Thursday, December 17, 2015

Preventing Bad Breath

Preventing and battling bad breath is essential to self -esteem. Halitosis or bad breath is an unpleasant condition that's a cause for embarrassment. Some individuals with bad breath are not even aware of the problem and interestingly, some who don't have bad breath are convinced that they do( a condition called halito-phobia).

Bacteria that reside in the mouth, especially on the back part of the tongue are primarily responsible for bad breath Teeth and dentures not cleaned properly harbor odor causing bacteria and produce the foul smelling compounds.

Certain foods like garlic and onions contribute to objectionable breath because they contain odor causing compounds that directly enter the blood stream and then transferred t the lungs where they are exhaled. Until the body eliminates these compounds, oral hygiene will only temporarily mask the odor.

Bad breath is also induced by tobacco products including cigarettes, cigars, pipes and smokeless tobacco.  These products also increase the risk for oral and lung cancer.

Dieters can experience bad breath a a result of the breakdown of reserve fat and protein for energy, releasing ketones (organic compounds) in the breath.

Dental and systemic disease are also causes of bad breath. Persistent bad breath and bad taste are warning signs for periodontal disease and may signal other medical disorders like chronic sinusitis, chronic bronchitis, diabetes, GERD ( frequent reflux of stomach contents), oral and pharyngeal cancer, liver and kidney disease.

Dry mouth is another condition associated with bad breath. Normal salivary flow cleanses the mouth and removes odor causing particles. Dry mouth occurs when salivary flow is reduced as a side effect of medications, salivary gland problems , auto immune conditions  and from mouth breathing.

TIPS for Preventing Bad Breath:

Avoid constant use of breath mints and other hard candies that temporarily mask malodor and lead to decay.

Discuss your medications with a pharmacist, physician and dentist to reduce dosage or substitute medications that cause drying of the mouth.

Adhere to dental hygiene recommendations made by dentist and hygienist.

Thursday, December 3, 2015

Dental Veneers- Ceramic or Composite- What are the Considerations?

For a discolored tooth, chipped tooth, misshaped tooth or a tooth slightly out of alignment, a dental veneer may be an option.

 An explosion of dental materials and techniques have provided ample solutions to correct the condition and there are several considerations to assess to arrive at the best choice for you..

Age, cost and  durability are usually at the top of the consideration list. Location of the defect, is defect natural or acquired, oral habits, smile line, personality, occupation are other important considerations.

Veneer is a thin covering that is placed over the front of the tooth. Any stain or decay present on any additional surfaces will more likely be better served with a crown or other full coverage restorations making a veneer an inadequate choice.

The age of the patient is another important consideration. A conservative composite veneer is an excellent choice for a tooth is the developing stage. A developing smile which is constantly evolving is best fitted with a composite veneer that is economical and  can be easily modified with changes in shape, shade and configuration, unlike a lab fabricated ceramic veneer.

Ceramic veneers are thin shells made of a strong, stain resistant and durable dental ceramic. A very small amount of tooth structure is removed  to make room for a natural and ideal looking tooth form.This restoration involves more than one visit and is fabricated in the dental lab. Ceramic veneers are the most natural looking with customizable,  polychromatic shades to exactly match and compliment the adjacent teeth- an ideal option for highly visible smiles requiring a confidence boost. These are  the veneers that are highlighted in the much publicized smile make overs. A thorough understanding of the underlying design principles and identifying dental labs and technicians that are detail oriented and take pride in their creations is the key to achieving these results.

Teeth must be healthy and free of decay and active periodontal disease prior to veneer preparation. The process is irreversible once the enamel is removed.

Patients who clench and grind their teeth are not good candidates for veneers, because the thin veneers may chip or break. A plastic dental nightguard is usually recommended to help minimize the stress on the teeth.

No special maintenance is needed other than good oral hygiene each day. Avoid biting fingernails and chewing on hard objects such as pencils or ice to keep veneers well maintained.

Visit or call our office at 909 627 6699 to schedule a cosmetic consultation. 

Thursday, August 13, 2015

Smile, You're on Intraoral Camera

A tiny new camera allows patients to see the insides of their mouth by projecting the image on a TV monitor.  For many patients, this is the first time they have had a clear view of  the inside of their mouth. And what they are seeing is not always a pretty picture.  Many patients are surprised if not shocked by their oral condition.

An image can be worth a thousand words when motivating patients to improve their oral health.  Once an image is projected on the monitor, the dentist can easily discuss any problems and explain the treatment. 

Because oral conditions can be magnified, this method provides better visibility than direct vision.  Once on the screen, the image can be rotated, saved, printed and sent electronically to family, a specialist or submitted as supporting documentation.

Another valuable and common use of camera is helping patients make cosmetic decisions about their teeth.  The image of a patient's teeth can be projected onto the screen and manipulated to show how the person's smile might look after treatment. Patient's can get a good idea of what the recommended procedure will look like before it is even done.  

Call our office 909 627- 6699  or visit our website for more information.

Friday, July 31, 2015

Palliative Treatment for Frail and Older Adults (Article 4 of 4)

The goal of palliative treatment is to enhance the quality of life during a painful episode  or for someone with a terminal illness A dentist's role could greatly enhance patient comfort and quality of life as the mouth is often the first site on pain.

  The first step in  palliative oral care is establishing good communication with the patient. With a good understanding of the patient's health circumstance, conducting a thorough oral exam  and asking for symptoms, severity and frequency is very important to determine the most bothersome issue and dealing with it promptly.

The most common oral complaint is dry mouth  If possible increase water consumption or use ice chips if choking is not a concern.. Foam swabs are helpful with providing moisture although not effective for plaque removal.  The swabs can be soaked  in warm salt water or an alcoholfree mouth rinse prior to swabbing the inside of patient's mouth.
 Daily oral hygiene is essential with modifications as needed for the palliative patient. An ultra soft  small toothbrush head can be used to promote comfort.

Candidiasis or fungal infections are common in palliative patients.  Anti fungal gels can be applied if patient cannot rinse.  Dentures can be scrubbed with soap and water and antifungal gel applied on the under surface of denture.

Preserving dignity is important part of palliative care. Maintaining a satisfactory facial appearance may be important to some patients and dentures, if needed should be made.

This concludes the series on dental care for the older adults.  Call 909 627 6699  or visit for more information.

Friday, July 24, 2015

Treatment Planning for Frail Older Adults (Article 3 of 4)

 Treatment planning  for frail and dependent patients should meet the objectives of preventing pain and infection, maintaining function, preventing systemic complications and improving or maintaining quality of life.

Frail adults live in the community but have varying degrees of functioning limitations.Their treatment options are guided by their level of dependency- no dependency, medium dependency or high dependency status.

For medium dependency adults, the recommendation is to treat teeth conservatively. Restore carious lesions using atraumatic techniques and floride releasing restorative materials. Dentures or removable teeth replacements should be designed to facilitate hygiene and easy removal.

Dependent older adults typically live in long term care settings and are home  bound. For homebound and long term care residents, recommendations include managing discomfort and infection and performing  only procedures necessary for social interactions and normal function.

Early in the interactions with frail or dependent patients, it is important to gauge the patients ability to comprehend treatment recommendations and independently make competent decisions. Patient's financial resources, general health, cognition and  capacity for home care must be taken into account. The benefit from the proposed treatment must be weighed very carefully against the physical discomfort and mental anguish a particular patient may experience.  The focus is to address the patient's primary concern.

For more information call 909 627 6699 or visit

Friday, July 17, 2015

Prevention and Disease Management for Older Adults( Article 2 of 4)

The rapid growth of population that is 65 and older will profoundly affect dental care in a number of ways.
Risk assessment for this vulnerable group  will help develop the most appropriate prevention plan and treatment strategy.


Majority of older patients suffer from hyposalivation or Drymouth

Simple preventative remedies  to alleviate drymouth include-

Regular sips of water throughout the day
Limiting number of alcoholic beverages and beverages
Limiting beverages high in sugar and caffeine particularly sodas,juices and sweetened coffee and tea
Avoid spicy and salty foods
Caution using mouth washes containing alcohol
Using  salivary substitutes  such as Oralbalance gel, Biotene Moisturing spray, liquid mouthspray etc
In extreme cases, a salivary stimulant may be prescribed which does require consulting with patient's physician. 
Discussion with physician and or pharmacist regarding substitution of medicines causing dry mouth can also be an option.

For patients with an increased risk of caries or dental decay, an oscillating tooth brush is best.  Automated toothbrushes remove more plaque than manual brushing alone. It is particularly helpful for patients with limited dexterity and arthritis.

Use floridated toothpaste daily and floride rinses
 Periodic topical application of 5% sodium floride varnish in severe cases of caries.
  This mode is inexpensive, non invasive and shown to reduce decay.

As the old adage goes " an ounce of prevention is worth more than a pound of...."

Visit or Call 909 627 6699 to contact our office. We are more than happy to help you with your question.

Friday, July 10, 2015

Dentistry for the Elderly (1st of the series)

The aging population is the most important demographic trend.  Nearly 20% of the U S population will be older than sixty five by the year 2030.  As the age of the older adult is upon us, the services rendered should be age appropriate and have lasting value. 

Older adults have the most diverse clinical and physical presentation than any other age group. We could see fully functioning independent adults, frail older adults characterized by numerous medical conditions that impair mobility and dexterity and those who are dependent on help to carry out the normal daily activities.

.  Age is often a primary consideration when developing a treatment plan but it is important to assess each patient’s individual needs and capacities instead of relying on stereotypes of aging. 

The rapid growth of the elderly population affects dentistry in a number of ways. 
1/ the elderly are retaining teeth longer than the previous generation

        Approximately 90% of the seniors who have their natural teeth have    experienced decay with 64 % suffering from periodontal or gum disease.

2/ the body changes that occur with aging often make treatment planning more complex.

3/ medical problems and medications complicate and in some cases exacerbate dental disease.

Limitations in frail older adults create barriers to achieving and maintaining optimum oral health. 

 Visit our website or Call 909 627 -6699 for more information.

Revisit this site next week for more on prevention and disease management of this vulnerable group.

Friday, June 26, 2015

Dry Mouth or Xerostomia

Dry Mouth is a symptom rather than a specific disorder. Saliva cleanses the mouth and begins the digestive process as foods are chewed. Adequate saliva flow coats and lubricates the mouth. When dry mouth or xerostomia occurs, soft tissues get irritated and inflamed and are more susceptible to oral infections. Without the cleansing and shielding effects of adequate salivary flow, tooth decay and periodontal disease become more prevalent.   Constant dryness and lack of protection provided by saliva contribute to bad breath.  In denture wearers, dentures feel less comfortable without the thin film of saliva to help them adhere properly to the mouth.

Causes of Dry Mouth

Prescribed and over the counter medications have emerged as the most common cause of dry mouth.
Medications including  antihistamines, decongestants, pain killers, diuretics, anti hypertensives and anti depressants are among 400 other medications that have side effects of dry mouth.

Aging does minimally reduce the salivary flow.

Radiation of head and neck

Emotional stress 

Autoimmune disease like Sjogren’s  syndrome and diabetes
Hormonal alterations associated with  pregnancy and menopause have been associated with dry mouth.

Symptom Relief

Chewing sugar free gum or candy to stimulate salivation
 Drinking frequent sips of water
Use of alcohol free oral rinses
Restricted use of caffeine, alcohol and carbonated beverages

Regular check- ups and teeth cleaning are more important in mouths experiencing  xerostomia  to minimize decay and periodontal disease.  Additional fluoride products may be recommended to safeguard your dental health.

Visit for additional information.

Friday, June 19, 2015

Tooth Loss and Replacement Options

Because looking and feeling good are important to us all, it is wise to maintain a healthy and attractive smile throughout life.
Over 35 million Americans are missing all their teeth and 178 million people in the US are missing at least one tooth. Regular dental visits and early intervention significantly reduce the need to extract teeth.
 Loss of teeth happens from dental decay, gum or periodontal disease, result of injury or excessive wear from habits like grinding and teeth clenching.
All teeth work together to help you chew, speak and smile. When teeth are missing, it is difficult to do these things. Fortunately, missing teeth can be replaced to restore function and smiles.
A Dental implant is much like a natural tooth where a metal post in placed into the bone beneath the gum. It fuses to the bone and acts like the root of a tooth. When the metal post is secure in the bone, a crown is designed and fabricated to blend with the other teeth in the mouth. Dental implants also can be used to anchor loose dentures. Dental implants are safe, predictable and secure but not an option for everyone.
Fixed  Bridge is a restoration of one or more adjoining teeth by anchoring onto  the teeth  adjacent to the space.  These restorations are cemented or bonded and therefore remain in the mouth permanently without the need to remove and clean them. This option involves tooth preparation and reduction of the  anchor teeth.
Removable partials and dentures are the least invasive  and  are readily taken out of the mouth for cleaning. Removables usually have replacement teeth attached to gum colored plastic bases connected by a metal framework and are either supported by embracing natural teeth or by simply resting over the gum tissue. Over time, with age and bone changes, the removable may no longer fit well and may need periodic modifications.
How best to replace missing teeth is an important decision. 
For a thorough evaluation and discussion on choices, call 909 627 6699 or visit

Friday, June 12, 2015

Time to De-Stress

 Stress has become a common concern as more of us encounter stress in our daily lives. We do know of its negative effects on the body and mind. Our mouths too are just as likely to be affected by stressful situations as our bodies and mind.

Dental conditions associated with stress include-

Bruxism or night grinding: Teeth significantly wear and/or fracture due to heavy biting during sleep as  a result of internalizing stress.  Long term bruxism eventually can lead to facial and tempero-mandibular pain which is often debilitating.  A nightguard is recommended to protect the jaw and teeth.

Canker sores- Although the causes of these sores are still unknown, they are often brought on by stress. They are quite painful  and treatment is often symptomatic. Medications and laser treatment can  reduce the severity and duration of the sores.

Dry Mouth is often caused by stress reducing the salivary function  as well as with the use of anti depressants and other medications. Chronic dry mouth leads to a host of dental issues including increase in cavities, periodontal and gum disease, soft tissue conditions.  Improved oral hygiene and regular visits significantly reduce the potential for  loss of bone or teeth. 

Lichen Planus in the mouth is characterized by white lacy patterns, sores and ulcers. This condition is believed to be a reaction to viral infections caused by stress.

Gum disease- Long term stress suppresses the immune system  which in turn increases the susceptibility to infections including periodontal disease.

If you are feeling stressed, take proper measures to reduce the stress in your life such as eating well, exercising, getting plenty of sleep.  If you suffer from extreme anxiety or depression, seek timely professional help.

If you are concerned with stress affecting your mouth or teeth, our office can address your concerns and treat as necessary.
 Call  909 627 6699 or Visit to reach us.

Friday, June 5, 2015

Teeth Clenching and Grinding

Bruxism is a condition where the individual clenches or grinds teeth causing significant damage to the teeth, facial muscles and the TMJ (tempero  mandibular  joint).

Sleep bruxism or night grinding is a sleep disorder that is often associated with other sleep conditions like snoring and/ or pauses in breathing (sleep apnea)

Symptoms include-
Teeth grinding and clenching sounds that can awaken the sleep partner
Worn, flattened, chipped or loose teeth
Worn enamel causing increased sensitivity from exposed dentin
Jaw or facial pain and soreness
Dull headaches originating in the temple region
Tired of tight jaw muscles
Teeth Indentations on the tongue

Causes include-
Emotions such as anxiety, stress, anger
Abnormal alignment of upper and lower teeth
Uncommon side effects to psychiatric medications
Stomach acid reflex into esophagus
Coping or focusing habit

Prevention and early intervention is key to alleviating debilitating pain and irreversible damage of tooth structure requiring extensive restorative procedures

Call 909 627 6699 to schedule  a one on one consultation with Dr. Cherukuri