What prompted me to pen this write up is that, 80%-85% of the patients that I see, suffer from BAD BREATH. Medically known as Halitosis, Bad Breath can have extreme adverse effects on the mental health & self-esteem of the Patient. It is also known to cause Anxiety & Depression in these cases.

Most patients hesitate to talk about it even with a dentist & the dentist needs to be subtle in mentioning it & recommending a treatment, lest the patients get offended.

90% of the cases with Halitosis, have the causative inside their mouths, Plaque & Calculus being the most common etiological factors.

Plaque is the soft deposit that starts building around the teeth, soon after brushing. When Plaque hardens due to faulty brushing, it leads to the formation of Calculus. This condition can be easily treated by a dental practitioner by oral prophylaxis, commonly known as scaling. What is more important post scaling that most dentists miss doing is, instructing the patient about the right brushing technique [I have covered this in detail in my next blog].

Other intraoral causes include, Xerostomia which means lack of salivary secretions, and Habits like Smoking, Tobacco & Alcohol consumption.

Systemic causes of Halitosis are indicative of disorders involving different organ systems.

Conditions of Digestive System that lead to Halitosis are:

• Diabetes: Sweet breath.

• Chronic Acidity: Sour smell.

• Liver Ailments: Musty/ Stale smell.

Respiratory ailments that can cause halitosis are:

• Pneumonia, Bronchitis, Sinus infections & in all these cases, breath smells like that of Pus.

Kidney Failure causes Ammonia smell & metallic taste.

Coming to the circulatory system, Heart disease may not directly cause bad breath, but gum disease exponentially increases the risk of Heart disease.

Having known the above, treatment of Halitosis in such cases would involve treating the underlying disease.

Hence a visit to your Dentist every 6 months can give you a lot of insight to your general health, apart from maintaining oral health & boosting your self-esteem.

The benefits of good oral hygiene are multifold. Good oral habits don't just maintain the teeth in good condition but can also prevent almost all infectious diseases.

Having said that, one needs to address the fact that in spite of regular brushing, some patients tend to develop tartar & bad breath. What then could be the reason behind this?

What goes wrong in almost all these cases is the technique of Brushing. Moreover, wrong methods of brushing can cause more harm to the oral tissues than good.

To understand this, let me introduce you to some terms:

1. Plaque: Plaque is a collection of microorganisms on the food debris that gets accumulated on the surface of the teeth if the teeth aren't brushed or aren't brushed properly.

2. Calculus: Commonly known as tartar, Calculus is hardened plaque.

Formation of Plaque & Calculus is detrimental to the teeth, gums and the underlying bone. Plaque leads to the infection of the gums, a condition called gingivitis, manifested as bleeding gums. If neglected at this stage, the underlying bone gets infected leading to a condition called Periodontitis where the teeth get loosened and give way. The most embarrassing consequence of plaque & calculus accumulation is Bad breath, known as Halitosis in medical terms.

3. Gingival Sulcus: There is normally a gap of 1 to 2 mm depth between the tooth & the gum called the gingival sulcus. Sulcus is the most vulnerable area for plaque accumulation.

4. Gingival Recession: All of you are familiar with the economic recession. Did you know, the gums can recede too! Gingival recession is the exposure of the tooth root because of the moving of the gums towards the root tip.

We also need to know the different Tooth cleaning aids required for maintaining oral hygiene. The most important aids used are obviously the toothbrush & the toothpaste. Dentists frequently get asked this question as to which brand of paste or brush is to be used. No specific brand of toothpaste or toothbrush can be singled out to be clearly superior for routine use. The technique of brushing is more important than the brand of the brush or the paste.

For routine brushing, a soft to medium brush is recommended. Selecting the shape of the handle of the brush is a matter of individual preference. Electrically powered brushes that are available over the counter can be used for hospitalized or handicapped patients. Ideally, a brush has to be changed every three months.

Talking about toothpaste, most brands available in the market are satisfactory for routine usage. Caries prone patients can opt for fluoridated brands of toothpaste after consulting their dentists.

In order to achieve maximum efficacy of the toothpaste, it has to come in intimate contact with the teeth. This is best achieved by placing the toothpaste in between the bristles and not on top of them. After applying the toothpaste over the toothbrush, tapping the brush would do the needful.

TOOTH BRUSHING TECHNIQUE:

The most effective and recommended technique for regular oral care is called the BASS technique, wherein the bristles of the brush are to be placed at a 45 degrees angulation to the tooth surface, so that the bristles enter the sulcus. Gentle back and forth strokes need to be given to the brush without dislodging the tip of the bristles. Moderate pressure is recommended. Rigorous brushing will lead to Gingival recession.

Three teeth are to be brushed at one time, about 20 strokes in each position, after which the next set of three teeth can be brushed.

Horizontal strokes are to be used for sulcular areas of the teeth & vertical strokes for the rest of the teeth surface.

Biting surfaces of all teeth have to be brushed in the horizontal direction.

The tongue has to be brushed invariably both back & forth to avoid bad breath.

One can judge the pressure applied while brushing by observing the fraying of the bristles of the toothbrush. If the bristles lose shape within a week or two, then the brushing is too rigorous. If they stay intact for more than six months, then the brushing is too gentle.

Interdental Cleansing Aids:

The area between two teeth is called the interdental area which is more prone to plaque accumulation. Regardless of the brushing technique used, it has been observed that the brush does not completely remove the interdental plaque. Cleaning this area is of utmost importance because most dental & gum diseases originate here.

The most commonly used interdental cleansing aid is Dental Floss, other aids being toothpicks & interdental brushes.

Dental floss: Floss is available over the counter as a multifilament nylon yarn. A piece of floss long enough to be grasped securely needs to be cut out from the roll. The yarn needs to be wrapped around the index fingers of both hands & then passed gently through each contact, deep enough to enter the sulcus, taking care not to injure the gums.

Interdental Brushes: Mainly indicated in cases with large gaps between teeth, they are to be used in horizontal strokes in & out in the interdental areas.

Frequency of Tooth Brushing:

Brushing teeth twice a day is ideal. Brushing at night before going to bed is more crucial than brushing in the morning. This is because, during sleep, the secretion of saliva is reduced & hence its cleansing effect.

Despite regular personal oral care, a professional consultation with your dentist every six months is mandatory. The dentist would then decide whether a motorized cleaning (Scaling) is required.

And yes, it's worth investing that kind of time on your smile, because you wear it every day!