Surprising Sources of Bad Breath

Many of my patients tell me they are worried about having bad breath or halitosis and ask what they can do to prevent it.  According to Dictionary.com, halitosis is defined as the condition of having offensive smelling breath.  There are several sources of bad breath, but thankfully most are preventable.  The most common sources of bad breath are as follows:

dental plaque- the sticky white film that develops on teeth surfaces consisting of bacteria, mucus, and food.
Impacted food- Often food can get stuck between the teeth if not brushed and flossed out.  Over several days, this food begins to break down and give off foul odors.
Tonsiliths- These are small round white globs that form in the tonsils and occasionally get coughed up from the back of the throat.  Tonsiliths are an accumulation of mucus and volatile sulfur compounds (VSCs) which come from bacteria in the mouth.  The VCSs give off a smell like rotten eggs.

Now that we have addressed the most common sources of bad breath, let's talk about some sources of bad breath you may not know:

Tooth decay- Did you know that severely rotting teeth give off a distinctive odor?  Tooth decay is caused by bacteria that produce acid which erodes the teeth.  Once cavities become big enough, they can be quite smelly and this can affect the breath.  Patients also may have decay beneath old fillings or crowns as well.  Regular dental visits and routine x-rays can help alert you if you have cavities. Of course getting cavities fixed, and defective fillings and crowns replaced will help keep your breath smelling fresh.

Periodontal "gum" disease- Gum disease is also caused by certain types of bacteria.  These bacteria give off chemicals that cause gums to weaken, bleed, swell, and recede.  These chemicals also cause bone destruction which can eventually lead to tooth loss.  Gum disease usually progresses due to poor oral care habits (not brushing and flossing regularly) and infrequent dental hygiene visits.  Patients with moderate to severe gum disease tend to have halitosis associated with their disease due to the bacterial infection and tissue destruction.  There are estimates that 85% of adults have some form of active gum disease.  Early diagnosis and treatment of gum disease is recommended.

Sinus infections- Patients with seasonal allergies or who have recently had a cold may experience inflammation and swelling of the tissues inside their sinuses.  This swelling may prevent sinuses from draining properly, allowing bacteria to multiply and sinuses to become infected.  Signs and symptoms of a sinus infection may be as follows: Dull throbbing facial pain, post nasal drip, headache, toothache, colored nasal discharge, cough, congestion, fatigue, facial swelling, and fever.  Since the maxillary sinuses drain through the nose and mouth, the infection may also cause the breath to smell bad.  Patients who suspect they have a sinus infection should see their physician for evaluation and treatment.

Dentures/false teeth: Dentures are removable, custom-made appliances worn in the mouth to replace missing teeth.  Dentures are made of acrylic which, overtime can pick up stains and odors if not properly cleaned.  Food, plaque, and tartar (a hard build up consisting of bacterial plaque and minerals found in saliva) can build up on dentures, just like on natural teeth.  It is recommended that patients clean their dentures every day.  Also patients with dentures should have them professionally cleaned regularly to reduce the build up of bacteria.  This cleaning can be combined with a regular oral examination to screen for oral cancer or infection and is recommended at least once a year.

Dental Abscess- An abscess is a localized collection of pus in the tissues of the body, often accompanied by swelling and inflammation and is frequently caused by bacteria.  They form after the nerve of a tooth dies.  The nerve may die due to a deep cavity, caused by bacteria. These bacteria can infect the nerve, cause inflammation, and if untreated, cause the nerve to die.  In addition, teeth that are subjected to trauma may get disrupted from their blood supply and die.  The body recognizes the dead nerve tissue in a tooth as foreign matter and sends white blood cells to try to clear it away.  The resulting swelling and inflammation is what is known as an abscess.  The bacteria from the abscess and the dying tissue give off a characteristic smell, causing halitosis.

Acid reflux/GERD, and ulcers- Patients with acid reflux, also known as Gastroesophageal reflux disease and ulcers may have associated halitosis.  Both GERD and ulcers are serious medical conditions which need to be diagnosed and managed by a physician.

So, the question is, how do you prevent bad breath? Many of the above mentioned sources of bad breath can be prevented by having good oral hygiene.  Brushing twice a day, and flossing once a day go a long way to prevent halitosis.  Don't forget to brush or scrape your tongue to remove the odor-causing bacteria that live there.

 Avoiding sugary drinks, and sweets also helps keep bacterial plaque levels down. Be sure that the gum and mints you choose are sugar free to prevent tooth decay.   Drinking water also helps prevent dry mouth as well. Ironically mouthwashes with a high alcohol content can be drying to mouth tissues.  This dryness creates a welcoming environment for the bacteria that give off bad-smelling VSCs. Try to choose a mouthwash that is alcohol free for fresher breath.

Lastly, regular preventive dental visits and medical visits can help patients avoid conditions that contribute to bad breath.  Staying cavity free, gum disease free, and healthy are key to having fresh breath!

Happy Smiling!

Questions? Email Dr. Lisa Curry at info@currydentalcenter.com 

Sour on Social media

Imagine my dismay this morning when I received an email from Yelp! informing me I had a new review on their site.  I logged in to my Yelp! for business page and discovered that a patient whose insurance paid less than expected and was billed for $7.00 (yes, seven dollars), was flaming my practice on the internet.  I am officially over Social media for my practice.  *Sigh*

Like most dentists, I listened attentively as advertising gurus spouted the importance of having a great online presence and reputation for your dental practice.  I read several articles on the web with titles like "7 Pearls to Reach Patients through Facebook and Twitter".   There are also multiple references on how to get patients to post positive online reviews about you and your office.  However, I have discovered a few realizations about the much touted Social media wave which I will now share.

1. Maintaining an ACTIVE online presence is a full-time job.  I found that trying to keep my dental Facebook page updated hourly, daily, weekly with pictures, posts, jokes etc. takes up a lot of time.  I already have a job and am not interested in another one, thanks.  Does having a fresh Twitter feed say anything about my skills as a dentist, really?  I have found that I would rather catch up on conversations with my patients.
2. Most REAL people who review dental offices have an axe to grind.  There are very few unsolicited reviews of dental offices that are positive, at least in my experience.  I think I may have one or two genuine positive reviews out there somewhere.  Unfortunately, the majority of people who take the time to write a review feel like they had a negative experience at an office and it is usually due to financial reasons.  Just like in restaurants, sadly, few people take the time to tell management when they felt their experience was great.  Most only speak up when things fell short of expectations.  Similarly, offices that have a bunch of glowing reviews online either write them themselves, incent patients to write them, or get their staff members and their family members to write reviews.  Why?  The more mentions of the practice and doctor's name on the internet, the more the office comes up in internet searches.  This means patients searching for dentists on the web will be more likely to see their name.  However, again this is not a real indicator of the doctor's skill in dentistry, but rather of their skill as a marketer.
3. Word of Mouth is still the best referral source for dentists.  I have been in solo practice since 2003.  I have tried advertising in several types of media.  Yes, I do agree that it is important for patients to see your name and face, and know that you exist.  The more you get your name out there, the better result you will have.  However, patients still want to know a few things about a dentist that an ad cannot convey.  That is why a word of mouth referral from and actual patient is more valuable and effective than any other type of advertising.  An online or print ad can tell you that I do a good job giving injections, but a testimonial from a friend in your bowling club holds more weight.
4. A slick, fancy, web page does not equate to an increase in patients calling your phone. One day I will have to do a study to confirm this theory.  However, I don't believe that there is a direct relationship between the amount of money spent on a practice website and the number of patients who schedule appointments.  What I have found is that most patients who find me on the web USUALLY already have my name from another source.  They use my site to get contact information, directions, confirm that I take their insurance, or third party payment plan.  They may look at my photo to make sure I don't look crazy.  Some may even read my bio if they are especially bored or nervous about their visit.
5. People don't care about friending, following, or linking to their dentist.  I personally use social media on my down time.  I find ads (and invitations to play games, hint) on these sites annoying.  I am usually logging in to connect with friends and family, have a laugh or some fun.  Believe it or not, I am not there to talk dentistry.  I am also okay and comfortable with the fact that most people do not equate going to the dentist with fun.  Even though a lot of my patients will say that they do laugh a lot at my office because we like to joke around during the day.  Side note: I also do not care if I see people drinking soda or eating candy when I am in social settings.  Those are your teeth!
6. Internet contests.  Yawn...  People may be attracted to a dental site or page if they are giving out free goods or services.  However, this does not necessarily mean that these people will become part of their patient family.  I would rather people seek me out as a dentist because I do a good job, not because I give out swag.
7. A lot of the "free" review sites are not free.  There are sites that claim they do not charge businesses to have a profile which is partly true.  Just like the old phone book may have a free listing of basic information, these sites may have a simple listing of a practice name and phone number.  However, if business owners want to edit their listing, have access to/ or dispute reviews, there is often an advertising fee to do so.  I prefer not to advertise on these sites because I do not find I receive sufficient referrals to justify the expense.   I also do not like the deceptive advertising that says patients can trust these sites because businesses do not have to pay to appear on them.

So, given what I have shared above, I have decided not to spend a lot of time actively cultivating my online reputation.  Social media for dentistry, in my experience, has not been the boost it was said it could be.  I am sure if I invested more time, money, and energy in it, I could see a better result.  However, given my disappointing experience thus far, I plan to focus on practicing the best dentistry I can for the patients in my community.  This is not to say that I will not participate online in the future.  I will just be more realistic in my expectations of Social media's impact on my dental practice.

Common Causes of Discolored Teeth

One of the most common complaints people have about their smile is that their teeth are too dark.  There are several factors that can contribute to discolored teeth and we will discuss several of these causes below:

What determines the color of teeth?
Teeth are made up of layers of mineralized material.  The outer layer is called enamel and is usually translucent.  This means that the enamel itself does not really affect the color of the teeth because it is see through.  The inner layer of the tooth (just outside of the nerve or pulp) is made of dentin.  The dentin makes up the bulk of the tooth and it is colored.  The color of the dentin shows through the enamel layer which gives the teeth their color.  The more darkly pigmented the dentin is, the darker the teeth appear.
Factors that can affect the color of the dentin:

• Age- As we get older, the nerve tissue or pulp of the teeth continues to make more dentin on the inside of the tooth.  As the dentin thickens, the color of the tooth intensifies.  This helps explain why teeth appear to darken with age.
• Medications- There are certain medications that expectant mothers can take that may affect the color of their unborn infant's teeth.  Tetracycline is an example of a medication that is known to cause such discoloration.





tetracycline staining

• Genetics- There are certain specific genetic disorders that may cause individuals to have darkly colored enamel.  These disorders may also have symptoms in other organ systems in the body and are somewhat rare and usually diagnosed in infancy.  An example of such a disorder is Dentinogenesis Imperfecta.
• Necrosis- Sometimes when a tooth sustains trauma, the blood supply to the tooth is cut off and the nerve of the tooth dies.  When this occurs the tooth may darken in color.  A tooth with a dead nerve is diagnosed as being necrotic.  Necrotic teeth are treated either with a root canal (endodontic procedure) or extraction to clear away the dead, infected nerve tissue.




Necrotic upper left central incisor



Factors that affect the color of the enamel:

• High fever in infancy- Some patients who had a high fever as an infant may have bands of discolored or and even malformed enamel on their teeth.  This is because the fever disrupts the normal function of the enamel producing cells as the teeth are being formed.  The location of the defects depends on how old the patient was when the fever occured.
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  Fluorosis-  Patients who are exposed to high levels of fluoride in their drinking water and other beverages while teeth are being formed may develop white and brown spots on the enamel of their teeth.  This is because the fluoride is taken up into the structure of the teeth in place of calcium and therefore alters the structure and appearance of the tooth.  Although it looks unsightly, it is not harmful to the tooth.  Patients with fluorosis may opt to have cosmetic dental procedures to improve their smile as adults.



fluorosis

• Cavities-  It may seem obvious, but cavities also cause teeth to be discolored.  Bacteria in the mouth metabolize sugar from foods and drinks and produce acid as a by product.  The acid produced causes tooth enamel and dentin to erode which results in white spots, as well as brown, and black areas on the teeth. 
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• External Stains:
• Tobacco Stains- smoking and using smokeless tobacco products can leave stains on the enamel of the teeth.
• Beverages- Coffee, tea, dark colored sodas also can leave stains on the surface of the teeth.

tobacco stained teeth

Fortunately, most external stains can be removed with a professional dental cleaning.  However, repeated use of staining materials may leave behind a fine residue in the texture of the enamel that can only be removed by dental tooth whitening or other cosmetic procedures.

As you can see, there are several factors that can cause discoloration of the teeth.  If you are displeased with the color of your teeth.  Talk with your dentist to see what options are available to you to improve the appearance of your smile.

Happy Smiling!



Harmful Habits

Over the years I have gotten emergency calls from patients who have accidentally damaged their teeth or mouths.  Unfortunately these patients were often unaware that certain practices can be harmful.  Thus to raise awareness about some of these potentially problematic habits, I decided to describe them below:

• Chewing ice- Some patients have a habit of chewing on ice or ice cubes.  The problem with this is that it can weaken the teeth and cause them to crack or fracture.  Often times a patient will only partially crack their tooth while biting ice.   Later when they eat something soft like a sandwich or chewy like a bagel or bacon, a piece of their tooth will break off.  If the patient is lucky, the tooth can be repaired with a restoration like a filling or a crown.  However in some cases the tooth is not salvagable and may have to be extracted.  People who feel compelled to regularly chew ice may be suffering from Pica which is a form of iron deficiency.  I advise my patients who compulsively chew ice to have their iron levels checked and fight that craving unless they want to have a dental emergency.

• Using teeth as tools- Sometimes patients who call to report they "chipped a tooth" will remorsefully admit that they had been using their teeth as a tool when it broke.  I have heard of patients who open bottles, crack crab legs or nuts, pull tags off clothes and perform various other tasks with their teeth.  These habits may not cause problems initally, but one day a weakened tooth may receive too much pressure and crumble.  My advice is, don't be lazy.  Go and get the appropriate tool for the job because it is cheaper and less painful to replace the tool than it is your teeth!
• Tongue rings-Some years ago, tongue piercing became popular among women and men.  For the sake of brevity, I will not go over the background and history of this practice.  However, the only reason I mention it is because I have observed that many of my patients who had a tongue ring eventually managed to chip or crack their teeth with it.  Most where not aware that this was a potential hazard of having this type of piercing.  Fortunately there are other options available such as soft plastic attachments that can help avoid tooth fracture.  However, the best way to avoid such problems is to remove the tongue ring altogether.
 

• Eating lemons (acidic foods)- There are people who actually enjoy eating lemons (go figure!).  The only problem with this is the prolonged exposure of the teeth to acid.  This can cause erosion of the tooth structure /wear away the enamel.  Teeth can then become sensitive and more susceptible to decay.  Also once the damage has been done, patients are often displeased with the appearance of their teeth and may require veneers or crowns to restore them.  Erosion can also occur with consuming oranges, grapefruits, their fruit juices as well as other acidic foods.  Therefore try to limit eating highly acidic foods and drinks to prevent damage.

• Aspirin burns- Since we are talking about acid in the mouth I thought I should also cover aspirin burns.  Occasionally patients with a severe toothache will decide to place a tablet of aspiring on the gum near the aching tooth to try and numb the pain.  Unfortunately,this often results in an extremely painful ulcer as the acidic aspirin burns a hole in their cheek or gum, worsening their pain.  I always ask these patients if they rub aspirin on their forehead when they get a headache.  They get the picture and hopefully you will too.  Never place any medication designed to be swallowed directly on the delicate cheek or gum tissue!  Take all medicine as directed on the packaging or as prescribed by your doctor.
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  Note the whitish appearance of the aspirin burned cheek

  

The habits listed above are the things I've most commonly observed to cause dental emergencies.  My advice to stay healthy and problem free? Break these habits or avoid them! Happy smiling!

The Dental and Physical Health Connection

Many people have heard the recommendation "See your dentist for a check up every 6 months".  However, this advice comes from an old Crest toothpaste advertisement and is not based on any real scientific evidence.  However, it is still advisable to maintain regular dental examinations and professional cleanings because there have been a lot of recent studies that show a connection between poor oral health and systemic health problems.  The following are a few examples of diseases seen frequently in patients with gum disease:

Gum Disease and Cardiovascular Disease:
Gum Disease or Periodontitis is inflammation of the gum tissue, bones, and ligaments that support the teeth.  It can lead to the destruction of these tissues and eventual loss of teeth, if untreated.  The damage caused by untreated gum disease affects more than just the teeth and gums.  Studies have shown that there is a link to the inflammation of the gums and Cardiovascular Disease.  Patients with cardiovascular disease are at increased risk for heart attack and stroke due to clogged arteries as a result of the disease.  The following article http://perio.org/consumer/perio_cardio.htm speaks about this relationship between gum and heart disease.   It is believed that the dental plaque germs get into the blood stream through the periodontal ligament space around the teeth, cause an inflammation response which over time may result in ccardiovascular disease.  

Gum Disease and Diabetes:

This is a direct quote from the American Academy of Periodontology's website, perio.org.

“Everyone should maintain healthy teeth and gums to avoid periodontal disease, but people with diabetes should pay extra attention,” said Samuel Low, DDS, MS, Associate Dean and professor of periodontology at the University of Florida College of Dentistry, and President of the American Academy of Periodontology (AAP). “Periodontal disease triggers the body’s inflammatory response which can affect insulin sensitivity and ultimately lead to unhealthy blood sugar levels. Establishing routine periodontal care is one way to help keep diabetes under control.” 

It is believed that certain types of infection-fighting white blood cells in patients with diabetes do not work as well.  This allows gum disease causing bacteria to destroy teeth-supporting structures (bone, gums, and ligaments) and helps explain why diabetic patients are more likely to have gum disease than non-diabetic patients. 

Gum Disease and Cancer:

The following is a quote from the e-news letter "Study Suggests Gum Disease Increases Men's Cancer Risk."

"Research published in the June 2008 issue of The Lancet Oncology found that men with a history of gum disease are 14 percent more likely to develop cancer than men with healthy gums. In fact, researchers uncovered that men with periodontal disease may be:

• 49 percent more likely to develop kidney cancer
• 54 percent more likely to develop pancreatic cancer
• 30 percent more likely to develop blood cancers"

As you can see, researchers are finding ties between gum disease and systemic diseases such as cardiovascular disease (which may lead to heart attack and stroke), diabetes, and certain types of cancers.  You should make it a priority to protect your dental health as a strong defense against these and other related health problems.  Good home oral care, regular dental exams, diagnostic dental x-rays, professional cleanings coupled with prompt treatment of any signs of gum disease are essential to protect your health.  Ask your dentist to screen you for signs and symptoms of gum disease at your dental visits and follow home oral care instructions to decrease your risk.   Happy smiling!

Thumbsucking

I am mom of a 2 1/2 year old who has a finger sucking habit.  Therefore I can empathize with the parents of my pediatric patients who suck their thumbs or fingers.  My daughter began her habit in infancy and was very determined to keep it.  I tried to put little cotton mittens over her hands to break the habit but she would just suck on the mittens!  I decided not to fight her on sucking her fingers as a baby and resigned myself to addressing the issue when she was older.

According to the American Academy of Pediatric Dentistry, thumb, finger, and pacifier sucking habits are normal for babies and young children.  It helps soothe children and makes them feel secure.  Children with this habit do it to calm themselves when they are hungry, bored, sleepy, or afraid.  I have even seen ultrasound pictures of infants sucking their fingers in their mother's womb.


18 week ultrasound showing thumb sucking



While many children will stop their thumb, finger or pacifier habit on their own (between the ages of 2 and 4 years), others may continue for several years.

The questions I get from most of my patient's parents are: "Will this habit harm my child's teeth?" "At what age should they stop" and "How do I get my child to stop?"

Q: "Will this habit harm my child's teeth?"

A:  Unfortunately a prolonged habit of sucking fingers or a pacifier can have negative effects.  The pressure or suction from the habit may cause the child's teeth to come in crooked or flare outward.  In some cases, the roof of the mouth may become malformed or narrow.  Children can also have problems with speech such as a lisp or difficulty pronouncing sounds such as "T or "D".  Others may develop a tongue thrust while talking. 

Q:  "At what age should children stop their habit?"

A:  As mentioned earlier, usually if children are able to stop their sucking habit by age 3 or 4 they are not at risk for speech or dental problems.  Children who wait until later to stop may need orthodontic treatment to correct their bite.



Full face photo of child with thumb sucking habit



Intraoral photo of same child with habit



Q:  "How do I get my child to stop?"

A:  Parents and the dentist can help encourage a child to stop their habit by explaining the consequences of sucking their finger, thumb, or pacifier.  If this does not work, the dentist can suggest ways to help change the child's behavior.  My oldest daughter used a pacifier until she was three and then only at bedtime.  I spoke with her several times about how the pacifier was affecting her teeth.  She finally agreed to stop when I bribed her with a new toy in exchange for throwing her pacifiers away.  I will admit, she cried after she realized her pacifier was in the trash can, but when I told her she could have it back if we took the toy back to the store she kept the toy and never looked back.

Some of my patients have had success breaking their habit by using a thumbguard or fingerguard for a few weeks.  According to the thumbguard website;  This flexible plastic device fits over the finger or thumb and "prevents a seal from being created around the thumb with the lips. Without this seal, there is no suction, which is the primary source of pleasure in thumb sucking."  

The American Academy of Pediatric Dentistry also recommends using an ACE bandage for night-time finger sucking habits.  This combined with encouragement and rewards from parents over a period of 6 weeks has been shown to be helpful. 

In rare cases, a child over 5 years old may have a thumb or finger sucking habit due to an emotional problem like anxiety.  These children may need to be evaluated by a physician.  If you or someone you know has a child with a thumb, finger, or pacifier habit, contact your dentist for advice and support. 

Happy Smiling!



Hidden Causes for Cavities

Cavity Basics:
Many people know the most common cause for cavities, also known as tooth decay.  Sugar, candy, sodas, sticky fruit like raisins, fruit snacks, cough drops and other sweets are all well-known cavity causing foods.  Starchy foods like bread, crackers, and chips can also cause cavities because starches are broken down into sugars by digestive enzymes found in saliva. 
Cavities are caused by germs (Streptococcus mutans, Lactobacillus) in the mouth which metabolize sugar from food or drinks and produce acid as a by product.  This acid removes the minerals from the teeth through the process of erosion, causing a hole or cavity in the tooth.  So the basic "cavity equation" is TEETH + SUGAR + GERMS = ACID  -> CAVITY.  Our goal is to keep the teeth, it is difficult to get rid of the germs, therefore the item to eliminate in the cavity equation to prevent cavities is sugar.

Next I will review some lesser known sources of tooth decay, which are as follows:

• Diet soda- Diet soda does not contain sugar, instead it contains artificial sweetners.  Although the sweeteners used in diet sodas generally do not cause cavities; diet soda contains acid as a preservative which erodes teeth.  I like to say that diet soda "skips the middle man," sugar and goes straight to putting acid on the teeth, causing decay.
• Fruit juice- Fruit juice is high in sugars (fructose, sucrose and glucose).  Certain juices such as orange juice and grapefruit juice contain high concentrations of citric acid as well as a lot of sugar and this combination can rapidly cause tooth decay. 
• Sports drinks- Many sports drinks are advertised as being healthy for active people because they "hydrate", replace minerals, and electrolytes lost through perspiration.  However many sports drinks contain sugar and even diet versions contain acid as a preservative which can cause tooth decay.
• Chronic dry mouth (xerostomia)- Dry mouth or xerostomia may be caused by various health conditions, or as a side effect of certain prescription medications.  Decreased saliva flow allows cavity causing bacteria to stick to the teeth longer, affects the pH of the mouth, and can contribute to tooth decay.  Also patients with dry mouth may use hard candy or drink cavity-causing beverages to relieve discomfort from dry mouth.
• Acid reflux (Gastroesophagal Reflux Disease or GERD)- Acid reflux or GERD is a condition that causes stomach acids to escape the stomach and flow up through a patient's esophagus into their mouth.  This may be accompanied by frequent heart burn, and nausea.  The regular flow of acid in the mouth may also erode teeth and cause cavities.
• Asthma inhalers- Please note:  This observation is anecdotal, meaning I have seen increased  occurrence of cavities with some of my patients who use inhalers, however I do not have specific scientific studies to verify this process.  Some theories as to why inhalers may cause cavities are: beta2 agonists, such as salbutamol, and corticosteroids, such as fluticasone propionate, decrease the pH of the dental plaque  (high acidity in the mouth leads to erosion and decay). Beta2-adrenoceptor agonists in inhalers cause decreased saliva secretion by 20 – 35%. The lactobacilli (cavity causing bacteria) count will increase producing more acid by production. The combination of these factors may explain why there can be a higher cavity rate in patients using these types of inhalers.

So, what should you do to avoid these hidden causes of cavities?

• Diet sodas- decrease or eliminate diet soda from your diet.  A healthier beverage choice is water.
• Fruit juice- Better choices to prevent decay are less acidic juices such as 100 % apple, grape, and cranberry juice.  These should be consumed in moderation and can even be diluted with water to decrease the amount of sugar per serving.  I occasionally get creative and mix 2/3 of a cup of no-sodium seltzer water with 1/3 of a cup of one of the less acidic, 100 % fruit juices for a lower sugar "soda".
• Sports drinks- According to the report, “Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate ?"  in the June 2011 issue of Pediatrics ), water is the best drink for routine physical activity.
• Chronic dry mouth/ xerostomia- Consult your physician about your dry mouth symptoms especially if it is a side effect of a presciption medication. Use products specifically formulated to help with dry mouth such as Biotene, or Oasis.  There are toothpastes, mouthrinses and saliva replacement sprays on the market that can give relief.  Avoid oral care products containing alcohol which can cause dry mouth.  Use sugar free candies, gum, or cough drops to stimulate saliva flow.  Sip water frequently through out the day. 
• Acid reflux/ GERD- Consult your physician about controlling this condition.  Reflux can cause other serious health problems as well.
• Asthma inhalers- I would never advise patients to stop using their inhalers. Asthma can be life threatening, as opposed to cavities which are treatable.  Instead, I advise patients who use inhalers to decrease consumption of sugary foods and drinks, brush teeth after meals, and use alcohol free oral care products to prevent dry mouth.

The last and most obvious recommendation is to have regular dental exams so that your dentist can monitor for any new cavities.  I wanted to be sure and talk about these lesser known sources of cavities because I have found that many patients were unaware of them.  Hopefully this information will help people prevent tooth decay.  Happy Smiling!