Scaling, Root Planing, and teeth Whitening

Scaling and Root Planing

Scaling and root planing is a deep cleaning below the gumline used to treat gum disease.
Why Do I Need It?
Gum disease is caused by a sticky film of bacteria called plaque. Plaque is always forming on your teeth, but if they aren’t cleaned well, the bacteria in plaque can cause your gums to become inflamed. When this happens, your gums will pull away from your teeth and form spaces called pockets. Plaque then gets trapped in these pockets and cannot be removed with regular brushing. If untreated, gum disease could lead to bone and tooth loss.
If gum disease is caught early and hasn’t damaged the structures below the gum line, a professional cleaning should do. If the pockets between your gums and teeth are too deep, however, scaling and root planning may be needed.
This deep cleaning has two parts. Scaling is when your dentist removes all the plaque and tartar (hardened plaque) above and below the gumline, making sure to clean all the way down to the bottom of the pocket. Your dentist will then begin root planing, smoothing out your teeth roots to help your gums reattach to your teeth. Scaling and root planing may take more than one visit to complete and may require a local anesthetic.
After Care Tips
After a deep cleaning, you may have pain for a day or two and teeth sensitivity for up to a week. Your gums also may be swollen, feel tender and bleed.
To prevent infection, control pain or help you heal, your dentist may prescribe a pill or mouth rinse. Your dentist may also insert medication (sub-antimicrobial-dose doxycycline) directly into the pocket that was cleaned.
Your dentist will schedule another visit to see how your gums have healed and measure the depth of your pockets. If they have gotten deeper, more treatment may be needed.
Good dental care at home is essential to help keep gum disease from becoming more serious or recurring. Brush your teeth twice a day with a soft brush, clean between your teeth daily, eat a balanced diet, avoid using tobacco and see your dentist regularly.
BAD BREATH
– What is Halitosis (Bad Breath)?
Halitosis, commonly known as bad breath, is an embarrassing health condition that affects approximately 30% of people around the world. Additional medical terms for this condition include stomatodysodia, fetor oris, and ozostomia. Regardless of the term used, this is the presence of a foul-smelling odor that seems to come from the mouth cavity. According to the Academy of General Dentistry, in more than 90% of cases, the odor originates in the mouth, throat, and tonsils. Although this is something everyone experiences at one time or another, if your case does not improve after brushing, flossing, and rinsing the mouth with an alcohol free mouthwash, it may be chronic.
The foul oral odour is usually caused by a group of anaerobic, sulfur-producing bacteria that breed beneath the surface of the tongue and often in the throat and tonsil area. The term “anaerobic” literally means living without oxygen, and in fact, these bacteria do not require oxygen to live. They occur naturally in the oral environment and are essential because they assist in digestion by breaking down proteins into amino acids. Proteins are commonly found in food, mucus or phlegm, blood, and in diseased oral tissue.
As these bacteria feast on proteins in your mouth, sulphur compounds are released from the back of your tongue and throat. The bacteria excrete waste as hydrogen sulfide, methyl mercaptan, and other odorous and bad tasting compounds known as volatile sulphur compounds. As long as the anaerobic bacteria feed on proteins and excrete volatile sulfur compounds unchecked, your breath will become worse and worse.
Four Common Bad Breath Causes
There are many underlying causes of halitosis, but four of them are very common.
Dry mouth: Xerostomia, the medical term for dry mouth, provides a perfect environment for anaerobic bacteria reproduction. Long periods of speaking, smoking, drinking alcohol, and snoring are a few common underlying causes. Most people experience foul breath in the morning due to lack of saliva production while they sleep. For healthy individuals, food odors are temporary and normal salivary flow will eliminate them within several minutes. However, those who suffer from dry mouth and lack of saliva find that even minor food odors may lead to long-term issues.
Foods: Halitosis can be exacerbated by certain foods such as onions and garlic because they contain smelly sulfur compounds, while dairy, meat, and fish contain dense proteins which are used as a food source by the anaerobic, sulfur-producing bacteria. Refined and processed sugars also provide a food source for bacteria. Coffee and juices can contribute to this problem because they are acidic and provide these bacteria with an ideal breeding environment.
Poor dental hygiene: Inadequate oral care causes bacterial buildup on the teeth and gums. Teeth cannot shed their surfaces the way skin can, so microorganisms can easily attach to the teeth and remain there for extended periods. If they are not continuously removed by adequate brushing, these bacteria develop into something called biofilm, commonly known as dental plaque. When plaque is allowed to accumulate near the gumline, it will harden and begin destroying teeth and gum tissues due to intense bacterial activity. This leads to gum disease such as gingivitis and periodontitis, which enable proteins from bleeding gums and diseased oral tissue to fuel odor-causing bacteria. Tooth decay and poorly fitting or dirty dentures can also contribute to this problem.
Illness and disease: According to studies, an estimated 10% of all halitosis cases are caused by certain illnesses. Individuals who suffer from diabetes, lung disease, kidney disease, cancer, liver disease, respiratory tract infections, or metabolic disorders often experience chronic foul breath due to dry mouth. Sinusitis, pneumonia, bronchitis, postnasal drip, and polyps affect the airways and may also contribute to the problem. Other common illnesses associated with bad breath include nasal odor and tonsil stones, yeast infections of the mouth, and gum disease. Certain drugs such as antidepressants, high blood pressure medications, and antihistamines can factor into dry mouth because they reduce saliva production.
Illness and disease: According to studies, an estimated 10% of all halitosis cases are caused by certain illnesses. Individuals who suffer from diabetes, lung disease, kidney disease, cancer, liver disease, respiratory tract infections, or metabolic disorders often experience chronic foul breath due to dry mouth. Sinusitis, pneumonia, bronchitis, postnasal drip, and polyps affect the airways and may also contribute to the problem. Other common illnesses associated with bad breath include nasal odor and tonsil stones, yeast infections of the mouth, and gum disease. Certain drugs such as antidepressants, high blood pressure medications, and antihistamines can factor into dry mouth because they reduce saliva production.
Note: Halitosis is rarely associated with life-threatening diseases. However, it is important that you consult your doctor or dentist as soon as you notice consistent white spots on the tonsils and sores in the mouth with or without a fever. Sometimes bad breath is triggered by severe health conditions such as throat or mouth cancers, human immunodeficiency virus (HIV) infection, digestive system disorders, or diabetes – and further, can indicate dehydration or zinc deficiency. Taking proper care of your teeth and visiting the dentist at least twice a year are the easiest ways to avoid these issues.
Halitosis Symptoms
Offensive breath tells us that something is out of balance. In fact, anthropologists have reported that once humans started to kiss each other, the ability to smell one another’s breath became a very important way to test a partner’s compatibility. If the other person didn’t pass the smell test, they were not able to get to the next step towards securing a mate.
Halitosis is a medical condition that lowers self-esteem and affects everyday life and personal relationships. People with chronic or recurring bad breath often lose their self-confidence. It can be difficult to know if you have this problem, because it is often challenging to pick up on one’s own scent. Furthermore, family members and colleagues may not feel comfortable telling you. One of the best ways to find out if you have foul breath is to lick the inside of your wrist, wait five seconds, and then take a whiff.
Most symptoms of halitosis depend on the underlying cause. The most common symptoms include postnasal drip, a bitter metallic taste, a white coating on the tongue, and thick saliva. Many individuals who have foul breath associated with dry mouth can experience difficulty speaking or swallowing, a burning sensation in the mouth, or dry eyes. Fever, sore throat, persistent cough, and swollen lymph nodes in the neck indicate respiratory tract infections, which can also be a contributing factor.
Getting a Proper Diagnosis
The best way to truly identify the source of chronic halitosis is to visit a dentist or doctor for a professional diagnosis. When you are ready to tackle this situation, be sure to be open and honest with the healthcare professional performing the examination. It is important for him or her to understand all the health problems you are experiencing in order to determine the underlying cause and recommend appropriate treatment.
The Halimeter (also known as a portable sulfide gas monitor) is the most commonly used clinical diagnostic instrument utilized in this field. It measures the concentration of hydrogen sulfide in parts per billion (ppb) in mouth air. The Halimeter uses a patented electrochemical voltammetric sensor, which has provided reproducible results to clinicians for the past 20 years. It has been demonstrated hundreds of times on national and local television by Dr. Harold Katz on programs such as “The View,Good Morning America”, and “CBS Morning News”.
Getting Proper Treatment
For more than a century, pharmaceutical companies attempted to alleviate halitosis by using mouthwash that contained alcohol. This is the exact opposite of what should be done because alcohol is a drying agent. Clinicians have learned a good deal in the ensuing years, and in most cases, this condition can be successfully treated. Like the symptoms, treatment depends on the underlying cause.
It is important to keep in mind that you cannot eliminate the bacteria from the tongue that cause bad breath. Consequently, scraping or brushing the tongue is a temporary remedy at best, and is typically frustrating for those who believe tongue scraping or tongue brushing is a permanent solution. The bacteria that cause this are part of your normal oral flora and are essential to breaking down proteins, a key step in normal digestion.
A much simpler and clinically-proven method to treat bad breath is to interrupt the bacteria’s chemical production of odors by introducing oxygenating compounds to your oral environment. Oxygen is the natural enemy of the bacteria that cause this problem because they are anaerobes and cannot function in the presence of oxygen.
In general, a dentist will recommend mouthwashes and toothpastes that contain oxygenating agents such as chlorine dioxide or sodium chlorite to neutralize volatile sulfur compounds and help control odor causing bacteria found in the mouth.
If you are experiencing mouth dryness, your dentist will recommend a saliva substitute to moisten the mouth throughout the day. Some effective, natural ingredients to look for in oral care products are zinc gluconate, aloe vera, green tea, tea tree oil, xylitol, CoQ10, glycyrrhizic acid and oral probiotics like K12 and M18.
Six Bad Breath Home Remedies
The practice of a few, simple, self-care techniques can help to minimize halitosis. There are several things you can do at home.
  1. Advanced oral care products: Use oral care products such as mouthwashes and toothpastes that have been shown to be effective in fighting bad breath.
  2. Proper oral care: Brush and floss your teeth at least twice a day. Be sure to get a toothbrush with soft bristles (as to not damage tooth enamel or gums) and also use fluoride toothpaste. Brushing and flossing helps to remove any food and plaque which can be used as a fuel source by the anaerobic, sulfur-producing bacteria that are at the root of this problem.
  3. Stimulate your salivary flow: Prevent dry mouth with chewing gum, lozenges, or mints that are sugar free. Look for Xylitol, a non-sucrose sweetener, which in recent years has been shown to have anti-cavity properties.
  4. Eat fibrous fruits and vegetables: One of the best ways to remove bacteria in the mouth is to eat an apple a day. It helps moisten the mouth, too.
  5. Take a dietary supplement: Vitamin C, Vitamin D, Vitamin E, and Vitamin B are effective at helping your body eliminate excess mucus and toxins naturally.
  6. Brush your teeth occasionally with baking soda: The bacteria that cause bad breath thrive in an acidic oral environment. Brushing your teeth with baking soda helps neutralize excess acids found in the oral cavity.
12 Easy Ways to Prevent Bad Breath
Please remember, preventing halitosis is always easier than treating it. By developing the right habits, you can effectively help prevent it.
  1. Eat foods rich in fiber: High fiber foods help prevent halitosis. Avoid eating heavily processed foods that contain refined carbohydrates such as cookies, cakes, sweets and ice cream.
  2. Use mouthwash: Some mouthwashes or oral rinses are effective at preventing bad breath. However, you should never use alcohol based mouthwashes because the alcohol makes the mouth very dry, which will actually make the problem worse.
  3. Drink green and black teas: They contain polyphenols that help eliminate sulfur compounds and reduce oral bacteria.
  4. Avoid drying medication: Try not to take antidepressants, diuretics, pain relievers, and antihistamines unless it is absolutely medically necessary. These drugs inhibit saliva flow and can cause chronic dry mouth.
  5. Avoid products with sodium lauryl sulfate or alcohol: Do not use any oral hygiene products that contain sodium lauryl sulfate or alcohol because the alcohol makes the mouth very dry, one of the most common causes of bad breath.
  6. Clean your mouth after eating meat, fish or dairy products: Practicing consistent and thorough oral hygiene is an effective prevention tool.
  7. Stop smoking: Studies have shown that smokers are at higher risk of developing periodontal disease and dry mouth. Furthermore, people who smoke may also engage in other habits that promote this condition such as dieting, drinking alcohol, and suffering from chronic anxiety conditions that require exacerbating prescription medications.
  8. Breathe through your nose instead of your mouth: Try to address any snoring or sleep apnea issues that could be affecting your breath and causing dry mouth.
  9. Drink water: Keep your mouth moist by drinking plenty of water.
  10. Clean your dentures at least once a day: Practice the same, proper oral care that you would with your original teeth.
  11. Eliminate dairy products from your diet: Lactose intolerance can be an underlying cause of halitosis.
  12. Use an oral probiotic like S. salivarius K12 and M18: Use probiotics to balance the oral cavity and prevent an overgrowth of the odor-causing bacteria involved in halitosis.

Teeth Whitening of Abnormal Tooth Color

Color of teeth
Slightly yellowish permanent teeth
Since the enamel of permanent teeth is slightly transparent, the yellowish colour of the underlying dentine is shown through it. Therefore, permanent teeth will appear slightly yellowish. As we get older, the dentine increasingly grows thicker, and it is normal that our teeth become more yellowish.
Milky white deciduous teeth
The enamel of deciduous teeth is not as transparent as our permanent teeth. That is why deciduous teeth look milky white
Factors causing tooth discoloration
There are two factors causing tooth discoloration — internal factor and external factor.
1. External factors causing tooth discoloration
– Brown and black stains on the surface of teeth
Cause
Drinking of dark-coloured beverages, such as tea, result in the food colours being adsorbed onto the tooth surfaces.

Treatment
The dentist will use:

  • Dental pumice to remove the stain, and then prophylaxis paste to smoothen the tooth surfaces; or
  • Prophyjet — utilizing air to spray a mixture of fine baking soda powder and water onto the surfaces of teeth to remove stains.
Prevention
Avoid drinking dark-coloured beverages to minimize food colours being adsorbed.
Teeth with black stains
Teeth after black stain removal
– Green and orange stains at the surface of teeth
Cause
Teeth has not been cleaned thoroughly, and the accumulated dental plaque contained bacteria or fungi that can produce colour and formed green and orange stains.
Treatment
Dentist will perform scaling to remove accumulated dental plaque and stains.
Prevention
Brush the teeth every morning and before bed at night, and use dental floss to remove dental plaque to keep the teeth white.
Teeth with orange stain
Teeth after orange stain removal
2. Internal factors causing tooth discoloration
– Teeth appear to be greyish-blue to brownish-yellow
Cause
If there was certain sickness or, if tetracycline (a kind of antibiotics) is taken during the development of teeth, the teeth formed will be greyish-blue to brownish-yellow.
Treatment
Bleaching, Laminate Veneer
Prevention
Brush the teeth every morning and before bed at night, and use dental floss to remove dental plaque to keep the teeth white.
greyish-blue to brownish-yellow
– Teeth appear to be greyish-black
Cause 1
Tooth decay
Treatment
The dentist removes the tooth decay, and then puts on a filling.
greyish-black
– Teeth appear to be greyish-black
Cause 2
Pulp necrosis : The pulp becomes necrotic because of tooth trauma or tooth decay, and the tooth will appear greyish-black.
Treatment
Endodontic treatment must be done to treat the discoloured tooth which has pulp necrosis
Pulp necrosis
Tooth after root canal therapy
– Brownish-yellow or white patches at the surface of a tooth

Cause

  • Early tooth decay
  • Disturbance during the development of tooth
    If a deciduous tooth is so decayed that the pulp is exposed, the bacteria, via the apex of the tooth, will cause an infection in the vicinity of the developing permanent successor. This will disturb the development of the enamel of the permanent tooth, resulting in the formation of brownish-yellow patches
  • Fluorosis
    Long term excessive fluoride ingestion will alter the development of the enamel of teeth. This disturbance will show as white patches on the teeth.
Treatment
  • Early tooth decay Dentist can apply topical fluoride onto the surfaces of teeth so that the early tooth decay lesion can be remineralised.
  • Disturbance during the development of a tooth or Fluorosis
    Treatments such as Filling, Laminate veneer or Crown.

Teeth Whitening

Tooth whitening (or bleaching) has been part of Dr. Vivek’s cosmetic dentist practice for over 22 years. It is a safe and effective way of removing discoloration and stains from the teeth. The cosmetic dentist, Dr. Vivek, offers two types of bleaching procedures. One is done completely in the office (known as “power bleaching”). Power bleaching involves the isolation of your teeth and the application of a very strong bleaching solution. The results are immediate but there is usually sensitivity afterward. The second type of bleaching is the take home tray system which is dispensed and supervised by the office, but involves the home use of professional strength bleaching gels. These gels are used in a custom tray specially designed to fit your teeth.
Dr. Vivek believes these systems provide complete and even cosmetic tooth whitening, while producing little or no sensitivity during and after treatment.

Tooth whitening can be a very effective way of lightening the natural colour of your teeth without removing any of the tooth surface. It cannot make a complete colour change, but it may lighten the existing shade.

There are a number of reasons why you might get your teeth whitened. Everyone is different; and just as our hair and skin colour vary, so do our teeth. Very few people have brilliant-white teeth, and our teeth can also become more discoloured as we get older.

Your teeth can also be stained on the surface by food and drinks such as tea, coffee, red wine and blackcurrant. Smoking can also stain teeth.

‘Calculus’ or tartar can also affect the colour of your teeth. Some people may have staining under the surface, which can be caused by certain antibiotics or by tiny cracks in the teeth which take up stains.

Fluorosis Stains due to excess of fluoride in water.

Professional bleaching is the most usual method of tooth whitening. First the dental team will put a rubber shield or a gel on your gums to protect them. They will then apply the whitening product to your teeth, using a specially made tray which fits into your mouth like a mouth guard.

The ‘active ingredient’ in the product is usually hydrogen peroxide or carbamide peroxide. As the active ingredient is broken down, oxygen gets into the enamel on the teeth and the tooth colour is made lighter.

The total treatment can usually be done within three to four weeks. First, you will need two or three visits to the dentist. Your dental team will need to make a mouth guard and will take impressions for this at the first appointment. Once your dental team has started the treatment, you will need to continue the treatment at home. This means regularly applying the whitening product over two to four weeks, for 30 minutes to one hour at a time.

However, there are now some new products which can be applied for up to eight hours at a time. This means you can get a satisfactory result in as little as one week.

There is now laser whitening or ‘power whitening’. During this procedure a rubber dam is put over your teeth to protect the gums, and a bleaching product is painted onto your teeth. Then a light or laser is shone on the teeth to activate the chemical. The light speeds up the reaction of the whitening product and the colour change can be achieved more quickly. Laser whitening is said to make teeth up to five or six shades lighter.

Your dentist will need to assess your teeth to make sure that you are suitable for the treatment. Once it has been agreed, this procedure usually takes about one hour.

The effects of whitening are thought to last up to three years. However, this will vary from person to person. The effect is less likely to last as long if you smoke, or eat or drink products that can stain your teeth. Ask your dental team for their opinion before you start the treatment.

Some people may find that their teeth become sensitive to cold during or after the treatment. Others may have discomfort in the gums, a sore throat or white patches on the gum line. These symptoms are usually temporary and should disappear within a few days of the treatment finishing.

If any of these side effects continue you should go to your dentist.

Yes. Sometimes dead teeth go discoloured after a root filling. If the tooth has been root treated, the canal (which contained the nerve) may be reopened. The whitening product is applied from the inside to whiten the tooth.

Tooth whitening can only lighten your existing tooth colour. Also it only works on natural teeth. It will not work on any types of ‘false’ teeth such as dentures, crowns and veneers.

If your dentures are stained or discoloured visit your dental team and ask for them to be cleaned.

You can help to keep your teeth white by cutting down on the amount of food and drinks you have that can stain teeth. Don’t forget, stopping smoking can also help prevent discolouration and staining.

We recommend the following tips to take care of your teeth:

  • brush your teeth last thing at night and at least one other time during the day, with a fluoride toothpaste
  • cut down on how often you have sugary foods and drinks
  • visit your dental team regularly, as often as they recommend.