Bad Breath (halitosis)

For those who have never consulted a dentist about treatments for sleep apnea and snoring, it may be time to make an appointment. Dental sleep medicine is a growing segment of dentistry that focuses on managing snoring and sleep apnea with oral appliance therapy (OAT) – an effective alternative to the standard continuous positive airway pressure (CPAP) machine and mask. According to the American Academy of Dental Sleep Medicine (AADSM), up to 50 percent of sleep apnea patients do not comply with or tolerate CPAP.

Oral appliance therapy (OAT) uses a “mouth guard-like” device worn only during sleep to maintain an open, unobstructed airway. OAT devices prevent the airway from collapsing by either holding the tongue or supporting the jaw in a forward position. For many, oral appliance devices are more comfortable to wear than a CPAP mask. The devices are also quiet, portable and easy to care for. Research suggests that oral appliance therapy often can equal CPAP in effectiveness and offers a higher patient compliance rate than CPAP. There are more than 80 different styles of oral appliance devices that have received FDA clearance.

 

The many faces of OSA are revealed by examining frequently associated conditions such as: high blood pressure (hypertension), heart failure, heart rhythm disturbances, Atherosclerotic heart disease, pulmonary hypertension, insulin resistance, and even death are some of the known complications of untreated obstructive sleep apnea. Cognitive impairment (memory problems), depression, anxiety, and gastro esophageal reflux disease (GERD) are also among possible complications of untreated sleep apnea. Dentists can treat the vast majority of patients with OSA and have the ability to screen for it, at a minimum, within our patient population. The most commonly quoted statistics on OSA are summarized below.

1/3 of population suffers from some sleep disorders (20M OSA 10M PLMD, 20M Insomnia)

Snoring prevalence 67% general population. NSF 2005 (habitual snorers 35% Parati)

94% of OSA population snores, 6% are silent apneics
Wisconsin Study 1938: 17-20% of general population have some OSA (AHI>5)

Sleep Heart Health Study: 22% have OSA (Smoking gun intermittent Hypoxia)

Young in 1993, Wisconsin Study : AHI>5 w/o EDS (excessive daytime sleepiness), 9% females, 24% males
Metabolic Syndrome effects 24% of general population

Weight loss of 10% can decrease AHI (apnea-hyponea index) 30-50%

We are now providing oral appliance therapy for sleep-related breathing disorders.  It’s our goal to treat this disorder working with your physician and health care provider and improve your health and well being. 

The American Academy of Sleep Medicine now recommends oral appliances as a primary or first line of treatment for mild to moderate obstructive sleep apnea. The guidelines state that patients should always be offered the choice of an oral appliance if they have mild to moderate OSA.

 For Mild to Moderate Obstructive Sleep Apnea:
Oral appliances (OAs) are indicated for use in patients with mild to moderate OSA who prefer OAs to Continuous Positive Airway Pressure (CPAP), or who do not respond to CPAP, are not appropriate candidates for CPAP, or who fail treatment attempts with CPAP or treatment with behavioral measures such as weight loss or sleep position change.

For Moderate to Severe Obstructive Sleep Apnea:
The American Academy of Sleep Medicine recommends Continuous Positive Airway Pressure (CPAP) for the treatment of moderate to severe sleep apnea. If patients have tried and failed CPAP, they should be offered treatment with an oral appliance. 

Patients with severe OSA should have an initial trial of nasal CPAP [prior to trying oral appliances]. Reference:  1.American Academy of Sleep Medicine website http://www.aasmnet.org

 Below is a SECURE CONFIDENTIAL LINK to complete our online sleep disorder/apnea evaluation forms.  

  Obstructive Sleep Apnea

Sleep Consult

 

 

Sleep Screening Consultation SleeSleep Screening Consultation Sleep Screening Consultation Sleep Screening Consultation  Sleep Screening Consultation Sleep Screening Consultatio Please have the following available before you begin.  This registration will take about 15-20 minutes to complete so please save enough time.  Once we have your information, we can visit further about your symptoms.

  1. your insurance card
  2. a list of your physicians
  3. a complete medication list and dosage 

 

Online Dental Education Librarycontact us contact us

Our team of dental specialists and staff strive to improve the overall health of our patients by focusing on preventing, diagnosing and treating conditions associated with your teeth and gums. Please use our dental library to learn more about dental problems and treatments available. If you have questions or need to schedule an appointment, contact us.

Online Dental Education Library

Our team of dental specialists and staff strive to improve the overall health of our patients by focusing on preventing, diagnosing and treating conditions associated with your teeth and gums. Please use our dental library to learn more about dental problems and treatments available. If you have questions or need to schedule an appointment, contact us at 785-738-3758,   

                      

Know your Teeth

BCBS Delta Dental Care Credit

An estimated sixty-five percent of Americans have bad breath. Over forty-million Americans have "chronic halitosis," which is persistent bad breath. Ninety percent of all halitosis is of oral, not systemic, origin.

Americans spend more than $1 billion a year on over the counter halitosis products, many of which are ineffective because they only mask the problem.

What causes bad breath?

Bad breath is caused by a variety of factors. In most cases, it is caused by food remaining in the mouth - on the teeth, tongue, gums, and other structures, collecting bacteria. Dead and dying bacterial cells release a sulfur compound that gives your breath an unpleasant odor. Certain foods, such as garlic and onions, contribute to breath odor. Once the food is absorbed into the bloodstream, it is transferred to the lungs, where it is exhaled. Brushing, flossing and mouthwash only mask the odor. Dieters sometimes develop unpleasant breath from fasting.

Periodontal (gum) disease often causes persistent bad breath or a bad taste in the mouth, and persistent bad breath may mean a sign that you have gum disease.

Gum disease is caused by plaque - the sticky, often colorless, film of bacteria that constantly forms on teeth. Dry mouth or xerostomia may also cause bad breath due to decreased salivary flow. Saliva cleans your mouth and removes particles that may cause odor. Tobacco products cause bad breath, stain teeth, reduce your ability to taste foods and irritate your gum tissues. Bad breath may also be a sign that you have a serious health problem, such as a respiratory tract infection, chronic sinusitis, postnasal drip, chronic bronchitis, diabetes, gastrointestinal disturbance, liver or kidney ailment.

Here are characteristic bad breath odors associated with some of these illnesses:

  • Diabetes - acetone, fruity

  • Liver failure - sweetish, musty

  • Acute rheumatic fever - acid, sweet

  • Lung abscess - foul, putrefactive

  • Blood dyscrasias - resembling decomposed blood

  • Liver cirrhosis - resembling decayed blood

  • Uremia - ammonia or urine

  • Hand-Schuller-Christian disease - fetid breath and unpleasant taste

  • Scurvy - foul breath from stomach inflammation

  • Wegner`s granulomatosis - Necrotic, putrefactive

  • Kidney failure - ammonia or urine

  • Diphtheria, dysentery, measles, pneumonia, scarlet fever, tuberculosis - extremely foul, fetid odor

  • Syphilis - fetid

Bad breath may also be caused by medications you are taking, including central nervous system agents, anti-Parkinson drugs, antihistamines/decongestants, anti-psychotics, anti-cholinergics, narcotics, anti-hypertensives, and anti-depressants.

Caring for bad breath

Daily brushing and flossing, and regular professional cleanings, will normally take care of unpleasant breath. And don't forget your often overlooked tongue as a culprit for bad breath. Bacterial plaque and food debris also can accumulate on the back of the tongue. The tongue's surface is extremely rough and bacteria can accumulate easily in the cracks and crevices.

Controlling periodontal disease and maintaining good oral health helps to reduce bad breath.  If you have constant bad breath, make a list of the foods you eat and any medications you take. Some medications may contribute to bad breath.

Improperly cleaned dentures can also harbor odor-causing bacteria and food particles. If you wear removable dentures, take them out at night and clean them thoroughly before replacing them.

If your dentist determines that your mouth is healthy and that the odor is not oral in nature, you may be referred to your family physician or to a specialist to determine the cause of the odor and possible treatment. If the odor is due to gum disease, your dentist can either treat the disease or refer you to a periodontist, a specialist in treating gum tissues. Gum disease can cause gum tissues to pull away from the teeth and form pockets. When these pockets are deep, only a professional periodontal cleaning can remove the bacteria and plaque that accumulate.

Mouthwashes are generally ineffective on bad breath. If your bad breath persists even after good oral hygiene, there are special products your dentist may prescribe, including Zytex, which is a combination of zinc chloride, thymol and eucalyptus oil that neutralizes the sulfur compounds and kills the bacteria that causes them. In addition, a special antimicrobial mouth rinse may be prescribed. An example is chlorhexidine, but be careful not to use it for more than a few months as it can stain your teeth. Some antiseptic mouth rinses have been accepted by the American Dental Association for their breath freshening properties and therapeutic benefits in reducing plaque and gingivitis. Instead of simply masking breath odor, these products have been demonstrated to kill the germs that cause bad breath. Ask your dentist about trying some of these products.