Bad Breath (Halitosis) What is it, What Causes it and What can we do about it.

Published on December 4, 2018 by Walter J Jankowski DMD

Bad breath is known medically as halitosis.  It is commonly a result of poor oral hygiene and may be a sign of other health problems.  If you don't brush and floss your teeth daily the food particles remain forming plaque promoting bacterial growth on the teeth gums and tongue.  This bacteria releases sulfur containing compounds that result in bad breath.

Persistent bad breath may be a warning sign of periodontal disease.  Periodontal disease is caused by the body's immune system fighting the build up of bacteria leading to an autoimmune response that leads to tissue destruction such as bone  loss around the teeth.

Other dental causes of bad breath include poorly cleaned dental appliances, dental caries and a tongue that is not cleaned.  

Dry mouth (Xerostomia) can also cause bad breath.  We need saliva to moisten the mouth, neutralize acids produced by the bacteria in the plaque.  Dry mouth is cased by medication, salivary gland problems or mouth breathing.  Another source of bad breath can occasionally result from small stones that form in the tonsils that produce odor.  Disease such as some cancers, metabolic disorders and chronic stomach acid reflux.

How do we  prevent bad breath?  First of all practice good oral hygiene, brush after you eat, brush your tongue when you brush your teeth.  Also, floss once a day and rinse with an antibacterial rinse.  If you have dentures  remove them every night and clean them thoroughly. See your dentist regularly.  He or she will perform an oral exam and find oral problems before they become major issues such as cavity detection, periodontal disease and/or dry mouth.  Stop using tobacco based products.  Your dentist can help you stop.  Drink plenty of water.  Remember people with low saliva production lack the enzymes to neutralize the acids produced by the bacteria and the saliva also helps rinse the mouth that would help prevent the odors from starting.


How to Start Good Habits and Keep them long Term!

Published on July 16, 2018 by Dr. Joe Jankowski

     I was thinking about what subject to write about for the Lakeland HIlls Dental blog and I was wondering what can I do to get people to start good habits like flossing.  I did an online review of multiple articles and found some common themes among what others have written.

     Most people have all kinds of excuses not to floss.  Remember only 8% of the adult population floss on a regular basis.  I have heard several jokes on the subject, especially on social media like "Doc, you remember the last time I flossed, it was 6 months ago and you did it!".

     The first thing to remember is to start small.  You don't start out January 1st  planning on hitting the gym four times a week with a new diet and expect to be successful. It takes a tremendous amount of willpower and willpower is a lot like a muscle.  If you use it a lot it will get tired and you will quit.  Start small by maybe just go for a walk on a regular basis and add a vegetable to your noon meal. When flossing try say to yourself "I will floss just one tooth."  Before you know it you will automatically floss all of them.

     Next try to create a chain that you won't want to break and have clear intentions of when and where you want to perform the habit. I have developed the habit of eating a salad every day before I eat my lunch.  Most people brush their teeth before bed and link the flossing to same time you brush.  This is called habit stacking.  A calender may be necessary or program a reminder into your phone.  Before you know it you won't want to break the chain and its linked to something you already do every day.

     Another crucial thing is design your surroundings to make it conducive to perform the good habit.  Ever walk by the break room at work and see a tray of brownies out and before the end of the day you ate three of them!  Pack your gym clothes the night before.  I make my salads a week ahead of time so I don't have to worry about making them when its time to eat.   Putting the floss with the toothbrush and toothpaste in the medicine cabinet or bathroom drawer together is always a good idea.

   One thing that I consider to be very important is surround yourself with supportive people.  Don't hang out with smokers if your trying to quit smoking enough said.  Try to incorporate the support of family members or your spouse with what you want to accomplish.  You can tell them what you are trying to do and they can help remind you.  They might even join you.  Hope this helps someone start and maintain a good habit such as flossing.  Your welcome to ask me more questions next time I see you so have a great summer and start flossing!


Dental Amalgam Vs Resin Composite Fillings (Silver Vs Composite)

Published on September 19, 2017 by Joe Jankowski DMD

In today's modern dentistry we have choices in what type of filling material we use to restore our teeth.  The most popular is the tooth colored resin composite and the more traditional dental amalgam that has been with us for over 150 years.  Each have distinct advantages and disadvantages depending on where in the mouth they are used and this article will help explain them so we can make a good decision in which type we choose to get.

In 1836 a young dentist in nearby Winchester Illinois, known to many dentist as the father of Modern dentistry saw a need for a cheap, quick to make alternative to expensive gold cast inlays, onlays and gold foil fillings.  He formulated the basic mixture of Silver, mercury, tin and later copper to control the chemical expansion of the filling.  It was easy to use, cheap, quick to set and worked well in the moist oral environment.  This fact makes it the best  material when the decay is below the gumline when it is not possible to keep the preparation dry to place a resin composite.

Resin composite fillings are made of ceramic glass and plastic resin compounds.  The blending of the resin and glass can mimic the tooth and are the closest we have when it comes to matching the natural tooth and is not only used to fill cavities but to repair mishapen and chipped teeth making them look as natural as possible.  One of the biggest advantages is the fact that resin fillings actually bond to the tooth giving the dentist the ability to remove less tooth structure and forming a stronger restoration.

Dental amalgam or sometimes referred to  as Silver fillings have some inherent shortcomings.  The first being that they do not bond to the tooth like a resin composite or tooth colored filling.  Therefore the dentist has to create undercuts to make the amalgam retentive.  Over time the tooth becomes more brittle and instead of flexing it cracks and breaks which leads to the patients needing buildups and crowns to get the tooth back to its full shape and function.  Even in some instances the tooth crack so severely that the nerve is effected requiring a root canal or an extraction.  There is concern over whether amalgam is safe since it contains mercury.  Both the American Dental Association and The Food and Drug Administration have deemed amalgam safe for use in the mouth.  The amount of mercury that leeches out of a filling as it wears is minimal.  We consume much more mercury consuming fish yearly.  Taking out amalgam fillings just to replace them exposes the patient to many time more mercury than just leaving them in place.

Resin composites or white fillings also have their share or shortcomings too.  Originally they could not tolerate high pressures and heavy wear forces of the posterior teeth.  Now they have greatly improved but still wear quicker than amalgam and the natural enamel. Also cost can be a factor in resin composite too and sometime insurance will not pay the additional cost of the white filling and patient ends up paying the difference

Opioid/Narcotic Abuse and how it Effects the Practice of Dentistry.

Published on September 8, 2016 by Joe Jankowski DMD

     Opioid abuse has become an epidemic in the United States.  In the past 15 years the nation's opioid epidemic has claimed more than 250,000 lives.  This includes Illegal drugs such as heroin and prescription drugs such as morphine, Percocet and Vicodin.  We also consider this class of drugs also to be synonymous with narcotics. We as dentists often prescribe opioid pain killers.  This is usually in the form of Vicodin or its generic form of Hydrocodone with Acetaminophen.  Some dental practitioners prefer Vicoprofen which has Ibuprofen instead of acetaminophen.

     I was taught in dental school to only prescribe opioids for short term pain relief.  Also, I recommend non-steroidal anti-inflammatories such as ibuprofen and Aleve as a first line of defense for pain.  Starting right away before the numbness wears off and taking the pain medicine before leaving the office. I tell people that most of your pain and swelling does not occur right away but 36 to 48 hours after the procedure.  So start taking the first line pain medicines for the first two days before you get the pain.  This will hopefully prevent inflammation and swelling so you may not even need something stronger like Vicodin. We were also taught in dental school to only prescribe medications such as Vicodin for 3 days duration or less because if you still have pain for more than 3 days something else is probably going on and you need to see us and be reevaluated for example you may have a dry socket or a boney spicule that needs removal following an extraction.  We can always prescribe you another three days worth of pain medicine.

     The government is trying to help all providers identify patients that may be abusers.  Each state have set up their own prescription drug monitoring program that all providers and pharmacies have access to help identify potential abusers.

      Another recent change that helps providers is making certain prescription only in written form.  We can no longer phone in Vicodin.  You have to be seen in the office and get a written prescription.  This has helped many dentists sleep better at night if nothing else, since we don't get calls in the middle of the night requesting pain meds until they can be seen the next day and then they somtimes don't show up questioning if they had legitimate pain!

      I hope you gained some insight into how we treat patients for pain.  Remember prevention beats a pound of cure!  Hopefully Nonsteroidals like ibuprofen, ice therapy and rest can help keep our dependence on opioid meds to a minimum in the dental office.

The Importance of Proper Sleep and What a Dentist can Do to Help You.

Published on August 31, 2015 by Joe Jankowski

     All of us need not only enough quantity of sleep but also quality.  There are different types of sleep such as light sleep when we nap, all the way to deep REM (rapid eye movement).  During a typical night's sleep we vary how much deep sleep we get. It varies due to many variables.  Deep and uninterrupted sleep is the the sleep that allows us to be at our best.  

     By improving our sleep we allow our body to heal itself..  When we get proper sleep, our bodies produce more hormones, like growth hormone.  It also allows us to repair our bodies.  This can improve our overall healing, headaches, heart health, immune system deficiencies and other illnesses.  

     What is happening when our body doesn't get proper sleep?  We get sick when our body sleep gets interrupted.  Proper sleep gets us feeling better.  When we are born we are all dealt a genetic deck that we have to make the best of.  While we sleep we strengthen every one of our genetic weaknesses. When we do not sleep properly the diseases we are susceptible to manifest themselves.  Medical Doctors have done studies that show when we get proper sleep there are drastic improvements in many of the patients illnesses resulting in less need for headache, heart and diabetic medicines.      

     What causes sleep to go bad?  One thing is lack of vitamin D3.  Vitamin  D is actually a hormone made when sunlight on your skin converts cholesterol to vitamin D.  Have you ever noticed the big push in the last decade or so of people getting diagnosed with sleep apnea?   Some theorize the invention of Air conditioning and people staying inside on a hot summer day when we were getting the proper exposure to summer UVB rays necessary.  We substitute this by getting vitamin D milk and taking vitamins with the recommended 1000 I.U. Vitamin D is also needed to use Vitamin B12.  

     What is obstructive sleep apnea (OSA) and what causes it?  Obstructive sleep apnea is a partial or complete collapse of the upper airway that causes muscles controlling the soft palate and tongue to relax.  When this happens a person experiences apneas, hypopneas and flow limitation.  Apnea is a stop of the airflow for more than 10 seconds.  Hypopnea is a decrease in airflow lasting more than 10 seconds with a 30% oxygen reduction in airflow and at least a 4% oxygen desaturation from baseline.  Flow limitation is a narrowing of the upper airway and an indication of an impending upper airway closure.  When the airway is totally blocked snoring is the obvious symptom.

     Signs and symptoms of sleep apnea include a lack of energy, high blood pressure, frequent nocturnal urination, depression, obesity, excessive daytime sleepiness, gastro esophageal reflux and snoring to name a few. Increased risk factors are but not limited to being male, obesity, diagnosed with high blood pressure, excessive use of alcohol or sedatives, smoking, family history of OSA, large neck circumference and endocrine or metabolic disorders.  Studies have shown that sleep apnea is a independent risk factor hypertension.  43% of patients with mild OSA and 69% of patients with severe OSA have hypertension. 65% of stroke patients have some form of sleep disordered breathing.  

    How can we treat OSA?  The gold standard is to treat it with CPAP therapy.  This stands for continuous positive airway pressure therapy.  A physician diagnoses OSA by having a sleep study done and prescribing a CPAP machine.  Not everyone can tolerate the mask, the noise it creates and how it limits your flexibility sleeping.  This bring us to what a dentist can do.  We as dentists can treat OSA with a mandibular repositioning device (MRD).   It is a custom made, adjustable oral appliance that maintains the lower jaw in a forward position during sleep.  This mechanical protrusion widens the space behind the tongue and reduces the vibration and physical obstruction to breathing and the tendency to snore.

   MRDs have many benefits in mild to moderate cases equal to a CPAP machine.  MRDs offer significant improvement of sleep apnea symptoms including daytime sleepiness, quality of life, blood pressure and cognitive performance.  Although CPAP remains the most efficacious treatment option, dentist today are offering effective oral appliance therapy for thousands of patients that often have a better adherence rate that CPAP.  If you don't wear the CPAP it can't help you.  Oral appliances have a better track record for long term use helping thousands of patients that can't tolerate the CPAP.

     The recommendation I can make to you is if you have some of the signs and symptoms we discussed get checked out by your physician and if needed have a sleep study done.  If you are diagnosed with sleep apnea try the CPAP machine and make sure you are getting enough Vitamin D.  If you can't tolerate the machine please try an oral appliance that is usually better tolerated and sometimes can be equally effective.  If you have any questions give us a call, I would love to discuss this further.



Why do I Have Dental Insurance? Why do I need Dental Insurance? I don't Understand Dental Insurance?

Published on November 6, 2014 by Dr. Joe Jankowski

As a dentist I have been practicing for quite some time and I have had the opportunity to talk with patients and the staff about the frustrations dealing with and understanding dental Insurance.  

I would like to share with you some of what I have learned and try to explain what is going on.  First, dental insurance is very different from health insurance.  Health insurance is provided to cover routine and preventative medical needs but specifically is there for some catastrophic event such as a major surgery and/or life threatening event that the average person could not pay for otherwise. You have the insurance mainly for the one time you need it and hope that doesn't come for a very long time.  Like homeowners insurance where you pay premiums year after year without a claim and hope the house never burns down! Dental insurance is very different in that it is there to help pay for a set amount of benefits and that's it! I can't think of the last time someone died from not going to the dentist. Your employer sat down with a dental insurance company representative and decided what the company wanted to provide for the employees as a benefit. The more money the company spent, the better the plan. Two people with the same insurance company, but have different employers will have different plans with different coverage, waiting periods and reimbursements. This makes it hard for the dentist staff to discuss money when there are so many differences. We then have to research each patient individually. Many patients are fortunate to receive benefits from their employer which is what dental insurance is. The amount of dental benefits has not really changed since the 1960's. $1,000-$1,500 does not pay for much more than preventative procedures and basic care such as fillings and maybe a crown.

Many people know they have necessary dental work that needs to be done and they say to me "I am waiting until I have dental insurance.". People need to realize that there are waiting periods before any benefits are provided and usually major work is not covered for the first year. The insurance companies only stay in business by keeping some of your money.  Most people are better off taking the dental insurance if the employer offers it. Think of it as a coupon for $1,000-$1,500 with restrictions for redemption. If your employer doesn't offer dental insurance, look into health savings accounts and flexible spending accounts if you know you're going to be incurring major dental bills such as major rehabilitation such as wisdom teeth or orthodontics. 

Insurance companies do their homework before they offer plans to your employer or individuals. They can be vague and misleading in what is and what is not covered. Most people do not like surprises. We do our best to send pre-estimates and to check and verify the patients insurance benefits. My best advice with insurance is to do your homework, read the literature that you receive when you get your insurance. 

Why Do We Take Out Wisdom Teeth? (Third molars)

Published on August 26, 2014 by Joe Jankowski DMD

     Some people consider getting their 3rd molars or better known as wisdom teeth out as a right of passage going into adulthood.  Today we are finding out that may not always be the case and a multitude of factors go into a dentist and patient deciding to get their wisdom teeth removed.  A lot of us wonder why do people have so many problems with their wisdom teeth?  What other body part is routinely removed?  Maybe tonsils and the appendix but those are  not our specialty.

     Anthropologists have studied humans and due to evolution our jaws have gotten smaller and not all of us have the proper space for our 3rd set of molars.  This results in a variety of conditions that result from the lack of space.

     Wisdom teeth usually erupt in most people in their late teens to early twenties.  When we have adequate space, healthy gingiva and properly aligned teeth they can be a valuable asset. The problem is they usually don't have enough room which is referred to as impacted and usually require removal.  When the teeth are impacted this can lead to multiple complications such as: infection, damage to the adjacent teeth, formation of a cyst and most commonly pericoronitis.  When the teeth are partially erupted they are more difficult to keep clean resulting in decay on the tooth and the second molar also leading  to periodontal problems resulting in bone loss and ultimately infection/abscess.  Also when the teeth are fully impacted cysts can form around the root of the tooth leading to further bone loss and damage to the surrounding nerve and teeth.  Usually though when a wisdom tooth becomes partially erupted the flap of gingival tissue called an operculum can get food under it and it becomes inflamed and this condition is called pericoronitis and if it persists is the main acute condition that motivates people to get their wisdom teeth out.

Ultimately I feel if the wisdom teeth come in completely, straight, functional without pain and the patient is able to keep them clean they may not need to be taken out.  I also like to state that if things change later in life the condition can change and then they can give the patient problems leading to removal.  I feel its hard to criticize other dentists opinion whether a wisdom tooth will give the patient a problem later in life and need extraction. Sometimes the wisdom tooth may be appear that it may or may not give the patient a problem in the future but there are circumstances where it should be left alone due to its proximity to nerves or the sinus where the possible side effects outweigh the benefits.  That is why we have informed consent.  So that patients and their dentist can discuss these factors so patients can make the right decision. That is why most dentists caution on the safe side and get the teeth out at an early age when the roots haven't fully formed, the bone is softer, and the patient recovers quicker.  I welcome anyone with questions to contact us and we can evaluate your wisdom teeth and give you a recommendation!


Dental implants

Published on May 13, 2014 by Joe Jankowski DMD

Dental implants by definition are artificial tooth roots placed in the jaw to hold a replacement tooth, bridge or dental prosthesis which is usually a partial or complete denture

          The most common dental implants are the full size root form dental implants. They have many advantages. They are versatile in that they can be used to replace one tooth. When more than one is used it can be used to replace multiple teeth by supporting a bridge or removable denture.

          A newer alternative to full size dental implants are mini dental implants. We offer them in our office as a cheaper alternative for the cost conscious patients who already wear dentures. They are used to stabilize dentures both top and bottom. They are about 1/4 - 1/3 the cost of full size implants. They can be placed in a minimal amount of bone; typically do not require an incision into the gums and help restore chewing function that can’t be achieved with dentures alone. The main disadvantage is that they are not upgradable like full size implants are by changing abutments and adding more implants.

          After completing my dental residency, implant fellowship and numerous seminars on dental implants, I feel confident to discuss with our patients at Lakeland Hills Dental all of the options and help you decide what best fits your needs and budget. Dental implants by definition are artificial tooth roots placed in the jaw to hold a replacement tooth, bridge or dental prosthesis which is usually a partial or complete denture

When should I take my child to the dentist?

Published on December 4, 2012 by Dr Jankowski

Many parents ask me when should I bring my child in for their first appointment. I tell them that most dental organizations recommend the child should come in before their first birthday or within six months of the first teeth erupting.  There are many reasons behind these recommendations.  The first few visits help get the child acclimated to the office and hopefully imprints a pleasant experience before any problems occur.  The child gets used to the sights, sounds, smells and routine of seeing the dentist.  Many first visits are just going along with the parent on his or her visit and sitting on their lap and seeing what they get done.  Sometimes we may look in their mouth and count their teeth.   At subsequent visits we will do more and more such as simple cleanings and fluoride treatments.  Usually X-Rays are not needed until adjacent teeth are touching each other to look for interproximal cavities.

During those initial exams it allows us to check oral hygiene and diet so that each child has the opportunity to properly care for their teeth.  Before the child has the dexterity to properly brush the parent will have to help brush when the child finishes.  I was taught that when the child can color in a coloring book and can stay in the lines you can start to let them brush without helping them.  Along with that before the age of two they usually can’t spit so only a smear of toothpaste can be used to prevent ingesting too much flouride and an upset stomach.  We can also evaluate if the child needs fluoride supplimentation due to lack of flouride in well water or having a high caries risk.  Remember even babies can get cavities especially when they are put to sleep with a bottle with any type of liquid with sugar in it.  The only really safe liquid is water!

Informed Consent in the Dental Office

Published on September 28, 2012 by Dr Jankowski

Informed consent is a phrase used in the dental office to indicate that a person gives consent for a procedure based upon the clear understanding of the facts, implications, and future consequences of a procedure or action. In our case it is typically a filling, root canal, cleaning, extraction, placement of a dental implant or a periodontal procedure such as periodontal surgery or scaling and root planing.

At our office we make a point to discuss what we want to perform, why and what could possibly go wrong during a procedure and what could happen if nothing is done because doing nothing is always a choice.

When nothing is done we then encounter the dilemma of informed refusal where you need to know the consequences of refusing treatment.   An example is when a patient refuses to have a crown placed on a root canal treated tooth when they understand the increased potential for fracture and probable tooth loss.  An honest dentist gives priority to good patient care, conservative treatment and presents all treatment options in order to ensure that a patient makes an informed decision. The sad truth that there are some dentists that push overtreatment and extravagant treatment plans on patients without discussing lesser alternatives pros and cons and the risks of doing nothing at all.

I pride myself in our office that the staff and myself answer all of your questions, explain what we will be doing before we do it. One of my favorite sayings is “Inform before you perform” If you tell someone what could go wrong after it happens your looked upon as making an excuse not informed consent.  The days of just sitting down in the chair and you letting me work on does not count as informed consent.  For more than basic procedures we even have written consent forms to help make sure we don’t miss anything.

I hope you find this informative. Contact us and schedule an appointment or a free consultation if you have questions about proposed treatment or want to learn more about improving your oral health.

What’s the point of Good Oral Health?

Published on July 23, 2012 by Dr Jankowski

By treating dental caries and periodontal gum disease we are improving/maintaining our own systemic health.  There is a definite link between taking care of your teeth and gums and your overall health.  We all know how abusing our bodies can have a negative effect on our health such as smoking, alcohol and poor diet.  I believe that how we take care of ourselves definitely effects quality of life.

People in the dental field constantly preach to us the importance of brushing and flossing.  Even the use of fluoride toothpaste and mouthrinses have a positive effect.  Having healthy teeth that are not loose and in proper alignment have many benefits such as allowing us to properly chew our flood that are required in a healthy diet.  We have seen people without teeth that can only eat refined carbohydrate diet which lead to poor nutrition.  We also see that in a social setting the positive effects such as looking more successful whether its to ask someone out or a job interview.

Most of us have heard in the media the link between gum disease and heart disease.  There are also links between diabetes and gum disease.  These relationships have to do with the bacteria from your mouth getting into your bloodstream effecting your entire body.  Also this is a constant battle going on in your mouth with your immune system fighting the bacteria in leading to your own bodies destruction by an autoimmune reaction.

To put things simply, we need to take care of our mouth just like athletes take care of their bodies.  We have the old adage: an ounce of prevention beats a pound of cure.  By spending the time and money brushing and flossing on a daily basis with a fluoride toothpaste while seeing your dentist/hygienist on a regular basis to catch things when they are small you will be doing yourself a big favor to saving money and living a long healthy life.  I have seen it many times people use the excuse I didn’t have insurance before or have the finances for not seeking regular dental care.  When they do come in, the many years of neglect are evident and things then cost thousands of dollars and we can never get them back to a totally healthy state. We just manage the disease.

Dr. Joe’s Flossing Philosophy and Fun Facts!

Published on June 7, 2012 by Dr Jankowski

In my opinion flossing is just as important as brushing your teeth.  Some statistics show that only 8% of us actually floss and if your a guy its less than that.  My philosophy here at Lakeland Hills Dental is that if I was stuck on a deserted Island and I only had the choice of a tooth brush or floss, I would choose the floss.

Dental floss or  such as floss picks allow you clean between your teeth where a tooth brush can’t reach.  Have you ever got a piece of food stuck between your teeth and couldn’t get it out with a toothbrush?  It takes 24 hours for plaque to form on your teeth, so flossing and brushing thoroughly once a day is better than just doing a poor job three times a day.

Flossing is a habit we should all try to incorporate into our personal hygiene routine.  For those of us without the dexterity such as elderly and the  young a floss pick is a great alternative to use.  It’s a great way to start developing a healthy habit for the rest of your life.

A  final thought:  only floss the teeth you want to keep!!

Invisalign Teen

Published on May 30, 2012 by Toni

Let’s face it. You’ve got school, sports, hanging out with friends. So getting metal braces is not at the top of your list of favorite things to do. You want the confidence of a great smile – let Invisalign Teen® get you there, with the virtual invisibility of our clear aligners.