by a physician and the severity of liver affection should be taken into consideration by arranging for a coagulation screen tests  before any surgical treatment like extraction. Patients may need vitamin K or freshfrozen plasma to gain enough coagulation and, therefore, should be managed in hospital and the dentist also will concentrate on local methods of reducing post extraction bleeding like stitching or mesh supported dressing.

Drugs & medications: Drugs prescription is really dilemma as liver is responsible for the breakage and excretion of many toxic chemical materials including many drugs. Also there is some drugs that considered liver toxic and can really hurt the liver in compromised patients. so many drugs should be used with caution or avoided completely in severe liver disease. Paracetamol, NSAIDs, sedatives that usually prescribed after extraction or surgery  are the most common. Any drug prescribing should include reference to a drug formulary.  As some drugs even with normal dose can be txic to liver patient because he fails to break and excrete the drug so it accumulate in the body.  It is difficult to estimate the impairment of drug metabolism even with liver function tests so adjusting the doses of drugs can be very hard even for the experienced physician .

Cross viral infection:The most common form of liver disease is the A,B and C viral hepatitis caused by HAV, HBV AND HCV  so the routine precautions for infection control is essential which  means that all patients who needs extraction or any other oral surgery treatment, whether known high risk or not, should be managed in the same strict way to eliminate the risk of transmission of infectious agents like viruses and bacteria.

Many dental patients asking about the cheapest type of false teeth to replace an extracted teeth. Lets say that the good academic replacements available are porcelain bridges, Metal + porcelain tooth caps, Full metallic bridges, metal based partial denture and acrylic based temporarily partial dentures. I ordered the solutions available from expensive to cheap.

So the cheapest type of false teeth is full acrylic partial denture. This type is considered temporary academically and in many countries it is un legal to introduce it to the patient as permanent solution. But many patients allover the world even in developed countries use it as permanent prosthetic because it is far cheaper than bridges or metal based partials.

This type of dentures can be functional and perform well on the short term (year or two) but on the long run after years the troubles begin. The problem in this type of false teeth that it concentrate all the force of mastication on the gums covering the place of the extracted tooth and the underlying jaw bone. In case of the more expensive metal based partial dentures the force of mastication is distributed between the gums and the remaining neighboring natural teeth. Something called occlusal rest is used to support or hang the denture partially on teeth during function.

This distribution of force is very important to the long run durability of the partial denture. When the mastication force fall on the jaw bone the bone shrink or resorp as response to stress, By the time after two or three years the bone in the extracted tooth place become concave which will make the construction of bridge very hard because the false teeth will be very long to accommodate the bone concavity.

So it will be better if can pay to more money to avoid this poor type of partial dentures. But if you cant afford the expensive alternatives like metal based partial denture then it will be a good decision to make a cheap temporally full acrylic denture to conserve the lost tooth space till you can pay for permanent solution.

Many patients suffering from impacted wisdom molars. Molar wisdoms are the last molars in each arch side if you didn’t extracted any molars wisdom should be after the LAST  two permanent molars. Many patients ask if the wisdoms or 3rd molars are erupted in their mouth and i will give you a simple way to know, If you can count three large molars in the end of jaw side then it is erupted if you only find two large molars then it is not erupted. I use the word large molars to distinguish between the small premolars that is located just after the canines and the larger molars that present near the end of the jaw .

So why wisdoms get impacted?

There is many theories explaining this phenomena but it will be overkill to go deep here so we will keep the explanation simple a possible. The wisdoms impacted simply because there is no jaw enough space for them to erupt . This space problem is explained in many ways some authors say that the western soft cooked food is not grinding the teeth from its sides, this grinding was enough to offer space for the wisdoms. Others saying that if the jaw size is small (inherited from one parent ) and the teeth sizes are large (inherited from the other parent  ) this may cause this problem. Any way it just happened

Impaction can be full when the molar is completely under jaw gums or partially  impacted if a small part of it is out in the mouth. The symptoms vary according to the impaction type.

Symptoms of impacted 3rd molars or wisdoms:

Lets say that most of people won’t have any problems with their wisdoms they just erupt in place with no problems and even you won’t notice it. Sometimes the 3rd molars are impacted and not erupted and also not causing any problems and may still silent for years.

some times impacted wisdoms start to make troubles and symptoms this problems includes

1- Pain : pain that is related to the end of the jaw or even sometimes not localized and may extend to the whole face side. The pain type change according to the the case, presence of infection and impaction type .

2-gums swelling, tenderness and redness :

Some times especially in partial impaction  Gums around the area become swollen , red ,tender and hot as a result of infection. Some times in partially impaction a small gum piece (flap) remain over the molar crown and the opposing molar if present bite on this flap causing severe pain on chewing and more inflammation.

3-Face swelling:

some times the inflammation spread and cause swelling in the side of impacted wisdom even the swelling may extend to the eyes which become almost closed(don’t panic we see this every day, but you should see your dentist in the moment) .

4-Food impaction or wedging:

Some times especially in partial impaction when the wisdom is erupt in a anterior angulation food may become impacted between impacted 3rd & second molar which may cause severe pain and gum pocket.

5-fever :

in some severe cases of infection the body temperature may raise as a reaction to infection.

6-bad breath and bad taste :

impacted food, pus formation and some anaerobic bacterial products can cause a salty bad taste and also the breath smell may change.

7-sometimes pus or blood oozing from gums.

8-Inability to open the mouth widely:

Muscles that is responsible of mouth opining lies close to the end of the jaw so any infection in this area can cause muscle stiffness.

9-lymph node tenderness and pain with swallowing food:

the lymph nodes under the lower jaw react to infection and become enlarged and tender which may cause pain with swallowing.

after all once you feel any of the previous symptoms you should visit your dentist quickly to start the treatment early because if you delay the infection may become very annoying and dangerous. till you go to your dentist you may take over the counter pain killers to decrease pain also peroxide mouth wash may help in removal of impacted food  and killing anaerobic bacteria that cause the infection.

choosing between extraction and filling or conservation is a very common decision that both dentists and patients have to take every day. With adults the decision making is much more easier, if the tooth is restorable and the patient can pay for the treatment then we simply conserve the tooth. If the patient is a child then the process of decision making is much more harder as many factors affect the selection of the treatment plan that the dentist have to follow.

1-Child’s age:

This factor is very important as it well judge the cooperation of the child during treatment process so the cooperative patient is giving more chance to the success of lengthy treatments like filling or even root canal when uncooperative patient may drive the dentist to extraction.

2- The time left for the tooth to come out or shedding:

The dentist here estimate the time left for the milk tooth in the mouth by considering the normal eruption time averages and also the eruption time variations of your kid. Some kids tend to change their teeth earlier of later than normal and this should be taken in consideration when the dentist calculate the estimated of the milk tooth left.

if the dentist estimated that the permanent tooth needs only 6 months or less to come out then it would be better not to waste money and time in filling or root canal.

We have to know that premature extraction of the milk teeth will result in less effective chewing also may cause malalignment or crowding in the permanent teeth which will need an expensive orthodontic treatment after that.

3-General medical state of the child:

If the child suffer from generalized medical illness this may change the treatment plan dramatically. For example if the kid suffers from cardiac disease or the immunity of the child is compromised for any reason like uncontrolled diabetes etc. The recurrence of infection here should be avoided so extracting the affected tooth with a antibiotic coverage may be better than performing deep filling or root canal treatment that may fail and cause recurrence of infection.

In other cases if the child suffers from diseases that affect blood coagulation (like hemophilia ) then the extraction should be avoided and we should try to conserve the tooth till it fall out or shedd normally to avoid the risk of bleeding after extraction.

4-Parents insistence:

Most of the parents of our patients have a good knowledge about problems of early extraction of milk teeth but sometimes we meet parents who insist in extraction and keep saying “the tooth will fall naturally any way in a year or two why should i spend money on it ” In many of this cases the dentist will just pull the tooth as he feels that the patient is not believing what he say about early extraction.

5-Number of decayed milk teeth:

If the child has only one carious tooth then we should conserve this tooth and his mouth clean. But if we have extensive caries allover the mouth sometimes we have to sacrifice some teeth to keep the treatment plan affordable and realistic. The very common decision here is to extract the first milk molar and conserve the second milk molar as the first milk molars tend to cause less problems when extracted early.

6-The degree of tooth destruction:

simply some teeth are too late to be fixed

7-position of the tooth:

Although loss of first incisor will have less effect on permanents alignment, loss of canines or molars will lead to more problems especially in patient with a crowding susceptibility .

8-orthodontic consecrations:

Many times the orthodontist can give an order of early extraction or insist on keeping a tooth that may require lengthy treatment to avoid serious orthodontic problems in the future.

last thing we have to say that early extraction of deciduous teeth can cause really bad problems in permanents alignment or even affect the child’s chewing and psychology. so take your time to think before pulling the tooth