What Is It?
Your teeth can become discolored by stains on the surface or by changes in the tooth material. Dentists divide discoloration into three main categories:
- Extrinsic discoloration -- This occurs when the outer layer of the tooth (the enamel) is stained by coffee, wine, cola or other drinks or foods. Smoking also causes extrinsic stains.
- Intrinsic discoloration -- This is when the inner structure of the tooth (the dentin) darkens or gets a yellow tint. Causes include excessive exposure to fluoride during early childhood, the maternal use of tetracycline antibiotics during the second half of pregnancy and the use of tetracycline antibiotics in children 8 years old or younger.
- Age-related discoloration -- This is a combination of extrinsic and intrinsic factors. In addition to stains caused by foods or smoking, the dentin naturally yellows over time. The enamel that covers the teeth gets thinner with age, which allows the dentin to show through. Chips or other injuries to a tooth can also cause discoloration, especially when the pulp has been damaged.
In rare cases, children with a condition called dentinogenesis imperfecta are born with gray, amber or purple discolorations.
Symptoms include stains on the enamel or a yellow tint in the dentin.
No special tests are needed. A dentist can diagnose tooth discoloration by looking at the teeth.
Some tooth discoloration can be removed with professional cleaning, but many stains are permanent unless the teeth are treated (whitened) with a bleaching gel.
Brushing your teeth after every meal will help to prevent some stains. Dentists recommend that you rinse your mouth with water after having wine, coffee or other drinks or foods that can stain your teeth. Regular cleanings by a dental hygienist also will help to prevent surface stains.
Intrinsic stains that are caused by damage to a nerve or blood vessel in the inner part (the pulp) of a tooth sometimes can be prevented by having root canal treatment, which removes organic material before it has a chance to decay and darken. However, teeth that undergo root canal treatment may darken anyway. To prevent intrinsic stains in children, avoid water that contains a high fluoride concentration. You can check the concentration of fluoride in your drinking water supply by calling the public health department. Then consult your dentist.
Discoloration often can be removed by applying a bleaching agent to the enamel of the teeth. With a technique called "power bleaching," the dentist applies a light-activated bleaching gel that causes the teeth to get significantly whiter in about 30 to 45 minutes. Several follow-up treatments may be needed.
It's also possible to remove discoloration with an at-home bleaching gel and a mouth guard given to you by your dentist. The bleaching gels designed for use at home aren't as strong as those applied by your dentist, so the process takes longer -- usually two to four weeks. Whitening toothpastes may remove minor stains, but they aren't very effective in most cases.
If you've had a root canal and the tooth has darkened, your dentist may apply a bleaching material to the inside of the tooth.
When a tooth has been chipped or badly damaged or when stains don't respond to bleaching, your dentist may recommend covering the discolored areas. This can be done with a composite bonding material that's color-matched to the surrounding tooth. Another option is to get veneers, which are thin shells of ceramic that cover the outer surfaces of the teeth.
When To Call a Professional
Tooth discoloration is mainly a cosmetic problem. Call a dentist if you're unhappy with the appearance of your teeth. Any change in a child's normal tooth color should be evaluated by a dentist.
The prognosis is very good for extrinsic stains. Intrinsic stains may be more difficult or take longer to remove.
What Causes My Bad Breath?
What Is It?
Bad breath, also known as halitosis, is breath that has an unpleasant odor. This odor can strike periodically or be persistent, depending on the cause. In many people, the millions of bacteria that live in the mouth (particularly on the back of the tongue) are the primary causes of bad breath. The mouth's warm, moist conditions make an ideal environment for these bacteria to grow. Most bad breath is caused by something in the mouth.
Some types of bad breath, such as "morning mouth," are considered to be fairly normal, and they usually are not health concerns. The "morning mouth" type of bad breath occurs because the saliva that regularly washes away decaying food and odors during the daytime diminishes at night while you sleep. Your mouth becomes dry, and dead cells adhere to your tongue and to the inside of your cheeks. Bacteria use these cells for food and expel compounds that have a foul odor.
In addition, bad breath can be caused by the following:
- Poor dental hygiene -- Infrequent or improper brushing and flossing can leave food particles to decay inside the mouth.
- Infections in the mouth -- Periodontal (gum) disease
- Respiratory tract infections -- Throat infections, sinus infections, lung infections
- External agents -- Garlic, onions, coffee, cigarette smoking, chewing tobacco
- Dry mouth (xerostomia) -- This can be caused by salivary gland problems, medications or by "mouth breathing."
- Systemic illnesses -- Diabetes, liver disease, kidney disease, lung disease, sinus disease, reflux disease and others
- Psychiatric illness -- Some people may perceive that they have bad breath, but it is not noticed by oral-health-care professionals or others. This is referred to as "pseudohalitosis."
A person may not always know that he or she has bad breath. This phenomenon is because odor-detecting cells in the nose eventually become accustomed to the constant flow of bad smells from the mouth. Others may notice and react by recoiling as you speak.
Other associated symptoms depend on the underlying cause of bad breath:
- Poor dental hygiene -- Teeth are coated with film or plaque, food debris trapped between teeth, pale or swollen gums
- Infections in the mouth -- Gums may be red, swollen and bleed easily, especially after brushing or flossing; pus may drain from between teeth; a pocket of pus (abscess) at the base of a tooth; loose teeth or a change in "fit" of a denture; painful, open sores on the tongue or gums
- Respiratory tract infections -- Sore throat, swollen lymph nodes ("swollen glands") in the neck, fever, stuffy nose, a greenish or yellowish nasal discharge, a mucus-producing cough
- External agents -- Cigarette stains on fingers and teeth, a uniform yellow "coffee stain" on teeth
- Dry mouth -- Difficulty swallowing dry foods, difficulty speaking for a prolonged period because of mouth dryness, a burning sensation in the mouth, an unusually high number of dental caries, dry eyes (in SjÃ¶gren's syndrome)
- Systemic (bodywide) illnesses -- Symptoms of diabetes, lung disease, kidney failure or liver disease
A dentist may notice the patient's bad breath while the patient is discussing his or her medical history and symptoms. In some cases, depending on the smell of the patient's breath, the dentist or physician may suspect a likely cause for the problem. For example, "fruity" breath may be a sign of uncontrolled diabetes. A urine-like smell, especially in a person who is at high risk of kidney disease, can sometimes indicate kidney failure.
Your dentist will review your medical history for medical conditions that can cause bad breath and for medications that can cause dry mouth. Your dentist also will ask you about your diet, personal habits (smoking, chewing tobacco) and any symptoms, including when the bad breath was noticed and by whom.
Your dentist will examine your teeth, gums, oral tissues and salivary glands. He or she also will feel your head and neck and will evaluate your breath when you exhale from your nose and from your mouth. Once the physical examination is finished, your dentist may refer you to your family physician if systemic problems are the most likely cause. In severe cases of gum disease, your dentist may recommend that you be seen by a periodontist (dentist who specializes in gum problems).
You will need diagnostic tests if the doctor suspects a lung infection, diabetes, kidney disease, liver disease or SjÃ¶gren's syndrome. Depending on the suspected illness, these tests may include blood tests, urine tests, X-rays of the chest or sinuses, or other specialized testing.
How long bad breath lasts depends on its cause. For example, when the problem results from poor dental hygiene, proper dental care will begin to freshen the mouth immediately, with even more impressive results after a few days of regular brushing and flossing. Periodontal disease and tooth abscess also respond quickly to proper dental treatment. Bad breath resulting from chronic sinusitis may be a recurring problem, especially if it is caused by a structural abnormality of the sinuses.
Bad breath the results from a systemic illness may be a long-term problem that can often be controlled with proper medical care.
Bad breath caused by dental problems can be prevented easily. Daily maintenance calls for brushing your teeth, tongue and gums after meals, flossing, and rinsing with mouthwashes approved by the American Dental Association (ADA). Regular visits to the dentist (at least twice a year) should be made for dental examinations and for professional teeth and gum cleaning.
Bad breath also can be combated by drinking plenty of water every day to encourage saliva production. An occasional swish of the mouth with water can loosen food particles. Other products that keep breath fresh and prevent plaque from forming include sugar-free gum, sugarless lozenges, raw carrots and celery.
The treatment of bad breath depends on its cause.
When To Call A Professional
Call your dentist promptly if you have bad breath with painful, swollen gums that bleed easily or loose teeth. Also, call your doctor if you have bad breath along with a fever, sore throat, a postnasal drip, a discolored nasal discharge or a mucus-producing cough. Even if you have none of these associated symptoms, call your dentist or physician if your bad breath continues despite a good diet and proper dental hygiene.
If you have diabetes, gastroesophageal reflux disease (GERD) or chronic liver or kidney disease, ask your doctor how bad breath can be a sign that your underlying medical condition needs immediate medical attention.
Once bad breath has been diagnosed, the outlook for fresh breath is usually excellent as long as you stick to your dentist's or physician's treatment plan.
Bruxism (Teeth Grinding)
What Is It?
Bruxism is clenching or grinding your teeth, often without being aware that your are doing it. In the United States, bruxism affects an estimated 30 to 40 million children and adults.
Some people grind their teeth only during sleep; this condition is called "nocturnal bruxism" or "sleep-related bruxism." Others grind their teeth during the daytime as well, most often during situations that make them feel tense or anxious. People with severe bruxism can fracture dental fillings or cause other types of tooth damage. Severe bruxism has also been blamed for some cases of temporomandibular joint dysfunction (TMD), mysterious morning headaches and unexplained facial pain.
Bruxism can have a variety of psychological and physical causes. In many cases, it has been linked to stress, but it can also simply be the body's reaction to the teeth being aligned wrong or a poor bite (the way the teeth come together). Bruxism can sometimes occur as a complication of severe brain injury, or a symptom of certain rare neuromuscular diseases involving the face. Bruxism also can be an uncommon side effect of some psychiatric medications, including antidepressant medications, including fluoxetine (Prozac), sertraline (Zoloft) and paroxetine (Paxil).
Symptoms of bruxism include:
- Rhythmic contractions of the jaw muscles
- A grinding sound at night, which may disturb the sleep of someone who shares a bedroom with a "bruxer"
- A dull morning headache
- Jaw muscles that are tight or painful, especially in the morning
- Chronic facial pain
- Damaged teeth, fractured dental fillings and injured gums
Your dentist will ask about your current life stresses, your general dental health and your daily medications. He or she also will want to know whether you routinely drink beverages containing alcohol or caffeine, because both of these chemicals seem to increase the tendency to grind your teeth.
If you share your bedroom, the dentist also may want to ask that person about your sleep habits, especially about any unusual grinding sounds heard during the night.
Your dentist will examine you, paying special attention to your mouth and jaw. During this exam, your dentist will check for tenderness in your jaw muscles, as well as for any obvious dental abnormalities, such as broken teeth, missing teeth or poor tooth alignment. If your dentist suspects that you have bruxism that is related to dental problems, he or she may conduct a more detailed assessment. In addition to checking your "bite," the dentist will examine your teeth and gums for damage caused by bruxism. The dentist will also take a series of mouth X-rays.
If your child grinds or clenches his or her teeth, discuss the problem with your family dentist. Although many children eventually outgrow bruxism, even short-term tooth grinding can cause damage to your child's permanent teeth.
Of all children who brux between the ages of 3 and 10, more than half will stop spontaneously by age 13.
In teenagers and adults, how long bruxism lasts depends on its cause. For example, bruxism can last for many years if it is related to a stressful life situation that doesn't go away. However, if bruxism is being caused by a dental problem, it should stop when the teeth are repaired and realigned -- often within a few dental visits.
If your bruxism is related to stress, you may be able to prevent the problem by seeking professional counseling or by using strategies to help you learn to relax. Also, try cutting down on stimulants such as tobacco and caffeine.
In both children and adults, tooth damage related to bruxism can be prevented by wearing a night bite plate or a bite splint (a dental appliance worn at night to stop teeth grinding).
The treatment of bruxism varies depending on its cause:
- Stress -- If you have bruxism that is stress-related, your dentist or physician may recommend professional counseling, psychotherapy, biofeedback exercises or other strategies to help you relax. Your dentist or physician also may prescribe muscle relaxant medications to temporarily ease the spasm in your clenched and overworked jaw. If conventional therapy does not help, your dentist may refer you to an oral surgeon who may inject botulinum toxin directly into your jaw muscles (to temporarily interfere with muscle contractions).
- Dental problems -- If your bruxism is related to tooth problems, your dentist will probably treat it with occlusal therapy (to correct tooth alignment). In severe cases, your dentist may need to use onlays or crowns to entirely reshape the biting surfaces of your teeth.
- Brain injury or neuromuscular illness -- Your bruxism may be especially hard to treat if you have these medical problems. Your oral surgeon may give you injections of botulinum toxin if more conservative treatments fail.
- Medication -- If you develop bruxism as a side effect of antidepressant medications, your doctor either can switch you to a different drug or give you another medication to counteract your bruxism.
When To Call A Professional
Call us if you have symptoms of bruxism, or if you are told that you grind your teeth while you sleep.
Also, make a dental appointment immediately if you fracture a tooth, lose a filling, or notice that your teeth are becoming abnormally loose in their sockets.
Even without special treatment, more than half of young children with bruxism stop grinding their teeth by age 13. Until your child stops bruxing on his or her own, your dentist can fit your child with a night bite plate to prevent excessive tooth wear. This device is effective in almost all children who use it as directed.
In teenagers and adults, the outlook is excellent if bruxism is treated properly. Even if all other therapies fail, injections of botulinum toxin can temporarily stop bruxism in most patients.
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