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Temporomandibular Joint Disorders (TMD, TMJ)

Bad Breath

Bad breath is common. Everyone, at some point or other, will suffer from it. Coffee, onions, and garlic are all likely culprits. But what happens when the problem of bad breath isn’t easily solved? What happens when you brush and floss, stick to a quality dental routine, and you still have bad breath? The term for this extended, and sometimes chronic, condition is halitosis. Here are a few of the causes of halitosis, and the possible treatments.

Halitosis may be a sign of a chronic and severe condition; think of it as being a possible canary in the coal mine type of problem. Halitosis may be a sign of gum disease—gingivitis or the more severe periodontal disease—or even a cavity.

Halitosis may also be caused by an infection in the sinuses. Sinus infections, especially those infections accompanied by a post nasal drip, can trigger the condition of halitosis. This is because the bacteria in your mouth feed on the mucous secreted from the sinus membranes. Usually, if a sinus infection is the cause of bad breath, the condition will lessen or go away altogether, when the sinus infection is treated.

The condition of dry mouth may cause halitosis. Saliva clears the food debris from your mouth, and, if the mouth is unable to clear away food debris, bacteria are allowed to thrive, feed on the sugars in your mouth. The waste product produced by these bacteria is, unfortunately, stinky-smelling. The condition of dry mouth itself, may be the cause of any one of numerous things, including medication. Dry mouth is a very common side-effect for many medications.

If you think you suffer from bad breath then first consider your daily oral care routine. Make sure you’re brushing at least twice daily—for two minutes at least! Remember to brush your tongue as well as your teeth and gums (it’s kind of gross, but bacteria can thrive on your tongue!). Make sure you’re flossing or using interdental cleaners to clean the area between the teeth and around the gum line. Remember to stick to your regular dental visits, and visit your periodontist, Dr. Manhart, for treatment of gum disease.

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Restorative Dentistry Billings MT

Sleep Apnea

Sleep apnea is a breathing condition that affects our sleep. It happens when the muscles in the throat relax to the point that they block the airway. When the airway is blocked, there is a twenty-to-thirty second duration in which the person is no longer breathing. And when a person stops breathing, the brain sends panicked messages to the rest of the body to breathe. This panic comes as a jolt to the system, briefly awakening the person. These brief awakenings, most which are so brief that a person will not remember them the next morning, can happen up to thirty times an hour, even maybe more, and last all through the night.

What does Sleep Apnea have to do with Dental Health?

Sleep Apnea is a condition involving the muscles and tissues in the throat and mouth. It could be the product of enlarged tonsils (this is a common condition especially in children with tonsils, and, usually, the removal of tonsils is enough to treat it), a small jaw, or even a higher-than-normal palate. You may be able to treat the condition with an oral appliance that provides support to the structures in the mouth, preventing them from collapsing when your body relaxes during sleep. If a dental appliance doesn’t work, other treatments could include the recommended use of a CPAP machine; a machine that regulates your breathing while you sleep.

Symptoms of Sleep Apnea

There are many symptoms of the condition including: an inability to focus, to remain alert throughout the day, waking up in the night feeling short of breath, you may have a dry mouth or a sore throat in the morning (also the cause of excessive snoring), or you may even get headaches throughout the morning. While the symptoms of sleep apnea may not sound severe, the pervasiveness of these symptoms can lead to much worse conditions such as: hypertension, stroke, depression, ADHD, diabetes, and even heart attack.

If you believe that you’re suffering the condition of sleep apnea, it may be time to get help. Remember, this is a chronic condition that could lead to more intensive problems. But there is treatment.

Call today to schedule an appointment today with your Periodontal Specialist!

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Gum Disease and Increased Link to Many Cancers

Brushing, flossing, and regular dental checkups appear to do much more than maintain a healthy smile. Now, a large prospective cohort study shows that postmenopausal women with a history of periodontal disease, including those who have never smoked, are at significantly increased overall risk for cancer as well as site-specific cancers, including lung, breast, esophageal, gallbladder, and melanoma skin cancers.

Read more here.


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Periodontal Disease Treatment Billings MT

Diabetes and Daily Oral Care

Diabetes can take its toll on dental health. The main reason is that diabetes is a systemic disease involving high blood sugar. The higher a person’s blood sugar, the higher risk for dental diseases and tooth decay.

Cavities and High Blood Sugar

Cavities happen when bacteria within our mouths produce acids that eat away at the enamel (enamel is the hard protective outer-coating on a tooth). These acids come from plaque, which is a sticky film produced when mouth bacteria interact with the starches and sugars from our foods and drinks. If you are diabetic and dealing with a high blood sugar level, there will be a greater supply of starches and sugars within our bodies—you will also have different requirements for diet.

The Early Stages of Gum Disease

When someone has diabetes, their bodies have a reduced ability to fight back against bacteria. When things like plaque are not removed by brushing and flossing (remember the importance of brushing twice daily and flossing once!) that plaque hardens at the gum line. This harder substance, called tartar, forms around the base of the teeth, causing the gums to swell and begin to form pockets—pockets where bacteria can creep in below the gum line and cause problems! Over time, swollen gums can begin to bleed. These initial stages, called gingivitis, are usually easy and non-invasive to treat.

Advanced Gum Disease and Diabetes

Gingivitis that is left untreated can progress to the much more severe, and much more invasive and difficult to treat, Periodontal Disease. Periodontal Disease is an infection that can destroy the soft tissues and bones within the mouth. Obviously, this is bad, because the bones and soft tissues support everything in the mouth. Overtime this breaking down causes the gums and teeth to pull away from the bone—inevitably the teeth will become loose and, possibly, fall out. Why is Periodontal Disease worse for those with diabetes? It’s because diabetes hinders a body’s ability to resist infection. Diabetes, and all systemic disease for that matter, can also hinder the body’s ability to heal. It’s so important to keep up a regular routine of oral care that includes a regular checkup with your periodontist, Dr. Manhart.

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Do Mouthwashes Work?

Do Mouthwashes Work?

Not all mouthwashes are created equal. And most mouthwashes are placed into two categories: cosmetic mouthwash and therapeutic mouthwash. Therapeutic mouthwashes are available both in the aisle at the grocery store and by prescription. Therapeutic mouthwashes help to combat bad breath, fight gingivitis, and even control plaque. But how?

The condition of having bad breath, called halitosis, is caused by several things including: food breakdown and oral disease (pervasive plaque and bacteria). Now, for a mouthwash to fight these problems, it needs to have antimicrobial ingredients. These ingredients have long names like, chlorhexidine (chlorhexidine is an active ingredient in mouthwashes given out by prescription), chlorine dioxide, and, the less chemically-sounding, essential oils (usually therapeutic mouthwashes with essential oils are found in the aisle at the grocery).

These antimicrobials have proven effective at combating halitosis. But, mouthwashes are only effective at removing plaque and bacteria from the mouth when they’re used in conjunction with brushing and flossing. It all comes back to a good quality everyday oral care routine.

Now, there are certain rules to using mouthwash. Don’t swallow it, and don’t give it to young children, even if they understand how to spit the mouthwash back out of their mouths properly. A child who swallows large amounts of mouthwash may suffer the consequences of diarrhea, vomiting, and (it’s possible in higher doses) intoxication—if your child has ingested enough mouthwash to be intoxicated, call poison control.

Now, there’s no best way to incorporate mouthwash into your daily oral care routine. If you brush first, you may want to swish out your mouth with water before you use mouthwash. Other than that, it’s personal preference. It’s most important that you are brushing at least twice every day, and flossing at least once.

If you are concerned about halitosis and what’s possibly causing it, make an appointment with Dr. Manhart. He can check for signs of oral disease—remember, it’s best to catch gum disease in its earliest stages, when it’s easily treatable—and develop an action plan to get it fixed.

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Pregnancy and Gum Disease


Gum disease is common in adults, and many people will suffer from some form of it in their lifetime; the reasons for it will vary. But did you know that a pregnant woman can contract gum disease because of the hormonal changes happening in the rest of her body? It’s true. That’s one reason why it’s especially important that pregnant women practice good quality routine oral care throughout their pregnancy.

Do you treat a pregnant woman for gum disease?

The early stages of gum disease, called gingivitis, are easy to treat. At this stage, the gums are swollen and tender. Someone practicing good quality oral care may be able to fight gum disease at these initial stages naturally: brushing and flossing regularly, and doing it well, making sure to clean all areas of the tooth; Vitamin C (which can help to combat gingivitis, and could be taken naturally through certain fruits and vegetables or supplemented) and Vitamin A, which helps the teeth and bones to grow (Vitamin A does have certain drawbacks and limits and before you take on any extra Vitamin A in supplement, consult with you doctor first); also, an at-home remedy to reduce inflammation in the mouth is to gurgle with salt water twice daily. More severe cases of gum disease will be handled on a case-by-case basis between you, your doctor, and your periodontist.

More severe cases of gum disease involve sensitive teeth, teeth that move suddenly out of place, teeth that become loose altogether, and teeth that hurt when you chew food (obviously, these symptoms could also be symptoms of other oral problems, and Dr. Manhart will be able to determine which it is). And if gum disease evolves to the more severe periodontal disease, it will become more difficult to treat. That’s why early detection is very important to a swift and non-invasive treatment. Remember it is very important to the treatment of gum disease that it’s caught in its earliest stages.

If you have any questions as to how to keep a quality oral care routine during your pregnancy call Dr. Manhart’s office today, schedule an appointment.

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Recently, the routine practice of flossing has come under fire as being a nonsensical and ineffective way to clean the space between our teeth down to the gum line. Of course, the study got a ton of press, and news outlets everywhere were running ad hoc with the story as if it were revolutionary and based entirely in fact. As the story evolved through the news outlets it grew bigger, as stories tend to do, claiming that even the federal government’s health agencies also believed flossing to be a waste of everyone’s time. But that’s not true. The federal governments health agencies, as well as the ADA (American Dental Association) all claim flossing as an important, everyday practice.

Flossing is important because it helps to remove the plaque that builds up in the spaces between our teeth. Floss, or an interdental cleaner, scrapes away the plaque that builds up there. If plaque is allowed free reign to grow rampant, then you are likely to see problems such as gum disease develop, and, if the initial stages of gum disease are not dealt with appropriately (and remember, oftentimes gum disease has very little symptom in its early stages) it will progress to the more chronic stages—periodontal disease.


Flossing Refresher

It’s important to keep the practice of flossing between our teeth routine, done once daily. To floss, simply purchase a spool—it comes in a few different sizes—strand widths—and many different flavors, and pull from the spool about eight to ten inches of floss. Wrap the tag ends of the floss around opposing fingers, keeping a few inches of open space between your hands so that you may maneuver it down into the spaces between the teeth. Then use the floss to scrub the faces of the teeth with the floss, cleaning all the areas between the teeth down to the gum line. It’s a pretty standard, simple practice, although it’s often overlooked by many in their daily oral routine.

Remember to keep flossing once every day, keep brushing twice daily, that initial prevention is the best treatment for gum disease.

Make an appointment with Dr. Manhart today for all of your oral health needs.




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Periodontal Disease and Pregnancy

Periodontal Disease and Pregnancy

During pregnancy, there’s a whole host of changes that occur within a woman’s body. Hormone’s shift and the body’s immune system goes through little quirks. Did you also know that during pregnancy a woman’s periodontal health can change, even if they keep to the strict routine of brushing twice daily and flossing once.

Periodontal Disease and Pregnancy

It’s true! there are links between periodontal disease and pregnancy (For those of you not immediately familiar, periodontal disease is a chronic condition caused by bacteria—the most severe condition of gum disease—and, if left untreated, can cause tooth loss, damage to the tissue in the mouth, and it’s even been linked to systemic diseases such as heart disease). Many woman experience what is called pregnancy gingivitis somewhere between the second and eighth months. Remember that any progression of gum disease is bad and needs to be treated.

Gum disease is progressive, and to not treat the disease could mean a progression to full-blown periodontal disease. Studies show that periodontal disease can cause premature birth, or cause an infant to be born at a dangerously low birth weight. A baby born underweight is susceptible to other bodily conditions, such as respiratory problems, and growth issues—both social and physical.

Periodontal Disease and Pregnancy

This makes it imperative during pregnancy to keep to a strict routine of oral health—remember, brush twice and floss at least once, and it may also be beneficial to use certain mouthwashes during pregnancy to ensure a clean mouth. And this oral care routine includes dental checkups with your periodontist to ensure that your mouth is staying healthy. Oftentimes gum disease can begin without a patient knowing. If a person has already been diagnosed with having periodontal disease, and is currently pregnant, that patient will need to keep up regular appointments and treatments.

Make an appointment with Dr. Manhart today, if you are pregnant, and would like a comprehensive periodontal exam. Remember it’s much easier to treat gum disease in its early stages. And remember to keep up a quality oral care routine, whether you are pregnant or not.


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A Cracked Tooth

A cracked tooth can present symptoms similar to other dental emergencies, and, in almost all cases, a cracked tooth will be painful. A common presentation of symptoms would include: it hurt while chewing, but the pain feel localized to a tooth, to a localized position on the jaw; when the chewing stops, the pain subsides or goes away completely.

Now, say you have these symptoms, and you’ve looked in the mirror to check for a line down the tooth, a fracture or crack, something noticeable, but there’s nothing there? What should you do? Obviously, if you have pain in your teeth, or localized on the jaw near your teeth, you should consult your periodontist. Not always will you see a fracture or crack on a tooth. Oftentimes, a cracked tooth could have a hairline fracture, something so small it may not even show on the X-Ray.

Causes of a cracked tooth vary, however chewing hard foods such as nuts, ice, hard candy, etc., are likely culprits. You can also damage a tooth playing sports, or maybe you’re someone who grinds their teeth; it’s possible even, when a set of teeth are not properly aligned to have bite problems that cause a cracked tooth.

You might be wondering now, just how will your cracked tooth be fixed, knowing now that even an X-Ray may not show the exact location of a fracture. There’s a few options, and they differ depending on the severity of the crack.
The simplest methods are bonding the tooth back together, sealing the crack, and, or, a root canal treatment to seal the tooth back up again. It is possible, however, that a crack be too great and the tooth should be removed, however your periodontist, Dr. Manhart, will be able to determine the best course of treatment when you visit. And if you are suffering from tooth pain, don’t let it persist, call the office immediately.
A cracked tooth is a common dental emergency, and, often, it is easily fixable, so you shouldn’t have to suffer through the tooth pain.

If you have a cracked tooth, please schedule an appointment today with your Periodontal Specialist today!


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E-Cigarettes Can Cause Gum Disease

There’s no safe alternative for tobacco, however, there’s an opinion out there that the use of e-cigarettes or vaporizers are more health conscious—there’s even advertisements claiming that it’s just a harmless vapor, nothing dangerous. Hopefully we’re seeing through those advertisements, because e-cigarettes are far from being healthy, or even safe.


For those of you who don’t know, e-cigarettes are refillable modern-looking pipe or cigarette-looking devices, that use battery power to vaporize a nicotine-type solution, which is then inhaled.

Because e-cigarettes are relatively new, there is very little, if any, standards in place to govern the substances used. Therefore, there’s no control over what the level of contaminants are—contaminants include cancer-causing carcinogens, some of which are found in products like anti-freeze, etc. Also, because e-cigarettes are new, it is impossible to know what exactly the adverse health effects of “vaping” are. However, what we know for sure is that nicotine in any dose has adverse health effects on bodies. E-cigarette companies like to state that the levels of nicotine are much lower than that from a classic tobacco cigarette, also claim that the nicotine doesn’t have the same adverse effects on a person’s health because it’s not being burnt—understand, however, that regardless of the severity of the nicotine intake, nicotine in any amount of form has a negative effect on your body, and your oral health.

E-cigarettes and oral health

Studies have shown that nicotine causes our gum tissues to recede, and these recessed pockets can become likely sights for gingivitis or the more severe periodontal disease. There’s information on the internet that vaping will benefit a person’s gum health. However, this has been shown to be false. The reasons for this myth—yes, we’re calling it a myth—are varied, but to put it simply, nicotine usage in any dosage will cause inflammation in the gum tissues. This inflammation makes the gum tissue appear healthy—vibrant pink, etc. But the problem is that the inflammation is only masking the underlying issues, and the gum tissue is, in fact, still receding from the teeth.

The signs for gum disease are the same for the person using an e-cigarette. Your gums will bleed, they will have receded from the teeth, and pockets of space will form around the base of the tooth. If you think you are suffering from gum disease, make an appointment with your periodontist immediately, as early detection is essential in a successful treatment of the disease.

If you are experiencing periodontal disease, please schedule an appointment today with your Periodontal Specialist today!






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