I Brush and I Floss, but I Still Have Bad Breath!

I Brush and I Floss, but I Still Have Bad Breath!

By Mina Levi, DDS, 09/18/2015

Bad breath is not something that anyone wants to suffer from, but sometimes no matter how often you brush and floss your teeth, your breath is still bad. In this week’s article, San Francisco Dentist Mina Levi, DDS discusses causes of bad breath, what bad breath could mean, and how we can treat it.

What are some of the causes of bad breath?

1. Food particles in the mouth. The first cause is simple, which is a buildup of old food/drink residue still left on the teeth. If you are brushing and flossing well every day, this shouldn’t be the problem causing the bad breath for you.

2. Bacteria build up on the tongue. While brushing and flossing your teeth is great and definitely necessary to clean the bacteria and food debris from the teeth, sometimes the tongue is ignored and can be a place where bacteria builds up into a film over the tongue and can cause bad breath.

3. Using tobacco. Smoking or chewing tobacco-based products can cause bad breath and stain the teeth.

4. Something’s wrong somewhere else in the body. Bad breath can be a sign that there is something going wrong or needs attention from somewhere else in the body, no matter how clean your mouth is. For instance, diabetes and acid reflux tend to have a specific breath odor associated with them.

What health problems are associated with bad breath?

1. Gum disease. Bad breath could mean that you are in the beginning stages of gum disease. Gum disease is caused by build up of plaque and bacteria in between the teeth and gums. If the gum disease goes untreated, it will advance to periodontitis and can cause tooth loss and jaw bone damage.

2. Dental decay. Decay of the teeth and especially the roots of the teeth can cause bad breath.

3. Dry mouth. Dry mouth is an underproduction of saliva, a necessary substance in the mouth to moisten and neutralize acids. Dry mouth can cause bad breath when dead cells are not washed away and the acids in the mouth build up.

4. Disease. Pneumonia, sinus infections, diabetes, acid reflux and liver or kidney failure all have associated bad breath odors.

What can we do to treat bad breath?

1. Brush your tongue too!

2. Drink lots of water

3. Quit using tobacco products

4. See the dentist and general health practitioner regularly

If you have concerns about your bad breath, visit Dentist San Francisco Mina Levi, DDS on the web at www.minalevidds.com or give us a call at (415) 513-5066.

Topics: San Francisco Dentist, bad breath, bad breath even when flossing, bad breath even when brushing, good oral hygiene, oral hygiene, dental hygiene, brushing the tongue, mouthwash, halitosis, breath, causes of bad breath, treatment of bad breath, get rid of bad breath 

Be Informed About Oral Piercings

Be Informed About Oral Piercings

By Mina Levi, DDS 02/13/2014

Many people get piercings, but there are risks to your dental and oral health involved in getting an oral piercing that you need to know about before deciding on getting one. In the article below, we discuss risks and other information associated with oral piercings so that you can be as informed as possible.

Risks of Getting an Oral Piercings

1. Symptoms after oral piercings include pain, swelling, and increased saliva flow.  

2. The mouth is home to a large amount of bacteria even when oral hygiene is readily executed, and infections occur readily after an oral piercing. Although not as common, severe infections such as hepatitis or endocarditis can occur as a result of an oral piercing.

3. Piercers do not typically have training in anatomy and physiology, and if a blood vessel or nerve is in the pathway of the needle during the piercing process it can cause severe bleeding or nerve damage.

4. Sometimes blood poisoning, metal allergies, or blood clots can occur.

5. Metal jewelry in the mouth is often the cause of cracked and broken teeth. This risk is reduced slightly by plastic jewelry, but is not eliminated.

6. Piercings of the lips in which the backside of the jewelry lies on the inside of the mouth can cause irritation of the gum tissue as it can scrape and wear gum tissue away as it moves in the mouth. This requires reconstructive surgery to repair and sometimes results in the loss of teeth. It is incredibly important to check the gum health regularly at the dental office of Dr. Mina Levi DDS to discover this early.

If You Already Have an Oral Piercing

If you already have an oral piercing, you may want to consider having the jewelry removed to protect

 your teeth and gums. If you decide to keep it, make sure to do the following:

1. Remove the jewelry when participating in sports, and also wear a mouth guard.

2. Check the tightness of your jewelry regularly with very clean hands, to ensure the jewelry is never loose.

3. Have regular check-ups with the dentist Dr. Mina Levi to keep track of the health of the gums and teeth.

How to Choose a Good Piercer

Choosing a professional is very important when considering having

an oral piercing done, because you want it done correctly. The Association of Professional Piercers (APP) provides resources for finding a reputable piercer on their website at www.safepiercing.org. It is important to make sure your piercer uses an autoclave sterilizer and that they do not re-use needles. Make sure that the piercing room is clean and that you will be receiving aftercare instructions. It is encouraged that you ask your piercer questions that will help you evaluate their experience. Be sure to follow your instincts; if the piercer or piercing location does not seem to meet all of the standards or does not make you feel comfortable, then go somewhere else.

It is your personal decision whether or not to get an oral piercing, but make sure that you are as informed as possible before deciding. If you have any questions or concerns about oral piercings and the risks involved with your oral health, visit Dentist San Francisco Mina Levi DDS on the web at www.minalevidds.com or give us a call at (415) 513-5066.

Topics: Dentist San Francisco, Oral Piercing, Risks of Oral Piercings, Oral Health, Gum Damage, Tooth Loss

Don't Forget to Floss!

Don’t Forget to Floss!

By Mina Levi DDS, 01/23/2014

Flossing should always be a part of your daily oral hygiene routine. However, as most of us are told when we visit the dentist, many people are not flossing enough or correctly. Even just by flossing once per day, the risk of gum disease decreases dramatically. Below we discuss flossing techniques, routines, and types.

Why is flossing necessary?

When you brush your teeth, you are cleaning the side and top surfaces of the teeth, which is wonderful and necessary. However, your toothbrush cannot reach in between your teeth. Flossing removes the plaque and buildup that stick to the teeth and gums in the crevices where the toothbrush cannot reach. Also, flossing helps to polish the surfaces of the teeth so they look shiny and healthy.

How often do I need to floss?

Flossing should occur for about two to three minutes at least once per day, but twice per day is even better. The best time to floss your teeth is during your night time oral hygiene regimen to ensure that the teeth are cleaned from a day’s worth of eating and chewing.

What is the best way to floss?

When flossing, make sure that you aren’t rubbing the floss from side to side. This technique is not able to lift the plaque and buildup out from the spaces between the teeth. Instead, use an up and down motion that forms a “C” pattern on the side of the tooth. Also, make sure to floss below the gum-line to get the plaque from the periodontal pockets. Flossing should not cause you any pain, but if you have not flossed in a while you may experience some bleeding. If these effects do not subside in about one to two weeks, contact the Dentist San Francisco Mina Levi DDS.

What kind of floss should I be using?

Wide floss or woven floss is the best for patients who have not very tight teeth contacts. Waxed floss is the best for patients with tight spaces between the teeth or crowding of the teeth. Un-waxed or woven floss is thicker than waxed, and makes a squeaking noise when the plaque has been cleaned from the teeth. There are also pre-

threaded flossers or floss holders that are good for people who have

limited mobility of the hands and arms, or for people just learning

how to floss. Floss threaders are good for patients who have retainer

bars attached to their teeth or patients that have a dental bridge or braces. Children should begin flossing as soon as they have two teeth that touch each other. A waterpick is often used in addition to flossing, but should not be used as a substitute because it does not remove plaque; it is just helpful for removing food from the teeth.

If you have any questions about your flossing routine, visit the Dentist San Francisco Mina Levi DDS on the web at www.minalevidds.com or give us a call at (415) 513-5066.

Topics: Dental Floss, Dentist San Francisco, Flossing Techniques, Toothbrush, Waterpick, Floss Threader, Pre-Threaded Floss

New Years Resolutions for Your Mouth

New Year's Resolutions for Your Mouth

By Mina Levi, DDS 01/02/2014

As we kick off this New Year of 2014, many people will have New Year’s Resolutions involving their health such as “lose 10 pounds” or “eat healthier”. What some people will not think about though is to have New Year’s Resolutions for your mouth and oral health. Your smile goals as well as taking better care of your mouth and teeth are incredibly important, especially since your oral health is linked to your overall health. Below, we discuss five New Year’s Resolutions for your mouth and how you can accomplish them.

1. Whiter Smile. There are many ways to achieving a whiter smile this year. There is an at-home option where Dentist San Francisco Dr. Mina Leviwill make customized whitening trays and provide you with concentrated whitening gel. There is also the very popular Zoom whitening in-office procedure. This procedure takes about an hour in the dental office and can achieve up to eight shades whiter in just one sitting! There are also many foods that can help you whiten your teeth, see the article “How to Keep Teeth White Through the Holidays” for more details.

2. Straighten Teeth. Some people are embarrassed by or unhappy with teeth that are crooked or out of alignment. Invisalign clear alignment is an option for straightening teeth that is nearly invisible, comfortable and easily removable for eating and keeping up with oral hygiene.

3. Reduce Cavities. The first step toward this goal is to visit the dentist to see if you have any cavities or areas of concern. If the areas of concern are early stage cavities, then Icon: No Drilling resin infiltration may be right for you. Icon treats areas that are in an early stage to stop the cavity from progressing without drilling. If the area is a later stage cavity, however, a filling or crown may be necessary. Either way, it is essential that you get a diagnosis as soon as possible so that any unhealthy tooth structure can be removed or healed.

4. Follow a Stricter Oral Hygiene Regimen. Many people are pretty lax about their daily oral hygiene routine. Some brush well but do not floss while others only brush their teeth once per day. This at-home routine is essential to optimal oral health. It is recommended that the teeth are brushed at least twice daily and flossed at least once per day. Also, it is very important to see the dentist at least twice a year to have a check up and get a professional cleaning done. These professional cleanings remove plaque and tartar that is not able to be removed at home, and if avoided this plaque will begin to eat away at healthy tooth structure.

5. Heal Periodontitis. Periodontitis is an inflammation of the gums that has progressed from gingivitis from plaque build-up. The best ways to heal periodontitis and achieve optimal gum health is to have professional cleanings done more often than usual and keep a very strict oral hygiene regimen. There is also another option for advanced periodontitis cases called Perio Protect, which delivers medication directly to the gums using custom-made trays.

For more information regarding your own smile or oral health goals for 2014, visit Dentist San Francisco Mina Levi DDS on the web atwww.minalevidds.com or give us a call at (415) 513-5066. We wish you the best of luck in achieving your goals and wish you a Happy New Year!

Topics: New Year’s Resolutions, Oral Health, Teeth Whitening, Zoom Whitening, Cavities, Oral Hygiene,Icon, Perio Protect, Periodontitis, Gingivitis,Straighten Teeth, Invisalign, Dentist San Francisco 

Dental Anxiety and Phobia

Dental Anxiety and Phobia

Some people do not enjoy and do not look forward to going to the dentist, even for routine check-ups and cleanings. Most are able to suffer through some anxiety about dental visits and procedures, but those with dental phobia often put off going to the dentist for long periods of time due to the thought of going to the dentist is so terrifying. Avoiding dental appointments is not good for oral health and overall health, and creates problems that could have possibly been prevented. Below we go over what dental anxiety and phobia are, what the causes are and symptoms of dental phobia and anxiety.

What is it?   

People with dental anxiety feel uneasy about dental appointments, and may have exaggerated worries. People with dental phobia have a much more serious condition in which they feel an intense fear or dread. These people are terrified and/or panic stricken rather than feeling anxious or nervous. Although people with dental anxiety will avoid the dentist, people with dental phobia will put off dental care for years and deal with gum disease, pain, and other serious dental issues in order to avoid going to the dentist. People with dental phobia are at higher risk for gum disease, tooth loss as well as emotional costs due to teeth that are not taken care of properly being discolored or unsightly and causing them to become insecure.

What are the causes?

There are many different reasons that people develop dental anxiety and phobia. A few of the leading reasons are:

1. Pain. Fear of pain is common in adult patients, probably due to past experiences earlier in life before many of the advantages in dentistry allowed it to be mostly “pain-free”.

2. Helplessness. Many people develop fear in situations in which they do not have any control. When visiting the dentist, they need to sit still in the chair and cannot see what’s going on and cannot predict whether or not there will be pain involved. It is very common for people to feel helpless of not in control and trigger anxiety.

3. Negative Past Experiences. People that have had negative dental visits that included pain and discomfort amongst other things will most likely be more anxious to go back to the dentist again.

4. Embarrassment. The mouth is one of the most intimate parts of the human body, and it can be embarrassing to have someone looking inside the mouth. This issue can be worsened if the person is embarrassed about the way their teeth looked or the way that they’ve taken care of them. Also, dental visits usually require the dentist and staff to be very close to the person’s face, which may make people uncomfortable and cause anxiety.

What are the symptoms?

Many people experience anxiety and phobia differently and have different methods of coping with it. Some of the main symptoms of dental phobia are:

1. Losing sleep the night before a dental exam.

2. The thought of going to the dentist makes the person feel nauseous.

3. When thinking of going to the dentist, the person feels like crying.

4. The person panics or has difficulties breathing when objects are placed in the mouth for the dental exam.

5. The person feels increasingly nervous while in the waiting room of the dentist.

If any of these symptoms relate to you, or if you have any questions or concerns about dental phobia and anxiety, visit Dr. Mina Levi Dentist San Francisco on the web at www.minalevidds.com or give us a call at (415) 513-5066. She can help you overcome feelings of anxiety about dental visits and will be proactive about it in your treatment.

Topics: Dentist San Francisco, Dental Anxiety, Dental Phobia, Symptoms, Dental Exams, Oral Health, Gum Disease

Seven Factors That Lead to Gum Disease

Seven Factors That Lead to Gum Disease 
By Mina Levi DDS, 12/12/2013

Gum Disease is an infection of the tissues that surround and support the teeth. It is a major cause of tooth loss, but since gum disease is pretty painless, you may not know that you have it. Research has shown that gum disease can be linked to heart attack and stroke as well, but only about three percent of those affected by gum disease seek treatment for it. Visiting the Dentist San Francisco Mina Levi DDS will be effective in determining if you are afflicted by gum disease and need treatment. Below we discuss seven factors that make you vulnerable to gum disease.

1. Genetic Susceptibility. Unfortunately, sometimes we get some susceptibility from our parents or grandparents at no fault of our own. About thirty percent of the population inherits the tendency to be six times more at risk for gum disease. If anyone in your family has been diagnosed with gum disease, it’s a good idea to see the Dentist Mina Levi DDS in San Francisco to see if you are at risk.

2. Stress. We all have times in our lives where we are overly stressed, especially now around the holidays. This stress has been linked to cancer and can make it more difficult for you to fight off oral infections such as gum disease. During periods of stress, keep a close eye on your oral and gum health, and get a professional check up if you feel a difference in your mouth.

3. Clenching or Grinding Teeth. Clenching and grinding of the teeth is an unconscious activity that usually occurs during sleep, but can occur when a person is concentrating. This grinding puts excess force on the supporting tissues of the teeth as well as tooth structure itself, and can speed up the deterioration of the gums and teeth which leads to gum disease.

4. Hormonal Changes. Many people, especially women, go through life stages in which hormones in the body are changing, such as pregnancy, puberty, menopause or andropause. These changes can cause differing levels of oral bacteria and saliva production and cause gum disease easily.

5. Tobacco and Alcohol. Smoking or chewing tobacco and drinking alcohol are the leading causes of oral cancer and the use of these tobacco products cause a drastic change in the oral environment and can lead to gum disease and gum recession, amongst many other issues. Using both tobacco and alcohol could put you at fifteen times greater risk than others.

6. Diabetes. Diabetics are at higher risk for infections, which includes oral infections like gum disease. This can make it more difficult to control blood sugar, so it is important to have these infections diagnosed as soon as possible.

7. Avoiding Dental Exams. Many people openly admit to disliking or have dental anxiety and thus avoid dental visits. This can lead to a multitude of problems in the mouth. Regular exams and confirmation of proper home care techniques can help you prevent gum disease, and professionals are able to identify the signs and symptoms of gum disease that would not be identified at home. This can help you to halt or even reverse gum disease progression.

For more information on gum disease, the signs and symptoms of gum disease and what you can do to avoid it, visit Dr. Mina Levi DDS on the web at www.minalevidds.com or give us a call at (415) 513-5066.

Topics: Gum Disease, Oral Cancer, Oral Bacteria, Dentist San Francisco, Oral Hygiene, Tobacco Use, Clenching and Grinding , Dental Anxiety 

Tips to Reduce Cavities

Tips to Reduce Dental Cavities

          When we think of cavities in the mouth, we immediately think that the teeth brushing routine has been poorly implemented and that must be the only reason. However, there are quite a few components that go into the cause of dental caries and along with them come a few ways to reduce their occurrence. Visiting the Dentist San Francisco Mina Levi, DDS is the most important aspect of keeping cavities out of the mouth. Below, we discuss the components that lead to caries and how to avoid them.

 

 
 

Components:

1.      Diet and Sugar Intake. When a person ingests carbohydrates (sugars), the bacteria in the mouth produce acid as they break down and metabolize these sugars. This acid causes dental caries and deepens the cavity over time with exposure, so-called tooth de-calcification.

2.     Oral Hygiene. Yes, we have been told over and over again that if you don’t have a proper oral hygiene regimen, that you will see decay in your teeth. This not only means brushing often, but also includes brushing correctly, using dental floss, and properly cleaning the tongue. Another important aspect of oral hygiene is to get your teeth professionally cleaned and examined by the Dentist San Francisco Mina Levi DDS.

3.     Genes and the Strength of the Enamel. Sometimes, unfortunately, we inherit genes that give us weakened enamel without any fault of our own. Enamel is the hard substance that makes up the outside of the teeth, and protects the tooth structure from bacteria and decay. If enamel is weak or is weakened, dental caries will be more prominent.

 

Tips to reduce caries:

 

1. Use Xylitol products. Xylitol is a sweet, white substance that looks and tastes like sugar, but has 40% fewer calories than sucrose and is diabetic -friendly. Xylitol is a naturally occurring alcohol found in the fibers of fruits and vegetables like corn, berries and mushrooms, and the wood of trees like the birch. It is even produced naturally in small amounts by our bodies.  Unlike sugar, it is not converted in the mouth to acids that cause tooth decay. It reduces levels of decay-causing bacteria in saliva and also acts against some bacteria that cause ear infections. Xylitol not only rids the mouth of sticky harmful bacteria, it actually promotes the growth of tooth-protective, non-acidic bacteria. Plaque bacteria use sucrose and carbohydrates from our diet to grow and multiply. They create sticky threads that allow them to attach to the tooth surface and each other to form thick layers and acids that damage teeth. When plaque bacteria absorb Xylitol, they cannot multiply, produce acids, or stick to teeth. Using products like Oxyfresh toothpaste and mouthwash and chewing Spry gum means less plaque will form on teeth, and eventually plaque bacteria may be undetectable in the mouth. Xylitol also raises mouth pH and encourages mineral-rich saliva to flow into the mouth. This can protect and re-mineralize teeth by repairing the deep layers of enamel.

2.  Using MI Paste or “Liquid Tooth”. Saliva helps provide essential minerals that strengthen teeth and protect enamel. MI Paste is a product that helps release these vital minerals and stimulates saliva flow in the mouth, which helps strengthen enamel and prevent cavities from forming so easily. MI Paste uses casein phosphopeptides that are derived from milk casein, and is ideal for buffering acids produced by bacteria and plaque, comforting dry mouth, minimizing tooth sensitivity before and after cleanings, and reducing high oral acid levels. Video: http://youtu.be/qHfBDfIZ6kQ

3. Reducing Carbohydrate Intake. Carbohydrates are sugars, which stimulate acid release in our mouths when we consume them and cause cavities. Women should try to reduce their added sugar intake to no more than six teaspoons per day and men should try to reduce their added sugar intake to no more than nine teaspoons per day. Reducing sugar intake will also reduce the acid production by bacteria in the mouth and thus, reduce the presence of dental caries.

4.     Dental Visits. The most important tip to reduce the prominence of dental caries in the mouth is to visit the dentist regularly. It is normally recommended to have a professional cleaning and exam done about twice per year. These exams and cleanings remove built-up plaque and calculus from the mouth and reduce the amount of bacteria that cause dental caries.

For more information regarding how to reduce and prevent cavities from forming, visit the Dentist San Francisco Mina Levi DDS on the web at www.minalevidds.com or give us a call at (415) 513-5066.

Topics: Dentist San Francisco, Dental Caries, Cavities, Dental Plaque, Oral Health, Oral Bacteria, Cleanings and Exams, Xylitol, MI Paste, Tooth Mineralization, Tooth Decalcification

How to Take Care of Your Tongue

How to Take Care of Your Tongue 

          We all have been told over and over again how important it is to brush and floss your teeth, and even how using mouthwash is great for destroying germs. One thing that isn’t emphasized enough is how to take care of our tongue, leaving questions such as, “is my tongue getting clean with just mouthwash?” and “does my tongue need to be cleaned separately?” The tongue is one of the strongest muscles in the body relative to size, and helps us speak, eat and drink throughout our entire lives. We think that deserves some recognition and that our tongue deserves to be cleaned and taken care of properly. Visiting the Dentist San Francisco Mina Levi DDS can be helpful with getting familiar with the proper tongue cleaning techniques and routines. Below we discuss the nature of the tongue and how to properly clean it.

Understanding the Tongue

 

The tongue is a mysterious, wriggly muscle that lives in our mouths and although we use our tongues every day almost constantly, many people don’t know much about the tongue. The tongue is covered with papillae and taste buds (receptors for taste), which allow it to be the primary organ of taste and helps us manipulate food for eating. The tongue is very sensitive since it is supplied immensely with nerves and blood vessels, which is why it is so painful when we accidentally bite down on it. Not only is the tongue used for eating, but it also functions in creating sounds and words. For example if you hold your tongue between your fingers and try to complete a sentence, you will notice that not only can you not produce the words and sounds that you want to, but also your tongue will contract and fight against your fingers slightly to try to make the correct sounds. Another very important function of the tongue is a natural toothbrush. The saliva that keeps the tongue moist has antibodies and proteins that clean up the bacteria in the mouth, and the tongue can manipulate itself into many positions and areas in the mouth which allows it to detect and remove bits of food that are left over from our last meal.

The tongue has what is called a “tongue map”, which shows that different areas of the tongue are more sensitive to different tastes. Contrary to popular belief, these areas of the tongue are not completely secluded to one particular taste, but different areas of the tongue have different thresholds for sensitivity to particular tastes. The tip of the tongue (4) is known for the sweet taste and the sides of the tongue toward the tip (3) are known for the salty taste. The sides of the tongue toward the back of the tongue (2) are known for the sour taste and the back area of the tongue (1) is known for the bitter taste.

The papillae and taste buds in the tongue are very sensitive and are what help us taste food at all. However, if the tongue is not cleaned properly, build up can cover up endings of the taste buds and dull the sensitivity, making it more difficult for the tongue to taste foods. Also, an unclean tongue can cause very bad breath and allow more bacteria to linger in the mouth, leading to other problems such as plaque build-up on the teeth and cavities. But, how are we supposed to clean the tongue? Here are a few good tips:

 

1.     Get a tongue-cleaning device. These tongue-cleaning devices usually have a handle similar to a toothbrush but the tip is a triangle or oval shape with a large hole in the center, similar to an enlarged, widened eye-hole of a needle. You can find these devices at grocery stores and online, or you can get one through the Dentist San Francisco Mina Levi DDS. Some toothbrushes have a textured back designed for scrubbing of the tongue, but this doesn’t work as well as getting a separate tongue scraper.  

2.     Scraping the tongue. In the morning before eating or drinking anything, take the tongue-cleaning device and place it on the surface of the tongue towards the back. Then firmly but gently press the tip of the device and then “drag” the tip from the back of the tongue to the front. The residue you’ve cleaned off of your tongue will build up on the device, so you will need to rinse it off after each scraping. Repeat this process multiple times until the entire tongue has been scraped with the device.   

3.     Rinse. After the tongue scraping is completed and you have cleaned off your tongue-cleaning tool, rinse your mouth thoroughly with mouthwash. This will wash away any of the build-up that still remains in the mouth, and will also clean away bacteria in the rest of the mouth.

4.     Repeat! The most important part of cleaning your tongue is to continue to clean it and make it part of your every day routine.

5.     Cleaning Your Tongue Scraper. Once every two weeks, soak your tongue-cleaning device in denture cleaner or a hydrogen peroxide-water solution to ensure that it remains sanitary.

 

For more information about the tongue cleaning process or how it affects your overall oral health, visit the Dentist San Francisco Mina Levi DDS on the web at www.minalevidds.com or give us a call at (415) 513-5066.

 

Topics: Dentist San Francisco, Oral health, Tongue Cleaning, Teeth Cleaning, Tongue, Oral Bacteria, Dental Plaque, Tongue Scrapers