Dentistry/bad odor

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QUESTION: HI, COULD YOU ADVISE ME PLEASE. FOR ABOUT 5 DAYS NOW I HAVE A AWFUL SMELL ON MY INTERDENTAL BRUSH WHEN I USE IT BETWEEN 2 TEETH, THE 1ST TOOTH IS A PONTIAC ON MY BRIDGE AND THE 2ND IS THE ADJACENT RETAINER FOR THE BRIDGE, ITS WHEN I USE MY LITTLE BRUSH TO CLEAN IN BETWEEN THESE 2 TEETH IT SMELLS. I PUT A LOT OF TIME AND EFFORT INTO MY DENTAL HYGIENE, AS I HAVE GUM DECEASE WHICH I HAVE KEPT UNDER CONTROL FOR ABOUT 10 YEARS NOW. THE BRIDGE IS FAIRLY NEW 2/3 YRS IT REPLACED ANOTHER BRIDGE THAT I HAD FOR 20+ YEARS. I REMEMBER HAVING THIS PROBLEM SHORTLY AFTER HAVING THE WORK DONE, BUT I PERSEVERED AND KEPT CLEANING THE AREA WITH CHLOREXIDINE WASHES AND BRUSHING THE GUM AREA UNTIL I FINALLY GOT RID OF IT. I DID MENTION THIS TO MY DENTIST BUT HE DID NOT SEEM CONCERNED. I HAD A CHECK UP IN MAY, MY DENTIST TOLD ME THEN THAT HE WAS HAPPY WITH MY GUM HEALTH AND IT WAS TOTALLY UNDER CONTROL. I KEEP CLEANING THE AREA ON A BRUSH WITH CHLOREXIDINE AND IN BETWEEN WITH THE INTERDENTAL BRUSH ON AND OFF ALL THE TIME. I FORGOT TO MENTION THAT IT HAS BEEN BLEEDING, BUT I HAVE MANAGED TO STOP IT BLEEDING OVER A 3 DAY PERIOD OF CLEANING. I THINK THE SMELL MAYBE LESSENING EVEN? I WAS ADVISED IN MAY TO HAVE A VISIT FOR A CLEAN WITH THE HYGIENIST, WHICH I DID NOT FOLLOW UP, BUT MAINLY BECAUSE I HAVE A STRICT DENTAL CLEANING ROUTINE WHICH I CARRY OUT RELIGIOUSLY DAILY, SHOWN TO ME FROM MY PERIODONTIST WHEN I WAS FIRST DIAGNOSED WITH GUM DECEASE. TO BE QUITE HONEST I NEED TO BE INJECTED WHEN I GET MY TEETH CLEANED BECAUSE THEY ARE SO SORE AND SENSITIVE, AND THE HYGIENIST CAN ONLY GET CERTAIN AREAS DONE. THE COST DUE TO THE INJECTION IS VERY HIGH AS WELL. FINALLY THERE IS A LITTLE RAISED RED AREA ON THE GUM (NOT ABSCESS SORT OF THING), MORE LIKE IF THE GUM IS SORT OF SLIGHTLY SQUASHED, I AM SO WORRIED AS THIS IS A 7 UNIT BRIDGE, ANY ADVICE WOULD BE GREATLY APPRECIATED, COULD IT JUST GO AWAY LIKE LAST TIME IF I CONTINUE TO CLEAN AND ATTEND IT? UNFORTUNATELY MY PERIODONTIST IS TO FAR FOR ME TO SEE ANYMORE AND THERE ARE NO OTHERS IN MY AREA. THANK YOU SO MUCH DOL X

ANSWER: Dear Dolly,
I think your dentist's recommendation for you to have a cleaning with the hygienist is an excellent idea. This professional cleaning can help remove plaque that you may not have been able to remove, even with your best efforts. Long span bridges often can be hard to keep perfectly clean for a patient and frequent professional cleanings can help the situation a lot. After the cleaning your " plaque bioload" around teeth should be greatly reduced. Also the number of anaerobic bacteria should also be reduced. After a cleaning, most patients gingiva looks healthier.  This "health" may not last forever because the bacteria will tend to gradually accumulate around teeth and bridgework again.  This is why most periodontists place their patients on a three month recall schedule. This frequent recall cleanings make it less likely for "bad" bacteria to get a firm foothold around your teeth and can help keep periodontal disease in remission.

As for your concerns about pain involved with cleanings. Ask your hygienist to use a generous amount of topical anesthetic around your bridge in order to cut down on your discomfort.

As to your home care, Please make sure to clean under pontic areas with Superfloss or a regular floss threader. Ask your hygienist to show you. Some pontics have a concave area where they hug the gums and this can become an area where plaque can accumulate and can be harder to clean. Ask your hygienist to show you how to clean under your bridge pontics. Also you might consider using a Waterpik at home since this can help keep gums more healthy, especially around a long span bridge.


---------- FOLLOW-UP ----------

QUESTION: THANKS FOR THAT BRILLIANT ADVICE, IT MAKES SUCH GOOD SENSE. I WILL MAKE IT MY FIRST PRIORITY TO GET A CLEANING SESSION WITH THE HYGIENIST, AND WILL ASK FOR ADVICE ON CLEANING THE PONTIC AREAS. COULD I JUST ASK IF YOU DON'T MIND
1. WOULD YOU SUGGEST THAT I MAKE A APPOINTMENT TO SEE DENTIST ALSO OR WOULD      THE CLEANING SESSION DO THE TRICK? (TRYING TO CUT COSTS IF POSSIBLE)
2. DO YOU MEAN I SHOULD ALWAYS OF BEEN USING FLOSS (STRING TYPE) AND NOT JUST THE SMALL TEPE BRUSHES?
3. WHAT IS A WATERPIK? I HAVE NEVER HEARD OF ONE
YOU ARE SO GOOD I HAVE CONTACTED YOU BEFORE SOME TIME BACK AND YOU GAVE EXCELLENT ADVICE THEN, I CAN'T THANK YOU ENOUGH FOR PUTTING MY MIND AT REST, THE KINDEST REGARDS DOL XXX

Answer
If you can save money by just seeing the hygienist, that is  ok, but you do need to see the dentist every 6 months or so. I wasn't implying that using little interproximal brushes is bad, but they do not clean under a pontic area. Waterpik shoots a jet of water through your teeth and creates a small vacuum effect to help clean debris out from between your teeth. It also helps change the crevicular fluid that may carry 'seeded' bacteria. Google the term Waterpik and see what turns up.

Dentistry

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Lawrence Spindel DDS, www.lspindeldds.com

Expertise

Cosmetic Dentistry, Endodontics, General Dentistry, Preventive Dentistry, Comprehensive Dental Care

Experience

Former Clinical Instructor of Comprehensive Dentistry, and Prosthodontic Department New York University School of Dentistry. Also former instructor of Preventive Dentistry Columbia University School of Dentistry.

Publications
Ask Dr Spindel Dental Blog also numerous articles on http://www.lspindeldds.com (over 100 pages of original content)

Education/Credentials
1980 DDS New York University College of Dentistry 1981 GPR Manhattan VA Hospital

Awards and Honors
OKU 1980 Honor Society 1980 Long Island Academy of Odontology award for highest combined Academic and Clinical Achievement.
In 1997 he was elected to Fellowship into the International Academy for Dental Facial Esthetics

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